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Cortisone in the relatively high doses used by Dr. Bartaand Dr. Simon is likely to depress the activity of theanterior lobe of the pituitary and of the adrenal cortexand so make their rabbits more sensitive to insulin.This would explain the increased blood-sugar fallsdue to insulin in their cortisone-treated rabbits. It is

difficult, however, to understand why hypoglycæmicshock did not occur with insulin in their cortisone-treatedrabbits, during cortisone treatment, if the blood-

sugar fell to shock-producing levels. Cortisone appearsto have some form of stimulating effect on the cerebralcortex at normal or raised blood-sugar levels, but thereis no clear evidence that it has this effect or will mitigatethe effects of hypoglycaemia at coma-producing blood-sugar levels.

W. W. KAY.

The Mental Hospitals’Group Laboratory,

West Park Hospital,Epsom, Surrey.

1. Goldberg, A., Paton, W. D. M., Thompson, J. W. Brit. J.Pharmacol. 1954, 9, 91.

2. Goldberg, A., Rimington, C. Proc. Roy. Soc. B. (1955) 143, 257.3. Goldberg, A. Lancet, 1954, ii, 172.4. Bonner, R., Cannon, J. R., Johnson, A. W., Sutherland, I.,

Todd, A. R. Nature Lond. 1955, 176, 328.

APOPLEXY OF YOUTH

G. B. FORBES.Kent and Canterbury Hospital,

Canterbury.

SIR,—A recent experience in the postmortem roomprompts me to add another cause of apoplexy in youngadults to those mentioned in your leading article ofOct. 5.

The subject of the necropsy was a 16-year-old schoolboy whowas admitted to hospital in deep coma after he had collapsedsuddenly at his home while going to bed. A few days previouslyhe had complained of headache but otherwise he had beenwell and had taken full part in school activities. Clinical findingsincluded a blood-pressure of 160/90 and heavily blood-stainedcerebrospinal fluid. He died shortly after admission.At necropsy a large fresh haemorrhage was found in the

substance of the left cerebrum, mainly in the region of theinternal capsule. The heart weighed 450 g. and the enlarge-ment was due to hypertrophy of the left ventricle, the wallof which was up to 2-5 cm. thick. The medulla of the rightadrenal gland was replaced by a rounded phaeochromocytoma3 cm. in diameter.

The cause of apoplexy in this youth was clearly hyper-piesis due to an occult physiologically active phaeochromo-cytoma.

NERVOUS SYSTEM IN PORPHYRIA

SiR, Your annotation (Sept. 14) fails to mention rele-vant experimental work which renders unlikely the

suggestion that a neurotoxic agent is responsible for thenervous and mental symptoms in porphyria. It has beenshown that purified porphyrins, acute-porphyria urine,and porphobilinogen are pharmacologically inactive ;there is moreover no evidence that a circulating vasocon-strictor substance exists in this disease.’ This view isstrengthened by the production of an experimental por-phyria in rabbits, rats, and fowls by the non-hypnoticsubstance allyl-isopropyl acetamide.2 The animalsexcreted large amounts of porphyrins and porphobilino-gen, but showed no clinical features in common withhuman acute porphyria, apart from constipation and lossof weight.In acute porphyria there is a fundamental disturbance

of pyrrole pigment metabolism which has its site in thelivery Associated with this there may be a related dis=turbance in the metabolism of the nervous system, ofwhich demyelination is the pathological expression. Theexact nature of this association is not clear. The por-phyrin-like structure of vitamin B124 demonstrates thatat least one tetra-pyrrolic substance is essential formyelination of the nervous system. Some other tetra-pyrrole, formed in the liver and of which porphobilinogenis a precursor, may also be essential for the nutrition ofthe myelin of the nervous system. A metabolic

" block "

to the formation of this substance in the liver would leadto an excessive production and urinary excretion of

porphobilinogen b and to demyelination of the nervoussystem. A genetically determined deficiency in a specificenzyme, variable in the expression of its severity, mightexplain the " block." The intermittent nature of thedisease would then be related to the effect of other factors- e.g., endocrine changes, infection, and barbiturates-on this abnormally sensitive pathway.The neuropsychiatric features of acute porphyria, as

well as its pathological chemistry, can be explained onthis hypothesis.

A. GOLDBERG.

Department of Medicine,Gardiner Institute,

Western Infirmary,Glasgow, W.1.

