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VITAMIN-G SATURATION TEST
218
subject. Whether the present trend is definite or merely transitory is of vital importance to the future of this country and the Empire. Under present conditions should the birth-rate increase to 19-3, involving about 54,000 additional births a year, replacement of the present female population aged 15-45 should be assured and the threatened decline in population averted.
Two important points must be borne in mind in treating patients with the QP course. The first is that the patient must be kept under strict medical supervision throughout treatment, and if cyanosis or abdominal colic appears pamaquin should be discontinued and the course completed with quinine only. In 295 patients under our personal care only 3 had to have treatment interrupted in this way ; medical officers in
charge of other groups,
Statistical section, Public Health Dept., County Hall, SE1.
perhaps being more cautious than was really necessary, stopped the QP course in from 2 to 4% of their cases. The second is that Indian troops do not tolerate pamaquin as well
as
British ; for this
VITAMIN-G
reason, Indians should receive
J.
KEITH THOMPSON. WAR AND THE BIRTH-RATE SiR,-With reference to the leading article of July 7, the following facts regarding fertility trends in this country during the last 75 years may be of interest. 1. The fertility-rate-i.e., live births per 1000 women aged 15-45-which was 153in 1871, has, except during periods of war and trade revival, steadily fallen since, and just before the war was only 38% of that value. 2. Fertility has decreased in each age-group and in all classes of the community, being lowest among the professional and well-to-do and highest among labourers and unskilled workers. 3. Between 1871 and 1931, the year of the last census, both the married and total female populations aged 15-45 nearly doubled, while annual marriages increased by about 63%. The fertility-rate however declined by 58%, with the result that the births during 1931 were only 75% of those in 1871. 4. During the decennium 1921-31 fertility fell below 78-9, the rate required to replace the existing potential mothers aged 15-45 in successive future generations, and just before the war it was 61-4, or 78% of this value. 5. Apart from the decrease in fertility at each agegroup the resulting fall in the birth-rate has caused the gradual ageing of the female population aged 15-45, which has further reduced their fertility ; there has also been a slight increase in the average age at marriage. 6. The average number of children aged 0-15 per family fell during the period 1871-1931 from 3-1to 1-9. 7. Since the outbreak of war fertility has of course been adversely affected by the absence of the male on activeservice, and as the table below shows this was reflected until 1942 by a falling birth-rate in spite of a substantial increase in marriages. Since that year however the birth-rate has increased while marriages have declined. It will also be noticed that as a result of the war the illegitimate birth-rate has increased and in 1944 was double that of 1939. r--
rate e
..
1939 1940 1941 1942 1943 1944
..
..
..
..
17-4 19-3 22-0 20-7 18-2 16-0
..
..
..
..
14-3 14-0 13-4 14-9 15-4 16-7
..
..
..
..
0-6 0-6 0-8 0-9
..
..
..
..
..
..
..
..
..
..
..
..
‘
Total
Illegit.
that
conducted. The average amount of ascorbic acid calculated to be in the uncooked food did not exceed 30 mg. per head per day. Very little fruit was consumed, and all vegetables were boiled thoroughly, so fairly heavy cooking losses may be assumed. These men, and many others from the same unit, were carefiilly examined for clinical evidence of scurvy, with entirely negative results. Their health record was good, they performed hard physical work; and there was no evidence of delayed healing of wounds. Many of them suffered from pyorrhoeic gingivitis, which was unaffected by intensive vitamin-C therapy. We have, on occasion, inspected other Indian troops whose vitamin-C intake had been even lower for considerable periods, the average daily uncooked food supply not providing more than 10-15 mg. as calculated. No case of scurvy, even in the mildest form, has yet been encountered. Our results, although on a relatively small series of tests, confirm the conclusion of previous investigators (e.g., Harris, Lancet, 1942, i, 644) that a poor vitamin-C status, as revealed by the urine test, is not necessarily indicative of actual scurvy having developed. It seems that developed scurvy, as described among Indian troops in Mesopotamia during the last war, or in the Hissar famine by C. M. Nicol (Ind. med. Gaz. 1940, 75, 662), must result from an extremely severe and long-. continued lack of vitamin C. It should be pointed out that the figures given above are not representative of the vitamin-C intake of Indian troops as a whole, but are exceptional. The Indian soldier is now fed much better than he was in 1916. We wish to thank the Director of Medical Services in India for permission to publish this note, and the Roche Scientific Division (Bombay) for supplies of‘ Redoxon ’ &c. A. M. THOMSON. M. W. WILLIAM.
,
Legit.
the vitamin-U
515) states
_
Birth-rate
Marriage-
Year -
i,
TEST
°
y
.
