173
Campylobacter fetus var. fetus has been associated with gastroenteritis, endocarditis, and bacteraemia in man; Campylobacter fetus var. intestinalis, Campylobacter fetus var. jejuni, and Campylobacter sputorum var. sputorum clinical isolates. Of these four the first is clearly established as a human species, only pathogen; the others appear to be predominantly animal pathogens or saprophytic members of the normal human flora which may be pathogenic for man under unusual circumstances. Other members of the genus Campylobacter have also been described whose precise taxonomic position and role in human disease remain unclear. Although confusion has been inevitable in the past because of the poorly defined status and questionable pathogenicity of many of these organisms, it is nonetheless obligatory at this point for both clinicians and microbiologists to adhere to what is now standard taxonomy and nomenclature in referring to these organisms in the literature.
are
the other
adenovirus and herpesvirus infections. Also one single application was effective in the prevention of infection after removal of foreign bodies and after ophthalmic surgery. Moscow Helmholtz
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, U.S.A.
MICHAEL L. TAPPER.
SOLUBLE OPHTHALMIC DRUG INSERTS SIR,-An experimental and clinical study has been completed on a better way of introducing medication into the eye. Experiments demonstrated the potential of new films (inserts) polyvinylalcohol medicinal ophthalmic mpregnated with antibiotics.1 Yet it was observed 2,
Ophthalmological
Institute, Moscow, U.S.S.R.
common
Y. F. MAICHUK.*
INTRAVENOUS PROSTAGLANDINS AND OXYTOCIN FOR MID-TRIMESTER ABORTION
SIR,-Opinions still vary as to the most effective way of terminating mid-trimester pregnancies, although most clinicians now favour prostaglandins. We report the successful termination of 19 consecutive late first and second trimester pregnancies using a combination of intravenous prostaglandins E2 (P.G.E.2 Upjohn) and
oxytocin (’ Syntocinon’). P.G.E.:(5 mg. in 500 ml. of 5% glucose) was infused into a superficial arm vein at an initial rate of 2-5 (.Lg. per minute, the rate being increased to 5 ;jLg. per minute after half an hour. If after four hours the uterine response was regarded as inadequate
the P.G.E.. infusion was increased to a maximum of 10 jj.g. per minute. To allow ample time for the enhancement phenomenon,’,2 INDUCTION OF ABORTION BY A COMBINATION OF INTRAVENOUS P.G.E.. AND OXYTOCIN
that they, like polypeptide-polysaccharide ocular inserts,33 did not dissolve in the conjunctival sac, and discomfort necessitated their removal from the sac. Therefore soluble ophthalmic drug inserts (S.O.D.I.) have been suggested2 and produced by the Moscow Helmholtz Ophthalmological Institute in collaboration with the All-Union Research Institute for Medical Equipment, U.S.S.R. S.O.D.I. were endorsed for use in ophthalmic practice in the U.S.S.R., following the June 11,1971, decision of the Pharmacological Committee, Ministry of Health. S.O.D.1. are made from polymers of polyacrylamide, ethylacrylate, and vinylpyrrolidone, prepared as thin elastic oval plates with neomycin, kanamycin, sulphamethoxypyrid-
azine, idoxuridine,Florenal ’, atropine, pilocarpine, dexamethasone, and other drugs used in ophthalmology. S.O.D.I. offer a number of advantages over eye-drops (aqueous solutions, viscous solutions of polymers, suspensions), ointments, and subconjunctival injections. In fact, their use makes it possible to achieve prolonged
bioavailability of active substances in the conjunctival fluid and conjunctival and corneal tissue. Though in many of the applications studied S.O.D.I. dissolved in 60-90 minutes, the incorporated active material was found in the conjunctival fluid for up to 34-72 hours. This long duration secures therapeutic concentrations in the conjunctival sac, enhances the penetration of drugs into the tissues and may therefore replace subconjunctival injections in certain cases. This possibility has, of course, to be weighed against tolerance of the active material. However, experience with more than 500 patients (a single application daily or every other day for a maximum of 10 days) demonstrated good tolerance and therapeutic efficacy in different forms of glaucoma, keratitis, iridocyclitis, cornea ulceration, trachoma, conjunctivitis, and 1. 2.
