676 and very much ,1"-’ severe. In both the diastolic pressure had impulses to pass to the spinal cord might provoke greatly fallen by about 20 mm. Hg...

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676 and very much ,1"-’ severe. In both the diastolic pressure had impulses to pass to the spinal cord might provoke greatly fallen by about 20 mm. Hg. increased efferent impulses tending to bring about hyperAs the filling of the coronary arteries-is largely dependent regeneration. In later life this reflex arc might be more on the level of the diastolic pressure, it was easy to explain constantly invoked and, if the energy of the epithelium became what had occurred here. A larger dose or narrower coronaries exhausted, processes leading to maldevelopment and the well have a infarction. I have might precipitated myocardial development of tumours might occur. no doubt that most of the unexplained deaths under thyroid In the precancerous phase the interruption of such a segtreatment (nearly all of which occurred in cases of myxoedema) mental reflex arc by drugs or physical treatment (for example, were due to sudden coronary insufficiency or myocardial by electric shock) might prevent this development of tumours. infarction. That high dosage in the absence of coronary County Hospital, BÉLA HERMAN. Gyula, Hungary. narrowing is unattended by any risk is the conclusion I have reached after many years’ experience in the use of this hormone. EARLY DIAGNOSIS OF PREGNANCY Thyroid, then, should be given with care in angina and in all who have had a coronary thrombosis. Because of my early SIR,-In your issue of Oct. 10, Dr. Macdonald and experiences, I regarded such evidence as an absolute contra- Dr. Sharman describe a test using the cervical mucus, indication to treatment. Recently, however, I decided that which by its very simplicity could be of great use to the it would be justifiable to treat hypertensives having angina But in the general practitioner if it proves to be reliable. with smaller doses. The fall in the diastolic pressure would not of their letter they say: " The test is less final paragraph be so precipitous and it would thus be possible to gauge the valuable to the average busy practitioner since a vaginal level at which the diminution in coronary blood-supply would speculum examination is required ". This does reflect be more than compensated for by the diminution in the work a most regrettably low opinion of general practice. I of the heart. should like to think that it is in fact quite unjustified, and To date 5 such cases have responded favourably to this a In 6th case in which there was no hypertension that the routine use of a vaginal speculum in ordinary approach. the angina had reached the stage of decubitus. Here the general practice is a great deal more usual than their underlying cause was xanthomatosis tendinosum associated opinion implies. with hypercholesterolxmia. A daily dose of gr. 2 reached by Great Dunmow, Essex. GEOFFREY BARBER. weekly increments of gr. 1/2 daily on an original dose of gr. 1/2 daily enabled the patient after 2 months’ treatment to carry BLOOD-GROUPS on normal activities without pain.

symposium recently published in England1 many of the leading British investigators presented their most recent work on blood-grouping. In view of their highly specialised nature, this group of papers will probably be of interest chiefly to workers in the field. CANCER AND THE CENTRAL NERVOUS SYSTEM the presentation is slanted SlR,-In their exceptionally interesting article on the Unfortunately, however, almost to the contributions and views of British entirely neurological syndromes associated with carcinoma Sir workers, and does not do justice to the findings of pioneerRussell Brain and Dr. Henson1 pointed out that the disease process in the nervous system does not necessarily ing American investigators. As a result, the articles are not only incomplete but also contain serious errors and parallel the duration or the size of the tumour. These misinformation that destroy the usefulness of the volume, observations prompted the idea that some primary for those few critical workers who are capable of except functional change in the central nervous system may have a the facts and fallacies which it between discriminating fundamental significance in the origin of human cancer. contains. The first piece of evidence for this hypothesis seemed to One of the outstanding faults of the volume derives from the be the determination of the concentrations of acetylcontinued use of the Fisher-Race C-D-E notations in the face SiR,-In

One can only hope that further work will confirm these results and those obtained by Dr. Barnes. PERICLES MENOF. Johannesburg.


choline and noradrenaline in the central nervous system and cerebrospinal fluid (c.s.F.) of patients with cancer.

of overwhelming evidence of their numerous fallacies. These notations teach triple inheritance of Rh-Hr genes and agglutinoBecause of technical difficulties I had to limit my own gens even though a gene such as R" has been shown to give investigations to determining the concentration of true cholin- rise to an agglutinogen Rh1w with the blood factors Rho, RhA, esterase in the c.s.F. The technique developed by Stedman RhB, Rhc, RhD, rh’, rh,, rh’, hr", and Hr.-atotal of ten et al. for measuring true cholinesterase in serum was used, factors instead of three. As Wiener2 has demonstrated, the for sodium that was substituted number of blood factors characterising an agglutinogen N11000 N/100 except hydroxide. depends in large degree on one’s industry and ingenuity in In 35 control cases (15 healthy subjects and four groups of searching for and finding blood-grouping antibodies of new 5 patients with acute inflammation, hypertension, congenital specificities. Thus, the main issue at stake here is on a seroheart-disease, and cholelithiasis), c.s.F. true cholinesterase logical level and not on a genetic level. Moreover, the linkage measured between 8-0 and 12-0 units (average 9-4). On the other theory credited to Fisher was not original with him, since hand, in 29 of 30 patients with histologically proven cancer in Wiener3 published an analysis of the theory two years before widely different sites, the figures were lower and ranged between Fisher entered the picture. Fisher merely elaborated on an 38 and 7-6 units (average 58). erroneous idea that Wiener had previously disproved and disSerum-cholinesterase in cancer patients, however, was not carded. The symposium includes no reference to the recent necessarily different from that of controls. From results in detailed and well-documented report 4 of the Committee on more than 100 patients with various mental or liver diseases, Medicolegal Problems of the American Medical Association, I am certain that the levels of cholinesterase in the serum andl in which it is recommended that C-D-E notations be disc.s.F. are independent of one another-perhaps because the: carded, and the Rh-Hr Nomenclature be used exclusively. main site of cholinesterase production is in the ganglion cellsi Again, much space is given to studies on blood-groups and of the central nervous system. disease-a different kind of blood-group paradox also inspired Because of this reduced cholinesterase concentration,, by the biometricians. Of course, the clinical importance of activity in the ganglia might possibly be increased. Conse- 1. Brit. med. Bull. 1959, 16, no. 2, pp. 89-174. quently any lesion affecting the epithelium and causing afferent 2. Wiener, A. S. Science, 1958, 128, 849. ,

1. 2.

Brain, W. R., Henson, R. A. Lancet, 1958, ii, 791. Stedman, E., Hall, G. E., Lucas, C. C. Dtsch. med. Wschr. 1956, 80, 1959.


Wiener, A. S. Blood Groups and Transfusion; p. 254. Springfield, Ill.,


J. Amer. med. Ass. 1957, 164,

1943. 2036.