EDITORIAL
rained in a number of cases of chronic and acute nlania through the administration of lithium salts. Many cases which had been manic for years were controlled in a matter of weeks and enabled to h:ave the institution and return to work. All this leads to the speculation as to whether lithium, a trace element, could, through a lack of its ions, actually cause mania. It amy be an essential trace element. The author feels that the proper use of lithium iu restless, mental defectives would be as effective as lcucotonly and prefer:rifle. (Caution: one ought not to use lithium salts in these cases without consulting the original article for dosage, for, if given in excess, the drug may prove fatal). BEELER, J. W., TILLISCH, a. H. AND POPP, W. C.: A new drug in the treatme~t of radiation sickness. (Prec.
Staff Meet. Mayo Clin., 24, 19, 44,-483). A preliminary study on the treatment of radiation sickness in a series of 82 patients using a new drug, dramamine, showed a significantly higher percentage relief of synq)toms than a control series of 23 cqses. ]t is felt that this inexpensive drug can safely be used both as a therapeutic and prophylactic agent in radiation sickness. A coml)ination of dramamine and pyridoxine in the more severe cases gives tile therapist an additional agent of great value. KARN, ]:[.: The use of ,~qrcplonlyci~l in lh( lreal~e~t of
251 progressive post-operative gangrene of the abdominal wall.
(New Zealand Mad. J., 48, 266, 380-384). The rapid response to streptomycin in 24 to 48 hours with marked clinical improvement after the exhibition of all other antibiotic drugs had failed, is described in 3 cases of progressive post-operative gangrene of the abdominal wall. Theoretically the disease is caused by the symbiosis of two bacteria, a staphylococcus aureus and a micro-aerophilie anerobic streptococcus. Presunmbly streptomycin kills one of them and appears to inactivate the combination in 24 to 48 hours. No reports of such rapid response to therapy have previously been recorded. RAO, B.: Peritonitis following non-penetrating trauma. (J. Indian Mad. Assoc., 18, 8, 281-282). A man of 40, struck a blow on the abdomen, died 59 hours later of peritonitis due to B. Coll. Obviously he suffered a perforation of the pelvic colon, but like so many of these cases, he did not report for treatment until nearly 24 hours after the injury, and so operation was delayed. The medicolegal aspects of these and similar cases are interesting, because it is necessary to decide if the inflicted blow was a sole or partial cause of death. (The tendency in America would be to consider the assault as part of the cause of death, for it is well known that even a minor blow to the abdominal wall nmy produce perforation of the gut. The judgment would depend somewhat on the circumstances attending the assault).
EDITORIAL FOOD, POPUI,ATION A N D W O R I , D POIATICS~ B e r t r a n d Russell's paper, " C a n a Scientific Society be Stable?", read before the Royal Society of Mediciue, and published as the leading article in t h e D e c e m b e r 10, 1949 isstle of the British Medical J o u r n a l , is cast in his usual lucid prose, and contains interesting conclusions d r a w n from his study of the effects of science upon the stability of human society. Its chief intent, however, easily boils down to h i s ' s i n g l e s t a t e m e n t , - " I think it is the duty of all who are capable of facing facts to realize, and to proclaim, that opposition to the s p r e a d of birth control, if successful, m u s t inflict upon m a n k i n d the most appalling depth of misery and d e g r a d a t i o n , and that within another fifty },ears or so." N o one will deny that there are a l r e a d y too m a n y people in the world in p r o p o r t i o u to the available food supplies, but not everyone a i l l agree that B e r t r a n d R u s s e l l , - - o r anyone else, has the solution of this g r a v e difficulty. It is possible that e m e r g e n c y solutions of p a r t s of the problem are all that m a y be expected. T h e distinguished mathematician, philosopher and exponent of logical analysis, for whom most r e a d e r s have the highest respect and a w a r m regard, feels that a world society u n d e r the m u l t i p l e x influences of science, as ours is, cannot be stable unless there exists a w o r l d g o v e r n m e n t to enforce the r a t i o n i n g of food to the nations. Such a g o v e r n m e n t " s h o u l d deal out the w o r l d ' s food to the various nations in p r o p o r t i o n to their population at the time of the establishment of the authority. If any nation subsequently increased its population it should not on that account receive any m o r e food. T h e motive for not increasing potmlation would therefore be very compelling." Russell's plan is realh" a controlled world society on the most ambitions scaie imaginable. \Ve g r a n t that birth control education e x e r t s au appreciable influence on p o p u l a t i o n increase, but in a d d r e s s i n g ourselves to the point at issue, without reference to the wide spread p r e j u d i c e against birth control or to the moral issue involved, we feel that Russell's plan contains basic JULY, 1950
