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755 THE LANCET. LONDON: SATURDAY, NOVEMBER 17. 1917. The New Voluntary Rationing Scheme. THE scheme of voluntary rationing outlined by Sir ARTHUR YAPP this week should appeal to all classes of the community. When we are assured that a faithful adherence to the limited amounts of the staple foods set forth will save a grave situation, it becomes a national duty on the part of everyone to fall into line, while what strikes us at once is that no hard dietetic or physiological sacrifice is called for. Economy essentially is enjoined for the staples, but, of course, economy is desirable also as a patriotic effort in regard to all foods. The staple foods are bread, flour and other cereals, meat, butter, margarine and lard, and sugar. There is no rationing suggested outside this list, and it will occur to many in what directions the foods in the rationing scale may be supplemented or replaced. Potatoes, for example, are not included, and as a valuable source of carbohydrate supply they may be largely employed to eke out the stock of scheduled food-stuffs and so save the staples. In addition, an exchange can be made in certain cases, notably with regard to bread and meat. Thus, any person may take half a pound of meat over and above his meat ration in exchange for half a pound of bread to be deducted from his bread ration, and conversely any person may take half a pound extra of bread in exchange for meat. The scheme bears evidence of being well thought out from the economic point of view, while it provides a physiological sufficiency for all. The public would do well to bear this point in mind, for it is important to remember that a voluntary rationing scheme which provides amply for all physiological needs is much less a hardship than actual famine, while its adoption means the releasing of so much tonnage, and adding to the efficiency of transport services. In plain words, the individual who loyally enters into the spirit of the scheme is helping to win the war, and is doing so in con- tradiction to no law of physiology or of medicine. It is easy to see that the Director of National Economy was guided in drawing up the scheme by the advice of recognised scientific authority. We find in it, for example, the substance of a number of recommendations contained in an article entitled "The Food of the Nation " by Dr. EDMUND SPRIGGS, which was published in THE LANCET of Feb. 10th, 1917. The valuable report on " The Food Supply of the United Kingdom," drawn up by a committee of the Royal Society last year, has, no doubt, also been of assistance. It will be remembered that this Committee included the professors of physiology in the Universities of London, Glasgow, and Dublin, and the professor of bio-chemistry in the University of Cambridge. The following table gives at a glance the pro- posed new rations :- Atlitit Rations Per Head Per Week. MEN. Bread. Butter, MEN. lb. oz. Margarine, 1. Men on very lielvy industrial Lard, Oils, work or on agricultural work 8 0 Other and 2. Men on ordinary industrial or cereals. Meat. Fats. Sugar. other manual work......... 7 0 oz. Ib. oz. oz. oz. 3. Men unoccupied or on seden- tary work ............... 4 8 WOMEN. 12 ... 2 0... 10 ... 8 4. Women on heavy industrial work or on agricultural work 5 0 5. Women on ordinary industrial FOR ALL ADULTS. work or in domestic service... 4 0 6. Women unoccupied or on seden- tary work ............... 3 8 The "bread rations include all flour, whether used for bread or for cooking. Flour maybe taken instead of bread at the rate of lb. of fiour for every pound of bread. The " other cereal " rations include oatmeal, rice, tapioca, sago, barley meal, cornflour. maize meal, dried peas, beans and lentils, and all cereal products except bread and flour. The weight given is the weight of the dry article, as bought. If the full bread ration is not used, the amount saved can be taken in other cereals at the rate of lb b. of cereals for every pound of bread saved. The meat" rations include the average amount of bone, which may be taken as one-quarter of the weight of the actual meat. Any parts of meat (such as rump steak, bacon, or suet) which are bought without bone must count for one- quarter more than their actual weight. On the other hand, any bone in excess of a quarter of the actual meat bought may be deducted. Poultry and rabbits may be counted at half their actual weight. The meat rations include suet. It will be seen that Sir ARTHUR YAPP divides the population into six sections, three for men and three for women. Children are to receive their reasonable ration of essential foods, and, as their needs differ so greatly, a definite ration has wisely been omitted for them. Broadly, the scheme pro- vides more bread but less meat and sugar. The discrimination in regard to individuals in different occupations in life is well in accord with physio- logical considerations and common-sense. Clearly, the allowance should be highest for those carrying out heavy industrial or agricultural work. Next to be considered come those employed in ordinary industrial work, while unoccupied persons or those engaged in sedentary occupation will admit that the food demands in their case must come last. This class includes the more thoughtful section of the population, and they will recognise the simple truth that the machine which is doing most work requires most fuel. This important point was missed, we think, in previous proposals which pro- vided, for example, an all-round weekly allowance of 4 lb. of bread or its equivalent in flour. Sir ARTHUR YAPP now lays down that men on heavy work should have a weekly allowance of 8 Ib. of bread, women 5Ib., men engaged on industrial work 7 lb., and women 4 lb., and sedentary persons (men) 4 lb. 8 oz. and (women) 3 lb. 8 oz. Cereals other than bread are now rationed at 12 oz.per week all round. Previously there was no control in regard to these allowances. The quantity of meat allowed to both men and women is 2 lb., as against 2½ lb. under the former proposals. Fatty foods, butter, margarine, and lard, also were not previously rationed, but now they come under an allowance of 10 oz. per week, to which no exception can be taken physiologically, though the difficulties of cooking are obviously increased. The allowance of sugar was previously lb., but it is now fixed at 8 oz., where it has been for some time.

