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CURES AND PREVENTION.
1012 To these wo may add the classics case varied. of the Emperor Frederick and similar cases ’where the microscopical evidence from the part removed has been inconclusive and has led to delay and a, terrible suspense. The only evidence produced in favour of biopsy at this meeting was negative. Dr. Jobson Horne instanced (Proceedings, pp. 66, (7) four cases where the larynx was opened for a tuberculous lesion which had been thought to be cancer. Apparent these were gleaned from the history of
question
at issue.
sentences from "
our
We may quote here the following previous pa/per:—
varied diet which includes milk, butter, eggs, other veget,ables, the absence of vitamin B from bread may not be a serious defect. But th& people who can afford such a diet do not eat much bread anyhow. It is among the poorer classes, and especially the children of the poorer classes, where bread represents the bulk of the daily diet, and where butter is replaced by margarine, that the absence of vitamin B from white bread has to be considered as a serious dietetic defect. Reports of medical officers of health show that many of these children live on a diet composed of white bread, margarine, jam, and fish, with perhaps some potatoes. Such a diet is certainly deficient in both vitamin A and B, and could be madeadequate as regards the latter vitamin by the consumption of bread rich in vitamin B." On
a
porridge, potatoes, and
over a period of 50 years. C’lns; 13 does not afford many opportunities for performing a biopsy and none from the cases that come within Class A (2). In cases coming under Class A (1) section of a gland may clinch the diagnosis A man came up to the as in the following patient. It will be seen that there is here again agreement clinic with a cauliflower mass in the larynx which looked like a carcinoma. He had such dyspncea that between our views and those of Mottram and Hartwell, it was necessary to do a tracheotomy on the next but it will also be seen that these authors evade the day before the complete medical examination could issue that according to the reports of medical officers be made. While doing this operation the crico- of health many children live on a diet composed thyroid gland was found to be enlarged ; the section chiefly of fish, potatoes, white bread, margarine, and proved to be tuberculous. This was subsequently jam. This is not " an ordinary mixed diet," and confirmed by examination of the lungs. from what we know of the vitamin-B content of the I am, Sir, yours faithfully, articles of food composing this diet, it is poor in T. B. LAYTON. vitamin B 1. It would not require long and costly experiments to prove whether on such a diet the partial substitution of wholemeal bread or germ bread for white bread as suggested by us would or THE MEDICAL SICKNESS, ANNUITY, AND would not have a beneficial effect. LIFE ASSURANCE SOCIETY, LIMITED. The diet chosen by Mottram and Hartwell in their To the Editor of THE LANCET. experiments, and called the " diet of the Essex labourer," is a very different one. Their SIR,-In reply to Mr. Bowdler Henry’s attack on the agricultural experiments, incomplete as they admittedly are, board of this Society, I should like to saythat the diet is defective, and since the defects prove (1) that I was present at the general meeting and are not remedied by the substitution of bread rich heard the discussion on Dr. Harvey Hilliard’s resolu- in vitamin B for bread poor in it, all that one can tions and was perfectly satisfied with the board’s conclude is that the defects of this diet cannot be treatment of them which was at once sympathetic remedied the addition of vitamin Bl alone. But by and firm ; and when in the last sentence of their paper the authors (2) that as the unanimous recommendations of the make the bold assumption of implying that the diet as set out in the annual report, were directly called " the diet of the Essex directors, labourer " agricultural attacked it was only to be expected that the board represents the diet of the working classes of this would send out for proxies. country we cannot agree with them. There is no I am, Sir, yours faithfully, justification for this assumption. Nobody can lay E. F. THOMAS. down a definite diet as representing that of the working or any other class. Diet varies from household to household. The letter from Sir Bruce BruceTHE BROWN v. WHITE BREAD Porter and the experience of medical officers of health referred to in the quotation from our paper paint a CONTROVERSY. very different picture from that given by Mottram To the Editor of THE LANCET. and Hartwell.