Maichuk, Maichuk,
Y. F. Antibiotiki, 1967, 5, 435. Y. F. in Proceedings of Moscow
Ophthalmological
Conference, 1967, p. 403. 3. Dohlman, C. H., Pavan-Langston, Dr., Rose, J. Ann. Ophthalmol. 1972, 4, 823. 4. Maichuk, Y. F., Khromov, G. L., Koneva, E. B., Tishina, I. F., Pozdnijkov, V. I. in Proceedings of Conference on Ophthalmology, Chuvash, A.S.S.R., 1970, p. 136.
+ = 1 or 2 episodes of vomiting. + + 3 or 4 episodes of vomiting. + + + =more than 4 episodes of vomiting. =
c=complete.
oxytocin
i/c=incomplete.
started two hours after the P.G.E’2 and infused at a of 128 mu per minute. Mixing the P.G.E., and in the same bottle of 5 % glucose had no adverse effects. was
constant rate
oxytocin
Individual results are shown in the accompanying table. The mean total dose of P.G.E’2 used was 5-9 mg.- at an overall rate of 6-1 g. per minute. The average induction/ delivery interval was 16 hours, with only 1 patient (13) taking more than 24 hours. In 13 cases (68%) abortion was
complete. 13 women experienced vomiting, but the nursing staff said that this was distressing in only 2 cases, the remainder responding well to ’Stemetil’ by intramuscular injection. Pain was not a problem and was well controlled by pethidine, the average dose of which was 100 mg.
When the two uterine stimulatants
were run
through the same infusion set, there was a tendency to superficial thrombophlebitis, but this was never anything *
Present address: Regional Adviser, W.H.O., E.M.R.O., P.O., Box 1517, Alexandria, Arab Republic of Egypt.
1. 2.
Brummer, H. C. J. Obstet. Gynœc. Br. Commonw. 1971, 78, 305. Gillespie, A. Br. med. J. 1972, i : 150.
174 other than mild and transient. No patient experienced diarrhoea and there were no instances of cervical damage. As with any method of terminating mid-trimester pregnancies, the main considerations are ease and safety of administration of the abortifacient, side-effects, length of the induction delivery interval, and effectiveness in terms of success-rate and uterine evacuation. As yet, no one method meets all these requirements. However, when compared with’ the use of intravenous prostaglandin alone, 3-5 prostaglandin given intra-amniotically on its own 6,7 or with intravenous oxytocin 8,9 and prostaglandin given extra-amniotically on its own 10-12 or with intravenous oxytocin 13,14 we feel from the results of this small series that a combination of intravenous P.G.E’2 and oxytocin at the dose level described goes much of the way to meeting all the desired criteria for acceptability. Department of Obstetrics, Guy’s Hospital, London.
T. M. COLTART M. J. COE.
AUTONOMIC CONTROL OF IMMUNITY
SIR,—I was interested to read the letter of Dr Casirola and his colleagues,15 who drew attention to the impairment of cellular and humoral immunity by reserpine, and to the control of lymphoid-tissue activity in vivo, by its sympathetic innervation. I have been wondering 16 whether intramuscular injection of long-acting anti-psychotic preparations may at times impair immunity, particularly perhaps in the brain-injured. A preliminary review of my patients in this psychiatric hospital suggests that a small proportion of those on such long-acting intramuscular anti-psychotic preparations may have low lymphocyte counts within 24-48 hours after iniection. Stone House Hospital, Near Dartford, Kent. J. P. CRAWFORD. ENURETIC ALARM TRAINER
SIR,-In their interesting article Mr Glen and Mr Rowan (Oct. 26, p. 987) write: "... it occurred to us that a simpler device could be employed on a long-term basis as a bladder training aid ". I should like to point out that a number of miniature portable enuresis alarms for daytime toilet training have already been described and experimentally evaluated, particularly in the field of mental retardation (e.g., Van Wagenen et al.,17 Mahoney et al.,18 Azrin et al.,19 Smith et al. 20). Psychology Department, Prudhoe and Monkton Hospital, Prudhoe, Northumberland.
PAUL S. SMITH.
