1163 a transient lessening of pain only-in contrast to the results in rheumatoid arthritis where pain, tenderness, walking time, range of joint movement, and limitation of joint movement improved for longer periods." This effect in osteoarthritis was a result we would expect from pathological considerations and from our previous experience. It is possible that patients with acute synovitis with tense effusion may respond differently; it is also possible that they may respond equally well to aspiration alone-only a properly conducted study would resolve this question. We regard patients of this type as examples of traumatic synovitis superimposed on existing osteoarthritis, and none were included in our series. We should be interested to learn the criteria by which a subgroup of osteoarthritic activity based on localised strains of the capsule might be established. Rheumatism Research Unit, V. WRIGHT
The General Infirmary,
G. N. CHANDLER.
NEUROLOGICAL DISEASES SIR,-Your leading article (May 8), and the
the potentiality of cerebrospinal fluid (c.s.F.) in the diagnosis of cerebrovascular accidents,’8 enzymes prompt me to report a further series in which the aim was to correlate values of c.s.F. glutamic-oxaloacetic transaminase (G.O.T.) and lactic dehydrogenase (L.D.H.), taken by lumbar puncture within forty-eight hours of the episode, with the clinical features of the infarction. In performing early analysis it was hoped to establish whether these early values could give an estimate of the size of the infarct, and hence whether early anticoagulation could safely be undertaken. In so doing it was appreciated that the maximum elevation of the enzyme values is from the third to fifth day following the incident.99 on
The G.o.T. was measured by the method of Mohun and Cook 10 (serum level 0-40 Caubaud units), and the L.D.H. by that of King 11 (serum level 225-540 units). Cerebral infarction was assessed clinically as basilar episodes and as carotid territory hemiplegias with complete recovery, residual hemiplegia, or infarction sufficient to cause death. Control values were first established, and the results analysed for significance by Student’s " t " test. Xanthochromic fluids and fluids containing red cells were not used (see accompanying table). C.S.F. G.O.T.
(IN CAUBAUD UNITS) AND
these results accord with those of other workers who have concluded that c.s.F. enzyme values are not of clinical value.
I am indebted to the physicians of St. Alfege’s Hospital for the opportunity of investigating their patients; and to Dr. G. Thomas, Mrs. P. Oakley, and Mr. A. N. Heard, at the Miller Hospital, for the enzyme
St. Alfege’s Hospital, London, S.E.10.
E. N. WARDLE.
ENCEPHALOPATHY AND FATTY DEGENERATION SIR,-In your issue of May 15 you published a letter
by Dr. Giles
CEREBROSPINAL-FLUID ENZYME ACTIVITY IN
be in investigating the attack of unconsciousness occurring without witnesses and without physical signs. Postepileptic enzyme values, and levels after infarction of the frontal lobes and other silent areas, are raised, and serve to distinguish the situation from hysteria.
C.S.F. L.D.H. LEVELS IN CONTROLS
on Encephalopathy and Fatty Degeneration of the Viscera. The case described by Curry et al.1 may have sparked off the report by Reye et al. In our case1a full toxicological analysis
to be negative. An unexpected finding, however, was the presence in the urine of a pteridine. It would be interesting to know whether in recent cases the urine has been examined for this substance. In our case the child was given an aspirin mixture 48 hours before the onset of the fatal illness. Pathology Department, Beckett Hospital, D. E. PRICE. Barnsley.
" CHEAP " DRUGS SIR,-Retail pharmacists have been able to obtain " cheap " drugs for several years, but, as you say in your annotation (May 1), it is still not clear whether these may legally be dispensed. Since about 90% of drugs used in the N.H.S. are dispensed in retail pharmacies and this proportion is increasing owing to the closure of many hospital outpatient dispensaries, this issue is far from academic. It would seem to be in the public interest to "
help pharmacists to dispense good-quality cheap drugs whenever possible. This might have the further advantage of persuading the patentees to test the law in the courts. The Crown might reasonably be expected to undertake the defence of a retail pharmacist in a test case. Department of Pharmacology, London Hospital Medical College, London, E.1.
AND PATIENTS WITH NEUROLOGICAL DISEASE
C. R. B.
BOVINE FREEMARTINS AND TRUE HERMAPHRODITISM
SIR,-Miss Goodfellow and her co-workers (May 15) favour the hypothesis3 that the freemartin is virilised by the presence of XY cells in the gonadal ridge. This hypothesis is supported by the work of Ohno et awl. who
In each infarction group there is an elevation of G.O.T., but the overlap with normal values is such that the estimation is of doubtful value. Highest values are found with large infarcts sufficient to cause death, but in all cases clinical assessment is far more reliable. The only use of the estimation appears to Chandler, G. N., Wright, V., Hartfall, S. J. Lancet, 1958, ii, 659. Mellick, R. S., Bassett, R. L. ibid. 1964, i, 904. Katzman, R., Fishman, R. A., Goldensohn, E. S. Neurology, 1957, 7, 853. 9. Leibmann, J., Daiber, O., Dulkin, S. I., Lobstein, O. E., Kaplan, M. R. New Engl. J. Med. 1957, 257, 1201. 10. Mohun, A. F., Cook, I. J. Y. J. clin. Path. 1957, 10, 394. 6. 7. 8.
King, J. J. med. Lab. Technol. 1959, 16,
obtained chromosomal evidence for gonad chimaerism in twin calves. Genital abnormalities have also been described in twin chick embryos derived from double-yolked eggs.56 In pairs where the embryos are of opposite sex, masculinisation of the female in the form of regression of the Mullerian ducts and testicular abnormalities in males are found. In both investigations,56 it was concluded that these changes were due to the passage of sex hormones through the common chorio-allantoic circulation. No attempt was made to investigate possible germ-cell chimxrism in the
developing gonads. A 1. 2. 3.
technique has been developed in this laboratorv for the Curry, A. S., Guttman, H. A. N., Price, D. E. Lancet, 1962, i, 885. Reye, R. D. K., Morgan, G., Baral, J. ibid. 1963, ii, 749. Fecheimer, N. G., Herschler, M. S., Gilmore, L. O. 11th International
Conference on Genetics, 1963; vol. I, p. 265. Ohno, S., Trujillo, J. M., Stenius, C., Christian, L. C., Teplitz, R. L. Cytogenetics, 1962, 1, 258. 5. Lutz, H., Lutz-Osterag, Y. Devl Biol. 1959, 1, 364. 6. Ruch, J. V. Archs Anat. Histol. Embryol. 1962, 45, 61.