362

which he uses to post a letter at the end of the street. I considerhim grossly unfit.

I sometimes wonder if the cause of lack of correlationbetween coronary disease and obesity is omission to

measure " vital statistics ". The man mentioned above iswithin my classification of

" obesity ", but would not beso if " obesity " is taken as being above the average weightfor height. Of my own cases of coronary disease, morethan three-quarters have waist measurements well abovemy normal limit.

Leeds. R. A. MURRAY-SCOTT.

SIR,-Professor Yudkin (July 4) reports differences insugar intake between atheromatous subjects and controls.Our study of two such groups revealed a number of othervery significant dietary differences. (The controls, more-over, were chosen randomly from the same defined

population as the cases.)We observed that a group of

" atheromatous " men ate moreof all the main foodstuffs than the control subjects, the excessbeing proportionately no greater for carbohydrate than fortotal calories. " Atheromatous " women were characterisedsimply by a high fat intake (both absolute, and as a proportionof total calories).

In the light of Yudkin’s results we have now studied ourdata for carbohydrate intakes in greater detail :

R. A. MURRAY-SCOTT.

It can be seen that the sugar intake of the " atheromatous "

men is not increased out of proportion to their intake ofcalories as a whole. As Yudkin rightly comments, " an associa-tion between one dietary constituent and disease ... may occurbecause of an association between this constituent and another ".In a population whose eating habits vary as little as our own, itis very difficult to discover which constituent-if any-is toblame.

HARRY KEEN.Department of Medicine,

Guy’s Hospital,London, S.E.1.

GEOFFREY ROSE.

Department of Medical Statistics andEpidemiology, London School ofHygiene and Tropical Medicine,

London, W.C.1.

TRAINING OF SURGEONS

DAVID H. PATEY.Middlesex Hospital,London, W.1.

SIR,-Your annotation (July 11) brings out once againthe confusion resulting from the lack of a satisfactorydefinition of " general surgery ".

’

The general surgeon is as much a specialist as any of hisspecialist colleagues, but lack of realisation of this in an age ofspecialisation gives the term an unjustified aura of inferiority.Definitions of what the general surgeon’s specialty is, basedon some anatomical region such as the neck, breast, or abdomenin one or other of which he may be a subspecialist, are obviouslyunsatisfactory. No one would think, for example, of termingas

" general surgeons " surgeons, such as we find in the UnitedStates, who deal only with diseases of the breast. The essenceof the specialty which the general surgeon practises is for mebest conveyed by the French word triage, a better word thanthe English " sorting " as having stronger connotations, e.g.,gare de triage or marshalling yard. A general surgeon is onewho sees in the outpatient department and wards, or in aforward surgical unit or a mission station, an appreciableproportion of patients whose only initial label is that theyare candidates for surgery, and who is competent to " mar-shal " them as circumstances may demand, which includesability to deal with at least the immediate surgical problem.Circumstances may vary considerably from time to time, andfrom place to place; and this definition gives the necessary

1. Brit. med. J. 1958, i, 1508.

flexibility, for lack of which previous definitions have brokendown. From this broad base the general surgeon usually hasa choice of a wide variety of subspecialties in which to develophis experience and expertise, or he may set out on an evenmore exciting voyage to explore the unknown. Such a definitiontakes account of the claim of general surgery to be the bestmedium for inculcating the general principles of surgery.

Since the language of scientific terminology is classical, I havesought the expert help of Prof. Eduard Fraenkel, of theUniversity of Oxford, himself the father of a general surgicalprofessor of surgery. Professor Fraenkel points out that in thelife of the Greeks and Romans there existed no exact parallelto the gare de triage, but he suggests that the nearest is theGreek verb (&dgr;&igr;&agr;&khgr;&rgr;&igr;&ugr;&egr;&igr;&ugr; (diakrinein)-to separate one fromanother. He therefore tentatively suggests the term " diacriticalsurgery ", pointing out also that the adjective " diacritical "has the advantage that it is already used in English, though ina slightly different sense. Until, therefore, someone thinks ofa better definition or a better term, I suggest that we adoptProfessor Fraenkel’s term of " diacritical surgery for theprimary specialty of the general surgeon.

WECHSLER TEST

L. B. PETERS

SIR,-I read Dr. Heaton-Ward’s letter (July 18) withinterest.

So far as the Stanford-Binet test is concerned, I regard thenew Terman and Merrill revision form L-M as most usefulin schoolchildren, whereas in adults other tests are generallymore suitable.

Nevertheless, the i.Q. is no longer regarded as a sort of fixedstar. For instance, if a child is not making any progress inthe ordinary school despite an i.Q. of, say, 80, serious thoughtmust be given to his transfer to a school for the backward-assuming that no such complicating factor as hearing lossexists to depress his achievement in school.

It seems to me that more than an i.Q. should benecessary to determine a decision about people in prison,whose background must often contribute greatly to theirmental state.

Brighton. L. B. PETERS.

HÆMOLYTIC-URÆEMIC SYNDROME

F. J. W. MILLERS. D. M. COURTR. H. JACKSON.

The Children’s Department,The Royal Victoria Infirmary,

Newcastle upon Tyne.

SIR,-The haemolytic-uraemic syndrome of infants andyoung children, beginning with apparent infection andfollowed by haemolytic anaemia, thrombocytopenia, andvarying degrees of renal failure, is being reported in

Europe and America. There has been little reference to itin English medical literature, but there are suggestionsthat it is becoming commoner. At the British PaediatricAssociation’s meeting in Scarborough in April, Dr.Muriel McLean gave an account of ten cases occurringin the space of a few weeks in a single district of NorthWales in children ranging from 6 weeks to 8 years. Inthis small group there was one death.

In the past 3 months three children (aged 5 weeks,6 weeks, and 9 months) have been admitted to our depart-ment with this syndrome. Two have died and the thirdis now recovering. In the previous 5 years we have hadonly two other children whose illnesses would fit into thissyndrome.We are writing to ask whether other paediatricians are

seeing such cases and to discover whether the illness isoccurring frequently enough to need coordinated study.We should be grateful if those meeting the problem wouldwrite to us so that we can decide together what furthersteps can usefullv be taken.