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pain on swallowing with each attack. On examination

there was localised tenderness over the lower part of the

anterior belly of the right omohyoid muscle, increased byswallowing. Treatment was conservative, and by the endof September she was symptom-free.

T. J. WILMOT.Omagh,

Co. Tyrone.

CYCLAMATES

SIR,-It is understandable that some of your readers 1.2are uneasy about the banning of cyclamates on undisclosedevidence of noxious effect. What is less understandable,however, is the suggestion that the Minister of Agriculture,or his advisers, were not competent to assess the evidencefrom the studies on eggs 2 or that it should be claimed thedecision to ban cyclamates was based on insubstantialevidence or resulted from pressure from purveyors of non-artificial sweeteners.l.3The fact is that the advice to ban the use of cyclamates in

Britain was made on substantial, but as yet unpublished,evidence of noxious effect generously and courteously sentto Britain by the U.S. Food and Drug Administration withthe full knowledge and consent of the largest manufacturerof cyclamates in the United States.Delays of weeks or months may separate the completion

of an experimental study from the time when the full factscan be assembled in a form suitable for publication, andthere may be further delays before papers accepted forpublication are actually published. Some of the dataobtained may require time-consuming reassessment byothers to ensure that there is no error in presentation orinterpretation. In the present instance the new data weredisclosed in confidence to the Ministry of Agriculture’sFood Additives and Contaminants Committee and to the

Department of Health and Social Security’s PharmacologySubcommittee so that their members could considerwhether an immediate banning of the use of cyclamates inBritain should be recommended. Careful evaluation of thenew evidence led to a recommendation to ban, although thepossibility that future work would clear cyclamates fromsuspicion of being hazardous to man was entertained. Therecommendation was made on the basis of the new data,and not on the grounds that other countries, including theUnited States, had already decided to ban them. Therecommendation to ban was made even though it was notpossible to disclose the new evidence further. In duecourse-and probably very soon now-the new evidencewill be published, and the matter can then be debatedpublicly more usefully than at present.Those who, without the facts, deplore the decision,

should be quite clear what it is they deplore. Presumablyit is not the fact that important but unpublished evidencewas supplied by the U.S. authorities. Do they think thataction should have been delayed until formal publicationof the facts, even though there is little possibility of thefacts materially changing before publication ? Surely mostof us would feel this to be a senseless delay, since eventuallythe same committee members would have the same res-

ponsibility for making recommendations on the basis ofmore or less the same facts. Surely no-one would suggestthat the information supplied in confidence should havebeen disclosed.There will certainly be much to debate when the new

facts about cyclamates are published. Many will feel thatthe latest evidence provides few grounds for believing thatcyclamates, in the amounts normally consumed, are likelyadversely to affect human health. Certainly, to date thereis no direct evidence that they do so. Meanwhile, there

1. Beaconsfield, P. Lancet, Nov. 15, 1969, p. 1079.2. Taylor, G. ibid. Nov. 29, 1969, p. 1189.3. Nature, Lond. 1969, 224, 398.

will also be some who are reassured by the knowledge thatthe Government has watchdogs whose job, independentlyof political considerations, is to see that no chemicals areused in food where there is the slightest suspicion that theymay be hazardous.

FRANCIS J. C. ROE.

Chester Beatty Research Institute,Institute of Cancer Research,

London S.W.3.

*** Our annotation of Nov. 1 (p. 941) was wrong instating that a derivative of cyclamates, cyclohexylamine,has been shown to be carcinogenic in animals. The onlyevidence of carcinogenicity in cyclamate-related compoundsconcerns dicyclohexylamine given to animals. Pliss 1 re-

ported the development of sarcoma at the site of a singleinjection of dicyclohexylamine; and dicyclohexylaminenitrite given subcutaneously was followed in some animalsby multiple cancer foci of different types. Cyciohexylaminewas not carcinogenic. Shabad 2 described the results of

feeding and subcutaneous injection in mice and rats. Again,cyclohexylamine gave rise to no tumours. Dicyclohexyla-mine and its nitrite were associated with the appearance ofsarcomas in 13% of surviving animals. The abstract 3 ofShabad’s paper (which is all we have access to at the

moment) does not say how the substances were given to theanimals in which sarcomas developed-presumably it wasby subcutaneous injection. Lomonova 4 has also producedsome evidence that dicyclohexylamine can cause tumours.Czech workers 5 studied the effects of oral administration of

dicyclohexylamine nitrite in rats and dogs and found noevidence of carcinogenicity. There is some reason to

believe that dicyclohexylamine nitrite may readily decom-pose in vitro and in vivo to N-nitroso-dicyclohexylamine,which would be expected to be carcinogenic. Any localeffects of subcutaneous injection are not necessarily due tochemical carcinogenesis: certain physical properties of thematerial used must also be considered.6-8-ED. L.

