In an interesting paper Campbell (1936), while welcoming the studies that were being concentrated on improving maternity care, drew attention to what he called "a more subtle and sinister condition", the "excessive smoking" which, during the previous two decades, had "clutched the young women of this country (America) in a manner resembling the invasion of an epidemic working in virgin soil". His paper, which was based on the conviction of his own observations, included his review of the literature and in particular a review of such experimental work as there was on the effect of nicotine or tobacco extracts. Campbell had also asked the members of the American Association of Obstetricians and Gynaecologists for their opinion about the effect of smoking 25 cigarettes or more daily on maternal health and he quoted some of the interesting replies he received, the great majority of which supported his beliefs that excessive smoking in pregnancy was harmful to the mother. There was no suggestion in his paper that smoking might also have an effect on the foetus.Since then smoking in pregnancy has received spasmodic attention. A few workers have presented evidence to suggest that smoking may prevent a successful outcome to the pregnancy (Frazier, Davis, Goldstein, and Goldberg, 1961;Zabriskie, 1963;Butler, 1965;Russell, Taylor, and Maddison, 1966;Steele and Langworth, 1966)

A significant minority of medical and dental students fail their undergraduate courses. Early warning systems (EWSs) have been developed in some areas of higher education to predict 'at-risk' students at an early remedial stage. An attempt is made to develop an EWS to predict failure in the bacteriology component of the Batchelor of Dental Surgery course at Manchester Dental School. A system based on class tests and previous end-of-year performance is derived which is used to predict those students likely to fail or fall in the bottom 20-25% in their finals examination. The predictors are combined by a simple equal weights method, which is found to have the same predictive power as using multiple regression. Failure was correctly predicted in 60% of cases, at the expense of 71% false alarms. The high number of false alarms reflects the low failure rate rather than the lack of predictive information. The need for effective cross-validation of EWSs is discussed; many previous studies have not been tested on independent data.

No abstract

As long ago as 1905 Folin observed that although considerable individual variation was noticed the daily quantity of creatinine excreted in the urine of any one person was remarkably constant. Vorzimer, Cohen and Joskow (1949) gave the range of creatinine excretion in women as 0.8 to 1 * 5 g. per day. Seegers and Potgieter (1937) observed that the excretion of creatinine in the pregnant woman was similar to that in the non-pregnant. The range of excretion in antenatal patients observed by Clark and Thompson (1949) was 1.09 to 1.61 g. per day, this range remaining unchanged when urines from the same patient were examined three months postpartum. Clark, Thompson, and Beck (1951) gave the daily creatinine excretion in pregnancy as 1.21 g., standard deviation 0.19 g. Folin (1905) had also suggested that the constancy of creatinine excretion should be used as a gauge of the completeness of 24-hour urine specimens. A range of creatinine excretion from 0.81 to 1 *76 g. per day with individual averages ranging from 0-96 to 1 ~5 0 g., standard deviation 0.09 to 0-16 g., was reported by Smith (1942) who found the test of great use in assessing the accuracy of collection of 24-hour specimens and suggested that specimens with a creatinine content of less than 0 -8 g. should be suspected of being incomplete. In cases of advanced chronic nephritis Goldman (1954) has drawn attention to the retention of creatinine in the blood and its consequent reduction in the urine.The present paper reports our experiences of creatinine estimation as a measure of the completeness or otherwise of supposed 24-hour urine specimens. MATERIAL AND METHODSFourteen co-operative, healthy women undertook to collect 24-hour specimens of urine during the last month of pregnancy. Eleven were either nurses or doctors and all realized the importance of accurate collection. Thirteen were primigravidae and one, an in-patient, was multigravid. A total of 324 specimens was collected shortly after completion and at the time the opportunity was taken of discussing with the patient any difficulties in collection. Besides the hormonal assays to be reported elsewhere the creatinine estimation was done as soon as the specimens reached the laboratory.The method of creatinine estimation used was a modification of the Folin test in current use at the Jessop Hospital, viz.:To 20 ml. of a saturated solution of picric acid was added 4 ml. N NaOH and 1 ml. of urine. After leaving to stand at room temperature for 10 minutes, the volume was made up to 200 ml. 623

No abstract

WHEN urinary incontinence takes the form of simple stress incontinence without nocturnal frequency and is associated with a cysto-urethrocele then it may be reasonable to treat the patient surgically without further detailed pre-operative investigation. However, as soon as there are inconsistencies between the symptoms and the physical findings or the patient has not been cured by a previous repair operation then it is important to aim at a more precise diagnosis before treatment is undertaken. This paper reports the results of the close investigation and treatment of 125 women with urinary incontinence in whom the degree of prolapse was thought to be insufficient to account for their incontinence, and 8 1 women previously operated on who continued to be incontinent. In particular we were concerned with the real meaning of common symptoms and signs. The work reported has been carried out over the last 7 years.

No abstract

FOR a number of years Zondek (1960) has maintained that a urinary oestriol level of less than 1 mg. per day is diagnostic of foetal death and that fluctuations greater than 70 per cent (60 per cent if toxaemia co-exists) indicate foetal danger. Greene, Touchstone and Fields (1 960) confirmed that oestriol values below 1 mg. per 24 hours indicate foetal death, and that placental insufficiency is signalled by values below 12 mg. in the last trimester. In the same year, Ten Berge (1960) reported that the urinary oestriol levels in 12 cases dropped suddenly to 9 mg. or less following the death of the foetus and his figures showed that a fall in excretion was often apparent before the foetal death. In the following year Ten Berge (1961) recommended Caesarean section in cases where the oestriol excretion lay below 12 mg. per 24 hours in the last 8 weeks of pregnancy on the grounds that the life of the foetus was endangered. Frandsen and Stakemann (1960) described subnormal oestriol levels ( 3 . 3 mg. or less) in 16 out of 17 cases of proven foetal death; they suggested that the normal level in the 17th case was due to an error with the specimen and consequently advocated the assay of at least 2 specimens before making a diagnosis. The oestriol excretion in 12 women with foetal death was reported to be severely depressed by Klopper, Macnaughton and Michie (1961). Cartlidge, Spencer, Swyer and Woolf (1961) at the same meeting stated that intrauterine death was invariably associated with