40

The pericardial sac was normal. There was soft jelly-likeantemortem clot in the right side of the heart. The rightventricle was dilated. There was no lesion in the valves, andthe muscle was pale from extreme ansemia. The lungs werefree from adhesions. Both were poorly aerated and slightlyosdematous at the bases, and were pale from ansemia. Therewas no evidence of bronchitis or pneumonia. The peritoneumwas normal. The liver was pale from anaemia, there was novisible fat, and nothing in the gross appearance to suggesttoxic hepatitis. The spleen was dark red and firm. Thekidneys were pale, and there was nothing to suggest nephritis.The alimentary tract showed no evidence of inflammation orother abnormality, and no threadworms were seen. The brainand its membranes were ansemio in appearance, but therewere multiple small haemorrhages in the region of the corpuscallosum. The rib marrow was fluid and dark, and the femurmarrow was abundant and dark red. Section of liver showedno evidence of toxic hepatitis.The blood-picture, and the contrast between the dark

red spleen and marrow and the pallor of the other organsis characteristic of an acute. haenlOlytic process. It isinteresting that the haemolysis, which evidently beganon the third day of phenothiazine administration, shouldprogress so alarmingly several days after administrationhad ceased..

Anaemia following phenothiazine medication was

recorded first by de Eds, Stockton and Thomas,l andwas of hsemolytic type with high reticulocytosis.Hubble 2 recorded three cases of anaemia, in one of whichthe count fell to 2,900,000 per c.mm. with 10% reticulo-:cytes, but in which jaundice was a well-marked feature,and he suggested that hepatitis was the chief toxic effect.In the case here recorded jaundice was barely perceptible,and the liver was practically unaffected.

I wish to thank Prof. K. D. Wilkinson for permission topublish this case, and Prof. Haswell Wilson for the report onthe autopsy and sections.

Reviews of Books

Radiology PhysicsJOHN KELLOCK ROBERTSON, F.R.S.C., professor of physics,Queen’s University, Kingston, Canada. London:Chapman and Hall. Pp. 270. 18s.Professor Robertson’s book is described as an intro-

ductory course for medical or pre-medical students andfor all radiologists. It is a clear and accurate expositionof the technical and physical considerations lying at thebasis of modern radiation therapy and diagnosis, contain- ..ing chapters on alternating currents, the production ofhigh voltage, the measurement and control of hightension voltage, cathode rays, positive rays and isotopes,roentgen-ray tubes, valve rectification, general propertiesof X rays, secondary X rays and absorption, roentgen-ray dosage, radioactivity, supervoltage tubes and highspeed particles, artificial radioactivity and high-frequencycurrents. The outlook is modern and the informationup to date ; for example. the section on radioactivitydeals clearly with artificial transmutation, and descrip-tions of supervoltage equipment and of the cyclotronmake an excellent introduction to the study of artificialradioactivity. The emphasis, unlike that of many bookson radiology, is such that the diagnostic radiologist willfind much to interest him as well as the man whosemain interest is therapy. The book, well produced andillustrated as it is, should serve well both students

reading for the diploma and radiologists who wish toknow more of the scientific basis of their craft.

Immunity against Animal ParasitesJAMES T. CuLBERTSON, assistant professor of bacteriology,College of Physicians and Surgeons, Columbia University,New York. London : Humphrey Milford, Oxford Uni-versity Press. Pp. 274. 36s. 6d.IN 1929 W. H. Taliaferro, in " The Immunology of

Parasitic Infections," gave an authoritative account ofthe knowledge then available on the subject. ProfessorCulbertson begins where Taliaferro left off and bringsthe subject up to date. Work published before 1929was cited fully by Taliaferro ; that published later isequally fully listed in the present work, and for this alone1. De Eds, F., Stockton, A. B. and Thomas, J. O. J. Pharmacol.

1939, 65, 353. 2. Bubble, D. Lancet, 1941, ii, 600.

the book would be valuable. It deals consecutively withnatural resistance to parasitic infections, age resistance,acquired immunity, immune responses and the mechanismof immunity. Immunity following specific infectionsis discussed in relation to the amoebic infections, leish-maniases, trypanosomiases, malarial infections andcoccidioses, and infestations with cestodes, trematodes,nematodes and some arthropods. Finally it deals withvarious groups of parasites from the point of view ofimmunity resultant on infection and vaccination, andthe production of characteristic immune responses ofpossible value in diagnosis. The book is a valuablecompendium of information for workers on parasiticimmunology.A History of Science

(3rd ed.) Sir WILLIAM CECIL DAMPIER. London: Cam-

bridge University Press. Pp. 574. 25s.

