101

data are obviously sketchy, they do indicate that the structurallocus for IgA cannot at present be mapped with assurance onthe long arm of chromosome 18. Chromosome 18 presumablyhas some influence, at least indirectly, on the production of IgAand other immunoglobulins. Still, the precise underlyingmechanism seems to be as obscure as that responsible for thedisturbance of haemoglobin synthesis in certain types of

aneuploidy 7-9 such as trisomy 13.This work was supported in part by National Institutes of Health

grant CA 07941, and by a grant from the Children’s Bureau for agenetics clinic. We thank Dr. Starkey D. Davis, University ofWashington, for suggestions.

FREDERICK HECHT.

Division of Medical Genetics,Crippled Children’s Division,and Department of Pediatrics,

University of Oregon Medical School,Portland, Oregon 97201, U.S.A.

RETIRING OLD DRUGS GRACEFULLY

J. H. WRIGHT.Crewe and District Memorial Hospital,

Crewe, Cheshire.

SIR,-During the past two years, three drugs which I use inanxsthesia have quietly been withdrawn by their manufac-turers. While I do not question the right of the manufacturersto withdraw unprofitable lines, I do question the manner inwhich they do it.Recently Ciba have stopped producing Nupercaine ’ heavy

spinal solution after 30 years. The only notice the companygave was in the pharmaceutical trade press, last December,which is taken only by pharmacists. I suggest that they arecompletely out of touch with their market if they think it

probable that this information will filter down to the cliniciansconcerned before existing stock is exhausted.The publicity given to the withdrawal of a drug compares

extremely unfavourably with that given to its launching. Iwould suggest as appropriate a full-page advertisement in

journals such as The Lancet and British Medical Journal fordrugs which have a wide spectrum of usage, and an individualletter to consultants for drugs with a narrow spectrum, such asanaesthetic drugs. The manufacturers have a commercial if nota legal duty to see that their customers who have supportedthem are fully informed on these matters-otherwise they maytake their business elsewhere.

*** This letter has been shown to Dr. A. K. PITTMAN(medical director, Ciba Laboratories Ltd.), who writes as

follows: " When ’Nupercaine ’ heavy spinal solution was with-drawn from the market in December, 1967, because its use inthis country had declined to almost negligible proportions, wemade two assumptions: (1) that hospital pharmacists, readingour announcement of withdrawal in their trade press, woulddraw the attention of anxsthetists in their hospitals known touse the product to this situation before stocks were exhausted;(2) that a satisfactory alternative would be available. In theevent we have become aware that in most cases both these

assumptions were wrong. I should like, therefore, on behalf ofCiba Laboratories Ltd., to express sincere regret to Dr. Wrightand his anaesthetist colleagues, who have been inconvenienced toan extent neither intended nor envisaged. May I take thisopportunity of stating the company’s intention of makingnupercaine ampoules (heavy spinal solution) available as a" service" to anaesthetists until such time as an acceptablealternative becomes available. Although the product will notappear in our price list, we shall be in a position to meet ordersas from Jan. 1, 1969. The price has inevitably to be increased,and will be 40s. per pack of 10 ampoules."-ED. L.7. Huehns, E. R., Hecht, F., Keil, J. V., Motulsky, A. G. Proc. Natn.

Acad. Sci. 1964, 51, 89.8. Lee, C. N. S., Boyer, S. H., Bowen, P., Weatherall, D. J., Rosenblum,

H., Clark, D. B., Duke, J. R., Liboro, C., Bias, W., Borgaonkar, D. S.Bull. Johns Hopkins Hosp. 1966, 118, 374.

9. Hecht, F., Jones, R. T., Koler, R. D. Ann. hum. Genet. 1967, 31, 215.

TRIC-AGENT NEONATAL CONJUNCTIVITIS

L. H. COLLIERSHIONA SOWA

J. SOWA.

M.R.C. Trachoma Research Unit,The Lister Institute ofPreventive Medicine,

London S.W.1.