-We are, Sir, yours faithfully, J. C. MOTTRAM. SIR,-The letter by Dr. S. H. Belfrage in THE LANCET W. CRAMER. of Nov. 2nd, asking those who hold opposing views to Radium Institute, Imperial Cancer Research Fund, those of Prof. V. H. Mottram and Miss Gladys A. Nov. 4th, 1929. Hartwell to express their views on these experiments, Mottram comment. us to make the induces following and Hartwell have now definitely abandoned their CURES AND PREVENTION. former contention that white bread contains a considerable amount of vitamin B, and is not markedly To the Editor of THE LANCET. inferior in that respect to wholemeal bread or germ bread. They now admit that the two last-named Sin,—Dr. Ainley Walker makes a fine point. The fact types of bread are richer in vitamin B, although they cannot be denied that the injection of the antitoxinstill conceal the fact that white bread is exceedingly causes destruction of the diphtheria bacilli in the poor in vitamin B. Incidentally they make an error patient, whatever the exact method of that destruction in suggesting that the controversy has been com- is, and is therefore an intravital germicide. I plicated by the advent of germ breads. If they had will take him on the theoretical point he has made. consulted some such standard text-books on nutrition Assuming, an assumption with which, perhaps, he as Hutchison’s " Food and Principles of Dietetics," will not agree, that the toxin is the ferment by which they would have found that germ breads had been the microbe hydrolyses, therefore kills, the living manufactured and consumed long before the vitamins tissues, in order to live, surely if the combining power It is therefore now agreed that of that ferment were neutralised, and the ferment, were discovered. white bread is inferior to wholemeal bread and germ therefore, not capable of bringing about the digestion bread in so far as its vitamin-B content is concerned. of the material, the microbe must die of inanition; Whether thi is a matter of importance to the general the antitoxin can therefore quite properly be conpublic or not may be left to the judgment of your sidered a germicide. If antiferments to X.Y.’s readers. digestive ferments were injected into X.Y., causing Mottram and Hartwell now shift the discussion to his death by inanition, it would be a very efficient a new ground. They say that " an ordinary diet " homicide.-I am, Sir, yours faithfully, contains so much vitamin B amongst other things W. M. CROFTON. that " the deficiencies of white bread " are amply 1 THE LANCET. 1927, ii., 1090. compensated. In saying this they beg the whole
laryngology
I
-
question
at issue.
sentences from "
our
We may quote here the following previous pa/per:—
varied diet which includes milk, butter, eggs, other veget,ables, the absence of vitamin B from bread may not be a serious defect. But th& people who can afford such a diet do not eat much bread anyhow. It is among the poorer classes, and especially the children of the poorer classes, where bread represents the bulk of the daily diet, and where butter is replaced by margarine, that the absence of vitamin B from white bread has to be considered as a serious dietetic defect. Reports of medical officers of health show that many of these children live on a diet composed of white bread, margarine, jam, and fish, with perhaps some potatoes. Such a diet is certainly deficient in both vitamin A and B, and could be madeadequate as regards the latter vitamin by the consumption of bread rich in vitamin B." On
a
porridge, potatoes, and
over a period of 50 years. C’lns; 13 does not afford many opportunities for performing a biopsy and none from the cases that come within Class A (2). In cases coming under Class A (1) section of a gland may clinch the diagnosis A man came up to the as in the following patient. It will be seen that there is here again agreement clinic with a cauliflower mass in the larynx which looked like a carcinoma. He had such dyspncea that between our views and those of Mottram and Hartwell, it was necessary to do a tracheotomy on the next but it will also be seen that these authors evade the day before the complete medical examination could issue that according to the reports of medical officers be made. While doing this operation the crico- of health many children live on a diet composed thyroid gland was found to be enlarged ; the section chiefly of fish, potatoes, white bread, margarine, and proved to be tuberculous. This was subsequently jam. This is not " an ordinary mixed diet," and confirmed by examination of the lungs. from what we know of the vitamin-B content of the I am, Sir, yours faithfully, articles of food composing