THE LANCET. LONDON: SATURDAY, NOVEMBER 17. 1917

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Page 1: THE LANCET. LONDON: SATURDAY, NOVEMBER 17. 1917

755

THE LANCET.

LONDON: SATURDAY, NOVEMBER 17. 1917.

The New Voluntary RationingScheme.

THE scheme of voluntary rationing outlined bySir ARTHUR YAPP this week should appeal to allclasses of the community. When we are assuredthat a faithful adherence to the limited amountsof the staple foods set forth will save a gravesituation, it becomes a national duty on the part ofeveryone to fall into line, while what strikes us atonce is that no hard dietetic or physiological sacrificeis called for. Economy essentially is enjoined forthe staples, but, of course, economy is desirablealso as a patriotic effort in regard to all foods. Thestaple foods are bread, flour and other cereals,meat, butter, margarine and lard, and sugar. Thereis no rationing suggested outside this list, and itwill occur to many in what directions the foods inthe rationing scale may be supplemented or

replaced. Potatoes, for example, are not included,and as a valuable source of carbohydrate supplythey may be largely employed to eke out the stockof scheduled food-stuffs and so save the staples.In addition, an exchange can be made in certaincases, notably with regard to bread and meat.

Thus, any person may take half a pound of meatover and above his meat ration in exchange forhalf a pound of bread to be deducted from

his bread ration, and conversely any person

may take half a pound extra of bread in

exchange for meat. The scheme bears evidenceof being well thought out from the economic

point of view, while it provides a physiologicalsufficiency for all. The public would do wellto bear this point in mind, for it is importantto remember that a voluntary rationing schemewhich provides amply for all physiological needsis much less a hardship than actual famine,while its adoption means the releasing of so muchtonnage, and adding to the efficiency of transportservices. In plain words, the individual who

loyally enters into the spirit of the scheme is

helping to win the war, and is doing so in con-tradiction to no law of physiology or of medicine.

It is easy to see that the Director of National

Economy was guided in drawing up the scheme bythe advice of recognised scientific authority. Wefind in it, for example, the substance of a number ofrecommendations contained in an article entitled"The Food of the Nation " by Dr. EDMUND

SPRIGGS, which was published in THE LANCET ofFeb. 10th, 1917. The valuable report on " TheFood Supply of the United Kingdom," drawn up bya committee of the Royal Society last year, has,no doubt, also been of assistance. It will beremembered that this Committee included the

professors of physiology in the Universities of

London, Glasgow, and Dublin, and the professor ofbio-chemistry in the University of Cambridge.

The following table gives at a glance the pro-posed new rations :-

Atlitit Rations Per Head Per Week.

