ABDOMINAL WOUND DISRUPTION

ABDOMINAL WOUND DISRUPTION

394 EFFECTS OF IRON AND/OR What our Health Service needs is a new philosophy, and a reorientation towards prevention of disease and the maintenance ...

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394 EFFECTS OF IRON

AND/OR

What our Health Service needs is a new philosophy, and a reorientation towards prevention of disease and the maintenance of health. For this, those who work the service must have a target-normal structure and function. This brings me back again to the word that a handful of misguided clinicians are striving to erase from the medical curriculum-anatomy.

FOLATE DEFICIENCY IN RATS

Anatomy Department, The

University, Glasgow, W.2.

G. M. WYBURN.

A CASE FOR DIAGNOSIS your suggestion last week that universities placed to carry out research into the services required of general practitioners, though, of course, many of the staff engaged in such projects must be in active practice. I believe, however, that the Institute of General Practice proposed by Prof. J. N. Morris and Dr. John Fry will lose much of its

SIR,-I support

are

best

effectiveness unless it takes as its title the Institute of Domiciliary Medical Care, and thus enlarges its field to its proper dimensions. DONALD C. BOWIE. London, W.8. *

Mean

plus

range.

Eighteen-day-old C D male albino rats obtained from the Breeding Laboratories, North Wilmington,

Charles River

were fed and watered ad libitum, housed in individual screened-bottom cages, and killed after two weeks. There were fifteen rats per dietary group. The control purified diet contained all of the known essential nutrients and 2 mg. of iron and 1 mg. of folate per kg. of diet. The enzyme, glutamate formimino transferase, was isolated5 from the combined livers of rats fed a control, iron-deficient, folic-acid deficient, or iron-deficient and folate-deficient diet. Its activity was assayed according to the method of Tabor and

Massachusetts,

Wyngarden.5 The values for haemoglobin, packed-cell volume, serumfolate, and serum-iron are shown in the accompanying table. Formimino-transferase activity (see figure) was notably and equally diminished in the livers from iron and doubly deficient (folate and iron) rats. While it is not possible to produce any ill-effect in standard rats by omitting.folate from the diet, such animals nevertheless have greater urinary excretion of FIGLU and lower levels of urinary folate than rats fed folate-containing diets.2 Formimino-transferase activity would not be expected to be low in the livers of folate-deficient rats since the assay system requires the addition of T.H.F. Thus, urinary FIGLU excretion is elevated (a) when low folate diets are fed and T.H.F., the accepter for the formimino group of FIGLU, is present in low concentration, and/or (b), in dietary iron deficiency, where tissue T.H.F. is presumably present in normal amounts but where the activity of the glutamate-formimino-transferase enzyme activity is significantly decreased. The present results indicate that the enzyme(s) involved in the transfer of the formimino group of FiGLU—and thus in the metabolism of one carbon unit-is(are) presumably irondependent. Thus, these results support the view, expressed by Chanarin et al., Vitale et al., and Velez et al., that iron deficiency may result in a defect in folate metabolism. J. J. VITALE Department of Nutrition Harvard School of Public Health, Harvard Medical School and Thorndike Memorial Laboratory, Boston City Hospital, Boston, Mass.

R. R. STREIFF Department of Medicine E. E. HELLERSTEIN Department of Pathology.

THE NOTTINGHAM MEDICAL SCHOOL SIR,-I was disappointed that Sir George Pickering chose to join the mob shouting " a la lanteme " with anatomy rather than answer my question: What did his committee aim to produce to run the Health Service ? Clinicians who act as advisers on the training of those responsible for the Health Service have the disadvantage that disease is their livelihood. They worship at the shrine of disease and their votive offerings are

drues. 5.

Tabor, H., Wyngarden,

L.

J. clin. Invest. 1958, 37,

824.

ABDOMINAL WOUND DISRUPTION SIR,-Mr. Graham-Stewart (July 24) believes that the solution to the problem of wound disruption lies in the surgeon’s technique, in that he fails to suture the abdominal wall securely. Wound disruption is not limited to wounds sewn up by surgical registrars but is equally common in wounds sutured securely by surgeons of international repute both in Great Britainand in the United States.2 I do not believe that the surgical technique of wound closure in this serieswas faulty, but rather that the methods available are inadequate. Every abdominal wound is potentially liable " to disruption; therefore the necessary steps to ensure that the abdomen is closed in such a manner that the burst abdomen becomes a surgical rarity " should be carried out in every case. What these " necessary steps " are Mr. Graham-Stewart unfortunately fails to tell us. Albert Einstein College of Medicine, Lincoln Hospital, GERSHON EFRON. Bronx, N.Y. 10454.

Public Health Poliomyelitis

in Blackburn

beginning of this week 19 cases of poliomyelitis, 1 of them fatal, had been confirmed in Blackburn, Lancashire. A further 8 suspected cases, none with paralysis, were under observation in Blackburn, and 4 girls from the district on holiday in Wales were being kept in hospital at Caernarvon. Several public functions had been postponed, and people were advised to avoid cinemas and dance halls. Most people had been immunised, and those who had not were being offered oral vaccine. Statistical Review for 1963 Part 11 (population tables) of the Registrar General’s Statistical Review of England and Wales for 1963 has now been published.4 For the fifth year in succession marriages increased; in 1963 there were 351,000. There were 854,000 live births (2°.o more than in 1962), and the ratio of boys to girls was 1055. 6-9% of the live births were illegitimate. At the

Drug Addiction in 1964 drug addicts were registered in 1964,

246 new and the total number of registered addicts increased by 19%-from 635 in 1963 to 753 in 1964.s Since the total number of addicts is unknown it is not clear whether these figures represent a 1. Efron, G. Lancet, 1965, i, 1287. 2. Mayo, C. W., Lee, M. J. Archs Surg. 1956, 62, 883. 3. See Guardian, Aug. 16 and 17, 1965. 4. Statistical Review of England and Wales for the Year 1963. Part II: Tables, Population. H.M. Stationery Office, 1965. Pp. 173. 18s. 5. Working of the International Treaties on Narcotic Drugs. Report to the United Nations by Her Majesty’s Government in the United Kingdom of Great Britain and Northern Ireland. Home Office, 1965.