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SMOKING AND BODY-WEIGHT
282 occult steatorrhcea. It seems likely that such stomatitis, which simulates in every way the condition described by Sircus et al., is due to a metabolic disorder ; and it is improved in differing degrees by folic acid, nicotinamide, cyanocobalamin, or a gluten-free diet. It is difficult to understand the comparative failure of therapy in the cases reported by Sircus et al. unless their underlying cause is different. Reflecting on their findings, and on the response of oral ulceration in Behoofs syndrome to cortisone or corticotrophin,5 Sircus et al. conclude that there may be important endocrine factors in the resistance of the mucous membrane, accounting for the greater prevalence and speedier periodicity in women, the remissions during pregnancy, and the frequency of onset during menstruation. PREVENTING TUBERCULOSIS THOSE who have watched the changes in tuberculosis during the past ten years may wonder whether a new textbook of tuberculosis lately published s will be the last of the line. In this admirable book, nearly twice as much space is given to the demography and prevention of tuberculosis and to chest-clinic practice as to the clinical aspects of the respiratory form of the disease. " According to Prof. F. R. G. Heaf, its editor, the general the National Health Service is that since impression Act has been in operation, prevention of tuberculosis has not had sufficient attention." Many will agree that too little is done to prevent the disease ; but it seems doubtful whether preventive measures are less efficiently applied now than in 1948, and, if they are, whether the deterioration can be attributed to the Act. It has often been said that the division of responsibility that the Act introduced has, by separating the therapeutic and preventive branches, impaired the efficiency of both. In the new book’s section on prevention Dr. J. E. Geddes says " the schism created or perpetuated ... by the Act must be a source of weakness and its correction a matter of importance." But schemes that are administratively untidy are not necessarily inefficient ; and though the position may change later, there is no satisfactory evidence that the present administrative structure is harmful. On the other hand, many attractive improvements in preventive measures have been suggested : a less timid central approach to B.C.G. vaccination and greater local freedom to, use it as the particular circumstances require ; revision of the methods of using mass radiography ; compulsory examination of selected groups ; extension of the schemes for finding unknown cases among industrial contacts ; greater use of routine tuberculin testing ; and more efficient antibacterial treatment. Existing measures It would be could also be more efficiently applied. interesting to know, for instance, how the extent of contact examination and B.C.G. vaccination varies throughout the country, and whether, if some areas appear less efficient than others, the causes are being investigated and remedies applied. Tuberculosis, it is to be hoped, will continue to decline until it becomes a rarity in this country. For the past ten years the chest-clinic service has been evolving from the system of tuberculosis dispensaries (conceived and initiated by Sir Robert Philip seventy years ago) into a diagnostic and therapeutic service for all diseases of the chest. It has been suggested that as tuberculosis declines the resources of the clinics in well-trained specialists, health visitors, and almoners could profitably be used to prevent and treat the other two major chest Last diseases-lung cancer and chronic bronchitis. year7 we expressed doubts about this plan, and we still see a need for careful thought before it is adopted.
Deaths from lung cancer increase, but hospitals and their thoracic departments will almost certainly be able to cope with its diagnosis and treatment. Much lung cancer is preventable ; but the necessary preventive measures are very different from those applicable to infectious diseases. They would include education, propaganda, and conceivably fiscal action to alter smoking habits, and further research into the mechanism of action of tobacco smoke and the identification and elimination of factors giving urban life its higher risk. Chronic bronchitis presents similar though less welldefined problems. In its present position, therefore, the chest clinic seems poorly equipped to undertake a preventive campaign against these two diseases. Tuberculosis cannot be finally eradicated, and the population kept free from infection, without continued application of efficient preventive measures by those trained and skilled in their use ; and this is the proper function of the specialists in preventive medicine. The present administrative arrangements may be adequate for the time being, but it seems inevitable that at some stage the work of preventing tuberculosis will have to be done by the public-health authorities, who already bear the responsibility for seeing that it is done. Prevention might then be organised on a regional basis with the executive bodies closely linked to university departments of preventive medicine. It may be many years before such a situation arises ; but it seems prudent to foresee it now and to plan a tuberculosis service in which the preventive value of chest clinics is not forgotten.
Phillips, D. L., Scott, J. S. Lancet, 1955, i, 366. Symposium of Tuberculosis. Edited by F. R. G. HEAF, David Davies professor of tuberculosis, Welsh National School of Medicine, Cardiff. London: Cassell. 1957. Pp. 755. £55s. 7. Lancet, 1956, i, 272.
1. Brozek, J., Keys, A. Science, 1957, 125, 1203. In The Biological Effects of Tobacco, edited 2. Batterman, R. L. E. L. Boston, 1955; p. 140. by Wynder. 3. Keys, A., et al. The Biology of Human Starvation. Minneapolis,
5. 6.
