Europe's Need
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761 Europe’s Need THE LANCET LONDON: SATURDAY, NOV. 22, 1947 WHAT is the present state of continental Europe ? 1 How is the health of the people ? 1 There can be few doctors in this country and fewer still in America who could give a clear answer. No reliable opinion can be offered without sufficient facts. The reports of journalists who have travelled widely in Europe are conflicting and often based on hearsay or super- ficial impressions. Doctors returning from the Continent have usually been preoccupied with a single problem in a limited area, and so can give no broad review. Public-health statistics, when obtainable at all, have generally been collected under difficulties ; and, since they have not always been correctly analysed, their interpretation is sometimes open to doubt. It has thus been very hard to get a satisfactory overall picture of the present situation, and the International Committee of the Red Cross is the more to be congratulated on attempting a general review. Summarising information from its delegates in all European countries except Norway, Sweden, Den- mark, Eire, Luxemburg, Switzerland, Portugal, and Bulgaria, the committee paints a gloomy picture.l There is still an appalling lack of elementary shelter in the areas devastated by war. Essential clothing, and especially footwear, is almost everywhere scarce.. The shortage of food for urban populations is in general worse than a year ago, owing to the unbroken succession of poor harvests, and-although this is not sufficiently stressed-through the sudden ending early this year of the vast flow of foodstuffs imported by UNRRA into Central and Southern Europe. It is not surprising that in many countries the infant- mortality rate and general death-rate are still above pre-war levels. (The report claims that the general death-rate is actually rising, but it gives no figures.) In many towns children are now undersized as a result of several years of underfeeding, and rickets is undoubtedly common, though other vitamin deficiencies are notably rare. As might be expected, gonorrhoea and syphilis are still a serious problem in many. countries, though perhaps not " simply catastrophic " as the report suggests. While there have been no widespread epidemics of infectious disease, local outbreaks of enteric and diphtheria continue ; and malaria, despite vigorous preventive measures, is still prevalent in Italy and the Balkans. Perhaps the most remarkable feature of this post- war period, compared with that after the war of 1914-18, has been the general absence of exanthe- matic typhus on an epidemic scale-a phenomenon not unconnected with UNRRA’S importation of over 4 million pounds of pure D.D.T. into Europe for the prevention of this disease, besides large shipments 1. Health Conditions among the Civilian Populations of Certain European Countries Affected by the War. No. 3, revised edition. Geneva: Comité International de la Croix Rouge. August, 1947. for the control of malaria. As for tuberculosis, which is without doubt the most important infection in Europe today, mortality figures leave little doubt that it has much increased in many places. At the same time, all such figures need very careful scrutiny. For example, the committee’s statement that in the American zone (including the Berlin sector) the tuberculosis death-rate " rose from 20 per 10,000 inhabitants in April, 1946, to 37-5 in April, 1947 " seems to be unjustified. For the population of a little over 17 million it would imply between 35,000 and 65,000 deaths in the year, whereas the number of deaths from tuberculosis notified over this period was about 11,000.3 Also it is not clear why the report singles out Germany as one of the three countries (with Austria and Rumania) where the situation is " particularly disastrous " and pays little attention to Greece and Yugoslavia where the incidence is almost certainly higher. Some of the victims of aggression appear to be in more need of help than Germany, if only because they have suffered privation longer. The survey ends with a summary of relief needs. No-one who has travelled in post-war Europe would question the continued need for the means of improving local food-production-tools, tractors, draught ani- mals, fertilisers, and seed. Clothing and facilities for feeding children are also required, and (among the medical supplies) surgical instruments, dressings, penicillin, sulphonamides, arsenicals, and D.D.T. The primary need of infants is for dried milk, with sugar and farinaceous foods a very secondary requirement; and in this connexion it is to be hoped that the Inter- national Red Cross will consider the recent recom- mendations of F.A.O. and the World Health Organisa tion on relief for children.4 Owing to the termination of UNRRA before its task was finished, the health of many thousands of people in Europe depends for the moment on the efforts of the International Red Cross and other relief agencies : there has been a gap in the larger measures of relief. But the damage of war has gone far deeper than was at first supposed, and the fundamental need is not so much relief as the means to recovery. We must hope that this will yet be met through the great American " invest- ment in humanity " known as the Marshall plan. Carotid Ligation THE surgeon generally approaches ligation of the carotid arteries with a feeling of uncertainty ; for, as JEFFERSON 5 has pointed out, the pattern of the circle of Willis is incomplete in 8% of normals, and this defect is particularly serious if both anterior, cerebral arteries take origin from the same side of the arch. No great reliance is now placed on preoperative tests for the presence of such congenital anomalies. LAHEY and WARREN 6 conclude that the percutaneous compression test of MATAS " is of value only when positive in the production of symptoms." Protracted carotid compression each day, without incident, may yet be followed by postoperative catastrophe-perhaps 2. Sawyer, W. A. Amer. J. publ. Hlth, 1947, 37, 41. 3. Lancet, July 26, p. 144. 4. Report on Child Nutrition from the Food and Agriculture Organisation and the World Health Organisation (Interim Commission), Washington, D.C., July, 1947. 5. Jefferson, G. Proc. R. Soc. Med. 1947, 40, 419. 6. Lahey, F. H., Warren, K. W. Surg. Gynec. Obstet. 1947, 85, 281.
