93

account for the condition. In fact the evidence is so farin favour of some genetically determined degenerationof the central nervous system, and this is supported bythe facts that kuru has been known to develop in severalsiblings at the same age and that the disease may showthe phenomenon of anticipation. A congenital tremor hasbeen seen in two Fore natives and occasional instancesof parkinsonism are known in adjacent territories, butthese conditions are easily distinguished from kuru.Further information on this striking disease will be awaitedwith interest, for it may well serve to throw welcome lighton unsolved problems of neuropathology.

1. Hunter, D., Bomford, R. R. Clinical Methods. London, 1956.2. Silver, H. K., Kempe, C. H., Bruyn, H. B. Hand Book of Pediatrics.

Los Altos, California, 1957.3. MacCarthy, D. Practitioner, 1955, 174, 160.4. Holland, W. W., Young, I. M. Brit. med. J. 1956, ii, 1331.5. Robinow, M., Hamilton, W. F., Woodbury, R. A., Volpitto, P. P.

Amer. J. Dis. Child. 1939, 58, 102.6. Gaertner, G. Wien. klin. Wschr. 1899, 12, 696.7. Cappe, B. E., Pallin, I. M. Anesthesiology, 1952, 13, 648.8. Goldring, D., Wohltmann, H. J. J. Pediat. 1952, 40, 285.9. Reinhold, J. D. L., Pym, M. T. Arch. Dis. Childh. 1955, 30, 127.

10. Forfar, J. O., Kibel, M. A. ibid. 1956, 31, 126.11. Sullivan, M. P., Kobayashi, M. Pediatrics, 1955, 15, 84.12. Moss, A. J., Liebling, W., Austin, W. O., Adams, F. H. ibid. 1957, 20,

53.13. Smith, C. A. in Nelson’s Textbook of Pediatrics. Philadelphia, 1954.14. Nadas, A. S. Pediatric Cardiology. Philadelphia, 1957.

MEASUREMENT OF BLOOD-PRESSURE IN

INFANCY

ALTHOUGH determination of the blood-pressure is notalways regarded as a part of the routine examination ofinfants and children, 1 2more conditions are now beingrecognised in which a dependable method of estimationis necessary.3 For clinical purposes, one of the usual cuffmethods (using auscultation, palpation, or oscillometry)can generally be applied, even to newborn babies, andHolland and Young 4 succeeded in measuring the systolicpressure in premature infants weighing as little as 4 lb.by palpation of the brachial artery. The estimation mustbe made while the infant is quiet, which may mean waitinguntil he is asleep, or giving a sedative. By comparing theresults with those obtained by direct intra-arterial measure-ment, Robinow et awl. showed that if a cuff of suitablewidth is used (25 cm. for newborn and 5 cm. for olderbabies) sufficiently accurate readings of the systolicpressure can be obtained by ordinary clinical methods,though there are errors in the diastolic readings becauseof difficulty in hearing the Korotkow sounds. The use ofan amplifying stethoscope may make auscultatory deter-mination both easier and more accurate. Where theconventional methods are unsuccessful, the " flush "

technique of Gaertner 6 may be used. It depends on theproduction of reactive hyperasmia by deflating a cufffrom a pressure of 300 mm. Hg, at a rate of about 5 mm.per second, on a limb made relatively bloodless distallyby compression with an Esmarch or similar bandage. Thelimb is held at heart level and watched in a good light, andthe pressure at which the first flush appears is noted.Since this method was first used in infants by Cappe andPallin and by Goldring and W ohltmann, a numberof reports on it have appeared,9-12 and it has become anestablished clinical method. 13

Average figures for normal brachial pressures in new-born babies are 80/46 mm. Hg, for babies aged six months89/60, and at one year 96/66 ;14 but the flush method givesvalues 10-20 mm. lower than systolic pressures obtainedby palpation, auscultation, or direct measurement-i.e.,it gives approximately mean pressures. The arm pressureis normally given as a few mm. higher than the leg bythis method,8 but in 8 cases of coarctation of the aorta

the difference was 36-88 mm.12 The flush method takes

longer than conventional methods of sphygmomanometry,and is more likely to make babies cry ; but even if they do,according to Forfar and Kibel, an error of only 7-10%is introduced. Schaffer 15 wrote " the flush method is

simple but coarse and unreliable," and it is undoubtedlyinferior to auscultation when the sounds can be well heard.It is useful, however, for babies whose brachial pulsescannot be felt, and for femoral blood-pressure estimationin suspected coarctation of the aorta.

15. Schaffer, A. I. Amer. J. Dis. Child. 1955, 89c, 204.16. Millions Still Go Hungry. Food and Agricultural Organisation of the

United Nations. Rome, 1957. Pp. 102. Obtainable from H.M.Stationery Offices. 5s.

F.A.O.

A SMALL book16 sets out in simple language the problemsthat the Food and Agriculture Organisation of theUnited Nations has faced in the first twelve years of itslife. These problems still exist, for, as the director-

general, R. B. Sen, says in his foreword, " there are todaymillions of hungry people, there are unused resources,maladjustments of distribution, depressed rural popula-tion." Nevertheless, the record is heartening, for F.A.O.has proved a good means of spreading knowledge in under-developed countries. The greatest difficulty in its way hasbeen that of getting the necessary cooperation betweenGovernments, especially in economic matters: too narrowa nationalism remains an important hindrance to scien-tific development. But it is significant that the Govern-ments of the various countries of North Africa have neverbeen so united--or so effective-as when serving as mem-bers of the Desert Locust Control Committee, sponsoredby F.A.O. National political wisdom may grow on adiet of international scientific knowledge.

NEW YEAR HONOURS

Sir Harry Platt was knighted six years before hebecame president of the Royal College of Surgeons, andthe baronetcy now bestowed on him recognises his threeyears’ tenure of that great and strenuous office, as well asthe value, in all his capacities, of his vigour and freshnessof mind. The particular reason for Sir Stewart Duke-Elder’s promotion to be a knight grand cross of theVictorian Order is presumably his services to the RoyalFamily, but these are of course only one manifestation ofhis remarkable services, through ophthalmology, to medi-cine. Of the new knighthoods, two, in the Order of theBritish Empire, are conferred on the recently appointedheads of the medical departments of the Royal Navy andthe Royal Air Force, Rear-Admiral R. C. May andAir Marshal P. B. Lee Potter. Three of the knightsbachelor work in Australasia (Dr. H. R. R. Grieve, Mr.W. G. D. Upjohn, and Dr. Ralph Whishaw) and three inGreat Britain. Of Professor Krebs, of Oxford, Nobelprizewinner of 1953 and discoverer of the citric-acid

cycle, it has been said that as a leader and teacher he hasinstilled the element of genius that turns possibilities intorealities. Dr. Kenneth Cowan has retained and increasedthe confidence of his colleagues by his understandingwork as chief medical officer of the Department of Healthfor Scotland. Dr. Bentley Purchase’s championship of thedifficult office of coroner, as well as his outstanding laboursin it, deserve the honour they now receive. These are

only the first names of a list which brings forward, forpublic thanks, much notable work-some of it widelyknown but much of it done in places where only a fewcolleagues can be aware of its quality.