Apr 30, 1983 - Stanley E, Paget J. (eds). Descriptive catalogue of the pathological specimens, vol III, no 1507.London: Royal College of Surgeons, 1848:182.
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rectum at necropsy was described as ". . . much thickened in its coats, and of a hardish gristly texture, a good deal like the turtle's intestines."3 Few modern human pathologists are familiar with the intestines of reptiles, and it is only relatively recently that veterinary surgeons have developed an interest in this group of animals. These and other cases exemplify Hunter's breadth of interest and experience and, at a time when there is increasing contact and cooperation between doctors and veterinary surgeons, are a timely reminder of the importance of comparative studies.
ELIZABETH ALLEN JOHN E COOPER Hunterian Museum, Royal College of Surgeons, London WC2A 3PN Hunter J. Dissections of morbid bodies. Manuscript number 33. Clift Transcript. Vol III:21 (Royal College of Surgeon's Library.) Stanley E, Paget J. (eds). Descriptive catalogue of the pathological specimens, vol III, no 1507. London: Royal College of Surgeons, 1848:182. Hunter J. Cases and dissections. Manuscript number 59. Clift Transcript. Vol V: 133-6 (Royal College of Surgeon's Library.)
Coxsackie B infection and arthritis SIR,-It would be easier to evaluate the report by Dr N P Hurst and others ( 19 February, p 605) if we were told what type of antibodies were concerned, by what technique they were measured and by whom, and what is the background distribution of such titres in the populations concerned. In our experience neutralising antibody titres of 256 to Coxsackie virus B4 (case 2) are found in about one in 10 of our local population and are no more than suggestive of recent infection.' To mention the unknown virologist(s) would be not a mere courtesy but an essential part of the scientific evidence.2 NORMAN R GRIST ELEANOR J BELL University of Glasgow, Department of Infectious Diseases and the Enterovirus Reference (Scotland) Laboratory of the Regional Virus Laboratory, Ruchill Hospital, Glasgow G20 9NB 'Bell EJ, Irvine KG, Gardiner AJ, Rodger JC. Coxsackie B infection in a general medical unit. Scott Med J (in press). Editorial. Authorships and acknowledgements. J Clin Path 1978;31 :299.
***We sent a copy of this letter to the authors, who reply below.-ED, BMJ. SIR,-We are happy to acknowledge the work of a number of virologists. The sera from case 1 were examined by Dr Geraldine Cambridge in Professor Waterson's laboratory at the Royal Postgraduate Medical School using a microneutralisation test system, developed by Dr Bell and Professor Grist.' The sera from cases 2 and 3 were sent to Professor Grist's laboratory after initial detection of Coxsackie B neutralising antibodies in the regional virus laboratories of the City Hospital, Edinburgh (case 2 and late sera case 3), and the Public Health Laboratory at Newcastle General Hospital (early sera case 1). Other virological tests in case 3 were undertaken by Dr Edmond in Edinburgh. We would certainly agree that the neutralising antibody titre of 256 to Coxsackie virus B4 in case 2 was only suggestive of recent infec-
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tion. Indeed, a statement to this effect was included in the original manuscript submitted for publication, along with a brief reference to the serological technique used, but was omitted from the published article in order to save space. N P HURST G NUKI
for aetiological inquiry. In time the identification of specific environmental factors, such as smoking, may require a reorientation of health education to ensure that high risk groups receive advice and information which make sense to them. D F LEVINE K WOODS
Rheumatic Diseases Unit, Northern General Hospital, Edinburgh EH5 2DQ
Medical Unit and Department of Epidemiology, London Hospital Medical College, Whitechapel, London El iBB
J R SEWELL G R V HUGHES Rheumatology Unit, Department of Medicine, Royal Postgraduate Medical School, London Bell EJ, Grist NR. Further studies of enterovirus infection in cardiac disease and pleurodynia. ScandJ Infect Dis 1970;2:1.
