1249

1. Lancet, 1956, i, 159.

moralising, unwanted legitimate babies will continue tobe born.

It will inevitably be argued that this change wouldopen the gates to abuse and complications. But anabuse does not invalidate a principle, if the principle isgenerally accepted. The rules governing all good adop-tion procedure would naturally have to be applied, andcare taken to weigh carefully the best long-term interestsof each baby, its real parents, and its adopting parents.It would be naive to pretend that adoption is alwayssuccessful, but it seems the best possible means of dealingwith this tragic situation.A second point which is seldom discussed, because we

have in this country a deep respect for each other’s

religious beliefs and differences, is the denominational bar.There is at present a shortage of Roman Catholic adopt-ing parents and as a result many illegitimate babies ofRoman Catholic mothers are denied the chance of

adoption and are brought up in baby homes. A mother’swishes about the religious upbringing of her child mustbe respected, but where mothers only claim denomi-national membership for form-filling purposes and haveno real feeling about it, it seems to me wrong to allowthis label to prevent babies from being adopted whenthere are so many parents waiting to give them a home.

B. M. HUNTERAlmoner.

HOME CONFINEMENTS

Public Health Department,County Hall,London, S.E.1.

J. A. SCOTTChairman,

London Local Obstetric Committee.

SiR,-About this time last year you assisted the LondonRegional Obstetric Committees by publishing a letterof mine 1 to the effect that, save in exceptional circum-stances, practitioners who qualified after Jan. 1, 1951,and who wished to be included in the London list of

general-practitioner obstetricians would, as a conditionof admission to that list, be required to have held aresident house-job in obstetrics for a period of six months.It was then indicated that any applications received

prior to May 1, 1957, would be considered in the lightof the conditions which obtained prior to that date.At the instance of the London Obstetric Committees I

would again ask for the hospitality of your columns toremind all prospective applicants that the new require-ments are now being put into effect.

CHILDREN IN HOSPITAL

SIR,-As a layman whose occupation includes the

reading of medical journals, but also as a parent, I wassurprised to find that it was necessary to use six of yourcolumns to demonstrate, in Dr. Vaughan’s article ofJune 1, what any intelligent parent could have told yourreaders-namely, that a simple, reassuring explanationgiven to children admitted to hospital will almost

inevitably satisfy them. Indeed, very much could belearned by the staffs of our hospitals if they would con-sider, more rationally, the need for reassuring even theiradult patients. It takes very little imagination to realisethat people admitted to hospital are almost invariablyfrightened and disturbed, and that by overcoming thisvery real upset in their lives as far as possible, much willbe done to ease their suffering. So much good is donethat it makes the notable lapses much more difficultto understand.

Surely it can now be accepted that nearly all patientsare much happier to know what is going to happen tothem and to be relieved of the many and largelyunfounded fears with which, quite understandably, theytorment themselves.One simple solution, already used, I believe, by the

lllore enlightened, is to have printed cards telling patients

or relatives as much as they need know to give themsome degree of reassurance. It would be a rather graveindictment of those responsible if it should prove neces-sary to have hospital staff whose sole duty was toreassure patients and make their hospital experienceless frightening.

1. Bastenie, P. Lancet, 1956, ii, 628.2. Peters, G. Dtsch. med. Wschr. 1957, 82, 311.

SEASONAL INCIDENCE OF MEGALOBLASTICANÆMIA OF PREGNANCY AND THE

PUERPERIUM

J. W. B. FORSHAW.

SiR,-The results in Dr. Thompson’s interesting articleof June 8 might not represent the true seasonal incidenceof the disease unless all the cases which occurred duringthe period under review, were diagnosed. Dr. Thompsonhas reviewed a series of 105 patients, collected from threehospitals during a period of twenty-three years, but itseems probable that the total number of cases occurringduring this period would be considerably higher than this.During 1956, 30 cases of megaloblastic anaemia of

pregnancy and the puerperium were diagnosed at WhistonHospital, Lancashire, and it is unlikely that there wereany other cases, in which the diagnosis was missed. The

SEASONAL INCIDENCE OF ONSET OF MEGALOBLASTIC AN-2EMIA

AND OF PARTURITION

monthly incidence of parturition in these cases can beobtained with accuracy and the results agree closely withthose of Dr. Thompson (see accompanying table). Theseasonal incidence of the onset of the anamia cannot bedetermined with sufficient accuracy to give exact figuresfor each month. However, the figures are sufficientlyaccurate to confirm Dr. Thompson’s findings that thehighest incidence of the onset of the ansemia is during thelate winter and spring.

EFFECTS OF CARBUTAMIDE ON CARBOHYDRATEMETABOLISM IN DIABETES

SiR,-Professor Bastenie’s findings seem to indicatethat under treatment with carbutamide (B.Z. 55) bothoutflow of glucose from the liver, and resynthesis there,decrease. We have studied, in the rabbit, the effect ofcarbutamide, with or without cortisone acetate, on therise of blood-sugar following the fall induced by 10 unitsof insulin given intravenously. With insulin by itself,such a high dose ensures a significant rise of the blood-sugar-i.e., outflow of glucose from the liver.

Mild alloxan diabetes responds to carbutamide, butgrave alloxan diabetes and diabetes caused by cortisoneremain uninfluenced.2 Cortisone may inhibit the peri-pheral effect of insulin, but increases glucose productionin the liver. If carbutamide is really capable of decreasingthe outflow of glucose from the liver, the post-hypo-glycaemic blood-sugar rise must also be decreased.Male rabbits of the same breed, weighing about 3 kg., were

used in the experiments. We had previously observed, onadministration of 10 units of insulin, a significant fall followedby a rise in the blood-sugar level. The effect of the insulinlasted four hours, and it rarely caused hypoglycaemic shock.Blood-sugar curves after giving 10 units of insulin intravenouslyare, accordingly, well suited for comparative examinations.

Relatively high (therapeutic but not toxic) doses of carbu-tamide were administered-viz., 1-5 g. daily for three to fourdays. On the last day of the experiment, four hours after the