3. Karim, S. M. M., Filshie, G. M. Lancet, 1970, i, 157. 4. Embrey, M. P. J. reprod. Med. 1971, 6, 15. 5. Karim, S. M., Filshie, G. M. J. Obstet. Gynœc. Br. Commonw. 1972, 79, 1. 6. Toppozada, M., Bygdeman, M., Wiqvist, N. Contraception, 1971, 4, 293. 7. Craft, I. Lancet, 1973, i, 1344. 8. Wentz, A. C., Cushner, I. M., Austin, K., Shams, M. Am. J. Obstet. Gynec. 1972, 113, 793. 9. Roberts, G., Gomersall, R., Adams, M., Turnbull, A. C. Br. med. J. 1972, iv, 12. 10. Embrey, M. P., Hillier, K., Mahendran, P. ibid. 1972, iii, 146. 11. Miller, A. W. F., Calder, A. A., Macnaughton, M. C. Lancet, 1972, ii, 5. 12. Midwinter, A., Shepherd, A., Bowen, M. J. Obstet. Gynœc. Br. Commonw. 1973, 80, 371. 13. Morewood, G. A. ibid. p. 473. 14. Alderman, B., Thelwall-Jones, H. ibid. p. 1021. 15. Casirola, G., Marini, G., Ippoliti, G., Invernizzi, R. Lancet, 1974, ii, 1266. 16. Crawford, J. P. Br. J. Psychiat. 1974, 125, 432. 17. Van Wagenen, R. K., Meyerson, L., Kerr, N. J., Mahoney, K. J. exp. Child Psychol. 1969, 8, 147. 18. Mahoney, K., Van Wagenen, R. K., Meyerson, L. J. appl. Behav. Anal. 1971, 4, 173. 19. Azrin, N. H., Bugle, C., O’Brien, F. ibid. p. 249. 20. Smith, P. S., Britton, P. G., Johnson, M., Thomas, D. A. Behav. Res. Ther. 1975, 13 (in the press).
Obituary NORMAN BRANDON CAPON
M.D.L’pool, F.R.C.P., F.R.C.O.G. Prof. N. B. Capon, emeritus professor of child health in the University of Liverpool, died on Jan. 7 at the age of 82. He
was
born in
Liverpool, and
College and studied medicine
at
he attended
Liverpool
Liverpool University,
becoming president of the Guild of Undergraduates, and graduating M.B. in 1916 with first-class honours, and distinctions in medicine, obstetHe rics, and gynaecology. obtained the M.D. (with special merit) in 1921, and he was elected F.R.C.P. in 1931. He was research-worker, under the auspices of the Medical Research Council, in antenatal paediatrics from 1920 to 1922, and in renal disease in children from 1923 to 1924. He was appointed paediatrician to the in 1923 (one of the first such Hospital Liverpool Maternity appointments in the country), honorary physician to the Royal Liverpool Babies’ Hospital in 1924, honorary physician to the Royal Southern Hospital in 1925, and lecturer in clinical medicine in the University of Liverpool. He was appointed consultant paediatrician to the Royal Liverpool Children’s Hospital and Alder Hey Children’s Hospital, and, in 1935, he became lecturer in diseases of children, a position he held until 1944 when he was appointed the first professor of child health in the University of Liverpool. He retired in 1957. Professor Capon’s interest in paediatrics in the early 1920s was shared by members of the Provincial Children’s Club, who included Vining, Lapage, Ashby, Fordyce, Ward, Parsons, and Smellie, all of whom were original members of the British Paediatric Association when it was founded in 1928. When addressing the Postgraduate Medical Association in Cape Town in January, 1952, Norman confessed that the newborn baby was his first love in paediatrics. As early as 1923 he recommended the establishment of a special-care baby unit at the Liverpool Maternity Hospital, and, over half a century later, his suggestion will shortly become an accomplished fact. In 1955 he was awarded the Dawson Williams prize for his particular contribution to neonatal pxdiatrics, and he especially valued the honour of F.R.C.O.G. which was bestowed on him in 1957. Many of his numerous publications and contributions to standard pxdiatric textbooks were concerned with the newly born baby, but others reflected his wider interests. For example, his inaugural address when elected first president of the Liverpool Paediatric Club in 1949 was entitled Tradition in Paediatrics ; his presidential address to the paediatric section of the Royal Society of Medicine in 1945 was concerned with the training of clinical teachers; and the subject of his Blackham memorial lecture was the nursing of infants and sick children. He was a member of Medical Research Council committees on infections in infancy, on sulphonamide trials of rheumatism in childhood, and on streptomycin trials for tuberculosis in childhood; he was a member of the Ministry of Health B.C.G. subcommittee, and of the Platt Committee on the Welfare of Children in Hospital. Many honours were showered upon him. He was Milroy lecturer, Charles a
Campylobacter fetus var. fetus has been associated with gastroenteritis, endocarditis, and bacteraemia in man; Campylobacter fetus var. intestinalis, Campylobacter fetus var. jejuni, and Campylobacter sputorum var. sputorum clinical isolates. Of these four the first is clearly established as a human species, only pathogen; the others appear to be predominantly animal pathogens or saprophytic members of the normal human flora which may be pathogenic for man under unusual circumstances. Other members of the genus Campylobacter have also been described whose precise taxonomic position and role in human disease remain unclear. Although confusion has been inevitable in the past because of the poorly defined status and questionable pathogenicity of many of these organisms, it is nonetheless obligatory at this point for both clinicians and microbiologists to adhere to what is now standard taxonomy and nomenclature in referring to these organisms in the literature.