Sir,-In a study of neonatal conjunctivitis in a Gambianhospital,* we detected 4 infections with trachoma/inclusionconjunctivitis (TRic) agent in 297 infants. In all 4 infants theappearance of keratitis, pannus, and eventual cicatrisation

suggested a diagnosis of trachoma rather than classical inclusionconjunctivitis of the newborn. It has often been stated thattrachoma, by contrast with inclusion conjunctivitis, is not

transmitted to infants via the maternal genital tract, and wetherefore sought the source of infection. We were unable todemonstrate TRic agent in cervical material from the mothers,but succeeded in isolating a strain from the urethra of one ofthe fathers by inoculating scrapings into chick embryos.2 Usingthe " Montreal " nomenclature,3 the strain isolated from thebaby’s eye was designated as TRIC/ /WAG/MRC-300/oN, andthat from the father’s urethra as TRic/ /WAG/MRC-301/G(abbreviated to MRC-300 and MRC-301 respectively).

In terms of their antigenic affinities, TRic agents are bestcompared by the mouse toxicity prevention test (M.T.P.T.)first described by Bell et awl. With a modification of thismethod, Alexander et al. found that 62 of 64 TRIC agentsisolated from ocular trachoma fell into one of three subgroups(A, B, C), whereas all of 16 strains isolated from other sources(punctate keratitis, neonatal conjunctivitis, and the adult

urogenital tract) fell into subgroups D, E, and F.The 3rd chick-embryo passages of each of our paired strains

MRC-300 and MRC-301 were sent as yolk-sac suspensions toProf. J. T. Grayston and Dr. K. S. W. Kim (University ofWashington, Seattle, U.S.A.). After a further passage in yolksacs they were typed by the M.T.P.T. Whereas neither strain

protected mice against challenge with prototype strains of

groups B, C, D, or E, each protected well against challengewith the homologous strain and with ic-Cal-3, the prototypestrain of group F. These findings strongly suggest a commonorigin for MRC-300 and MRC-301, and it is reasonable to inferthat the baby in question was infected at birth from the parentalgenital tract. It is also noteworthy that MRc-300, althoughbelonging in the " genital " category, was capable of causinglesions characteristic of trachoma in the infant eye.

We are most grateful to Professor Grayston and Dr. Kim forundertaking the mouse tests, and for permission to quote theirresults.

LEPROUS ENDOCRINOPATHY

S. G. BROWNEDirector, The Leprosy

Study Centre.57a Wimpole Street,

London W.1.

SIR.-The interesting article by Dr. Martin (Dec. 21, p. 1320)and his colleagues contains the misleading statment: "Gynae-comastia and testicular atrophy occur in 10-20 % of patients withleprosy ". The sources cited refer to highly selected seriesof patients with long-standing lepromatous leprosy in Carville,Louisiana, and Karigiri, South India. The condition occursnot at all in tuberculoid and indeterminate leprosy, and veryinfrequently in borderline leprosy. Since these latter types of

leprosy account for a large proportion (up to nine-tenths ormore) of the total number of leprosy patients in any country,it is evident that the gynxcomastia of severe and long-standinglepromatous leprosy will affect a far lower proportion than" 10-20% of patients with leprosy

1. Sowa, S., Sowa, J., Collier, L. H. Lancet, 1968, ii, 243.2. Sowa, S., Sowa, J., Collier, L. H., Blyth, W. A. Spec. Rep. Ser. med.

Res. Coun. no. 308, 1965.3. Gear, J. H. S., Gordon, F. B., Jones, B. R., Bell, S. D. Nature, Lond.

1963, 197, 26.4. Bell, S. D., Snyder, J. C., Murray, E. S. Science, N.Y. 1959, 130, 626.5. Alexander, E. R., Wang, S. P., Grayston, J. T. Am. J. Ophthal. 1967,

63, 1469.