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habits or attitudes inimical to wellbeing; to foster support for such community health measures as the fluoridation of water-supplies; and to disseminate the kind of medical knowledge that will encourage patients to seek their doctors’ help in the earliest stages of serious illness. The report emphasises that neither the aim nor the effect of these activities should be to create a nation of hypochondriacs; and indeed, in the light of much current unconcern, there seems little enough risk of any such thing. On the other hand, a more positive attitude to health is overdue. In the absence of actual disease, there are yet many degrees of fitness. A health service that confines itself merely to picking up pieces after damage has been done is fulfilling only half its function: if the damage had been prevented, suffering as well as expense would have been spared. Some subjects in particular the committee consider deserve more creative attention than they receive. With the development of community care for the mentally ill, for instance, the public will have to adopt a more informed attitude towards mental disorder; and better general understanding of human relations might well leads to reduction in the rates of illegitimacy, venereal disease, and delinquency. People must, moreover, be persuaded that cancer can often be cured with prompt treatment and that delay is more to be feared than diagnosis of the condition. And they must be converted from their present disproportionate faith in drugs and nostrums and the self-medication which, by suppressing symptoms, may postpone specific therapy. Doctors themselves might be encouraged to give their patients more advice and fewer prescriptions. But the attainment of these goals is simple in comparison with inducing a populace to modify habits and ways of life where these are impairing health. In this context the health educator appears as a kill-joy, an enemy of many of the small pleasures of life-of smoking, for example, sweet-eating, and over-indulgence. His is the task of persuading the middle-aged television addict and motorist to take exercise and, more difficult still, of convincing the fashion-conscious girl that her shoes should be at least physiologically sensible.
as
vaccination;
to
change
Plainly neither he nor his tenets will be popular. His preaching that the preservation of health may demand sacrifice will tend to be heard only by the converted and will provoke the sceptic to agree that we are healthy in live and not the other way round. Besides, some of those who would benefit most from health instruction are those to whom it seldom penetratesthose with the least intelligence, the lowest income, and the poorest environment. But these may now be reached through the mass media, and television in particular. Health education should, says the report, exploit these methods to the full: it has often to fight their influence in commercial advertising (of, for example, cigarettes) and should not be prevented by financial considerations from turning that influence to its own ends. The committee finds that group discussion is probably the most effective means of inculcating change of habits or attitudes. But it urges the health order
to
educator to neglect no technique of propaganda, from the mass advertising campaign to the personal interview, and to do all with consummate skill. Local authorities for health education in their should retain own areas, but the report recommends the setting up of central boards to coordinate effort throughout the country. The Board for England and Wales would take over the present educational functions of the Ministry of Health and the Central Council for Health Education, while that for Scotlandwould assume those of the Scottish Home and Health Department and the Scottish Council for Health Education. These boards would assess priorities, plan publicity campaigns, study the results, and organise the training of health educators. The sum of E500,000 (about 0-06% of the cost of the National Health Service) is requested yearly for the financing of their staffs and activities. Without doubt this would be money well spent. Intense and sustained effort will be needed if health education is to have half the success envisaged for it in this report. But perhaps modern advertising techniques and the threat of cardiovascular disease may yet achieve what the promise of hell-fire could not-general abiding by the rule of moderation in all things.
responsibility
Peace
Through Psychology
FOR a special University of London lecture on May 7, Prof. OTTO KLINEBERG, now of the Sorbonne and formerly of Columbia, New York, chose as his title The Psychological Approach to International Relations; and the fleeting thought that, after all the witticisms about war and peace being too serious to be left to generals and politicians, we might be asked to put them in the hands of social psychologists was faintly spinechilling. With disarming insight Professor KLINEBERG at once disclaimed any such professional imperialism: instead, from a good deal of personal experience with various international bodies, he offered a wealth of acute observation and practical advice. Touching briefly on an extensive study in America which revealed beyond doubt that people who are dissatisfied with their lot (but not people who are satisfied) tend to be aggressive, prejudiced, intolerant, and generally a pest, he went on to discuss the fascinating " circular life " of national stereotypes. Italians, he reminded those who needed reminding, are noisy, volatile, and artistic; Germans are humourless, sheeplike, and hard-working; Russians are savage, melancholy, and usually drunk; and the French are-well, just shockingly French. These monsters have long acquired an autonomous, Pygmalion-like existence; and Professor KLINEBERG discussed four intellectual -processes (none of them entirely unfamiliar to readers of medical journals) which keep them alive and vigorously kicking. These are selection of evidence, distortion of evidence, reinterpretation of evidence, and the glorious exception which confirms the rule. The second and third are especially promising fields for psychological excavation. To illustrate distortion, Professor KLINEBERG recalled the experiments of ALLPORT and HOLMAN, who showed
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of students the photograph of a white American and a Negro waiting side by side in a New York underground station, the accoutrement of the former including an open cut-throat razor tucked into his belt. The students were asked to recount the contents of the picture to another group; and the members of this group were instructed to pass on the information to further groups. When the picture was described by the last links in the rumour-chains, in half the cases the razor had passed from the belt of the white man into the clenched fist of the Negro. Unlike distortion-a relatively crude process-reinterpretation is a sophisto a group
Annotations HOW BIG IS A BABY?
