- Email: [email protected]
BED REST AFTER MYOCARDIAL INFARCTION
29 of the isotope depends mainly on the changing pressures inside the peritoneal cavity. In forecasting the most fruitful line of inquiry into the cause of cancer, one man’s guess is as good as another’s. It seems not unlikely that it is to the intensive study of cell behaviour under widely varying conditions that we But it is can most hopefully look for further progress. heartening to find that the B.E.C.C. is encouraging work in almost every branch of medicine and biology. Judging from the projects recorded in the pages of this report, the contributions of the radiophysicist and biophysicist will feature increasingly in this widening field of inquiry. THE CUP THAT CHEERS
THE popularity of caffeine-containing beverages in many different civilisations is testimony to the solace and stimulus which mankind derives from this delectable alkaloid. But caffeine has always had its opponents, one of whom, Professor Steyn, of the University of Pretoria, has lately marshalled the case against it.1 Much of the evidence that Steyn cites is based on the results of experiments in which large doses of caffeine and the clinical were given to laboratory animals ; of must such always be somewhat application findings
conjectural.
Thus, when dogs
given caffeine by per kg. body-weight
are
mouth in doses of 50-400 mg. the plasma-prothrombin time falls.2 Steyn remarks that this " appears to have brought conclusive proof that the ingestion of caffeine most probably aggravates the already serious state of thrombosis in man." But this conclusion is not justified on the evidence presented. Steyn is on firmer ground when he discusses the relation between caffeine and peptic ulcer. Roth et aL3 gave 250 mg. of caffeine dissolved in 200 ml. of water to normal persons and to ulcer patients after an overnight fast, and demonstrated a copious flow of acid gastric juice. In most of the normal people this was shortlived, whereas in most of the patients with ulcer it continued longer. Similar results were obtained with caffeine-containing beverages as ordinarily served, but the addition of sugar and cream to coffee almost halved the secretory response. Merendino et awl. obtained similar results after giving two cups of strong black coffee to people who had fasted overnight. The experimental production of gastric ulcers in cats and guineapigs 4-6 by the repeated daily injection of large amounts of caffeine can be dismissed by the clinician as irrelevant. children drinking large quantities Steyn of soft drinks in warm weather ; and he would like it to be better known that many of these beverages contain appreciable quantities of caffeine. The caffeine content of one of the best known of these cola drinks is stated to be 33 mg. per bottle, and a similar well-known drink contains twice this amount.3 (This compares with .an estimate of 100-120 mg. of caffeine per cup of coffee, though-Steyn thinks that in South Africa the true figure for coffee is probably below 30 mg. per cup.) The young man admitted to hospital with a perforated peptic ulcer after drinking 150 bottles of an iced cola drink during five warm August days4 is an extreme example, and the danger from cola drinks in this country is probably slight. Professor Steyn, however, is right in saying that in certain soft drinks larger quantities of caffeine are consumed, especially by children, than in coffee, tea, or cocoa, and that those parents who do not wish their children to take caffeine should be informed of its presence in such drinks.
frequently sees
1.
2. 3. 4. 5. 6.
Steyn, D. G. Caffeine-containing Beverages and Human Health. Pretoria, 1954. Field, J. B., Lassen, E. G., Spero, L., Link, K. P. J. biol. Chem. 1944, 156, 725. Roth, J. A., Ivy, A. C., Atkinson, A. J. J. Amer. med. Ass. 1944, 126, 814. Merendino, K. A., Judd, E. S., Baronofsky, I., Litow, S. S., Lannin, B. G., Wangensteen, O. H. Surgery, 1945, 17, 650. Judd, E. S. Bull. Amer. Coll. Surg. 1943, 28, 46. Roth, J. A., Ivy, A. C. Gastroenterology, 1944, 2, 274 ; Surgery, 1945, 17, 644.
All this does not amount to a very damaging brief against caffeine-containing drinks. The only way of proving that excessive drinking of tea and coffee is harmful is to compare the prevalence of the various morbid conditions to which they are alleged to give rise, in large groups of people comparable in all respects other than consumption of caffeine. This is the method by which the relation between cigarette-smoking and lung
established.