5. Goldberg, A. Lancet, 1954, ii, 1095.

ObituaryARTHUR JOHN CLEVELAND

O.B.E., M.D. Lond., F.R.C.P.Dr. A. J. Cleveland, consulting physician to the

Norfolk and Norwich Hospital, died on Oct. 8 at the ageof 85.He was born in Brighton, the son of a solicitor to the

Government in Bombay. From Clifton College he wentto Guy’s Hospital, where, after qualifying in 1897, heheld posts as house-physician, medical registrar, andmedical tutor. During the five years he held these postshe took the M.D. and the M.R.c.P. In 1902 he settled inNorwich in general practice, and two years later he wasappointed to the Norfolk and Norwich Hospital as itsfirst radiologist. In 1905 hewas elected assistant physi-cian to the hospital. Duringthe 1914-18 war he wasattached as physician, withthe rank of major, to theThorpe Military Hospital,and he was appointed O.B.E.for his services.

Cleveland’s chief interestwas neurology, and until ayear or so before his deathhe acted as consultant inneurology to the Ministry ofPensions ; a lesser interestwas dermatology. But it isas an outstanding hospitaladministrator that he willbe remembered. He waschairman of the board ofgovernors of the Norfolk andNorwich Hospital during thecritical years from 1938 to 1943. He played an importantpart in creating special departments and, with the lateFrank Inch, secretary and house-governor, in foundinga private patients’ department. He was active in sattingup a scheme of insurance whereby people of moderatemeans could obtain specialised treatment in a nursing-home. His history of the hospital from 1900 to the endof 1946 brought the earlier history by Sir Peter Eade upto date.

Largely as a result of the impression he had made inhospital management, Cleveland, though taking no partin local politics, was, in 1943 at the age of 70, electedLord Mayor of Norwich-an office which he filled withenergy and dignity. For ten years he was a director ofthe Norwich Union Insurance Societies. As an after-dinner speaker he was outstanding, and his name on atoast list never failed to attract a large audience to anymedical gathering.

B.B.M. writes:

Gifted with a logical, analytical, and, above all, a far-seeingbrain, Cleveland was at his best on committee and was anoutstanding chairman. He held strong views on the importanceof medical staff influencing the policy of the hospital. He wasforthright in putting forward the views of the staff and adam-ant in opposing exploitation of their services or invasion oftheir rights. To him in large measure was due the cordial and

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sympathetic relationship between the board and the honorar;medical staff that was such a feature of the Norfolk an(Norwich Hospital.

Dr. Cleveland’s wife died two years ago, and he leave:a son and daughter. The memorial service held in NorwiclCathedral on Oct. 11 was attended by City dignitarieland many of his friends and colleagues.

GEOFFREY WALTER BODEN

B.Sc.Lond., F.R.C.P., F.F.R., D.M.R.Dr. Geoffrey Boden, physician in charge of the radio-

therapy department of The London Hospital, died onOct. 18 at the age of 51.

After taking a B.Sc. with honours in 1928, he turnedto medicine and qualified from St. Bartholomew’s Hos-pital, where he held house-appointments. He laterbegan to specialise in radiotherapy and worked for a timein the radiotherapy departments at Barts and St. George’s,before joining the staff of the Christie Hospital and HoltRadium Institute, Manchester. There he rapidly madea name for himself as one of the ablest radiotherapists inthe country. In 1950 he was appointed physician incharge of the radiotherapy department of The LondonHospital, and in 1952 he was awarded the Twining medalof the Faculty of Radiologists for a fellowship thesis ofoutstanding merit. In May of this year he was electeda fellow of the Royal College of Physicians.W. S. writes :

he liked things done in the approved manner. As an ableIphysician and distinguished radiotherapist he will be remem.

bored with abiding affection by his colleagues and patients,Dr. Boden leaves a widow and two daughters.

I ALEXANDER DEWAR WILLIAMSONM.B. Glasg., F.R.C.S.E., D.O.M.S.

Mr. Alexander Williamson, who retired earlier thisyear from his appointments as ophthalmic surgeon to theGeneral Hospital, Singapore, and as lecturer in theUniversity of Malaya, died on Aug. 18.He was the son of a Glasgow seedsman, and he was

educated at Glasgow High School and University. Aftergraduating M.B. in 1927 he held house-appointments atGlasgow Western Infirmary and Eye Infirmary. Laterhe was awarded the McCunn research scholarship, andwhile holding a clinical assistantship at the Eye Infirmaryhe took the D.o.M.s. in 1930 and the F.R.C.S.E. two yearslater. After an operating tour with Dr. McPhail’s missionhospital in India he was appointed, in 1935, ophthalmicsurgeon and university lecturer in Singapore. In theearly years he ran his department alone. Later he trainedAsian medical officers and encouraged them to come toEngland for postgraduate study. His beds, at first scat.tered through the General Hospital, were increased andgathered together, and now the ophthalmological schoolhas an up-to-date air-conditioned unit with 75-80 beds,

