ability, and, second, the skier should wear a pair of cut-off jeans or a short wet-suit. R.F. EDINOTON, MD, FRCs[C]

136 Durham St. S Sudbury, Ont.

Reference 1. L.smx JE, BEAUKNIGHT C, TWEEDALE P: in Collected Letters, International

Society of Obstetricians and Gynecologists, Lakeland, Fla., ser 15, Apr 15, 1974, p 61

The controversial internship To the editor: Dr. D. Laurence Wilson's editorial urging that medical graduates be made to serve a 3-year internship before entering general

practice is ridiculous (Can Med AsSoc J 118: 879, 1978). If medical schools cannot do an adequate job in the present 4- plus 1-year system, then we should look towards replacing large areas of so-called "basic" science training with clinical training. I believe, however, that the

present system is adequate. Lord save us from a 3-year internship. Cmus BLOUNT, MD,

blood loss into the amniotic cavity or per vaginam. It is necessary to note such details when one is trying to assess the potential causes of fetal bleeding, since clearly the problem posed in their first patient was remarkably different from the problem posed by their fourth patient. It would be useful and helpful to know whether there was any primary placental abnormality in patient 4 and whether the vessels in patients 1, 2 and 3 showed any of the changes described by others in spontaneous rupture of fetal vessels and placental surfaces.1 In a previous paper it was shown that a spontaneous subamniotic hematoma, as in patient 1 of Akhter and colleagues, was often associated with distinct abnormalities in the vessel wall, which suggested a relatively prolonged development of vascular lesions in the fetal circulation prior to rupture.1 These criticisms aside, Akhter and associates are to be congratulated for once more drawing our attention to the dangers posed by fetal blood loss. DJ. DESA, MB, D PHIL, MRC PATh

Department of pathology

Intern Dalhousie Family Medicine Centre Halifax, NS

Fetal exsanguination associated with antepartum hemorrhage To the editor: The paper by Dr. M.S.

McMaster University Hamilton, Ont.

Reference 1. DESA DJ: Rupture of fetal vessels on placental surface. Arch Dis Child 46: 495, 1971

Akhter and associates (Can Med Assoc J 118: 651, 1978) re-em-

cord. It would have been interesting to know the approximate volume of blood loss and its relation to the body weight of the infant, and whether the vessel wall showed any abnormalities near and away from the tear. Patients 2 and 3 had small ruptures of the cord vessels, but again no description of the cord vessels or the estimated size of the hematoma is provided. In patient 4 there was obvious evidence of feto-

maternal bleeding without frank fetal

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phasizes the importance of fetal Signing of absentee bleeding as a cause of perinatal medical certificates mortality and morbidity. If any criti- To the editor: I have read with incism can be leveled at their paper it terest the very appropriate editorial is the relative lack of histologic in- by Dr. N.P. Da Sylva (Can Med Asvestigation of the placenta in all Soc J 118: 881, 1978). I fully agree cases. with him that physicians should not The authors describe the first pa- be forced into becoming truant oftient as having a subamniotic hema- ficers - we caution them against toma around the insertion of the



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CMA JOURNAL/AUGUST 26, 1978/VOL. 119 311

Fetal exsanguination associated with antepartum hemorrhage.

ability, and, second, the skier should wear a pair of cut-off jeans or a short wet-suit. R.F. EDINOTON, MD, FRCs[C] 136 Durham St. S Sudbury, Ont. R...
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