569

BP contains 330. IU per drachm, the Ministry of Foodcod-liver oil compound 750 IU per drachm, and cod-liveroil and malt only a small and variable quantity. Theunderweight or premature infant needs at least as muchvitamin D as one of normal birth-weight-in fact, doublethe usual dose is recommended, though it should bereached gradually. In active rickets ultraviolet radia-tion should be used to supplement vitamin D.

INVOLUNTARY VEGETARIANS

IN June, 1940, the Channel Islands became untenableand the British withdrew, taking almost the whole

population of Alderney, two-fifths of that of Guernsey,and a smaller proportion from Jersey. From then untiltheir liberation in 1945 the islands were under Germanoccupation. In a review of the effect of this occupationon the islanders’ health and nutrition, Dr. A. LeslieBanks and Mr. H. E. Magee, D SC, point out 1 that con-ditions became changed greatly for the worse when theGermans were driven out of the Cotentin peninsula.Previously the average diet was very much the same asin agricultural districts of occupied France. But whenthe islands became isolated the food position deteriorated,because the islanders, plus a garrison of 30,000 Germans,had to depend on their own produce, which in peace-timeis insufficient. Food, fuel, and other necessities were on thepoint of running out when the Germans finally collapsed.

In the earlier period the diet was probably satisfactoryas regards calories. In 1943-44 the middle-class familycould obtain about 2600 calories, while even a largefamily on public assistance could achieve 1680-too little,it is true, but unfortunately not unusual in Englandbefore the war. The main characteristics of the dietwere the 100% extraction flour used for bread and thelarge proportion of vegetables. Bread was rationed butvegetables were not. At least a quarter of the caloriesof the middle-class diet came from potatoes and vege-tables, whereas the corresponding proportion in GreatBritain was only a tenth. Until 1945 milk was moreplentiful than here, and even during the first six monthsof the period of isolation it was more than adequate.Pigs and poultry " disappeared," and so did dogs andcats in 1945-stolen, it was thought, by the Germangarrison, who during the period of isolation were worsefed than the islanders. But the number of cattle wasmaintained throughout, despite pressure by the enemy.On such a diet vitamin and mineral deficiencies were notto be expected, and careful examination of the skin, eyes,mouth, and tongues of the children gave no evidence of’them. Their teeth were excellent and rickets was veryrare. On the other hand there was evidence of reductionin height and weight measurements in 1943 comparedwith 1940. The children had not had enough proteinand calories.

In adults there was an increase in boils, skin sepsis, andimpetigo-no doubt attributable mainly to lack of soap-and delay in the healing of wounds. The incidence ofappendicitis and colds, and of new cases of peptic ulcer,decreased, though the change to a vegetarian diet coin-cided with an increase of perforations of old cases ofpeptic ulcer. The effect of this change in diet agreesgenerally with the results of experiments made byMcCance and Widdowson in the early days of the war onhealthy adults in Cambridge. Hardly anyone, it seems,escaped a looseness of the bowels, with two or threeevacuations per day ; nor did this diminish after theregimen had been in force for months. Polyuria was asource of inconvenience, especially to the elderly, whowere obliged to get up in the night to urinate. Therewas also much flatulence, which even masked the loss ingirth of the obese. People with sensitive gastro-intes-tinal canals, however, suffered more keenly: they losttheir tolerance for this, or indeed any, food ; they became

1. Mon. Bull. Min. Hlth and EPHLS, September, 1945, p. 184.

emaciated; and some of these developed nutritionalcedema. Treatment in hospital wrought improvement,but symptoms recurred soon after discharge. For suchpeople this highly vegetarian diet was tantamount tostarvation, and after liberation a few of them had to beevacuated to London. Some of the obese, who naturallylost weight on this diet, also lost all trace of cardiacand respiratory embarrassment on exertion. Cases ofneuritis were seen and locally attributed to deficiency ofvitamin B ; but the diet was rich in this complex, anddeficiency could only be explained by failure of absorp-tion, associated with the diarrhcea.The main conclusion from this involuntary experiment

in dietetics is that healthy adults can tolerate a highlyvegetarian and whole-wheat diet, though it has incon-veniences in looseness of stools, polyuria, and flatulence.It also abolishes constipation, which became exaggeratedin the islands after the resumption of white bread. Onthe other hand there are a number of people, doubtless aminority, who cannot tolerate such a regimen and slowlystarve on it.

BREAKING DOWN THE BARRIERS

IN an informal speech at the British OrthopaedicAssociation’s dinner last week, Sir Wilson Jamesonwelcomed the chance of talking to colleagues about someof the ideas he had formed in close on five years as chiefmedical officer of the Ministry of Health. Since leavingthe more academic atmosphere of the London School ofHygiene, he had acquired a great esteem for the men whocome to the top in the Civil Service, and a belief in thevalue to medicine of joint endeavour by doctors and ablelaymen. Similarly the doctor from outside could do agreat deal for the Government department. The EMS,which on its formation looked as though it could neverwork, had worked " because of the people who’ve beenrunning it." Sir Wilson was impressed with the need tointroduce people of the same kind into government-menand women giving part of their time to a Ministry whilestill engaged in practice. Freedom of exchange betweenGovernment departments was useful, but there must alsobe freedom of exchange between departments and theoutside world. The Treasury has now accepted theprinciple of part-time service, and with agreed rates ofremuneration and some kind of pension scheme for doctorsthe Ministry would be in a better position to secure the helpof those best qualified to advise on some of our medicalproblems.

Pursuing the same thought, Sir Wilson turned to thequestion of the Colonies. To have a first-class ColonialEmpire, he said, we must have a first-class ColonialMedical Service ; but it is very difficult to recruit men forsuch work if they have got to undertake it permanently-if they have the prospect perhaps of spending their wholelives in distant and isolated places. If we are to have aNational Health Service in this country, why should wenot allow young men in that service to go out and workin the Colonies for a limited time-to the great benefitboth of themselves and of the Colonial Medical Service ’JSuch an arrangement would open a new vista for themedical service of this country : there would be none likeit in the world.

NORMAL DISEASE

TAKING as his text a subject he has made peculiarly hisown-diseases of the heart-Alfred E. Cohn 1 pleads forexact methods of thinking. In the first place, what do wemean by " disease "’? Our hazy ideas as to what constitutesdisease have obscured the possibility that there may beailments that are inseparable from the life and growth ofthe human organism. For instance, can an old man benormal ? Old men usually die through failure of theheart. " This form of death in the aged in a strict senseis physiological death, or, if you please, anatomical. If

1. Cohn, A. E. Science, 1945, 101, 471, 499.