MEN. Bread. Butter,MEN. ’

lb. oz. Margarine,1. Men on very lielvy industrial Lard, Oils,

work or on agricultural work 8 0 Other and2. Men on ordinary industrial or cereals. Meat. Fats. Sugar.

other manual work......... 7 0 oz. Ib. oz. oz. oz.

3. Men unoccupied or on seden-tary work ............... 4 8

WOMEN. 12 ... 2 0... 10 ... 8

4. Women on heavy industrialwork or on agricultural work 5 0

5. Women on ordinary industrial FOR ALL ADULTS.work or in domestic service... 4 0

6. Women unoccupied or on seden-tary work ............... 3 8

The "bread rations include all flour, whether used forbread or for cooking. Flour maybe taken instead of breadat the rate of lb. of fiour for every pound of bread.The " other cereal " rations include oatmeal, rice, tapioca,

sago, barley meal, cornflour. maize meal, dried peas, beansand lentils, and all cereal products except bread and flour.The weight given is the weight of the dry article, as bought.If the full bread ration is not used, the amount saved can betaken in other cereals at the rate of lb b. of cereals for everypound of bread saved.The meat" rations include the average amount of bone,

which may be taken as one-quarter of the weight of theactual meat. Any parts of meat (such as rump steak, bacon,or suet) which are bought without bone must count for one-quarter more than their actual weight. On the other hand,any bone in excess of a quarter of the actual meat boughtmay be deducted. Poultry and rabbits may be counted athalf their actual weight. The meat rations include suet.

It will be seen that Sir ARTHUR YAPP divides the

population into six sections, three for men andthree for women. Children are to receive theirreasonable ration of essential foods, and, as theirneeds differ so greatly, a definite ration has wiselybeen omitted for them. Broadly, the scheme pro-vides more bread but less meat and sugar. Thediscrimination in regard to individuals in differentoccupations in life is well in accord with physio-logical considerations and common-sense. Clearly,the allowance should be highest for those carryingout heavy industrial or agricultural work. Next tobe considered come those employed in ordinaryindustrial work, while unoccupied persons or thoseengaged in sedentary occupation will admit that thefood demands in their case must come last. Thisclass includes the more thoughtful section of thepopulation, and they will recognise the simpletruth that the machine which is doing most workrequires most fuel. This important point wasmissed, we think, in previous proposals which pro-vided, for example, an all-round weekly allowance of4 lb. of bread or its equivalent in flour. Sir ARTHURYAPP now lays down that men on heavy work shouldhave a weekly allowance of 8 Ib. of bread, women5Ib., men engaged on industrial work 7 lb., andwomen 4 lb., and sedentary persons (men) 4 lb. 8 oz.and (women) 3 lb. 8 oz. Cereals other than bread arenow rationed at 12 oz.per week all round. Previouslythere was no control in regard to these allowances.The quantity of meat allowed to both men andwomen is 2 lb., as against 2½ lb. under the formerproposals. Fatty foods, butter, margarine, and

lard, also were not previously rationed, but nowthey come under an allowance of 10 oz. per week,to which no exception can be taken physiologically,though the difficulties of cooking are obviouslyincreased. The allowance of sugar was previously lb., but it is now fixed at 8 oz., where it has beenfor some time.

Page 2: THE LANCET. LONDON: SATURDAY, NOVEMBER 17. 1917

756

These are the principal features of the scheme.Lord RHONDDA, the Food Controller, has definitelystated that unless the new scale of voluntaryrations is generally adhered to there is nothing forit but compulsory rationing. We feel confident thatthe nation will not wish such an undesirable con-clusion to the attempts to deal with our food

problems in terms free from coercive measures.

The rationing suggested is eminently reasonableand designed to inflict no excessive hardship onanyone; it is easily a living allowance. The successof the scheme depends, of course, on the temperof the nation; but that should not be in doubtwhen the assurance is clear that the allowancesset forth are adequate to individual needs.

War-time Prescribing andDispensing.

