Rh FACTOR: THEORY AND NOMENCLATURE BgRITISH MEDICAL JOURNAXL also states that the relative frequency of gene R" to gene R2 as compared with R' to R' indicates that his mythical, gene locus c lies between d and e. However, these statements are based entirely on the findings in England and disregard the findings in other countries. In America, for example, the relative frequency of R' to R" is reversed, while in negroes the frequency of r°(42.1%) is quite different from the sum of R' (2.7%) and R" (none found).'7 As a result Fisher's theory leads to a contradiction. In my opinion a much more plausible explanation is that the genes ro, R', and R" arose by mutation. Thus the high frequency of gene -ro and of the intermediate R genes, as well as the intermediate gene A1, 2, suggests that the peculiar distribution among negroes is due to a higher mutation rate in this race.The argument that the discovery of the so-called cw factor"8 supports Fisher's theory does not seem correct, because this factor appears to have the characteristic predicted by me'2 for factor Rh"'.In this connexion I should like to point to a recent attempt'9 to develop an elaborate theory of inheritance of the four blood groups by means of four gene couplets. On the basis of this theory, Myslivec derives formulae for the gene frequencies involving the square root of the difference 0-2 AB. Since populations exist in this world where the frequency of group O is less than twice the frequency of group AB, the theory leads to an obvious contradiction.In conclusion I should like to take this opportunity to answer the rather academic attack20 on my use2' of the term " conglutination" in connexion with the Rh antibody reactions. Recent findings22 have all sought to justify my use of this term. The term " co-agglutination," used by other workers, applies to a phenomenon obviously identical with mixed agglutination, and one would expect this to occur in conglutination where the second stage is non-specific.23 In agglutination, involving bivalent antibodies, where the second stage is specific, coagglutination or mixed agglutination does not occur. My new ideas and findings concerning univalent (blocking antibodies or glutinins) and bivalent antibodies (agglutinins) have led me to the theory2"25 that erythroblastosis foetalis actually comprises three separate entities instead of a single disease. According to my proposed nomenclature, these three entities are as follows: (1) Congenital haemolytic disease (with anaemia and hydrops), usually due to univalent Rh antibodies; (2) icterus gravis with kernicterus, usually due to bivalent Rh antibodies; and (3) icterus praecox (formerly confused with " physiologic" icterus, usually due to A-B sensitization. Further details will be given in papers now in the press and in preparation. REFERENCES Fisher, R. A., and Race, R. R. (1946). Nature, 157, 48.2 Wiener, A. S. (1941). Arch. Path., 32, 227. 3-(1942). Amer. J. clin. Path., 12, 302. 4 (1945)
SUMMARY We reviewed 388 very low birthweight infants admitted to this neonatal intensive care unit over a four year period to determine the pattern of neonatal and postneonatal deaths up to age 2 years. Neonatal mortality is no longer an adequate indicator of outcome because deaths arising from perinatal events occur after the first month of life.
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