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Neuroblastoma is an extremely rare tumour in adults,and complete regression in adults, whether spontaneous orinduced, is also very uncommon. Cyanocobalamin is wellknown to have maturation effects on neuroblastomas; but,since it was given for such a short time, I wonder whetherplacental gonadotrophins may have had such an effect onthe tumour.

A. CHAUDHURY.

Dunlop India Ltd.,P.O. Sahaganj,Dist. Hooghly,West Bengal,

India.

HOSPITAL STATISTICS OF THE OLDAND YOUNG

W. A. WILSON.

Office of Population Censuses and Surveys,H.I.P.E.,

Somerset House,London WC2R 1LR.

SiR,—Your correspondents (Oct. 23, p. 923) allege theabsence of hospital data on the elderly sick; readers maylike to know that national data have been available, althoughnot published in detail, since 1962. Computer tables areavailable for reference or photocopying at SomersetHouse, and they cover every 4-digit I.C.D. category bysex, number of discharges, immediate admissions, anddeaths. A catchment-area table, providing the source

(local-authority area) of patients in the major hospitaldepartments for each hospital management committee isunder preparation.A catchment-area table for children under the age of 15

is already available, and those wishing to obtain copiesfor areas in which they are interested are invited to writeto the undersigned.

TRYPTOPHAN/NICOTINIC-ACID METABOLISMDURING LEVODOPA TREATMENT OF

PARKINSONISM

GIUSEPPE COZZOLINOSANDRO CAMPRIANISANDRO ALUNNORICCARDO GIANNINILUCIANO GIOMBINI.

Divisione di Medicina Generale,Sezione Malattie Dismetaboliche,Ospedale Generale Provinciale,

06012 Città di Castello,Perugia, Italy.

SIR,-Levodopa has been shown to disturb the conver-sion of tryptophan to 5-hydroxytryptamine. In a

patient with Parkinson’s disease we have studied thebehaviour of some metabolites of the tryptophan/nicotinic-acid pathway during a 24-day period of levodopa treatment.The patient, a man aged 50, was given increasing dosesof levodopa up to 3 g. daily, and no other treatment. Onthe 7th day he became agitated and complained of anorexia,dysphagia, glossitis, and abdominal pains. These symptomsimproved after a further 7 days, and levodopa did not haveto be withdrawn. Kynurenine (Ky), anthranilic acid (A.A.)and its glucuronide (A.A.G.), o-aminohippuric acid (o-A.H.A.),3-hydroxykynurenine (3-H.K.), and 3-hydroxyanthranilicacid (3-H.A.A.) were measured in 24-hour urine specimensby column chromatography. 3On the lst day, excretion of these metabolites was

significantly higher than in normal people.4 Correspondingto the appearance of levodopa side-effects, there was anincrease in urinary Ky, A.A., A.A.G., O-A.H.A. and 3-H.x.,while 3-H.A.A. excretion fell. The curve for urinaryexcretion of 3-H.A.A. was the mirror image of that for3-H.K. The changes in excretion-rates reached a peakbetween 11 and 12 days, and had returned to basal levelsby day 14-15.The opposite behaviour of urinary 3-H.K. and 3-H.A.A.

shows that the activity of kynureninase (which catalyses

1. Bartholini, G., Da Prada, M., Pletscher, A. J. Pharm. Pharmac.1969, 20, 228.

2. Butcher, L. L., Engel, J. Brain Res. 1969, 15, 233.3. Brown, R. R., Price, J. M. J. biol. Chem. 1956, 985, 219.4. Cozzolino, G. Metabolismo del triptofano; chap. VII. Perugia, 1968.

the conversion of 3-H.K. to 3-H.A.A.,5 mediated by pyridoxalphosphate 6) is decreased. Since no other drugs were given,we presume that this effect was due to levodopa. Similarbiochemical inhibition is seen in pellagra,’- in whichabnormalities in the tryptophan/nicotinic-acid pathwaycause a decrease in the formation of pyrimidine coenzymes,and hence pathological changes in cellular oxidation. Ourresults lead us to suggest that some of the gastrointestinaland neurological side-effects of levodopa may be due toalteration of the tryptophan/nicotinic-acid pathway andconsequent lack of pyridoxal-phosphate-dependentenzvmes.