Asian and non-Asian morbidity in hospitals
SIR,-Preliminary results from a current survey in the Tower Hamlets health district support and extend some of the findings of Dr L J Donaldson and Dr J B Taylor (19 March, p 949). Tunstall Pedoe et all in 1975 suggested that Asian immigrants in Tower Hamlets had an above average rate of "coronary heart attacks." We have studied the incidence of myocardial infarction and duodenal ulcer in immigrants from Bangladesh (Bengalis) whom we have identified by name from Hospital Activity Analysis lists and then case records. Concentrating on the two teaching hospitals, which take most patients from the district and which keep systematic records we found, over two years, that 42% (n=49) of all admissions for myocardial infarction in men living in Tower Hamlets aged under 50 were Bengalis. Bengalis aged 16-44 represent only about 1 1% of men in this age range living in Tower Hamlets. (This was based on the age structure of people living in households where the head was born in the "New Commonwealth or Pakistan"-from the 1981 census we know that 590/% of the latter residents were from Bangladesh.) Allowing for deficiencies of the denominator population estimate we consider the apparent excess of young Bengali men admitted for myocardial infarction noteworthy. We have not, however, found any record of Bengali women of any age having been admitted for myocardial infarction to these hospitals during the five years before 1982. Our findings for duodenal ulcer closely resemble those for myocardial infarction.2 Forrest and Sims stated recently that the health problems of Bengali immigrants are those of a rural and impoverished population.3 We would suggest that there is also a high incidence of Western disease affecting predominantly young male immigrants. Could the considerable sex difference in smoking habits of Bengalis be one explanation ? Workers in this subject should look for age-sex differences in disease4 and identify the particular region of origin of Asian immigrants. Failure to do so could mask important differences in patterns of disease, such as those for duodenal ulcer throughout the Indian subcontinent.5 Although this is an area fraught with difficulties in collecting and assessing data, we support the view that if differences between host and immigrant populations are found to be real there is both a need and an opportunity
Tunstall Pedoe H, Clayton D, Morris JN, Brigden W, McDonald L. Coronary heart attacks in East London. Lancet 1975;ii:833-8. 2 Levine DF, Woods K, Evans S, Beer M. Duodenal ulcer in Bengali immigrants in East London. Gut (in press). 'Forrest D, Sims P. Health Advisory Services and the immigrant. Health Trends 1982;14:10-3. Susser M. Causes of peptic ulcer. A selective epidemiologic review. J Chron Dis 1967;20:435-56. Tovey F. Peptic ulcer in India and Bangladesh. Gut 1979 ;20 :329-47.
Artificial blood SIR,-Dr K C Lowe (2 April, p 1143) rightly criticises the use of the term "artificial blood" for emulsified perfluorochemicals; it is clearly important that the use of such terms does not lead to confused thinking. His comments on histamine release by Fluosol-DA, however, could also lead to confusion. The rat is the maverick of histamine metabolism,' and great care must be taken before applying findings in rats to humans. Even within the same species peritoneal mast cell suspensions may be poor predictors of the response of the intact animal.' A comparable situation applies with dextrans, which consistently release histamine from rat peritoneal mast cells but do not cause appreciable histamine release in man even during severe adverse reactions.3 Adverse reactions to intravenous agents should not be attributed to histamine without evidence of increased plasma histamine concentrations under controlled conditions and using a sensitive and specific assay.4 5 J V PARKIN Department of Surgical Studies, Middlesex Hospital, London WIN 8AA
Code CF. Histamine and gastric secretion: a later look, 1955-1965. Fed Proc 1965;24:1311-21. Pearce FL. Functional heterogeneity of mast cells from different species and tissues. Klin Wochenschr 1982 ;60 :954-7. Lorenz W, Doenicke A, Schoning B, Neugebauer E. The role of histamine in adverse reactions to intravenous agents. In: Thornton JA, ed. Adverse reactions of anaesthetic drugs. Amsterdam: Elsevier/ North-Holland Biomedical Press, 1981:169-238. Lorenz W, Barth H, Thermann M, et al. Fluorometric histamine determination in canine plasma under normal conditions, following application of exogenous histamine, and during histamine release by haemaccel. Hoppe Seylers Z Physiol Chem 1974;355 :1097-111. 5Beaven MA, Robinson-White A, Rodericke NB, Kauffman GL. The demonstration of histamine release in clinical conditions: a review of past and present assay procedures. Klin Wochenschr 1982;60: 2
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Cycling in patients with chronic airflow limitation SIR,-It is not surprising that Dr A A Woodcock and others (9 April, p 1184) found that breathless patients could cycle considerably further than they could walk in a given time; the same is true of normal subjects and is a well recognised feature of cycling as a mode of transport. It is, of course, spurious to compare the 297%', increase in distance covered using a
