425 oi a baby seems to be of no ungofaHy?
more
consequence than the
On either view it is clear that they have forfeited the respect and trust of their patients, most of whom continue to believe that doctors are there to save human life and not to destroy It.
18 The Garlings,
Aldbourne, pear
Marlborough,
Wiltshire
D. P. OLLERENSHAW
I
BREAST-FEEDING IN SHEFFIELD
swat-
publication of the letter by Professor Fairweather and his co-signatories support for their views has -been received from a further 77 doctors.-ED.L. ’,’Since
MELATONIN IN SERUM AND CEREBROSPINAL FLUID
Ste,-1’he mammalian pineal is a neuroendocrine gland which secretes methoxyindoles, including melatonin, in response to stimuli arising from the retina. The hypothalamus is probably a major target organ for melatonin, which is concentrated in this area of the brain’ and has been shown experimentally to exert a wide influence on hypothalamic function.2 Melatonin has a short half-life in serum, and the most direct route from gland to target organ is via the third ventricle. Much debate has centred around the possibility that melatonin may be secreted directly into the cerebrospinal fluid (c.s.F.) rather than into the bloodstream. We have developed a sensitive radioimmunoassay for melatonin, based on that of Arendt et al., which shows no crossreactions with related indoles. We now report serum and lumbar C,S.F. melatonin concentrations in children undergoing simultaneous venepuncture and lumbar puncture during treatment for teuksmia. All the children were in leukxmic remission when studied. Specimens were obtained between 11.0 A.M. and to P.M. The results are shown in the table. The serum
SIR,-Although the case for breast-feeding is overwhelming, the proportion of British infants who are breast-fed is low. Since Jan. 1, 1973, we have been engaged in a prospective study aimed at detecting infants at increased risk of sudden unexpected death ("cot death"). This has involved recording information at birth on all Sheffield infants (total live births 1973, 6004; 1974, 5420; 1975, 5654). The data collected included whether the mother intended to breast-feed. At the start of this study period we found that only 36% of mothers intended to attempt breast-feeding and the number appeared to be decreasing. At the same time we became aware that hypernatrxmia was a factor contributing to some sudden infant deaths.’ We also found that many of our study infants were receiving an overstrength unmodified dried cow’s milk formula.2 The use of "humanised" dried-milk feeds with their lowered protein and mineral content is an advantage, but the best solution lies in the repopularisation of breast-feeding. In February, 1974, the specialist in community medicine (child health) (M.E.J.) convened a working-party on infant feeding which included the consultant pxdiatricians caring for the newborn in the three maternity units, together with representative hospital and domiciliary midwives and health visitors. This working party continues to meet. It has aimed to increase the number of mothers breast-feeding by (1) education of doctors and nurses in the advantages of, and practical
MELATONIN CONCENTRATION IN SERUM AND C.S.F.
Breast-feeding intentions in three Sheffield hospitals.
values were comparable with those we have observed in normal aduits’ but in each case in which melatonin was detectable the concentration was higher in the c.s.F. than in the serum. J. A. SMITH Department of Pharmaceutical Chemistry,
T. J. X. MEE
University of Bradford
59%.
Department of Pædiatrics,
N. D. BARNES
Addenbrooke’s Hospital, Cambridge CB2 2QQ Ida Darwin
management of breast-feeding; (2) education of the community through the local Press and radio; (3) education of the expectant mother in antenatal classes and particularly antenatal clinics; (4) modification of lying-in ward routines so as to facilitate breast-feeding; (5) improving help given to the mother at home by domiciliary midwives and health visitors. The accompanying figure shows the intent of Sheffield mothers to breast-feed their babies as recorded at the time of the baby’s delivery. The proportion of mothers is indicated in three-monthly intervals during the years 1973-76. The proportion of mothers intending to breast-feed has increased in all three maternity units. The three units deliver approximately equal numbers of Sheffield infants and cover over 98% of infants born in Sheffield. By the second quarter of this year, the proportion of mothers attempting to breast-feed had risen to
R. J. THORBURN
Hospital,
J. L. C. BARNES
Cambridge
Since Aug. 1, 1975 health visitors have filled in an extensive form on the state of health of mothers of all babies born in Sheffield, on which is also recorded the method of feeding. Information has been obtained on over 98% of the infants: Fully breast-fed
1 Anton-Tay, F, Wurtman, 2
J. Nature, 1969, 221, 474. Minneman, K P , Wurtman, R. J. Life Sci. 1976, 17, 1189. 3 Arendt, J. Paunier, L., Sizonenko, P. C. J. clin. Endocr. Metab. 1975, 40,
347 4 Smith A., J lished
of birth Aug.-Oct , 1975
Month R.
Mee, T. J. X., Padwick, D., Bird, E., Minneman,
K. P.
Unpub-
Nov
’75-Jan. ’76 Feb.-Apnl,1976 1. 2.
at one
month 218 20.0 27.7
(%)
Emery, J. L., Worthy, E., Swift, P. Archs Smith, B A M Br. med. J. 1974, iv, 741.
Partly breasr-fed (o/c) 102 10.6 11.9
Dis. Childh.
