523

receiving specific therapy), the level of phenylalanine inthe first specimen was high enough for clear differentiationfrom the normal infant.Whatever the comparative rise in phenylalanine between

males and females, it would appear that females with

phenylketonuria are not missed in the Massachusettsnewborn screening programme.

HARVEY L. LEVYVIVIAN E. SHIHVALERIE KAROLKEWICZROBERT A. MACCREADY.

Division of Diagnostic Laboratories,State Laboratory Institute,

Massachusetts Department ofPublic Health,

Boston, Massachusetts 02130.

AN UNUSUAL CASE OF RABIES

A. M. N. GARDNER.Newton Abbot Hospital,

Devon.

SIR,-During service in Burma in 1945, I had under mycare a Burmese Army officer with rabies. He rememberedbeing bitten by a mad mongoose fourteen years previously,but was unaware of any more recent contact. I do not knowwhether he had any prophylactic treatment at the time. Hedied in a most unpleasant way with convulsions, despiteinjection of 21/4 grains of morphia and 5 grains of pheno-barbitone in the few hours before death. A further pointof interest in this case was his desperate increase in libido;in retrospect this may be analogous with the condition inanimals where mares are known to go into season andbitches to go on heat. The pathological basis for this is

presumably the infection of the hippocampus by the virus;Negri bodies were indeed seen on section of this patient’shippocampus.

IMMUNOGLOBULINS IN SCHIZOPHRENIC

PATIENTS

SIR,-Dr. Strahilevitz and Dr. Davis (Aug. 15, p. 370)detected significantly raised IgA levels in schizophrenicpatients, but unlike Solomon et all were unable to findincreased IgM.We have measured 20 serum proteins in 32 psychiatric

patients and in 32 healthy medical-staff members matchedfor age and sex.2 The immunoglobulins were determinedby the method of Laurell.3 All blood-samples were drawnduring the first two weeks after admission, and all patientshad been off drugs for at least one month. As shown in the

accompanying table, we found normal IgA and low IgMvalues in the schizophrenic patients.We agree that it is important that the patients tested

should be newly admitted, to avoid the possible influenceon serum proteins of infection and malnutrition, but webelieve it is of similar importance to eliminate the influenceof psychotropic drugs. Perhaps our most interesting finding1. Solomon, G. F., Allansmith, M., McClellan, B., Amkraut, A.

Archs gen. Psychiat. 1969, 20, 272.2. Bock, E., Weeke, B., Rafaelsen, O. J. Unpublished.3. Laurell, C. B. Anal. Biochem. 1966, 15, 45.

was the extremely low IgA values in borderline-psychoticpatients. This is at present under investigation.

ELISABETH BOCKB. WEEKE

O. J. RAFAELSEN.

Psychochemistry Institute,Rigshospitalet,Copenhagen,

andProtein Laboratory,

University of Copenhagen,Denmark.

LITHIUM DISTRIBUTION IN THE BRAINS OF

TWO MANIC PATIENTS

SiR,-Lithium levels in serum, liver, and brain have beenmeasured in animals treated with lithium salts, but there islittle published information about the distribution of lithiumin the human brain. We have measured lithium concen-trations in various parts of the brains of two patients treatedwith lithium for mania.Both patients had received lithium carbonate, 900 mg.

daily in three divided doses. Both died the same morning-the first after 4 days’ treatment, the second after 3 days’treatment, the causes of death being respectively asthma andcardiac disease (probably beriberi, because of a grosslydilated heart and very fatty liver). Necropsies were per-formed 30 and 29 hours after death. Slices were taken from

BRAIN LITHIUM LEVELS

the frontal lobe, the lateral aspect of the cerebellum, andthrough the pons (transverse section), and were frozen pend-ing testing. For testing they were thawed enough to allowspecimens of grey and white matter to be cut out. (Speci-mens from cerebellum and pons contained both grey andwhite matter.) Lithium content was determined by themethod of Schou,l using a Unicam SP90’ atomic-

absorption spectrophotometer and lithium sulphate as

standard solution. Later, the sodium and potassiumlevels were measured in the same specimens; but theresults of these estimations are less reliable because no

special precautions were taken to prevent contamination.The results are shown in the accompanying table. Of

particular interest are the lithium levels in the pons, whichwere higher than elsewhere. Since the release of lithium

1. Schou, M. Acta pharmac. tox. 1958, 15, 115.

IMMUNOGLOBULIN LEVELS IN PATIENTS AND CONTROLS