THIRTEEN years ago Sir William Dampier wrote, incomparatively short compass, a history of the evolutionof science. His book was enthusiastically received, anda second edition is now followed, after some ten yearsinterval, by a third. The history of science has beenstudied much of late, and the stream which formerlyseemed to be disturbed and often interrupted nowappears as a broad and continuous river. Sir Williamhas embodied much of this new knowledge in his work,and has outlined the wide prospects which now lie inview of the scientific inquirer. Indeed, in his endeavournot to omit the smallest point worthy of notice, he hassomewhat overburdened his main theme;, but this doesnot detract from the review which he gives of the out-standing achievements of science, or his comprehensivevision of the essential unity of different aspects of man’sstudy of the phenomena of nature. He has emphasisedthat there is no real antagonism between science, meta-physic, and religion : that philosophy, and not purematerialism, is essential for the continued progress ofnatural science. "At such historic moments" hesays of the great achievements of the masters " physicalscience seems supreme. But the clear insight into itsmeaning which is given by modern scientific philosophyshows that by its inherent nature and fundamentaldefinitions it is but an abstraction, and that with all itsgreat and ever-growing power it can never representthe whole of existence. Science may transcend itsown natural sphere ... but to see life steadily and see itwhole we need not only science but ethics, art andphilosophy: we need the apprehension oaf- a sacredmystery, the sense of communion with a Divine Power,that constitute the ultimate basis of religion."The Intervertebral Disc

F. KEITH BRADFORD, M.D., and R. GLEN SPURLING, M.D.London : Bailliere, Tindall and Cox. Pp. 158. 22s.THIS book deals chiefly with the part played by the

intervertebral disc in causing back pain and sciatica.It is the first clinical monograph on the subject to appearin this country, and the authors have succeeded in cun-densing their own ex2erience and a review of the rathervoluminous publishecrwork into a slim and handy volume.There are lucid chapters on the anatomy, physiology andpathology of the intervertebral discs, and the clinicalpicture is clearly drawn. The indications for conserva-tive treatment and operation are discussed; a useful seriesof representative case-reports will make many readersfeel that this is a commoner lesion than they had supposed.

Manual de PsicoterapiaEMILIO MIRA Y LorEZ, formerly professor of psychiatry inBarcelona University. Buenos Aires: Aniceto Lopez. Pp. 314.THIS comprehensive and readable treatise was pre-

pared because Professor Mira believed it high time thatpsychotherapy should form part of the instruction ofmedical students in Latin America ; there were alreadySpanish translations of standard works on the subject,propounding a particular doctrine or method, but nosurvey of the whole field. He therefore amplified aseries of lectures he had delivered in 1941, and hoped thebook would serve to prevent the development of see-tarian groups of psychotherapists in South America.His presentation is broad and fair enough to succeed inthis aim so far as a book can further it. It is wider inits scope than any comparable English work.

41

THE LANCETONDON.- SATURDAY, JULY 11, 1942

EFFECT OF WAR-TIME FOOD ON CHILDRENIT should be possible to judge the adequacy of our

children’s diet by studying the state of their health,but there is as yet little information about childhealth during the war and many changes besides diet-may have influenced it ; -, moreover, it is usuallyimpossible from a purely clinical examination of anindividual child definitely to correlate subnormalhealth with specific dietetic deficiencies unless they aregross. The main effects of the war on diet have beena higher carbohydrate intake for civilians as a whole,including school-children, as a result of shortage ofmeat, fish, eggs, milk and fruit ; a better diet for thepoorest families, since there is now no mass un-

employment and more money in the pockets of thepoor (for poverty is the greatest cause of dieteticdeficiencies in peace-time) ; and a fairer distribution offoodstuffs through rationing, the national milk scheme,and school and other communal meals, though thesefacilities still need extending. The net result has beena levelling down of the diet of the majority of civilians

) towards that of the poor, and a levelling up of the dietof the poorest. The inadequacy of the prewar dietsof the poor scarcely needs stressing, but recent workin Toronto,2 showing the remarkable effect on mothersand infants of supplementary feeding of expectantmothers, and the findings of the People’s League of

