685

tion. The provision of a medical dossier for all patientsmight be a proper and valuable feature of the NationalHealth Service. Perhaps a National Medical ArchiveOffice storing microfilm copies of records is not an

impracticable suggestion.Meanwhile, the practical problem of keeping patients’

records revolves around the question of the space requiredfor their storage. The ideal way of keeping records is

probably in their original and complete form. Lesssatisfactory is to employ some selection of types ofrecords to be conserved. Microfilm records obviouslysave an enormous amount of space, but the initial cost ofthe apparatus, as well as the continual employment ofextra staff to operate it, represents a formidable financialburden, and such a solution might be more suitable to aCentral Medical Archive Office than to smaller units suchas hospital groups.In my view, it is better that case-papers be kept

intact and indefinitely and in their original form untilsome further consideration be given to this problem ona national scale. It seems unsatisfactory that the fateof patients’ records should be decided at the level of localhospital management committees whose practice willcertainlv varv.

M. 0. SKELTON.Lewisham Hospital,London, S.E.13.

INSULIN TREATMENT OF SCHIZOPHRENIA

H. PULLAR-STRECKER

SIR,—I should like to congratulate Dr. Ackner, Dr.Harris, and Dr. Oldham on their controlled study,a masterpiece of planning and execution, described inyour last issue (p. 607). Whether we like it or not, weshall have to accept their conclusion that insulin is notthe therapeutic agent of the coma regime. However,this need not sadden the old hands ; it simply confirmsthat for getting there’in medicine there is nothing likethe prescription : Sweat makes good mortar.

HEBERDEN SOCIETY

A. T. RICHARDSONJ. H. JACOBSR. L. MARKHAME. V. HESS.

Department of Physical Medicineand Rheumatology,Royal Free Hospital,

London, W.C.1.

SIR,—Your report of March 16 (p. 565) of the papersread at the meeting of the Heberden Society on Feb. 22contains a number of inaccuracies which we would be

grateful if you would correct.First, with regard to the electrodiagnostic changes in

polymyositis, no evidence of spontaneous lower-motor-neurone activity was found and it was the association ofa high rheobase with an intensity-duration curve charac-teristic of denervated muscle that was of significance.The characteristic electromyographic change was a pre-dominance on volition of the short duration and poly-phasic motor unit potentials typical of a myopathy with,in half the cases, the coexisting features of a neuropathiclesion-i.e., long duration polyphasic motor unit poten-tials with occasional fibrillation potentials and positivepotentials.

Second, the paper on the electrophoresis of serum-

proteins referred not, as you report, to "

glycoproteins,"but to " mucoproteins," the fractions wrl and M2 of whichform a part only of the &agr;1 and &agr;2 glycoproteins respectively.Therefore, mucoprotein wrl or M2 should be read for &agr;1or &agr;2 glycoproteins throughout your report. While thespot shapes indicative of fraction micro-heterogeneitywere obtained after two dimensional electrophoresis,semi-quantitative estimation of the two mucoproteinfractions were, in fact, based on a single electrophoreticanalysis at pH 4.5.

Finally, in the paper on sheep-cell agglutination tests,the figures you report-e.g., positive results in 48% ofcases of lupus erythematosus—relate to those quotedfrom the world literature and were not the resultsobtained at this hospital upon which the paper was based.More important, however, is the fact that not all of ourlupus cases with positive agglutination with the super-

natant had a positive result with the precipitate and asa method of distinguishing between rheumatoid arthritisand lupus erythematosus, it was apparently reliable inthe event of a positive agglutination with the supernatant.Finally, it was the cases of systemic lupus erythematosuswithout joint involvement that appeared to have a higherincidence of false positive Wassermann tests (especiallythe cardiolipin test) and it was in two cases, not one, ofsystemic lupus with positive agglutination tests that theactivity lay in the &bgr;-globulin zone.

CIGARETTE SMOKING AT SCHOOL

P. W. BOTHWELLDeputy County Medical Officer.

Health Department,Oxfordshire County Council,

Oxford.

SIR,—I was most interested in the article by Dr.Parry Jones in your issue of March 23. I notice that hethinks his results might be abnormally high.

I am at present conducting an investigation into thesmoking habits of school-children in this county. This is

being carried out by means of an anonymous question-naire, following an explanatory talk to the pupils. Theeventual total number involved will be in the region of9500 children between the ages of 11 and 16 and attendingall types of school. Several months will elapse beforethe survey has been completed and analysed, but pre-liminary results indicate that Dr. Parry Jones’s findingsare not in any way abnormal, and, in fact, some of myearlier findings show that the incidence of smoking is

higher than he has quoted.

RHEUMATOID ARTHRITIS WITH CHRONIC LEGULCERATION

SIR,—It was not at all our intention, in our article ofFeb. 9, to suggest that varicose ulceration may notcoexist with rheumatoid arthritis. It would indeed besignificant if two such common disorders were not oftenseen in the same patient. We are naturally familiarwith cases like the one Dr. Rivlin mentions (March 9) inwhich, as he says, the ulcer obviously results from venousstasis.Our point is that in the cases we described we could

decide that the ulcers did not so originate. We needhardly detail the bed rest and ancillary treatment wegave for these ulcers except to emphasise that themethods we used were those by which we regularly healstasis ulcers and that failure of these cases to heal wasstriking and at first unexpected. ,

We agree with Dr. Laine and Dr. Vainio (March 23)that the L.E.-cell phenomenon is not specific, but we hadmore evidence than this. Because of the clinical simi-

larity of the cases, all showing skin ulceration withrheumatoid arthritis in the absence of vascular stasis,we thought it right to group them together, and it thenis seen that among six patients four had shown drugsensitivity, all had serum abnormalities, four showed theL.E.-cell phenomenon, and there were many other featureswhich taken together can all be covered by the diagnosisof disseminated lupus erythematosus and by no othersingle diagnosis.

In describing these cases as " rheumatoid arthritiswith chronic leg ulceration " we were careful to avoidcalling them " disseminated lupus erythematosus withleg ulceration," and in our discussion we indicated thecontrast between these cases and the more acute casein which the diagnosis of disseminated lupus erythema-tosus is more acceptable.

In general the diagnostic criteria of disseminated lupuserythematosus cannot be precisely laid down. If, there-fore, we put these cases into the category of disseminated