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ANAEMIA BRITISH ----9~~~~~~~~~~~~~M EDICAL JOURNAL had died), and these were all reassessed. In 61 (32%) the haemoglobin level was below 80%. Hypochromic anaemias, of the non-specific variety, accounted for 55 (50 in females). The reasons for these relapses were generally failure to continue with iron therapy.As a result of this study it is recommended that full facilities for investigations be given to all family doctors in at least one hospital in each local hospital group; that more teaching be given to undergraduates and postgraduates (in general practice) on the frequency of anaemia and on the principles of successful management; and that the importance of the long-term treatment and follow-up of the particularly vulnerable group of women in their later reproductive phase (that is, 30-50) is appreciated. It is quite useless to treat those women by a prescription for 100 iron tablets and then to forget all about them. Treatment, with regular blood tests, is necessary right up to and well past the menopause.My thanks are due to Dr. John Keall, Mr. E. J. Maddox, and others at the pathological laboratory at Beckenham Hospital for their kind co-operation.

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Summary. Community samples of 673 subjects who had had serum vitamin B12 concentrations measured in 1958 were followed‐up 10 yr later. 134 of these subjects had died; the death rates showed no consistent trend in relation to the original serum vitamin B12 concentrations. Comparisons of concentrations in 1958 and 1968 in 480 subjects showed correlation coefficients (r) of between 0.46 and 0.71 in various subgroups. The oldest age group had a slightly lower mean concentration, and a larger proportion of this group had values below 100 pg/ml. Several subjects with a consistently low serum vitamin B12 concentration for 10 yr maintained an apparently satisfactory circulating haemoglobin concentration.

SYNOPSIS Red blood cells aggregated by 5 % dextrose solutions are rapidly destroyed in the circulation, as demonstrated by radio-chromium studies. Possible mechanisms are discussed.The aggregation of red blood cells into macroscopic clumps in the presence of 5 % dextrose solutions is a familiar sight to most clinicians who have transfused blood and dextrose in succession through the same giving-set, particularly since the introduction of transparent plastic tubing (Fig. 1). As the proportion of dextrose to blood increases within the tubing, the residual red cells form large aggregates which are capable of obstructing the lumen of the needle. The phenomenon is reversible since the addition of small amounts of electrolytes causes the clumps to disperse: this is presumably what occurs should these aggregates enter the circulation.In an attempt to determine whether this aggregation has any clinical significance and if possible to elucidate its mechanism, red cell survival studies were made using radio-chromium. MATERIALS AND METHODS DEXTROSEThe 5 % dextrose solutions used in this investigation were prepared according to B.P. specifications for infusion.RADIO-CHROMIUM TAGGING Samples of blood, each of 10 ml., were taken from normal subjects and the cells labelled with approximately 75 yg. 51Cr. as sodium chromate by a modification of the established method (Wetherley-Mein, Epstein, Foster, and Grimes, 1958). The suspension was then centrifuged, the supernatant fluid replaced by 20 ml. 5% dextrose solution and after 15 minutes the fresh suspension was re-injected into the donor's circulation. Erythrocyte survival was studied by examination of samples taken 15 minutes and one hour after the injection and subsequently at daily intervals for four days. Assessment of red cell destruction was expressed as 'percentage chromium loss per day', up to 5 % chromium loss per day being accepted as normal.

The incidence and nature of electrocardiographic changes occurring in subarachnoid haemorrhage was determined by a prospective study of neurosurgical patients. Electrocardiography was performed daily. The patients were grouped according to whether the electrocardiogram was always normal, always abnormal, or changing. A high incidence of electrocardiographic changes occurred not only in patients with subarachnoid haemorrhage (62 per cent) but also in those with space-occupying lesions (68 per cent). The prognosis in patients with changing electrocardiographic abnormalities was worse than in those in whom the electrocardiogram was consistently normal or consistently abnormal. The cause of these electrocardiographic changes was not elucidated but they were noted to occur more frequently in association with deteriorating levels of consciousness, pyrexia, and diastolic hypertension.

Summary New entrants to four medical schools in Britain were questioned with regard to those factors which made them choose one medical school rather than another. Approximately 400 replies were obtained which indicated that acceptance of the student's personal qualifications for entry and the buildings and facilities of the medical school were attractive features and an emphasis on community medicine and the availability of living accommodation also exerted a positive effect on would‐be medical students. The fact that relatives went to the school, that the school had a traditional approach or that they were advised to choose that particular institution by their school teacher appeared to be found unattractive by possible applicants.