are
the other
adenovirus and herpesvirus infections. Also one single application was effective in the prevention of infection after removal of foreign bodies and after ophthalmic surgery. Moscow Helmholtz
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, U.S.A.
MICHAEL L. TAPPER.
SOLUBLE OPHTHALMIC DRUG INSERTS SIR,-An experimental and clinical study has been completed on a better way of introducing medication into the eye. Experiments demonstrated the potential of new films (inserts) polyvinylalcohol medicinal ophthalmic mpregnated with antibiotics.1 Yet it was observed 2,
Ophthalmological
Institute, Moscow, U.S.S.R.
common
Y. F. MAICHUK.*
INTRAVENOUS PROSTAGLANDINS AND OXYTOCIN FOR MID-TRIMESTER ABORTION
SIR,-Opinions still vary as to the most effective way of terminating mid-trimester pregnancies, although most clinicians now favour prostaglandins. We report the successful termination of 19 consecutive late first and second trimester pregnancies using a combination of intravenous prostaglandins E2 (P.G.E.2 Upjohn) and
oxytocin (’ Syntocinon’). P.G.E.:(5 mg. in 500 ml. of 5% glucose) was infused into a superficial arm vein at an initial rate of 2-5 (.Lg. per minute, the rate being increased to 5 ;jLg. per minute after half an hour. If after four hours the uterine response was regarded as inadequate
the P.G.E.. infusion was increased to a maximum of 10 jj.g. per minute. To allow ample time for the enhancement phenomenon,’,2 INDUCTION OF ABORTION BY A COMBINATION OF INTRAVENOUS P.G.E.. AND OXYTOCIN
that they, like polypeptide-polysaccharide ocular inserts,33 did not dissolve in the conjunctival sac, and discomfort necessitated their removal from the sac. Therefore soluble ophthalmic drug inserts (S.O.D.I.) have been suggested2 and produced by the Moscow Helmholtz Ophthalmological Institute in collaboration with the All-Union Research Institute for Medical Equipment, U.S.S.R. S.O.D.I. were endorsed for use in ophthalmic practice in the U.S.S.R., following the June 11,1971, decision of the Pharmacological Committee, Ministry of Health. S.O.D.1. are made from polymers of polyacrylamide, ethylacrylate, and vinylpyrrolidone, prepared as thin elastic oval plates with neomycin, kanamycin, sulphamethoxypyrid-
azine, idoxuridine,Florenal ’, atropine, pilocarpine, dexamethasone, and other drugs used in ophthalmology. S.O.D.I. offer a number of advantages over eye-drops (aqueous solutions, viscous solutions of polymers, suspensions), ointments, and subconjunctival injections. In fact, their use makes it possible to achieve prolonged
bioavailability of active substances in the conjunctival fluid and conjunctival and corneal tissue. Though in many of the applications studied S.O.D.I. dissolved in 60-90 minutes, the incorporated active material was found in the conjunctival fluid for up to 34-72 hours. This long duration secures therapeutic concentrations in the conjunctival sac, enhances the penetration of drugs into the tissues and may therefore replace subconjunctival injections in certain cases. This possibility has, of course, to be weighed against tolerance of the active material. However, experience with more than 500 patients (a single application daily or every other day for a maximum of 10 days) demonstrated good tolerance and therapeutic efficacy in different forms of glaucoma, keratitis, iridocyclitis, cornea ulceration, trachoma, conjunctivitis, and 1. 2.
