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thrombin is low and relatively flat, whereas that fromantithrombin in defibrinated plasma rises in relationto the time of incubation of the mixture. Thus it is diffi-cult for us to reconcile the finding of low antithrombintitres obtained from serum with unequivocal diagnosisof cystic fibrosis of the pancreas regardless of the extentof involvement.

In our data only extreme cases of cystic fibrosis of thepancreas, with minimal or absent external pancreaticsecretions, show very low antithrombin titres. Further,in our experience there is no constant relation betweenabsent pancreatic secretions in the duodenum and theantithrombin level in the blood.

Since it is apparent that serum-antithrombin deter-minations result in low flat curves, the stage of pancrea-titis characterised by markedly increased antithrombinand trypsin levels in the blood would necessarily be missedin serum determinations.

It would indeed be most helpful in clarifying thedifferences in results obtained if plasma-antithrombindeterminations could be made on the 67 cases so wellpresented and discussed by Dr. MacFarlane.

IRVING INNERFIELDALFRED ANGRISTJAMES W. BENJAMIN.

Department of Physiologyand Pharmacology,

New York Medical College,New York.

CONGENITAL DEFECTS FROM MATERNALRUBELLA

IAN G. ROBIN.

SiR,-As an otologist and a member of the committeeof the Deaf Children’s Society, I have been very per-turbed to learn that some general practitioners are

questioning the diagnosis of rubella in the first threemonths of pregnancy when associated with fcetal abnor-malities. In 1940 and subsequently, Gregg, Swan, andothers in Australia pointed out the very definite danger ofrubella early in pregnancy leading to congenital deafness,blindness, and sometimes a cardiac lesion. It is thoughtby some that the infection was not true rubella and thatother cases have not occurred since.

This is a very dangerous, as well as an erroneous,supposition. There is no doubt whatever that childrenare still being seen with these tragic defects as the resultof infection in their mothers by a simple " illness

indistinguishable from typical rubella often this hasbeen very mild. Pregnant women should still be extremelycareful to avoid contact with rubella : in fact there seemsevery justification to recommend that all girls shouldbe exposed to rubella before leaving school.London, W.I. IAN G. ROBIN.

DENTAL TREATMENT FOR CHILDREN

T. H. LIPTROTHon. Secretary, Public Dental Officers’ Group,

British Dental Association.

SiR,-Your leading article of Oct. 25 contains the

following statement concerning children’s dentistry :"The work is mainly routine and holds little interestfor the highly trained dental surgeon." May I encroachon your space to challenge as briefly as possible thecorrectness of this statement.The public dental officer in treating the priority

classes performs the same range of operations as is

performed in the general dental service. In the case ofschool-children, who form the bulk of his patients, hemust perform these same operations in a much smalleroral cavity and on a patient who is emotionally lessstable than an adult, requiring from the operator a

greater skill and more tact and patience than is necessaryin other spheres of dentistry. As the school dentistis dealing with patients in their developmental stage, hisknowledge and understanding of developmental irregu-larities, and their prevention and treatment, must beof a high order. By contrast the treatment of maturemouths, subject only to the processes of decay, is flatand insipid. The more frequent use of general anaes-thetics, with increased dimculties of administration,is a further feature of children’s dentistry.

I trust that this letter will go some way towardsremoving your implied slur on those dental surgeonswho for vocational reasons remained faithful to thechildren, and resisted the financial attractions of theeasier, though less satisfying, work of general service.

THE CORRECT SPELLING OF MEDICAL TERMS

KENNETH MARSH.

Sm,ňDr. L. E. Napier (Nov. 1) is fighting a battlefor many of us in defence of etymologically correct

spelling. Nowadays, editors refuse to accept emp’yemata,and one journal recently removed sinus into the seconddeclension.

Camberwell, London, S.E.5. KENNETH MARSH.

SKIING ACCIDENTS

SiR,-In 1950 a committee was set up by the SkiClub of Great Britain to inquire into ways of reducingthe number of skiing accidents. A simple safety devicewas introduced consisting of a strap passing from theheel-spring of the ski binding to a ring attached to theski 2 in. behind the heel. The object of this device wasto cause the foot to come adrift from the ski in the eventof a severe forward fall. Other and more elaboratesafety bindings prevent rotation strains, but they havenot yet been widely used in the Alps.

In order to obtain information on (a) the incidence ofskiing injuries, and (b) the effectiveness of this simplesafety device, a card was circulated in 1951 to 12,750members of the Ski Club of Great Britain, asking for thefollowing information :

Age ; sex number of seasons’ experience ; safety deviceused, if any ; description of injury from any accident inprevious season ; causes of accident (fall, collision, snow

conditions) ; days on ski before accident ; feet downhill perday (average).

254 replies were received ; the results of analysis wereas follows :

The injuries were as follows sprairas 46 (ankle 22, knee 20,shoulder 4) ; fractures 7 (ankle 3, patella 1, thumb 1, ribs 2) ;muscle lesions 2 (calf 1, thigh 1) ; lacerations 2 (thigh 1,wrist 1) ; unspecified 1.Under causes of the accident the replies were as follows:

snow conditions 40 (powder snow 15 ; wet soft snow 9 ; ice 7 ;icy ruts 5 breakable crust 4) ; obstructions 4 (tree, rock, orice block) collisions nil. Snow conditions were not reportedin 3 cases ; 11 accidents happened in good snow conditionson the piste.

There are obvious statistical objections to this type ofinquiry. The findings would not necessarily be the samein a random sample of the members of the Ski Club ofGreat Britain ; they may apply only to the type of personwho takes the trouble to reply, and people who have hadaccidents may be more likely to reply than those whohave not. On the other hand, those who have worn asafety device and escaped injury may be more likely toreply than those who have had no injury and worn nosafety device.

Despite these objections, the results confirm theimpression gained from empirical observation thatinjuries to skiers are extremely common, though mostof them are not serious. The evidence also suggests thatthe Ski Club of Great Britain safety device significantlyreduces the incidence of accidents. This device clearlycannot influence the incidence of injuries to parts of thebody other than the lower limbs. The number of such