491

and. experience is against this-surely by now, in thethird or fourth relay, the torch will be held quite differ-

.

ently and will throw different shadows. We have infact been told that " the procedure has been slightlymodified in the light of experience." It is difficult tobelieve that the present criteria of malnourishment arejust the same as those that Professor Sydenstrickerfollowed in 1942. Moreover, the only clinical signswhich are now classified are folliculosis, gingivitis, andcorneal vascularisation, none of which can be acceptedas true criteria of nutritional deficiency. As for nutri-tional trends, the Ministry’s observers never examinedanything approaching a cross-section of the population.To quote from two of their reports : " It is importantto point out that the type of child examined was some-what different " (1946) ; and " It should be rememberedthat the earlier surveys were carried out by selection inwhat had formerly been depressed areas " (1947). Onecannot justifiably set one collection of figures againstanother, except in one or two recent instances wheresmall groups have apparently been examined twice.

In 1942, when the food position seemed precarious,a

" snap " survey was probably necessary. But sincethen it would have been advantageous to organise severallarger teams of expert nutritionists, who could haveapplied all the known methods of nutritional assessmentregularly and throughout the population. By now therewould then have been sufficient information to enableus to evaluate the usefulness of the different methods,and we should have had a good idea of the nutritionaltrend through the last few years. Professor Marrackended his paper with the remark : " It is essential toestablish base-line data in 1948 if we wish to know in1951 what has been happening to the nutrition of thepeople," and Professor Yudkin pointed out that this wasexactly what the advocates of a Nutrition Council askedfor in 1942. It is too late now to find out what

changes have occurred, but it is not too late to devisemachinery for detecting future changes.

CRAMP IN PREGNANCY

ONE of the most distressing symptoms which thepregnant woman has to endure is cramp. The attacks

usually being in the 28th week, occurring at night andsometimes several times during the night. A commonsite is one of the muscle groups of the legs, but the hipsand thigh and feet, and occasionally the arms and hands,may also be affected. The cramp tends to recur in thesame place, each attack being short and sharp. Movingafter a period of rest brings on the pain ; the patientscomplain that it- starts when they wake up at night andchange their position in bed. There is no resemblanceto tetany, since the pregnancy cramps are asymmetricalin distribution, do not produce characteristic postures,and are unaccompanied by signs of neuromuscular

irritability.Robinson 1 has investigated 198 cases of pregnancy

cramp, of which 93 were treated with sodium chloride,at first given as gr. 60 of powder twice daily but later aspills containing gr. 15 t.d.s. after meals with water; 48with calcium lactate tablets gr. 10 t.d.s. ; 25 with saccha-rine tablets ; and 32 with nothing. The sodium chloridequickly stopped the attacks in over 80% of cases, whereasthe calcium lactate and saccharine were both successfulin about 40%. In almost all the women there was nomore cramp after the onset of labour. The recurrence-rate in the cases successfully treated was roughly 10%and it was clear that the recurrences followed salt loss ;in 2 patients the cramp returned after a period of diar-rhoea and vomiting, and the other recurrences all occurredin hot weather when sweating would be active. Thedanger of giving salt to the pregnant woman is negligible,

1. Robinson, M. J. Obstet. Gynœc. 1947, 54, 826.

provided there is no sign of toxaemia; nor is the infantor the course of labour affected. Robinson concludesthat the cramps of pregnancy are similar to the heatcramps in industry due to salt deficiency. She suggeststhat there may be an adrenal insufficiency in pregnancy,or that the greater activity of the ovary necessitates anincreased salt intake.

WESTMORELAND LODGE

FOR some time past the Royal Medical BenevolentFund 1 have been preparing this house, near WimbledonCommon, to receive a number of old ladies who aretheir beneficiaries. In a progress report Mr. R. , M.Handfield-Jones, chairman of the committee of manage-ment, tells us that 12 residents have now been comfoFt-ably installed, each with her own bed-sitting-roomequipped with either gas or electric fires and apparatusfor minor cooking. A large room on the ground floor,with a sun lounge overlooking the garden, serves ascommunal dining and sitting room. The success ofWestmoreland Lodge leads the committee to ask whetherthere should not be a similar house for men, and alsoaccommodation for the sick and bedridden. - Theanswers to these questions, Mr. Handfield-Jones pointsout, must to some extent depend on the reaction ofdoctors to the fund’s ideas. The committee would-therefore like to know how far the profession approvesof the work being done in its name.

PANCREATIC FAILURE AND PROTEIN LACK

THE conception put forward by Dr. Davies in his

paper of Feb. 28 (p. 317)-that the kwashiorkor or

malignant malnutrition common in Uganda is primarilya pancreatic disorder-is carried a step further. byProfessor Veghelyi, of Budapest, in his letter in thisissue. After the siege of Budapest in 1944-45 he wasable to observe from the earliest stages the develop-ment of what seems to be a similar syndrome in peopleliving on a diet containing no milk or other completeproteins. He noted that the first effect of the dieteticdeficiency was a failure in the exocrine secretions of thepancreas ; this stage was followed by diarrhoea and liverenlargement, and then after a few weeks by progressiveanaemia and fall in plasma proteins ; finally the patientsdeveloped the full picture’ of nutritional oedema.Necropsies showed the same findings in the pancreasand liver as Davies noted in Uganda. The condition didnot respond to vitamin supplements but could be checkedin a few days by giving sufficient amounts of milk.. ;.

Dietary deficiency sufficient to lead directly to thiscondition is unlikely to occur in the normal circumstancesof western civilisation ; but in the history of our know-ledge of deficiency diseases there are many instances inwhich recognition of the dietary factors directly respon-sible for a deficiency syndrome in malnourished raceshas led to the realisation that similar deficiencies arisein temperate climates as the indirect result of disease.:It seems at least possible that a protein-deficiencysyndrome, similar in part to that described in the

tropics as kwashiorkor or malignant malnutrition, may.occur in this country as a complication of severe intestinaldisorders in children, and also perhaps as a result of

impairment of metabolic function.

F.R.S.

IN the list of fellows of the Royal Society elected onMarch 18 we note with much pleasure the name ofSir Leonard Parsons, emeritus professor of diseases ofchildren at Birmingham, and of R. A. McCance, professorof experimental medicine at Cambridge. Non-medicalfellows include A. L. Hodgkin, W. A. H. Rushton, andDorothy Needham, of the Cambridge schools of p4y,,io-logy and .biochemistry.

1. Balliol House, Manor Fields, London, S.W.15.