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man with immoderately long working hours " wh(" finds no time for reading and still less to study for the..final examinations ... on which he has set his heartand this must be true of any house-officer under th<

present system, especially in a provincial hospital.If the purpose of junior appointments in hospitals is t(

provide training for higher qualifications-as well ai

covering the day-to-day work of the hospital-then moreattention needs to be paid to the working conditions ojunior hospital doctors; and this probably means shorte:working hours, more staff, and more incentive to sta;in hospital work than to leave for work abroad or it

general practice.SENIOR HOUSE-OFFICER.

CALCIUM AND INFANTILE ECZEMA INWEST INDIAN BABIES

S. SHUBSACHS.

SIR,-T’he very high frequency of infantile eczema inWest Indian babies in England has been explained asdue to shortage of sunshine.

In the past two years I have found that many improvedgreatly when given mist. calc. carb. co. pro inf. (inaddition to local treatment)-on the ground that in chroniceczema altering the acidity of the urine sometimes helps. Butthey seemed to do better with the calcium mixture than withmist. pot. cit. Calcium preparations have long been used ineczema.

The final link in the chain came when I was examining anewborn West Indian baby in the presence of a West Indianmidwife. I remarked on the baby’s dry skin as an eczematouscondition and said I had found mist. calc. carb. useful,though I would have thought the mothers got enough calciumin the milk provided at reduced rates. The midwife then

explained that she could not drink the milk here when shefirst came over, because West Indians are used to fresh milk.

Many West Indian mothers, it seems, do not drink the milk,which is not as fresh here as in the West Indies.

HORMONES IN LYMPH LEAVING ENDOCRINEGLANDS

E. CZEIZELM. HANCS&Oacute;KI. PALKOVICH.

State Institute of Hygiene,Budapest Hungary.

SIR,-Professor Daniel and his collaborators foundthat hormones of the adrenal, thyroid, testis, and ovary arecarried away by the lymphatics draining these organs.Using primates they tested for oestrogens by a bioassaymethod.

Last year we described 2 our experiences with a chemicalmethod; 50 ml. of lymph is extracted with ether beforeand after enzymic hydrolysis; the extract is divided intoa strong and a weak phenol fraction; this is followed bydescending chromatography; and the oestrogens are

developed with ferric-chloride/potassium-ferricyanide re-agent and quantitatively assayed by the method of Kecskeset al.3 By this method we demonstrated the presenceof oestrone and oestriol in the lymph of the thoracic ductof dogs during prooestrus, cestrus, and early metoestrus.The average quantity of all cestrogens was 3-6 g. per50 ml. (The corresponding value in peripheral blood is4-6 g. per 50 ml.) Whereas the blood contains oestrogensalways in esterified form, in the lymph we found freeoestrogens also. On paper chromatograms of the lymph,we several times observed unidentified coloured patches.

1. Daniel, P. M., Gale, M., Pratt, O. E. Lancet, 1963, i, 1232.2. Palkovich, I., Czeizel, E., Hancs&oacute;k, M. Magy. N&ouml;orv. Lap. 1962, 25, 214.3. Kecsk&eacute;s, L., et al. Acta endocr. Kbh. 1961, 38, 545.

TREATMENT OF NON-UNION

M. A. NELSON.Guy’s Hospital,London, S.E.1.

SIR,-Mr. Hicks (Aug. 10) suggests that persistentmovement is a cause of non-union in certain fractures andshows that rigid fixation, by eliminating this movement,can bring about union.

I should like to take this hypothesis one step further,and suggest that union of a fracture depends fundament-ally on the blood-supply to the fragments and that non-union occurs when the blood-supply is inadequate fromwhatever cause, excessive movement being one. Rigidfixation-that is, internal fixation so secure that allexternal support is unnecessary-is effective becausenormal muscular activity can be encouraged, thus

improving the blood-flow to the bone fragments. I would

suggest that if internal fixation be so rigid, then: (1) theincidence of non-union would be negligible; and (2) therisks inherent in internal fixation would be justifiable.

HUMAN ANTIH&AElig;MOPHILIC FACTOR

SIR,-Dr. Holman and Dr. Wolf (July 6) state that" Sweden is at present the only country in the worldrelying mainly on human A.H.F. concentrate for thetreatment of classical hxmophilia ". They mention thatvan Creveld and Mochtar have advocated the small-scale " two-donor " fibrinogen preparation of Nitschmannet al. for treatment of haemophilia A,

"

though Nitsch-mann et al. did not themselves suggest this ".What we reported in 1957 was a method of preparing

" dried fraction i for clinical use from smallest pools, sterilewithout filtration ". At this time and long before Cohnfraction I, when quickly prepared from fresh plasma, wasknown to contain antihxmophilic globulin as well as fibri-

nogen. Since 1957 the Central Laboratory of the Swiss RedCross blood-transfusion service in Berne has prepared anddistributed for clinical use in Switzerland and to some extentabroad about 5000 units of fraction I labelled Anti-

hasmophiles Globulin S.R.K." and 8000 units labelled Fibri-nogen S.R.K.". Our method which is at present unmatchedin simplicity of preparation has proved very satisfactoryduring the last six years.3

It is true that the A.H.F. titre may vary remarkably fromunit to unit (1 unit contains the fraction I from 0-5 litre of

plasma), but this has not been a serious disadvantage. Fromeach lot of fraction I (about 150 units being prepared simul-taneously from blood drawn at the same time from a groupof donors) 10 units are tested for A.H.F. activity. If the resultis satisfactory the lot is labelled " antihxmophilic globulin ",if not,

"

fibrinogen ". We do not believe that losses in activityduring preparation are due mainly to prothrombin activationand there is no indication from clinical experiences that thepresence of prothrombin in our preparation is a disadvantage.Losses in A.H.F. activity are probably due rather to an acti-vation of the fibrinolytic system. Preliminary experimentshave shown that A.H.F. titres in the final solutions are signi-ficantly higher when the citrate solution into which the bloodis drawn contains Epsamin’ (e-aminocaproic acid). We areabout to introduce the addition of this fibrinolysis inhibitorinto the routine production. Details will be reported elsewhere.

Gugler 4 has reported on extensive clinical experienceswith fraction i prepared according to Nitschmann et awl. bythe Swiss Red Cross blood-transfusion service. Many casesof anbrinogenaemia, haemophilia A, angiohaemophilia A and B,thrombopenia and other more complex disorders of the

clotting system have been treated successfully. In the more

complex disorders the positive effects seem to be due to our1. van Creveld, S., Mochtar, I. A. Canad. med. Ass. J. 1962, 87, 993.2. Nitschmann, H., Kistler, P., Joss, A. Vox Sang. 1957, 2, 100.3. Kistler, P., Nitschmann, H. ibid. 1962, 7, 414.4. Gugler, E. Bericht der 9-ten Tagung der deutschen Gesellschaft fur

Blut-transfusion. Bibl. h&oelig;mat., Basle, 1960, 12, 270.5. Gugler, E. M&eacute;d. et Hyg., Gen&egrave;ve, 1962, 20, 1000.