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He was on holiday with his family in the west of Ireland and was breathless. They asked me to see him—it was the 1940s and I had only just got my MD. They asked me …

Antenatal screening in the West Midlands during a three-year period identified 297 mothers who were chronic carriers of hepatitis B surface antigen (HBsAg)--a prevalence of about 1 in 850. About half of their infants had HBsAg in the cord blood, but of 122 infants followed up for over three months (mean 8.5 months) only 17 (14%) were still positive for HBsAg. Cord-blood HBsAg-positivity was evenly distributed among different ethnic groups, but the transmission rate was highest among the Chinese, and no carriers were discovered among 39 European infants. Raised serum transaminase concentrations were found in some of the carrier infants who were otherwise healthy. The results suggest that adequate follow-up of HBsAg-positive infants may be achieved by tests at 4 months and 1 year of age, and that the role of breast-feeding in mother-to-infant transmission of HBsAg is unimportant. The Chinese community may be a suitable population in which to test the effectiveness of specific immunoglobulin administration at birth in preventing the development of the HBsAg carrier state.

Intrahepatic cholestasis is manifested by an obstructive type jaundice but the exact mechanism which cause failure of bilirubin secretion because of drugs is not known. It is recognized as a benign complication of oral contraceptive agents. This paper describes the case report of 2 sisters who were using contraceptive agents where the common component was norethisterone. Both sisters were well built with auburn hair and hazel eyes. Both were 0 rhesus -positive. In each case pruritis was severe and the most unbearable symptom. It was treated successfully with intravenous ACTH and oral prednisone and the itching was relieved but the jaundice continued over many months. One sister had severe pruritis during the latter part of her 3 pregnancies. The mother of these women had no problems during her 3 pregnancies. The other sister in this family was taking Anovlar 21 which she had used for 2 years without problems. This sister presented a totally different physical appearance and is A rhesus-positive. The strong similiarity between these 2 sisters and their common reaction to this steroid causes speculation that the jaundice may be due to a genetic abnormality and possibly a single enzyme defect.

A woman who had had high titres of rubella antibodies some months before she became pregnant gave birth to an infant in whom congenital rubella was confirmed at 4 months. Rubella haemagglutination inhibition tests, complement fixation tests, and immunofluorescence tests with anti-human IgG were carried out on sera from the mother. Rubella antibody titres in sera obtained in March 1971, seven and a half months before conception, were equivalent to 400 units, which is usually taken as indicating good immunity. Rubella virus was isolated from the baby's nose and throat in July 1973 but was not isolated from a cervical swab taken from the mother in December 1973; tests of her immunological competence did not show any definite abnormality. The presence of high levels of rubella haemagglutination inhibition antibodies does not invariably confer immunity or exclude the possibility of congenital rubella in a subsequent pregnancy.