References. 1. OLIVER JF: Moonlight and nervous disorders: a historical study. Am J Psychiatry 99: 579,. 1943. 2. GUTHMANN H, OSWALD A: Menstruation und.
that peaks in number of deliveries of babies are related to the full moon, and that generally a relation between delivery and the lunar cycle, if indeed it exists, is of minor proportions and not detectable by simple observation. Sophisticated statistical techniques would have to be applied, possibly to more refined data,3 to detect and filter out such minor effects. Popular beliefs in this regard appear to be just that popular beliefs. BERNHARD SCHWAB, M Sc, MBA, PH D Faculty of commerce and business administration University of British Columbia Vancouver, BC
References 1. OLIVER JF: Moonlight and nervous disorders: a historical study. Am J Psychiatry 99: 579, 1943 2. GUTHMANN H, OSWALD A: Menstruation und Mond. Monatsschr Geburishilfe Gynakol 103: 232, 1936 3. LIEBER AL, SHERIN CR: Homicides and the lunar cycle: toward a theory of lunar influence on human emotional disturbance. Am J Psychiatry 129: 69, 1972
The Ulysses syndrome To the editor: In his article "The Ulysses syndrome" Dr. Mercer Rang (Can Med ASSOC J 106: 122, 1972) drew attention to a syndrome that is characterized by psychologic and physical consequences (anguish, expense, loss of time, and so on) following the discovery of a false-positive clinical or laboratory finding. We have had experience with six such cases and report two of them below. A 19-year-old married woman, depressed and considering divorce, was admitted to hospital in February 1967. During the month before admission, asthenia, bilateral blurred vision, occasional diplopia and myalgia in the lower limbs had developed. She had been well previously except for a reactive depression 20 months before admission when her first baby died 3 days after he was born. She was told at that time that the child had died of syphilis and that both she and her husband had positive blood tests for this disease. She entered hospital for investigation of "latent syphilis, with precocious invasion of the central nervous system". She had previously received adequate penicillin treatment for syphilis. Physical examination revealed nothing abnormal. Blood tests were positive several times and negative several times. Additional tests were performed by another laboratory outside the hospital and all results were negative. The patient was therefore considered to be healthy and was discharged approximately a month after admission.
A 47-year-old single mechanic was admitted to hospital in October 1969. He had been well until 12 days previously, when he suffered a head injury and possibly . lost consciousness for 20 minutes while he was in a state of alcoholic intoxication. He had ecchymoses of both
eyelids, epistaxis and fractures of the nose and left malar bones. He was hospitalized for 4 days. He was then brought to Mexico City and a rhinoplasty was performed. During the postoperative period dilatation of the right pupil was noted. In view of his recent injury a subdural hematoma was considered possible and he was transferred to a neurologic hospital. The only abnormal finding on physical examination was inequality of the pupils (right, 4 mm; left, 2 mm). Both reacted to light, although the reaction was slower in the right eye. The optic fundi were normal. Cerebrospinal fluid was normal, as were the electroencephalogram, brain scan and radiographs of the skull and chest. Detective work by the house staff revealed that a mydriatic solution had been instilled in the right eye. FRANCISCO-JAVIER CAMPOS, MD ULISEs MERCADO-RODRIGUEZ, MD
Villa Olimpica 10-204 Mexico 22. DF Mexico
Fee schedules To the editor: I am disturbed by Dr. Oleksiuk's suggestion (Can Med Assoc J 113: 15, 1975) that a range of fees for physicians' services should be considered, with higher fees being charged to people with higher incomes. I find it very irritating to be charged what I think are excessive amounts because I am a physician and therefore presumed to have a high income and I certainly would not be in favour of playing the same game. I work hard for my money and do the best I can for my patients regardless of their incomes. I am sure that most physicians do the same. I think there should be a set fee for these services regardless of who receives them. The only justification for charging more to people with higher incomes would be if we could offer them a better service. I hope we shall never grade the quality of our services according to the incomes of our patients. FRANCES WREN, MD
6622 - 20A St. SE Calgary, Alta.
Neoplastic disease in Eskimos
To the editor: The article "The changing pattern of neoplastic disease in Canadian Eskimos" (Can Med Assoc J 112: 1399, 1975) provides a useful record of the occurrence of cancer among Canadian Eskimos. In Table IV the authors have included carcinoma in situ of the cervix with invasive cancer of the cervix. I suggest that, in comparing variations in case frequency, only invasive cancer be considered because geographic and temporal variations in the identification of in situ lesions can create erroneous
impressions regarding relative frequency. May I also suggest that it is not correct to say that "cases of cervical cancer outnumbered those of breast cancer by 18 to 4"; at best it is really 10 to 4 since the data for Canadian women relate to invasive cancer. As the authors point out, the data on breast cancer among Eskimo women are of great interest. The unusually high frequency of lung and nasopharyngeal cancer is of special note in view of the probable influence of controllable factors. However, it seems a little unreasonable to imply that urbanization or Western culture or both have played much part in the secular changes noted. The small number of cases reported makes the application of the usual tests of significance a bit hazardous; the danger of false inferences from Table II has already been illustrated by the comments carried in the press. By my standards, very few of the observed differences so designated would be significant, even at the 5% level! The authors are to be commended for their study and it is hoped that they will continue to extend and to explore their valuable data base on cancer among Canadian Eskimos. A.H. SELLERS, MD, DPH
Medical statistician The Ontario Cancer Treatment and Research Foundation Toronto, Ont.
To the editor: We agree with Dr. Sellers that carcinoma in situ of the cervix should be considered separately from invasive carcinoma if for no othei reason than that screening programs are certainly more prevalent in the Arctic now than they were 25 years ago. For that reason we omitted cases of cervical carcinoma in situ from the calculations in Table V. We think, however, that the number of cases of invasive cervical cancer is still impressive, both in terms of a probable increase in recent years and also in relation to breast cancer. Even if we eliminate the in situ cases from the calculations the ratio of 10 cases of cervical cancer to 3 of breast cancer is a remarkable reversal of the usual pattern. In spite of the comment to the contrary we still think it reasonable to consider as contributing factors to the recent increase in incidence of lung cancer such imports as cigarettes, tuberculosis and drugs. On the other hand, since the incidences of nasopharyngeal and salivary cancers do not appear to have changed there is no reason to implicate urbanization or other acculturation factors in the occurrence of these tumours. Dr. Sellers questions the validity of
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