984 A SAMPLE OF THE POPULATION.

prophylactic inoculation with a pneumococcus vaccine offered the beat means of raising the normally small immunity to the pneumococcus in ithe black race. Mass experiments, in which large 1numbers of men were inoculated, were made and alarge amount of information was obtained which, :collected in the form of comparative statistics, "showed in every case a reduction in the incidence-rate and death-rate of pneumonia among theinoculated." The following table shows some ofthe results obtained :-

The work thus begun by Sir ALMROTH WRIGHT was continued at the South African Institute for Medical Research, under the Director, Dr. W. WATKINS- ]PITCHFORD. In addition to continuing the provisionof the vaccine required for routine inoculations,research was undertaken which led to the discoveryby Dr. F. S. LISTER (contemporaneously with theAmerican bacteriologists DucAEZ 2 and GILLESPIE)that the pneumococcus can be separated intoseveral serologically independent groups. The

practical application of this discovery lies in thepreparation of specific-group vaccines. A short summary of the practical results achieved now reaches us in the form of a pamphlet containingthe evidence of Dr. WATKINS PITCHFORD,3 submittedby him as Director of the Institute. It is shownin this publication that the fall in incidence andcase-mortality of pneumonia, which began in 1911,has continued, and, further, that the only periodwhen there was a halt in the downward tendencyof the pneumonia curve (1915) coincided with areduced issue, due to war difficulties, of thevaccine. The average annual death-rate from

pneumonia for the years 1908 to 1911 was about12 per 1000; from 1911 it had steadily fallen, untilin 1918 it was less than 4 per 1000. Since thepneumonia mortality formerly represented over

40 per cent. of the general mortality, it followsthat the general death-rate has sunk correspond-ingly. Whether the non-specific beneficial effectnoted by WRIGHT and printed above has continuedis not clearly shown.

Additional experience as to the value of prophy-lactic vaccination against pneumonia was obtainedin the American Medical Corps during theEuropean war. Lobar pneumonia was very preva-lent in the American Army, especially in canton-ments and among the coloured troops. At CampUpton, CECIL and AUSTIN inoculated 12,519 menwith a vaccine consisting of Types 1., II., and III.,the dosage being 6 to 9 billion of Types I. and II.and 4½ to 6 billion of Type III. ; the inoculationswere generally three or four in number at intervalsof five to seven days. The results obtained in thismass experiment were, briefly stated, that duringten weeks that the men were under observation,

2 THE LANCET, 1919, i., 704.3 Statement of Evidence Submitted by the South African Institute

for Medical Research to the Low Grades Mines Commission, August,1919.

4 Cecil and Austin : Jour. Exp. Med., 1918, xxviii., 19.

among the vaccinated troops (12,519) the (annual)pneumonia death-rate was 0’83 per 1000; amongthe unvaccinated troops (20,000) it was 12’8. Inthis experiment it may be noted that the doses ofvaccine injected were very large-10 to 15 billion-and that several inoculations were employed. More.over, in a certain number of men there occurredlocal effects-sterile infiltrations-which caused dis-comfort and anxiety. These incidental disadvan-tages have been largely abolished by the use of alipo-vaccine, that is, a suspension of the microbes inan oily medium. This technique, first employedby the French, has the following advantages:First, relatively enormous doses may be admin.istered with no, or very slight, local or generalsymptoms; secondly, the immunising response isgreater; and thirdly, only one inoculation isnecessary. Using a lipo-vaccine, CECIL and VAUGHAN5 inoculated 13,460 men with Types 1., II., and III. ofthe ppeumococcus in doses of, approximately,10 billion of each type. The experiment wascomplicated by the occurrence of an epidemic ofinfluenza, but the general result was extremelysatisfactory; the incidence and case-mortality of

pneumonia among the inoculated men were muchlower than among the uninoculated. The resultsare among the most encouraging obtained in thewhole range of vaccine-therapy.

A Sample of the Population.WHEN the Minister of National Service rested

Erom his great task and handed over what remainedof his functions to the Minister of Pensions he hadaccumulated the materials of a health census ofthe country, and when the report on this censusappears it will surely afford a firm basis on whichto build a new system of preventive medicine.What may be taken as a first instalment of thereport appears at the front of our present issue.Dr. JOHN D. COMRIE, of Edinburgh, while pre-siding over a recruiting medical board, examinedmany thousands of unselected male citizens betweenthe ages of 18 and 41 years, and he now reports on10,000 of these examinations, the round numberbeing chosen so that percentages or permillionagesmay be read off at a glance. He claims that these10,000 were a fair sample of the countryside, com-prising, as they did, both agricultural and industrialconstituents of a lowland Scottish population. Andhis claim is confirmed by the close agreement in .

the familiar grades and categories between hissample and the sum of all the examinations inGreat Britain supplied by the late chief commis-sioner of medical services.

