Seventh age itch.

however, that the real value of any such trials is that they encourage standardisation of management methods, including all the items mentioned above. This conclusion might disappoint a trial technocrat, but it should be accepted as part of the difficulty and frustration inherent in clinical research. Furthermore, the scientific committees of grant giving bodies need to acknowledge more readily that, by its very nature, this type of clinical investiga-tional work is not "clean" (in a scientific sense). Imaginative proposals should be encouraged to help generate reliable information based on some standardisation of treatment patterns, both operative and perioperative, which might help the outcome of the increasing numbers of patients requiring bowel resection. In any event, until it can be shown that blood transfusion is not harmful in the long term to patients with large bowel cancer, it seems reasonable to avoid it whenever possible.ship between blood transfusions and sursival after colectomy for colon cancer. "Sans teeth, sans eyes, sans taste, sans everything."' Shake-speare knew that blunting of the senses was one of the hallmarks of old age, but there is one exception-itch. All too often it appears or is exaggerated in the elderly. Pruritus is synonymous with itch but when used as a diagnostic term is applied to patients whose itch is unaccompanied by any visible primary skin disease. Many such elderly patients have little to see on their skins, but excluding a primary skin disorder is not as easy as it might seem since scratching may have caused more than scratch marks. "Prurigo" is an ill defined term which describes the excoriated pink papules which are often seen on itchy skin and which seem to be due to scratching.2 Lichenification-thickened skin looking like Morocco leather-is also due to prolonged scratching and rubbing. Similarly, purpura, broken hairs, and pigmentation may be secondary to repeated trauma. On the other side of the coin, even the use of a lens will not prevent trained doctors with intact sensory faculties from falling into some common traps. All of us can tell embarrassing stories about missing scabies in clean people, forgetting to ask about infested pets, overlooking under-clothes crawling with lice, omitting to check for contact with fibreglass,3 disregarding minor eczema, and failing to appreciate the existence of conditions such as winter itch4 and aquagenic pruritus.5 Even when these have been considered, however, many elderly patients still have no recognisable skin disease responsible for …