A. Michael Davies

BIRTH DEFECTS AND ŒSTROGENS AND PROGESTERONES IN PREGNANCY

Possible teratogenic effects of hormone pregnancy tests and of oral contraceptives taken inadvertently in early pregnancy are discussed. Of 11468 West Jerusalem babies examined 432 had definitely or probably been exposed to estrogens or progesterones in utero. A rate of 108.8 babies with 1 or more major or minor malformations per 1000 was found among women who had undergone hormone treatment compared with a rate of 77.6 malformed babies per 1000 among women who had not. The risk of major malformations was about 26% higher in the group exposed or probably exposed to hormones; the risk or minor malformations was about 33% higher.

Suicide in Israel An Epidemiological Study

HE cultural heterogeneity of her population and the social tensions assoT ciated with mass immigration and settlement<5. 11) side by side with good sources of demographic data make Israel a convenient place for an epidemiological analysis of factors involved in suicide. This paper presents a summary of recorded cases of suicide between the years 1949 and 1958 and a more detailed analysis of the cases between 1954 and 1958 after the first flood of immigration had slowed down and for which most of the necessary demographic information was available. In addition, some observations are presented on the reliability of death certification data.

Illness: A mechanism for coping with failure☆

Abstract Illness represents one way of coping with failure and the physician plays a unique role as the sole authority granting legitimation for the sick role. For people of limited means or incomplete knowledge of and access to other medical alternatives, the neighborhood clinic, when it is free and accessible, may serve as the major locus for obtaining legitimation of illness. Such a situation places a special burden on the physician particularly in a social context in which feelings of failure could be widespread in the population. Helping people cope with failure is a stable function of medical institutions and is likely to persist in the face of possible changes in the structure of the professional role. It probably has a good deal of generality to many societies.

EXPERIMENTAL GRANULOMATOUS MYOCARDITIS: GENESIS AND IMMUNOLOGICAL ASPECTS*

The clinical association of “rheumatism” with disease of the heart was noted by Pitcairn about 180 years ago,’ and experimental studies aimed at reproducing this type of myocarditis have been in progress for half a century.*. Although production of Aschoff bodies (or Aschoff-like bodies) as the morphological expression of human rheumatic heart disease was soon a ~ h i e v e d , ~ production of valvular lesions was less frequent.4 In attempting to understand the pathogenesis of these myocardial lesions, we were impressed by the similarity of the histological patterns resulting from a wide variety of noxious agents. The main features of this picture are twofold: myofiber damage, either of displacement and/or necrosis, and a cellular infiltrate consisting mainly of histiocyticor lymphocytic-type round cells, with rare polymorphonuclear and giant cells. Foci of this type of lesion may be single or scattered, may be found anywhere in the ventricles, and may vary widely in intensity. Early experiments5 involving the injection of streptococci, lactobacilli, and Escherichia coli into the myocardium produced this type of lesion (FIGURES 1 and 2) , and similar results were obtained with staphylococci and Pseudomonas aeruginosa.Gv7 In no case were the pathogens found in the myocardial lesions. In other work, proteolytic enzymes were injected into the bloodstream,* and streptococci were introduced into the tonsilsR of experimental animals. Success with the latter method has been confirmed by Ginsburg and his colleagues,I0 who also obtained focal myocardial lesions (but with more extensive muscle damage) by the intratonsillar injection of extracellular streptococcal products. Murphy’s classical experiments with repeated subcutaneous injections of streptococci:’ and Rubenstone’s and Saphir’s direct physical damage to the heart” produced the identical pattern of focal myocarditis. To this list of noxious agents may be added viruses of different species,12 bacterial lipopolysaccharides,13 toxins such as diphtheria,14 and parasites such as Trypanosoma cruziI5 which, if they damage the heart, always produce the same pattern. An identical histological picture is well known in man,16 associated mainly with acute, generalized bacterial and viral disease’’ but also found in chronic viral and parasitic infections. Jaffe18 noted a 10% incidence of myocarditis in a series of 5,000 autopsies in Venezuela, associated with both infectious and metabolic diseases. He assumed that there was primary, multicausal damage to the myofiber, the cellular infiltration being secondary. Myocarditis also occurs as a result of heat stroke, burns,I6 and some types of autoimmune disease;IQ this indicates that there must be a specific response to a variety of noxious stimuli. FIGURE 3 shows the picture of granulomatous myocarditis in a 75-year-old man with a thymoma but without clinical evidence of myasthenia gravis. Another patient, a three-year-old girl, died suddenly two days after the onset

Transformation of rabbit lymphocytes by specific antigens.

