Phenylbutazone and acute leukemia.

Correspondence BMJORL 16 of the facilities provided, all general practitioners , paediatricians, and district medical officers in the county were circularized. They were informed of the existing provisions for the mentally handicapped in the county, and were advised that if they wished to refer such patients, and their parents, to the county medical officer, arrangements would be made for them to be seen at their county health clinic by the medical officer for mental health. In addition, discussions have been held with groups of health visitors to help them recognize mental subnormality. Since this service commenced there have been 29 referrals, 18 from general practitioners , eight from district medical officers, and three from paediatricians. Seventeen (iore than half the total) were children aged 5 years or less, of whom six were 2 years or less. As regards recommendations, all parents were given advice and information as to the needs of the mentally handicapped and the likely rate of development. All were put in touch with the National Society for Mentally Handicapped Children. In other respects special recommendations as to admission to training centres or residential units were similar to the recommendation in Dr. Kirman's series. In a few cases hospital care, either permanent or short-term, was required, and such were referred to the outpatient clinic conducted by the consultants of the hospital for the subnormal which serves this county. This service has been welcomed by the parents, many of whom had not previously received any accurate advice or information about mental handicap, and the community services. Also, it was welcomed by the general practitioners, who were intereqted to receive information about the provisions in the community for the mentally handicapped. SIR,-We have previously reported' that 8 out of 5 5 cases of acute leukaemia in adults studied between April 1959 and mid-1963 had a history of phenylbutazone inges-tion. Of these three were excluded from the calculations (two because they had received radiotherapy and one because of the brevity of the period of ingestion before the diagnosis of leukaemia). This number, 5 out of 55 (9/), compared with a similar history in 5 out of 417 (1.2%) cases of chronic leukaemia, lymphoma, and allied disorders. The significance of these findings has been debated, and a suggestion has been made that the difference between the two groups may be due to disparity in age structure. The statistics for the five-year period …