Sherlock Holmes and syphilis

Radioisotope synovectomy

To the editor: I believe Dr. Cooperman's suggestion that Conan Doyle described the occurrence of Marfan's syndrome and homocystinuria in the fictional villain-hero Jefferson Hope (Can Med Assoc J 112: 423, 1975) requires rebuttal. Commentators on the Sherlock Holmes saga must expect critics to spring upon them "like so many staghounds" (a felicitous phrase from the scene of Hope's capture in "A Study in Scarlet") in attempts to demolish their theories, and Dr. Cooperman will not be exempt. Hope had a lethal aneurysm of the thoracic aorta. Only the nature of the underlying disease is debatable. Andrew1 drew attention to the fact that Hope's memory was pathologically deficient. He was trapped by a message directing him to report to Holmes's quarters at 221B Baker St. only 1 day after he had avoided a similar trap by sending a confederate to the same address. Surely he had neurosyphilis, which would account for his bizarre actions and deficient memory for recent events. And just as surely he died of a ruptured syphilitic aneurysm of the aorta. In another Holmes adventure, "The Sign of the Four", Conan Doyle slyly implied that Thaddeus Sholto, a thinly disguised caricature of Oscar Wilde, might have had cardiovascular syphilis by his comments on the condition of Sholto's mitral and aortic valves.

To the editor: In the article "Treatment of persistent knee effusions with intra-articular radioactive gold" (Can Med Assoc J 112: 1085, 1975) Topp, Cross and Fain reported that as much as 60% of an intra-articular injection of 158Au-labelled colloid could escape from the knee joint during radioisotope synovectomy. They postulated that the lesser escape reported for yttrium-90 colloids probably depends partly on the larger colloidal size. We have prepared a stable 50Y-citrate colloid for clinical use. The particle size of this colloid is similar to that of the 195Au colloid manufactured in Canada (A. Warbick: personal communication), yet in 28 patients treated with intra-articular injections of 90Ycitrate colloid 96 to 100% of the injected dose was retained in the knee 24 hours after administration.1 We have seen no evidence of extra-articular accumulation of radioisotope in the regional lymph nodes or the liver. No radioactivity has been detected in the feces and less than 0.4% of the injected dose is excreted in the urine by 48 hours. Therefore, although the two colloids are of similar size, the difference in the amount of leakage from the joint suggests a mechanism that is independent of particle size.

HAMPTON R. RAms, MD

641 Mobrey Dr. Richmond, VA, USA

Reference 1. ANDREW CR: A difficulty in "A Study in Scarlet". Baker Street J 3: 13, 1948 Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.

B.M. BOWEN, M Sc PHARM J. DARRACOTr, MB, BS, D PHYS MED, FRCP[C] E.S. GARNETT, MB, MRCP RH. TOMLINSON, PH 0

McMaster University and McMaster University Medical Centre Hamilton, ON

Reference

Assoc J 112: 799, 1975) follows the general plethora of publications on this subject. The ultimate conversion of our society to metric measurements would seem to be desirable and inevitable. Young,' of the National Institutes of Health, Bethesda, Maryland, is a lucid and vocal proponent of the implementation of the logical SI system for medical measurements. Whether implementation of this system will enable the physician to care more efficiently for his patient remains to be seen. An unrelated, but to my mind equally logical method of reporting laboratory data has not been greatly popularized. This is the SD Unit System, suggested by Gullick and Schauble2 in 1971. This system proposes that each laboratory report its determinations in terms of units of standard deviation from the normal mean for the method as determined by the laboratory. The physician would no longer need to know the various normal values for each procedure and each laboratory; indeed, he would no longer need to know the normal values at all. An increased blood glucose value of + 3.8 SD units would mean the same whether the laboratory used a "true" method of glucose determination or some other technique. The physician's time would be better spent in assessing the importance of the deviation than remembering multiple normal values. Probably, when the implementation of a new system for reporting laboratory determinations is being proposed, there should be some consideration of the value of the SD Unit System. H.M. Ross, MD Victoria General Hospital winni.g, MB

1. BOWEN BM, DARRACOTE J, GARNETr ES, et al: A 90Y-citrate colloid for radioisotope synovectomy. Am J Hosp Pharm (in press)

SI units or SD units or both? To the editor: The editorial "The metric system, the International System of Units (SI) and medicine" (Can Med

References 1. YOUNG DS: Standardized reporting of laboratory data. N Engi J Med 290: 368, 1974 2. GULLICK HD, SCHAUBLE MK: S.D. Unit System for standardized reporting and interpretation of laboratory data. Am J Clin Pathol 57: 517, 1972

CMA JOURNAL/NOVEMBER 8, 1975/VOL. 113 815

Letter: Sherlock Holmes and syphilis.

Sherlock Holmes and syphilis Radioisotope synovectomy To the editor: I believe Dr. Cooperman's suggestion that Conan Doyle described the occurrence...
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