745 The low

fasting blood-glucose

in the non-diabetic African

referred to by Umez-Eronini et al. probably related to diminished glucose absorption and the high fibre content of his diet rather than a low renal threshold for glucose. Department of Medicine, Ahmadu Bello University Hospital, Zaria, Nigeria

CHARLES AWUNOR-RENNER

RIFT VALLEY FEVER IN EGYPT, 1978 autumn of 1977, Rift Valley fever (R.V.F.) in Egypt for the first time.I-3 This represented a 1900 km northward extension of the known distribution of the disease. During the epidemic an estimated 18 000 cases occurred, with 598 deaths.3 Concurrent epizootics occurred in several areas among sheep, cattle, goats, and camels.3 Disease transmission ended with the onset of cold weather and intensive mosquito control. However, in 1978, reports of abortions and deaths in livestock from areas on the Nile Delta and in Upper Egypt suggested that the virus may have survived the winter as sporadic cases or chronic infections or in hibernating infected mosquitoes. The potentially explosive nature of R.v.F. outbreaks and movement of men or animals incubating infection could result in the spread of R.V.F. in or outside Egypt if the disease recurred. To find out if the disease was occurring in 1978, a laboratory was set up within the AI-Azhar University Girls’ College. The laboratory consisted of a room, which was kept locked, into which only those immunised against R.v.F. virus were allowed. All manipulations with potentially infected material were conducted in a Porton type microbiological safety cabinet

SIR,-In the

broke

out

(Engineering Developments [Farnborough] Ltd., Farnborough, Hants), and protective gowns and gloves were worn. On July 7 and 10, 1978, blood-samples were obtained from thirteen adult males, mostly military recruits, who had no known contact with livestock, during an outbreak of febrile illness in the Inshas area of Sharqiya Governate north-east of Cairo. Five of the samples were collected on the first day of fever and eight on the third day. Serum was inoculated intracranially (0.01 ml) into 1-2-day-old Charles River strain mice, intraperitoneally (0-2 ml) into weanling mice, and into duplicate culture tubes (Nuclon Delta flat-based tissue-culture tube no. 1409, each tube containing approximately 6x105 Vero cells in 2 ml L-15 medium with 10% tryptose phosphate broth and 5% calf serum) containing Vero cell monolayers (0-1ml/ tube). Four of five sera taken on the first day of illness and six of eight taken on the third day caused death in suckling mice in -approximately 40 h, death in weanling mice in 72 h, and cytopathic effect in Vero cells in 72 h, which progressed to complete destruction by 96 h. Complement-fixation tests4 5 conducted with mousebrain antigens and hyperimmune anti-R.v.F. monkey serum (kindly supplied by Dr B. McIntosh, South African Institute for Medical Research), or serum from one of us (B.K.J.) who had recently received R.V.F. vaccination, indicated that the virus strains were R.v.F. Neutralisation tests were done by incubation (1 h at 37°C) in duplicate wells of tissue-culture plates (’Linbro Multi-Dish’, no. 76-033-05, Flow Laboratories Ltd.) of a calculated 400-1000 plaque-forming units of firstpassage Vero-cell-derived virus with equal volumes of either hyperimmune R.V.F. monkey serum or normal mouse serum controls. The

sera were diluted 1:20 in tissue-culture medium. After incubation 1 - 5 x 101 Vero cells were added to each well. Carboxymethylcelluloseoverlay medium was added 14 h

1. Wkly epidem Rec 1977, no. 50, p. 401. 2 ibid. 1978, no 1, p. 7. 3 ibid 1978, no. 27, p. 197. 4 U.S. Public Health Service. Pub. Hlth. Monogr 1965, no. 74. 5. Sever, J. L. J. Immun. 1962, 88, 320.

6. de Madrid, A. P., Porterfield, J.S. Bull. Wld Hlth Org 1969, 40, 113.

later. Hyperimmune anti-R.V.F. monkey serum completely inhibited cell destruction, indicating that all ten isolates were indistinguishable from R.v.F. virus by neutralisation tests. Work is in progress on fourteen additional sera or pharyngeal washings collected during this outbreak. The detection of the recurrence of R.V.F. in Egypt in 1978 suggests that the virus may have become endemic or enzootic in the country. If so, a serious and long-term public-health and veterinary problem exists. Continuous and intensive surveillance, mosquito control, and livestock vaccination will be necessary. The gravity of endemic or enzootic R.V.F. in Egypt is obvious. The concentration of the large human and animal population in areas near limited water brings together dense populations of vertebrate hosts and large numbers of mosquitoes. Moreover, the wide vertebrate and intervertebrate host-range of R.V.F. and the fact that the mosquito species (Culex pipiens complex) implicated in the 1977 outbreak3 is abundant in Egypt and in Europe poses a problem with international implications. Arbovirus Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

B. K. JOHNSON A. C. CHANAS

Central Microbiological Laboratory,

Cairo, Egypt Faculty of Medicine, Girls’ College, Al-Azhar University, Cairo

ESMAT

EL

TAYEB

KOUKA S. E. ABDEL-WAHAB FATIMA AHMED SHEHETA ALAA EL-DIN MOHAMED

Commentary from Westminster

From

Parliamentary Correspondent Hospital Closures THE Government’s programme of hospital closures, which has caused much opposition among local comour

munities in many parts of the country, will be slowed down if the Conservatives win the election. For, they maintain, health authorities are closing many smaller hospitals unnecessarily on the grounds that they are out of date and uneconomic. This news will come as a message of hope for many campaigners now fighting to keep open their local hospital. Among those affected by the Conservative policy is likely to be the Lord Mayor Treloar Hospital in Alton, Hampshire, where a fierce rearguard action against proposed closure is now under way. This 140-bed orthopxdic hospital is facing shutdown in three or four years after Hampshire Area Health Authority decided to withdraw the specialty from the hospital and transfer it to district general hospitals in Basingstoke, Winchester, and Portsmouth. The proposed closure, although supported by the community health council, has aroused furious opposition from consultants and local people. Hundreds of letters have poured into Westminster complaining about the absurdity of closing the hospital at a time when there are over 300 people on the area’s orthopxdic waiting-list. The proposed closure and many others over the past few years are the inevitable result of what the Conservatives now believe to have been a strategic error made years ago-the decision to concentrate facilities on the big district general hospitals at the expense of specialist and community hospitals. During the present economic re-

