1394 THE HEALTH AND DIET OF THE SCHOOLBOY

anatomy, that the whole body should be dissected,and many must regard this as unnecessary, andan anomalous suggestion when time is to be foundfor bringing anatomy into relation with clinicalmedicine, as is so rightly proposed. That specialdissections accompanying research will be made asa matter of course at a later stage by those whoare working along special lines is obvious; but

remembering the opportunities which the studentnow possesses for seeing without actually dissectingthe details of much anatomical structure, we

think that dissection of the whole body is needless,and that many teachers of anatomy will agreewith that view. From these teachers definitecounsel may be derived as to how the rangeof their subject can be modified so that needlessburdening of memory is avoided and more

time found for the acquisition of fundamentalknowledge equally useful in future stagesof the curriculum and in, professional practice.And when the student is bringing the knowledgethat he has acquired of anatomy, physiology, andchemistry, under its three headings, to his assist-ance in the study of pathology, it might be wellthat pathology should be considered from a ratherdifferent angle than that suggested by the report.Pathology is the science of diseased processeson which clinical medicine must be based,while the words of the report imply that clinicalmedicine is as yet divorced from this science.The words used are meant, probably, to conveythat the pathologist instead of concentrating onmorbid anatomy should develop his science untilit has become an integral and necessary part ofclinical medicine. But surely that is what he isdoing.The analysis of the curriculum as given in the

report is beautifully clear. Many of the generalrecommendations for its improvement are thosethat have been made, some of them over and overagain, but they gain force by the endorsement ofthe central educational authority. Two new

recommendations, if acted upon, would renderthe first stages of professional life far less per-plexing to the young doctor while making hisservices of markedly greater value to the com-

munity. It is to be hoped that they will receivesupport from the various educational centres, asto carry them into effect may not be universallyeasy. We are referring here to the necessity of thestudent residing for a certain period within aninstitution while he is undergoing the later stagesof his training, and to the proposal that after

qualification he should hold a resident appoint-ment. Both procedures have been advocated inmany quarters, and the first is to some extent inactual action ; the advocacy of the G.M.C. willbe warmly approved. Other passages in the

report which point to useful developments in thestudent’s training are the recommendations thatthe curriculum should include more organisedinstruction in such subjects as child welfare,paediatrics, psychology, and radiology. All willrecognise that a certain knowledge of the funda-mentals of such matters is to-day necessary for thepractitioner’s equipment.

THE HEALTH AND DIET OF THESCHOOLBOY

IN most modern resident schools for childrenof all ages food is provided in ample quantity,though the distribution over the day is some.

times open to criticism, and the proportion of

protein, especially first-class protein, to carbo-

hydrate and fat is still often regrettably low.There seems to be an impression among parentsthat in general boys at preparatory schools arewell fed and that the tradition of public schoolspermits a much lower standard in quality andvariety, as well as in cooking and service of meals.The supplementary hamper from home, however,which used to be accepted as almost a necessity,has now become an agreeable incident in manyschools, and in some, we understand, is even for-bidden. There can be no doubt of the generalphysical improvement which has followed the

greater attention devoted to diet in schools, andnot in this country alone. By a careful statisticalanalysis of the measurements of school-childrenin Berlin, Dr. GEORG WOLFF has clearly shownthat both the school entrants and school leaversin that city have substantially improved in theirheight and weight over the nine years 1924 to1932.1 A similar improvement is to be seen inthe English schoolboy according to the extensiveobservations published by Dr. G. E. FRIEND, themedical officer of Christ’s Hospital, Horsham,whose records of growth and diet are more detailedthan any previously issued in this country.2 2 For

instance, in his experience, boys aged 14t-15tyears in the school year 1928-29 were 10 poundsheavier and just over an inch taller than boysof the same ages in 1919-20, while boys of 9z 102years were 4 pounds heavier and one-fifth of aninch taller in the later year than their predecessorsof 1919-20.The study of these measurements, analysed

under the direction of Prof. MAJOR GREEN-WOOD, Dr. FRIEND supplements with a detailedinquiry into the diet provided in the school overa period of 20 years, 1913 to 1933, and with aclinical survey made over the same period. Dividingthe 20 years into four sections, the food consump-tion, the physical measurements, and the incidenceof disease can be correlated in an interestingmanner. In the years 1916-22 there was an

average calorific intake of 2780, but the proportionof first-class to second-class protein was relativelylow, while, in comparison with previous years,there was a reduction in the proportion of animalfat consumed, and a substitution was made of

margarine for butter. During this period theaverage heights and weights were below theestimated pre-war values (exact pre-war measure-ments are not available) but, on the other hand,the general health of the boys was good exceptfor a higher incidence of rheumatic affections thanin subsequent years. The incidence of fractureswas also relatively high in these years. The

1 THE LANCET, April 27th, 1935, p. 1006.2 The Schoolboy ; a Study of his Nutrition, Physical Develop-

ment and Health. Cambridge : W. Heffer and Sons, Ltd. 1935.Pp. 128. 7s. 6d.