ACUTE PHENOTHIAZINE DYSTONIA

SiR,ŅThe interesting account by Dr. Pierce James(Nov. 29, p. 1194) about acute phenothiazine dystoniain narcotic addicts prompts me to report a case whereacute dystonic symptoms were followed by a remarkableimprovement in mental state. The patient was a man of39, committed from prison where he had been found tobe suffering from a severe paranoid schizophrenia. Hebelieved that he was being poisoned, and had other

persecutory delusions. He was completely without insight,and, after admission to this hospital, refused medicaltreatment. He continued to have severe persecutoryideas, believing that his food was being poisoned andthat the staff were plotting against him.He was given 0-5 ml. (12-5 mg.) of fluphenazine enan-

thate by injection to test for sensitivity. This producedsevere spasms affecting the mouth and tongue. The

dystonic reaction responded to treatment over the courseof a few days. With recovery from the physical disturbance,there appeared also to be a dramatic improvement in hismental state. He was now found to have acquired con-siderable insight, accepting that he had been sufferingfrom mental illness, and agreeing to cooperate in anytreatment that was thought necessary.1. Pliss, G. B. Vopr. Onkol. 1958, 6, 659. See Chem. Abstr. 53, 9439d.2. Shabad, L. M. Khim. Nauka Prom. 1958, 3, 828. See also Acta Un.

int. Cancr. 1963, 19, 458.3. Chem. Abstr. 53, 9432i.4. Lomonova, G. V. Fedn Proc. Fedn Am. Socs exp. Biol. 1965, 24,

96 (translation from Russian text published in 1963).5. Marhold, J., Hub, M., Ruffen, F., Andrysova, O. Neoplasma, 1967,

14, 177.6. Grasso, P., Golberg, L. Food Cosmet. Toxicol. 1966, 4, 269.7. Grasso, P., Golberg, L. ibid. p. 297.8. Gangolli, S. D., Grasso, P., Golberg, L. ibid. 1967, 5, 601.

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He had previously been treated with trifluoperazine,but this had not had any apparent effect on his condition.After the acute dystonic reaction, he was continued ontrifluoperazine. The acute improvement noted was main-tained, and, with the concurrence of the Home Office, hewas discharged from hospital about four months later andhas now been in full employment for the past two years.He was kept on the trifluoperazine for a time, but has nothad any medication now for over a year.The remarkable feature of this case is the dramatic

improvement in mental state immediately following theacute dvstonic reaction.

AARON GILLIS.Cherry Knowle Hospital,Ryhope, Co. Durham.

FETUS FALSIFIEDSIR,-

The unborn child is not to blameFor bastard spelling of his name.The Romans knew their Latin best.To Virgil, Ovid, and the restHe was a FETUS and so stayedTill later Isidore madeA diphthong of the vowel EConfusing us and Dr. B.1

The FETAL noun you can relateTo the verb feo-generate.Its origin cannot be hungOn the verb fceto-bring forth young.If so, then FETUS should adornThe newborn child, not the unborn,And so in mother’s arms we’d seeOur FtETAL physiology.

To other words the diphthong came,But they’ve their old form back again.You won’t be thanked in ’69To tell your bird she’s faeminine.To call the FETUS transatlanticWill drive the editors quite frantic.Ere Norsemen on Cape Cod were wrecked,The spelling FETUS was correct.

GEOFFREY CHAMBERLAIN.King’s College Hospital,

London S.E.5.

VIRUS FROM BABOONS

SIR,-In 1963 this laboratory reported 2 the cytopathiceffects of a number of viruses recovered from SouthAfrican vervet monkeys. One of these agents, designatedSA 15, was isolated on one occasion only, when it appearedin an uninoculated culture of primary vervet-monkeykidney cells. This agent induced slow formation of syncytiacontaining nuclei with pleomorphic and bizarre inclusions,which suggested that it might be a herpesvirus. Sincehorse-serum had been used in the culture-medium we

regarded the origin of the agent with some reserve; but nosimilar virus has been recovered from serum or fromuninoculated monkey-kidney cultures.

