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In a cohort of Australian national service conscripts, death rates from International Classification of Diseases, Eighth Revision (ICD-8) cause of death classes for 19,205 veterans of the Vietnam conflict were compared with those of 25,677 veterans who served only in Australia. Comprehensive, clinically reviewed cause of death data were collected and coded to a single ICD-8 three-digit cause of death code by the Australian Bureau of Statistics. Over 98% of the deaths among veterans were included in five classes of causes of death. These were neoplasms (14%), diseases of the circulatory system (7%), accidents, poisonings, and violence (external causes) (74%), and diseases of the digestive system and mental disorders (2% each). For the last two classes, chronic abuse of alcohol was a common factor in most deaths among Vietnam veterans. The death rates of Vietnam veterans were statistically significantly higher than those for other veterans for only two classes of causes of death: diseases of the digestive system and external causes. After adjustment for Army corps grouping, this excess was not statistically significant for external causes. There was no statistically significant difference in death rates from neoplasms, nor were deaths from specific neoplasms more frequent among the group that served in Vietnam. While this suggests that service in the Vietnam conflict has not increased death rates from neoplasms among servicemen, the follow-up period, ranging from 9-16 years, is shorter than the latency period for some neoplasms. The study findings provide a measure of support for claims by Australian Vietnam veterans of an increased incidence of stress-related disorders associated with service in the Vietnam conflict.

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Rubella-Brown et al. BRITISH 265It is confirmed that little reliance can be placed on statements concerning a past history of rubella. In this series about one-third of all firm statements were proved to be wrong on subsequent laboratory investigation. The histories, mostly obtained from parents, were most accurate for the 1-5 years age group. Similar findings have been reported by other workers (Vesikari et al., 1968). This lack of correlation between statements concerning a past history of rubella and serological studies may be ascribed to the difficulty in diagnosis of rubella which is often simulated clinically by other infections (Krugman, 1965). Ignorance of infection may also be due partly to the occurrence of subclinical attacks, and, to a certain extent, failure to remember the occurrence of clinical infection many years in the past.The results of this and previous serological studies of children seem to raise a number of important problems concerning vaccination against rubella. Several vaccines have been developed and the results of preliminary clinical trials published (Proceedings of the 23rd Symposium on Microbiological Standardization, Rubella Vaccines, 1969). Before these vaccines become freely available the age at which they are to be administered must be decided. As yet, insufficient data have been published concerning the possible transmission of vaccine strains of rubella virus across the placenta and the teratogenic effects of these strains on the fetus. Consequently, the vaccination of adult women will involve the prevention of pregnancy immediately before and after administration of the vaccine. If children are to be vaccinated, it must be taken into consideration that the majority are already naturally immune by the age of 10-15 years, and mass vaccination at this stage may be regarded as impracticable or uneconomical. The selection of children on the basis of past histories cannot be relied on, and the alternative screening of all children to detect immune status prior to vaccination would be very laborious. The vaccination of infants below the age of 5 years may be more logical, as this age group has the lowest level of natural immunity. In this case, however, vaccine-induced immunity may not be sufficient to afford protection into adulthood, and it may be necessary to revaccinate in later years.

Seven patients with Macleod's syndrome of abnormal transradiancy of one lung have been investigated with special reference to regional lung function. The principal abnormality was found to be obstruction of the airways. This was severe in the affected lung but was often present in the other lung as well. Five of the seven patients suffered from chronic bronchitis, as judged by the M.R.C. questionnaire. Although functional impairment of the affected lung was severe, it was by no means uniformly distributed there. There was evidence of defective gas transfer in all the patients who complained of breathlessness on exertion; the blood gases were only slightly abnormal at rest, and hypercapnia, in particular, was not a feature. During exercise arterial oxygen tensions tended to fall. Clinically it was found that the stethoscope gave a rough guide to the extent of regional underventilation and that radiographs were useful for judging the distribution of blood within the lung. We conclude that treatment should be conservative, directed towards avoidance of environments and habits likely to cause or exaggerate airways obstruction or bronchitis.In 1954 (Belcher, Capel, Pattinson, and Smart, 1959). Clinical reports emphasize the frequency of productive cough in subjects with this abnormality who come under medical observation. They are said to be unusually prone td repeated chest infections (Dornhorst, Heaf, and Semple, 1957;Darke, Chrispin, and Snowden, 1960;Fouche, Spears, and Ogilvie, 1960). The physiological investigations of these and other authors (Bentivoglio, Beerel, Stewart, Bryan, Ball, and Bates, 1963a; Bates and Christie, 1964) show that the transradiant lung takes little part in gas exchange and emphasize the danger to the patients of damage from any cause to the better lung. It is clear that the prognosis in these patients depends on the condition of this lung. Some attention has been given to this by Dornhorst et al. (1957) and 148 on 12 May 2018 by guest. Protected by copyright.