, Health Survey published in these columns last week(p. 10) emphasise the point once more ; ; the poorToronto- diets resemble in many ways the present dietof most of us in Britain.. The experience of Germany during and after thelast war, when food shortage was acute, was that thegrowth of children was retarded, and the death-ratefrom tuberculosis rose rapidly and steadily.3 On theother hand, infant mortality declined in spite of severefood privation for the people as a whole, and, apartfrom the influenza pandemic, deaths from the commoninfectious fevers of childhood showed no tendency torise. Vitamin-deficiency diseases-rickets, scurvy,keratomalacia, and so on-increased. These findingssuggest subjects for review in this country where fewobservations on the growth of children under present-day war conditions have been published. This springMILLIGAN, with the help of LEWIS-FANNING of thestatistical department of the Medical Research Coun-eil,4 compared the growth of two groups of Glossopschool-boys, observed in 1940-41 and in 1941,with similar groups observed between 1936 and 1939.Both war-time groups showed a significant reduction

- in rate of weight increase ; the weekly rise in weightof the group observed in 1941, during the period ofstrict rationing, was less than half that of the prewarcontrols. Glossop had been free from bombing andthere seems no doubt that it was inadequate diet1. Proc. R. Soc. Med. 1941, 25, 273.2. Ebbs, J. H., Tisdall F. F. and Scott, W. A. J. Nutrit. 1941, 22, 5.3. Statistisches Jahrbuch für das Deutsche Reich, 1921-22, Berlin.4. Milligan, E. H. M. and Lewis-Fanning, E. Med. Offr, 1942,

67, 77.

which retarded the boys’ growth, though the actualdeficiencies responsible are uncertain, Yet the pre-war heights and weights of Glossop boys were cer-tainly far from optimal, and in 1938 Glossop boysaged 13 years were nearly a stone lighter than boysat this age at Christ’s Hospital. But BASHFORD 5 hasfound London 14-year-olds in 1941 at least as heavyas in 1938. Many more observations on rate of

weight increase are urgently required, particularly onboys and girls over 14 years, who are particularlylikely to be hard hit by rationing. STOCKS hasreviewed the vital statistics of England and Walesin the second year of war. Infant mortality (exclud-ing air-raid casualties) rose on the average by 6iper 1000 live births in the second four quarters of thewar, compared with the four quarters immediatelypreceding the war ; the first quarter of 1942 howeverpromised better. The efficacy of the sulphonamidedrugs in many of the serious infections of infancyshould have produced, but for adverse war influences,a definite drop in infant mortality comparable to therecent drop in maternal mortality. Importantamong these adverse effects are probably a diminishedsupply of breast milk-a subj ect on which information isnow being collected-and an increase in anaemia amonginfants. Recent death-rates from the four commoninfectious fevers-diphtheria, whooping-cough,measles and scarlet fever-have fluctuated, but 1941was a bad year for the first three of them. Deathsfrom tuberculosis show a disquieting rise: for

example, among children under 10 years in 1941deaths from all forms of tuberculosis were 45% inexcess of those in 1939 ; among children under 5 yearsold death from tuberculosis of the respiratory tracthad nearly doubled. This increase, which may wellhave been exceeded during the past six months, is dueto a variety of factors, including the use of unboiledmilk in country districts, but it seems likely thatreduced resistance from dietetic deficiencies also playedan important part. ,

A survey reported on p. 32 has demonstrated a

drop, as compared with prewar groups, in the averagehsemoglobin levels of school-children and has showna very high incidence of anaemia among children under2 years, particularly in day and residential nurseries.Anaemia at preschool ages could and should be

successfully tackled by iron administration. Whetheranaemia at school age is widespread in all parts of thiscountry, whether or not it is a conditioned deficiencyand its response to iron treatment have all yet to bedetermined. WIDDOWSON and MCCANCE’S work 1

indicates that the use of wheatmeal instead of whitebread will not increase the iron available for haemo-globin building and may even diminish it. InGermany it appears that large-scale administra-tion of vitamin C to school-children has improvedgrowth and resistance in infection. Whether vitamin-C deficiency has retarded the growth of Britishchildren is not known, but the intake is almost cer-tainly below the optimal.9 The wide use of ascorbicacid for infants before the Government issue offruit juice may well have saved us a crop of infantilescurvy. No figures apparently exist concerning

5. Lancet, 1942, i, 239.6. Stocks, P. Ibid, 1942, i, 189; and Brit. med. J. 1942, i, 789.7. Widdowson, E. M. and McCance, R. A. Ibid, p. 588.8. Bull. War Med. 1941, 2, 1. 9. Harris, L. J. Lancet, 1942, i, 642.