1974, 49, 686.
more
consequence than the
On either view it is clear that they have forfeited the respect and trust of their patients, most of whom continue to believe that doctors are there to save human life and not to destroy It.
18 The Garlings,
Aldbourne, pear
Marlborough,
Wiltshire
D. P. OLLERENSHAW
I
BREAST-FEEDING IN SHEFFIELD
swat-
publication of the letter by Professor Fairweather and his co-signatories support for their views has -been received from a further 77 doctors.-ED.L. ’,’Since
MELATONIN IN SERUM AND CEREBROSPINAL FLUID
Ste,-1’he mammalian pineal is a neuroendocrine gland which secretes methoxyindoles, including melatonin, in response to stimuli arising from the retina. The hypothalamus is probably a major target organ for melatonin, which is concentrated in this area of the brain’ and has been shown experimentally to exert a wide influence on hypothalamic function.2 Melatonin has a short half-life in serum, and the most direct route from gland to target organ is via the third ventricle. Much debate has centred around the possibility that melatonin may be secreted directly into the cerebrospinal fluid (c.s.F.) rather than into the bloodstream. We have developed a sensitive radioimmunoassay for melatonin, based on that of Arendt et al., which shows no crossreactions with related indoles. We now report serum and lumbar C,S.F. melatonin concentrations in children undergoing simultaneous venepuncture and lumbar puncture during treatment for teuksmia. All the children were in leukxmic remission when studied. Specimens were obtained between 11.0 A.M. and to P.M. The results are shown in the table. The serum
SIR,-Although the case for breast-feeding is overwhelming, the proportion of British infants who are breast-fed is low. Since Jan. 1, 1973, we have been engaged in a prospective study aimed at detecting infants at increased risk of sudden unexpected death ("cot death"). This has involved recording information at birth on all Sheffield infants (total live births 1973, 6004; 1974, 5420; 1975, 5654). The data collected included whether the mother intended to breast-feed. At the start of this study period we found that only 36% of mothers intended to attempt breast-feeding and the number appeared to be decreasing. At the same time we became aware that hypernatrxmia was a factor contributing to some sudden infant deaths.’ We also found that many of our study infants were receiving an overstrength unmodified dried cow’s milk formula.2 The use of "humanised" dried-milk feeds with their lowered protein and mineral content is an advantage, but the best solution lies in the repopularisation of breast-feeding. In February, 1974, the specialist in community medicine (child health) (M.E.J.) convened a working-party on infant feeding which included the consultant pxdiatricians caring for the newborn in the three maternity units, together with representative hospital and domiciliary midwives and health visitors. This working party continues to meet. It has aimed to increase the number of mothers breast-feeding by (1) education of doctors and nurses in the advantages of, and practical
MELATONIN CONCENTRATION IN SERUM AND C.S.F.
Breast-feeding intentions in three Sheffield hospitals.
values were comparable with those we have observed in normal aduits’ but in each case in which melatonin was detectable the concentration was higher in the c.s.F. than in the serum. J. A. SMITH Department of Pharmaceutical Chemistry,
T. J. X. MEE
University of Bradford
59%.
Department of Pædiatrics,
N. D. BARNES
Addenbrooke’s Hospital, Cambridge CB2 2QQ Ida Darwin
management of breast-feeding; (2) education of the community through the local Press and radio; (3) education of the expectant mother in antenatal classes and particularly antenatal clinics; (4) modification of lying-in ward routines so as to facilitate breast-feeding; (5) improving help given to the mother at home by domiciliary midwives and health visitors. The accompanying figure shows the intent of Sheffield mothers to breast-feed their babies as recorded at the time of the baby’s delivery. The proportion of mothers is indicated in three-monthly intervals during the years 1973-76. The proportion of mothers intending to breast-feed has increased in all three maternity units. The three units deliver approximately equal numbers of Sheffield infants and cover over 98% of infants born in Sheffield. By the second quarter of this year, the proportion of mothers attempting to breast-feed had risen to
R. J. THORBURN
Hospital,
J. L. C. BARNES
Cambridge
Since Aug. 1, 1975 health visitors have filled in an extensive form on the state of health of mothers of all babies born in Sheffield, on which is also recorded the method of feeding. Information has been obtained on over 98% of the infants: Fully breast-fed
1 Anton-Tay, F, Wurtman, 2
J. Nature, 1969, 221, 474. Minneman, K P , Wurtman, R. J. Life Sci. 1976, 17, 1189. 3 Arendt, J. Paunier, L., Sizonenko, P. C. J. clin. Endocr. Metab. 1975, 40,
347 4 Smith A., J lished
of birth Aug.-Oct , 1975
Month R.
Mee, T. J. X., Padwick, D., Bird, E., Minneman,
K. P.
Unpub-
Nov
’75-Jan. ’76 Feb.-Apnl,1976 1. 2.
at one
month 218 20.0 27.7
(%)
Emery, J. L., Worthy, E., Swift, P. Archs Smith, B A M Br. med. J. 1974, iv, 741.
Partly breasr-fed (o/c) 102 10.6 11.9
Dis. Childh.
1974, 49, 686.
