¢ obo FO ‘Aus, 13, 1960 i reduces ipaemia, may, delay the development of itheroselerosis. If pefsons who clear lipaemia slowly have a particular tendency to develop atherosclerosis, then physical exercise might be specially beneficial for them. ‘Stocks (1951) suggested that class differences in. the idence of ischaemic heart disease might be related to the physical demands of occupation. ‘This susgestion hhas been amplified by the epidemiological studies of Morris and his associates (1953, 1958), which support the. bypothesis. that physical activity is a protection “against ischaemic heart disease. To explain this observa tion various proposals based on experimental studies have been put forward. Eckstein (1957) found that exercise promoted the ‘growth of collateral anastomoses of the coronary arteries Sf dogs. By observations on human volunteers Mann fand his associates (1955) found that increased physical activity prevented the rise in serum cholesterol and lipo- proteins that resulted from overfeeding. McDonald and Fullerton (1958) found that physical exercise abolished the increase in blood coagulability that occurs after neal of fat. If changes in the clearing of alimentary Tipaemia affect the cholesterol-lipoprotein system and the Diood-coagulation mechanism, our observations may be related to those of other investigators. : oslerosis. If this i v, then physical exercise, if Summary “The effect of physical exercise on the clearing of lip- emia hns been investigated, ‘The plasma turbidity of So student volunteers was measured at various times after a standard meal containing either 75 or 60 g. of fat. During one test the students rested, but during. nother similar test they took exercise, either walking or eyeling, Ina statistically significant number of Cases the plasma turbidity was less after exercise: than alter resting, ‘We acknowledge the assistance received from Miss R. F. Mincher and Miss B. Freeman, the dietitians atthe Sheficld Miners osptely snd thank them for their co-operation. We Tere eur, E. Gumpert for bis constant encouragement hu advice, and particularly the medical students who took art in the investigation, . Technical assistance was provided Bria grant from the United Sheffield Hospital endowment fond. Rereeices Bard, D. W. (1956), Belt. med, 3,2, 610. Besig, OH Moye Bu a8 exe H. (90) Seer 8 R. W. (95D. Circular, Res, 8,290 Mabousid, Gn Ac and Fullerton, H. W, (1958). Lancet, 2, 6. Mann, Gi: Ve Ted, Ke Hayes, Gp, McNally, A. and Bruno, D. "9S. Rew Boat, Med, 283, 303 Moreton, J, Re (1947). Selence, 106 190, Morris i. Nos and Crawford, M.D. (1958). Brit, med. J. 2, 1485 srewrliegdy i, Ao, Ratle, P A.B., Roberts, C. Gu and Pars, TAM isSife Lancet 2 1053, WAL Zinn, Weds and Wharton, G. K, (1950). J. Amer et 10d 3. Sechwayte. be Woldow, Ax and Dunsmore, R. A, (1982). Ibid oes Stocks, P. (95 354 omer, Lance! “The New South Wales PucKament has given a fist reading toa Bill to combat ait pollution. The Bill provides for the fctablishment of a central organization to investigate the ‘cases of air polation and to give expert advice (0 industry Shd monicipol authorities. (Radio Australia News, April 8) LIPAEMIA AND PHYSICAL EXERCISE Medical Memoranda ———— Dietary Deficiency of Vitamin Biz In noa-tropcal areas ofthe word, dietary defcieacy of amin Bry is ares even tropical mutitional macro- Gye anaeihia is primarily due to folivackd deficiency Daz Gp etal, 1953), Vegans—namely, people who Go'hot cat-any: form of animal protein—are Lnble to develop dietary vilamin-B,, deficiency, because vegetable Stolen apart from seaweed and pround-nes, contain negligible quantities of this vitamin: Wokes et al. (19553, 19858) have presented a fll sceount of th problem in Wteane, ‘They showed that, even in this group, vitamin- Bee deficiency takes some years to develop, and in fact, Ry Got netesserly. occur. On the other hand, 2 Tuber of eases. Of megalobastic anaemia duet stay. deficieney have been described, but many of these cases were investigated before vitamin B,y had been ineovered and. many before. steraalmerrow [EStnioation was a routine procedure, Some of these Sonded eases could be regarded as showing Tanifestations of vtamin-B,, delciency due a0 Inadequate diet, but many had other possible causes of