SMOKING AND BODY-WEIGHT IT is
widely believed that people who give up smoking put on weight; but there is no conclusive evidence that this is so, and a report of a systematic investigation by Brozek and Keys1 is therefore welcome. Approximately 300 normal " business and professional men were being examined yearly as part of some research on ageing, so it was possible to obtain an experimental " group of men who had voluntarily stopped smoking cigarettes and whose weights were known for two years before and two years after the year in which they had stopped. A control group was obtained by matching these men with men who had not stopped smoking for age, relative bodyweight (actual weight expressed as a percentage of standard " weight for sex, age, and height), and actual body-weight at’the beginning of the first year of the fiveyear period. There was no statistical difference at the "
"
"
outset between the groups in respect of these criteria, and the intensity and total duration of smoking were similar. Both groups consisted of " normal " men, and those who gave up smoking did so voluntarily, not because of the onset of disease or on medical advice. When the average weights for the fourth and fifth years were compared with the average weights for the first two years it was found that there was a small (1-1lb.),), statistically non-significant fall in the control group, and a substantial (8-2 lb.), statistically highly significant rise in the group which had stopped smoking. Brozek and Keys do not offer a firm explanation of this phenomenon, but point out that experiments demonstrating inhibition of hunger contractions by smoking2 and increased tobacco consumption by people on a reduced diet3 suggest that smoking tends to depress the appetite for food. It is also possible that some psychogenic smokers become psychogenic eaters instead. Dr. A. FERGUS HEwAT, consulting physician to the Edinburgh Royal Infirmary, and a past president of the Royal College of Physicians of Edinburgh, died on Aug. 3 at the age of 73.
1950 ; p. 830.
Deaths from lung cancer increase, but hospitals and their thoracic departments will almost certainly be able to cope with its diagnosis and treatment. Much lung cancer is preventable ; but the necessary preventive measures are very different from those applicable to infectious diseases. They would include education, propaganda, and conceivably fiscal action to alter smoking habits, and further research into the mechanism of action of tobacco smoke and the identification and elimination of factors giving urban life its higher risk. Chronic bronchitis presents similar though less welldefined problems. In its present position, therefore, the chest clinic seems poorly equipped to undertake a preventive campaign against these two diseases. Tuberculosis cannot be finally eradicated, and the population kept free from infection, without continued application of efficient preventive measures by those trained and skilled in their use ; and this is the proper function of the specialists in preventive medicine. The present administrative arrangements may be adequate for the time being, but it seems inevitable that at some stage the work of preventing tuberculosis will have to be done by the public-health authorities, who already bear the responsibility for seeing that it is done. Prevention might then be organised on a regional basis with the executive bodies closely linked to university departments of preventive medicine. It may be many years before such a situation arises ; but it seems prudent to foresee it now and to plan a tuberculosis service in which the preventive value of chest clinics is not forgotten.
Phillips, D. L., Scott, J. S. Lancet, 1955, i, 366. Symposium of Tuberculosis. Edited by F. R. G. HEAF, David Davies professor of tuberculosis, Welsh National School of Medicine, Cardiff. London: Cassell. 1957. Pp. 755. £55s. 7. Lancet, 1956, i, 272.
1. Brozek, J., Keys, A. Science, 1957, 125, 1203. In The Biological Effects of Tobacco, edited 2. Batterman, R. L. E. L. Boston, 1955; p. 140. by Wynder. 3. Keys, A., et al. The Biology of Human Starvation. Minneapolis,
5. 6.
SMOKING AND BODY-WEIGHT IT is
widely believed that people who give up smoking put on weight; but there is no conclusive evidence that this is so, and a report of a systematic investigation by Brozek and Keys1 is therefore welcome. Approximately 300 normal " business and professional men were being examined yearly as part of some research on ageing, so it was possible to obtain an experimental " group of men who had voluntarily stopped smoking cigarettes and whose weights were known for two years before and two years after the year in which they had stopped. A control group was obtained by matching these men with men who had not stopped smoking for age, relative bodyweight (actual weight expressed as a percentage of standard " weight for sex, age, and height), and actual body-weight at’the beginning of the first year of the fiveyear period. There was no statistical difference at the "
"
"
outset between the groups in respect of these criteria, and the intensity and total duration of smoking were similar. Both groups consisted of " normal " men, and those who gave up smoking did so voluntarily, not because of the onset of disease or on medical advice. When the average weights for the fourth and fifth years were compared with the average weights for the first two years it was found that there was a small (1-1lb.),), statistically non-significant fall in the control group, and a substantial (8-2 lb.), statistically highly significant rise in the group which had stopped smoking. Brozek and Keys do not offer a firm explanation of this phenomenon, but point out that experiments demonstrating inhibition of hunger contractions by smoking2 and increased tobacco consumption by people on a reduced diet3 suggest that smoking tends to depress the appetite for food. It is also possible that some psychogenic smokers become psychogenic eaters instead. Dr. A. FERGUS HEwAT, consulting physician to the Edinburgh Royal Infirmary, and a past president of the Royal College of Physicians of Edinburgh, died on Aug. 3 at the age of 73.
1950 ; p. 830.