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about old people and for arranging for the necessary supporting
services, e.g. health visitors, nurses, home helps, practitioners,
meals clubs, chiropody, libraries, and if need be more frequent
transfer in and out of hospital to relieve the strain on relatives;
or arranging accommodation in one room flats where meals and domestic
service are laid on for whole blocks.
Malnutrition.
I have already had several elderly people come showing signs of
malnutrition. If a person is allowed to choose freely anything he
wishes to satisfy appetite he will probably get every essential
foodstuff. Many cannot do this because they have not the money. As
the money gets less, they cut out fruit and vegetables, protein and
then fat. They are left with bulky starchy foods as the cheapest
food available. It is true you can buy protein in the cheaper cuts
of meat. You can cook effectively and appetisingly, but if you have
rheumatoid arthritis and are feeble it is often impossible and malnutrition
is the result. In a number of cases I have applied to the
National Assistance Officer for extra allowances and these have
always been granted. These cases have been brought to light because
the clinic has been there for them to come to.
The prevention of Atheroma
I find that a great many people coming to the clinic are showing
signs of atheroma or arteriosclerosis. Atheroma of the coronary
artery which supplies the heart muscle is the commonest cause of
failure of blood supply to the heart muscle with injury to the
heart or even death. It also causes injury to the conducting
tissues of the heart which maintain the heart rhythmn. Atheroma can
affect the heart valves and also the arteries in other parts of the
body, causing for example cramps in the calves.
The Role of Fat
Pat in the body is in two forms (l) saturated, e.g. stearic
acid, and palmitic acid and (2) unsaturated, e. g. linoleic,.
linolenic,and arachidonic acids; and oleic and palmitoleic acids.
LinoleicjLinolenic and arachidonic acids are essential for health
and are known as essential fatty acids, (E. P. A.) In the body
linoleic is converted to arachidonic in the presence of vitamin B6pyridoxine.
The linoleic acid must be in a certain chemical shape
called the cis-trans-cis form and not in its mirror image form
which may be even antagonistic. Arachidonic acid is needed in the
body; it is very unstable because it has four double bonds and is
very rarely found naturally. Linoleic acid is abundant in maize
oil, soya oil. safflower oil and sunflower oil, which may contain
50% or more. They also contain vitamin E or tocopherol which protects
the linoleic acid from going rancid. In the body vitamin E
prevents the break-down of arachidonic acid; this protection is
still further supported by vitamin C, ascorbic acid which acts as
a synergist or chemical accelerator.
In the body the protected arachidonic acid combines with
cholesterol to form a cholesterol ester, cholesterol is manufactured
in the body probably in the liver, the exact method being in doubt;
it is a steroid. The ester is very soluble and can be carried easily
in the blood stream. It enters into combination with glycerol to
form a triglyceride which contains a stearic radicle, an arachidonic
radicle and a phosphocholine. This product is a phospholipid or
lecethin and is needed to form brain and nerve tissue and the
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