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towards means of detecting latent coronary heart-disease 1;and this is an obvious approach for the screening ofastronauts, who are subjected to every possible physio-logical investigation before selection and before each

flight. Infectious disease is hardly a hazard to aviatorswhose flights, compared with incubation periods, are

exceedingly brief; but on two counts it must now enterthe reckoning of Space medicine: first because it canaffect the astronaut in transit; and secondly because it isan undesirable export. In the words of Generales: " Itwould be well to recall that the medical profession hasstill not eradicated syphilis since its introduction into

Europe about 1493 and the explosive epidemic of Naplesin 1495-an onerous heritage among the blessings andcountless commodities that followed in the wake of the

comparatively simple exploration of the WesternHemisphere 11 "There may not be a man in the moon, nor life on Mars,

but we ought to act as though there were.

NEAR RETIRING

IN its own modest words, this Nuffield study 3 is a"minor contribution to fuller understanding of the

problems of ageing among manual workers in industry ".Based on interviews with older men employed in Sloughfactories, it reports the kind of jobs they were doing, theirsubjective experience of strain at work, the foremen’sattitudes towards them, and changes of job in later

working life. Though the material consists more of

impressions than facts, the style is readable, the conclu-sions are cautious, and useful suggestions are made formore precise and detailed studies. Though nothing verynew emerges, this succinct statement of the problems of anageing labour force is valuable in a period of rapidlyincreasing industrial technology. In particular, the reportbrings out the opinions and attitudes of older workersthemselves and shows how few give any serious considera-tion to the impact retirement will make on their lives.Work involving time-stress again appears as the main

difficulty of older workers, and the report confirms thefinding from other studies that men in paced jobs oftenmove in middle age to relatively unskilled tasks whichoffer opportunities for self-regulation of speed of work.On the whole, foremen seem to be helpful and under-standing about adjustments of this kind, and indeed toshow foresight inasmuch as they try to move older men tosuitable work before they break down. By these internaltransfers industry can reduce the casualty-rate among itsown employees, but in the favourable employment con-ditions of Slough the older men were prepared to searchfor more attractive jobs elsewhere and to make a successof them; furthermore, supervisors did not seem to beunduly prejudiced in their attitudes to older workers.Any report that draws attention to the need for a

preventive approach to ageing in industry is to be wel-comed. Though a good deal is now known about what toexpect in groups of men reaching middle age in certainkinds of work, industry itself seems to have a low aware-ness of this knowledge and how to apply it; and people inresponsible positions in management and labour couldread this study with profit.

It prompts a further thought. How does ageing affect1. Rumball, A., Acheson, E. D. Brit. med. J. Feb. 16, 1963, p. 423.2. N.Y. St. J. Med. 1963, 63, 1310.3. Workers Nearing Retirement. Nuffield Foundation, Nuffield Lodge,

Regent’s Park, London, N.W.1. 1963. Pp. 53. 5s.

medical occupations today ? So far, little seems to beknown about time-stress and fatigue in older doctors.Some information about the attitudes to, and use of,retirement by physicians might help us to decide whetherthe retirement policy in the health service is sound. Wealso need information on the most suitable occupationsfor doctors in their late sixties. Perhaps the NuffieldFoundation will provide us with some of the answers ina future study in this series.

SALT-POISONING IN INFANCY

DANGEROUS salt retention in infancy may result frominjudicious intravenous therapy, and troublesome saltretention may result from the use of corticosteroids.Accidental salt-poisoning must be very rare, and we areindebted to three Baltimore workers I for an account ofa serious incident in a newborn nursery, in which salt wasput into the infants’ feeds in place of sugar. 14 infantsreceived the salt-containing feeds, and 6 of them died-5 of them before the condition was recognised. Symptomsdeveloped in 11. All had convulsions or twitching, andall became feverish. All but 1 vomited. 5 showed

respiratory distress, with tachypnoea and flaring of thealae nasi. All showed intense thirst until they becameseriously ill. In the 5 cases where necropsy was carriedout this revealed a haemorrhagic encephalopathy, withsevere capillary and venous congestion, subarachnoid andparenchymatous haemorrhages, and sinus thromboses.4 of the patients were treated by peritoneal dialysis,followed by low-electrolyte oral feeds, and 3 of thesesurvived. The highest serum-sodium recorded was

274 mEq. per litre, and this child survived.Prolonged hypernatrasmia is known to damage the

brain, and children with inadequately treated nephrogenicdiabetes insipidus, in which hypernatrsemia is a feature,undergo mental deterioration. A form of hypernatrxmicmental deficiency has been described. Consequently it isnoteworthy that all the survivors of this episode areapparently physically and mentally normal.This is not the first time that infants’ feeds have been

poisoned by a substance accidentally added in place ofsugar, and it is valuable that we should be reminded ofthe fact. Perhaps we should add immunity to accidentalpoisoning of this nature to the list of advantages ofbreast-feeding.

INGROWING TOENAILS

SURGERY is never so meddlesome as in the treatment of

ingrowing toenails. The accolade of the aspiring ortho-paedic surgeon seems to depend on his ingenuity in

devising a new operation for this common affliction. Yet,properly handled, ingrowing toenails scarcely ever needoperative treatment. Lloyd-Davies and Brill 2 say thatthe policy of the toe clinic at St. Thomas’s Hospital isprimarily conservative, but that many patients arriveafter their nails have already been avulsed in the casualtydepartment. The drawback to operative treatment is that,for a short time afterwards, the patient is disabled fromwalking, and that often he has to hobble about in slippersor split shoes for some time. A new nail takes about sixmonths to grow, and the end-result of operation nearlyalways leaves an unsightly toe.1. Finberg, L., Kiley, J., Luttrell, C. N. J. Amer. med. Ass. 1963, 184, 187.2. Lloyd-Davies, R. W., Brill, G. C. Brit. J. Surg. 1963, 50, 592.