weaknesses and insuperable difficulties. P r o v i d e d that such a global scheme could be accomplished at all, it would i m m e d i a t e l y result in a universal black m a r k e t in foods, and such unlawful p r o c u r e m e n t w o u l d be completely condoned t h r o u g h s y m p a t h y with the hung r y and dislike of the u n p o p u l a r regulations. Reliance on birth control education, b u t t r e s s e d bv food penalties for excessive procreation, r e p r e s e n t s an impossible type of procedure. W h e r e v e r penalties are p r o v i d e d there m u s t be a law against the commission of the act invoking the penalties. T h e hypothetical world g o v e r n m e n t would be at once forced to pass such a law m a k i n g it an offense for any family to have m o r e than a certain n u m b e r of children, and penalizing t h a t p a r t i c u l a r f a m i l y by the w i t h h o l d i n g of food from them. O b v i o u s l y no national, state or provincial gove r n m e n t would be able to enforce such a penalty. O w i n g to the very slow results of birth control education, the global authority, in o r d e r to consolidate its urgent aims, would almost at once find it necessary to resort to m e a s u r e s other than education, or else a b a n d o n its efforts. Russell avoids mention of this contingency, although it logically follows from the establishment of a world a u t h o r i t y bent on reducing the h u m a n population. T h e simplest and cheapest effective p r o c e d u r e would be the ligation of the v a s a d e f e r e n t i a in selected categories of males, since Russell is opposed to infanticide and s t a r v a t i o n on g r o u n d s of h u m a n s y m p a t h y . T h i s surgical p r o c e d u r e might be tolerated a m o n g institutionalized psychotics and feebleminded citizens, but once a criterion for a b r o a d e r selection of subjects were adopted, w h e t h e r on an economic, a psychological or a physical basis, h u m a n liberty would be considered seriously infringed upon, and no d e m o c r a t i c g o v e r n ment would have the t e m e r i t y to accept it. T h u s the hypothetical w o r l d g o v e r n m e n t would at once, a n d of necessity, become despotic in the exercise of its p o w e r s over the individual. Surely, if starvation itself had not p r o d u c e d a w a r of conquest, such laws would p r o v i d e ample inspiration for w a r s of liberation.
252
BOOK REVIEWS, GENERAL ABSTRACTS OF CURRENT LITERATURE
W e submit that the most effective weapon against o v e r - p o p u l a t i o n is that process which we c a l l , - - c i v i l i z a tion. W h a t e v e r civilization means, it at least means fewer children. A t p r e s e n t the w e s t e r n nations are not c o n t r i b u t i n g m u c h to the daily increase of 80,000 in the w o r l d ' s population. E c o n o m i c restraints and cultural influences in an advanced society greatly depress the birth rates. Civilized man, even in a scientific age, succumbs unconsciously to the conq u e r i n g drive of abstract ideas, which noticeably divert his attention f r o m the exercise of the p r o c r e a t i v e faculty. If we could civilize the entire w o r l d we would at once accomplish o u r purpose, but unfortunately, civilizing is m u c h too slow a process to meet the deadline to which Russell refers. O n the national level, planned societies are not t u r n ing out too well these days, so that we could not expect much from the global control of a biological function of
man. T h e logical and m a n d a t o r y philosophy of the h o u r is regional self-preservation. Specifically, the W e s t e r n nations nmst find a way of p r e v e n t i n g the inroads of f o o d - h u n g r y and p o w e r - h u n g r y hoards upon our territories. T h i s military duty m a y r e m a i n u r g e n t for half a c e n t u r y or more. T o resist these millions bent on pure p l u n d e r the W e s t n e e d s , - - n o t birth control, but its opposite. W e need m o r e children, not fewer, if we value liberty and the t r e a s u r e s of civilization. All natural laws justify us in p r o t e c t i n g ourselves from the instability, which, as Russell shows, arises from the population crisis of the world. It is not necessarily true that the sympathetic distribution of our food and wealth to s t a r v i n g areas will eventually protect us from the military e n c r o a c h m e n t of vital populations upon us. B i r t h control dictated by a global g o v e r n m e n t is, in the light of our c u r r e n t social conciousness, bizarre and unacceptable. T h e b r e e d i n g of children is natural, and so also is self-preservation.
