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total of 6, 8, and 10 days, respectively. Cessation of 0, therapy incase 3 was followed by return of the murmur and boundingperipheral pulsation. 30-35% 02 was then readministered for afurther 10 days; there was no second relapse. The Pao, wasmeasured intermittently by radial arterial stab in 2 cases; in30 % 0 . the mean Pay, was 80 mm. Hg and in 35 % 0 it was136 mm. Hg. The highest Pao2 recorded was 152 mm. Hg. Ineach case the fundi were examined carefully and repeatedly: noeffects of oxygen toxicity were observed. In cases 1 and 2 noother therapy apart from O2 was given. In case 3 digoxin anddiuretics had been given for 9 days before starting O2 therapywithout controlling the cardiac failure. This infant had strikingwater-hammer pulses and a very loud murmur and thrill; theclinical, radiological, and E.C.G. improvement in 35% 0 wasparticularly dramatic in this case. All 3 infants have been seen

repeatedly at the follow-up clinic and are considered ncrmalwith respect to both cardiopulmonary status and develop-ment.

Obviously our findings must be treated with caution,since no cardiac-catheterisation studies were performed.However, the rapid return of cardiac status to normal ineach case supports the clinical diagnosis. Also, the fact thatP.D.A. and cardiac failure were recognised only on 3occasions in 21 months suggests that the condition was notoverdiagnosed. Clearly, though, more sophisticated studiesare required before these preliminary findings can be

accepted. If and when confirmation is received it mayprove possible to treat a relatively common and seriousproblem by applying a physiological principle. In themeantime it will be wise to continue to use oxygen withcare in such infants. Apart from the risks of oxygentoxicity it is also possible that a raised P a02 might induce afall in pulmonary vascular resistance without closing theP.D.A.; in such a case the left-to-right shunt and cardiacfailure might then be accentuated.

It is of interest that all our 3 mothers were heavy smokers.While this may be a coincidence, it is at least possible thatmaternal smoking might increase the likelihood of P.D.A.either by having a direct effect on the ductus or by loweringthe oxygen-carrying capacity of the infant’s blood at a

critical time. We hope to investigate this possibilityfurther.

University of Bristol,Department of Child Health,Southmead Hospital, Bristol.

PETER M. DUNNBRIAN D. SPEIDEL.

NEONATAL HYDROCEPHALUS TREATED BYCOMPRESSIVE HEAD WRAPPING

Sn,-In the article by Dr Epstein and his colleagues 1there are two points worth pondering.

First, since the patients selected by the authors had" normal or only slightly raised intraventricular pressure ",how can they be sure that these patients were not going toprove to have " compensated hydrocephalus "? All of ushave seen patients with the astiological factors noted by theauthors in their cases, manifesting an

" arrested " or"

compensated " state. Not everyone therefore will agreewith the authors’ statement that " Untreated human neo-natal hydrocephalus, secondary to an obstruction of C.S.F.circulation, is more often relentlessly progressive."

Second, it is a pity that the authors did not carry theirhistorical research beyond 1823. They might then havelearnt why Barnard’s suggestion was given up. One quotewill suffice here:

" I have myself tried it [repeated aspiration of c.s.F. fromhydrocephalic patients] in two cases; but should never proposeit again-not on account of the severity of the operation but fromthe want of possible success-when the fluid is drawn off it will

again form, and in order to prevent this, if a bandage be appliedsymptoms of compression follow. Our difficulty was so to regulate

1. Epstein, F., Hochwald, G. M., Ransohoff, J. Lancet, 1973, i, 634.

an elastic bandage as to exert pressure sufficient to preventexpansion, and yet not to cause undue compression."$Department of Neurosurgery,

K. E. M. Hospital,Parel, Bombay 12. S. K. PANDYA.

ERRORS IN PHENYTOIN DOSAGE

SIR,—Dr Clow and his colleagues (Aug. 4, p. 256)stated that Parke-Davis would shortly be improving theidentification of ’Epanutin’ capsules by dose stampingand colour coding. For the information of your readers,epanutin capsules 50 mg. are now presented in a no. 4white opaque hard gelatin capsule overprinted with thename Parke-Davis and PD 50 to indicate the productstrength. This change was implemented as from weekcommencing May 7, 1973. Epanutin capsules 100 mg.are now presented in a no. 3 capsule with a white opaquebody and an orange cap. Parke-Davis and PD 100 areprinted on the capsule. This change was made as fromJuly 16, 1973. The contents of each of the above capsulesremain unchanged.

Parke-Davis,Pontypool, Mon. NP4 8YH.

J. R. ARCHER,Director,

professional services.

2. Dr Wilks, Diseases of the Nervous System, p. 145. Cited by theeditor of Rest and Pain, by John Hilton. London, 1887.

Obituary

MARY ELIZABETH MAUREEN STEPHENSM.B.Cantab., M.R.C.P.

Dr Elizabeth Stephens, a research fellow in the

gastroenterology laboratory at St. Thomas’s Hospital,London, died early in June at the age of 32. Herdeath has ended a medical career which had seemedvery promising.

" Liz " Stephens, as she was affectionately known to herfriends and colleagues, had a very distinguished under-graduate record. She won scholarships to Girton College,Cambridge, where she did her preclinical studies, and toUniversity College Hospital, London where she also wonnumerous prizes and medals during her clinical years.Her preregistration and postregistration appointments wereheld in some of the best medical units of London’s hospitals.Her interests gradually drifted towards gastroenterology,in which she specialised during the last few years of her life.She published two papers on aflatoxins and folic acid.

Liz Stephens’ interests were not confined to medicine.She was an accomplished pianist and, in her undergraduateyears, actively participated in drama. She had a warm,pleasing personality, and she won the respect of her

colleagues with her shy but determined and conscientiousways. Her patients were well looked after-and knew it.

M.S.

Births, Marriages and Deaths

DEATHS

LING.—On July 30, in Perth, Western Australia, Thomas MortimerLing, n.M.Oxon, M.R.C.P., of Shackleford, Surrey.