SummaryTwo large-scale surveys of body temperatures in elderly people living at home were carried out in the winter of 1972. Most of the homes visited were cold with room temperatures below the minimum recommended by the Department of Health. Deep body temperatures below 35 5'C were found in 10% of those studied, and the difference between the skin temperature and the core temperature was also reduced in this group. Such individuals are at risk of developing hypothermia since they show evidence of some degree of thermoregulatory failure. Further research is needed, but meanwhile there are practical measures that could be taken to reduce the risk of hypothermia in the elderly.

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Body-temperature regulation has been studied in two communities in New Guinea. On Karkar Island in the hotter coastal region, 40 young adult males and the same number of young female villagers, together with 39 plantation workers and 14 Europeans, were examined. At Lufa, near Goroka, in the cooler and drier highlands, 30 male and 25 female adult villagers, together with 36 older people, were investigated. Tem perature regulation was studied using an air-conditioned bed in which the subjects received standardized exposures to cool and warm environments and the sweating response was measured during controlled hyperthermia at 38 °C. The results did not reveal any important difference in response between the coastal villagers and the highland people. The Europeans living on Karkar Island had the high sweating capacity which is characteristic of the acclimatized European, whereas the sweat rates of the New Guinea people were closely comparable to the level for an unacclimatized European. Comparison of the two sexes showed the lower sweat rates and the pattern of deep body and skin temperature changes found in women in previous studies using this technique. The changes in deep body temperature, skin temperature, blood flow and heart rate during the successive periods of exposure to a thermally neutral climate, with cooling and during rewarming, do not indicate that the indigenes of New Guinea utilize the vasomotor control mechanism more efficiently than Europeans.

BRITISH MEDICAL JOURNAL 6 JANUARY 1973 21 lytic activity. Such changes have been interpreted as a physiological development to provide for effective haemostasis and preservation of the maternal blood volume during parturition (Bonnar et al., 1971). The increased levels of coagulation factors associated with pregnancy have been reported as occurring, in the main, in the third trimester. In the present study factors VII and X were found to be increased early in the second trimester. An increase of similar magnitude in the activity of these factors at an unspecified time during the second trimester was reported by Nilsson and Kullander (1967). Already there are reports emphasizing the haemhorragic complications of therapeutic abortion, and it is likely that in some instances defective blood coagulation may be responsible.The increase in the activity of factors V, VIII, and X which were found during induction of abortion in mid-trimester pregnancy by extra-amniotic prostaglandin F2,a indicates that activation of the coagulation system is taking place. In particular the increase of factor X may be due to the escape of thromboplastin substances from the placental site during uterine contractions and especially at the time of placental separation. It has been shown in hamsters that thromboplastin material enters both the maternal and fetal circulation during placenta separation (Brown and Stalker, 1969). During placental separation at term in normal pregnancies increased levels of coagulation factors V and VIII have been found in both peripheral and uterine blood (Bonnar et al., 1970). Stander et al. (1971) suggested that induction of abortion by intra-amniotic injection of hypertonic saline initiates disseminated intravascular coagulation. They reported more extensive changes than were found in the present study.It is of interest that virtually no changes in the coagulation system were found during termination of early pregnancy by vacuum aspiration. It seems, therefore, that when pregnancy is terminated in the mid-trimester, whether by hypertonic saline instillation or by extra-amniotic prostaglandin, coagulation system changes in the circulating blood take place. These are most probably related to the physiological changes which have taken place in the haemostatic system in the second trimester. Coagulation changes associated with abortion will establish a vulnerable state for intravascular clotting and thromboembolic complications. It is likely, therefore, that in susceptible patients termination of pregnancy after the first trimester may give rise to such complications as defective haemostasis or thromboembolic complications.

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