BOOK REVIEWS CLINICAL NUTRITION. Norman Jolliffe, M. D., F. F. Tisdall, M. D. and Paul R. Cannon, M. D., 925 pages, Paul B. Hoeber, Inc., New York, 1950, $12.00. This volume, which could not have been published at its sale price except for assistance from the Food and Nutrition Board of the National Research Council, probably exceeds in scope and usefulness any single work ever published on the subject of clinical nutrition. All profits from its sale will be returned to the Board to support its research projects. First, the pathogenesis of deficiency disease and methods of diagnosis (clinical, laboratory and x-ray) are presented in sufficient detail. Second, the various nutrient elements are dealt with somewhat individually, each by an authority who has spent most of his life-time upon pertinent investigations. Finally treatment and prevention, dietotherapy and food tables, weight tables and '~dietary patterns" complete the work. The book is profusely illustrated with a great many beautiful color plates of lesions. Apart from its value as a practical text, some of the chapters, particularly those by Jolliffe, serve to give the subject of nutrition a very broad orientation. The following quotation indicates how easily and naturally food becomes or may become a weapon for political or warlike purposes: " T h e pressure of peoples to obtain and lusure dietary adequacy has been a frequent cause of mass migrations and of w a r . " It is 5olliffe's conclusion that even in America, where food conditions are much better than elsewhere, unsatisfactory diets are widespread throughout the nation. Our national intake of thiamine, riboflavine and niacin are particularly below optimum by any acceptable standard. The excessive consumption of highly refined foods has contributed to the poor nutritional status of our country, although this hRs been in part remedied by the enrichment of bread and flour.
Not only is Clinical Nutrition an invaluable addition to the study-shelf of any physician from the purely technical aspect, but it is also a monumental contribution to the entire conception of human nutrition and its bearing on health, disease and world politics. It is a most worthwhile investment at $12.00. WATER AND SALT DEPLETION. H. L. Marriott, M. D., 80 pages, Chas. C. Thomas, Springfield, Ill., 1950, $2.00. Perhaps this little volume presents in a concise form all that is necessary for the clinician to know about the diagnosis aud treatment of water and salt depletion. In cases where the patient has failed, for any reason, to imbibe sufficient water, we are deMing purely with a water deficit. In cases in which there has been excessive loss of secretions, such as vomiting especially, we are dealing with salt depletion as well. This is an over-simplified epitome of the treatise. The book is valuable particularly since it helps the physician to know when to give water, isotonic saline or hypotonic saline. FAMILY FARE: FOOD MANAGE1V£ENTAND RECIPES. ~T. S. Dept. of Agriculture. (For sale by the Superintendent of Documents, U. S. Gov't. Printing Office, Washington 25, D. C., 25 cents). This 96 page book. prepared by the Bureau of Human Nutrition and Home Economics, is intended to acquaint the lay person with the fundamental nature of foods, particularly the nutritionM aspects of diet, and also offers advice with respect to "smart buying" of commodities. The bulk of the book coutains recipes and cooking instructions. The physician might suggest this book to the normal housewife who desires to delve into the problem of nutrition from a practical standpoint.
GENERAL ABSTRACTS OF CURRENT LITERATURE WILSON, H.: Portal hypertension and its treatment. Med. J. Australia. 37:2, 33-37. Portal hypertension may be of the intrahepatic type in which case cirrhosis causes engorgement of the entire portal system. In the extra-hepatic type the cause is obstruction of the portal vein. In cases in which portal hypertension is generalized and causing hcmatemesis, an anastomosis between the splenic and the left renal veins gives great comfort, reduced ascites and postpones the onset of further hematemesis. SCOTT, G. E. M.: Celiac disease and celiac syndrome. Med. J. Australia, 37:2, 37-46. Scott feels that the celiac syndrome presents features indieative of a state of malnutrition, which is initiated and maintained by gastrointestinal disorders dependent on infection
and toxic states. The faulty absorption of vitamins which results may play a Dart in the development of cystic fibrosis of the pancreas. We should regard the celiac syndrome as a physical state brought about by a number of contributing causes. At times the derangement of physiological processes in the organism may cause and maintain tissue changes which become irreversible. Scott's paper is critical and argumentative and serves to impress upon the reader the fact that the celiac syndrome today represents one of the most poorly understood conditions in pediatrics. DOLL, R.: Perforated carcinoma of the stomach simulating perforated gastric ulcer. Brit. Mad. J. JRn. 28, 1950, 215-218. Of 86 perforations in men, diagnosed as being simple ulcers
AMER. JOUR, DIG, DIS.