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HOUSEWIVES ON FOOD
1
450 Annotations HOUSEWIVES ON FOOD Mnss-OssERVATioN have taken the opinion of house- wives on the food situation this spring and compared it with opinions given on the same subject this time last year. They find that 77% of their sample think the position good on the whole, 13 % consider it fair and 7% are dissatisfied ; the answers of the remaining 3% could not be classified. The points system of rationing tinned foods and fruit has been_welcome. Some oj the foods lacking last spring have been plentiful this year-for example, in 1941, 59% of women mentioned the cheese shortage, whereas it was scarcely mentioned in 1942. In 1942 the commonest grumble is about the lack of cakes, but only 23% of women mentioned it-well under half the number who felt so strongly about cheese last year. There has been less grumbling, too, about marma- lade, onions, tinned foods, dried fruit and syrups ; the change here can be put down to more certain and equit- able distribution and to the points system. Fresh vegetables and fruit have become scarcer since last year, and they hold a higher position on the grumbler list in consequence. Some resent the high price of fish and complain that in order to get any they have to turn up early at the fishmonger’s. Salted cod does not yet seem to be a universal taste. Grumbles about eggs have fallen off in spite of the greater shortage. People realise that though eggs are few those available are fairly distributed; their chief complaints have been about bad eggs. Milk, on the other hand, they feel is unequally shared ; some of those who live near the end of a milk round do unusually well because the milkman at’that stage can use his discretion. On the whole, however, grumbles about specific foodstuffs have fallen off greatly since 1941, and queues seem to be less common than they were. The most regular queues are for confectionery and tobacco-which looks as though people are getting necessities in comfort, and are prepared to take a little extra trouble to get luxuries. MINOR PSYCHIATRY IN GENERAL MEDICINE A TASK of moment for constructive planners is to ensure more general and competent teaching of psycho- logical medicine. The failure of medical recruitment boards to weed out a large number of -the mentally unfit from among applicants, and the delay which is usual before such men are recognised and discharged from the Forces, as well as the shortage of trained psychiatrists, all show that psychiatry has not yet been given an adequate place in medical education. Improved teaching does not mean that the student should spend more hours in visiting mental hospitals to see the inmates demon- strated like freaks in a circus-the only psychiatric instruction still provided in many famous schools. What is sometimes called minor psychiatry-border-line cases, neurotics and those with psychopathic personali- ties-are of far greater interest to the future general practitioner. It is even more essential that he should realise how closely psychological factors are woven into the causative nexus of many ordinary conditions. This was brought out well in a lecture given last year by Franconi,l professor of paediatrics at the University of Zurich-itself one of the nurseries of modern psychiatry and psychotherapy. That a teacher who is not a psychiatrist should try to bridge the gap between psychological and general medicine is itself significant ; the indifference shown by teachers in other branches of medicine has seriously obstructed the student in appreci- ating the psychological factors in disease. Such factors, it is true, often spoil the scientific picture, and many teachers are content to leave them out for the sake of clearness when presenting the physical aspects of an illness. Franconi besan his lecture by demonstrating 1. Franconi, G. Schweiz. med. Wschr. 1941, 71, 1465, 1489. a typical case of rheumatic arthritis with endocarditis in a child of 6, and comparing it with a case of acrodynia (vegetative neurosis) in a child of 7. Joint pains were present in both, but the child with acrodynia showed in addition tremor, listlessness, hypotonia and the charac- teristic photophobia, rapid pulse-rate, flushed extremi- ties and rash of pink disease. A third child, aged 3, was shown, in whom tremor, night sweats, and disturb- ances of sleep might have suggested pink disease ; but she was, in fact, an only child mismanaged by a nervous mother, and all her symptoms were referable to that misfortune. From these and similar cases Franconi developed a scheme showing how physical, functional, psychological and environmental factors overlap in the production of a disease picture. It is especially difficult to establish the psychological factors operating in children ; Franconi’s hints to students were based on common sense and clinical experience, but they were just the things which are often left unsaid