the anemia or such blunderbuss therapy. that.proof of diary vitamine,, deficiency is uncertain, "As far back as 1927, O'Hara and Grewal described a cate which they said had pernicious anaemia. Theit Salient was a {4year-old boy living on bread, milky Potatoes; and “candy.” He was anaemic, with Petoblasie marrow and schlorhyéria, and responded {Ty oral liver, Other similar cases, some well ives: tiated and ‘thers poorly investigated, were deseribed SP Aykcoyd G30), Kern (1931), and Longcope (1938). Groen and Snapper (1937), in. very sound study of fw cases, pointed ont the Inck of “extcisie™ factor WrGsce sadly lacking in meat, milk, and eggs. The fuidents had free acid, and one responded to a full dit Bathe other wae. aiven intramuscular live Uneley Opashdeserfoed, two cates, but probably, one of {ie wis receiving antcoovatsant drugs, and We BOW Know that these drugs can produce a. megaloblastic haem (Badenoch, 1954; Hawkins and Meynell, 1958) The same is true ofthe case he described later (Unaey, T9se) Sit, we must agree that all three patents were ta ict erosy deficient in animal protein and there- 2.2 Gin, deficiency was possible. . (Townsend id Bogor’ (1342) case was probably a tse ease of” distarp ita, deficiency, and_we, must siilarly SES the case of Badenoch (1954), and of Harzson SGP dose), and tHE Tiree cases of Molin and ROS i950. We feel that to prove that a. case of macrocytic anwenit is due to Gietary vitamin-By, deficiency the fiitowing itera are. necessary: ()_megaloblasic Tre inkrows @) noemal. vitamin-B,, absorption by BRS Ur the ‘techniques. vsing radiouctive cyanoco- eatamin ; CD normal fatabsorption ; () the absence of CSlanicaing factors suchas the faking of an SONRitan geugs, (Hawkins and -Meynll, 1958), otantncy, of gastric operations (S) low serum Ievel reerieedn Bes (Oe would be helpful but not Shaolutly neetvary to find free acid in the stomach $ AAG) conversion of the mepaloblastic marrow Homoblastic by small oral doses of vitrin By. NltT eee 512_ Aue. 13, 1960 Our case satisfies these criteria, except that we were tunable to estimate the serum level of vitamin By. Case Histon A 40-yeac-old nulliparous woman had. been separated fsom ‘het husband Tor 12 yeary and Hived with he ooed mother. Until she became ill she hod. worked io at fpneerng factory assembling else motors “ler mah Somplaiat was angular stomauis anda Tough sore ionsus Her weight had bean steady and appetite good, "There wets no paraesthesia or Uarhoea, and apart fom ion whe bad taken no. drugs. “Her det consined no meat or puke a she disliked these foods, and not becauve of vegearian elif, [She had fish once weskly, took an ccearal cee or helping of cheese, had mi in her te, and used buses on her bread. When fst seea she was moderately pale and had some impetigo on the right check and soeneh at the aogle the mouth,” The tongue was smooth and ied. ‘The bios Bressure_was 145/90. There was no abnotinalty in the ENS. ‘The spleen and liver were impalpable, Toe ucne Yas normal. “A blood count showed” red els, 32000005 Hb, I g/t00 mis cde 116 “Becosym” was given for three weeks without any tenet Ga November 19, 1957, she was seen again, en’ & Fepeat blood count showed: ted sel, 3.500005 1 12 ef 100 mks Che 12; MEH, 36 me; MEV. 106 cubic imine; MCHG. 32 She was admitted for farther investigations on November 23, Physical findings were ag above. Further Iovestgatons were as follows: red cll, 3820000; Hoy 11 g/100 mls Ci, 099; MCV, 94 cobie mrom ; MOHS29 yup, MOHLC, 305%) “Gastric analysis showed fee aid. Fat balance showed an excretion of 1g. of faty acids pet diem over thes days. sising mean’ ‘Steral_ arr moderately cellar fntrmedint and fatr sages of erythro Poesy showed lager eel caricr baemodtobaication, aod 2 nuclear patierd snore retislar shan useal. Tw tical ofa matiow of eatly metaloblastic amaemis (be. DW. Dawson). Serum ‘proteins, iverfunton tei and serom tren wete nova On December 12 she went home on er old det but with the aditon of $9 of wan Br (cstacon otal cach day. This. wos continued unit January 21, 1958. ‘Her Syiptoms disappeared andthe stoma marrow ‘on anuaty 3 stat normal. ere wat ho Teisfocyosin ut ths wast Uc expected, asthe inal level of haemoglobin was nt very low. "There was no. significant. change