Summary Lymphocytes from the blood of rabbits immunized with extracts of bovine or rat heart or with human IgG, reacted in vitro when cultured with the specific antigen. The reaction consisted of intense blast transformation, mitotic activity and incorporation of H3-thymidine. The level of response was found to be dose-dependent. Some unstimulated (control) cultures showed moderate “spontaneous” blast formation, without, however, mitotic activity or thymidine uptake.

Birth Weight In Israel, 1968–70 I. Effects of Birth Order and Maternal Origin

An analysis of 96% of Israeli live births, 1968–70, gives a mean birth weight of 3299 ± 543 g with 5·7% weighing less than 2500 g. The mean values increased from 3193 ± 510 g for first born to 3469 ± 604 g for tenth and subsequent births. There were significant differences between the mean birth weights, adjusted for birth order, of the different ethnic-origin groups. Infants of Jewish immigrants from North African countries weighed 3356 g followed by Christian Arabs (3337 g), Israeli-born Jews (3310 g), immigrants from Western countries (3303 g), Moslem Arabs (3251 g), Druze (3244 g) and immigrants from countries of Asia (3223 g). For the Jewish groups, the differences were diminished in the second generation of Israeli-born but those descended from Asian immigrants continued to be the lighter group. In order to determine the extent to which these differences are truly ‘ethnic’ further analyses of more homogeneous groups will be necessary taking into account a number of other demographic and socio-economic variables. (Summary in Hebrew, p. 58.)

The health of Israel: Preventive medicine in a developing society

Abstract From its inception, Israel faced many medical and social problems consequent on the absorption of large numbers of immigrants with widely differing cultural backgrounds. Urgent problems of housing, the aged, and the chronic sick were alleviated and success achieved in the control of malaria, tuberculosis and those epidemics of childhood preventable by immunization. Expectation of life at birth is now 69.5 years for Jewish men and 73.3 for women; the figures for the Arab population being 68.6 and 71.2. Infant mortality per 1,000 for Jews fell from 51.7 to 18.9 over 20 years and for Arabs, from 67.9 to 40.3. There is, however, a high morbidity, and an infant hospitalization rate of 25.9 admissions per 100 live births. An account is given of the uncohesive health services, the wide coverage of personal preventive care and the high utilization rates, coupled with dissatisfaction of ambulatory curative services. The process of acculturation and improvement in living standards have paralleled an increase in coronary heart disease, cancers, and stroke, the mortality of older immigrants from the West having increased disproportionately to that of Eastern immigrants. Examples are given of the differential morbidity patterns of the ethnic groups and the unusual opportunities for research in population genetics. With the years there has been a “regression to a biological mean” but the welding of this old-new nation is bringing the same type of social and medical problems as in the West.

Fibrogenesis in the human myocardium: An electron microscopic study

Summary Biopsies of auricular appendages of patients with congenital and chronic rheumatic heart disease have been studied by electron microscopy. The fine structure of the microfibrils, elastic and collagen fibers in areas of fibrosis of the myocardium is described. Morphological evidence is presented which indicates that both fibroblast and cardiac muscle cell participate in the production of the different extracellular fibers. The stimulus for the production of these extracellular elements by cardiac muscle cells is unknown.

Birth Weight in Israel, 1968–70

The influence of the country of origin of the father on mean birth weight of offspring of Jewish immigrants to Israel has been examined in an analysis of 98% of records of live births for the period 1968–70. The mean birth weight of infants born to parents from the same country (in-group marriages) was 3309 ± 570 g and that of infants whose parents came from different countries (out-group marriages) was 3289 ± 565 g: these differences are not significant. Infants born to immigrants from North African countries are heavier, and those born to immigrants from Asian countries lighter, than the Israeli mean. Apart from Algeria (whose immigrants have babies heavier than those from other North African countries) and India and Yemen (whose immigrants have babies lighter than those from other countries of Asia) there were no significant differences in adjusted mean birth weight by country of origin, within each continental group. Mean birth weight is determined by a combination of maternal and environmental factors, paternal factors having little effect. Analysis of birth weights of second and subsequent generations of Israeli-born, by origin of their grandparents, shows a fall in mean birth weight of those of North African descent and a rise in those of Asian descent, i.e. a tendency to approach an Israeli mean. (Summary in Hebrew, p. 164.)

ENDOTOXIN AS ADJUVANT IN AUTOIMMUNITY TO CARDIAC TISSUE.

Summary and conclusion Endotoxin administered together with homologous heart tissue homogenate in rats had a marked adjuvant effect in production of circulating anti-heart antibodies. This effect was greater than that of Freunds complete adjuvant and was abolished when the endotoxin was given separately, before or after the homogenate. Focal infiltrative myocarditis was seen in some of the animals but could be attributed equally to the endotoxin as to the administered antigen. It is suggested that the autoimmune process can be partially explained on the basis of modification of tissue antigen by linkage to endotoxin.