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VEGETARIANISM AND DRUG USERS
381 12 mg. per sq.m. given prophylactically every 90 days and therapeutically weekly is well tolerated and not associated with serious neurological complications. We do not agree that a smaller and much more frequent dose schedule should replace the more widely used schemes. Department of Oncology, Children’s Hospital, Denver, Colorado, U.S.A.
EDWARD S. BAUM CHARLENE P. HOLTON.
CARCINOMA OF THE ŒSOPHAGUS AFTER GASTRIC SURGERY
SIR,-We reported1 that, in
our
necropsy material from
Ulleval Hospital, previous gastric operations for benign conditions were two to three times more common among patients with gastric cancer than among controls matched for age, sex, and year of necropsy. In an earlier report, Shearman et awl. indicated that a similar association may exist between carcinoma of the oesophagus and previous
gastric
surgery.
CARCINOMA OF THE (ESOPHAGUS AFTER GASTRIC SURGERY
MORBIDITY AND MORTALITY IN RELATION TO SOCIAL CLASS
Sm,—Your readers may like to know that the suggestion of Dr. Wald (Jan. 29, p. 259) has already been implemented in the Commentary (vol. III, 1965) of the Hospital InPatient Enquiry, 1960-61. Hospital admissions analysed by occupation and social class have enabled the potentiality of this method to be assessed. Information from hospital patients is, as your correspondent stresses, less precise than that obtained at Census time; in addition, the concept of social class as reflected in official statistics needs handling with care. For example, the proportion recorded in social class v in 1951 was 12-7%, but only 8-0% in the 1961 census-a smaller proportion and presumably further removed from the overall average. There are suggestions that the characteristics which lead families into social-class-v status also cause them to be insouciant of the best action to prevent or deal with disease and injuries-cigarette-smoking can be quoted as one example. Finally, the data displayed is of relative deterioration, whereas the absolute mortality-rates have improved in all classes. Office of Population Censuses and Surveys, Somerset House,
Strand, London WC2R
1LR.
WILLIAM A. WILSON.
VEGETARIANISM AND DRUG USERS
We have reviewed all necropsy reports on patients dying from or with cancer of the oesophagus in Ulleval Hospital in 1960-70. Wherever the reports gave any indication that the patient might have been subjected to gastric surgery for a benign condition, further information was sought from clinical records. The control group from our study on gastric cancerwas used for comparison. These controls were drawn from the necropsy material of the same laboratory from the same years except 1970, and the mean age of the controls was close to that of the patients with cancer of the oesophagus. As shown in the accompanying table, previous gastric surgery was even less common among patients with cancer of the oesophagus than among the controls, although this difference is not a significant one. As in the gastric-cancer study, only operations performed five years or more before death were listed in the table. The two patients with oesophageal cancer had been operated on six and twenty-one years before death. A third male patient with cancer of the oesophagus had been operated on for gastric haemorrhage four years before death, and a fourth, also a male, had undergone partial gastrectomy for a cancerous gastric ulcer eleven years before he died from cancer of the oesophagus. In all four patients the centre of the tumour was in the middle third of the oesophagus and histological examination showed squamous-cell carcinoma. Thus, there is nothing in our data to indicate that cancer of the oesophagus has any peculiar features in patients who have undergone gastric surgery, either in appearance or in frequency. Our observations agree with those of MacDonald et al.,3 who studied patients treated for rectal cancer as controls. Cancer Registry of Norway and Department of Pathology, Ullevål Hospital, HELGE STALSBERG. Oslo 1, Norway. 1. 2.
Stalsberg, H., Taksdal, S. Lancet, 1971, ii, 1175. Shearman, D. J. C., Finlayson, N. D. C., Amott, S. J., Pearson, J. G. ibid. 1970, i, 581. 3. MacDonald, J. B., Waissbluth, J. G., Langman, M. J. S. ibid. 1971, i, 19.