But immense labour would be case against caffeine does not seem strong enough to justify this. Meanwhile the addicts among us will continue to rely on the reassurance of personal experience, as did Samuel Johnson. When attacked by a certain Mr. Jonas Hanway for his habit of tea-drinking, Johnson, than whom " no person ever enjoyed with more relish the infusion of that fragrant leaf," declared that Mr. Hanway had " considered the effects of Tea upon the health of the drinker, which, I think, he has aggravated in the vehemence of his zeal, and which, after soliciting them by this watery luxury, year after year, I have not felt."
cancer was
involved, and the prima-facie
BED REST AFTER MYOCARDIAL INFARCTION
MOST clinicians agree on the importance of bed rest after myocardial infarction, though they are mindful that in old persons complete immobilisation has its own hazards from venous stasis. Lary and de Takats1 have drawn attention to arterial embolism in patients who were on their feet shortly after a cardiac infarction. Of eight such patients, in whom embolism to the lower limb occurred 5-30 days after the infarct, five had not been kept in bed at all: and in two of these the embolus occurred within 6 days of the infarct. In four patients the infarction was not diagnosed until after the embolus had occurred ; but all except two had a clinical episode consistent with infarction-either chest or sudden dyspnoea. One had complained only of pain " " " while another dizziness," apparently had a silent infarct following cholecystectomy. There was electrocardiographic evidence of infarction in all but two cases. In one of these necropsy revealed multiple old infarcts. The other patient had auricular fibrillation, with no clear-cut history suggestive of infarction ; this case did not come to necropsy, so that embolism could not definitely be attributed to myocardial infarction. Failure to enforce bed rest seems to have been due as much to non-recognition of the myocardial infarction as to deliberate early ambulation after it. There can be little doubt that after a major infarction bed rest for at least 6 weeks is advisable, although variations, such as Levine’s2 "chair treatment," may sometimes be of value. The report by Lary and de Takats re-emphasises that myocardial infarction may show itself in several different ways, particularly in the elderly, and that sudden dyspnœa, syncope, and dizziness may be presenting symptoms without much pain.3 Landman et al.4 found that 11% of 255 myocardial infarcts were " silent." It is probably rare for infarction to be unaccompanied by any symptom whatever, although old people may give a vague history because their memory for the event is clouded. Infarction may present as angina of effort, and the sudden onset of this symptom is an indication for rest in bed. Lary and de Takats are not convinced of the value of anticoagulants in the prevention of arterial embolism following myocardial infarction. (There is a growing weight of opinion against administering anticoagulants to patients with a clinically small infarction, shortlived pain, and no hypotension or congestive heart1. Lary, B. G., de Takats, G. J. Amer. med. Ass. 1954, 155, 10. 2. Levine, S. A., Lown, B. Trans. Ass. Amer. Phycns. 1951, 64, 316. 3. See also Papp, C. Brit. Heart J. 1952, 14, 250. 4. Landman, M. E., Anholt, H. S., Angrist, A. Arch. intern. Med. 1949, 83, 665. 5. Wade, E. G., Morgan Jones. Brit. Heart J. 1951, 13, 319.
30 " In the " silent " or quiet" infarct the severity to be difficult whatever the decision but, gauge ; may on giving anticoagula-nts, rest in bed is essential.
-failure. 6
SMOKING AND CANCER OF THE LUNG build-up of clinical and epidemiological evidence which culminated- in the well-controlled studies of Doll and Bradford Hilland Wynder and Graham 8 convinced most of us of the chill realitv of the association between to cancer of the lung. smoking habits and But, as we have already pointed out,9 the historical or retrospective approach used in these and similar studies is open to criticism which may appear pedantic but cannot be ignored. Bias in the observer may have an appreciable effect on the frequency of eliciting a history of heavy smoking ; the cancer patient himself may propose his smoking habits as an innocent cause of his respiratory symptoms, and these symptoms themselves may in turn change his smoking habits. The experience of Doll and Hill with patients suffering from intrathoracic growths which later proved to be non-malignant showed that these objections can be overstated. Nevertheless, since, Dr. Graham remarks,lO human experiments are as impossible, these objections are important enough to make " prospective " inquiries an essential step in the proof of the carcinogenic qualities of tobacco smoke. The basic idea is quite simple. A large and reasonably homogeneous group of men are catechised about their smoking habits, present and past. The information is filed and the deaths occurring in subsequent years are collected. A comparison of the death-rates in groups with contrasting smoking habits will then confirm or deny the suggestions implicit in the results of the historical " approach. In his family studies of the relation between social and personal characteristics and longevity Pearl 11 showed that heavy smoking was associated with excessive mortality-rates in middle life. Unfortunately he gave no analysis by cause of death, and his genealogical methods were not, strictly speaking, prospective studies. A more satisfying development of this theme