Accepting, then, the fact that the sample was afair one, what light does it throw on the characterof the whole ? Dr. CoMRiE states that only 20 percent. of the male population between 18 and 41years of age were found free from noteworthyphysical defect. This means that at a time whenthe army could pick and choose its men-whichwas obviously not the case in 1917-only aboutone-fifth of possible recruits would have been con-sidered fully qualified in bodily physique for amilitary life. It should be added at once thatmany of the defects found, although likely to betiresome and disabling to their possessors, did notnecessarily preclude them from being placed in Cate-gory A or Grade I. Using the simpler classification

5 Jour. Exp. Med., 1919, xxix., 5.

985SYNTHETIO FOOD.-A GALLERY OF RADIOGRAMS.

into grades adopted by the Ministry of NationalService after the end of 1917, 52 per cent. of thesample were placed in the first, 21 per cent.in the second, 18 per cent. in the third, and4 per cent. in the fourth grade, the remaining 5 percent. being postponed for later classification. The

general bearing of this result has been widelyknown for some time, but the further, and hithertoless recognised, fact emerges from Dr. COMRlE’s

figures that between the ages of 18 and 23 years arapid deterioration of physique occurs in the malepopulation of this country. While three men outof four, he states, were fit for general militaryservice at the age of 18, only two out of fourremained fit at 23 years of age. If this disquietingobservation is confirmed in the extended records, itwill be one of the first tasks confronting the newpreventive medicine to discover the causes of thisswift deterioration, and to stop it at the source. Is it-which Heaven forbid !-an inherent failure on thepart of the germ-plasm to attain its full development ? Is it due largely or entirely to the present conditionsof industrial life which become operative duringthis particular five-year period of life ? Is it due insome measure to the appalling conditions found inthe teeth of recruits ? At the age of 18 years Dr.COMRIE found the teeth generally sufficiently goodfor practical purposes, although frequently eventhen the upper incisors were beginning to decay.With advancing age the state of the teeth becameprogressively worse, and of the sample 10,000recruits 928 had artificial teeth, while another 1120were urgently in need of them. Whichever of thetwo later factors suggested is found to be the moreproductive of harm, consoling it is that each iswithin the range of preventive medicine in itsbroadest aspect.

It may be urged that the standard of healthrequired for the strenuous life on active service isnot precisely that needed for the pursuits of peace,and that our aim is not necessarily to produce anation of

"

strong men" and prize-fighters. It hasoften been insisted that the possessor of a physicalframe,with some measure of disability of which he isaware and careful, may outlive his comrade whosephysical development is apparently beyond reproach.And, of course, Dr. COMRIE’S figures and those ofthe National Service in general, refer only to

physical data. But no one who studies these

figures carefully can do other than realise theexistence of a vast amount of preventable diseasewhich might have been avoided by attention to thebeginnings in early natal or even in antenatallife. Sir GEORGE NEWMAN states, in his recentoutline of the practice of preventive medicine,that the results obtained from recruitment doroughly form a kind of index of the health ofthe people, and of their upbringing in infancy,childhood, and adolescence. We may, indeed, bearwith some equanimity the discovery that over

2 per cent. of all recruits have mitral systolicmurmurs, that varicose veins were found in

approximately 5 per cent., and that hernia waEpresent in 3’6 per cent. But if we have not settleddown to an ignoble acquiescence in the inevitability of ill-health, the prevalence of dental caries and oiother preventable disease must excite dismay andstimulate us to determined action. The publicationby the Ministry of Pensions of the records withirits possession will, we trust, not be long delayedThey will form a complete justification for every measure yet conceived or to be conceived by thEMinister of Health.

Annotations.

SYNTHETIC FOOD.

"Ne quid nimis."

IN a paper read before the Society of ChemicalIndustry, a reprint of which has just reached us,Mr. A. Chaston Chapman opened up some attractivequestions connected with the employment of micro-organisms in the service of industrial chemistry.So important, he thought, were the developments inthis field that he pleaded for the formation of a.

national Institute of Industrial Micro-biology. Whenwe consider, he said, the wonderful synthetic pro-cesses accomplished by the leaves of plants underthe stimulus of light, the formation of starchor of protein in the growing plant, the con-

version of carbohydrates into fat in the animal

organism or by some of the microscopic fungi, orany of the numerous instances of enzyme action;and when we compare the ease and completenesswith which these complex transformations are

effected at ordinary temperatures with the clumsyand often wasteful syntheses of the organiclaboratory, we must realise how far we are stillfrom understanding Nature’s methods, and howmuch we have to learn before we can hope toimitate them. He quoted the following remarkableinstance, amongst many, of the powers of synthesispossessed by micro-organisms. One of the professorsof the Institutfur Garungsgewerbe in Berlin receivedin 1916 from a pupil, stationed on the Eastern front,a small specimen of a growth found on the stumpsof certain trees in the district. After considerableinvestigation it was found that the growth con-tained an organism which exhibited some veryinteresting features. Thus, not only did it produceunder certain conditions considerable proportionsof fat, but it also had the property of building upcrude protein from ammonium salts (without anyform of organic nitrogen) in the presence ofphosphoric acid and traces of compounds of

potassium and magnesium. Since, as Mr. Chapmanpoints out, ammonium salts could be obtainedreadily from the air, and inasmuch as the carbo-hydrates resulting from the acid hydrolysisof wood could be used as a source of carbonit was clear that this organism rendered itpossible in the short space of 36 hours to build upfat and protein from such comparatively cheap rawmaterials as ammonium phosphate and the acidconversion products of sawdust. It is some yearsago now that the late Sir William Crookes urgedthe importance of manufacturing fertilisers fromthe air by the formation of nitric acid and the sub-sequent production of nitrate. That has been

accomplished on a commercial scale, and a furtherstep has been the synthetic formation of ammonia.If now our methods of cultivation, by the employ-ment of micro-organisms, prove feasible, the practiceof agriculture may well lie in new directions, withthe application of micro-biological methods takinga prominent place. It is to be hoped, however, thatsuch methods will not detract from the æstheticqualities of food, which are of well-known physio-logical importance. ____

A GALLERY OF RADIOGRAMS.

. AN exhibition will be held at the Royal Photo-graphic Society’s house, 35, Russell-square, London,W.C., under the auspices of the Rontgen Society,from Jan. 6th to Feb. 7th, 1920. The exhibition, to