575 Oliff et al. suggest that cranial irradiation is likely to augthe already increased intracranial pressure in leukxmic meningitis by producing oedema within or around areas of leukaemic infiltration. We suggest, therefore, that prophylactic therapy with dexamethasone before and during the course of cranial irradiation may prevent or at least minimise the risk of ment
acute
encephalopathy.
Department of Medicine and Neurology, Hadassah University Hospital, Jerusalem, Israel.
ODED SHALEV RUTH SILVERBERG
SCHOOL MILK AND GROWTH IN PRIMARY
SCHOOLCHILDREN
SIR,-When the Education (Milk) Bill to stop the provision of free school milk to most 7-11-year-old schoolchildren was introduced in 1971, the Minister of Education announced that the D.H.S.S. Sub-Committee on Nutritional Surveillance was making plans to monitor any effects of the change. The Opposition spokesman suggested that the effects of the withdrawal of free milk should have been estimated before the presentation of the Bill. The timing of the Bill was such that it was possible neither to acquire adequate information on children who were at that time receiving milk and facing its withdrawal nor to undertake the experiment suggested by the Opposition. It was for these reasons that, with the support of the subcommittee, we set up a randomised controlled trial to study the effect on growth of the provision of a third of a pint (190 ml) of free milk daily in selected primary schools in Mid-Glamorgan in 1976. Schools were selected by percentage of children having free school meals and subjects identified who were aged 7 or 8 on Sept. 1, 1976, and who had three or more sibs in their families. In this manner we acquired 581 children, of whom only nine were from social classes I and II. 23% of the children came from families where the fathers were unemployed and 8% were of single parent families. Measurements of standing height and weight were made by the same observer at the outset and on six subsequent occasions over six school terms (21 months). The table shows our preliminary findings for those children measured on the lst and 7th occasions. GROWTH IN
7
AND
8-YEAR-OLD
CHILDREN OVER
21
MONTHS
The differences in growth by height of 0-11 cm for boys and 0-45 cm for girls and by weight of 0-21 kg for boys and 0-05 kg for girls do not achieve statistical significance at the 5% level of probability. When subsidised school milk was introduced in 1934 and made free in 1944 there was some evidence that supplementary feeding could substantially increase growth in some nutritionally disadvantaged children.’ The preliminary results of our study suggest that the re-introduction of free school milk for 7-11-year-old children is unlikely to have any appreciable effect on the physical development of the children. I. A. BAKER P. C. ELWOOD J. HUGHES
M R.C. Epidemiology Unit, 4 Richmond Road,
M. JONES P. M. SWEETNAM
Cardiff CF2 3AS
1.
Mann, C. Spec Rep. med. Res. Coun. 1926,
no.
105.
DIETARY ANTIGENS IN BREAST MILK
SiR,—Dr Jakobsson and Dr Lindberg (Aug. 26, p. 437) demonstrated bovine antigens in the milk of women ingesting cow’s milk, and recorded the clinical effects of this on their infants. We have examined human breast milk for the presence of wheat antigens. Of eighteen samples collected at random in a Madras maternity hospital, positive Ouchterlony reactions were obtained in three cases, using a sheep antiserum to wheat gluten. Two of these milks showed the presence of more than
antigen.1 In previous work with rats, transmission of dietary bovine IgG labelled with radioiodine to the suckling as macromolecular breakdown products was measured, and about 15% of the oral dose given to the mother appeared in the sucklings’ tissues in the first 24 h after feeding.2 Placental transmission of dietary antigens also occurs, in rat and rabbit3 4-indeed the fetal tissues may contain more antigen than the maternal tissues at
one
the time of parturition. These findings are important in pxdiatrics for it would seem that elements of the maternal diet, although foreign proteins, are normally transmitted to the fetus and suckling in significant amounts, and must play an important role in development. Attention is only drawn to this process when it goes wrong, as where there is a familial history of allergic response. Food allergy has lately been discussed in The Lancet5-7 and dietary antigens in breast milk are closely related to this topic. A.R.C.