was reported last week by Dr. Richard Doll and Professor Bradford Hill.12 In October, 1951, they_ asked doctors in the United Kingdom to classify themselves according to whether they were at that time smokers, whether they had given up smoking, or whether they had never smoked as much as one cigarette a day for as long as one year. Supplementary questions on the duration and manner of smoking tobacco were put to both present and previous smokers. To this questionary, 24,389 replies were received from men aged 35 years and over and in the twenty-nine months which have elapsed, the Registrar-General has reported on the cause of death of Of these 789 deaths, 35 were 789 of these doctors. certified as due to lung cancer ; in 1 other, lung cancer was a contributing cause. Inquiries from the attending showed that the diagnosis could be given with physician certainty in at least 33 of these patients. Other causes of death were also separated out in the analysis, and agestandardised death-rates are given for six groups of diseases among non-smokers, moderate, and heavy smokers. The results are impressive. There is a clear gradient in lung-cancer mortality from the non-smoking to heavysmoking groups. There is also a rise, although less steep, in the death-rate from coronary thrombosis ; but no appreciable gradient appears in other forms of cancer, other cardiovascular diseases, respiratory diseases, and all other causes of death. In short, the results of this prospective inquiry confirm the indications so strongly THE
disposition
"
6. See Lancet, 1954, i, 917. 7. Doll, R., Hill, A. B. Brit. med. J. 1950, ii, 739. 8. Wynder, E. L., Graham, E. A. J. Amer. med. Ass. 1950, 9. Lancet, 1952, ii, 667. 10. Graham, E. A. Lancet, 1954, i, 1305. 11. Pearl, R. Science, 1938, 87, 216. 12. Doll, R., Hill, A. B. Brit. med. J. 1954, i, 1451.
143, 329.
given by Hill and Doll’s previous retrospective controlled study, and the methodological objections already noted have been effectively answered. With commendable caution, the report has been called preliminary, although, with the possible exception of the trend in the respiratorydisease group, the ultimate results should differ little from the pattern now observed. In these prospective studies, publication of early results is important in diminishing the dangers of bias to which they, too, may be subject. Increasingly, a history of heavy smoking may come to be taken by physicians certifying death as a diagnostic indicator of lung cancer, and the association between smoking and lung-cancer mortality may thus become unduly inflated. Again, the very candour of reports such as those of Doll and Hill who thank " the survivors of the 40,000 men and women " who make them possible, may in time free some of the heavy smokers of 1951 from the tobacco habit. For these reasons, contemporary and similar studies in other countries are of particular value. American press accounts of a report by Dr. Cuyler Hammond and Dr. Daniel Horn of the American Cancer Society to the recent meeting of the American Medical Association suggest that they are reaching similar conclusions. They instituted a forward inquiry through lay members of the American Cancer Society, who were asked in 1951 to report on current smoking habits and subsequent mortality experience of about ten of their male acquaintances between the age of 50 and 69. Like Pearl, they find that the total death-rate among men between 50 and 64 is more than twice as high as among non-smokers of the same age. Like Doll and Hill, they find excessive death-rates for lung cancer and coronary thrombosis in the heavy-smoking group ; they suggest that the lung-cancer death-rate is at least five times as high as the rate for non-smokers. On the other hand, they also report an excess in cancer of throat, kidneys, stomach, and intestinal tract which is not in line with the British findings. Although much larger, the American experience is based on a socially less homogeneous group, which, being composed of friends of members of the American Cancer Society, may contain an unduly high proportion of persons with a familial history of that disease. Informed comment must await the publication of detailed results. Meanwhile, we have, in the Doll and Hill report, one more sound reason for ordering the priorities among our next New Year’s resolutions. RATIONING AND SPECIAL DIETS
THIS week sees the demise of the Medical Research Council’s Food Rationing (Special Diets) Advisory Formed in 1940 at the request of the Committee. Ministry of Food, the Ministry of Health, and the Department of Health for Scotland, it was asked to advise on any modifications of the ordinary civilian rations which might be necessary on medical grounds for invalids and others for whom special diets had been prescribed. Now that civilian rationing is ended, its task is
complete. No system of rationing can ever be entirely equitable. A food that is properly regarded as a pleasant luxury for the majority may be almost a necessity for a few. The dietetic problems presented by clear-cut physical disorders such as diabetes, steatorrhoea, and tuberculosis are difficult enough ; but, when food-supplies were limited, such indefinite conditions as food allergies and food neuroses posed even more awkward individual problems for which a judicious blend of scientific knowledge and tact was needed. Some of the details of the committee’s work have already been recorded.! There are always in this country a considerable number of food cranks, some of whom are well informed and 1.
