416

ANNOTATIONS

SUGGESTIONS ON HEALTH EDUCATION

THE third edition of a small handbook 1 issuedby the Board of Education for the consideration ofteachers and others concerned in the health and educa-tion of school-children may be warmly commended tothe consideration also of medical practitioners. Thetext generally has been revised while the chapter pnthe hygiene of food and drink has been largelyrewritten in the light of the importance now attachedto nutrition and the facilities afforded by the schoolfor the provision of milk and meals. The openingchapter deals with the significance and place of educa-tion in health within the school curriculum, the

planning of a health education programme and themethods which may usefully be employed. A chaptersets out in detail what is involved in the practice ofhealth habits particularly in the infant and juniorschool. A chapter on biology and health shows howessential is a study of life in its various forms as abasis for any intelligent appreciation of health

problems by the older boy and girl. Sections dealwith nature and nurture, plants and animals in rela-tion to health, useful and harmful bacteria. Unfor-tunately the place of biology in the course ofelementary science in the senior school is at present,for various reasons, inadequately recognised and healtheducation accordingly suffers in presentation andapplication. Under the heading of Progress towardsHealth the growth of preventive medicine is treatedin a living manner likely to interest older boys andgirls and accounts are given of the lives and work ofsome of the great health pioneers. Housing and townplanning, the supply of pure water, the disposal ofrefuse, the methods adopted for the guarding ofhealth in factory, workshop and mine are related tothe experience of the boy and girl and presented ina way calculated to appeal. A chapter is devoted tothe prevention of infectious disease, but it is significantthat no paragraph deals with the facts bearing upon,or the practice followed, in the prevention ofdiphtheria by immunisation. Nor is a chapter dealingwith education in matters of sex in relation to healthincluded among these suggestions for teachers.

Here, then, is presented the opportunity, through-out the life of the child at school, "to awaken," in thewords of Sir Arthur MacNalty in his introduction tothe book, " the imagination of boys and girls and leadthem to adopt healthy ways of living which will persistall through their lives." How far in practice is thisgreat aim of education realised ? Imperfectly it mustbe admitted, and the fault by no means lies entirelywith the school. Education in health cannot attainits end if it ceases to operate in the very middle of theadolescent period. Health education as envisaged in thisbook can only be realised as it operates throughout thewhole developmental period up to the age of 18. Forthe large majority of the nation’s children no con-

sistent guidance in the art of living is forthcomingafter the age of 14. In the secondary school the pupilsare usually too fully occupied with other things ofmoment to be concerned with matters affecting thehealth of the individual or of the community. Thetime is coming when the Board of Education and thelocal authority will undertake responsibility for theprovision of education, whether for part or whole timeand in association with industry, of all children duringthe whole adolescent period. Until then these admir-able suggestions on health education will bear fruitimperfect both in quality and quantity.

1. Health Education. H.M. Stationery Office. 6d.

LIPOCAIC

THE depancreatised dog develops two types of fattyinfiltration of the liver. One comes on immediatelyafter the operation and clears up with insulin andsuitable diet, whereas the other appears from two toeight months after the operation, in spite of adequatediet and insulin therapy. In 1924 Macleod reportedthat the second type could be prevented by giving thedog raw pancreas. Later Hershey stated that thecondition could be relieved by feeding 10 grammes oflecithin daily, and Best found that the active con-stituent of lecithin was choline or a closely relatedbody. Dragstedt and his associates in Chicago haveobserved that dogs suffering from the delayed foirnof hepatomegaly show loss of appetite and activity,a fall in their insulin requirement, a tendency to

hypoglycaemic convulsions and evidence of impairedhepatic function with the bromsulphalein test; theyhave also confirmed the presence of fatty infiltrationof the liver by biopsy. The condition affected nine outof ten of their depancreatised dogs. It was unrelievedby giving 1000 c.cm. of fresh pancreatic juice or 1000units of insulin by mouth daily. Some of the dogswere benefited by choline in amounts exceeding 2 g.a day, but feeding the dogs on tissues known to berich in choline. such as liver and brain, had noeffect. A cure was, however, always obtained byadding 100 g. of raw pancreas to their daily diet.Dragstedt analysed various fractions obtained from rawpancreas and found that the active substance wascontained in the fat-free alcohol extract. This extractworked equally well whether given by mouth or sub-cutaneously. The ether-soluble fractions containingalmost all the lecithin and most of the choline wereinert. The fat-free alcohol extract contained less than2 per cent. of free choline and therefore the amountof eholine in the effective dose could not be enough torelieve the fatty infiltration. On this evidence Drag-stedt and his colleagues conclude that there is presentin the pancreas a substance which they have namedlipocaic pB&iacute;7rO<; fat and to burn). They pre-sume that it is another internal secretion of thepancreas and that it may arise from islet tissue otherthan the Beta cells, since they have been able to extractan active preparation from pancreatic glands in whichalmost the whole of the acinar tissue had degenerated.Enlargement of the liver has long been observed in

clinical diabetes and has been attributed to inadequatecontrol of the disease. The existence of a conditionanalogous to that described by Dragstedt in the dog isnot as yet recognised in human diabetics, and in aseries of cases of enlargement of the liver in diabeticchildren White and Marble found that raw pancreashad little influence on the enlargement. There have,however, been two reports, by Grayzel and Radwin/ 6and Rosenberg/ of cases of diabetes associated withan hepatic enlargement which did not respond toinsulin and diet therapy, but receded after the admin-istration of lipocaic. Of great interest from theclinical standpoint is the observation by Dragstedt S

1. Allan, F. N., Bowic, J. J., Macleod, J. J. R. and Robinson,W. L. Brit. J. exp. Path. 1924, 5, 75.

2. Hershey, J. M. Amer. J. Physiol. 1931, 98, 74.3. Best, C. H., Ferguson, G. C. and Hershey, J. M. J. Physiol.

1933, 79, 94.4. Dragstedt, L. R. J. Amer. med. Ass. Jan. 6, 1940, p. 29.5. Marble, A., White, P., Bogan, I. K. and Smith, R. M. Arch.

intern. Med. 1938, 62, 740.6. Grayzel, H. G. and Radwin, L. S. Amer. J. Dis. Child. 1938,

56, 22.7. Rosenberg, D. H. Amer. J. digest. Dis. 1938, 5, 607.8. Dragstedt, L. R., Goodpasture, W. C., Venueulen, C. W. and

Clark, D. E. Proc. Amer. physiol. Soc. April 26, 1939, p. 63.