Journal of the Royal Society of Medicine Volume 83 July 1990 6 Williams P, De Salvia D, Tansella M. Suicide, psychiatric reform and the provision of psychiatric services in Italy. Soc Psychiatry, 1986;12:89-95 7 Williams P, De Salvia, Tansella M. Suicide and the Italian psychiatric reform: an appraisal of two data collection systems. Eur Arch Psychiatry Neurol Sci 1987;236:237-40 8 Williams P, Tansella M. The time for suicide. Acta Psychiatr Scand 1987;75:532-5
Spinal cord compression associated with pseudohypoparathyroidism I was very interested to read the article by Alam and Kelly (January 1990 JRSM, p 50). They state that 'there have only been four previous reports' of this. Their paper illustrates the difficulty in comparing diagnosis over a long time when the advances in medicine result in newer criteria being used to confirm a diagnosis. They report normal plasma immunoactive PTH levels and a low bioactive PTH concentration while not giving the figures for the 'subnormal rise in urinary cAMP' with bovine PTH. All these tests are relatively new compared with the long standing difficulty in distinguishing pseudohypoparathyroidism from hypoparathyroidism. Other cases of spinal cord compression in hypoparathyroid disease have been reportedl2. I suspect that spinal pathology is not an uncommon complication of idiopathic disorders associated with hypoparathyroid metabolism. F B GIBBERD
Consultant Physician and Neurologist Westminster Hospital, Dean Ryle Street, Horseferry Road, London SWlP 2AP
References 1 Gibberd FIB. Idiopathic hypoparathyroidism with unusual bone changes and spastic paraplegia. Acta Endocrinol 1965;48:23-30 2 Salveson HA, Boe J. Idiopathic hypoparathyroidism. Observation on two cases. Acta Endocrinol 1953;14:214-26
Seizures and alcohol How do Heckmatt et aL (January 1990 JRSM, p 6) know that some of their patients who abuse alcohol have primary epilepsy? My experience from the other end is that patients who drink excessively and have fits are frequently labelled 'epilepsy' for life, without anyone having taken a proper drinkin history. They are then given anti-epileptic drugs without advice to stop or cut down their drinking. Admittedly many are already seriously dependent on alcohol when fits occur, but sometimes a first fit is a salutary event that can provide the incentive to stop drinking, provided that the doctor recognizes the cause. ALEX PATON
Honorary Consultant Physician Oxford Regional Alcoholism Unit, Warneford Hospital, Oxford
Fine needle aspiration We support Mr Ryan (January 1990 JRSM, p 59) in advocating fine needle aspiration as an invaluable means of distinguishing benign from malignant parotid lesions. Mr Gallegos in his reply (January
1990 JRSM, p 59) counselled against fine needle aspiration in patients with clinically benign lumps in the parotid although in his original case record (July 1989 JRSM, p 442) he describes using fine needle aspiration biopsy. This technique is too valuable and safe a diagnostic test to dismiss and the onus must rest on those who do not advocate its use to provide the evidence of what real risks if any, there are. In any event what is a 'clinically benign' lump in the parotid? Many pleomorphic adenomas present as apparent benign masses and these are the very ones that fine needle aspiration will distinguish. 88 Harley Street A E KARK London WlN 1AE E R T C OWEN References 1 Young JEM, Archibald SD, Shier KJ. Needle aspiration cytologic biopsy in head and neck masses. Am J Surg 1981;42:484-9 2 IJndberg LG, Akerman M. Aspiration cytology ofsalivary gland tumours: diagnostic experience from six years of routine laboratory work. Laryngoscope 1976;86:584-94 3 Webb AJ. Cytologic diagnosis of salivary gland lesions in adult and paediatric surgical patients. Acta Cytol 1973;17:51-8 4 Owen ERTC, Banerjee AK, Prichard AJN, Hudson EA, Kark AE. The role of fine needle aspiration cytology (FNAC) and computed tomography (CT) in the diagnosis of parotid swellings. Br J Surg 1989;76:1273-4
Kosher tests 'Kosher' is a Hebrew word meaning 'fit' or 'proper' and has been fully naturalized into American English usage. It can be found by anyone competent to use an English dictionary. The misunderstanding displayed by Drs Dundee and Westbury (October 1989 JRSM, p 635; January 1990 JRSM, p 128) would appear to be acts of self-proclaimed bigotry. The English language is enriched with many words and concepts of Hebrew origin. 'Jubilee', 'Messiah', 'Hosanna', 'Shibboleth"Halleluyah' are close transliterations. The concepts of Heaven, Salvation, Paradise, and the ideas of love of one's neighbour (Lev 19.18) and of one's enemy (Prov 25.21) are undisputed borrowings from Hebrew literature. Latterly, other Hebrew concepts such as cleanliness, long condemned as un-Christian, (St Jerome taught 'He who has washed in Christ has no need to wash again') have been Anglicized. At the present time there is growing interest in eating that which is fit and proper, ie kosher, for health. Dr Westbury used a capital K in order to knock it down. I do not. Perhaps these learned gentlemen write in order to preserve and propagate the myth that among research scientists no culture exists outside a Petri dish? G SAMUEL 12 Castle Garden Petersfield GY32 3AG
The author replies below I apologise for having upset Samuel over the use of the word 'Kosher' in my letter (October 1989 JRSM, p 635). This was unintentional, and I am now aware of its wider use than in Hebrew food. This was not an act of 'self-proclaimed bigotry', as is suggested. The letter was written after discussion with our statisticians. Just as an Irishman working for Guinness used the word 'student' when describing the 't-test', so we assumed that some American had developed the 'Kosher' test, of which we were
