blood ; they calculated that the patient had absorbed five times as much iron as
only 2% appeared
he could build into h2amoglobin. ALPER et al. in South Africa showed that a non-anaemic patient with haemochromatosis.absorbed and retained at least five much iron as the controls, and that as much Five months as 60% of a test dose was retained. still of the test dose was in the liver, later at least 15 % This in heart. retained the was and some patient died at the early age of 21, and necropsy showed typical changes already well developed in the organs. BALFOUR and others9 found that in a more chronic case the rate of iron uptake after a test dose was much less startling. It seems clear that an important factor in the pathogenesis of h2emochromatosis is excessive absorption of iron from the alimentary tract ; the mechanism that in the normal non-ansemic person limits the absorption of iron to very small amounts is not working properly, and since absorbed iron is excreted only very slowly deposition in the body tissues inevitably follows. If excessive iron absorption is the important factor in haemochromatosis, it might be rational to reduce the iron in the diet as far as possible. Unfortunately by the time patients come for treatment the damage is done. DAVIS and ARROWSMITH 10 did try the effect of repeated venesection in 3 patients with hsemochromatosis, and they claimed that serial liver biopsies showed lessening of the haemosiderin and improvement in the cirrhosis. Incidentally in these cases the red cells regenerated very quickly, and this suggests that the hsemosiderin iron may be utilisable for haemoglobin formation. The cause of the excessive absorption of iron is not yet known. The process must be slow, since 20-50 g. of iron is found in the body of patients after death, whereas iron in the diet rarely exceeds 20 mg. daily and only a proportion of this will be absorbed ; and ALTHA7USEN’s results show that iron deposition can be advanced before cirrhosis of the liver appears. The new facts do not disturb the idea that classical hsemochromatosis is the end-result of an inborn error of metabolism ; and now that the site of the error has been defined further research may enable us to determine its nature and perhaps start preventive measures in time. times
How should research be furthered ? " is a question that CEdipus would have found it a good deal harder to answer than the childish riddle set him. If the Sphinx had further restricted the question to research in psychiatry (with one aspect of which CEdipus’s name was later to be closely connected) his difficulty would have been greater still ; for the wind of research tends to blow where it listeth, and it has not yet blown to much purpose in clearing up the major problems of causation, pathogenesis, and prevention in mental disorder. The importance of these problems is now fully recognised. Several American organisations, including "
8. Alper, T., Savage, D. U., Bothwell, T. H. J. Lab. clin. Med. 1951, 37, 665. 9. Balfour, W. M., Hahn, P. F., Bale, W. F., Pommerenke, W. T., Whipple, G. H. J. exp. Med. 1942, 76, 15. 10. Davis, W. D. jun., Arrowsmith, W. R. J. Lab. clin. Med. 1950, 36, 814.
the Rockefeller Foundation and the Commonwealth Fund, have done much to advance research and training in this branch of medicine, and so, in this country, has the Nuffield Foundation ; the Beit trustees have likewise sought to help by expressing The a preference for research into mental disorder. Research formed Mental Health Fund, eager newly to advance the same cause, took the wise preliminary step of holding a conference at which those most intimately engaged in the work could tell each other, and the laymen who are alive to the importance of the matter, what steps would be most likely to bring us nearer the goal. As the guests of Magdalen the members of the conference College, Oxford, were under an obligation to its founder, WILLIAM OF WAYNFLETE, whose particular wish it was that no-one should engage in sophistry; and, happily, no marred their deliberations. At this consophistry we on which another ference, report page, it was that valuable research is going on, sufficiently plain and that its nature and rate of progress are chiefly determined by developments in the supporting sciences. The methods and concepts that emerge in anatomy, biochemistry, physiology, psychology, and the biological and social sciences generally, are those on which the investigator in mental health must depend. It is therefore a nice question, which the conference did not succeed in answering, whether progress is aided more by assisting first-rate study in neuro-anatomy, neurophysiology, psychology, genetics, and sociology, which have at present no obvious and direct bearing on mental disorder, or
by inquiries which apply unequivocally to psychiatry. Naturally most of the speakers dealt with the latter,
but such studies as those of which Prof. W. E. LE GROS F.R.S., Prof. ROGER RUSSELL, and Dr. G. W. HARRIS spoke testified to the impetus given to psychiatry when researches not primarily oriented towards mental disorder advance our knowledge of neural function and structure or of psychology. The conference gave recognition to this in its recurring emphasis upon research into the normal-a synonym for what is studied in all university departments concerned with the biological sciences. The members of the conference would have been more than human-as patients sometimes imagine psychiatrists to be-if they had not availed themselves of the occasion to declare their practical difficulties in getting material, recruits, and facilities for their work,and in keeping abreast of what is going on elsewhere. Naturally also they fell in with current trends towards team-work, emphasising the need for " a multi-disciplined approach. It was, however, pointed out by Sir GEOFFREY VICKERS, to whom many of the issues presented at the conference, especially in respect of training, were familiar -in other professional fields, that there may be dangers in persuading people to engage injoint or " integrated " inquiries when their interests and capacity lead them to concentrate on a narrow subject perhaps remote from the problem of mental health. In the long run it is from a few people with the requisite gifts and interests that advances through research chiefly derive. Research funds must look to them for the fruitful ideas and achievements that will enable the general run of investigators to get over obstacles which have proved so redoubtable in mental disorder.