413 component was the same (ethinyloestradiol 0-05 mg.) in all except one patient who received’Ovanon ’, which contains mestranol 0-075 mg. A group of twenty menopausal women, none of whom had previously been treated with hormones, were studied as older controls. Their mean with a group of twenty menopausal women who had been on treatment withPremarin’ (conjugated equine oestrogen) for at least one year. The mean age of this group was 50-25 years. Treatment consisted of premarin 1-25 mg. daily in 3-week cyclic periods. The final group comprised twenty women in the third trimester of pregnancy. Antithrombin-III levels in the pregnant women were reduced below those recorded for normal young nonpregnant controls (38.5 ±3.3 69-3 ±3-6 seconds; p < 0’001); this reduction was of similar order to that seen in the group on oral contraceptives (38-5 ±3-3 vs 46-9 ±3’8 seconds). The value for the group on oral contraceptives did not differ significantly from that for the pregnant group (0-05 >?< 0-1). The antithrombin-in levels in the untreated menopausal women (59-7 ±4-8 seconds) showed no significant difference when compared with the levels in young women not taking oral contraceptives (69-3±3-6 seconds; r < 0°1). Premarin administration had no effect The values in the treated on the antithrombin-m level. and control menopausal groups were 57-1±5’4 and As expected, a 59-7±4-8 seconds, respectively (P>0-1). statistically significant fall (P< 0-001) in antithrombin-in level was induced by contraceptive steroids. The mean values decreased from 69-3±3-6 seconds in the young controls to 46-9 ±3-8 seconds in women on oral contraception. Thus, premarin seems to have no effect on the antithrombin-in levels in menopausal women. However, pregnant women demonstrated a striking reduction in age
was
66-9 years.
They
were
compared
antithrombin-m levels, as did young women on combination oral contraceptives. The depressant effect of pregnancy on antithrombin-in levels has been reported 31,32 and is presumably due to the endogenous production of natural oestrogen. The reason for this difference is not clear, and further studies are required. The observed lack of effect of exogenous natural cestrogens on antithrombin ill may The have important clinical implications, however. substitution of a natural oestrogen for.synthetic ones might minimise the risk of thrombosis associated with their use. Department of Hæmatology, Medical School, University of Natal, Durban, South Africa.
H. B. W. GREIG.
Chelmsford Medical Centre,
Durban, South Africa.
M. NOTELOWITZ.*
APLASTIC ANÆMIA ASSOCIATED WITH LITHIUM SIR,—Dr Lazarus and his colleagues (Jan. 18, p. 160), while commenting on the role of lithium in the treatment of thyrotoxicosis, mentioned that lithium-related blood dyscrasias have not been reported. I should like to call attention to a case discussed by Hussain et al. 33 A 50-yearold woman developed a fatal aplastic anaemia in association with the use of lithium carbonate. Although a causal relationship could not be established and although the usual " Present address: Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, U.S.A 31. Peterson, R. A., Krull, P. E., Finley, P., Ettinger, M. G. Am. J. clin. Path. 1970, 53, 468. 32. Zuck, T. F., Bergin, J. J., Raymond, J. M., Dwyre, W. R. Surgery Gynec. Obstet. 1971, 133, 609. 33. Hussain, M. Z., Khan, A. G., Chaudry, Z. A. Can. med. Ass. J.
1973, 108,
724.
effect of lithium on the hsematopoietic systems is a benign, reversible leucocytosis,34,35 the possibility of severe reactions exists. Department of Psychiatry, University of Wisconsin Center for Health Sciences,
Madison, Wisconsin 53706, U.S.A.
J. W. JEFFERSON.
Obituary JOHN HAMILTON BARCLAY M.D., M.S.Durh., F.R.C.S. Prof. J. Hamilton Barclay, emeritus professor of surgery in the University of Durham, died on Feb. 3 at the age of 88. He received his medical education in the University of Durham College of Medicine, Newcastle upon Tyne, where he graduated M.B. in 1911, M.S. in 1915, and M.D. in 1919. He became F.R.c.s. in 1914, and served throughout the 1914-18 war in France, commissioned in the R.A.M.C., in field ambulance and casualty-clearing stations. He was appointed to the honorary staff of the Newcastle upon Tyne Royal Victoria Infirmary in 1920 as assistant surgeon, and from 1929 he served as full consultant until his retirement in 1947. During his career he was consulting surgeon to several other hospitals in the North-East, including the Fleming Memorial Hospital for Sick Children, the Princess Mary Maternity Hospital, Durham County Hospital, and the Ingham Infirmary, South Shields. He was professor in the University of Durham from 1944 to 1947, being the last of a distinguished line of parttime professors of surgery in Newcastle. After his retirement, at the inception of the National Health Service, he became pastoral visitor and surgical adviser to the Newcastle Regional Hospital Board. He was popular with students, and was a past president of their medical society. His ward-rounds and outpatient sessions were always well attended, and his teaching, in the Morisonian tradition essentially clinical and practical, was based on his personal experience. Trained in the days before specialisation, he gained a wide experience of all surgical conditions, and became a sound and successful general surgeon who was in constant demand by general practitioners for the treatment of themselves and their
families. He was an active member of several local medical societies and of the Association of Surgeons of Great Britain, and a past president of the North of England Surgical Society; he made valuable contributions to their discussions and was always a stimulus to his younger colleagues. Long after his retirement he maintained an intense interest in the advances of surgery, and his presence at clinical meetings ceased only when his total blindness made it impossible for him to attend. Professor Barclay was a kind and humane man, a practising Christian whose principles permeated all aspects of his life. His patients trusted him implicitly, and the nursing staff liked working with him and respected him. A man of the highest character, with a somewhat shy but friendly disposition, he was held in the greatest regard by all his colleagues, who valued his opinion and appreciated to the full all the contributions he had made to the work of the hospital. He is survived by one married daughter.