LAST year, at a symposium of the Nutrition Society, a plea for enlightenment about infant diets came from Mac Keith.1 As a puzzled paediatrician, he looked from animal studies to the sometimes conflicting aspects of human nutrition. His predicament was this: health and longevity in the adult were conferred by the avoidance of obesity; so, if the dietary habits of the adult stemmed from the dietary habits of the infant, as he believed, the paediatrician should be trying to ensure that infants did not form eating habits that would make them fat. In deciding when a baby is obese, Mac Keith favours the criterion " more than 20% above mean weight for age, or above the 97th percentile", though he agrees that allowance should be made for length. But it seems that paediatricians could perhaps find a more accurate scale. There have been attempts to set standards from measurements of large groups of children in several places. One of the largest, in Boston, Mass, evolved anthropometric tables of percentile measurements of height (or length), head circumference, chest and abdominal circumference, and pelvic width by calliper measurement. A method of measuring the thickness of body fat was also suggested. The normal subject falls in the same or an adjacent percentile in all measurements, and tends to keep to the same pattern from birth to puberty. A clear divergence then indicates abnormality, commonly of weight, in which case the measurements of body-fat point the same way. Then a child of even below " mean weight for age " may show up as distinctly obese when his skeletal and other
slight. Mayer2 showed that, when one parent is fat, there is a 50% chance that the child will be fat, and when both are fat there is an 80% chance. Fat women have fat babies; but they produce more milk. Diet, in fact, may activate a genetic tendency; even prenatal nutrition may be important here, for animal studies suggest that large placental size means large offspring, and ill-nourished animals certainly produce small offspring. The weights of newborn infants in countries deprived by war were below normal.4 Whatever the genetic inheritance, high-calorie eating habits are best avoided; and few will dispute that they begin in infancy. Although the fat baby often " thins down ", it is also common to see the fat baby become the fat adult. Paediatricians should be preventing highmeasurements are
1. Mac Keith, R. C. Proc. Nutr. Soc. 1963, 22, 128. 2. Mayer, J. Bull. N.Y. Acad. Med. 1957, 33, 744. 3. Widdowson, E. M. Amer. J. clin. Nutr. 1955, 3, 391. 4. Huggett, A. St. G. Brit. med. Bull. 1946, 4, 196; Brit. J. Nutrit.
1949, 3, 96.
ticated device which would probably suffer timely death if it were not carefully tended by skilled professionals. After concentrated brooding the man in the street might well come to the conclusion of My Country Right or Wrong; but it needs a politician to convince him of My Country Always Right. Professor KLINEBERG could suggest no painless weed-killer with which to eradicate these comforting misconceptions; but perhaps eradication is too high an aim. If we cannot live without our prejudices, at least from time to time we might rearrange them and even swop our pet hates. calorie eating habits, though, according to Wickes,5 they should confine their energies to the diets of late infancy. A supporter of self-demand feeding, he believes that there is a "morbid fear of overfeeding" young infants, which has already resulted in growth retardation and feeding dissatisfaction.
Parents,
out
of neurotic
or
real anxieties about poverty,
may have succeeded in stuffing the child to reassure themselves, as they survey the obese infant, that starvation is far off. In other cases, the parents, feeling a state
of unworthiness, tempt the child with sweetmeats to be assured of his love. Or the child himself is substituting food for love that is either denied or painfully ambivalent. There is no one psychogenic cause. Parental education-and that means education of the general public-in the advantages of the spare diet seems the best answer to Dr. Mac Keith’s problem. Further studies to establish the norm and thus to allow early recognition of obesity in infants are needed. Psediatric advice on dieting must be combined with sympathetic acknowledgment of possible psychogenic causes. It seems doubtful whether doctors will ever recommend diets low enough to retard growth, however much evidence arrives that general health is thereby benefited. Indeed, the world population explosion may make this an academic question, and make compulsory spare eaters of us all. TISSUE-CULTURE SMALLPOX VACCINE
SINCE the beginning of this century many attempts have been made to produce smallpox vaccine by a method that would ensure both quantity and purity ; and this has led to the use of animals other than the calf, which for more than a century had been the only vaccinifer. Vaccination lymph has been produced from rabbits and sheep, but the most interesting recent development has been the harvesting of vaccinia virus from tissue culture. Rabbit corneal epithelium, rabbit testes, and rodent embryos have been used in this way for virus propagation. But views on the efficacy of smallpox vaccines produced in this way have differed; and accordingly the report of an extensive trial of tissue-culture smallpox vaccine compared with the conventional preparation6 is of considerable interest.
Chick-embryo fibroblasts were used to provide the propagation medium, although experimental work in Sweden and the United States has now shown such cultures to be very liable to contamination with virus of the avian leucosis complex, and accordingly the use of 5. 6.
Wickes, I. G. Arch. Dis. Childh. 1952, 27, 449. Shaw, A., Kaplan, C. Mon. Bull. Minist. Hlth Lab. Serv. 1964, 23, 2.
