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TOXIC CHEMICALS IN AGRICULTURE
853
of renal disease, we attribute these renal lesions to the rheumatoid disease. In 2 of the 5 cases, the urine showed definite proteinuria and casts; in the other 3 cases, a trace of protein was found. Rheumatoid arthritis is well known to be complicated by amyloidosis when of sufficiently long duration. Proteinuria developing in a case of rheumatoid arthritis was empirically taken to indicate early amyloid change. This study points to the important fact that there are other genuine rheumatoid vascular and other renal lesions that may produce changes in the urine (and probably in renal function) besides amyloid degeneration, so that proteinuria developing in a patient with rheumatoid disease requires needle biopsy of the kidney to determine its exact cause. tom or
history
Department of Medicine and the Renal Clinic, Abbassia Faculty of Medicine, Ein-Shams University, Cairo.
M. NAGY EL MAHALLAWY M. S. SABOUR.
THE COCKETT/ELGAN JONES (ST. THOMAS’S) OPERATION
MEAN DIASTOLIC BLOOD-PRESSURE (B.P.) (mm. Hg) AT ROUTINE EXAMINATION OF 86 APPARENTLY HEALTHY MEN WHO BECAME HYPERTENSIVE
Figures in parentheses denote
mean
age
(yr.)
at
time of examination.
From a study of 10,000 case-records of both sexes we found that 86 men were hypertensive. In each case, three times in the evolution of the diastolic pressure were noted: (a) the first examination when " normotensive ", (b) the last examination " as normotensive " (under 105 mm. Hg), and (c) the first " examination as hypertensive (over 110 mm. Hg). The group was split into two, according to the age at which they became hypertensive: a younger group aged between 30 and 49, and an older one between 50 and 69. "
SIR,-Since 1954 I have used the Cockett/Elgan Jones operation for gravitational ulcers. A follow-up1 of the results obtained by a combination of this operation with stripping " of the varicose saphenous veins showed that all ulcers remained healed (1-4 years). Two ulcers treated by stripping " alone recurred. Postoperative bandaging "
"
lasted 2-4 weeks. In my opinion this operation is of paramount importance in our surgical treatment of venous leg ulcers, although in my experience all insufficient subcutaneous veins draining the ulcer region must be extirpated. The method of choice is thus " stripping " plus the Cockett/
EIgan Jones operation. CARL C. ARNOLDI.
Mariestad, Sweden.
THE NATURE OF ESSENTIAL HYPERTENSION
SiR,-Analysing the problem of the nature of essential hypertension, Professor Platt (July 25) considers that " there seem to be at least two possible factors which may tend to obscure the facts when populations rather than individuals are studied. First, if it be true that essential hypertension is a disorder which manifests itself chiefly between the ages of 45 and 60, there must be younger ages at which the blood-pressure is rising at different rates and to varying degrees in different individuals." Professor Platt goes on to say that the rate of rise of pressure is a complicating factor " when the distribution curves of blood-pressure are plotted against "
age.
Nevertheless, from a study of the rate of rise of pressure on age in a population sample 2we concluded that this " complicating " factor must be considered in any quantitative study of blood-pressure. Applying the equation of the regression line of pressure on age in a group of 231 apparently "
normotensive " men followed 12 years, we found that the rate of rise of pressure was 0-31 mm. per year between 20-49 years of age, and 1-06 mm. per year between 50-64 years of age. Thus, in the normotensive subjects the rate of rise of blood-pressure increases with advancing age. To determine the rate of rise of pressure of normotensive subjects when they became " hypertensive we studied a group of apparently healthy men who were normotensive at their first routine examination for employment and who at follow-up 11 years later had developed " essential
healthy
"
hypertension ". 1. 2. 3.
Arnoldi, C. C. Danish med. Bull. 1958, 5, 272. Cruz-Coke, R. Rev. Med. Chile, 1959, 87, 116. Cruz-Coke, R. J. Amer. med. Ass. 1959, 171, 1333.
(see table) show that in subjects who hypertensive the rise in diastolic pressure in the younger men was at a significantly higher rate, and at a significantly higher acceleration, than in the older patients. The quantitative component of blood-pressure has two factors: intensity or " height ", and " rate of rise ", of pressure.4 The problem of the nature of essential hypertension has been explored only by means of the first factor; the " height " of pressure plotted against age. We think that a quantitative analysis should be performed considering both factors, and that the second factor, instead of obscuring the problem, will clarify it. The results
became
Aguirre Hospital, University of Chile School Medicine, Santiago, Chile.
R. CRUZ-COKE.
of
TOXIC CHEMICALS IN AGRICULTURE SiR,-Mr. Whitehead’s letter of Oct. 31 pinpoints the
tragedy of the indiscriminate use of chemicals, and their ecological effects. What is so sad is that it has taken the death of one human being to bring to the fore the real dangers of a spray procedure which may well have caused the deaths of hundreds, if not thousands, of animals. Man’s vanity of his own importance! W. M. ALLCROFT.
Pyford, Surrey.
REFORM OF THE LAW ON HOMOSEXUALITY SiR,-No-one would disagree with Dr. Learoyd (Nov. 7) that homosexual seduction of the young must be prevented. However, there is no evidence that homosexuals are any more liable to commit this type of crime than heterosexuals; and it would require far stronger reasons than unsupported generalisation to justify the present law governing relations between adults. This disease can be difficult or impossible to cure, and it is surely mere common decency to allow those who are affected to lead their own lives as they think fit. The consequences of this law are often tragic, and the young can be effectively protected without it. G. E. G. WILLIAMS. 4.
Cruz-Coke,
R.
