4 January 1969 Correspondence MBuRf 55

Hospital (U.C.H.), Ibadan, on 23 April 1968,
from the psychiatric unit on account of increas-
ing drowsiness and the finding on physical
examination of bilateral papilloedema and left
hemiparesis. She had been under treatment for
paranoid schizophrenia since September 1967.

She was first seen in this hospital in April
1961 after miscarrying a 10-week pregnancy, her
second within two years. Her outside doctor
attributed these to inadequate rest in the early
months of pregnancy, "due to her high sense
of duty." Her first child was delivered normally
at home in 1959. There was no record of her
postnatal state. She delivered her second child
normally in April 1964 five weeks premature.
Six weeks later she reluctantly resumed duty,
and for the first time in her life suffered "a
terrible headache."

Since then she has had recurrent attacks of
frontal headaches weekly. She was treated for
migraine and obtained minimal relief for four
weeks. In January 1965, on account of the
increasing severity of headaches and the occa-
sional association of vomiting, she attended the
medical outpatient department of U.C.H.,
Ibadan. She was found to be bradykinetic (due
to repeated sedation), otherwise there was no
abnormality on physical examination. A diag-
nosis of depression was made. Two days later
she asked for her discharge and she was sent
home on meprobamate.

In September 1967 she was admitted into the
psychiatric unit on account of headaches, loss
of memory, and talkativeness. Her usual frontal
headaches became obstinate, and at their severest
she vomited easily. Early in the year she had
lost her job as secretary when the decay in her
memory became manifest, a feature which later
became progressive. She slept a lot, and, when
not sleeping, talked a lot. She was admitted,
and treatment was instituted for paranoid
schizophrenia. There were frequent reports of
her suddenly and spontaneously becoming
stuporose and dribbling saliva.

It became obvious that an organic lesion
was probably responsible for her strange be-
haviour. Radiography of skull showed some
erosion of her dorsum sella. On the carotid
angiograms the right middle cerebral artery
was displaced medially and upwards by a
mass in the middle-third of the sphenoidal
wing. The vascular flush suggested a
meningioma. A right temporal osteoplastic
craniotomy was performed and a large dis-
crete meningioma, about 5 cm. by 4 cm. by
6 cm., was removed from the sphenoidal wing.
It was highly cellular and relatively vascular
and histological sections later showed it to be
angioblastic in nature. The patient made a
satisfactory recovery and was discharged
home from hospital 18 days after her opera-
tion. Her headaches ceased, she became
mentally clear, and talked freely without lack
of wit. Her memory improved significantly,
and an intelligence test performed on her
while on holiday in England placed her
Wechsler scale at 130.

Of particular interest was the onset of the
patient's symptoms six weeks after the delivery
of her second child. Examples have been
described of meningioma which showed
accelerated development during pregnancy,
and in each case the meningioma has been
suprasellar, parasellar, or at the sphenoidal
wing in location. Sensitivity to hormonal
effects and increase in physical size of the
tumour as part of the generalized water
retention are reasons adduced for changes in
pregnancy. What bearing the histological
nature of the meningioma has on its bio-
logical behaviour during pregnancy remains
a subject for speculation. Any increase in
size in the angioblastic meningioma of our
patient during her pregnancy was probably

due to engorgement of the vascular elements
within the neoplasm. One of us (E. L. 0.)
has witnessed enlargement of intracranial
aneurysms during pregnancy.-We are, etc.,

ADELOLA ADELOYE.
B. 0. OSUNTOKUN.
E. LATUNDE ODEKU.

University College Hospital,
Ibadan, Nigeria.

Bilateral Parietal Thinning in Bronze Age
Skull

SIR,-Bilateral parietal thinning or bi-
parietal resorption was noted on a female
cranium recovered from Harappa (in West
Punjab), which is the type-site of the Indus
civilization belonging to the Bronze Age
cultures and dated 2300 B.C. The age at
death appeared to be about 45 years. This
is probably the only reported palaeo-patho-
logical case from the Indo-Pakistan sub-
continent.
The cranium, which was unearthed from

a regularly disposed burial at cemetery
" R 37," is otherwise normal and well pre-
served. It has two irregular large holes in
each parietal bone. Examination has
revealed that these holes are artificial and
post-mortem breaks occurring at the sites of
lesions causing depressions. These depres-
sions are situated bilaterally and almost
symmetrically. The thickness of the vault
bones at different places beyond the margin
of the lesions is on an average 6 mm. From
the outer margin of the lesions, where the
normal bone thickness is retained, to the
margin of the breakages, there is a decreasing
gradient in thickness of the bone. This
thinning was due to the migration of the
outer table at the area of involvement, and
the gradient was formed by gradual dis-
appearance of the diploic surface before
finally exposing the inner table just near the
margin of the holes. It thus involved a
resorption of bone and a deposition of com-
pact bony tissue along the surface. This
condition of thinning is. by itself indicative
that the woman had suffered from a lesion
of a severe nature. This evidence and the
specific localization suggest that it was a
typical case of thinning of the parietals,
which is not to be confused with other con-
genital anomalies located very near to the
parietal foraminae.'

