614
doctors in "Le Grand Monarque" fashion. An operation for fistula in 1686 cost him or his people an equivalent of$200 000. The surgeon Felix was assisted (onlookers) by three other physicians, four apothecaries, and an apprentice. Dr Willis, who had charge of George III in 1792 during his periods of derangements also attended the Queen of Portugal (while also mentally deranged), and was offered travel, suite, expenses, and C20 000 if he succeeded in curing the queen.3 However, these pre-arranged agreements were not without risk-for example, Morrell Mackenzie’s attendance on the Emperor Frederick earned him c 13 000 and yet the fatal tragic outcome created a lifetime of adverse criticism.5,6 Even royal patients neglected to pay their physicians, as Maitre Henri de Mondeville, surgeon to King Phillippe3decried. Osler liked to exhibit his first fee record to students, "speck in cornea 50 cents". A month as locum tenens provided him "$25 and a pair of old fashioned boots too small for Dr Charles O’Reilly."7 An old Dutch woodcut epitomised the average patient in matters mercenary: When the sick
man lies abed distraught with pain and dismal Death is clutching at his throat, he likens me to GOD and all his house kneel down and do me reverence ... and then at last when recompense is asked, he passeth me in dread, for lo, to him I stand a DEVIL, horned from out the lowest depths... At least Marcus Aurelius said of Galen "I have but one physician and he is a gentleman". The fourteenth century Father of Surgery, Guy de Chauliac8 best expressed a balanced view, "... let the [surgeon] be modest, dignified, gentle, pitiful and merciful, not covetous nor an extortionist of money; but rather let his reward be according to his work, to the means of the patient, to the quality of the issue and to his own dignity."
Yale School of Medicine, PO Box 8548, New Haven, Connecticut 06531, USA
of these could be enzymes. The N-terminal segment can now be synthetically produced and potentially used as a reagent for clinical purposes. It will also be possible to construct oligonucleotide probes for isolation of the corresponding cDNA from L destructor. Our characterisation will ultimately lead to the complete identification of the antigenic structure. some
This work was supported by the Swedish Work Environment Fund (project no 83-1182, 82-0881), the Swedish Medical Research Council (grants 16X-105 and 03X-3532), King Gustaf V 80th Birthday Fund, the Swedish Asthma and Allergy Association, the Ellen, Walter and Lennart Hesselman Foundation, the Petrus and Augusta Hedlund Foundation, the Magn. Bergvall Foundation, and the Karolinska Institute. M. VAN HAGE-HAMSTEN
T. BERGMAN E. JOHANSSON B. PERSSON Departments of Clinical Immunology and Chemistry I,
MARTIN E. GORDON
1. Dittrick H. Fees m medical history. Ann Med History 1928; 10: 90-100. 2. Bombaugh CC. John Hopkins Bull 1900; 11: 183. 3. Anon. A medico-literary causerie; fees, ancient and modern. Practitioner 1895; 55: 157-61. 4. Gantt WH. Russian medicine. Clio Medica, p 61-63. New York: Paul B. Hoeber, 1920. 5. Von Bergmann G. Die Krankheit Kaiser Fnedrich des Dritten. Berlin, 1888. 6. Stevenson RS. Morell Mackenzie: the story of a Victorian tragedy. New York: Henry Schuman, 1947. 7. Osler W. Evolution of modem medicine. New Haven, 1913. 8. Brennan WA. On wounds and fractures (Guy de Chauliac). Chicago, 1923.
