SEAT BELTS

1265 water was given to the patient in the fasted state and 1 exactly h later the venous blood-sample was drawn. D-xylose was measured by the method of Roe and Rice’ as modified by Colombo et a1. A previous investigations has shown that the normal range for intraepithelial lymphocyte counts in our laboratory is 7-20 lymphocytes per 50 epithelial cells (mean ± S.D.= 12-0 ± 3-3) and the mean 1 h blood-xylose value

100 ml

307 ± 8.6mg/d1. Fig. 2 shows the results. All blood-xylose values except one (at 21.9 mg/dl) were below 20 mg/dl (mean ± S.D. 12.0 ± 50 mg/dl). All intraepithelial lymphocyte-counts were above 23 lymphocytes per 50 epithelial cells (mean ± s.D.= 35.2 ± 6.1). There was a good correlation between these two indices (fig. 2). The correlation coefficient was r= -0.8163. Sensitive tests are required in the clinical and pathological follow-up with children with creliac disease, to evaluate the response to short-term gluten challenge (to confirm the permanency of gluten sensitivity) and also to monitor the strictness of the gluten-free diet. We plan to use the intraepithelial lymphocyte-count and 1 h blood-xylose test as routine follow-up procedures in such cceliac children. This work was supported by grants no. 3.676.0.75 from the Swiss National Science Foundation. We thank Dr Anne Ferguson for her comments, Prof. H. Cottier for making the histological sections available to us, and Mr A. Freiburghaus for helping with the statistical

analysis. Department of Pædiatrics, University of Berne,

U. SCHAAD B. HADORN

Berne, Switzerland

Hôpital des Cadolles,

tish Neurological Surgeons (May 28, p. 1155) is commendable. The evidence in favour of properly designed, fitted, and adjusted seat belts is beyond question and the oft-heard objections to the dangers of seat belts are as convincing as the condemnation of parachutes, which have in rare cases been unnecessary and have in other cases caused death by failing to act as intended.

Birmingham Accident Hospital, Birmingham B15

1NA

P. S. LONDON

U.M.T.s IN JOB ADVERTISEMENTS SIR,-My committee believes that it would be an extremely useful contribution if all advertisements for N.H.S. vacancies for junior hospital doctors were to include the number of units of medical time (U.M.T.S) allocated to the post. Employing authorities are already obliged by D.H.S.S. circulars to send a full job description (including details ofu.M.T.s) and a replica of the contract to all applicants for a post. It would appear to involve very little extra work for them to include details of U.M.T.S in their advertisements. R. J. RHODES, British Medical Association, Boyd House, Chairman, Contracts Committee, North West Regional Hospital Upper Park Road, Manchester M14 5RH Junior Staff Committee

H. GAZE

Neuchâtel

PERITONEAL ABSORPTION OF POVIDONE IODINE FUTURE OF GERIATRICS

SiR,—The recommendations of the Working Party of the

Royal College of Physicians of London on the Medical Care of the Elderly (May 21, p. 1092), which are designed to alleviate the shortage of doctors in the geriatric service in the U.K., would, if implemented, solve the problem only partially and temporarily. In the long term they might lead to the disappearance of geriatrics as a subspecialty of general medicine. The report suggests that the geriatrician could be easily replaced by a non-specialist. However, this would soon result in his being regarded as a second-class physician. The demotion of geriatrics to the status of the poor relation of internal medicine is

one

of the main

reasons

for its decline and lack of

appeal, especially for young doctors. If we want to provide the elderly with a better service and make geriatrics more attractive then the recommendations of the Royal College of Physicians, although useful, do not go far enough. The basic problem can only be solved by giving geriatricians a new outlook so that they can approach and solve the problems of the elderly not only from the viewpoint of the traditional physician but also from those of the psychiatrist and the community worker. Istituto Gerontologia e Geriatria, Universita di Perugia,

E. MANNARINO

Perugia, Italy.

SEAT BELTS

SIR,-Having regard to the influential Royal Australasian College of Surgeons

part played by the in the decision to make motorists in Australia wear seat belts it is regrettable that there has been so little authoritative medical demand for such legislation in Britain. The non-committal attitude of the British Orthopaedic Association is as regrettable as the opinion of the Society of Bri7. Roe,

J. H., Rice,

E.

W. J.

biol. chem.

1948, 173,

507.

SIR, -1’ietsche and Meakins -have suggested that absorption and potential toxicity may result from topical application of povidone iodone (’Betadine’) to burn areas. We would like to extend their observations to include the peritoneal cavity. A 15-year-old female with a pelvic mass underwent exploratory laparotomy. Severe pelvic inflammatory disease was seen and the area was liberally washed with povidone iodin (550 ml of a 1 / 10 solution) followed by suction. 1 day later a raised serum-glutamic-oxaloacetic-transaminase (S.G.O.T.) was noted in combination with mild proteinuria and microscopic haematuria. Povidone-iodine toxicity was suspected. Serum and urine free iodine levels measured 54 h postoperatively were very high (193 [ig / dl and 170 p. g / dl, respectively). Although the patient had absorbed large quantities of iodine, an increased S.G.O.T. was also found in a stored preoperative serum sample and the serum contained hepatitis B antigen suggesting no causal relationship between povidon iodine and the raised S.G.O.T. The hxmaturia and proteinuria, both transient, were probably caused by high-dose antibiotic therapy (cephalothin sodium and gentamicin sulphate). Although povidone iodine absorbed from the peritoneal cavity may be lethal in the rat2 clinically in man no toxic effects have been reported.2-4 The high level of peritoneal absorption noted in our patient and in rats (2) and the potential toxicity of povidone iodine absorbed from burn areas1,s suggest that intraperitoneal use be limited until further evaluatinn is cotnnlpted-

Departments of Pediatrics and Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, U.S.A.

C. FREDERIC STRIPE MICHELE UHL DON MORRIS GRAHAM FALLON

1. Pietsche, J., Meakins, J. L. Lancet, 1976, i, 280. 2. Lavigne, J. E., Brown, C. S., Machiedo, G. W., Blackwood, J. M., Rush, B. F. J. surg. Res. 1974, 16, 307. 3. Feldtman, R. W., Mozersky, D. J., Hagood, C. O. J. thorac. cardiovasc. 4.

Surg. 1975, 69, 972. Guignier, M., Brambilla, C., Brabant, A., Dubru, J. L., Hernandez, J. L.,

Pircher, C., Muller, J. M. Nouv. Presse méd. 1974, 3, 1559. 5. Lavelle, K. J., Doedens, D. J., Kleit, S. A., Forney, R. B. Clin. Pharmac. Ther. 1975, 17, 355.