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Serum alkaline phosphatase and rickets.

SIR,-We are interested to read the account by Dr. D. L. Barnard and others (21 April, p. 165) of the outbreak in Bristol of keratoconjunctivitis caused by adenovirus type 8. Similar outbreaks occurred in the Clyde valley in 1956, 1967, and 1971.1-3 Because of the importance of this disease as a cause of disability and occasional reduction in visual acuity, an attempt has been made to accumulate data in the Glasgow area during the interepidemic periods to determine whether the virus smouldered inconspicuously among industrial populations or among patients attending ophthalmic clinics or whether, as in Japan,4 the reservoir of infection was in children in whom the disease was unremarkable. To try and solve this problem virological surveillance of a sample of patients attending ophthalmic clinics with conjunctivitis and keratoconjunctivitis has been continued in Glasgow since the 1967 episode subsided. However, from over 1,000 conjunctival scrapings examined, only five isolations of adenovirus type 8 were found in 1968-they were obtained from members of a typical industrial group5-and no further isolations were made until the latest outbreak in 1971. Thus this continued six-year virus surveillance provides no clue as to the whereaibouts of adenovirus type 8 during the interepidemic period, but is compatible with the virus being periodically imported from other areas or countries-for example, by seamen, transport drivers, or other travellers. During the 1971 outbreak, in contrast to the findings in Bristol, there was very little family spread in Glasgow. In a survey of 584 family contacts of the 200 patients involved secondary spread occurred in only 14 contacts. It is likely that this was due to the strong propaganda measures (for example, to use separate towels, etc.) which were instituted at the start of the outbreak. It may be added that, though it should have been detectable by our methods, we encountered no case of picornaviral acute haemorrhagic conjunctivitis.6-We are, etc.,