422 ARE ALL ANTIBODIES IMMUNOGLOBULINS?

THE

QUESTIONS ASKED

AND THE PRINCIPAL RESPONSE OF

103 PARENTS

OF CHILD PATIENTS

SIR,-It is generally assumed that antibodies are immunoglobulins. However, a few natural antibodies-the anti-H in eel serum’ and the fructosan-binding precipitins in nurse-shark serum2-are certainly not immunoglobulins and the anti-A in trout serum,3 the anti-B+HP in toad serum,4 and the anti-B and anti-P in alligator serum’ are probably also not immunoglobulins.It seems, therefore, that non-immunoglobulin natural antibodies

present in

of lower vertebrates. Like sites. In the sera of salmonids with ulcerative dermal necrosis alpha and beta8 precipitins are produced as immune response and are not immunoglobulins. So perhaps even immune antibodies can be non-immunoglobulins. What is the relation of these substances with immunoglobulins ? Are they both derived, from a common ancestor? The results of aminoacid sequencing and work on structure of nonimmunoglobulin antibodies are awaited with interest. are

some sera

plant and animal lectins" they have small sugar-binding

Laboratory of Immunology, Bristol Royal Hospital for Sick Children, Bristol BS2

EDWIN R. GOLD

8BJ

WHAT DO PATIENTS KNOW ABOUT ANTIBIOTICS?

SIR,—It has been shown9 that patients, and their parents, misuse antibiotics. One possible reason is that patients do not know how antibiotics work.lO We therefore questioned 53 parents who had brought their children to the casualty department of the Mater Children’s Hospital, Brisbane, and 50 parents attending the private rooms of a consultant paediatrician. We also questioned 20 trained nurses now working in the Children’s Hospital. The questions asked are numbered 1-5 in the accompanying table. An unprompted answer was allowed for each question and then the specific points l(a), 1(b), l(c), &c. were asked on questions 1-4. 29% of the respondents had had less than 3 years secondary education, 56% had 3-5 years at secondary school, and 15% had tertiary education. The replies are summarised in the table. There was obviously much misinformation among the respondents. 13% thought that antibiotics were merely a stronger form of aspirin, and 8% thought that aspirin was an antibiotic. 15% said that penicillin was not an antibiotic; 75% thought that antibiotics should be used routinely for colds and influenza and 40% for gastroenteritis. Most knew that antibiotics could cause harm, but believed that this resulted only from too much or too many antibiotics. Most said that they had learned about antibiotics from their doctor or from "experience". There was slightly more accurate knowledge among the better educated, but when allowance had been made for educational levels there was no difference in knowledge between private and public patients. The small sample of 20 trained nurses showed that 7 (35%) believed that antibiotics killed viruses, 9 (45%) would use them routinely for colds and influenza and 4 (20%) for gastroenteritis. This study was limited to young parents, but the findings

frequently

1.

Bezkorovamy, A., Springer,

G. F., Desai, P. R.

Biochemistry, 1971, 10,

3761. 2.

Harisdangkul, V., Kabat,

E.

A., McDonough,

R.

J., Sigel,

M.

M. J.

would probably be similar in any section of the community. Much misinformation and confusion probably arises from doctors diagnosing "viral infection" and then giving an antibiotic. The patient makes the obvious inference which is confirmed by improvement following (but not necessarily because op the antibiotic. The patient then demands antibiotics for subsequent episodes; the demand is granted and the myths grow. If patients are to use antibiotics as instructed, we must prescribe them rationally and explain to the patient the indications, actions, and possible side-effects. The ignorance among trained nurses shows that our efforts in communication and education have a long way to go. University Pædiatric Unit, Mater Children’s Hospital, South Brisbane, Queensland 4101

DIANNE CHANDLER A. E. DUGDALE

GROWTH RETARDATION IN CHRONIC ASTHMA were interested to read the comments of Murray al.’ Our experience is similar to that of Lacey and Parkin’ and indicates that asthma is a relatively infrequent cause of severe short stature in the community. In the Scottish Growth Study we have so far identified 391 children aged between six and nine years, who are more than 2.5 standard deviations below the mean height for age.3 This was done by screening the heights of a population of 39 118 schoolchildren in Edinburgh and Glasgow. Only 6 children (3boys) aged 62to 8.0 years have clinical evidence of chronic asthma (1.5%). 4 have never been treated with steroids (S.D. scores2 -2.5, -26, -26, -3. 1); 2 had previously been treated with steroids (-2.5, —3-4). Both children more than -3 S.D. from the mean had parents whose midparental height was less than the third centile, so genetic factors undoubtedly also contributed. Organic illness contributes much less to short stature in the community than do genetic or environmental causes.

SIR,-We

et

This

project

is

supported by

the Medical Research Council.

Immun.

1972, 108, 1244; ibid. 108, 1259. 3. Holt, P. D. J., Aństee, D. J. Vox Sang. 1975, 29, 286. 4. Balding, P., Gold, E. R. Immunology, 1972, 30, 769. 5. Anstee, D. J. Personal communication. 6. Gold, E. R., Balding, P. Receptor-specific Proteins. Plant and Animal Proteins. Chapter 11. Excerpta Medica, Amsterdam, 1975. 7. Davies, D. H., PH.D. thesis, Salford, 1976. 8. Alexander, J. B., PH.D. thesis, Salford, 1976. 9. Hayes, P., Hickey, K., Lovell, S., Dugdale, A. E. Med. J. Aust. 1976, i, 235. 10. Blackwell, B. New Engl. J. Med. 1973, 289, 250.

Department of Child Life and Health, University of Edinburgh,

Edinburgh EH9 1.

Murray,

A.

1UB

GRAHAM V. VIMPANI ANNEF. VIMPANI

JAMES W. FARQUHAR

B , Fraser, B. M., Hardwick, D. F., Pine, G. E. Lancet, 1976,

ii, 197. 2. Lacey, K. A., Parkin, J. M. ibid, 1974, i, 42. 3. Tanner, J. M., Whitehouse, R. H., Takaishi, M. Archs Dis. Childh 1966,

41, 454.