SiR,—The density of errors is high in the letter by Dr. Dwyer and Professor Mayer (Dec. 25, p. 1429). A vegan is one who takes no animal substance as food. Those who take only milk and eggs are called lacto-ovo vegetarians. Both types are found among the Seventh Day Adventists. Hindus are expected to be vegans. The acknowledged authority on vegetarianism is Prof. Mervyn Hardinge, now dean of the School of Public Health, Loma Linda University, Loma Linda, California. Dr. Hardinge wrote his PH.D. dissertation on the health status of vegetarians. He found true vegans rare, even among Seventh Day Adventists, and to have significantly more ill health, especially anaernÏa.2 Thus, vegans do not have superior health. This work was actually done in the department of nutrition at Harvard. Dr. Mayer reminds me of the old Creole saying, " the last thing a fish would discover is water ! ". The pejorative term " hard-core ", used repeatedly by Dr. Dwyer and Professor Mayer to describe vegetarians, is inappropriate. Would the authors refer to a hard-core Catholic or a hard-core Frenchman ? This term, by usage, is reserved for criminality, and vegetarianism is not that. To contend, without data, that vegetarianism is a crutch for drug usage, is also unfair. Our experience indicates that the recourse of American youth to vegetarianism is based on two rationalisations. Those who emphasise a doctrine of love do not wish to see animals victimised for food usage. The mistrust of the rambunctious food technologists who add chemicals with little attention to human safety leads many health-conscious people to seek unprocessed, natural foods for their health protection. Thus, many feel a vegetarian diet is the best recourse in an era of promiscuous manipulation of the food-supply. Dr. Dwyer and Professor Mayer, finally, solicited only confirmation of their views. I suppose they intended to encourage all the facts and opinions. Department of Biochemistry, Division of Nutrition, School of Medicine, Vanderbilt University, Nashville, Tennessee 37232, U.S.A. 1. 2.
GEORGE V. MANN.
Hardinge, M. G. The Health Status of Vegetarians. Dissertation, Harvard University School of Public Health. Boston, 1954. Hardinge, M. G., Stare., F. J. J. clin. Nutr. 1954, 2, 73.
EDWARD S. BAUM CHARLENE P. HOLTON.
CARCINOMA OF THE ŒSOPHAGUS AFTER GASTRIC SURGERY
SIR,-We reported1 that, in
our
necropsy material from
Ulleval Hospital, previous gastric operations for benign conditions were two to three times more common among patients with gastric cancer than among controls matched for age, sex, and year of necropsy. In an earlier report, Shearman et awl. indicated that a similar association may exist between carcinoma of the oesophagus and previous
gastric
surgery.
CARCINOMA OF THE (ESOPHAGUS AFTER GASTRIC SURGERY
MORBIDITY AND MORTALITY IN RELATION TO SOCIAL CLASS
Sm,—Your readers may like to know that the suggestion of Dr. Wald (Jan. 29, p. 259) has already been implemented in the Commentary (vol. III, 1965) of the Hospital InPatient Enquiry, 1960-61. Hospital admissions analysed by occupation and social class have enabled the potentiality of this method to be assessed. Information from hospital patients is, as your correspondent stresses, less precise than that obtained at Census time; in addition, the concept of social class as reflected in official statistics needs handling with care. For example, the proportion recorded in social class v in 1951 was 12-7%, but only 8-0% in the 1961 census-a smaller proportion and presumably further removed from the overall average. There are suggestions that the characteristics which lead families into social-class-v status also cause them to be insouciant of the best action to prevent or deal with disease and injuries-cigarette-smoking can be quoted as one example. Finally, the data displayed is of relative deterioration, whereas the absolute mortality-rates have improved in all classes. Office of Population Censuses and Surveys, Somerset House,
Strand, London WC2R
1LR.
WILLIAM A. WILSON.