i” haemoploba encentation, Later in 1958 4 vitsmibis absospion test Berne e al 195) showed an absorption of 1%, wich well oto the normal nt, As the test voles giving a large dntramoscolar dose of ‘vismia Bin that been deliberately dsiayed mit ‘x normal’ masiow ad bees produced by oat vitamin Bu Between January 21 and July she was on her old et but didnot tke any exta ora Warn Bye Her bnemogiobin id not se in thin peiod, but her old symptoms ad ot fetum. “AX we Wanted to be sure of providing er with ‘tami iy and could not be certain that she Would Take fra vitamin By or 4 normal dit, we put het on vita Bs iatamusculary, 100 pa. every two weeks. "This was arted on Iuly 8 ad by September 2 her haemoglobin was 128 g/i00 ml and on Beceier 29s blood coutt showed: red ells 4360000; Hib, 132/100 ms Cis 1 Comment ‘As can be seen, the above case satisfies all but one of the criteria for dietary vitamin-B,, deficiency. The one missing fact was the estimation of serum vitamin B,,. ‘An average ‘normal diet contains about 5 ye. of vitamin B,, per. diem (Goodman and Gilman, 1955). ‘Meat and fish are the main sources of dietary vitamin MEDICAL MEMORANDA, meodelTae Bs. Mil butter, ad cheese contain only the merest trace and'there isa sight amount in epg yolk, Weree table products contain none, and] wheat has a trace; Levis of al, 1949; Redler er al, TOSI) | “Thus er patent dt was gente ed Th ‘The initia symptoms in vegans are soreness of the mouth and tongue and. parsesthese (Wolss er we 1985, 19550). Our patients complint wat sorencs of the mouth and tongue, but there were no Parasstesiog and no evens otsbacte combine! deencraton of the spinal cord. ‘Thee was also very Iie the wor of anaemia, but our ease was an cary one, JOtten at course, anaemia will belong delayed fn these pateng as folic acd is. taken in liberal amounts, Beene of this, manifestations in the central nervous sys ae more likely and the level of serum vitamin Bi mace Towser than one would expect for the degree of aac We thok Br M,C. G. lnmls for ranging he vita Bu absorption test. ving Maxri S. Bourne, M.B., Ch.B. Savet, OLgESKY, M.B., MSc, MRCP. (Ceumpsal Hospital, Manchester Rereeewcue ibs, WB A190, Bet. med. 2,247, adenoch F. G053). Pro toy Sec ede, 426, eripe, 1. Mi Uhverscdge, L.A an Einely EW. (195, “Estee, It GOR, Chae, 3. B, aod Basu, P. C98). Brit Googinas Ls and Gikgan, A (959. The Pharmacolotia! ‘Bots of Thirapeutey and ed. Macraans Rey Vee (Grae and Steppers (OND, Amst hed SS, 633, Haron’, oot, Cand Mol, BE dS), bance Hawis,'C. F, and Meynelh M. J. (958). Quart, 2. me, 27, Sr iY Rie Berta ane tnt a cost U, Be Thomas Wand Flvchiem, CA. G49): Prog. Soe exp. Bal (NV). 73, 9.0 eapong. Wet O80. Hew it med hak Malia Btn Ross, 6:1. ME(G880." Pros nop" Soe, Med rat, Dy and Grewal, 2.5. (1929. Bouton med, sure. J. 197, ccieii. T., Vacowle, M. Caton, C,W., Mller, R. F., Nos, LC, and Heuser, 'G.'F. GD iN 43. rented BW SRS ae, FW Cat ed An 2 owe EE, 1939). Ouare J, Meds 2 381 ne Eien: 8B Hotes Fe Badenoch, an Sinclar, H, M, (98S). Voeding ie, Ss = (19850). Amer. J cin, Nutr ‘The identification of foreign matter in food is always of interest to the analyst, and when the vast amount of food consumed per quarier in a city of a milion inhabitants is taken into account, the number of complaints reecived is, from the consumers’ point of view, fortunately very low. Five such faulty samples, submitted by private individuals were examined With the following results: bottle of miner water (spots of mould firmly attached on inside of bottle) bread (bakery char—no evidence of rodent contamination) bread (larva of food moth); tinned pork roll (whole pig's tooth) ; ‘minced chicken’ in jar ({ragments of chicken Teathers), Where appropriate, the complaints were referred to the Medical Oficer of Heaith of to the Food Inspection Department. . .. “A soggy home-made cake was received with an inguity ‘as to whether we thought the ingredicats ( baking were at fault, -Pemale members of the tall were ‘unanimous that the latter was the cause of the complaint ‘A tactful leiter was dispatched fo the housewife concerned. (A. H. Coombes, City “Analyst, City of Birmingham Ana- lytical Laboratories, Report for the First Quarter, 1960)selwauy 2sejqojeboy ay) SHaVYSONOW Tv9IG3]W NuzGOW vod h4h| ;