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Blood and urine enzyme studies are being used in thedifferential diagnosis of acute renal failure. Dr. E. KEMF

(Copenhagen) and Dr. S. RINGOR (Ghent) noted an earlyrise in lactic-dehydrogenase plasma-levels in acute tubularnecrosis, with an isoenzyme pattern suggesting a renal origin.High urinary excretion levels of aminopeptidase in tubularnecrosis and glomerulonephritis, and a low level in chronicrenal failure, were reported by Dr. F. SCHELER (Gottingen).The acute renal failure after cardio-pulmonary bypass, reportedby Dr. J. S. CAMERON, appeared to be typical acute tubularnecrosis, but had a high mortality, probably because of

persisting heart-failure after operation.Dr. J. A. JUTZLER (Homburg) had successfully treated

acute intermittent porphyria by htmodialysis, and Dr. H.YATZIDIS (Athens) had developed a charcoal-column artificialkidney which complemented conventional dialysis.

Dr. B. A. CLARKSON (Newcastle upon Tyne) reported reducedcross-infection in uraemic patients with stricter barrier-nursing.Prof. RALPH SHACKMAN had performed partial gastrectomy tocontrol intractable gastrointestinal hxmorrhage in uraemia,and Mr. A. PRINGLE had found that jaundice did not worsenthe prognosis of acute renal failure. The long-term prognosisof acute renal failure complicating pregnancy was consideredby Dr. R. W. ELLIOTT (Newcastle upon Tyne). Patients wholeft hospital with normal blood-urea and arterial tension, andsterile urine, remained well for up to five years, and withstoodsubsequent pregnancy without difficulty. Dr. S. SHALDONdescribed a nurse/patient-operated unit where patients weretrained for home hasmodialysis.Automated dialysis was demonstrated by Dr. J. BLACK-

MORE (Halton). Dr. E. E. Twiss (Rotterdam) used only onecatheter, with alternating flow, to simplify cannulation of thevessels.

The next meeting will be held in Newcastle upon Tyneon Sept. 17 and 18, 1965, under the presidency of Mr.John Swinney.

Public Health

Ages of PopulationFURTHER tables now published show that the population

of England and Wales increased at a rate of 0-52% per yearbetween 1951 and 1961. Previous annual increases were:1891-1911, 1-10% ; 1911-31, 0-51%; 1931-51, 0-46%.The distribution of age-groups changed as follows between

1951 and 1961:

In 1961, in the south-east (excluding London) 15-8% ofpeople were aged 65 or over, as against 11-9% in the wholecountry and 10% in the Midlands. The proportion ofchildrenwas greatest in the Merseyside conurbation (26-1% under 15)and the northern region (25-1%), which were also the areasmost affected by the drift of population to the south andeast.

The number of females per 1000 males decreased from 1082in 1951 to 1067 in 1961; the relative number is higher inregions such as the south-east and Wales where there arerelatively many old people.1. Census, 1961, England and Wales: Age, Marital Condition, and General

Tables. H.M. Stationery Office, 1964. Pp. 108. 22s.

In England Now

’ A Running Commentary by Peripatetic Correspondents,

AN old night watchman, 80-odd or so, collapsed yesterdayand was brought into our casualty department. Cold and

hungry, probably, but he had nothing wrong with him, apartfrom various chronic ailments and old age. Casualty wished tosend him home, but found he had " no fixed address ". They

. referred him to the county welfare department and he was sentto a reception centre, where they greeted him none too warmlyand immediately burnt his clothes. But the M.o. examined him,found that the old man had-allegedly-a high temperature,rang up our hospital, swore that he had galloping pneumoniaor words to that effect, and sent him back for urgent admission.

Seen by the registrar in the ward the morning after, he isafebrile but a shade depressed. Thinks he’ll have to give upwork and go into a home. But he does seem to have goodfriends. What can the medical social worker do ?

I nip smartly off to the ward, in time to find a stalwart fore-man who has known and liked old Bill for fifteen years. Alsoa younger man who, at Bill’s request, is off to take a messageto his lady friend. I have a talk with them and later with OldBill. As far as I can see, he needs:A surgical boot. (He was taking a letter about this from his G.P.

to his local hospital when he collapsed.)A new pair of spectacles. (He believes that the reception centre

incinerated his spectacles with his clothes.)New clothes to go out in. (These I can get speedily from the

W.V.S.)A fortnight’s convalescence. (He hasn’t had a holiday for years

and years.)And after that, to his and the foreman’s mutual content, hecan go back to work." No fixed address." Well, no. Not legally. He didn’t need

one, until the cold spell got him down. For many years he hasgot as much sleep as he needed in his watchman’s cabin, thoughready enough to be alerted by any potentially sinister noise.By day he sold papers on the street. And any leisure hours hemight have in his busy life were spent in chatting amicablywith his lady friend. To send him into a home would breakhis spirit, almost certainly shorten his life, and rob a largecontracting firm of a valued and still valuable employee.

I’ve promised to get him out of hospital within the week.The registrar begrudges a bed that is intended for acutely illpatients, and points out, fairly enough, that this episode, evenif I do it in a week, will cost the health service over E30. Butwhat will it cost the State if the old man is consigned prematurelyto institutional care ?

* * *

You cannot fail to notice the growing practice of decoratingthe rear of the motorcar with chromium-plated status labels." De Luxe " used to be quite common to indicate that theowner had sprung the extra C50 to include heater, screenwashers, over-riders, and leather upholstery. This is old hatnow, and such " better-than-you " signs as " Super "," G.T.", and " Super G.T.", are common, and there seemsno end to the business. " Overdrive " is not an index of theowner’s personality but of his extra gears;

" Automatic "

means he has given up the gear-changing struggle or growntoo old to care; and now, menacingly, " Discs ! ".

If we are going in for prestige-atising, why not a littlediscreet professional advertising as well ? One could add intasteful chromium script " M.D., F.R.C.P. ". At least it

provides some light reading in traffic jams.* * *

As our neurologist remarked the other day, " The way thingsare going, all the physicians will soon only be using psycho-therapy while the psychiatrists will only use pills."

* * *

Christmas is coming and the goose is getting fat;Please to put a penny in the old man’s hat.If you haven’t got a penny, a ha’penny’s the thing,But there isn’t any hurry; he must wait till spring.