MEDICAL NOTES.

Auckland Star, Volume LXVI, Issue 58, 9 March 1935, Page 8 (Supplement)

MEDICAL NOTES.

BUSINESS MAN'S DIET.

GOITRE AND lODINE.

IMMUNITY FROM DIPHTHERIA.

(By PEEITUS.)

An experiment covering several year 3 has been made in order to prove that meat may be safely excluded from ordinary meals without loss of health or strength provided that sufficient milk is taken as substitute, and also to indicate exactly how the diet should be adjusted. As nobody is likely to weigh each item of the food the weights are omitted here, but the quantities may be accepted as normal "portions;" the milk, however, is roughly quoted by quantity. The experiments showed that breakfast should be the chief, if not the most substantial meal of the day, and that starchy food does not well support the body from fatigue. To follow through one day:—Breakfast consisted of orange, toast and butter, two eggs, marmalade, and tea with three-quarter tumbler of milk; luncheon, cheese, salad, crackers and butter, baked apple with rice pudding, and milk onethird tumbler; tea, bread, butter, jam, cakes, tea, and three-quarter tumbler of milk; supper, soup, mutton, cutlet, tomato, spinach, toast, orange, tea, and milk half a tumbler. The daily allowance of milk is a little over a pint.

This diet sustained <i man of over 1401b, walking about three miles daily, and moving nbout in cars and trains. The supper meats can ho omitted if cheese is taken instead. Cutting oiit milk resulted in fatigue, and a loss of 2]lb weight in six weeks. It is obvious that the vegetarian ean flourish exceedingly if his milk ration is liberal, and the many starchy and nutty messes are not necessary, nor much fruit nor many vegetables; in fact the milk in place of meat is the only alteration required to put a man on the butcherless list. Goitre and lodine. In 1028 an exhaustive survey of the whole country by Prof. C. E. Hereus, Prof. W. N. Benson, and Mr. C. L. Carter —respectively bacteriologist, geologist, and chemist —led to the provisional conclusion that the incidence of goitre In New Zealand was inversely proportional to the amount of iodine in the soil (says the "Lancet"). A bulletin published in that year by the official departments of health and scientific research embodied the findings of this survey, * accepting in general the inverse relation- ' ship between goitre and soil iodine. There were then admittedly some exceptions; for instance, while South Taranaki soils were found to contain four' times the proportion of iodine in Thames soils, the incidence of goitre, was rather greater in the former than the latter district, and New Plymouth, with about 13 ' times as much iodine as Thames, had ' approximately the same incidence of ' goitre. A further inquiry was under- ' taken by the two officers who had carried ' out the* original investigation, and their report has now appeared. Three districts ' were selected: (1) The anomalous ■ Thames; (2) Palmerston North, in which soil iodine had been found to be low and goitre incidence high; and (3) New Plymouth (including part of South Taranaki) in which iodine was high and goitre low. The total number of children examined was 4012 boys and 3782 gir'.s, and the goitres were classified as "A" or "incipient" and "B" or "visible." Later a fourth 'district — Gisborne —was added. This area had previously shown a high incidence of goitre, but most of the cases fell into the incipient class, and it was desired to find out whether there was any alteration in the proportion of "A" and "B" goitre. Gisborne, however, alone of the four areas under survey, showed a reduction in tin incidence o. goitre among its school population. Each of the other three areas exhibited a deplorable increase, and New Plymouth, which had come out of the previous investigation nearly goitre-free, gave the alarming figures of 82 per cent goitre in boys and §8 per cent in girls. Thames had risen from 8 per cent boys and !) per cent girls suffering from goitre to 23 I and 31 per cent, and Palmerston North i from 35 per cent boys and 39 per cent girls to 07 and 73 per cent respectively. One outstanding variation in the result of the two surveys is that, whereas in 1028 the incidence of goitre among girls began to decline after the ago of 13, in the later group the increase continued up to 15 years. Differences in iodine intake in varying districts being mainly due to locally produced foodstuffs, • the, investigation was specially directed to vegetables, milk, and eggs, from which it appeared that the intake of iodine would bo neatly twice as high at New Plymouth as in Palmerston North or Thames. The result of the second survey is to reverse the findings of the iirst. The investigators were the same, the material was similar, and no i.oticeable" change had occurred in the circumstances in which the children were living; yet, whereas the previous finding was high intake of iodine associated with low incidence of goitre and vice versa, the opposite was true of the second group examined. No explanation is at present available of the enormous increase of goitre in ths school children of Taran tki. The whole subject of the importance of iodine in relation to the disease is shrouded in perplexity.

Inoculation and Immunisation. The foregoing shows how the most careful scientific men may he led astray by appearances. It was the same in relation to bush sickness in sheep. Deficiency of iron was asserted to be the cause and slieep were restored to health by iron scattered on the pasture. The latest reports stale that the iron as a drug was not the immediate cause of the improvement and that bush sickness is still a mystery. A list of what we do not know would reach round the world, but it is the things stated to be true, and then disproved or contradicted, which break the faith of the public. Protective inoculation by serum is now in 'question, and the "Lancet" says inoculation does not mean immunity in regard to diphtheria, the correct wording being "inoculation is not neecsearily immunisation." "It ie a peculiar fact that, while artificial active immunisation is an almost absolute protection against clinically recognisable diphtheria, it has no effect whatever in preventing subsequent carrier infection; at the same time and place the virulent carrier-rate is just as high among the artificially immunised as among those with natural negative tests. When a number of children in a school or community are made immune by inoculation with a diphtheria prophylactic, the density of virulent diphtheria carriers may be correspondingly increased. Fatal or severe cases are practically unknown in those

whose reaction is known to have become negative after anti-diphtheria inoculatio°n. It is, however, quite improper to use tlio word "inoculated' as a synonym for 'immunised , in anti-diphtheria work. Some 5 per cent to 10 per cent of children, according to circumstances, are not made immune. The carrierrate depends on a host of known and unknown factors, but other things being equal the rate should be directly proportional to the percentago of the population which is immune. In practice it can bo assumed that all carriers of virulent diphtheria bacilli have negative reactions. On the other hand those in whom the reaction remains positive are susceptible to diphtheria and cannot harbour virulent diphtheria bacilli for any leno-th of time without exhibiting symptoms of the disease. The exceptions to this working rule are too few to invalidate the argument." , When a child is naturally or artificially immune ho may easily become a carrier, showing no symptoms. The effect then of distributing artificial immunity is to increase the possibility of distributing the disease—an unpleasant consequence. "The best laid plans of mice and men gang oft agley."