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Summary 1. Using the isotope Cr51, the red cell and total blood volumes have been determined in a group of 97 men aged from 55 to 89 years. A description of the method is given. 2. The total blood volume of these geriatric patients was found to be systematically reduced both in relation to body weight and to body surface area. The total blood volume deficit was chiefly dependent on a reduction of the red cell mass. 3. Determination of the blood volume is advocated in all aged patients who are to undergo major surgery. The red cell mass if deficient should be brought up to an approximately normal value for the patient's age and carefully maintained during and after operation.

There has been increasing, worldwide dissatisfaction with the relevance of medical education to health care. Recently, a special task group set up by The Royal Australian College of General Practitioners made a study of how a department of personal and family medicine could participate in the education of the medical student. The task was to present first steps in a research and development programme for education of health personnel to work in and near the family setting. Two academics, two nurse educators, two general practitioners, one specialist surgeon involved in medical education and a fifth-year medical student made up the group. It worked at the task during a six-day live-in teaching and leadership seminar at Leura, New South Wales, in February, 1973.

The inter-relationship between education and training, the development of health manpower, and the quality and relevance of a country's health services is highlighted by the powerful sponsorship and financial support currently being given by the World Health Organization to a primarily educational project in its various regions. The project is designed to improve the insights of health professionals into the art and science of teaching and learning.

In both there is overproduction of thyroid hormone, but in other respects there are important differences. The precise aetiological relationship, for example, between secondary toxic goitre and classic Graves's disease is still not clear. On another side Graves's disease merges into the anxiety states, autonomie imbalance, and neurocircula tory asthenia. On still another there are the gross and intriguing conditions of exophthalmos and ophthalmo plegia that still baffle our comprehension. Beyond are even more obscure linkages with other endocrino pathies, conditions with thymic enlargement, and myopathies. Classification

The thyroidal I131 uptake rate was measured in 1,116 Australian subjects whose thyroidal status was established at the same time. The logarithm of the uptake rate factor for various functional groups was found to be normally distributed. Diagnostic borderlines are described for premenopausal and postmenopausal females with and without goiter, and for males with and without goiter. The I131 uptake rate was found to decrease progressively with age in male subjects. In females it remained constant until the age of the menopause, following which a progressive decrease was seen. In 76 per cent of subjects unaffected by prior medication a clear diagnosis was established by a single thyroidal I131 uptake test.

Summary A patient who underwent cholecystostomy and removal of multiple gall-stones, developed, twenty-eight years later, an empyema of the gall-bladder, an abdominal wall abscess and fistulous track. The underlying condition was a cancer in the gall-bladder. Note worthyfeatures were the long latent period of twenty-eight years between cholecystostomy and her presenting with cancer, the subsequent development of a massive recurrence in the abdominal wall three and one-third years after cholecystectomy, and the probability that this recurrence resulted from extension of the growth to the fistulous track. Failure to excise the track completely may have determined the eventually fatal outcome five years after cholecystectomy.

The thyroidal I131 uptake rate, one hour after injection of I131, was measured in 450 subjects before and after the administration of ι-thyroxine for about three weeks. In 57 thyrotoxic patients without prior medication, the uptake rate showed a small, but significant mean rise after ingestion of thyroxine; in 51 thyrotoxic patients previously treated with antithyroid drugs there was a small, insignificant mean rise after ingestion of thyroxine. When submitted to the suppression test, most of the 345 euthyroid subjects showed a marked fall in the initially elevated thyroidal I131 uptake rate. There was, however, a small region of overlap between the two types of patients, amounting to about 0.7 per cent of the total euthyroid group and 7.3 per cent of the total hyperthyroid group. The assessment of patients in these overlapping regions is discussed.

Seventy-six thyrotoxic patients were studied by means of thyroid suppression tests (using thyroxine or triiodothyronine) after treatment with radioactive iodine. They were grouped according to the various intervals after therapy. Significant suppression of thyroid function was demonstrated as early as six weeks after treatment with radioiodine. There was close correlation between the degree of suppression achieved and the final clinical status of the patient. Suppressibility, absent in the thyrotoxic state, returns when the patient is rendered euthyroid.

Measured thyroidal radiosensitivity factors were found to depend on goiter size but not on sex, thyroidal status (hyperthyroid or euthyroid), type of goiter (diffuse or nodular) or value of uptake rate. A method of radioiodine therapy for thyrotoxicosis is outlined which is predicted to yield a myxedema rate of about 2 per cent, with 60 per cent of the patients requiring only one dose, 30 per cent two doses, and 10 per cent three or more doses. The average time required to achieve a permanently euthyroid uptake rate is about ten weeks. Later than three years after completion of therapy there seems to be a slight fall in the uptake rate beyond that expected on account of the patient's aging.