215

1. von Studnitz, W. Klin. Wschr. To be published.2. von Studnitz, W. Clin. Chim. Acta, 1961 (in the press).3. von Studnitz, W. Scand. J. clin. Lab. Invest. 1960, 12, suppl. 48.

Only one make of syringe had a perfectly fitting nozzlewith no cavity. This syringe could be sterilised by boiling(though this is, of course, not a satisfactory method, whichis one reason why the central sterile supply service is beingintroduced). Only this make of syringe is now used in thishospital as it appears to be the only one with whichinfection can be avoided. The other syringes may be safe

after autoclaving or dry sterilisation; but errors in measur-ing volumes, particularly with small injections, remain aformidable hazard.

We should like to thank Mr. T. F. Dee for his help with thephotograph.

A. H. WRIGHT

The General Hospital, J. D. BLAINEY

The General Hospital, G T WATTSBirmingham. G. T. WATTS.

A. H. WRIGHT

J. D. BLAINEYG. T. WATTS.The General Hospital,

Birmingham.

NEUROBLASTOMA AND CATECHOLAMINEEXCRETION

SIR,-I read the letter of Mr. Bell and Dr. Steward(May 13) with great interest. We have recently investi-gated the excretion of 3-methoxy-4-hydroxyphenylacetic(homovanillic) acid in 25 patients with neuroblastoma.!With high-voltage paper electrophoresis we found excretion

of homovanillic acid increased above normal ( > 40 pg. per mg.creatinine) in 17 of them. In 24 of the 25 excretion of 3-methoxy-4-hydroxymandelic acid (V.M.A.) was increased

(>9-5 {ig. per mg. creatinine). V.M.A. excretion was normal in

only 1 of the 17 patients with increased homovanillic-acidexcretion.

In 3 cases with very high urinary levels of both these phenolicacids, we also succeeded in demonstrating a new catabolite of3, 4-dihydroxyphenylalanine (DoPA), 3-methoxy-4-hydroxy-phenylalanine.2 2 In 2 of them we determined the urinarydopamine, and found quite high values.3In 5 children with benign neural tumours, the excretion of

homovanillic acid and V.M.A. was normal.1Department of Clinical Chemistry,

University of Lund,General Hospital, Malm6, WIILFRIED VON STUDNITZ.Sweden. WILFRIED VON STUDNITZ.WILFRIED VON STUDNITZ.

Department of Clinical Chemistry,University of Lund,

General Hospital, Malmö,Sweden.

HYPOPHOSPHATÆMIA IN GOUT

SIR,-We have observed that hypophosphatsemia is

very frequently found in patients with gout.In a control

group of 20normal adultmen the aver-

age value for

serum-phos-phate was 3-43mg. per 100

ml., with a

standard de-viation of 0-42,so that we cantake 2.6 mg.per 100 ml. asthe lower limit

ofnormalphos-phataemia(3-43-2 S.D.).In 8 of 11

patients with

gout the valuesfell below thislevel (see fig-ure) 2 of theother 3 were

those who had had symptoms for the shortest time: a physician(case 7), was examined only two days after his first joint pain,and the other (case 11) first had symptoms two months beforethe examination; in case 7 the lowest value of serum-phosphatewas obtained after the illness had lasted one year. Clinical signshad been present in the patients with definite hypophos-phataemia for periods of between two and ten years.

Serum-phosphate was determined in every case beforetreatment; it was only repeated at least two weeks after discon-tinuing any therapy. Hyperuricxmia was demonstrated in everycase. Blood-urea was normal in all. Serum calcium andalkaline phosphatase were determined in 5 cases; the resultswere normal.A likely explanation for hypophosphatasmia in gout may be

a renal leakage of phosphate because of tubular damage due topersistent hyperuricaemia.

Department of Medicine, HELIO L. DE OLIVEIRAMedical School of Ribeirao Preto,

Sao Paulo, Brazil. JOSE A. LAUS-FlLHO.HELIO L. DE OLIVEIRA

JOSÉ A. LAUS-FILHO.Department of Medicine,

Medical School of Ribeirão Prêto,São Paulo, Brazil.

LANGUAGE: THE LOST TOOL OF LEARNING

SiR,-It was exciting to read the words of Sir GeorgePickering in last week’s issue.

His proposition that the teaching of the schoolmen was anobstacle to the scientific method is, at least, arguable. I feelit important that your readers distinguish between theThomism of the true schoolmen and the obscurities of thefollowers of William of Ockham. The teaching of Williaminfluenced the university world before the Renaissance; but,whatever it was, it was not scholasticism.

Though Sir George has no wish to return to medievalhabits of thought, I am sure he will forgive a hearty"distinguo ! ".

Glasgow. THOMAS L. O’DONNELL.

SIR,-Professor Pickering’s scholarly address givesmuch food for thought; but I should like to join issuewith him on the use of atherosclerosis.

As one of Professor Newcomb’s students I never understoodhis objection to the term, since to my mind it simply meanssclerosis as a result of atheroma, athero- being merely a prefix,and is only one variety of arteriosclerosis, which should be ageneric term to include hardening of the arteries from anycause. Marchand rightly stressed the importance of atheromaas the main cause of arteriosclerosis, resulting from fibrosisand calcification, but obviously we must use the term athero-sclerosis in a narrow and specific sense. An aneurysm arisingas a result of medical damage secondary to atheroma cantherefore legitimately be called an atherosclerotic aneurysm.

Another of Professor Pickering’s examples of the tyranny ofwords is the use of " stress ". Surely, if we are being scientific,this can have only one meaning and that is the mathematicalone-viz., the force which is applied to an object: in biologicalparlance, the stimulus. The result of its application is strain-_i.e., response. Stress and strain are commonly reversed inordinary speech, and Selye unfortunately so misused it. AsProfessor Pickering points out, we should be careful to

use words in their correct sense-and our largest univer-

sity has contemplated omitting English as a compulsorylanguage!

Chertsey, Surrey. C. F. ROSS.

SIR,—My strong agreement with most of ProfessorPickering’s criticism of the English of many medicalwriters has tempted me to air some views I have longheld on the subject and thereby to break a resolution Imade some time ago not to write anything more forpublication.About fifty years ago when I was collaborating with the late

Colonel C. E. Pollock in the writing of a small monograph,later published by the Oxford Medical Press, he diplomatically

THOMAS L. O’DONNELL.

C. F. Ross.