Obituary

LEWIS JOHN HURWITZM.D.Belf., F.R.C.P.E.

Dr. L. J. Hurwitz, neurologist at the Royal Victoriaand Claremont Street Hospitals, Belfast, died on Oct.19 at the age of 45.

He graduated M.B. in 1949, and after a general house-appointment he was house-physician in the department ofneurology at the Royal Victoria Hospital, later becomingjunior and then senior registrar. He then took up a house-appointment at the National Hospital, Queen Square,London, where he spent three years, becoming residentmedical officer and lecturer in developmental neurology atthe Institute of Neurology. He obtained a research fellow-ship at Cornell University, New York, where he took amajor part in a clinical-pathological survey of cerebraldisease with special relation to the extracranial vessels. Onreturning to London he obtained a Ciba travelling fellow-ship, which enabled him to work in clinical neurology at theSalpetriere in 1961. He returned to Belfast and wasappointed to the visiting staffs of the Royal Victoria andClaremont Street Hospitals. His many research interestsincluded parkinsonism, brain function in the organicmental disorders of elderly people, word-blindness,visual disorientation, simultagnosia, and aphasia.He is survived by his wife, who is a doctor, a daughter,

and two sons.

M. S. writes:" I first met Louis Hurwitz at the National Hospital,

Queen Square, in 1960, and I have had the privilege ofbeing closely associated with him as colleague and friend inthe department of neurology in Belfast for the past sevenyears. He was gifted with a truly remarkable brain andintellect, which greedily absorbed a classical training atQueen Square and the Salpetriere to produce a formidableclinical neurologist, who brought distinction to the hospi-tals and medical school in Belfast. In spite of his greatknowledge and authority on many subjects, his chiefcharacteristics were humility and eagerness to recognisethe contributions of others-often insignificant comparedwith his own.

5. Braunstein, A. E., Goryachenkova, E. V., Pashkina, T. S. Biokhimiya,1949, 14, 163.

6. Mitchell, H. K., Nyc, J. F. Proc. natn. Acad. Sci., U.S.A. 1948,34, 1.

7. Oliva, G., Cozzolino, G. Comun. Congr. naz. Soc. it. Biol. sper.Torino, October, 1967.

8. Cozzolino, G., Dominici, G., Latini, P. Boll. Soc. it. Biol. sper.1967, 43, 1493.

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"He was an inspiring teacher and well loved by hisstudents. In his clinical demonstrations he brought bothclassical description and recent investigations to bear uponeach problem. His undergraduate teaching extended tophysiotherapists, speech therapists, dental students, nurses,and psychologists, and his name on a programme for

general practitioners was sufficient guarantee of a largeaudience. There was no discipline which did not interesthim, and in the last years of his life he wrote with theenthusiasm of an artist wishing to leave behind him somerecord of his thoughts and ideas. His many papers on awide variety of topics bear witness to his success in thisrespect.

" It is said that no-one is indispensable, but LouisHurwitz was indispensable to us. His death leaves a voidin the life of the hospitals of Belfast and in the hearts of hiscolleagues and friends which can never be filled."

THOMAS ANWYL-DAVIESM.D.Lond., F.R.C.P.

Dr. Thomas Anwyl-Davies, honorary consultant toSt. Thomas’s Hospital, and a pioneer in the scienceand practice of venereology, died on Oct. 4.He graduated M.B. from St. Thomas’s Hospital in 1917,

served during the war in the R.A.M.C., proceeded to theM.D.-with gold medal-in 1930, and was elected F.R.C.P.in 1937. From 1935 until his retirement he was directorof the St. Thomas’s v.D. department.

It is difficult to realise now that until the end of the1914-18 war, 50 years ago, there were no special facilitiesor trained doctors to deal with the problem of venerealdisease, and this was true not only in Britain. When theSt. Thomas’s authorities invited Colonel Harrison to setup the first free treatment centre, Dr. Anwyl-Davies tookcharge of the v.D. department. His expertise and humani-tarian approach made it such a success that not long after-wards he was invited by the Ministry of Health to start asimilar clinic at the London Hospital. This was also a

great success. During 1936 he was invited by the UnitedStates Government to the White House to set up and headan advisory committee on the establishment of specialclinics in America. He also became consultant to theLondon County Council. In fact, he had an outstandingreputation in this sphere, and not only did much to educatethe general public, but also provided them with a servicein the specialty.