N-terminal aminoacid sequence of principal
allergen
immunogenicity of the 15 kDa protein, and sequence analysis was done with an Applied Biosystems 470A. No homology was found between the N-terminal sequence (30 ltg sample, 95% repetitive yield) of the 15 kDa protein (Gly-Lys-Met-Thr-Phe-Lys-Asp-XGly-Lys-Gly-Glu-Val-Lys-Glu-Leu-Asp-Ile [X= residue not established]) and other proteins in the Swissprot sequence database (release 21) with the FASTA programwhich raises the possibility that this allergen represents a novel protein family, thus far analysed only from L destructor. By contrast with the group I, III, and IV allergens from the house dust mite Dermatophagoides pteronyssinus, the N-terminal segment of the 15 kDa allergen shows no homology with either cysteine7,8 and serine8 proteases or mite amylase.9 However, we have earlier identified at least 21 IgE-binding components in L destructor,° and
of storage mite Lepidoglyphus destructor
SIR,-Interest in storage mite allergy has increased over the past few years and the connection between exposure to storage mites and allergic diseases, such as asthma and rhinoconjunctivitis, is well established. The most common storage mite genera are
Lepidoglyphus, Tyrophagus, Glycyphagus, Acarus, and Blomia. Storage mites feed on various substances and can be found in grain, flour, hay, and straw, but also in house dust. Several studies have reported on sensitisation to these mites, not only among rural workers’ but also among urban populationsespecially in areas with high humidity. L destructor is the predominant species in northern and central Europe and constitutes the major part of the mite fauna in hay.3 The principal allergen of this species has a molecular mass of about 14-15 kDa, as assessed by gel electrophoresis under non-reducing conditions,4,5 and more than 90% of farmers are sensitised to this protein whose function is still unknown. Affinity chromatography of the principal allergen of L destructor has been described,5 but the aminoacid sequence has not been reported. We have purified the 15 kDa protein and analysed its N-terminal sequence. Whole L destructor extract was precipitated with 60% ammonium sulphate, separated by SDS/PAGE (7-5-20% acrylamide gradient), and analysed by immunoblotting, after which the 15 kDa allergen was isolated from excised gel pieces by passive elution. The preparation was tested with human IgE to verify the
Karolinska Institute, 10401 Stockholm, Sweden
H. JÖRNVALL B. HÄRFAST S. G. O. JOHANSSON
Hage-Hamsten M, Johansson SGO, Hoglund S, Tüll P, Wirén A, Zetterstrom O. Storage mite allergy is common in a farming population. Clin Allergy 1985; 15:
1.
van
2.
Luczynska CM, Griffin P, Davies RJ, Topping MD. Prevalence of specific IgE to storage mites (A. siro, L. destructor and T. longior) in an urban population and cross-reactivity with the house-dust mite (D. pteronyssinus). Clin Exp Allergy 1990,
555-64.
20: 403-06
Hage-Hamsten M, Johansson E, Wirén A, Johansson SGO. Storage mite dominate the fauna of Swedish barn dust. Allergy 1991; 46: 142-46. 4 Johansson E, Borgå Å, Johansson SGO, van Hage-Hamsten M. Immunoblot multi-allergen inhibition studies of allergenic cross-reactivity of the dust mites Lepidoglyphus destructor and Dermatophogoides pteronyssinus. Clin Exp Allergy 1991; 21: 511-18 5. Ventas P, Carreira J, Polo F. Purification and characterization of Lep d I, a major allergen from the mite Lepidoglyphys destructor. Clin Exp Allergy 1992; 22: 454-60. 6. Pearson WR, Lipman DJ. Improved tools for biological sequence comparison. Proc Natl Acad Sci USA 1988; 85: 2444-48. 7. Chua KY, Stewart GA, Thomas WR, Simpson RJ, Dilworth RJ, Plozza TM. Sequence analysis of cDNA coding for a major house mite allerge. Der p I. homology with cysteine proteases. J Exp Med 1988; 167: 175-82. 8. Stewart GA, Thompson PJ, Simpson RJ. Protease antigens from house dust mite. Lancet 1989; ii: 154-55 (correction in Lancet 1989; ii: 462). 9. Lake FR, Ward LD, Simpson RJ, Thompson PJ, Stewart GA. House dust mite-derived amylase: allergenicity and physicochemical characterization. J Allergy Clin Immunol 1991; 87: 1035-42. 3.