WHEN, some three months ago, an order of theGeneral Medical Council was gazetted which deletedfrom the British Pharmacopoeia, until further

notice, preparations containing glycerine or sugar,it was suggested in THE LANCET that an authori-tative series of formulae should be established totake the place of those which had been withdrawn.Some such action as this was clearly necessaryin order to secure uniformity in dispensing andso obviate the probability of a patient being sup-plied with two different kinds of medicine dispensedaccording to the same prescription. Within a shorttime of the gazetting of the General Medical’Council’s order the Pharmaceutical Society set inmotion the necessary machinery for preparing aseries of formulae, and these have now been

published as an addendum to the "British Pharma-ceutical Codex," 1911. This addendum contains not

only substitutes for pharmacopoeial compounds, butsubstitutes for other commonly prescribed glycerineand sugar preparations, the number of formulaebeing over a hundred. Generally speaking, thesubstances which replace the sugar in thepharmacopoeial formulae are: (1) A mixtureof tragacanth, chloroform, and distilled water,known as syrupus factitius or syrup sub-

stitute ; and (2) diluted glucose, consisting of90 parts of glucose and 10 parts of distilled water.In cases where these are not used the sugar isomitted altogether, as in cod-liver oil emulsion;in compound liquorice powder the sugar has beenreplaced by maize or rice starch. Where glycerinehas been replaced by tragacanth and chloroform,as in the glycerines of carbolic and tannic acid, thestrength has been diminished, since the preparationin its new form is less viscous and more readilyabsorbed. In a considerable number of preparationsit has been possible simply to omit the glycerine.A list of these and specimen formulae containingsugar and glycerine substitutes is given on p. 766.

It remains to be added that the Pharmaceutical

Society has submitted these new formulae to theBritish Medical Association, and it has been mutuallyagreed that as from Dec. 1st the new preparationsshould be used for prescribing and dispensingall new prescriptions. So far as dispensing under.

the National Health Insurance scheme is con-

cerned, it is understood that all local insuranceformularies will be revised simultaneously onthe appointed date by the substitution of thenew formulæ for the deleted Pharmacopceial pre-

parations in the place of the ingredients in anyformula including glycerine or sugar. This will

not entail the reprinting of the formularies if bothpanel practitioners and pharmacists are instructedby their respective committees that the newalternative formulae must be used. It will notbe necessary for prescribers to concern them-selves about the names of these modified pre-parations, as the original titles have beenretained and the doses remain approximately thesame, It will suffice, therefore, if the prescribermerely adds W.E.F.-which means, of course, WarEmergency Formulary-to the name of the prepara-tion. It has not been possible in many cases topreserve all the physical properties of the originalglycerine- and sugar-containing preparation as

regards either appearance or taste, and it will

clearly be advisable for the pharmacist who dis-

penses an old prescription containing a sugar orglycerine ingredient to inform his client that anydifference that may be noted in the medicine is dueto a war-time emergency exchange of adjuvants orother components, and that the activity and effi-

ciency of the medicine have been in no way

impaired by the modification.

Annotations.

AUTOMATIC WANDERING.

" Ne quid nimis."

AT the request of the Minister of Pensions theLocal Government Board has forwarded to thevarious boards of guardians a brief Memorandumon automatic wandering. It appears that theMinister of Pensions has had his attention drawnto certain cases of discharged soldiers "sufferingfrom neurasthenia or epilepsy, and that symptomof these conditions which is described as

’ automatic wandering,’ and is often accompaniedby loss of memory." In these cases soldiershave occasionally found their way to Poor-lawinstitutions and have been there detained forobservation in the mental ward, and have in someinstances, it appears, been sent to a lunatic asylum.The suggestion is made that where any such menare received in a Poor-law institution inquiryshould be made of the Special Medical Board forNeurasthenics " to ascertain whether neurastheniawas the cause of discharge from the Army

"

before arriving at any conclusion as to the disposalof such cases. It is satisfactory to learn thatofficial cognisance is now taken of a difficultclass of case, which, though no doubt small innumbers, is deserving of intelligent investigationand in no way merits summary treatment. In the

ordinary civilian instances of the condition thediagnosis in practically every case lies betweenhysteria and post-epileptic confusional states, andto come to a definite conclusion is not always easy.To take the latter first : there may, of course, be adefinite history of major epilepsy or obviousevidence of epilepsy, under which circumstances