His public-spiritedness, however, was by no meanslimited to his doctoring; for many years he held office as

secretary to the Royal Medical Benevolent Fund, and was akeen and active councillor of the Westminster City Council.He was held in great esteem by his colleagues and manypatients, and he will be sorely missed He performed adifficult task supremely well, and unobtrusively showedthe light to numerous followers.

H. G.-H.

A memorial service will be held in the chapel of St.Thomas’s Hospital, London, at noon on Friday, Nov. 19.

FRANCIS REGINALD LEONARDM.B.Otago, B.Sc.Auckland, F.R.C.S.

Mr. Rex Leonard, surgeon to the Benedictine Mis-sion Hospital, Nongoma, Zululand, died in Natal onAug. 21.He was born in 1902 in Auckland, New Zealand, and

educated at Auckland Grammar School, the University ofAuckland, where he graduated B.sc., and the Universityof Otago, where he graduated M.B. in 1925. He then workedas a resident medical officer for two years at Auckland

Hospital, followed by a period of private practice. In1930 he went to England and joined the London CountyCouncil Hospital Medical Service, working at Archwayand other hospitals. In 1936 he became F.R.C.S. Follow-

ing the outbreak of the 1939-45 war he joined the R.N.V.R.as a surgical specialist, serving in cruisers patrollingSouth American waters and later at the R.N. Hospital,Simonstown, Cape Province, and at R.N.A. Hospital,Wentworth, Durban, Natal. After the war he went backto England, but returned in 1948 to settle in South Africa,where he set up private practice in Durban. He alsoheld appointments on a part-time basis as assistant

visiting surgeon to Addington and King Edward VIIHospitals, and lectured to nurses in surgery at EntabiniHospital. In addition he was senior medical officer of theSouth African Naval Reserve in Durban, holding thehonorary rank of surgeon commander.

After the death of his wife he left Durban in 1967 fora surgical appointment at the Benedictine Mission Hospitalin Nongoma, Zululand. In 1969 he revisited New Zealandon his vacation for a reunion with his family, and to attendthe centenary celebrations at his old school. Those closeto him at this time were aware of the supreme happinessand sense of fulfilment the work at Nongoma had given him.

Leonard was a most kind and genial personality and aloyal and true friend; his gifts as a surgeon and physicianwere appreciated by many. His recreations includedmembership of the Auckland University Hockey Club andmountaineering, and he had a great love of yachting andmusic.He is survived by three brothers and three sisters.

E. M. C. W.

ARTHUR GEOFFREY SHERAM.D.Cantab., F.R.C.Path.

Dr. A. G. Shera, formerly consulting pathologistto Eastbourne hospital group, died on Oct. 13 at theage of 81.

He was educated at the University of Cambridge andUniversity College Hospital, London, qualifying in 1914,and graduating M.B. in 1915 and M.D. in 1918. During the1914-18 war he served as pathologist to the Red CrossHospital at Netley. He was clinical assistant to the EvelinaHospital for Children and resident medical officer at

Fulham Hospital before being appointed consulting patho-logist to the Eastbourne Hospital. He was one of the

original members of the British Pathological Association,which became the Association of Clinical Pathologists. Hewas a founder fellow of the College of Pathologists when itwas formed jointly by the Association and the PathologicalSociety of Great Britain. He was also vice-president of thePathology Section of the British Medical Association.He is survived by his son; his wife died some years ago.A. R. writes:" Geoffrey Shera and I first met in 1917 at Netley/where

he was clinical pathologist to the Red Cross Hospital; wemet again a few years later at a meeting of some thirtyclinical pathologists to form the British Pathological Asso-ciation, which soon changed its name to the Association ofClinical Pathologists. The Association gradually grewinto a very large organisation, and Shera was appointed tooverhaul its rules.

" Shera was a fine example of the medical graduatesturned out from Cambridge. He was a loyal friend andsteadfast in his views. He helped me in my own researchesright up to the end. He had retired from active practicesome years ago, but still kept his own private laboratory.The original group of 30 pathologists now, it is sad to see,numbers only a few."