5 241

THE LANCET.

LONDON: SATURDAY, JANUARY 30, 1915.

The Dearer Loaf.

THE rise in the price of wheat flour from 26.s. asack before the war to the present figure of 45s. is,of course, serious. With the economic conditionswhich have led to this advance we do not proposeto deal beyond expressing a belief that it is duenot to a famine but to a shortage of labour anda resulting congestion of shipping. If we are

right the remedy is obvious, and its applicationshould be simple and near, and in that case there

’is no ground for panic, though some apprehensionas to immediate effects is reasonable. We look withconfidence to the Cabinet Committee, recentlyappointed to consider the question of food suppliesand prices, and presided over by the Prime Minister,to deal promptly with the conditions which are atthe root of the present general advances. All

medical men and sanitarians are concerned in the

question of applying scientific methods with a viewof relieving the inconvenience of high prices whenthey prevail. In a former article 1 we referred tothe directions in which our food-supplies could beaugmented, and the present seems to be an oppor-

. tune moment for returning to this subject. We are

inclined to think that the time has come to putaside a conventional contempt for or prejudiceagainst so-called substitutes, because it is

undoubted that dietetically many of them can

effectively replace certain articles of food for whichonly custom has reserved a place of respect in thecommon dietary. So long as honest dealing is therule, substitutes supply a common need in a waynot appreciated in all quarters ; their use, at anyrate, would materially help the householder to keephis domestic expenses down while ministeringequally to his physiological needs.For the present we may defer presenting the

case for margarine or dripping as substitutes forbutter, or glucose for dear sugar, and confine ourattention to the loaf. According to reports fromGermany, attempts have already been made inthat country to lighten the burden of thedear loaf by putting in it a notable pro-portion of potato or forms of potato flour.

Cheaper admixtures have been proposed, in-

cluding materials possessing very little nourish-

ing or even energy value at all. We do not thinkthat this country will be reduced to any such

expedients. But in the meantime it is just as well toconsider how the loaf may be cheapened without

1 THE LANCET, August 15th, 1914, p. 464.

affecting its energy value. To the majority of

people bread is not a source of nourishment, butonly of energy. To the extreme poor, often

limited sadly enough to bread with butter or jam,the nitrogenous contents of the loaf become of

very great importance. It does not matter clearlyto the man who can add to his bread some cheeseor meat whether that bread, is rich in nitrogenousmaterial or not. To the poor it matters a greatdeal, and that is a difficulty to be faced when

suggestions are made to cheapen bread by mixingwith wheat flour a cheap farinaceous substitute.On this point some interesting observations are

made by Dr. E. FRANKLAND ARMSTRONG in an

article on the " Chemistry of Wheat and

Flour." 2 He observes that flour is primarilya starchy material, but those characteristic

properties which enable it to be made intobread are due almost entirely to the presenceof some 10 per cent. of nitrogenous material-the gluten. Consequently from the point of viewof the miller and baker gluten is the all-importantconstituent of flour. But to-day, and somewhatirrationally, gluten has come to be regarded by thewould-be food expert as the essential constituent,overlooking the fact that bread is eaten

primarily, not as a source of protein, but as aneasily digestible, attractive form of starch. The

man in the street properly regards bread as

equivalent to rice, potatoes, or the like, rather thanas a substitute for meat; and it is not surpris-ing, Dr. ARMSTRONG thinks, that the academic

reformers have failed to secure followers.The proportion of gluten, we may point out,varies widely in different flours, and "grade" is

based largely upon this fact. It would be possibleto add to rich gluten flours a proportion of starch,as, for example, cornflour, which is very much

cheaper than wheat flour, without materiallyreducing the nitrogen value when compared witha low-grade wheat flour. The energy value

of such a loaf would be quite high, while its

nourishing properties would be little impaired. If

it should be feasible to introduce, say, 20 per cent.of cornflour in this way into a strongly glutinousflour a very definite economy would be gained, anda loaf decidedly cheaper than the all-wheat-flourloaf would be available for food purposes. Thereare the probabilities, also, of increasing the"

strength" of the gluten as a formative agentby activators such as phosphoric acid or phos-phates which are not foreign ingredients of flour ;thus it might be possible to increase the additionof cheap starchy materials still further. Since the

supply of pure maize starch is practically inex-

haustible, and there has been no appreciable risein its price-certainly no advance anything like

that in wheat flour-the attention of our authorities

may usefully be drawn to this suggestion. It maybe remembered that cornflour is amongst the mosteasily digested farinaceous foods.

