The hospital admission rates for symptomatic colonic diverticulitis (International Code No. 572.1) in the populations served by the main teaching hospitals in Fiji, Singapore, Nigeria and North East Scotland have been estimated. In non-Europeans the condition is very rare occurring in about only one person in a million per year. It is some forty times commoner in Europeans living in the Tropics, and about eighty times more common in Scotland. It is considered that the difference is due principally to the greater age and low-residue diet of the European populations.

birth but a narrow insertion of the conjoined tendon and a low origin of the inferior epigastric vessels allow for a wide femoral ring and a weakened transversalis fascia over it, thus predisposing towards herniation.The treatment is surgical, a truss has no place. Repair of a femoral hernia in a child and adult should comprise suture of the deficiency in transversalis fascia combined with a widening of the attachment of the conjoined tendon to Cooper's ligament.

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EDITORIAL SYNOPSIS The possible relationship between hyperparathyroidism and peptic ulcer has stimulated renewed interest in the relationship between calcium and gastric secretion. This study shows that in patients with primary hyperparathyroidism the basal secretion of acid was raised but the augmented histamine secretion was essentially normal. The basal secretion was lowered by parathyroidectomy. Studies in dogs shows a different pattern of gastric secretory response.A possible relationship between the parathyroid glands and gastric secretion was suggested nearly 50 years ago in experiments with innervated (Pavlov) gastric pouches. Keeton (1914) found that parathyroidectomy reduced secretion in the cat, and Rogers, Rahe, Fawcett, and Hackett (1915) observed that a crude extract of parathyroid tissue caused an increase in secretion in the dog. Several others have studied the problem from time to time, while today many are interested in it because of the recognition that peptic, and especially duodenal, ulceration is a frequent feature of both primary hyperparathyroidism and the syndrome of multiple endocrine adenopathy in man (Welbourn and Ward, 1962 Parathyroidectomy (partial or total and usually combined with thyroidectomy) has always been found to reduce the secretion of acid and of pepsin in animals, and subsequent injections of calcium salts have restored it (Keeton, 1914;Chang and Sloan, 1927). Here, however, it is difficult to distinguish between the separate influences of the thyroid and the parathyroid glands, even when thyroid substitution therapy is provided, for gastric secretion is reduced by an excess and possibly by a deficiency of thyroxine (Nasset and Goldsmith, 1961). However, in a patient with idiopathic hypoparathyroidism studied very thoroughly by Donegan and Spiro (1960) free acid was completely absent and the concentration of pepsin was very low in the basal juice. An infusion of calcium gluconate and an injection of parathormone both restored secretion rapidly for short periods of time. Prolonged therapy with vitamin D and calcium maintained the secretion of acid and of pepsin at normal levels. Low concentrations of acid in the gastric juice have also been found in infants with hypocalcaemic tetany and restoration of the serum calcium concentration has increased the acidity (Babbott, Johnston, and Haskins, 1923). In both these studies the critical level of serum calcium, at which gastric secretion was restored, was about 7 0 to 7 5 mg. per 100 ml. Parathyroidectomy in patients with primary hyperparathyroidism has not been found to produce any consistent change in secretion (Donegan and Spiro, 1960

The present study represents an analysis of all patients admitted to the Royal Victoria Hospital, Belfast, during the period 1953 to 1956 inclusive. The object was to determine the incidence and mortality in relation to sex, age, and the blood pressure on admission and in particular in relation to climatic factors. The influence of weather was especially studied, because of an impression that the admission rate varied with the time of year, a feature that has been reported previously (Teng and Heyer, 1955), but inadequately studied. METHODSThe records of all patients admitted as coronary thrombosis or myocardial infarction during the period 1953 to 1956 inclusive were reviewed and in addition meteorological data for the City of Belfast were obtained from the Meteorological Observatory of Queen's University of Belfast. In each case details of age, sex, blood pressure on admission, address, date of infarction, activity at the time of infarction, and ultimate fate were recorded. Where there was a history of more than one attack, only the details of the first were taken. There were in all 390 cases, but 30 of these were excluded, because they lived outside Belfast, where no meteorological information was available. In a further 62 cases the records were incomplete in one or more respects: these were excluded from the study apart from certain comparisons, for which data were available. In only 126 cases were the activities of the patients at the time of onset of myocardial infarction recorded.There is no reason to believe that the patients for whom data were incomplete differed in any way from the rest. Also, the system of admissions in the Belfast area would justify the assumption that the admissions of patients with coronary disease into the Royal Victoria Hospital are typical of those of all general hospitals in Belfast.Summary of Statistical Techniques. In this report the frequency of admissions of patients with coronary thrombosis has been examined in relation to age and sex, daily, monthly, and seasonal variations, and also in relation to the possible influences of meteorological changes. The immediate mortality of these cases has also been examined with regard to age and blood pressure on admission.Throughout this report these observed frequencies have been tested against frequencies expected by particular hypotheses by means of the x2 test. The hypotheses on which the expected values are calculated vary for the different variables given above. For example, the observed number of admissions on each day of the week was compared with that expected on the hypothesis that, if there was no variation with the day of the week, then admissions would be expected to occur with equal frequency (i.e. on any one day one-seventh of the total admissions). The expected values for monthly and seasonal distributions of admission were calculated on similar hypotheses. 635 group.bmj.com on June 23, 2015 -Published by http://heart.bmj.com/ Downloaded from