because they seem so obvious. There is, of course, a danger that the student introduced to the elements of psychiatry will be tempted by those attractive solutions of almost any human problem which are offered by some psychotherapeutic schools. It calls for experience and critical judgment on the part of the teacher if psychiatry is to be given its appropriate place-no more, no less-in medicine. Franconi treats Freud’s doctrine as a metaphorical pattern, and indicates the scope and the limitations of psycho-analytical interpretation when applied to bio- logical events. Diagnosis must depend on both somatic and psychological investigation, as he illustrates from case-histories. Psychology, he believes, can be better taught on the single case than in theoretical lectures. FATIGUE DEFINITIONS of fatigue are misleading because the subject’s own opinion plays such a large part in the symptoms. The term is commonly used to denote a diminished capacity for doing effective work as a result of previous, activity ; but what actually causes the capacity to diminish A man may feel tired because he considers he has done enough. The psychic component often overshadows the physiological component; and stimulants may act by removing the sensation of weari- ness without changing the physiological state. Helle- brandt and Karpovich 1 have surveyed the methods commonly used to improve physical performance in man, and find they can be roughly grouped as measures which delay exhaustion, hasten recuperation, or dull awareness of fatigue. Of those which delay exhaustion the most important seem to be nutritional, whereas (except for sugar and salt) drugs are the chief agents in the other two groups. Rest, oddly enough, is not mentioned as a cure for fatigue, though the psychical and physiological benefits of rest pauses in factories are well known. Hellebrandt and Karpovich, however, are concerned chiefly with troops exposed to strains in which no pausing is allowed. Evidence about the effects of diet on physical performance is conflicting. Various classes of heavy workers, such as lumbermen, eat a great deal of fat, though it has been shown that work pushed to the pitch of exhaustion can be sustained longer on carbohydrate. But after all, the balance of a diet containing even as much as 40% of fat must be made up of carbohydrate and protein (which is readily convertible to carbohydrate). Sugar is thought to produce immediate benefit in exhaustion by relieving the effects of incipient hypoglycaemia on the brain. The authors of the survey, tind no conclusive evidence that glucose is used by the body immediately, or has any prompt’ effect in states short of hypoglycaemia ; and hypoglycsemia they consider is only induced after long and exhausting exercise. It is possible, however, that hypoglycaemia is not so difficult to achieve as they suggest, 1. Hellebrandt, F. A. and Karpovich, P. V. War Med. 1941, 1, 745.
Transcript of HOUSEWIVES ON FOOD
450
Annotations
HOUSEWIVES ON FOOD
Mnss-OssERVATioN have taken the opinion of house-wives on the food situation this spring and compared itwith opinions given on the same subject this time lastyear. They find that 77% of their sample think theposition good on the whole, 13 % consider it fair and 7%are dissatisfied ; the answers of the remaining 3% couldnot be classified. The points system of rationing tinnedfoods and fruit has been_welcome. Some oj the foodslacking last spring have been plentiful this year-forexample, in 1941, 59% of women mentioned the cheeseshortage, whereas it was scarcely mentioned in 1942.In 1942 the commonest grumble is about the lack ofcakes, but only 23% of women mentioned it-well underhalf the number who felt so strongly about cheese lastyear. There has been less grumbling, too, about marma-lade, onions, tinned foods, dried fruit and syrups ; the
change here can be put down to more certain and equit-able distribution and to the points system. Fresh
vegetables and fruit have become scarcer since last year,and they hold a higher position on the grumbler listin consequence. Some resent the high price of fish andcomplain that in order to get any they have to turn upearly at the fishmonger’s. Salted cod does not yet seemto be a universal taste. Grumbles about eggs havefallen off in spite of the greater shortage. Peoplerealise that though eggs are few those available are
fairly distributed; their chief complaints have beenabout bad eggs. Milk, on the other hand, they feel isunequally shared ; some of those who live near the endof a milk round do unusually well because the milkmanat’that stage can use his discretion. On the whole,however, grumbles about specific foodstuffs have fallenoff greatly since 1941, and queues seem to be lesscommon than they were. The most regular queues arefor confectionery and tobacco-which looks as thoughpeople are getting necessities in comfort, and are preparedto take a little extra trouble to get luxuries.