van
Creutzfeldt-Jakob disease after noncommercial dura mater graft SIR,- In their review of iatrogenic transmission of CreutzfeldtJakob disease (CJD), Dr Brown and colleagues (July 4, p 24) mention our Italian patient with this disease (unpublished) who had received a dura mater graft that was not Lyodura-which was held to be responsible for 5 previously reported cases.1-s A 32-year-old woman was admitted with mental deterioration, ataxia, and tremors of the head and trunk. Neurological symptoms had begun 5 months earlier, with unsteady gait and progressive walking disturbances. 10 years before, in November, 1981, at Rome University "La Sapienza", she received a cadaveric dural patch in the right frontal region after the removal of an ethmoidal meningocoele. At that time, dura mater was obtained at the university, cut into pieces, sealed in polyethylene bags containing sterile 70% ethyl alcohol and then gamma-irradiated (25 kGy).6At our centre, repeated electroencephalography demonstrated a
doctors in "Le Grand Monarque" fashion. An operation for fistula in 1686 cost him or his people an equivalent of$200 000. The surgeon Felix was assisted (onlookers) by three other physicians, four apothecaries, and an apprentice. Dr Willis, who had charge of George III in 1792 during his periods of derangements also attended the Queen of Portugal (while also mentally deranged), and was offered travel, suite, expenses, and C20 000 if he succeeded in curing the queen.3 However, these pre-arranged agreements were not without risk-for example, Morrell Mackenzie’s attendance on the Emperor Frederick earned him c 13 000 and yet the fatal tragic outcome created a lifetime of adverse criticism.5,6 Even royal patients neglected to pay their physicians, as Maitre Henri de Mondeville, surgeon to King Phillippe3decried. Osler liked to exhibit his first fee record to students, "speck in cornea 50 cents". A month as locum tenens provided him "$25 and a pair of old fashioned boots too small for Dr Charles O’Reilly."7 An old Dutch woodcut epitomised the average patient in matters mercenary: When the sick
man lies abed distraught with pain and dismal Death is clutching at his throat, he likens me to GOD and all his house kneel down and do me reverence ... and then at last when recompense is asked, he passeth me in dread, for lo, to him I stand a DEVIL, horned from out the lowest depths... At least Marcus Aurelius said of Galen "I have but one physician and he is a gentleman". The fourteenth century Father of Surgery, Guy de Chauliac8 best expressed a balanced view, "... let the [surgeon] be modest, dignified, gentle, pitiful and merciful, not covetous nor an extortionist of money; but rather let his reward be according to his work, to the means of the patient, to the quality of the issue and to his own dignity."
Yale School of Medicine, PO Box 8548, New Haven, Connecticut 06531, USA
of these could be enzymes. The N-terminal segment can now be synthetically produced and potentially used as a reagent for clinical purposes. It will also be possible to construct oligonucleotide probes for isolation of the corresponding cDNA from L destructor. Our characterisation will ultimately lead to the complete identification of the antigenic structure. some
This work was supported by the Swedish Work Environment Fund (project no 83-1182, 82-0881), the Swedish Medical Research Council (grants 16X-105 and 03X-3532), King Gustaf V 80th Birthday Fund, the Swedish Asthma and Allergy Association, the Ellen, Walter and Lennart Hesselman Foundation, the Petrus and Augusta Hedlund Foundation, the Magn. Bergvall Foundation, and the Karolinska Institute. M. VAN HAGE-HAMSTEN
T. BERGMAN E. JOHANSSON B. PERSSON Departments of Clinical Immunology and Chemistry I,
MARTIN E. GORDON
1. Dittrick H. Fees m medical history. Ann Med History 1928; 10: 90-100. 2. Bombaugh CC. John Hopkins Bull 1900; 11: 183. 3. Anon. A medico-literary causerie; fees, ancient and modern. Practitioner 1895; 55: 157-61. 4. Gantt WH. Russian medicine. Clio Medica, p 61-63. New York: Paul B. Hoeber, 1920. 5. Von Bergmann G. Die Krankheit Kaiser Fnedrich des Dritten. Berlin, 1888. 6. Stevenson RS. Morell Mackenzie: the story of a Victorian tragedy. New York: Henry Schuman, 1947. 7. Osler W. Evolution of modem medicine. New Haven, 1913. 8. Brennan WA. On wounds and fractures (Guy de Chauliac). Chicago, 1923.