Maichuk, Maichuk,
Y. F. Antibiotiki, 1967, 5, 435. Y. F. in Proceedings of Moscow
Ophthalmological
Conference, 1967, p. 403. 3. Dohlman, C. H., Pavan-Langston, Dr., Rose, J. Ann. Ophthalmol. 1972, 4, 823. 4. Maichuk, Y. F., Khromov, G. L., Koneva, E. B., Tishina, I. F., Pozdnijkov, V. I. in Proceedings of Conference on Ophthalmology, Chuvash, A.S.S.R., 1970, p. 136.
+ = 1 or 2 episodes of vomiting. + + 3 or 4 episodes of vomiting. + + + =more than 4 episodes of vomiting. =
c=complete.
oxytocin
i/c=incomplete.
started two hours after the P.G.E’2 and infused at a of 128 mu per minute. Mixing the P.G.E., and in the same bottle of 5 % glucose had no adverse effects. was
constant rate
oxytocin
Individual results are shown in the accompanying table. The mean total dose of P.G.E’2 used was 5-9 mg.- at an overall rate of 6-1 g. per minute. The average induction/ delivery interval was 16 hours, with only 1 patient (13) taking more than 24 hours. In 13 cases (68%) abortion was
complete. 13 women experienced vomiting, but the nursing staff said that this was distressing in only 2 cases, the remainder responding well to ’Stemetil’ by intramuscular injection. Pain was not a problem and was well controlled by pethidine, the average dose of which was 100 mg.
When the two uterine stimulatants
were run
through the same infusion set, there was a tendency to superficial thrombophlebitis, but this was never anything *
Present address: Regional Adviser, W.H.O., E.M.R.O., P.O., Box 1517, Alexandria, Arab Republic of Egypt.
1. 2.
Brummer, H. C. J. Obstet. Gynœc. Br. Commonw. 1971, 78, 305. Gillespie, A. Br. med. J. 1972, i : 150.
174 other than mild and transient. No patient experienced diarrhoea and there were no instances of cervical damage. As with any method of terminating mid-trimester pregnancies, the main considerations are ease and safety of administration of the abortifacient, side-effects, length of the induction delivery interval, and effectiveness in terms of success-rate and uterine evacuation. As yet, no one method meets all these requirements. However, when compared with’ the use of intravenous prostaglandin alone, 3-5 prostaglandin given intra-amniotically on its own 6,7 or with intravenous oxytocin 8,9 and prostaglandin given extra-amniotically on its own 10-12 or with intravenous oxytocin 13,14 we feel from the results of this small series that a combination of intravenous P.G.E’2 and oxytocin at the dose level described goes much of the way to meeting all the desired criteria for acceptability. Department of Obstetrics, Guy’s Hospital, London.
T. M. COLTART M. J. COE.
AUTONOMIC CONTROL OF IMMUNITY
SIR,—I was interested to read the letter of Dr Casirola and his colleagues,15 who drew attention to the impairment of cellular and humoral immunity by reserpine, and to the control of lymphoid-tissue activity in vivo, by its sympathetic innervation. I have been wondering 16 whether intramuscular injection of long-acting anti-psychotic preparations may at times impair immunity, particularly perhaps in the brain-injured. A preliminary review of my patients in this psychiatric hospital suggests that a small proportion of those on such long-acting intramuscular anti-psychotic preparations may have low lymphocyte counts within 24-48 hours after iniection. Stone House Hospital, Near Dartford, Kent. J. P. CRAWFORD. ENURETIC ALARM TRAINER
SIR,-In their interesting article Mr Glen and Mr Rowan (Oct. 26, p. 987) write: "... it occurred to us that a simpler device could be employed on a long-term basis as a bladder training aid ". I should like to point out that a number of miniature portable enuresis alarms for daytime toilet training have already been described and experimentally evaluated, particularly in the field of mental retardation (e.g., Van Wagenen et al.,17 Mahoney et al.,18 Azrin et al.,19 Smith et al. 20). Psychology Department, Prudhoe and Monkton Hospital, Prudhoe, Northumberland.
PAUL S. SMITH.
