1095

who had normal growth-hormone reserve but a reducedinsulin response to arginine.The dependence of normal insulin secretion on growth-

hormone production by the intact pituitary was suggested bythe subnormal increments in plasma-insulin after a glucoseload in patients with panhypopituitarism 6 and in adultateliotic dwarfs having a mono deficiency of growth hormone 7who had been given an arginine infusion. The clinicalobservations are strengthened by in-vitro work in rats 11

and in-vivo perfusions in dogs 9 which demonstrated the directinfluence of growth hormone on the release of insulin from thepancreas.The accumulating evidence of the existence of an immuno-

logically measurable but biologically inactive growth hormonestresses the importance of finding methods to diagnose thiscondition which, if it involves only growth hormone, mayeasily be misdiagnosed as primordial dwarfism.

I suggest that the insulin response to arginine infusion and,possibly, glucose, be used as a means of indirectly evaluatingthe biological activity of endogenous growth hormone. Thistest gives a more direct evaluation of growth-hormone activitythan does the response of glucose or free fatty acids to insulininjection, since both glucose and free fatty acids are alsoinfluenced by other hormones.

ZVI LARON.

Pædiatric Metabolic and Endocrine Service,Belinson Hospital, Petah Tikva,and Department of Pædiatrics,

Tel Aviv University Medical School.

FATTY ACIDS AND MULTIPLE SCLEROSIS

SIR,-In your interesting annotation (Sept. 30, p. 708) youcite the work of Bernsohn and Stephanides suggesting that" the cause of multiple sclerosis (M.S.) may be a specific defi-ciency of polyunsaturated fatty acids of the <d-3 series." 10 It is

suggested that the diet of North Europeans and Americans hasthis specific deficiency.Against this interesting hypothesis is the fact that White

South Africans eat a diet which is very similar to the diet ofNorthern Europe and yet have a low incidence of M.S. Thecompetition between M-3 fatty acids and saturated fatty acidsderived from animal fat in the diet of the White South Africanis greater than in Northern Europe, because the White SouthAfrican, particularly the Afrikaner, tends to eat a diet very richin animal fats. Nevertheless, the prevalence of M.S. in the

Afrikaans-speaking South-African-born is only an eleventh ofthat in immigrants from Europe, who have much the same riskas those North Europeans who stay in Northern Europe." Anyhypothesis attributing M.S. to a specific deficiency of polyun-saturated fatty acids of the w-3 series must also take account ofthe low prevalence of M.S. in the White South-African-born.

GEOFFREY DEAN.

HALOPERIDOL IN SUBACUTE SCLEROSING

LEUCOENCEPHALITIS

SiR,-We report here a clinical experience which we think ofsome interest.A 19-year-old girl was admitted to this clinic with symptoms,

which began gradually about a year earlier; the main featuresof these were mental regression, and large-amplitude, quick,periodic, jerking movements of myoclonic type of the head andarm muscles, which gave rise to certain postures (like those ofa fencer), and which often caused falling. The electro-

encephalogram (E.E.G.) showed diffuse disorganisation of basalactivity, especially of the frontal areas, with discharges of slow,bilateral, synchronous, polymorphous waves, increased in width6. Cerasi, E., Luft, R. Lancet, 1963, ii, 1359.7. Merimee, T. J., Burgess, J. A., Rabinowitz, D. Diabetes, 1967, 16, 478.8. Bouman, P. R., Bosboom, R. S. Acta endocr., Copenh. 1965, 50, 202.9. Campbell, J., Rastogi, K. S. Diabetes, 1966, 15, 749.

10. Bernsohn, J., Stephanides, L. M. Nature, Lond. 1967, 215, 821.11. Dean, G. Br. med. J. 1967, ii, 724.

and voltage. Cerebrospinal-fluid examination showed a slightincrease in cells (9 per ml.) and in reactions of globulins andproteins. Cerebral biopsy, carried out on the right prefrontallobe, showed striking proliferation of fibrous astroglia, neuronaldegeneration with neuronophagia, glial nodules, perivascularcollections of inflammatory cells, and haemorrhages. Subacute

sclerosing leucoencephalitis (Van Bogaert’s disease) was

diagnosed.From previous experience of treatment of choreic move-

ments, ballismus, and tics with butyrophenones, we tried givingthe patient 4 mg. a day of haloperidol (2 vials of ’ Serenase ’,Luso Farmaco). Within 24-48 hours there was striking reduc-tion of involuntary movements, which, during the next days,grew less and less until there was only a hint of eye andhead rolling. At the same time the mental condition of thepatient improved and she seemed more conscious of hersurroundings. The E.E.G. showed almost complete disappear-ance of the basal alterations, with a tendency towards diffusedesynchronisation, while the delta periodic activity remainedunchanged. On the other hand, a parkinsonian picture beganto appear which was modified by the addition of anti-

parkinsonian drugs (orphenadrine, tricyclamol chloride).In order to be certain that the improvement was due to

haloperidol, we tried suspending the drug. Within 5-6 daysthe patient had returned to the state before treatment-i.e.,there was rapid worsening in the E.E.G., the mental state, andthe hyperkinesia. We resumed treatment and again there wasnotable improvement of the symptoms.

P. DE GIACOMO

J. CAPPIELLOT. PERNIOLA.

Clinic for Nervous and Mental Diseases,Bari University, Italy.

Parliament

QUESTION TIME

Reservation of Antibiotics for Humans

Mr. T. DALYELL asked the Minister of Health if, in view ofthe fact that bacteria might acquire and subsequently inheritresistance to antibiotics and that they might transfer thisresistance to other species of bacteria, including those whichwere dangerous to both man and animals, he would take stepsto reserve exclusively for human use those antibiotics whichwere especially efficacious in the treatment of human infections.- Mr. ROBINSON replied: There is at present no power to

prohibit the use of such antibiotics in animals, but the implica-tions for public health of this use is a matter to which thereview body recommended by the Netherthorpe Committeewill be asked to give early attention. The Government’s

proposals for new medicines legislation would provide powersunder which use in animals could be prohibited if desired.

Scottish Health Services Review

In a written answer, Mr. WILLIAM Ross, Secretary of Statefor Scotland, said that he had decided to undertake a thoroughexamination of the administrative structure of the health ser-vices in Scotland. He said that he would keep in close touchwith the Minister of Health, who had announced his intentionof carrying out a similar inquiry in England and Wales.

Section 2 of the Homicide Act, 1957The number of convictions under section 2 of the Homicide

Act, 1957, and their disposal, was as follows:

The figures in parentheses are the numbers of persons who havebeen transferred to hospitals under section 72 of the Mental HealthAct, 1959.