Southey's tubes and vulval oedema.

before, though such high values are seen in cases of myeloproliferative diseases (Bases, 1962). The prostate was normal clinically and at post-mortem examination. Another cause of raised serum acid phosphatase is an extremely high level of alkaline phosphatase activity in the serum (Woodard, 1959), some of which persists even at an acid pH. The alkaline phosphatase, however, was never found to be raised in our patient. There are reports of high levels of serum acid phosphatase in patients with thrombocytopenia due to thrombolysis and of abnormally low levels of serum acid phosphatase in patients with thrombocytopenia due to defective production of platelets (Oski et al., 1963; Cooley and Cohen, 1967). In our patient the high serum acid phosphatase levels were seen when megakaryocytes were absent from the bone marrow and platelets were deficient in the blood. Since high values of serum acid phosphatase were concomitant with the presence of splenomegaly, the enzyme activity may have originated in the spleen (Bases, 1962). On phenylphosphate substrate the acid phosphatase of this organ is strongly inhibited by L-tartrate (Abul-Fadl and King, 1949). Another possible origin of the serum acid phosphatase values during the periods of active leukaemia proliferation in this case is the leukaemic cell itself (Fishman et al., 1968). This possibility is hypothetical, but in view of its interest it should be kept in mind and tested by histochemical methods in the future.