697 stiit remain to be determined.
However, our findings hitherto to indicate, as suggested earlier by Woods and Laurie,14 that the rarity of coronary occlusive episodes among Africans is not attributable solely to the lower incidence of coronary pathology among those people nor yet to their low blood lipids per se, but rather to other associated metabolic difference(s) and perhaps even those which we have hero indicated to be present. would
These possibilities are being actively explored by our group, clinically and experimentally, in the hope that greater understanding of the mechanisms promoting coronary thrombosis may yet be obtained from a study of the derangements in hepatic function, in sex-hormone and reticulo-endothelial activity, and several other consequences of that macromolecular syndrome which we believe to be present among Africans5 and which may
yet be shown to be responsible for
" preventing coronary despite that premature senility which is so striking a feature of the Union African. Of special interest, too, is the possibility, arising from these studies, that it may yet prove possible to assess the "coronary future " of individuals from a study of their chylomicronsmia, plasma fibrin, and fibrinolytic capacity under basal conditions and especially at various times after ingesting a single standardised fat meal.
Schlesinger Organisation Medical Research Unit, Department of Physiology, Medical School, University of Natal, Durban.
THEODORE GILLMAN S. S. NAIDOO MICHAEL HATHORN.
NERVOUS SYSTEM IN PORPHYRIA SiR,ŇYour annotation of Sept. 14 mentions that Waldenstrom porphyrin may be the toxic agent active in acute porphyria. This hypothesis deserves to be subjected to experimental study, and I want to point out that this should be feasible on small animals, such as rats and rabbits, known to develop symptoms much like human acute porphyria after ’!Sedormid’ poisoning, by using uroporphyrin ill prepared from the flight feathers of touracos by means of a recently described much simplified method.15 Touraco feathers may be obtained from most larger zoos, and if necessary the birds may be reared for
purposes. County Hospital. Svendborg, Denmark.
TORBEN K. WITH.
RUDOLPH MATAS M.D. New Orleans
Rudolph Matas died on Sept. 23 in New Orleans, where he had lived nearly all his ninety-seven years. By his ingenuity, skill, and vision vascular surgery was called into being ; by his lucid pen, patient observation, and careful garnering of clinical material its growth was fostered ; by his integrity, humanity, and friendliness his colleagues were refreshed and enriched. His work and personality were respected throughout the whole world.
His early education fitted him for the role he was to play in international surgery. He was born in 1860 in a parish close to New Orleans, the only son of a Spanish physician. Soon afterwards his parents returned to Europe, and Matas spent his first ten years in Spain and France. After the family’s return to the New he continued his World education in Texas, Mexico, and New Orleans, where he qualified in 1880. Immediately after graduation he established himself there. He quickly built up a large surgical practice and when only 34 was appointed to the chair of surgery at Tulane University. He was perhaps lucky to begin his surgical career [Surgery, St. louis at a time when asepsis was turning apparent miracles into every day performances, but he was not content merelv to accept the security it offered. Instead with its help he challenged long-accepted procedures. His most notable exercise in iconoclasm was the substitution of sutures for ligatures in the treatment of aneurysm. He first used this method in 1888 when operating on a young Negro with a traumatic aneurysm in the left arm. Ligatures and extirpation of the sac had failed, and as a last resort to avoid amputation of the arm Matas decided to suture the orifices that were keeping the sac in I recalled " he wrote more than fifty years pulsation. later, " the control of gunshot wounds of the intestines by suturing the orifices to prevent extravasation of intestinal contents, and it seemed a rational thing to control the hemorrhage by suturing the bleeding orifices. After suturing all the bleeding orifices within the sac (the wounded collaterals), I ordered the tourniquet released and found that the bleeding had all stopped. The sac became dry. Hemostasis was complete. In a short time the aneurysm dwindled to nothing as its blood supply was completely arrested, to my astonishment and great satisfaction. I then closed the wound, which healed, and the patient recovered with good use of the arm." The success of this first attempt led him to use the method again with success, and he gradually developed and modified the technique of the operation, to which he gave the name of endoaneurysmorraphy. Cases were soon referred to him from all parts of the country. From his studies of the peripheral vessels he turned to the problems of aneurysms of the central and visceral arteries. In 1899 he introduced intralaryngeal insufflation, which opened the way to surgery of the thorax. Recognising the danger of interrupting the blood-flow in the main arteries he devised a method for their temporary occlusion. In 1923 shortly before his retirement he performed the first successful ligation of the abdominal aorta. Though his work on the vascular system had the widest influence, his penetrating mind and gift of lucid exposition were valuable in many other directions. He was one of the first to recognise the advantages of local anaesthesia, and some sixty years ago was carrying out most major interventions with its aid. In regional "
SNAKE-BITE AND ITS TREATMENT SiR,-The letters of Sir Philip Manson-Bahr and Dr. Gibson (July 27) do great service in calling attention to the exaggeration of danger to human beings from
Among 443 Malayan victims known to have been bitten by potentially lethal snakes, such as the common cobra, the viper Ancistrodon rhodosto1na, (Boie), and sea-snakes, during 1955 and 1956, at least a third had no significant symptoms of poisoning at all. In only 16% did severe poisoning develop. For such patients the consequences can be extremely unpleasant, sometimes fatal, and they should be treated as medical emergencies. Clinically, it is usually possible to distinguish this minority at an early stage-as I hope to show in future publications. The majority, as Sir Philip wisely states, require only simple treatment. I would not, however, include injection of carbolic soap. It is most unlikely that such a procedure would help human victims of Vipera berus bites. Ahuja, who suggested this treatment as a result of animal experiments, himself admitted 16 that it only detoxified cobra and krait venoms-it had no action on Russell’s viper venom. In the treatment of bites in human beings it would almost certainly do more harm than good. General Hospital,
H. A. REID.
14. Woods, J. D., Laurie, W. Ibid, 1957, i, 1091. 15. With, T. K. Nature, Lond. 1957, 179, 824 ; Scand. J. clin. lab. Invest. (in the press). 16. Ahuja, M. L., Singh, G. Indian J. med. Res. 1954, 42, 4.