Transcript of Europe's Need
761
Europe’s Need
THE LANCETLONDON: SATURDAY, NOV. 22, 1947
WHAT is the present state of continental Europe ? 1How is the health of the people ? 1 There can be fewdoctors in this country and fewer still in Americawho could give a clear answer. No reliable opinioncan be offered without sufficient facts. The reportsof journalists who have travelled widely in Europeare conflicting and often based on hearsay or super-ficial impressions. Doctors returning from theContinent have usually been preoccupied with a
single problem in a limited area, and so can giveno broad review. Public-health statistics, whenobtainable at all, have generally been collectedunder difficulties ; and, since they have not alwaysbeen correctly analysed, their interpretation issometimes open to doubt. It has thus been veryhard to get a satisfactory overall picture of the
present situation, and the International Committeeof the Red Cross is the more to be congratulated onattempting a general review.Summarising information from its delegates in all
European countries except Norway, Sweden, Den-mark, Eire, Luxemburg, Switzerland, Portugal, andBulgaria, the committee paints a gloomy picture.lThere is still an appalling lack of elementary shelterin the areas devastated by war. Essential clothing,and especially footwear, is almost everywhere scarce..The shortage of food for urban populations is in
general worse than a year ago, owing to the unbrokensuccession of poor harvests, and-although this isnot sufficiently stressed-through the sudden endingearly this year of the vast flow of foodstuffs importedby UNRRA into Central and Southern Europe. It isnot surprising that in many countries the infant-
mortality rate and general death-rate are still abovepre-war levels. (The report claims that the generaldeath-rate is actually rising, but it gives no figures.)In many towns children are now undersized as a
result of several years of underfeeding, and ricketsis undoubtedly common, though other vitamindeficiencies are notably rare. As might be expected,gonorrhoea and syphilis are still a serious problemin many. countries, though perhaps not " simplycatastrophic
" as the report suggests. While there
have been no widespread epidemics of infectiousdisease, local outbreaks of enteric and diphtheriacontinue ; and malaria, despite vigorous preventivemeasures, is still prevalent in Italy and the Balkans.Perhaps the most remarkable feature of this post-war period, compared with that after the war of1914-18, has been the general absence of exanthe-matic typhus on an epidemic scale-a phenomenonnot unconnected with UNRRA’S importation of over4 million pounds of pure D.D.T. into Europe for theprevention of this disease, besides large shipments1. Health Conditions among the Civilian Populations of Certain
European Countries Affected by the War. No. 3, revisededition. Geneva: Comité International de la Croix Rouge.August, 1947.
for the control of malaria. As for tuberculosis, whichis without doubt the most important infection in
Europe today, mortality figures leave little doubtthat it has much increased in many places. At thesame time, all such figures need very careful scrutiny.For example, the committee’s statement that inthe American zone (including the Berlin sector) thetuberculosis death-rate " rose from 20 per 10,000inhabitants in April, 1946, to 37-5 in April, 1947 "seems to be unjustified. For the population of a littleover 17 million it would imply between 35,000 and65,000 deaths in the year, whereas the number ofdeaths from tuberculosis notified over this periodwas about 11,000.3 Also it is not clear why thereport singles out Germany as one of the threecountries (with Austria and Rumania) where thesituation is "
particularly disastrous " and payslittle attention to Greece and Yugoslavia where theincidence is almost certainly higher. Some of thevictims of aggression appear to be in more need ofhelp than Germany, if only because they havesuffered privation longer.The survey ends with a summary of relief needs.
No-one who has travelled in post-war Europe wouldquestion the continued need for the means of improvinglocal food-production-tools, tractors, draught ani-
mals, fertilisers, and seed. Clothing and facilities forfeeding children are also required, and (among themedical supplies) surgical instruments, dressings,penicillin, sulphonamides, arsenicals, and D.D.T. The
primary need of infants is for dried milk, with sugarand farinaceous foods a very secondary requirement;and in this connexion it is to be hoped that the Inter-national Red Cross will consider the recent recom-mendations of F.A.O. and the World Health Organisation on relief for children.4 Owing to the terminationof UNRRA before its task was finished, the healthof many thousands of people in Europe dependsfor the moment on the efforts of the InternationalRed Cross and other relief agencies : there has beena gap in the larger measures of relief. But the damageof war has gone far deeper than was at first supposed,and the fundamental need is not so much relief asthe means to recovery. We must hope that thiswill yet be met through the great American " invest-ment in humanity " known as the Marshall plan.
Carotid LigationTHE surgeon generally approaches ligation of the
carotid arteries with a feeling of uncertainty ; for,as JEFFERSON 5 has pointed out, the pattern of thecircle of Willis is incomplete in 8% of normals, andthis defect is particularly serious if both anterior,cerebral arteries take origin from the same side of thearch. No great reliance is now placed on preoperativetests for the presence of such congenital anomalies.LAHEY and WARREN 6 conclude that the percutaneouscompression test of MATAS " is of value only whenpositive in the production of symptoms." Protractedcarotid compression each day, without incident, mayyet be followed by postoperative catastrophe-perhaps2. Sawyer, W. A. Amer. J. publ. Hlth, 1947, 37, 41.3. Lancet, July 26, p. 144.4. Report on Child Nutrition from the Food and Agriculture
Organisation and the World Health Organisation (InterimCommission), Washington, D.C., July, 1947.
5. Jefferson, G. Proc. R. Soc. Med. 1947, 40, 419.6. Lahey, F. H., Warren, K. W. Surg. Gynec. Obstet. 1947, 85, 281.
