FERTILITY AND MENTAL ILLNESS

FERTILITY AND MENTAL ILLNESS

585 that the attacks of muscle spasm were due to glutethimide. The site of action remains obscure,but, in view of the changing posture of the limbs, ...

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that the attacks of muscle spasm were due to glutethimide. The site of action remains obscure,but, in view of the changing posture of the limbs, this may be in the corpus striatum. This case underlines the safety of the therapeutic dose of glutethimide, and also that it is a suitable sedative for patients where respiratory depression should be avoided. Bemegride is indicated in cases of poisoning. A. R. HORLER Royal Victoria Infirmary, N. R. ROWELL. Newcastle upon Type, 1.

FERTILITY AND MENTAL ILLNESS

SIR In your leading article of Aug. 16 you refer to finding that " schizophrenics ... were as a whole about a quarter as fertile as the. general population ". It may be of interest to point out that Reiss and Hemphill1 have shown that in many advanced schizophrenics there is vascular degeneration of the testes; this could undoubtedly have had an effect on the lowered fertility. I have also noted the relation between hypothalamic disturbances and impaired fertility, and many men suffering from such conditions are infertile. In two cases of narcolepsy there MIDGET ANÆSTHETIC MACHINES was severe infertility, and other observers have already SIR,—With reference to Dr. Burton’s letter last week, noted this connection. It may well be, therefore, that the universal adoption of the B.S.I. pin index fitting for there is an organic basis to be taken into account as medical gas cylinders should facilitate the development of well as the " premorbid schizoid personality" making lightweight anxsthetic machines. less marriage likely to which you refer. a

We have had in use for six months an apparatus weighing 7 lb. that can be fitted with any size of pin index cylinders. The basis of the apparatus is combined cylinder yokes, regulators, and plastic flowmeters for the gases. The fittings are

standard anxsthetic equipment

so

that additions

or

replace-

easily available. A full range of gases can be used and any standard vaporising bottle included in the circuit. The similar heads for all sizes of the new cylinders together with the use of lightweight alloys in the machine allow the machine to serve in daily use and as a portable emergency

ments are

apparatus. Royal Marsden Hospital, London, S.W.3.

J. D. K. BURTON.

THE PLACE OF THE RESEARCH INSTITUTE IN THE ADVANCE OF MEDICINE

SIR,-Sir Charles Harington’s article1 will have been read with great interest by medical research workers everywhere. As his closing theme he mentions the difficulty of establishing sufficient contact between the laboratory research institute and the sick patient, and considers the possible advantages of establishing institutes for clinical research. Conditions in Malaya are very different from those in England, but this Institute for Medical Research has over a few decades achieved a fortunate blend of laboratory and clinical work. The Institute itself has no beds, but is situated next to a large general hospital. When a patient is admitted to the hospital with an illness known to be of interest to one of the Institute staff, we are notified, and, if after initial examinations the patient is deemed suitable for further research studies, the hospital physicians have generously allowed us to take over complete control of the patient while retaining the use of the hospital bed. This has been practised in the study of such diseases as beriberi, malaria, filariasis, and the nutritional anaemias. This happy state depends entirely upon the good will and confidence between the hospital and Institute staff at the personal level-a trust which has been built up for half a century. Such a system has the great advantage of flexibility, for when the study of any particular problem has been completed it is easy to pass to another by drawing upon a different type of patient in the large hospital pool.

Many of the difficulties in tropical medical research are avoided by this efficient system, which allows maximum to be gained from the material at hand. here bears out Sir Charles Harington’s view Experience that such a combination of clinical and laboratory research can provide valuable results.

information

Institute for Medical Research, Kuala

Lumpur, Malaya. 1.

P. W. G. TASKER

Lancet, 1958, i, 1345.

BERNARD SANDLER. CARDIAC COMPLICATIONS OF COXSACKIE-VIRUS INFECTION

SIR,—We have already described2 infection with Coxsackie virus type B4 as a cause of benign pericarditis. Recently another of these cases has shown evidence of infection with Coxsackie virus type B3; and we would like to draw attention to the signs of cardiac involvement. A man, aged 50, contracted an acute febrile illness which lasted for 5 days. The onset was sudden with shivering, sharp pains in the chest, and considerable dyspnoea. The initial temperature was 1024°F. There were crepitations over the lower lobe of the right lung, and pericardial friction was audible over the precordium, especially at the base of the heart. The heart rhythm was regular, rate 100 per min. X-ray of the chest on the day of admission showed moderate cardiac " " enlargement and an area of ground-glass consolidation in the lower lobe of the right lung. An electrocardiograph at this time was abnormal; the T waves were negative in leads I, aVL, and V1—6, with slight elevation of the s-T segments. In association with the clinical findings these changes may be regarded as evidence of cardiac involvement with pericarditis. Ten days later the electrocardiograph had -reverted to normal, and repeat X-ray of the chest showed that the heart was now normal in size, and the consolidation of the right lung had resolved. Also the patient had made a complete clinical recovery.

Results of neutralisation tests for Coxsackie virus type B in tissue culture (monkey kidney) carried out by the Virus Reference Laboratory, Colindale, London, were:

Subsequent neutralisation tests over a period of three months showed titres of 1/64 for type B3. Routine laboratory investigations revealed no other significant features to account for the febrile illness: white blood-cells 9450 per c.mm.; anti-streptolysin titre positive 1/20 and negative 1/40; throat swab, The patient’s convalescence was Streptococcus viridans. uneventful, and recovery was complete. The neutralisation tests support the view that the a Coxsackie-virus infection type B3. The febrile illness is typical of such an infection, especially the chest pains and pulmonary complications. Cardiac involvement in Coxsackie-virus infection is becoming more widely recognised, and this case of type-B3 infection adds to the astiological factors of

patient had acute

benign nericarditis. Belfast City Hospital. 1. 2.

Reiss, M., Hemphill, R. E. J.

EVAN FLETCHER C. F. BRENNAN.

ment. Sci. 1944, 90, 681. Fletcher, E., Brennan, C. F. Lancet, 1957, i, 913.