G. Y. F. 34. Shopsin, B., Friedmann, R.,
Gershon, S. Clin. Pharmac. Ther. 1971,
12, 923. 35.
Murphy,
D.
L., Goodwin, F. K., Bunney, W.
1971, 127, 1159.
E. Am.
J. Psychiat.
was
66-9 years.
They
were
compared
antithrombin-m levels, as did young women on combination oral contraceptives. The depressant effect of pregnancy on antithrombin-in levels has been reported 31,32 and is presumably due to the endogenous production of natural oestrogen. The reason for this difference is not clear, and further studies are required. The observed lack of effect of exogenous natural cestrogens on antithrombin ill may The have important clinical implications, however. substitution of a natural oestrogen for.synthetic ones might minimise the risk of thrombosis associated with their use. Department of Hæmatology, Medical School, University of Natal, Durban, South Africa.
H. B. W. GREIG.
Chelmsford Medical Centre,
Durban, South Africa.
M. NOTELOWITZ.*
APLASTIC ANÆMIA ASSOCIATED WITH LITHIUM SIR,—Dr Lazarus and his colleagues (Jan. 18, p. 160), while commenting on the role of lithium in the treatment of thyrotoxicosis, mentioned that lithium-related blood dyscrasias have not been reported. I should like to call attention to a case discussed by Hussain et al. 33 A 50-yearold woman developed a fatal aplastic anaemia in association with the use of lithium carbonate. Although a causal relationship could not be established and although the usual " Present address: Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, U.S.A 31. Peterson, R. A., Krull, P. E., Finley, P., Ettinger, M. G. Am. J. clin. Path. 1970, 53, 468. 32. Zuck, T. F., Bergin, J. J., Raymond, J. M., Dwyre, W. R. Surgery Gynec. Obstet. 1971, 133, 609. 33. Hussain, M. Z., Khan, A. G., Chaudry, Z. A. Can. med. Ass. J.
1973, 108,
724.
effect of lithium on the hsematopoietic systems is a benign, reversible leucocytosis,34,35 the possibility of severe reactions exists. Department of Psychiatry, University of Wisconsin Center for Health Sciences,
Madison, Wisconsin 53706, U.S.A.
J. W. JEFFERSON.
Obituary JOHN HAMILTON BARCLAY M.D., M.S.Durh., F.R.C.S. Prof. J. Hamilton Barclay, emeritus professor of surgery in the University of Durham, died on Feb. 3 at the age of 88. He received his medical education in the University of Durham College of Medicine, Newcastle upon Tyne, where he graduated M.B. in 1911, M.S. in 1915, and M.D. in 1919. He became F.R.c.s. in 1914, and served throughout the 1914-18 war in France, commissioned in the R.A.M.C., in field ambulance and casualty-clearing stations. He was appointed to the honorary staff of the Newcastle upon Tyne Royal Victoria Infirmary in 1920 as assistant surgeon, and from 1929 he served as full consultant until his retirement in 1947. During his career he was consulting surgeon to several other hospitals in the North-East, including the Fleming Memorial Hospital for Sick Children, the Princess Mary Maternity Hospital, Durham County Hospital, and the Ingham Infirmary, South Shields. He was professor in the University of Durham from 1944 to 1947, being the last of a distinguished line of parttime professors of surgery in Newcastle. After his retirement, at the inception of the National Health Service, he became pastoral visitor and surgical adviser to the Newcastle Regional Hospital Board. He was popular with students, and was a past president of their medical society. His ward-rounds and outpatient sessions were always well attended, and his teaching, in the Morisonian tradition essentially clinical and practical, was based on his personal experience. Trained in the days before specialisation, he gained a wide experience of all surgical conditions, and became a sound and successful general surgeon who was in constant demand by general practitioners for the treatment of themselves and their
families. He was an active member of several local medical societies and of the Association of Surgeons of Great Britain, and a past president of the North of England Surgical Society; he made valuable contributions to their discussions and was always a stimulus to his younger colleagues. Long after his retirement he maintained an intense interest in the advances of surgery, and his presence at clinical meetings ceased only when his total blindness made it impossible for him to attend. Professor Barclay was a kind and humane man, a practising Christian whose principles permeated all aspects of his life. His patients trusted him implicitly, and the nursing staff liked working with him and respected him. A man of the highest character, with a somewhat shy but friendly disposition, he was held in the greatest regard by all his colleagues, who valued his opinion and appreciated to the full all the contributions he had made to the work of the hospital. He is survived by one married daughter.
G. Y. F. 34. Shopsin, B., Friedmann, R.,
Gershon, S. Clin. Pharmac. Ther. 1971,
12, 923. 35.
Murphy,
D.
L., Goodwin, F. K., Bunney, W.
1971, 127, 1159.
E. Am.
J. Psychiat.
