509THERAPEUTIC STARVATION.-CLEMENS PIRQUET.

from those of partial starvation in the ordinary senseof the word. A classical example of such confusionwas pointed out recently by S. K. KoN and J. C.

DRUMMOND,1 who showed that most of the symptomscommonly attributed to a lack of the vitamin B

complex in the pigeon were in reality due to deficienttotal intake of food. Those who employ restrictionof the diet for any therapeutic purpose should alwayskeep before their minds the possibility of unwittinglyproducing states of specific food deficiency by thevigorous exclusion of particular classes of foodstuffs.In his address to the Medical Society of London,reported in this issue, Dr. EDMUND SPRIGGS laiddown the principle that the ideal reducing diet shouldcontain all the usual components of a good mixeddiet, restriction being thus practised quantitativelyrather than qualitatively. It is not to be denied thatthe restriction of specific food elements has provedof value in the treatment of individual diseases andwe may well hope that with increasing knowledgeof the physiological action of particular food elementsit will in the future be possible to achieve by thismeans some measure of control over many morbid

processes which at present defy our medical skill.The commonest indication for a general limitation

of food intake is obesity, but as Dr. SPRIGGS wiselyobserves, in undertaking the treatment of obesitythe medical profession should concern itself ratherwith the associated disabilities impeding the normalfunctioning of the body as a whole than with themere aesthetic aspect of the condition. The guidingprinciple in all reducing cures must be to adjust theenergy value oa the food ingested so that it isless than the amount of energy spent in theform of heat and muscular work. In thenormal individual there appears to be some

mechanism which automatically adjusts the expendi-ture of energy so that within limits considerable.excess of food beyond the bare requirements can betaken without leading to any increased storage of fat.In certain types of obesity this mechanism seems tobe functioning imperfectly, so that quite severe

dietetic restriction has to be practised before anyappreciable weight reduction is observed. There are,of course, other cases in which obesity is due purelyto excessive indulgence in the good things of thislife, and’this group can be treated with greater easeand satisfaction, for when their weight has been

brought down to the required extent by strict dietingthey can maintain it at a constant level while they aretaking a normal amount of food. These two groupsare not separated by a hard-and-fast line and individualcases are sometimes difficult to classify. It is common

knowledge that obesity may appear quite rapidly asthe result of some change in the mode of living notobviously related to any alteration in diet or physicalexercise. Marriage and childbirth not uncommonlyprovoke a relatively sudden fat storage in a previouslynormal individual, or, on the other hand, these sameincidents may determine the apparent cure of pre-existing obesity. With our present knowledge it isnot possible to predict whether either of the opposingeffects will follow a given stimulus, but at least suchcases teach us that the metabolic balance-sheet of anindividual may at one time register a profit and atanother a loss, although there may be no grossvoluntary change in the items of expenditure andreceipts. In such cases there must be unnoticedvariations in the expenditure of energy to accountfor the gain or loss of weight, provided that the fuelvalue of the diet remains constant and that the

1 Biochem. Jour., 1927, xxi., 632.

digestive function remains unimpaired ; such varia-tions may occur either in the amount of physical workperformed or in the amount of heat produced, thatis to say, in the basal metabolic rate. In actualpractice it is rare to find any definite lowering of thebasal rate in cases of obesity. Dr. SPRIGGS points outthat the obese person has a relatively small surfacearea in proportion to his weight, and when this weight,and with it the rotundity of his figure, is reduced, hissurface area becomes relatively increased, and hisheat loss, which varies with the surface area, is alsoincreased. This principle does not apply to men inall states of nutrition ; it has been shown that whena man is wholely or partially starved so that he losesconsiderable weight and is definitely in a state ofundernutrition, his basal metabolism is reduced. Itappears that under such circumstances some protectivemechanism is called into play which favours themaximum conservation of energy within the bodyand by this means tends to diminish excessive lossof weight.The medical profession is becoming increasingly

alive to the virtues of prophylaxis and it may there-fore be asked whether partial starvation has anypart to play in guarding against the appearance of

