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552 hangs out to catch our attention. Yet the very term " breakdown" invites us to look deeper-implying, as it does, a special vulnerability, a genetic factor, which has encountered a second factor, a set of adverse circum- stances in the environment. In our mental-deficiency institutions there may be others besides psychotic children who began life with average mental capacity, and for whom the normal pattern of development was disrupted by something which happened postnatally. The concept suggests opportunities for preventive psychiatry which paediatricians and psychiatrists might explore-if possible together. 1. Luongo, M. A., Bjornson, S. S. New Engl. J. Med. 1954, 251, 995. 2. Smith, J. P. J. Path. Bact. 1952, 64, 467. IRON AS A LIVER POISON DEATHS from overdosage of iron preparations pres- cribed for therapeutic purposes are distressingly num- erous. Some of the attractive proprietary preparations are readily mistaken for sweetmeats ; and this, together with apparently special susceptibility in the young, no doubt accounts for the relatively high incidence of iron poisoning in infants and young children. The three fatal cases observed by Luongo and Bjornson over a period of two years in a population of a million may be a, rough guide to the frequency of such poisoning. The principal clinical manifestations are vomiting followed by profound shock, coma, and death despite prompt restorative measures. The depth and speed of development of shock suggests the rapid entrance into the circulation of a potent vasodilator,2 and it is not unreasonable to relate this to the known action of ferritin, an iron protein complex extractable from the liver which is thought normally to play an important part in the control of iron absorption from the alimentary canal. In the presence of a massive dose of ferrous sulphate this controlling mechanism is supposed to break down-a supposition borne out by the presence of histochemically demonstrable iron in the endothelial cells of the submucosal veins of the stomach. This gross excess of iron is then available to combine with the protein, apo-ferritin, which is normally present in the liver, resulting in the formation of an excess of ferritin. Necropsy usually shows oedema and ulceration of the stomach associated with characteristic brown staining of the mucous membrane. Apart from some pulmonary cedema and congestion of other viscera, the only organ consistently affected is the liver ; but the changes have been variously described as cloudy swelling, fatty infiltration, and zonal necrosis, sometimes central and sometimes periportal. The three cases reported by Luongo and Bjornson are notable for the striking peri- portal necrosis, which was recognisable even in the third child who survived only for about four hours. The relation of necrosis to the ingestion of iron was definitely established by the production of virtually identical lesions in laboratory animals. In rabbits given ferrous sulphate in solution by stomach-tube, doses of less than 0-75 g. per kg. body-weight were apparently non- toxic ; but doses of 0-75-1 g. per kg. regularly resulted in hepatic lesions in the periportal zones. Of 25 rabbits which received 1 g. per kg., 6 died in a few hours ; the remainder survived and were killed at intervals subse- quently. At twenty-four to forty-eight hours these rabbits had severe haemorrhagic periportal necrosis. Little evidence of necrosis remained at five to six days, but slight periportal fibrosis had developed which gradually increased ; and after two weeks the lobular architecture was distorted by a fine diffuse fibrosis. Thus both clinical and experimental observations leave no doubt that ferrous sulphate in large doses produces serious liver injury. The maximal severity of the lesions in the periportal as opposed to the centrilobular zones suggests that the hepatic cellular damage is due to the direct toxic effect of the metal and not to impaired intra- hepatic circulation, such as is unquestionably found in severe shock ; but the shock usually associated with ferrous-sulphate poisoning may enhance the direct toxicity, as with many other liver poisons including chloroform and carbon tetrachloride. Two forms of hepatic cirrhosis associated with heavy deposits of iron in the liver are now recognised; luerao- chromatosis in this country, and the nutritional cirrhosis described by the Gillmans in South Africa. The patho- genesis of both these types is still far from clear. It is essential to investigate the various factors, nutritional and environmental, which might modify the susceptibility of the liver-cells to the toxic action of iron, in order to clarify the role, if any, of the iron deposits in the genesis of cirrhosis in these siderotic livers. 3. Gillman, J., Gillman, T. Arch. Path. (Lab. Med.), 1945, 40, 239. 4. Rice and Rice Diet. A Nutritional Survey. F.A.O. Nutritional Study no. 1. Rome, 1954. Obtainable from H.M. Stationery Office. Pp. 93. 3s. 9d. 5. Hinton, J. J. C. Brit. J. Nutrit. 1948, 2, 237. RICE RICE, wheat, and maize (corn) are the three main cereals of the world. Of these, rice is quantitatively the most important, for it is the staple food of over half the people of the world. In the densely inhabited rice-growing countries of Asia, rice provides 70% or more of the total calories in the daily diet of most of the population. For the poor peasants and the rapidly increasing industrial workers, both the quantity and the quality of their rice are all-important. In 1948 F.A.O. published a small monograph setting out the nutritive value of different forms of rice in relation to other foods usually consumed in these countries and to the over-all dietary needs of the people. This monograph at once became popular and was twice reprinted. A new edition incorporates the results of recent investigations. Rice may lose much of its original nutritive value during milling, washing, and cooking. In this it resembles wheat and other cereals, but the extent of the losses and their effect on the over-all value of the diet are usually much greater than in wheat-eating countries. In the rural districts most of the rice is still milled by the women of the household. This is a wearisome task, but home- pounded rice nearly always retains most of the nutrients in the original grain. Rice mills are now spreading into most of the small towns and larger villages. Since the war little mills have become popular in some countries, notably Thailand ; they are driven by small petrol engines, and the capital required for their purchase is not beyond the means of the headman of even a very small village. Almost all the rice consumed in towns has been through the mills. Most samples of milled rice are not satisfactory foods, especially when the rice provides a large proportion of the total calories in the diets. But several important advances have been made which may have great repercussions on the milling processes. Hinton,5 in England, has studied the distribution of vitamins in the various parts of the rice grain, which can be separated by microdissection. He found that the scutellum, which is a small structure between the embryo and the endosperm, contains about 50% of the total aneurine in a rice grain, although it accounts for only 1-5% of the total weight. The scutellum is also rich in nicotinic acid and riboflavine. Clearly a milling tech- nique that retained the scutellum attached to the grain would provide a rice of much superior nutritive properties. So far the problem of devising a milling process that will remove enough of the pericarp to provide an acceptable rice and yet retain the scutellum does not seem to have been solved. The fortification of refined wheat flours with vitamins and minerals has been practised for many years in the U.S.A. and elsewhere. Similarly rice can be fortified by preparing a rice premix and adding this to ordinary white