History of the Second World War. Medical Research. Edited by F. H. K. Green and G. Corell. H.M. Stationery Office, 1953.
THE popularity of caffeine-containing beverages in many different civilisations is testimony to the solace and stimulus which mankind derives from this delectable alkaloid. But caffeine has always had its opponents, one of whom, Professor Steyn, of the University of Pretoria, has lately marshalled the case against it.1 Much of the evidence that Steyn cites is based on the results of experiments in which large doses of caffeine and the clinical were given to laboratory animals ; of must such always be somewhat application findings
conjectural.
Thus, when dogs
given caffeine by per kg. body-weight
are
mouth in doses of 50-400 mg. the plasma-prothrombin time falls.2 Steyn remarks that this " appears to have brought conclusive proof that the ingestion of caffeine most probably aggravates the already serious state of thrombosis in man." But this conclusion is not justified on the evidence presented. Steyn is on firmer ground when he discusses the relation between caffeine and peptic ulcer. Roth et aL3 gave 250 mg. of caffeine dissolved in 200 ml. of water to normal persons and to ulcer patients after an overnight fast, and demonstrated a copious flow of acid gastric juice. In most of the normal people this was shortlived, whereas in most of the patients with ulcer it continued longer. Similar results were obtained with caffeine-containing beverages as ordinarily served, but the addition of sugar and cream to coffee almost halved the secretory response. Merendino et awl. obtained similar results after giving two cups of strong black coffee to people who had fasted overnight. The experimental production of gastric ulcers in cats and guineapigs 4-6 by the repeated daily injection of large amounts of caffeine can be dismissed by the clinician as irrelevant. children drinking large quantities Steyn of soft drinks in warm weather ; and he would like it to be better known that many of these beverages contain appreciable quantities of caffeine. The caffeine content of one of the best known of these cola drinks is stated to be 33 mg. per bottle, and a similar well-known drink contains twice this amount.3 (This compares with .an estimate of 100-120 mg. of caffeine per cup of coffee, though-Steyn thinks that in South Africa the true figure for coffee is probably below 30 mg. per cup.) The young man admitted to hospital with a perforated peptic ulcer after drinking 150 bottles of an iced cola drink during five warm August days4 is an extreme example, and the danger from cola drinks in this country is probably slight. Professor Steyn, however, is right in saying that in certain soft drinks larger quantities of caffeine are consumed, especially by children, than in coffee, tea, or cocoa, and that those parents who do not wish their children to take caffeine should be informed of its presence in such drinks.
frequently sees
1.
2. 3. 4. 5. 6.
Steyn, D. G. Caffeine-containing Beverages and Human Health. Pretoria, 1954. Field, J. B., Lassen, E. G., Spero, L., Link, K. P. J. biol. Chem. 1944, 156, 725. Roth, J. A., Ivy, A. C., Atkinson, A. J. J. Amer. med. Ass. 1944, 126, 814. Merendino, K. A., Judd, E. S., Baronofsky, I., Litow, S. S., Lannin, B. G., Wangensteen, O. H. Surgery, 1945, 17, 650. Judd, E. S. Bull. Amer. Coll. Surg. 1943, 28, 46. Roth, J. A., Ivy, A. C. Gastroenterology, 1944, 2, 274 ; Surgery, 1945, 17, 644.
All this does not amount to a very damaging brief against caffeine-containing drinks. The only way of proving that excessive drinking of tea and coffee is harmful is to compare the prevalence of the various morbid conditions to which they are alleged to give rise, in large groups of people comparable in all respects other than consumption of caffeine. This is the method by which the relation between cigarette-smoking and lung
established.