I diseases or the exaggeration of symptoms in alreadyexisting morbid processes. It has certainly beenestablished that diabetes and obesity are frequentlyassociated, and there can be no question as to thewisdom of enforcing dietetic restrictions on over-

weight subjects who may have inherited a predis-position to diabetes. Similarly, those afflicted withcirculatory disorders are, as a rule, greatly benefitedby a wisely directed course of food restriction if thereis any coexisting tendency to obesity. On the otherhand, it remains to be proved whether the efficiencyof a whole nation could be raised by attempts toregulate the average amount of food consumed bythe mass of its people. The experiences of the GreatWar, and in particular of the Central EuropeanStates, certainly lend no support to the view that astate of chronic undernutrition is compatible withnormal intellectual or physical vigour. The truthwould seem to be that the energy value of the averageman’s diet can be varied within certain limits without

producing any predictable effects on his weight orphysical fitness, so that the most precise calculationsas to the number of calories which a man of a givenweight and occupation should consume would by nomeans necessarily lead to his attainment of any givenstandard of nutrition.

CLEMENS PIRQUET.THE world is the poorer for the loss of FREIHERR

CLEMENS VON PIRQUET who, with his wife, was

asphyxiated by misadventure last week in Vienna.His name is perpetuated in a tuberculin test whichrevealed for the first time the ubiquity of tuberculousinfection in an urban community, an achievement initself sufficient to deserve well of his generation.But PIRQUET-as he preferred to be known withoutthe honourable prefix-was largely responsible forthe development of the magnificent children’s hospitalattached to the University of Vienna, and it was hewho collaborated with the British and American reliefwork in averting the worst horrors of starvation inthe youthful population of Vienna after the war.PIRQUET worked out the ration which enabled theSave the Children Fund and the Society of Friendsto provide a suitably balanced meal for manythousands of undernourished children at a cost to

510 THE KING.-NEW YEAR HONOURS.

their subscribers of only three-halfpence a head.The ideas which inaugurated this development ofhuman physiology may have arisen in the minds ofLIEBiG and BUNGE, but the conception of nutritionas an exact science, to which mathematical principlesmight be directly applied, was something that owedits existence to the enthusiasm and the amazingindustry of PIRQUET, whose life was devoted todetailed study of innumerable factors bearing onhuman nutrition, and more particularly from the

exogenous or dietetic i

point of view. Theinfluence of his earlierwork is reflected in the

change which took placein current views on

infant feeding and nutri-tional disorders towardsthe end of last century,the essence of the

change being the attri-bution of increased im-

portance to quantitativeconsiderations. Muchthat is admirable in theVienna and Berlinschools of paediatricsbears the impress of histrend of thought. The

opportunity came totest those theories bydevising a system of

rationing which shouldFrom the Weordale Press.

utilise the available resources, particularly of fats,with the maximum of efficiency; and they stoodthe test. Given an adequate supply of protein,the proportion of fat and carbohydrate in the dietwas shown to be of little importance, and this principlewas made the basis of the official scheme of rationing.It is probable, however, that PIRQUET’s name willbe perpetuated, at any rate in this country, ratherby the cutaneous tuberculin reaction than by his farmore important works on nutrition and Biometrik.For the latter, while accepted by experts throughoutthe world as masterpieces of their kind, must of

necessity be limited in the number of their readersby their great technicality and by the knowledge ofmathematics which they demand. Whether the" Nem " system of feeding will gain wide acceptanceis doubtful, but the mathematical relations whichPIRQUET established between simple measurements,such as the sitting height, and nutritional require-ments are likely to remain as the sound basis offurther research on human nutrition. Prof. PIRQUEThad accepted an invitation to read a paper on the [prevention and cure of tuberculosis in early childhoodbefore the Section of Diseases of Children at the

forthcoming annual meeting of the British MedicalAssociation in Manchester, and his untimely deathwill disappoint many who would have welcomed theopportunity of seeing in the flesh the virile andattractive personality of the Austrian nobleman,podiatrist and humanist. I

EXTENSION OF LANCASTER INFIRMARY. - LordDerby last week laid the foundation-stone of a series ofextensions of this hospital which has become inadequateowing to the demands of the wide area which it serves.The scheme, which will cost .875,000, provides for a newchildren’s ward, a maternity ward, the substitution of a

permanent building for a temporary structure added duringthe war, two eye wards, two theatres, extensions to thenurses’ quarters, and other additions.