Mr. Williamson continued to practise among the localpopulation in the first year of the Japanese occupation;he was then interned until the liberation. After only ashort convalescence in this country he returned toSingapore and took up the threads of his work. In 1949he was appointed an honorary consultant to the Army inSingapore. He was also consultant to the SingaporeAssociation for the Blind. During the post-war years,with Dr. P. C. Leong, he studied keratomalacia, which inSingapore was to be found in apparently well-nourishedinfants as well as among the under-nourished and maras.mic. Their investigations led to the fortification of alltinned and dried milks and the control of the disease inMalaya.When Mr. Williamson retired last April he left as his

memorial a department which was completely staffed byhis own former students. A colleague writes :

Williamson was an excellent linguist, widely read, and hismind was stored with valuable information. He was good’natured and kindly, with a forthrightness and directness whichwere characteristic, and sometimes, in his early years, mis-understood. He greatly enjoyed his work, and loved, particularly, the old Chinese women with their direct, quiteunabashed, claim for immediate attention. Many youngsterswere helped in their schooling, and many old people will misshis help and his cheerful badinage in Malay, or the mixture ofChinese dialects he had picked up.

Mr. Williamson leaves a widow, who is also an ophthalmologist.

DAVID LANDSBOROUGHM.A. Glasg., M.D. Edin.

Dr. Landsborough died at Redhill, Surrey, on Oct. 11,in his 88th year. He was one of three brothers to enterthe medical profession ; and he came of a family whoseother strong associations were with the PresbyterianChurches and with the study of natural history. Hispaternal grandfather and his father, both also calledDavid, were Ayrshire ministers and naturalists of repute,the former being the author of works on British zoophytesand on the natural history of Arran. An uncle, WilliamLandsborough, has left the family name on the maps ofAustralia and New Zealand, and a first cousin on thepaternal side was Sir J. Arthur Thomson, professor ofnatural history at Aberdeen.Having qualified in 1895, Landsborough held a house-

appointment at the Albert Dock Hospital, London. Fromthat time the whole of his professional life was spent inFormosa, where he won great respect as a medical Imissionary of the English Presbyterian Church. After hisretirement he lived at Redhill for many years, and wasknown as a man of fine character and most kiilcuvdisposition. His son, another David, is following in hisfootsteps as a medical missionary in Formosa; he is t

survived also by his wife and a daughter.

Soon after his appointment to the staff of The London,Boden applied himself vigorously to the task of reorganisingthe radiotherapy department. With his flair for administrationand his persuasiveness in committee, he readily accomplishedthis herculean task, and from a rabbit-warren of rooms thereemerged a new streamlined department with a fine radiumlaboratory. The cacophonous sounds of demolition which

oppressed his colleagues evoked from him an enrapturedsmile. During this period he was interested in the problemof the apparent discrepancy in the measurement of the rontgenin different centres, and it was largely due to him thatanomalous values were exposed, serious errors corrected, andthe whole system of measurement in clinical practice placedon a true foundation. Another of his important contributionsto radiotherapy was an investigation of radiation myelitis,and the importance in treatment planning of avoiding heavyirradiation of the spinal cord.

There are few who could have progressed so smoothly as hedid from the more restricted discipline of the specialisedhospital to that of the teaching hospital ; but he loved themore liberal atmosphere of a teaching hospital, and he soonmade his influence felt. He was full of farsighted plans forthe development of radiotherapy both at The London andthroughout the region. He was a consummate committee man.The radiotherapist at a teaching hospital is always in theunenviable position of trying, like the Baron Munchausen, toraise himself by his own bootstraps. This incredible feat

Geoffrey Boden was always able to bring off. Like all skillswith Boden, it seemed easy; the opposition floundered,capitulated, and melted like snow from a ditch ; but theonlooker could not see, though the percipient might surmise,the careful investigation, organisation, and planning whichhad preceded such an easy victory. He was a born negotiator.He was quick to realise the clinical advantages of super-

voltage therapy, and thanks to his efforts The London wasthe first teaching hospital to be equipped with a 1000-curietelecobalt unit. It was characteristic of the man that this

equipment was not used for the treatment of patients untilthe output and dosage distributions had been the subject ofprotracted physical measurement. The clamour of cliniciansto have their patients treated went unheeded until the treat-ment could be planned accurately and effectively. Treatmentplanning was a subject to which he had devoted much thought,both at Manchester, where he developed an elegant trunk-bridge method, and later at The London, where he replannedand systematised the wedge-filter technique.Although he had an absorbing interest in the diagnosis and

treatment of malignant disease in all its forms, his main interestlay in the reticuloses. Here, his powers of clinical diagnosisand prognosis were outstanding. Anyone can give a poorprognosis, but Boden could give a good prognosis with

uncanny accuracy.He was a keen swimmer and an enthusiastic follower of

rugby football. His mind was alert and perceptive, that of theintellectual rather than the athlete. By nature a traditionalist,