2 Nature, Jan. 7th, 1915.

242

The movement for " standard " bread has - beenrevived, for it is contended that the loaf productionof the country would be increased from 10 to 20 percent. by using practically the whole of the grain.By the rejection of the germ and by roller methodsof refining flour it is urged that much valuablefood material is lost. That may be so, but itis doubtful whether the adoption of a standardbread will cheapen the loaf, for the separatedgerm is an independent source of revenue; and itis not a famine we are confronted with, but dear-ness arising out of reduced transport facilities. To

meet the difficulty we ought to use all ingenuity.For example, the industrial use of low-grade floursfor "sizing" " and " filling " purposes in the textiletrades may want supervision from the food-supplyaspect. Although described as low-grade, therecan be little doubt that such flours would servefor human food, and they can be replaced forthis industrial purpose by " sizes

" showing alower food value. We hope that the attentionof the Cabinet Committee appointed to consider

the question of food supplies and prices willbe directed to the fact that very many thousandtons of wheat flour are annually used for " sizing "

purposes in the textile industries. And yet it

is well known in the trade that the "sizing" "

process is by no means dependent upon wheat flour,and that other materials such as the plain starchescan be used equally well for the purpose. The

Cabinet Committee will have evidence placed beforeit in many directions of the most interesting andimportant kind. The result of its labours will belooked for anxiously, and success will follow if thereasons for any measures adopted are scientificallysound, and are explained in simple language to thepublic.

Medicine and Surgery in War.IT is only natural that at the present time, when

all our energies are being devoted to the carryingon of a great’war, that the British Journal ofSurgery should contain little that is not connectedin one way or another with war. This month hasalso appeared the first number of a new medical

quarterly, the Journal of the Royal Naval MedicalService. This is edited by Fleet-Surgeon R. C.MUNDAY and Fleet-Surgeon W. L. MARTIN, andif from the first number we may gauge the valueof the contents of succeeding issues it will forma most important addition to British medicalliterature. Almost the only article in this numberwhich is not directly concerned with war is that byStaff-Surgeon E. L. ATKINSON, dealing with theBritish Antarctic Expedition from 1910 to 1913. Eventhis throws light on matters now affecting both ourarmy and navy, for it treats inter alia of frost-bites,various forms of which have been seen so widely oflate in our army in Flanders. It is of interest tonote that the snow of the Antarctic regions istoo cold to be employed for rubbing a frozen

.nose or ear, though this may be the best treatment

for frost-bite in more temperate climes. One of themost interesting papers is that by Fleet-SurgeonWALTER K. HOPKINS on the action off Heligoland,in which the value of an early and thoroughcleansing of wounds is clearly shown; he was onduty 37 hours during and after the action, andevidently did an immense amount of work. The

difficulty of localising bullets in the body andlimbs is sometimes very great, and the methodsuggested and described by Surgeon S. BRADBURYis simple and appears to be very useful; it consists

essentially in finding the position of the bullet fromtwo aspects and then tracing its real’ position bymeans of a strip of lead. This needs rotation ofthe limb through only a few degrees, and thereforelittle disturbance of the patient. The paper on the

prevention of typhoid fever by Fleet-Surgeon P. W.BASSETT-SMITH is timely, when we find preventivetreatment of typhoid fever so violently assailed.Of great interest and importance is the note bySurgeon SHELDON F. DUDLEY on a typhoid carrier; "the man was " ship’s cooper " and therefore he wasbrought in contact with articles of food when

opening casks; in 13 years he had served in 12.

ships, and he had given rise to 53 cases of

typhoid fever, of whom 11 had died. SurgeonA. VAVASOUR ELDER has written a valuable

paper on ambulance trains, containing an

account of Naval-Train No. I. In this the cots are.movable and not fixed; thus there is much less.

disturbance of the patient in taking him into andout of the train, and he is much less affected by thejarring of the train. We have said enough to showthat in the Journal of the RoyaZ Naval MedicalService we have a valuable addition to medicine.In the January number of the British Journal of

Surgery are many important papers bearing on thewar. Lieutenant-Colonel C. B, LAWSON. and. Mr.H. BECKWITH WHITEHOUSE: have published a com-munication on the treatment of acute emphysema-tous gangrene, a disease which has appeared withgreat frequency in the present war. The treatment

employed consists in the injection by means of aHigginson syringe of hydrogen peroxide into thehealthy tissues three or four fingers’ breadth above-the line of advancing gangrene, as shown by thedusky copper-coloured tint of the skin. It is.

essential that a complete belt of oxygen shouldbe formed above the gangrene, and therefore

several openings may be needed, and the dissemina-tion of the oxygen must be aided by kne ading andmassage. A certain amount of shock is produced,especially if the upper limb is affected ; and

general anaesthesia, or sometimes spinal anaes-

thesia, must be employed. As to the results:of 11 cases treated by infiltration 8 recovered,while of the 3 cases not treated by infiltra-tion all died. Especially it seems to follow

. from these cases that amputation above the, grangrene is not only not called for, but

that it may be dangerous, for it may provefatal from shock. Professor TUFFIER, of Paris, has

written a short note on military surgery as seen