Recent studies we have made of the viral flora of SouthAfrican baboons (Papio ursinus) have yielded a variety ofagents, including one which produces cytopathic changesclosely resembling those noted in cultures infected withSA 15. Several isolates from the throats of baboons havebeen made, and there is no doubt that the virus has comefrom the throats of these animals.

Further characterisation studies are in progress, but we

1. Bass, B. H. Lancet, Nov. 29, 1969, p. 1194.2. Malherbe, H., Harwin, R., Ulrich, M. S. Afr. med. J. 1963, 37,

407.

wish to record the recovery from baboons of this virus,which produces changes previously noted only in culturesinfected with SA 15 virus.Poliomyelitis Research Foundation,

H. MALHERBEM. STRICKLAND-CHOLMLEY.

South African Institute forMedical Research,

P.O. Box 1038, Johannesburg.

RECEPTIVITY AND THE PILL

SiR,—There are indications that some women taking oralsteroid contraceptives experience decreased libido,l,2although the definition and measurement of this term

present considerable uncertainties under clinical conditions.The paper by Dr. Bulbrook and Mr. Hayward (Nov. 15, p.1033), reporting that such women excrete lower-than-normal amounts of 11-deoxy-17-oxosteroids, suggests oneexplanation for this effect of the contraceptive pill on sexualbehaviour. It has been known for years that androgens canstimulate libido in women,3.4 a finding confirmed recentlyin female rhesus monkeys. Further experiments on mon-keys have now shown that adrenal androgens are necessaryfor the maintenance of normal levels of receptivity. Animalswhich are adrenalectomised, or in which the function of theadrenal has been suppressed by giving dexamethasone,show abnormally low levels of sexual responsiveness to themale. This effect can be reversed specifically by givingthem either testosterone or androstenedione, but not byother steroids of adrenal origin such as cortisol or progeste-rone.6-8 It may be, therefore, that a corresponding reduc-tion in androgens is a factor in the effect of the Pill onbehaviour in women.

Whilst it is true that some contraceptive pills containsteroids chemically related to the androgens, it is not knownwhether these substances are effective in stimulating recep-tivity in the same way as testosterone and androstenedione.One is loath to add another steroidal ingredient to thosealready contained in this form of contraception. But on thebasis of Bulbrook and Hayward’s paper, and the laboratoryevidence cited above, it seems logical to treat women inwhom decreased libido is a significant side-effect of the Pillwith small doses of an androgen. This would not, of course,apply to those in whom the effect on libido is part of a moregeneral depressive state.

J. HERBERT.University Department of Anatomy,

Birmingham.

HYPERTENSION AND THE PILL

SIR,-We have recently reported a case similar to theone described by Dr. Harris (Aug. 30, p. 466). In our

patient the raised blood-pressure (230/140 mm. Hg)returned to normal when she stopped taking the oral

contraceptive agent. Nine months later she started takingan oral contraceptive again, and the hypertension recurred.We think we should emphasise that in our patient, as inother reported cases, there was a history of precedingabnormalities including obesity, nephropathy, and impairedglucose tolerance, as well as a family history of hyper-tension.

Raised blood-pressure was noted after three weeks on theoral contraceptive. There is no direct evidence that the

hypertension in this case was related to increased synthesisof the angiotensin substrate, but it seems very likely that1. Grant, E. C. G., Mears, E. Lancet, 1967, ii, 945.2. Mears, E., Grant, E. C. G. Br. med. J. 1962, ii, 75.3. Salmon, U. J., Geist, S. H., J. clin. Endocr. Metab. 1943, 3, 235.4. Foss, G. L. Lancet, 1951, i, 667.5. Trimble, M. R., Herbert, J. J. Endocr. 1968, 42, 171.6. Everitt, B. J., Herbert, J. Nature, Lond. 1969, 222, 1065.7. Everitt, B. J., Herbert, J. Unpublished.8. Herbert, J. J. Reprod. Fert. (in the press).9. Bercovici, J. P., Collin de l’Hortet, G. Vie méd. 1969, 1, 2213.