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In England Now

Sir Arbuthnot Braintank sat back in contentment, havingcompleted his great work of analysing and reorganising theNational Health Service. Management ! That was it.

Suddenly he was seized with the most diabolical acuteabdominal pains, but he knew what to do. There could beno problems since everything was now planned so efficiently.He dialled a number on the special telephone with whichevery member of the Establishment had been supplied.

" State your name and number", answered a metallicvoice from the machine known as a Smart Dalek. QuicklySir Arbuthnot gave his number with its twenty digits andfour obliques, then his National Health number with itsthirty-seven jumble of letters and digits, and finally thenumber (with forty-nine hieroglyphics) of his past medical-history card.

In less than three days, the filing having a failing, a

mobile X-ray vehicle arrived, a helicopter dropped a seriesof volumes of his case-records, and into his home therepoured three qualified doctors from the Department ofHealth who had last examined a patient in 1933, two membersof the General Medical Council to ensure that the three werefully paid-up members, and seven doctors, each a specialistin a different medical discipline. 25% were in favour of theKiss of Life, 33% proposed immediate surgery, and twomembers of the Socialist Medical Association emphaticallyadvocated conservative measures.The next day Sir Arbuthnot went round to see his local

G.P., told him of the attack, and duly received a prescriptionto use in any further attacks. He had been sufficiently loud-mouthed to order all his medical visitors out of his house.He certainly learned the value of time and motion, for bythe grace of the new management system, he had beenallowed enough time to have a motion.

Moral: A manager is one who ages other men.* * *

The British love of fair play to animals seems to havespread to Australia. An account from that country of arecent furore in one of the medical faculties there mightsuggest that this attitude can go just a bit far. Apparentlya group of academic surgeons, in their desire to preventdeep-vein thrombosis in patients, have developed a specialcalf stimulator that causes rhythmic electrical stimulation,and therefore contraction, of the calf muscles duringanaesthesia. The small electronic black box that does thishas proved so effective that these impecunious surgeonsdecided to manufacture it in their department and sell it ata nominal profit, thus augmenting limited departmentalfunds. Naturally a request had to go to the universityadministration requesting permission to manufacture andsell this calf stimulator. Imagine the surprise of theworthy surgeons when a letter came back from the admini-stration couched in somewhat critical terms and castingdoubt on the propriety of manufacturing an instrument in auniversity department designed to stimulate (or was it

prod) calves (or young cattle). With characteristic Australianfrankness, the reply included a sentence suggesting thecriticism was " a load of bull

* * *

Mother to 6-year-old daughter: What are you goingto do when the new baby comes ? " " Oh, I shall lookafter it while you are on the ’phone."

* * *

The farm gate bore the instruction: Keep Out, V.D.Precautions. Gosh, I thought, those romps in the haymust really be getting out of hand. But no, of course, it’sthe pigs and their vesicles.

Letters to the Editor

NUTRITION : A PRIORITY IN

AFRICAN DEVELOPMENT

SIR,-Your review (March 17, p. 583) of the proceedingsof a Dag Hammarskjold Foundation seminar on this subjectexpresses views on the means of combating malnutrition,and more especially on the role of nutritionists in thisrespect, which are not shared by everybody. I should be

grateful for an opportunity to express some personalviews: they are certainly not original, but it still seems

important to reiterate them.

1. The first step towards action in this field is to createawareness among leading politicians and Civil Servants ofthe present situation concerning the prevalence, character,and severity of malnutrition. In a few African countries(Zambia and Tanzania among them) such an awarenessexists; in most others it does not. The seminar had an

important task in this respect, with so many high-rankingAfricans present. To quote from the introduction (p. 10):

" The reader will find that the presentation is not intendedprimarily for nutrition experts but rather for administrators, forpoliticians and for educated readers of any profession. It repre-sents an attempt to engage their interest in a field which does notlend itself to simple and standardized solutions and which,partly because of this, has had to wait too long for strong andwell-co-ordinated action."

2. The most serious effects of protein-calorie mal-nutrition (P.C.M.) are to be found in children. Wherever

systematic studies have been carried out in Africa, theyhave shown a monotonous picture of P.c.M. of varyingdegrees in the non-privileged groups of children between6 months and 3 years of age (often 80-90% of all the chil-dren), and even long after childhood. The effects are a highmortality-rate in early childhood (the vicious circle ofr.c.Nt. and infections) and often permanent sequel in thesurvivors. This is nowadays well known to nutritionists,but it is still unknown or at least not sufficiently known topoliticians. The seminar had the important task of pre-senting and enforcing a realistic picture in this respect.To quote an economist, Prof. Goran Ohlin (p. 205):

" In the case of nutrition, it is a circumstance of great impor-tance that the children occupy the centre of the stage. This addshuman poignancy to the sufferings of malnutrition, and it alsolends special strategic significance to anything that can be doneto relieve it. The next generation is the hinge on which theprocess of change turns. This is also why the relationshipbetween nutrition and mental development, which has beenbrought up here in both general and specific contexts, is of suchimmense importance."

3. There are today diverging opinions as to whether thewidespread malnutrition found in most developing countriesis mainly due to the under-consumption of food in generalor whether the under-consumption of protein of sufficientquality plays an additional and often crucial role. The

question of the credibility of the " protein problem "

will be discussed in some detail in a forthcoming documentfrom the Protein Advisory Group (P.A.G.) of the U.N.System. It is clear that for a number of reasons there isindeed a problem here, primarily for the most exposed andvulnerable groups of the population-namely, the children-and that it is often serious. It is therefore with some re-sentment that one reads in the review that " In particular,the fundamental connection between malnutrition and

poverty, and of the need therefore for programmes aimedat stimulating demand for food, is largely ignored in favourof the wearisomely repeated, but nonetheless largelydiscredited idea that most malnutrition is associated with