477
Spinal cord compression associated with pseudohypoparathyroidism I was very interested to read the article by Alam and Kelly (January 1990 JRSM, p 50). They state that 'there have only been four previous reports' of this. Their paper illustrates the difficulty in comparing diagnosis over a long time when the advances in medicine result in newer criteria being used to confirm a diagnosis. They report normal plasma immunoactive PTH levels and a low bioactive PTH concentration while not giving the figures for the 'subnormal rise in urinary cAMP' with bovine PTH. All these tests are relatively new compared with the long standing difficulty in distinguishing pseudohypoparathyroidism from hypoparathyroidism. Other cases of spinal cord compression in hypoparathyroid disease have been reportedl2. I suspect that spinal pathology is not an uncommon complication of idiopathic disorders associated with hypoparathyroid metabolism. F B GIBBERD
Consultant Physician and Neurologist Westminster Hospital, Dean Ryle Street, Horseferry Road, London SWlP 2AP
References 1 Gibberd FIB. Idiopathic hypoparathyroidism with unusual bone changes and spastic paraplegia. Acta Endocrinol 1965;48:23-30 2 Salveson HA, Boe J. Idiopathic hypoparathyroidism. Observation on two cases. Acta Endocrinol 1953;14:214-26
Seizures and alcohol How do Heckmatt et aL (January 1990 JRSM, p 6) know that some of their patients who abuse alcohol have primary epilepsy? My experience from the other end is that patients who drink excessively and have fits are frequently labelled 'epilepsy' for life, without anyone having taken a proper drinkin history. They are then given anti-epileptic drugs without advice to stop or cut down their drinking. Admittedly many are already seriously dependent on alcohol when fits occur, but sometimes a first fit is a salutary event that can provide the incentive to stop drinking, provided that the doctor recognizes the cause. ALEX PATON
Honorary Consultant Physician Oxford Regional Alcoholism Unit, Warneford Hospital, Oxford
Fine needle aspiration We support Mr Ryan (January 1990 JRSM, p 59) in advocating fine needle aspiration as an invaluable means of distinguishing benign from malignant parotid lesions. Mr Gallegos in his reply (January
1990 JRSM, p 59) counselled against fine needle aspiration in patients with clinically benign lumps in the parotid although in his original case record (July 1989 JRSM, p 442) he describes using fine needle aspiration biopsy. This technique is too valuable and safe a diagnostic test to dismiss and the onus must rest on those who do not advocate its use to provide the evidence of what real risks if any, there are. In any event what is a 'clinically benign' lump in the parotid? Many pleomorphic adenomas present as apparent benign masses and these are the very ones that fine needle aspiration will distinguish. 88 Harley Street A E KARK London WlN 1AE E R T C OWEN References 1 Young JEM, Archibald SD, Shier KJ. Needle aspiration cytologic biopsy in head and neck masses. Am J Surg 1981;42:484-9 2 IJndberg LG, Akerman M. Aspiration cytology ofsalivary gland tumours: diagnostic experience from six years of routine laboratory work. Laryngoscope 1976;86:584-94 3 Webb AJ. Cytologic diagnosis of salivary gland lesions in adult and paediatric surgical patients. Acta Cytol 1973;17:51-8 4 Owen ERTC, Banerjee AK, Prichard AJN, Hudson EA, Kark AE. The role of fine needle aspiration cytology (FNAC) and computed tomography (CT) in the diagnosis of parotid swellings. Br J Surg 1989;76:1273-4
Kosher tests 'Kosher' is a Hebrew word meaning 'fit' or 'proper' and has been fully naturalized into American English usage. It can be found by anyone competent to use an English dictionary. The misunderstanding displayed by Drs Dundee and Westbury (October 1989 JRSM, p 635; January 1990 JRSM, p 128) would appear to be acts of self-proclaimed bigotry. The English language is enriched with many words and concepts of Hebrew origin. 'Jubilee', 'Messiah', 'Hosanna', 'Shibboleth"Halleluyah' are close transliterations. The concepts of Heaven, Salvation, Paradise, and the ideas of love of one's neighbour (Lev 19.18) and of one's enemy (Prov 25.21) are undisputed borrowings from Hebrew literature. Latterly, other Hebrew concepts such as cleanliness, long condemned as un-Christian, (St Jerome taught 'He who has washed in Christ has no need to wash again') have been Anglicized. At the present time there is growing interest in eating that which is fit and proper, ie kosher, for health. Dr Westbury used a capital K in order to knock it down. I do not. Perhaps these learned gentlemen write in order to preserve and propagate the myth that among research scientists no culture exists outside a Petri dish? G SAMUEL 12 Castle Garden Petersfield GY32 3AG
The author replies below I apologise for having upset Samuel over the use of the word 'Kosher' in my letter (October 1989 JRSM, p 635). This was unintentional, and I am now aware of its wider use than in Hebrew food. This was not an act of 'self-proclaimed bigotry', as is suggested. The letter was written after discussion with our statisticians. Just as an Irishman working for Guinness used the word 'student' when describing the 't-test', so we assumed that some American had developed the 'Kosher' test, of which we were
477