But immense labour would be case against caffeine does not seem strong enough to justify this. Meanwhile the addicts among us will continue to rely on the reassurance of personal experience, as did Samuel Johnson. When attacked by a certain Mr. Jonas Hanway for his habit of tea-drinking, Johnson, than whom " no person ever enjoyed with more relish the infusion of that fragrant leaf," declared that Mr. Hanway had " considered the effects of Tea upon the health of the drinker, which, I think, he has aggravated in the vehemence of his zeal, and which, after soliciting them by this watery luxury, year after year, I have not felt."
cancer was
involved, and the prima-facie
BED REST AFTER MYOCARDIAL INFARCTION
MOST clinicians agree on the importance of bed rest after myocardial infarction, though they are mindful that in old persons complete immobilisation has its own hazards from venous stasis. Lary and de Takats1 have drawn attention to arterial embolism in patients who were on their feet shortly after a cardiac infarction. Of eight such patients, in whom embolism to the lower limb occurred 5-30 days after the infarct, five had not been kept in bed at all: and in two of these the embolus occurred within 6 days of the infarct. In four patients the infarction was not diagnosed until after the embolus had occurred ; but all except two had a clinical episode consistent with infarction-either chest or sudden dyspnoea. One had complained only of pain " " " while another dizziness," apparently had a silent infarct following cholecystectomy. There was electrocardiographic evidence of infarction in all but two cases. In one of these necropsy revealed multiple old infarcts. The other patient had auricular fibrillation, with no clear-cut history suggestive of infarction ; this case did not come to necropsy, so that embolism could not definitely be attributed to myocardial infarction. Failure to enforce bed rest seems to have been due as much to non-recognition of the myocardial infarction as to deliberate early ambulation after it. There can be little doubt that after a major infarction bed rest for at least 6 weeks is advisable, although variations, such as Levine’s2 "chair treatment," may sometimes be of value. The report by Lary and de Takats re-emphasises that myocardial infarction may show itself in several different ways, particularly in the elderly, and that sudden dyspnœa, syncope, and dizziness may be presenting symptoms without much pain.3 Landman et al.4 found that 11% of 255 myocardial infarcts were " silent." It is probably rare for infarction to be unaccompanied by any symptom whatever, although old people may give a vague history because their memory for the event is clouded. Infarction may present as angina of effort, and the sudden onset of this symptom is an indication for rest in bed. Lary and de Takats are not convinced of the value of anticoagulants in the prevention of arterial embolism following myocardial infarction. (There is a growing weight of opinion against administering anticoagulants to patients with a clinically small infarction, shortlived pain, and no hypotension or congestive heart1. Lary, B. G., de Takats, G. J. Amer. med. Ass. 1954, 155, 10. 2. Levine, S. A., Lown, B. Trans. Ass. Amer. Phycns. 1951, 64, 316. 3. See also Papp, C. Brit. Heart J. 1952, 14, 250. 4. Landman, M. E., Anholt, H. S., Angrist, A. Arch. intern. Med. 1949, 83, 665. 5. Wade, E. G., Morgan Jones. Brit. Heart J. 1951, 13, 319.
30 " In the " silent " or quiet" infarct the severity to be difficult whatever the decision but, gauge ; may on giving anticoagula-nts, rest in bed is essential.
-failure. 6
SMOKING AND CANCER OF THE LUNG build-up of clinical and epidemiological evidence which culminated- in the well-controlled studies of Doll and Bradford Hilland Wynder and Graham 8 convinced most of us of the chill realitv of the association between to cancer of the lung. smoking habits and But, as we have already pointed out,9 the historical or retrospective approach used in these and similar studies is open to criticism which may appear pedantic but cannot be ignored. Bias in the observer may have an appreciable effect on the frequency of eliciting a history of heavy smoking ; the cancer patient himself may propose his smoking habits as an innocent cause of his respiratory symptoms, and these symptoms themselves may in turn change his smoking habits. The experience of Doll and Hill with patients suffering from intrathoracic growths which later proved to be non-malignant showed that these objections can be overstated. Nevertheless, since, Dr. Graham remarks,lO human experiments are as impossible, these objections are important enough to make " prospective " inquiries an essential step in the proof of the carcinogenic qualities of tobacco smoke. The basic idea is quite simple. A large and reasonably homogeneous group of men are catechised about their smoking habits, present and past. The information is filed and the deaths occurring in subsequent years are collected. A comparison of the death-rates in groups with contrasting smoking habits will then confirm or deny the suggestions implicit in the results of the historical " approach. In his family studies of the relation between social and personal characteristics and longevity Pearl 11 showed that heavy smoking was associated with excessive mortality-rates in middle life. Unfortunately he gave no analysis by cause of death, and his genealogical methods were not, strictly speaking, prospective studies. A more satisfying development of this theme was reported last week by Dr. Richard Doll and Professor