Immunology Group, Zoology Department, University College of North Wales, Bangor, Gwynedd LL57 2UW
Immunology Division, Postgraduate Institute of Basic Medical Sciences, Taramani, Madras 600042, India
W. A. HEMMINGS
A. C. KULANGARA
CASE FOR BREAST-FEEDING
SIR,-We appreciate Professor Davis’ review (July 22, p.
Human Milk in the Modern World: Neverhis own term, we found some of his comments "off-putting". "Platitudinous" means "flat, dull, insipid, commonplace". Perhaps Davis fails to realise the general lack of knowledge of breast-feeding among health workers. Platitudes to cognoscenti can be revelations to the less informed. How many medical or nursing students ever hear of the let-down reflex ? "Repetitious" means "tiresomely reiterative". We believe reinforcement to be necessary if key ideas are to be appreciated. The accusation that we wrote "partly in that extraordinary jargon which masquerades as the scientific language of sociology" dealt a near-fatal blow to our literary egos. Plainly, Davis’ acquaintance with truly obscure sociological idiom is
201) of our book theless,
to borrow
slight. Incidentally, the word "dyad" has been long established in the English language (circa 1675) and has a different meaning entirely from "couple". Dyad implies two interacting entities. Two cucumbers are a couple; a mother and her nursing baby is a dyad. The word also has the advantage of having a crisp, eye-catching adjective which focuses on this long-neglected two-way interaction-"dyadic infant feeding," yes; "coupled infant feeding," surely meaningless. Davis says that we offer "no solution to the dilemma of how the trend away from good child-rearing practice." Chapter 14 (pp. 346-388) is entirely concerned with different practical approaches which might be combined in programmes to reverse
Kulangara, A C. in Protein Transmission across Living Membranes (edited by W. A. Hemmings). Lancaster (in the press). 2. Hemmings, C., Hemmings, W. A. I.R.C.S. med. Sci. 1977, 5, 247. 3. Hemmings, C., Hemmings, W.A. ibid. p. 335. 4. Hemmings, W.A. ibid, p. 281. 1.
5. Finn, R., Cohen, H. N. Lancet, 1975,i,426. 6 Hemmings, W A. ibid. p. 608. 7. Dickerson, J W. T., Ballantyne, L., Hastrop, K. ibid. p.
773.
acute
encephalopathy.
Department of Medicine and Neurology, Hadassah University Hospital, Jerusalem, Israel.
ODED SHALEV RUTH SILVERBERG
SCHOOL MILK AND GROWTH IN PRIMARY
SCHOOLCHILDREN
SIR,-When the Education (Milk) Bill to stop the provision of free school milk to most 7-11-year-old schoolchildren was introduced in 1971, the Minister of Education announced that the D.H.S.S. Sub-Committee on Nutritional Surveillance was making plans to monitor any effects of the change. The Opposition spokesman suggested that the effects of the withdrawal of free milk should have been estimated before the presentation of the Bill. The timing of the Bill was such that it was possible neither to acquire adequate information on children who were at that time receiving milk and facing its withdrawal nor to undertake the experiment suggested by the Opposition. It was for these reasons that, with the support of the subcommittee, we set up a randomised controlled trial to study the effect on growth of the provision of a third of a pint (190 ml) of free milk daily in selected primary schools in Mid-Glamorgan in 1976. Schools were selected by percentage of children having free school meals and subjects identified who were aged 7 or 8 on Sept. 1, 1976, and who had three or more sibs in their families. In this manner we acquired 581 children, of whom only nine were from social classes I and II. 23% of the children came from families where the fathers were unemployed and 8% were of single parent families. Measurements of standing height and weight were made by the same observer at the outset and on six subsequent occasions over six school terms (21 months). The table shows our preliminary findings for those children measured on the lst and 7th occasions. GROWTH IN
7
AND
8-YEAR-OLD
CHILDREN OVER
21
MONTHS
The differences in growth by height of 0-11 cm for boys and 0-45 cm for girls and by weight of 0-21 kg for boys and 0-05 kg for girls do not achieve statistical significance at the 5% level of probability. When subsidised school milk was introduced in 1934 and made free in 1944 there was some evidence that supplementary feeding could substantially increase growth in some nutritionally disadvantaged children.’ The preliminary results of our study suggest that the re-introduction of free school milk for 7-11-year-old children is unlikely to have any appreciable effect on the physical development of the children. I. A. BAKER P. C. ELWOOD J. HUGHES
M R.C. Epidemiology Unit, 4 Richmond Road,
M. JONES P. M. SWEETNAM
Cardiff CF2 3AS
1.