1943,
ot
although no extensive tests have been completed on adult subjects, " the observation of a 7-10 day deficit as characteristic of :advanced vitamin deficiency (developed scurvy) rests mostly on observations on adults." The following data, obtained by testing 15 apparently healthy young adults (Indian troops) are therefore of some interest. Harris’s technique was followed exactly. 7 5 6 8 .. 9 10 11 Day of response 2 4 3 3 1 1 No. of cases 1 These subjects were selected at random from a unit where a dietary survey on a company basis was being
M. F. H. KELLEHER.
rever.
SATURATION in his review
Harris, SIR,—ij. saturation test (Lancet,
only 0-02 g. instead of 0-03 g. of pamaquin daily. Pamaquin heemoglobinuria has been described in Indians ; it appears usually on the 4th or 5th day after pamaquin has been started. It should be treated like blackwater
C. A. GOULD.
14-9 14-6 14-2 15,8
TRICHLORETHYLENE IN THE SURGICAL WARDS SIR,—In minor surgical procedures and the aftercare Note.--Rates (per 1000) are based on the estÍ1l;lated midof the surgical patient there is a wide field for the relief 1939 population ; marriages (provisional figures) are the of pain, discomfort, and anxiety. At present, when average of the two previous years to relate with births. alleviation is attempted at all, the choice usually lies 8. As your article points out, this increase in fertility, between morphine gr. 1, which is often inadequate, and which follows that after the last war but on a reducedfull-scale anaesthesia which requires special arrangements scale, is striking and is not confined to this country.and may be undesirable. It seems worth while to draw Apart from the causes you suggest, may not this rise attention to the value of trichlorethylene (’ Trilene ’) also be partly due to the granting of marriage and child analgesia, using a Freedman inhaler in this connexion. allowances during the war ? In Germany similar measThe first convoys of patients with painful wounds and ures before the war resulted in the birth-rate increasingadherent dressings, which had often to be examined soon from 14-7 in 1933 to 18-8 in 1937. Another reason mayiafter arrival, proved the value of this method, but there be a more optimistic belief in the future resulting from .are many other applications in the general surgical fieldthe successful turn in the course of the war. All this is first dressings, such as those after amputation or ] painful mere conjecture of course in the absence of the necessary]mastoidectcmy ; removal of tight plaster casts ; changing social data, and it is to be hoped that the statistics pro4of drainage tubes, &c. ; and even minor surgery in suitable vided by the next census will throw more light on this I subjects. ..
..
..
..
..
..
1-1
1-3
..
..
16-5 18-0
.
.
subject. Whether the present trend is definite or merely transitory is of vital importance to the future of this country and the Empire. Under present conditions should the birth-rate increase to 19-3, involving about 54,000 additional births a year, replacement of the present female population aged 15-45 should be assured and the threatened decline in population averted.
Two important points must be borne in mind in treating patients with the QP course. The first is that the patient must be kept under strict medical supervision throughout treatment, and if cyanosis or abdominal colic appears pamaquin should be discontinued and the course completed with quinine only. In 295 patients under our personal care only 3 had to have treatment interrupted in this way ; medical officers in
charge of other groups,
Statistical section, Public Health Dept., County Hall, SE1.
perhaps being more cautious than was really necessary, stopped the QP course in from 2 to 4% of their cases. The second is that Indian troops do not tolerate pamaquin as well
as
British ; for this
VITAMIN-G
reason, Indians should receive
J.
KEITH THOMPSON. WAR AND THE BIRTH-RATE SiR,-With reference to the leading article of July 7, the following facts regarding fertility trends in this country during the last 75 years may be of interest. 1. The fertility-rate-i.e., live births per 1000 women aged 15-45-which was 153in 1871, has, except during periods of war and trade revival, steadily fallen since, and just before the war was only 38% of that value. 2. Fertility has decreased in each age-group and in all classes of the community, being lowest among the professional and well-to-do and highest among labourers and unskilled workers. 3. Between 1871 and 1931, the year of the last census, both the married and total female populations aged 15-45 nearly doubled, while annual marriages increased by about 63%. The fertility-rate however declined by 58%, with the result that the births during 1931 were only 75% of those in 1871. 4. During the decennium 1921-31 fertility fell below 78-9, the rate required to replace the existing potential mothers aged 15-45 in successive future generations, and just before the war it was 61-4, or 78% of this value. 5. Apart from the decrease in fertility at each agegroup the resulting fall in the birth-rate has caused the gradual ageing of the female population aged 15-45, which has further reduced their fertility ; there has also been a slight increase in the average age at marriage. 6. The average number of children aged 0-15 per family fell during the period 1871-1931 from 3-1to 1-9. 7. Since the outbreak of war fertility has of course been adversely affected by the absence of the male on activeservice, and as the table below shows this was reflected until 1942 by a falling birth-rate in spite of a substantial increase in marriages. Since that year however the birth-rate has increased while marriages have declined. It will also be noticed that as a result of the war the illegitimate birth-rate has increased and in 1944 was double that of 1939. r--
rate e
..
