Hutchison, J. H., Kerr, M. M., Douglas, T. A.,. Inall, J. A., and Crosbie, J. C., ibid., 1964,. 33, 956. ... St. David's Hospital,. ANNA R. KEMP. Carmarthen, Wales.
4 February 1967
Correspondence
Adoption of the practice of early feeding Ministerial intervention into clinical matters. in newborn infants and increasing experience -I am, etc., in the treatment of severe respiratory distress P. A. T. WOOD, London W.1. Chairman, with I.P.P.R. can be expected to lower the for Freedom in Medicine. Fellowship mortality in this condition in the future.-I am, etc., MARGARET E. R. STONEMAN. Psychiatric Sequelae of Termination Exeter City Hospital, Exeter, Devon. of Pregnancy 2
REFERENCES Usher, R., Pediatrics, 1959, 24, 562. Pediat. Clin. N. Amer., 1961, 8, S2S. Pediatrics, 1963, 32, 966. Hutchison, J. H., Kerr, M. M., Douglas, T. A., Inall, J. A., and Crosbie, J. C., ibid., 1964, 33, 956. Reid, D. H. S., and Tunstall, M. E., Anaesthesia, 1966, 21, 72.
Termination of Pregnancy Bill SIR,-Dr. J. Letitia D. Fairfield in her letter (21 January, p. 173) expresses her concern that termination of pregnancy, if Mr. Steel's Abortion Law Reform Bill becomes law, will be sought on bogus social grounds with the aid of heartrending but fictitious stories. She asks how the doctor can know whether or not the patient is lying. A similar problem arises in the practice of psychiatry. It may be impossible to tell whether a patient's extraordinary account of himself is true or delusional without local inquiry at his home. This is often done for this hospital by the mental welfare officers, sometimes with surprising results. In a country area such as this the nursing staff too are often in the position to supply relevant social information about patients. Suitable inquiries could readily be made if termination of pregnancy were proposed. Gynaecological clinics, however, will no doubt always receive women who come with a distressing story of menorrhagia, in fact angling for a dilatation and curettage to remove an early unwanted pregnancy. Only an astute clinician can rumble such patients. -I am, etc., ANNA R. KEMP. St. David's Hospital, Carmarthen, Wales.
SIR,-The views of the Council of the B.M.A. and the Royal College of Obstetricians and Gynaecologists on Mr. Steel's Termination'of Pregnancy Bill (31 December, p. 1649) are causing the gravest concern to those who appreciate their restrictive nature. To propose limiting any lawful operation to one section of the profession is to create a most dangerous precedent, which, once accepted, may allow further limitation in medical or surgical treatment to be imposed by the Minister of Health at some future time. To suggest deleting the clause in Mr. Steel's Bill which permits the operation for termination to be carried out in any registered nursing-home, and to replace it by limiting the operation to a National Health hospital or other place approved for the purpose by the Minister, must restrict the freedom of the patient to have the operation performed in the place of her choice, and implies that the B.M.A. and the R.C.O.G. believe that a registered nursing-home cannot be adequately controlled for the purposes of the Act. This slur on registered nursing-homes is quite indefensible, and it is difficult to understand why the Council of the B.M.A. are inviting
SIR,-In view of its current interest we would be grateful for the opportunity to comment on two recent statements on this topic. Firstly, your leading article (3 December 1966, p. 1342) is open to misunderstanding when it says that Ekbladt found "much residual disability" following abortion. While 25 % of the women experienced selfreproach or regret (" serious " in 14%), this author goes on to say that from the psychiatric point of view the symptoms were generally mild, that few women had consulted a doctor, and that only five (out of 479) were unable to work. All of the latter had difficulties not directly due to the abortion. It was therefore not a question of disabling psychiatric illness, and we feel that the word disability, not used by the author himself, could give a wrong impression. Secondly, the report of the Royal College of Obstetricians and Gynaecologists' contains the statement that " the incidence of serious (sic) permanent psychiatric sequelae is variously reported as being between -nine and 59%." However, we have been unable to discover the data from which the figure of 59% is derived. One of the references given' refers to a Swiss study' in which 61 women (51 of whom were also sterilized) were followed for two to three years after abortion. The findings were that 28 % showed no adverse reaction at all or were better adjusted than before, 59% experienced some feelings of guilt or -unhappy memories of the pregnancy, yet felt abortion had been the right course in the circumstances; and 13% were found to be suffering from more severe or persistent feelings of guilt or frustrated motherhood, and half of these regretted the operation. The author herself concluded, after viewing the entire histories, that abortion may have been the wrong decision in two of the women. We suggest that the literature permits the following conclusions: the outcome after legal abortion is good (considering the very adverse circumstances that often exist) in 85% ; some 10-15% of women experience for a time rather severe self-reproaches or regrets, but with little actual disability; about 1-2% suffer definite psychiatric illness not necessarily directly connected with the abortion' 5; and finally, when abortion is refused, the personality disorders and other unfavourable factors present in many cases render the outlook for future adjustment precarious both for the mother' and for the child.7-We are, etc., D. W. K. KAY. KURT SCHAPIRA. Department of
2 3
i 4 6
BRTIH
299
" Ryan Virus " SIR,-In the paper by Dr. J. A. Armstrong and Dr. M. S. Pereira (28 January, p. 212) identifying the "Ryan viruses " as amoebae of the genus Hartmanella these authors considered that these organisms probably came from the respiratory tract of the subjects examined, although no serological response to them was demonstrated in convalescent sera. Recently we have prepared complementfixing antigens from two of the strains of hartmanellae isolated in Manchester by grinding them up in a ball-mill at -70° C. With these antigens we have tested a small number of human sera, including convalescent specimens, from three children yielding amoebae, and from the mother (No. 2) of one case, who suffered an illness at the time of her child's infection. The results on the four sera from these subjects are given in the table. Complement-fixing Antibody Titres in Subjects Yielding Hartmanellae from the Throat 1 4/4/64 Agent isolated 8/5/65 20 22/12/66