this diet, it is poor in T. B. LAYTON. vitamin B 1. It would not require long and costly experiments to prove whether on such a diet the partial substitution of wholemeal bread or germ bread for white bread as suggested by us would or THE MEDICAL SICKNESS, ANNUITY, AND would not have a beneficial effect. LIFE ASSURANCE SOCIETY, LIMITED. The diet chosen by Mottram and Hartwell in their To the Editor of THE LANCET. experiments, and called the " diet of the Essex labourer," is a very different one. Their SIR,-In reply to Mr. Bowdler Henry’s attack on the agricultural experiments, incomplete as they admittedly are, board of this Society, I should like to saythat the diet is defective, and since the defects prove (1) that I was present at the general meeting and are not remedied by the substitution of bread rich heard the discussion on Dr. Harvey Hilliard’s resolu- in vitamin B for bread poor in it, all that one can tions and was perfectly satisfied with the board’s conclude is that the defects of this diet cannot be treatment of them which was at once sympathetic remedied the addition of vitamin Bl alone. But by and firm ; and when in the last sentence of their paper the authors (2) that as the unanimous recommendations of the make the bold assumption of implying that the diet as set out in the annual report, were directly called " the diet of the Essex directors, labourer " agricultural attacked it was only to be expected that the board represents the diet of the working classes of this would send out for proxies. country we cannot agree with them. There is no I am, Sir, yours faithfully, justification for this assumption. Nobody can lay E. F. THOMAS. down a definite diet as representing that of the working or any other class. Diet varies from household to household. The letter from Sir Bruce BruceTHE BROWN v. WHITE BREAD Porter and the experience of medical officers of health referred to in the quotation from our paper paint a CONTROVERSY. very different picture from that given by Mottram To the Editor of THE LANCET. and Hartwell.-We are, Sir, yours faithfully, J. C. MOTTRAM. SIR,-The letter by Dr. S. H. Belfrage in THE LANCET W. CRAMER. of Nov. 2nd, asking those who hold opposing views to Radium Institute, Imperial Cancer Research Fund, those of Prof. V. H. Mottram and Miss Gladys A. Nov. 4th, 1929. Hartwell to express their views on these experiments, Mottram comment. us to make the induces following and Hartwell have now definitely abandoned their CURES AND PREVENTION. former contention that white bread contains a considerable amount of vitamin B, and is not markedly To the Editor of THE LANCET. inferior in that respect to wholemeal bread or germ bread. They now admit that the two last-named Sin,—Dr. Ainley Walker makes a fine point. The fact types of bread are richer in vitamin B, although they cannot be denied that the injection of the antitoxinstill conceal the fact that white bread is exceedingly causes destruction of the diphtheria bacilli in the poor in vitamin B. Incidentally they make an error patient, whatever the exact method of that destruction in suggesting that the controversy has been com- is, and is therefore an intravital germicide. I plicated by the advent of germ breads. If they had will take him on the theoretical point he has made. consulted some such standard text-books on nutrition Assuming, an assumption with which, perhaps, he as Hutchison’s " Food and Principles of Dietetics," will not agree, that the toxin is the ferment by which they would have found that germ breads had been the microbe hydrolyses, therefore kills, the living manufactured and consumed long before the vitamins tissues, in order to live, surely if the combining power It is therefore now agreed that of that ferment were neutralised, and the ferment, were discovered. white bread is inferior to wholemeal bread and germ therefore, not capable of bringing about the digestion bread in so far as its vitamin-B content is concerned. of the material, the microbe must die of inanition; Whether thi is a matter of importance to the general the antitoxin can therefore quite properly be conpublic or not may be left to the judgment of your sidered a germicide. If antiferments to X.Y.’s readers. digestive ferments were injected into X.Y., causing Mottram and Hartwell now shift the discussion to his death by inanition, it would be a very efficient a new ground. They say that " an ordinary diet " homicide.-I am, Sir, yours faithfully, contains so much vitamin B amongst other things W. M. CROFTON. that " the deficiencies of white bread " are amply 1 THE LANCET. 1927, ii., 1090. compensated. In saying this they beg the whole
laryngology
I
-