1939 1940 1941 1942 1943 1944
..
..
..
..
17-4 19-3 22-0 20-7 18-2 16-0
..
..
..
..
14-3 14-0 13-4 14-9 15-4 16-7
..
..
..
..
0-6 0-6 0-8 0-9
..
..
..
..
..
..
..
..
..
..
..
..
‘
Total
Illegit.
that
conducted. The average amount of ascorbic acid calculated to be in the uncooked food did not exceed 30 mg. per head per day. Very little fruit was consumed, and all vegetables were boiled thoroughly, so fairly heavy cooking losses may be assumed. These men, and many others from the same unit, were carefiilly examined for clinical evidence of scurvy, with entirely negative results. Their health record was good, they performed hard physical work; and there was no evidence of delayed healing of wounds. Many of them suffered from pyorrhoeic gingivitis, which was unaffected by intensive vitamin-C therapy. We have, on occasion, inspected other Indian troops whose vitamin-C intake had been even lower for considerable periods, the average daily uncooked food supply not providing more than 10-15 mg. as calculated. No case of scurvy, even in the mildest form, has yet been encountered. Our results, although on a relatively small series of tests, confirm the conclusion of previous investigators (e.g., Harris, Lancet, 1942, i, 644) that a poor vitamin-C status, as revealed by the urine test, is not necessarily indicative of actual scurvy having developed. It seems that developed scurvy, as described among Indian troops in Mesopotamia during the last war, or in the Hissar famine by C. M. Nicol (Ind. med. Gaz. 1940, 75, 662), must result from an extremely severe and long-. continued lack of vitamin C. It should be pointed out that the figures given above are not representative of the vitamin-C intake of Indian troops as a whole, but are exceptional. The Indian soldier is now fed much better than he was in 1916. We wish to thank the Director of Medical Services in India for permission to publish this note, and the Roche Scientific Division (Bombay) for supplies of‘ Redoxon ’ &c. A. M. THOMSON. M. W. WILLIAM.
,
Legit.
the vitamin-U
515) states
_
Birth-rate
Marriage-
Year -
i,
TEST
°
y
.
1943,
ot
although no extensive tests have been completed on adult subjects, " the observation of a 7-10 day deficit as characteristic of :advanced vitamin deficiency (developed scurvy) rests mostly on observations on adults." The following data, obtained by testing 15 apparently healthy young adults (Indian troops) are therefore of some interest. Harris’s technique was followed exactly. 7 5 6 8 .. 9 10 11 Day of response 2 4 3 3 1 1 No. of cases 1 These subjects were selected at random from a unit where a dietary survey on a company basis was being
M. F. H. KELLEHER.
rever.
SATURATION in his review
Harris, SIR,—ij. saturation test (Lancet,
only 0-02 g. instead of 0-03 g. of pamaquin daily. Pamaquin heemoglobinuria has been described in Indians ; it appears usually on the 4th or 5th day after pamaquin has been started. It should be treated like blackwater
C. A. GOULD.
14-9 14-6 14-2 15,8
TRICHLORETHYLENE IN THE SURGICAL WARDS SIR,—In minor surgical procedures and the aftercare Note.--Rates (per 1000) are based on the estÍ1l;lated midof the surgical patient there is a wide field for the relief 1939 population ; marriages (provisional figures) are the of pain, discomfort, and anxiety. At present, when average of the two previous years to relate with births. alleviation is attempted at all, the choice usually lies 8. As your article points out, this increase in fertility, between morphine gr. 1, which is often inadequate, and which follows that after the last war but on a reducedfull-scale anaesthesia which requires special arrangements scale, is striking and is not confined to this country.and may be undesirable. It seems worth while to draw Apart from the causes you suggest, may not this rise attention to the value of trichlorethylene (’ Trilene ’) also be partly due to the granting of marriage and child analgesia, using a Freedman inhaler in this connexion. allowances during the war ? In Germany similar measThe first convoys of patients with painful wounds and ures before the war resulted in the birth-rate increasingadherent dressings, which had often to be examined soon from 14-7 in 1933 to 18-8 in 1937. Another reason mayiafter arrival, proved the value of this method, but there be a more optimistic belief in the future resulting from .are many other applications in the general surgical fieldthe successful turn in the course of the war. All this is first dressings, such as those after amputation or ] painful mere conjecture of course in the absence of the necessary]mastoidectcmy ; removal of tight plaster casts ; changing social data, and it is to be hoped that the statistics pro4of drainage tubes, &c. ; and even minor surgery in suitable vided by the next census will throw more light on this I subjects. ..
..
..
..
..
..
1-1
1-3
..
..
16-5 18-0
.
.