746 area health authorities are facing financial difficulties in running their big district hospitals and are looking for savings by closing down their smaller hospitals. The long-term aim of the Department of Health and Social Security is for a national network of fully equipped district general hospitals complemented by smaller community hospitals. But the short-term structural changes, or "sensible rationalisation" as Ministers prefer to call it, are proving painful. Small hospitals are often regarded with great affection by local communities and the Government’s elaborate consultation procedure does little to lessen the outcry. Conservatives claim that the closures are now widespread, but that the reasons for this policy and the effect it will eventually have are not being made clear. Last year there were 74 hospital closure decisions, a further 16 decisions to close part of a hospital, and 14 other decisions involving closure of buildings such as health clinics. In the first six months of this year 19 hospital closure decisions were taken, but this should not necessarily be taken to mean that the final year’s figure will be lower than 1977. Dr Gerard Vaughan, Conservative spokesman on health, commented: "What I am afraid of is that having now recognised it is a mistake to have these big hospitals we are closing down the small ones in order to sustain the big ones. So we are going to end up with a lot of big hoswe pitals which we know are uneconomic to run shall do everything we can to slow down this process".

straints,

...

Declining Standards in the N.H.S. Mounting criticism from consultants about falling standards in the National Health Service has led the

Joint Consultants Committee to set up its own SOS scheme. The plan is that a complaining consultant will be able to call in a special panel of experts to investigate his protest. If his complaint is found to be justified the consultant would then have the backing of the committee in his approaches to the local health authority or the Government. The J.C.C., representative of the B.M.A. and the Royal Colleges, devised the scheme because of its concern at the growing number of consultants approaching it unofficially for help. Their difficulty was that they found themselves unable to do anything about the inadequate resources and staff shortages they were being asked to cope with. The committee decided it was not practical to try to set down minimum standards for hospitals. So instead it came up with the idea of supplying teams of experts from among its 34 members and others to investigate complaints, on the understanding that they would be sent in only as a last after a consultant had failed to convince his health authority that there was a risk to patients. The committee envisages having to deal with a range of difficulties: surgeons responsible for the overall care of patients after operations may complain that when their patients are returned to the wards there are not enough people to look after them because of a shortage of nurses; consultants may declare that there is not much point in putting patients on life-support systems if there is no-one there to monitor them; and hospitals or units may continue to be threatened with closure. The J.C.C. could appoint a small team to carry an out on-the-spot investigation. If the experts resort

with the consultant, and the J.C.C. gave their full backing, the hope is that such pressure its report would persuade the health authority or the Government to act. Architects of the scheme believe it would be very unwise for the D.H.S.S. or a health authority to ignore a consultant supported by the J.C.C. panel. But should this happen the committee has two weapons at its disposal. The first, which it says it would use, is to reduce the rate of hospital admissions by the particular consultant. The other course, which it is. considering, would be the "blacking" of posts by the Colleges. After spending the past few weeks preparing its scheme, the J.C.C. is now ready to go into action. What response it gets from consultants and what effect such pressure will have on the authorities remains to be seen.

agreed

Obituary DERRICK GRAHAM FFARINGTON EDWARD

Dr Edward’s working life was largely devoted to the development of vaccines against a wide range of viral diseases of man and animals and to the study of mycoplasmas. He died on Sept. 4. He qualified from St. Bartholomew’s Hospital, London, in 1934, and started his long association with the Wellcome Research Laboratories when, during the war, he was a member of the research team assembled at their laboratories at Frant to develop a scrub-typhus vaccine. He joined the Wellcome Foundation in 1948 and some years later he was given the task of creating a new department of virology at the Wellcome Research Laboratories, Beckenham. His efforts soon bore fruit in the production of Sabin-type oral poliomyelitis vaccine and a living attenuated vaccine against measles. There followed the development of a rubella vaccine manufactured in a diploid-cell line. His leadership, direction, and enthusiasm were responsible for successful research and development in veterinary virology, leading to the production of vaccines against a number of diseases of farm animals and domestic pets, including many poultry diseases. He later became head of biological research at the Laboratories. His own research was mainly devoted to a study of the

mycoplasmas,

or

"pleuropneumonia-like organisms"

as

they

called when he began this work. He became widely known through his publications on taxonomy, classification, were

nomenclature, propagation, and growth characteristics, and the significance of these organisms in various infections of man and animals. When he left the Wellcome Foundation in 1969 to join the Public Health Service, firstly at County Hall and subsequently at Dulwich, he was able to concentrate his efforts on his first love, the mycoplasmas. He became a world authority and his outstanding contributions were recognised by one of the first two awards of honorary membership of the International Organisation of Mycoplasmatology. He was a man of firm principles and completely dedicated to his work. His management was firm but kindly and he always showed great interest in the welfare of his staff. He suffered a series of illnesses during the past fifteen years, twice involving brain surgery, but in between these episodes he carried on with his work with continuous enthusiasm, showing remarkable courage and determination not to give way to

adversity.

A.J.B.

Rift Valley fever in Egypt, 1978.

745 The low fasting blood-glucose in the non-diabetic African referred to by Umez-Eronini et al. probably related to diminished glucose absorption...
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