Mann, C. Spec Rep. med. Res. Coun. 1926,
no.
105.
DIETARY ANTIGENS IN BREAST MILK
SiR,—Dr Jakobsson and Dr Lindberg (Aug. 26, p. 437) demonstrated bovine antigens in the milk of women ingesting cow’s milk, and recorded the clinical effects of this on their infants. We have examined human breast milk for the presence of wheat antigens. Of eighteen samples collected at random in a Madras maternity hospital, positive Ouchterlony reactions were obtained in three cases, using a sheep antiserum to wheat gluten. Two of these milks showed the presence of more than
antigen.1 In previous work with rats, transmission of dietary bovine IgG labelled with radioiodine to the suckling as macromolecular breakdown products was measured, and about 15% of the oral dose given to the mother appeared in the sucklings’ tissues in the first 24 h after feeding.2 Placental transmission of dietary antigens also occurs, in rat and rabbit3 4-indeed the fetal tissues may contain more antigen than the maternal tissues at
one
the time of parturition. These findings are important in pxdiatrics for it would seem that elements of the maternal diet, although foreign proteins, are normally transmitted to the fetus and suckling in significant amounts, and must play an important role in development. Attention is only drawn to this process when it goes wrong, as where there is a familial history of allergic response. Food allergy has lately been discussed in The Lancet5-7 and dietary antigens in breast milk are closely related to this topic. A.R.C.
Immunology Group, Zoology Department, University College of North Wales, Bangor, Gwynedd LL57 2UW
Immunology Division, Postgraduate Institute of Basic Medical Sciences, Taramani, Madras 600042, India
W. A. HEMMINGS
A. C. KULANGARA
CASE FOR BREAST-FEEDING
SIR,-We appreciate Professor Davis’ review (July 22, p.
Human Milk in the Modern World: Neverhis own term, we found some of his comments "off-putting". "Platitudinous" means "flat, dull, insipid, commonplace". Perhaps Davis fails to realise the general lack of knowledge of breast-feeding among health workers. Platitudes to cognoscenti can be revelations to the less informed. How many medical or nursing students ever hear of the let-down reflex ? "Repetitious" means "tiresomely reiterative". We believe reinforcement to be necessary if key ideas are to be appreciated. The accusation that we wrote "partly in that extraordinary jargon which masquerades as the scientific language of sociology" dealt a near-fatal blow to our literary egos. Plainly, Davis’ acquaintance with truly obscure sociological idiom is
201) of our book theless,
to borrow
slight. Incidentally, the word "dyad" has been long established in the English language (circa 1675) and has a different meaning entirely from "couple". Dyad implies two interacting entities. Two cucumbers are a couple; a mother and her nursing baby is a dyad. The word also has the advantage of having a crisp, eye-catching adjective which focuses on this long-neglected two-way interaction-"dyadic infant feeding," yes; "coupled infant feeding," surely meaningless. Davis says that we offer "no solution to the dilemma of how the trend away from good child-rearing practice." Chapter 14 (pp. 346-388) is entirely concerned with different practical approaches which might be combined in programmes to reverse
Kulangara, A C. in Protein Transmission across Living Membranes (edited by W. A. Hemmings). Lancaster (in the press). 2. Hemmings, C., Hemmings, W. A. I.R.C.S. med. Sci. 1977, 5, 247. 3. Hemmings, C., Hemmings, W.A. ibid. p. 335. 4. Hemmings, W.A. ibid, p. 281. 1.
5. Finn, R., Cohen, H. N. Lancet, 1975,i,426. 6 Hemmings, W A. ibid. p. 608. 7. Dickerson, J W. T., Ballantyne, L., Hastrop, K. ibid. p.
773.