Bradford Hill.12 In October, 1951, they_ asked doctors in the United Kingdom to classify themselves according to whether they were at that time smokers, whether they had given up smoking, or whether they had never smoked as much as one cigarette a day for as long as one year. Supplementary questions on the duration and manner of smoking tobacco were put to both present and previous smokers. To this questionary, 24,389 replies were received from men aged 35 years and over and in the twenty-nine months which have elapsed, the Registrar-General has reported on the cause of death of Of these 789 deaths, 35 were 789 of these doctors. certified as due to lung cancer ; in 1 other, lung cancer was a contributing cause. Inquiries from the attending showed that the diagnosis could be given with physician certainty in at least 33 of these patients. Other causes of death were also separated out in the analysis, and agestandardised death-rates are given for six groups of diseases among non-smokers, moderate, and heavy smokers. The results are impressive. There is a clear gradient in lung-cancer mortality from the non-smoking to heavysmoking groups. There is also a rise, although less steep, in the death-rate from coronary thrombosis ; but no appreciable gradient appears in other forms of cancer, other cardiovascular diseases, respiratory diseases, and all other causes of death. In short, the results of this prospective inquiry confirm the indications so strongly THE
disposition
"
6. See Lancet, 1954, i, 917. 7. Doll, R., Hill, A. B. Brit. med. J. 1950, ii, 739. 8. Wynder, E. L., Graham, E. A. J. Amer. med. Ass. 1950, 9. Lancet, 1952, ii, 667. 10. Graham, E. A. Lancet, 1954, i, 1305. 11. Pearl, R. Science, 1938, 87, 216. 12. Doll, R., Hill, A. B. Brit. med. J. 1954, i, 1451.
143, 329.
given by Hill and Doll’s previous retrospective controlled study, and the methodological objections already noted have been effectively answered. With commendable caution, the report has been called preliminary, although, with the possible exception of the trend in the respiratorydisease group, the ultimate results should differ little from the pattern now observed. In these prospective studies, publication of early results is important in diminishing the dangers of bias to which they, too, may be subject. Increasingly, a history of heavy smoking may come to be taken by physicians certifying death as a diagnostic indicator of lung cancer, and the association between smoking and lung-cancer mortality may thus become unduly inflated. Again, the very candour of reports such as those of Doll and Hill who thank " the survivors of the 40,000 men and women " who make them possible, may in time free some of the heavy smokers of 1951 from the tobacco habit. For these reasons, contemporary and similar studies in other countries are of particular value. American press accounts of a report by Dr. Cuyler Hammond and Dr. Daniel Horn of the American Cancer Society to the recent meeting of the American Medical Association suggest that they are reaching similar conclusions. They instituted a forward inquiry through lay members of the American Cancer Society, who were asked in 1951 to report on current smoking habits and subsequent mortality experience of about ten of their male acquaintances between the age of 50 and 69. Like Pearl, they find that the total death-rate among men between 50 and 64 is more than twice as high as among non-smokers of the same age. Like Doll and Hill, they find excessive death-rates for lung cancer and coronary thrombosis in the heavy-smoking group ; they suggest that the lung-cancer death-rate is at least five times as high as the rate for non-smokers. On the other hand, they also report an excess in cancer of throat, kidneys, stomach, and intestinal tract which is not in line with the British findings. Although much larger, the American experience is based on a socially less homogeneous group, which, being composed of friends of members of the American Cancer Society, may contain an unduly high proportion of persons with a familial history of that disease. Informed comment must await the publication of detailed results. Meanwhile, we have, in the Doll and Hill report, one more sound reason for ordering the priorities among our next New Year’s resolutions. RATIONING AND SPECIAL DIETS
THIS week sees the demise of the Medical Research Council’s Food Rationing (Special Diets) Advisory Formed in 1940 at the request of the Committee. Ministry of Food, the Ministry of Health, and the Department of Health for Scotland, it was asked to advise on any modifications of the ordinary civilian rations which might be necessary on medical grounds for invalids and others for whom special diets had been prescribed. Now that civilian rationing is ended, its task is
complete. No system of rationing can ever be entirely equitable. A food that is properly regarded as a pleasant luxury for the majority may be almost a necessity for a few. The dietetic problems presented by clear-cut physical disorders such as diabetes, steatorrhoea, and tuberculosis are difficult enough ; but, when food-supplies were limited, such indefinite conditions as food allergies and food neuroses posed even more awkward individual problems for which a judicious blend of scientific knowledge and tact was needed. Some of the details of the committee’s work have already been recorded.! There are always in this country a considerable number of food cranks, some of whom are well informed and 1.
History of the Second World War. Medical Research. Edited by F. H. K. Green and G. Corell. H.M. Stationery Office, 1953.