Annotations.

THE KING.

" Ne quid nimis."

AFTER an interval of more than a fortnight withoutthe issue of any pronouncement by His Majesty’sdoctors the following official bulletin was issuedfrom Craigweil House, Bognor, last Saturday,March 2nd, at 8.15 P.M. : " During the last fort-night His Majesty the King has made satisfactoryprogress. Weight and strength have increased, andsleep is refreshing. His Majesty is now able to readand apply his mind for short periods of time. Wemust, however, recall that one of the most anxiousfeatures of His Majesty’s grave illness was severeexhaustion due to prolonged toxaemia. For thisreason careful avoidance of any sustained effort ofbody or mind will be necessary for a lengthenedperiod, in order to ensure that completeness ofrecovery which, although still some months distant,we confidently anticipate." The bulletin was signedby Sir Stanley Hewett and Lord Dawson of Penn.

NEW YEAR HONOURS.THE list of those upon whom it was intended by

the Crown to confer recognition upon the NewYear’s Day of this year has now been published, thedelay, of course, being due to the illness of the King.The list is headed, as far as medicine and the alliedsciences are concerned, with the name of Sir BerkeleyGeorge Andrew Moynihan, President of the RoyalCollege of Surgeons of England, upon whom thesignai honour ot a peerage nas been conferred.

Moynihan has devoted his life to building up a schoolof surgery unique in this country, and in so doinghas made a lasting contribution to the pathology ofthe living. Lady (Florence) Barrett, Dean of theLondon (R.F.H.) School of Medicine for Women, andPresident of the Medical Women’s InternationalAssociation, is created a Companion of Honour. Thefollowing two medical men have received the honourof knighthood-namely, Dr. Nasarvanji HormasjiChoksy, of Bombay, and Mr. Carrick Hey Robertson,of Auckland, N.Z. In the Order of the British Empirethe K.B.E. is conferred on Dr. Charles Hubert Bond,Commissioner of the Board of Control, and the D.B.E.upon Miss Louise McIlroy, professor of obstetrics andgynaecology in the London (R.F.H.) School of’Medicinefor Women. Sir Walter Fletcher, secretary, MedicalResearch Council, has been created C.B. The C.M.G.has been conferred on Dr. J. H. L. Cumpston,Director-General of Health and Director of Quarantinein the Commonwealth of Australia ; Dr. F. C. Madden,Dean of the Faculty of Medicine in the EgyptianUniversity, Cairo ; Mr. A. J. R. O’Brien, surgeonspecialist in charge of the Gold Coast Hospital, andon Dr. A. T. Stanton, chief medical adviser to theSecretary of State for the Colonies. Mr. WilliamThomas Paulin and Mr. Albert Levy receive knight-hoods for their services in a lay capacity to the LondonHospital and the Royal Free Hospital respectively.Sir Arthur Robinson, Permanent Secretary to theMinistry of Health, receives a G.C.B., and Sir WilliamMcCormick, chairman of the University GrantsCommittee, a G.B.E. Among those created C.B.E.are Lt.-Col. J. K. S. Fleming, Deputy Director-Generalof the I.M.S. ; Miss Frances Ivens, clinical lecturer inobstetrics and gynaecology in the University ofLiverpool; Miss Beatrice Monk, matron, London Hos-pital ; Miss Winifred Cullis, professor of physiology,London (R.F.H.) School of Medicine for Women,and Mr. William Nowell, Director of the AmaniResearch Institute, Tanganyika Territory. TheO.B.E. has been conferred upon Dr. Norman ParsonsJewell, resident surgical officer, European Hospital,Nairobi, Kenya, Dr. J. C. S. McDouall, director ofMedical and Sanitary Services, Sierra Leone, Miss