MINOR PSYCHIATRY IN GENERAL MEDICINEA TASK of moment for constructive planners is to
ensure more general and competent teaching of psycho-logical medicine. The failure of medical recruitmentboards to weed out a large number of -the mentally unfitfrom among applicants, and the delay which is usualbefore such men are recognised and discharged from theForces, as well as the shortage of trained psychiatrists,all show that psychiatry has not yet been given anadequate place in medical education. Improved teachingdoes not mean that the student should spend more hoursin visiting mental hospitals to see the inmates demon-strated like freaks in a circus-the only psychiatricinstruction still provided in many famous schools.What is sometimes called minor psychiatry-border-linecases, neurotics and those with psychopathic personali-ties-are of far greater interest to the future generalpractitioner. It is even more essential that he shouldrealise how closely psychological factors are woven intothe causative nexus of many ordinary conditions. Thiswas brought out well in a lecture given last year byFranconi,l professor of paediatrics at the University ofZurich-itself one of the nurseries of modern psychiatryand psychotherapy. That a teacher who is not a
psychiatrist should try to bridge the gap between
psychological and general medicine is itself significant ;the indifference shown by teachers in other branches ofmedicine has seriously obstructed the student in appreci-ating the psychological factors in disease. Such factors,it is true, often spoil the scientific picture, and many
teachers are content to leave them out for the sake ofclearness when presenting the physical aspects of anillness. Franconi besan his lecture by demonstrating
1. Franconi, G. Schweiz. med. Wschr. 1941, 71, 1465, 1489.
a typical case of rheumatic arthritis with endocarditisin a child of 6, and comparing it with a case of acrodynia(vegetative neurosis) in a child of 7. Joint pains werepresent in both, but the child with acrodynia showed inaddition tremor, listlessness, hypotonia and the charac-teristic photophobia, rapid pulse-rate, flushed extremi-ties and rash of pink disease. A third child, aged 3,was shown, in whom tremor, night sweats, and disturb-ances of sleep might have suggested pink disease ; butshe was, in fact, an only child mismanaged by a nervousmother, and all her symptoms were referable to thatmisfortune. From these and similar cases Franconideveloped a scheme showing how physical, functional,psychological and environmental factors overlap in theproduction of a disease picture. It is especially difficultto establish the psychological factors operating inchildren ; Franconi’s hints to students were based oncommon sense and clinical experience, but they were justthe things which are often left unsaid because they seemso obvious. There is, of course, a danger that the studentintroduced to the elements of psychiatry will be temptedby those attractive solutions of almost any human
problem which are offered by some psychotherapeuticschools. It calls for experience and critical judgment onthe part of the teacher if psychiatry is to be given itsappropriate place-no more, no less-in medicine.Franconi treats Freud’s doctrine as a metaphoricalpattern, and indicates the scope and the limitations ofpsycho-analytical interpretation when applied to bio-
logical events. Diagnosis must depend on both somaticand psychological investigation, as he illustrates fromcase-histories. Psychology, he believes, can be bettertaught on the single case than in theoretical lectures.
FATIGUE
DEFINITIONS of fatigue are misleading because thesubject’s own opinion plays such a large part in thesymptoms. The term is commonly used to denote adiminished capacity for doing effective work as a resultof previous, activity ; but what actually causes thecapacity to diminish A man may feel tired because heconsiders he has done enough. The psychic componentoften overshadows the physiological component; andstimulants may act by removing the sensation of weari-ness without changing the physiological state. Helle-brandt and Karpovich 1 have surveyed the methodscommonly used to improve physical performance inman, and find they can be roughly grouped as measureswhich delay exhaustion, hasten recuperation, or dullawareness of fatigue. Of those which delay exhaustionthe most important seem to be nutritional,whereas (except for sugar and salt) drugs are the chiefagents in the other two groups. Rest, oddly enough,is not mentioned as a cure for fatigue, though thepsychical and physiological benefits of rest pauses infactories are well known. Hellebrandt and Karpovich,however, are concerned chiefly with troops exposed tostrains in which no pausing is allowed. Evidence aboutthe effects of diet on physical performance is conflicting.Various classes of heavy workers, such as lumbermen,eat a great deal of fat, though it has been shown thatwork pushed to the pitch of exhaustion can be sustainedlonger on carbohydrate. But after all, the balance ofa diet containing even as much as 40% of fat must bemade up of carbohydrate and protein (which is readilyconvertible to carbohydrate). Sugar is thought to
produce immediate benefit in exhaustion by relievingthe effects of incipient hypoglycaemia on the brain.The authors of the survey, tind no conclusive evidencethat glucose is used by the body immediately, or has anyprompt’ effect in states short of hypoglycaemia ; andhypoglycsemia they consider is only induced after longand exhausting exercise. It is possible, however, thathypoglycaemia is not so difficult to achieve as they suggest,1. Hellebrandt, F. A. and Karpovich, P. V. War Med. 1941, 1, 745.
