No abstract

Twenty-two elderly people, who were vegetarians for many years, had high ascorbic-acid values in plasma (10.2 +/- 0.4 mg/l) and leucocytes (35.9 +/- 1.99 mug/10(8)WBC). Visual and photographic examination of their tongues showed a much lower incidence of sublingual petechiae and varicosities than is general in elderly people. It is proposed that previous, perhaps recurrent, vitamin deficiencies may lead to irreversible changes in the elderly that cannot subsequently be changed by vitamin-therapy. An epidemiological comparison between populations who have long maintained a high vitamin-status and those whose vitamin-status has been variable may be more informative than therapeutic trials of the effect of vitamins on these lesions.

BLAST INJURIES TO THE LUNGS MEDBRITISRNAL three gave unilateral shadows, the remaining two being radiologically negative. It seems reasonable to assume that, whatever the effect on the lungs, pain and tenderness of the chest muscles should occur. on the side facing the explosion; but in two of the five cases (Nos. 4 and 11) pain with or with-OLit tenderness was experienced on the side opposite to that described as facing the explosion. The remaining three cases had pain on the exposed side, the following case presenting the anomaly of muscle tenderness limited to the arm and chest facing the detonat:on, with fluid appearing in the opposite interlobar fissure. Case 10 This patient was injured on Aug. 8, 1944, by a hand-grenade which sLruck his left shoulder and exploded on or close to him. He was unconscious for a short time. On coming round he noticed soreness of the left chest and shoulder, and was coughing bloody sputum. On examination there was obvious dyspnoea, with generalized rhonchi in both lungs. Chest, radiologically clear. Aug. 9.-Still coughing bloodstained sputum. Aug. 11.-Cough and haemoptysis. Pain in left chest and arm. Radiographs gave an appearance of a small effusion in the right middle fissure. Aug. 12.-No change radiologically. Aug. 15.-Some pain in left chest on breathing. Occasional cough; mucoid sputum; no haemoptysis. Examination disclosed tenderness in the left pectoralis major and shoulder-girdle muscles. No abnormal signs in lungs. Radiographs revealed only a small amount of fluid in the right middle fissure.

has kindly assisted us with these calculations, and considers we are justified in giving a rough estimate that the number of living people in England and Wales who have suffered from peptic ulcer is around 1,500,000 and may even be higher. We do not wish to stress these figures except to indicate that peptic ulcer seems to be an appreciable problem in this country. Peptic Ulcer: A Modern Industrial Problem Unfortunately many cases of peptic ulcer relapse, and the majority of those who have had ulcers have to follow simple rules to avoid further symptoms-e.g., regular meals with balanced diet, avoidance of common indigestible foods, avoidance of undue fatigue, and maintenance of a calm philosophical outlook on life. It is a problem which mainly confronts men during their working life and often when at their prime. Although peptic ulcer does not cause heavy loss of life (little more than 1% of non-violent deaths) it results in much suffering and incapacity for work. The ulcer subject has " guts " even if they are weak ones, and he does not give in easily. The man with a duodenal ulcer is usually of special value to industry, for he is over-conscientious, with plenty of drive and a sense of good standards of work. 0 The magnitude of the problem demands further study of those factors in modern industrial life which favour peptic ulcer. Summary An analysis in given of all patients with digestive trouble coming to a large general hospital in Greater London. Of 1,522 patients, 952 were found to have peptic ulcer. The ratio of women to men with peptic ulcer was 1: 4.7. The ratio of gastric to duodenal ulcer was 1: 2.5. This is higher than in previous London series. The ratios of previous series are considered and possible causes for discrepancies discussed. An important factor is the exclusion of outpatients in most series, for patients with duodenal ulcer probably have less chance of hospital admission than those with gastric ulcer. The ratio of gastric and duodenal ulcer in Service series is found to be equivalent to the figure for males under 45 in the present civilian series. Calculations suggest there are about 1,500,000 living people in England and Wales who have suffered from peptic ulcer. Thanks are due to Miss C. F. Harris, our dietitian, who has kept a careful record of all in-patient and outpatient diagnoses. We are also grateful to Mr. R. M. Titmuss for statistical advice.

Geoffrey Taylor, who at the outbreak of the last war was Professor of Medicine in Lahore, here gives his medical history up to and including the cancer of the stomach from which he was suffering when he gave this address. He relates this to the high concentration of nitrates in our diet which he discusses in detail.