Lancet, 1958, ii,
752.
of renal disease, we attribute these renal lesions to the rheumatoid disease. In 2 of the 5 cases, the urine showed definite proteinuria and casts; in the other 3 cases, a trace of protein was found. Rheumatoid arthritis is well known to be complicated by amyloidosis when of sufficiently long duration. Proteinuria developing in a case of rheumatoid arthritis was empirically taken to indicate early amyloid change. This study points to the important fact that there are other genuine rheumatoid vascular and other renal lesions that may produce changes in the urine (and probably in renal function) besides amyloid degeneration, so that proteinuria developing in a patient with rheumatoid disease requires needle biopsy of the kidney to determine its exact cause. tom or
history
Department of Medicine and the Renal Clinic, Abbassia Faculty of Medicine, Ein-Shams University, Cairo.
M. NAGY EL MAHALLAWY M. S. SABOUR.
THE COCKETT/ELGAN JONES (ST. THOMAS’S) OPERATION
MEAN DIASTOLIC BLOOD-PRESSURE (B.P.) (mm. Hg) AT ROUTINE EXAMINATION OF 86 APPARENTLY HEALTHY MEN WHO BECAME HYPERTENSIVE
Figures in parentheses denote
mean
age
(yr.)
at
time of examination.
From a study of 10,000 case-records of both sexes we found that 86 men were hypertensive. In each case, three times in the evolution of the diastolic pressure were noted: (a) the first examination when " normotensive ", (b) the last examination " as normotensive " (under 105 mm. Hg), and (c) the first " examination as hypertensive (over 110 mm. Hg). The group was split into two, according to the age at which they became hypertensive: a younger group aged between 30 and 49, and an older one between 50 and 69. "
SIR,-Since 1954 I have used the Cockett/Elgan Jones operation for gravitational ulcers. A follow-up1 of the results obtained by a combination of this operation with stripping " of the varicose saphenous veins showed that all ulcers remained healed (1-4 years). Two ulcers treated by stripping " alone recurred. Postoperative bandaging "
"
lasted 2-4 weeks. In my opinion this operation is of paramount importance in our surgical treatment of venous leg ulcers, although in my experience all insufficient subcutaneous veins draining the ulcer region must be extirpated. The method of choice is thus " stripping " plus the Cockett/
EIgan Jones operation. CARL C. ARNOLDI.
Mariestad, Sweden.
THE NATURE OF ESSENTIAL HYPERTENSION
SiR,-Analysing the problem of the nature of essential hypertension, Professor Platt (July 25) considers that " there seem to be at least two possible factors which may tend to obscure the facts when populations rather than individuals are studied. First, if it be true that essential hypertension is a disorder which manifests itself chiefly between the ages of 45 and 60, there must be younger ages at which the blood-pressure is rising at different rates and to varying degrees in different individuals." Professor Platt goes on to say that the rate of rise of pressure is a complicating factor " when the distribution curves of blood-pressure are plotted against "
age.
Nevertheless, from a study of the rate of rise of pressure on age in a population sample 2we concluded that this " complicating " factor must be considered in any quantitative study of blood-pressure. Applying the equation of the regression line of pressure on age in a group of 231 apparently "
normotensive " men followed 12 years, we found that the rate of rise of pressure was 0-31 mm. per year between 20-49 years of age, and 1-06 mm. per year between 50-64 years of age. Thus, in the normotensive subjects the rate of rise of blood-pressure increases with advancing age. To determine the rate of rise of pressure of normotensive subjects when they became " hypertensive we studied a group of apparently healthy men who were normotensive at their first routine examination for employment and who at follow-up 11 years later had developed " essential
healthy
"
hypertension ". 1. 2. 3.
Arnoldi, C. C. Danish med. Bull. 1958, 5, 272. Cruz-Coke, R. Rev. Med. Chile, 1959, 87, 116. Cruz-Coke, R. J. Amer. med. Ass. 1959, 171, 1333.
(see table) show that in subjects who hypertensive the rise in diastolic pressure in the younger men was at a significantly higher rate, and at a significantly higher acceleration, than in the older patients. The quantitative component of blood-pressure has two factors: intensity or " height ", and " rate of rise ", of pressure.4 The problem of the nature of essential hypertension has been explored only by means of the first factor; the " height " of pressure plotted against age. We think that a quantitative analysis should be performed considering both factors, and that the second factor, instead of obscuring the problem, will clarify it. The results
became
Aguirre Hospital, University of Chile School Medicine, Santiago, Chile.
R. CRUZ-COKE.
of
TOXIC CHEMICALS IN AGRICULTURE SiR,-Mr. Whitehead’s letter of Oct. 31 pinpoints the
tragedy of the indiscriminate use of chemicals, and their ecological effects. What is so sad is that it has taken the death of one human being to bring to the fore the real dangers of a spray procedure which may well have caused the deaths of hundreds, if not thousands, of animals. Man’s vanity of his own importance! W. M. ALLCROFT.
Pyford, Surrey.
REFORM OF THE LAW ON HOMOSEXUALITY SiR,-No-one would disagree with Dr. Learoyd (Nov. 7) that homosexual seduction of the young must be prevented. However, there is no evidence that homosexuals are any more liable to commit this type of crime than heterosexuals; and it would require far stronger reasons than unsupported generalisation to justify the present law governing relations between adults. This disease can be difficult or impossible to cure, and it is surely mere common decency to allow those who are affected to lead their own lives as they think fit. The consequences of this law are often tragic, and the young can be effectively protected without it. G. E. G. WILLIAMS. 4.
Cruz-Coke,
R.
Lancet, 1958, ii,
752.