1395A NEW POISONS CODE

average number of fractures per year was 6 in1914-17, 14 in 1918-22, and again 6 in the11 years 1923-33. The most serious diet defi-ciences in the middle period were the limitationsof the milk-supply and the replacement of butterby margarine, which leads Dr. FRIEND to concludethat the greater fragility of the bones was prob-ably due to a shortage of bone-forming mineralsand a deficiency in the supply of fat-soluble vita-mins. It would be interesting to know whether thistime-sequence of fractures has been observed inother schools. In the last period, 1927-33, the diethas the comparatively high average calorific intakeof 3014, derived from 397 g. of carbohydrate,92 g. of protein, and 108 g. of fat. Larger amountsof butter and milk are now included, the amountof bread has declined but that of sugar has in-creased. The diet is a generous and well-balancedone but apart from the relatively low incidenceof rheumatism, already referred to, the sicknessrecords show surprisingly little variation though,as stated, the physical measurements have muchimproved.The incidence of colds, fevers of unknown

origin, and chills does not appear to be in

any way clearly related to changes in the

diet, while influenza and the incidence of com-

plications arising from it have increased underthe conditions of improved diet. Septic conditions--e.g., boils, -impetigo-have also shown. a some-what higher level in the most recent years, andmay, Dr. FRIEND suggests, be related to the risingsugar consumption. This is one of the manyinteresting observations of his study which showthe desirability of further investigation on thelines he has adopted. Dr. FRIEND also stressesthe value of his records of physical measurements

, as a clinical aid to the school medical officer.

Any boy who is seen to be failing to keep hisnormal rate of progress is detected, often longbefore he himself would have reported sick. Afailure to show a satisfactory increase in heightis usually found to signify little, whilst regressionin weight may or may not be important. Regres-sion in the chest grade or in any two grades atthe same date is held to indicate an immediateneed for inquiry. The most reliable results havebeen obtained by the use of " time-increment "

tables which show weight, height, and chest

grades for every six months of age. Dr. FRIEND

gives his tables in full and individual examples oftheir use, and this aspect of his work deservesparticular consideration.

A NEW POISONS CODETHE Pharmacy and Poisons Act, 1933, provided

for the formation of a Poisons Board which shouldbe required to prepare a list of substances to betreated as poisons under the Act. This list isreferred to in the Act as the " Poisons List." TheAct also empowered the Home Secretary, afterconsultation with the Poisons Board or on itsrecommendation, to make rules relating to poisons.These rules are termed the " Poisons Rules."The Board held its first meeting in December,1933, and has now, after many committees and

subcommittees, published its report, which con-tains the Poisons List and the Poisons Rules.The constitution of the Board, to which we haverecently alluded,2 enabled it, with the help ofMr. M. D. PERRINS of the Home Office to whomtribute is paid, to perform a task of considerabledifficulty-nothing less than the construction ofa new code to replace existing legislation. It was

wisely decided that the new code should resemblethe present restrictions, but be freed from theirdefects, and the Board submitted a first draft ofprovisional proposals to the organisations likely tobe affected. The draft received wide publicity intrade journals and was circulated to the policeforces. As a result of this extensive consultationmany of the original proposals were substantiallymodified. Its chief function the Board construedto be the utmost reasonable protection of the

public from the danger of death or injury fromcriminal or accidental poisoning. It had to bearin mind the problem of suicidal poisoning, but itwas unwilling to include a substance in the PoisonsList merely because it might be used as a meansof self-destruction, if it carried no real danger ofaccidental or criminal poisoning. Aspirin is >quoted in the report as an illustration. Statisticsshow that during the period 1925 to 1933 therewere 106 fatalities attributed to the taking bysuicides of large over-doses of aspirin ; it wouldbe unreasonable on this account to scheduleaspirin as a poison. Protection of the would-besuicide from himself is beyond the power of legis-lation ; apart from poisoning there are other

easily available modes of death.In the construction of the Poisons List much

difficulty was encountered in regard to nomen-

clature. There has never been a satisfactorydefinition of the term " poison " upon which tobase restrictions; the popular definitions are alleither too narrow or too wide for legal use. The

report in fact admits that for practical purposesthe word is indefinable. Many toxic substances inthe list gave trouble to indicate precisely. Thelist is made as descriptive as possible, terms suchas preparations, admixtures, and derivatives beingavoided. It contains the well-known older poisonsand also many substances of comparatively recentintroduction. In Part I. are to be found the

dinitrophenols and dinitrocresols which have

recently aroused interest as metabolic stimulants.The more powerful endocrine products are repre-sented by insulin and the principles of the thyroid,pituitary, and suprarenal glands. The barbi-turates are listed in a short but comprehensivelydefinitive two dozen words. The Board was dividedin opinion about the inclusion of Lysol in Part I.,and its retention was the outcome of a vote ; thereasons actuating the majority and minority areset forth in the report.The Poisons Rules concern the regulation of

the sale and supply of poisons. The power behindthem arises from Section 23 of the 1933 Act whichallows them to modify the provisions by both

1 Home Office : Report of the Poisons Board. Cmd. 4912.H.M. Stationery Office, Pp. 62. 1s.

2 THE LANCET, Feb. 2nd, p. 278.