N-terminal aminoacid sequence of principal
allergen
immunogenicity of the 15 kDa protein, and sequence analysis was done with an Applied Biosystems 470A. No homology was found between the N-terminal sequence (30 ltg sample, 95% repetitive yield) of the 15 kDa protein (Gly-Lys-Met-Thr-Phe-Lys-Asp-XGly-Lys-Gly-Glu-Val-Lys-Glu-Leu-Asp-Ile [X= residue not established]) and other proteins in the Swissprot sequence database (release 21) with the FASTA programwhich raises the possibility that this allergen represents a novel protein family, thus far analysed only from L destructor. By contrast with the group I, III, and IV allergens from the house dust mite Dermatophagoides pteronyssinus, the N-terminal segment of the 15 kDa allergen shows no homology with either cysteine7,8 and serine8 proteases or mite amylase.9 However, we have earlier identified at least 21 IgE-binding components in L destructor,° and
of storage mite Lepidoglyphus destructor
SIR,-Interest in storage mite allergy has increased over the past few years and the connection between exposure to storage mites and allergic diseases, such as asthma and rhinoconjunctivitis, is well established. The most common storage mite genera are
Lepidoglyphus, Tyrophagus, Glycyphagus, Acarus, and Blomia. Storage mites feed on various substances and can be found in grain, flour, hay, and straw, but also in house dust. Several studies have reported on sensitisation to these mites, not only among rural workers’ but also among urban populationsespecially in areas with high humidity. L destructor is the predominant species in northern and central Europe and constitutes the major part of the mite fauna in hay.3 The principal allergen of this species has a molecular mass of about 14-15 kDa, as assessed by gel electrophoresis under non-reducing conditions,4,5 and more than 90% of farmers are sensitised to this protein whose function is still unknown. Affinity chromatography of the principal allergen of L destructor has been described,5 but the aminoacid sequence has not been reported. We have purified the 15 kDa protein and analysed its N-terminal sequence. Whole L destructor extract was precipitated with 60% ammonium sulphate, separated by SDS/PAGE (7-5-20% acrylamide gradient), and analysed by immunoblotting, after which the 15 kDa allergen was isolated from excised gel pieces by passive elution. The preparation was tested with human IgE to verify the
Karolinska Institute, 10401 Stockholm, Sweden
H. JÖRNVALL B. HÄRFAST S. G. O. JOHANSSON
Hage-Hamsten M, Johansson SGO, Hoglund S, Tüll P, Wirén A, Zetterstrom O. Storage mite allergy is common in a farming population. Clin Allergy 1985; 15:
1.
van
2.
Luczynska CM, Griffin P, Davies RJ, Topping MD. Prevalence of specific IgE to storage mites (A. siro, L. destructor and T. longior) in an urban population and cross-reactivity with the house-dust mite (D. pteronyssinus). Clin Exp Allergy 1990,
555-64.
20: 403-06
Hage-Hamsten M, Johansson E, Wirén A, Johansson SGO. Storage mite dominate the fauna of Swedish barn dust. Allergy 1991; 46: 142-46. 4 Johansson E, Borgå Å, Johansson SGO, van Hage-Hamsten M. Immunoblot multi-allergen inhibition studies of allergenic cross-reactivity of the dust mites Lepidoglyphus destructor and Dermatophogoides pteronyssinus. Clin Exp Allergy 1991; 21: 511-18 5. Ventas P, Carreira J, Polo F. Purification and characterization of Lep d I, a major allergen from the mite Lepidoglyphys destructor. Clin Exp Allergy 1992; 22: 454-60. 6. Pearson WR, Lipman DJ. Improved tools for biological sequence comparison. Proc Natl Acad Sci USA 1988; 85: 2444-48. 7. Chua KY, Stewart GA, Thomas WR, Simpson RJ, Dilworth RJ, Plozza TM. Sequence analysis of cDNA coding for a major house mite allerge. Der p I. homology with cysteine proteases. J Exp Med 1988; 167: 175-82. 8. Stewart GA, Thompson PJ, Simpson RJ. Protease antigens from house dust mite. Lancet 1989; ii: 154-55 (correction in Lancet 1989; ii: 462). 9. Lake FR, Ward LD, Simpson RJ, Thompson PJ, Stewart GA. House dust mite-derived amylase: allergenicity and physicochemical characterization. J Allergy Clin Immunol 1991; 87: 1035-42. 3.
van
Creutzfeldt-Jakob disease after noncommercial dura mater graft SIR,- In their review of iatrogenic transmission of CreutzfeldtJakob disease (CJD), Dr Brown and colleagues (July 4, p 24) mention our Italian patient with this disease (unpublished) who had received a dura mater graft that was not Lyodura-which was held to be responsible for 5 previously reported cases.1-s A 32-year-old woman was admitted with mental deterioration, ataxia, and tremors of the head and trunk. Neurological symptoms had begun 5 months earlier, with unsteady gait and progressive walking disturbances. 10 years before, in November, 1981, at Rome University "La Sapienza", she received a cadaveric dural patch in the right frontal region after the removal of an ethmoidal meningocoele. At that time, dura mater was obtained at the university, cut into pieces, sealed in polyethylene bags containing sterile 70% ethyl alcohol and then gamma-irradiated (25 kGy).6At our centre, repeated electroencephalography demonstrated a