VEGETARIANISM AND DRUG USERS
We have reviewed all necropsy reports on patients dying from or with cancer of the oesophagus in Ulleval Hospital in 1960-70. Wherever the reports gave any indication that the patient might have been subjected to gastric surgery for a benign condition, further information was sought from clinical records. The control group from our study on gastric cancerwas used for comparison. These controls were drawn from the necropsy material of the same laboratory from the same years except 1970, and the mean age of the controls was close to that of the patients with cancer of the oesophagus. As shown in the accompanying table, previous gastric surgery was even less common among patients with cancer of the oesophagus than among the controls, although this difference is not a significant one. As in the gastric-cancer study, only operations performed five years or more before death were listed in the table. The two patients with oesophageal cancer had been operated on six and twenty-one years before death. A third male patient with cancer of the oesophagus had been operated on for gastric haemorrhage four years before death, and a fourth, also a male, had undergone partial gastrectomy for a cancerous gastric ulcer eleven years before he died from cancer of the oesophagus. In all four patients the centre of the tumour was in the middle third of the oesophagus and histological examination showed squamous-cell carcinoma. Thus, there is nothing in our data to indicate that cancer of the oesophagus has any peculiar features in patients who have undergone gastric surgery, either in appearance or in frequency. Our observations agree with those of MacDonald et al.,3 who studied patients treated for rectal cancer as controls. Cancer Registry of Norway and Department of Pathology, Ullevål Hospital, HELGE STALSBERG. Oslo 1, Norway. 1. 2.
Stalsberg, H., Taksdal, S. Lancet, 1971, ii, 1175. Shearman, D. J. C., Finlayson, N. D. C., Amott, S. J., Pearson, J. G. ibid. 1970, i, 581. 3. MacDonald, J. B., Waissbluth, J. G., Langman, M. J. S. ibid. 1971, i, 19.
SiR,—The density of errors is high in the letter by Dr. Dwyer and Professor Mayer (Dec. 25, p. 1429). A vegan is one who takes no animal substance as food. Those who take only milk and eggs are called lacto-ovo vegetarians. Both types are found among the Seventh Day Adventists. Hindus are expected to be vegans. The acknowledged authority on vegetarianism is Prof. Mervyn Hardinge, now dean of the School of Public Health, Loma Linda University, Loma Linda, California. Dr. Hardinge wrote his PH.D. dissertation on the health status of vegetarians. He found true vegans rare, even among Seventh Day Adventists, and to have significantly more ill health, especially anaernÏa.2 Thus, vegans do not have superior health. This work was actually done in the department of nutrition at Harvard. Dr. Mayer reminds me of the old Creole saying, " the last thing a fish would discover is water ! ". The pejorative term " hard-core ", used repeatedly by Dr. Dwyer and Professor Mayer to describe vegetarians, is inappropriate. Would the authors refer to a hard-core Catholic or a hard-core Frenchman ? This term, by usage, is reserved for criminality, and vegetarianism is not that. To contend, without data, that vegetarianism is a crutch for drug usage, is also unfair. Our experience indicates that the recourse of American youth to vegetarianism is based on two rationalisations. Those who emphasise a doctrine of love do not wish to see animals victimised for food usage. The mistrust of the rambunctious food technologists who add chemicals with little attention to human safety leads many health-conscious people to seek unprocessed, natural foods for their health protection. Thus, many feel a vegetarian diet is the best recourse in an era of promiscuous manipulation of the food-supply. Dr. Dwyer and Professor Mayer, finally, solicited only confirmation of their views. I suppose they intended to encourage all the facts and opinions. Department of Biochemistry, Division of Nutrition, School of Medicine, Vanderbilt University, Nashville, Tennessee 37232, U.S.A. 1. 2.
GEORGE V. MANN.
Hardinge, M. G. The Health Status of Vegetarians. Dissertation, Harvard University School of Public Health. Boston, 1954. Hardinge, M. G., Stare., F. J. J. clin. Nutr. 1954, 2, 73.