3. Karim, S. M. M., Filshie, G. M. Lancet, 1970, i, 157. 4. Embrey, M. P. J. reprod. Med. 1971, 6, 15. 5. Karim, S. M., Filshie, G. M. J. Obstet. Gynœc. Br. Commonw. 1972, 79, 1. 6. Toppozada, M., Bygdeman, M., Wiqvist, N. Contraception, 1971, 4, 293. 7. Craft, I. Lancet, 1973, i, 1344. 8. Wentz, A. C., Cushner, I. M., Austin, K., Shams, M. Am. J. Obstet. Gynec. 1972, 113, 793. 9. Roberts, G., Gomersall, R., Adams, M., Turnbull, A. C. Br. med. J. 1972, iv, 12. 10. Embrey, M. P., Hillier, K., Mahendran, P. ibid. 1972, iii, 146. 11. Miller, A. W. F., Calder, A. A., Macnaughton, M. C. Lancet, 1972, ii, 5. 12. Midwinter, A., Shepherd, A., Bowen, M. J. Obstet. Gynœc. Br. Commonw. 1973, 80, 371. 13. Morewood, G. A. ibid. p. 473. 14. Alderman, B., Thelwall-Jones, H. ibid. p. 1021. 15. Casirola, G., Marini, G., Ippoliti, G., Invernizzi, R. Lancet, 1974, ii, 1266. 16. Crawford, J. P. Br. J. Psychiat. 1974, 125, 432. 17. Van Wagenen, R. K., Meyerson, L., Kerr, N. J., Mahoney, K. J. exp. Child Psychol. 1969, 8, 147. 18. Mahoney, K., Van Wagenen, R. K., Meyerson, L. J. appl. Behav. Anal. 1971, 4, 173. 19. Azrin, N. H., Bugle, C., O’Brien, F. ibid. p. 249. 20. Smith, P. S., Britton, P. G., Johnson, M., Thomas, D. A. Behav. Res. Ther. 1975, 13 (in the press).
Obituary NORMAN BRANDON CAPON
M.D.L’pool, F.R.C.P., F.R.C.O.G. Prof. N. B. Capon, emeritus professor of child health in the University of Liverpool, died on Jan. 7 at the age of 82. He
was
born in
Liverpool, and
College and studied medicine
at
he attended
Liverpool
Liverpool University,
becoming president of the Guild of Undergraduates, and graduating M.B. in 1916 with first-class honours, and distinctions in medicine, obstetHe rics, and gynaecology. obtained the M.D. (with special merit) in 1921, and he was elected F.R.C.P. in 1931. He was research-worker, under the auspices of the Medical Research Council, in antenatal paediatrics from 1920 to 1922, and in renal disease in children from 1923 to 1924. He was appointed paediatrician to the in 1923 (one of the first such Hospital Liverpool Maternity appointments in the country), honorary physician to the Royal Liverpool Babies’ Hospital in 1924, honorary physician to the Royal Southern Hospital in 1925, and lecturer in clinical medicine in the University of Liverpool. He was appointed consultant paediatrician to the Royal Liverpool Children’s Hospital and Alder Hey Children’s Hospital, and, in 1935, he became lecturer in diseases of children, a position he held until 1944 when he was appointed the first professor of child health in the University of Liverpool. He retired in 1957. Professor Capon’s interest in paediatrics in the early 1920s was shared by members of the Provincial Children’s Club, who included Vining, Lapage, Ashby, Fordyce, Ward, Parsons, and Smellie, all of whom were original members of the British Paediatric Association when it was founded in 1928. When addressing the Postgraduate Medical Association in Cape Town in January, 1952, Norman confessed that the newborn baby was his first love in paediatrics. As early as 1923 he recommended the establishment of a special-care baby unit at the Liverpool Maternity Hospital, and, over half a century later, his suggestion will shortly become an accomplished fact. In 1955 he was awarded the Dawson Williams prize for his particular contribution to neonatal pxdiatrics, and he especially valued the honour of F.R.C.O.G. which was bestowed on him in 1957. Many of his numerous publications and contributions to standard pxdiatric textbooks were concerned with the newly born baby, but others reflected his wider interests. For example, his inaugural address when elected first president of the Liverpool Paediatric Club in 1949 was entitled Tradition in Paediatrics ; his presidential address to the paediatric section of the Royal Society of Medicine in 1945 was concerned with the training of clinical teachers; and the subject of his Blackham memorial lecture was the nursing of infants and sick children. He was a member of Medical Research Council committees on infections in infancy, on sulphonamide trials of rheumatism in childhood, and on streptomycin trials for tuberculosis in childhood; he was a member of the Ministry of Health B.C.G. subcommittee, and of the Platt Committee on the Welfare of Children in Hospital. Many honours were showered upon him. He was Milroy lecturer, Charles a