This condition was recognized on some
ancient Egyptian crania by Smith.! He
found those skulls having " strange, large
symmetrical depressions of the parietal
bones."' Rowling' also noted this in the
mummies of Thutmosis III and Meritamon
of the New Empire period, and also in Khety
from the middle kingdom. This abnormality
has interested pathologists as a contemporary
disease involving an atrophy of the parietals,
usually accompanying old age. It has been
concluded that it is a congenital dysplasia
of the diploe of non-progressive type and a
static nature of abnormality.`' Camp and
Nash' reported 119 cases (80 males and 39
females), of which 10 were 30 years or less,
one was a 4-year-old child, and another one
was a 9-week-old infant. Examining 26
cases (19 females ranging from 54 to 86
years), Epstein' concluded that this change
is associated with post-menopausal and senile
osteoporosis. A further attempt was made

to reveal the cause of the disease, its
peculiarity of localized susceptibility, and the
role of osteoporosis and ageing in the
thinning.9 Investigating only two patients,
one a female of 85 years and another a male
of 28 years, it was postulated that the
thinning may be an acquired and progressive
disease (progression was diagnosed in the
female), and the localized thinning is
explained in terms of decreased osteoblastic
activity resulted from gonadal insufficiency,
senility, or other causes of osteoporosis in a
region where there is a little stress or strain.'

It is apparent that this pathological change,
the origin of which has been traced back to
ancient civilizations, is not dependent on age
or sex, but the exact cause is as yet not
understood.-I am, etc.,

PRATAP C. DUTTA.
Anthropological Survey of India,

Indian Museum,
Calcutta 13, India.

REFERENCES
I Goldsmith, W. M., 7. Hered., 1941, 32, 301.
2 Smith, G. E., Bull. archaeol. Surv. Nubia, 1908,

I.
3 Sigerist, H. E., A History of Medicine, 1951, Vol.

I, p. 46. New York.
Rowling, J. T., Proc. roy. soc. Med., 1961, 54,

409.
5Greig, D. M., Edinb. med. 7., 1926, 33, 645.
Wilson, A. K., Amer. 7. Roentgenol., 1944, 51,

685.
Camp, J. D., and Nash, L. A., Radiology, 1944,

42, 42.
Epstein, B. S., Radiology, 1953, 60, 29.

9Steinbach, H. L., and Obata, W. G., Amer. 7.
Roentgenol., 1957, 78, 39.

Dr. Thomas Percival and Jane Austen

SIR,-When living in Southampton in
1808 Jane Austen sent a letter to her sister
Cassandra in which she mentioned the arrival
in the town of a new doctor-" We have got
a new physician, a Dr. Percival, the son of
a famous Dr. Percival of Manchester, who
wrote moral tales for Edward to give to
me."'

This reference is of particular interest.
Dr. Edward Percival was the eldest surviving
son of Dr. Thomas Percival, whose book on
medical ethics is a classic known to every
doctor. Jane Austen was, however, referring
to another of Dr. Percival's writings intended
for young children. He married in 1767 and
as his children were growing up he wrote a
series of short tales, each illustrative of one
of the moral virtues, so that the series demon-
strated the harm produced by selfishness,
untruthfulness, and the like. The first part
was published in 1775, and later a second and
third part were added to it. The Dictionary
of National Biography states that this book
" achieved great popularity," and we gather
from Jane Austen's statement that her brother
Edward gave her a copy when she was a little
girl. The full title of the book was
A Father's Instruction to his Children.
Though we have no doubt that as a child
Jane enjoyed reading the tales, we believe
that the preface may have had more influence
on her precocious mind, for in it are given
the reasons why Dr. Percival wrote the book.
They were three in number. Firstly, to
inspire the young with a love of moral excel-
lence; secondly, to awaken curiosity and to
convey in a lively manner knowledge of the
works of God; and, thirdly, to promote more
early acquaintance with the use of words and
ideas.

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