Vitamin C Prophylaxis at the shipyard of Stralsund

Vitamin C Prophylaxis at the shipyard of Stralsund [in German] By K. Renker and S. Wegner Deutsche Gesundheitswesen 1954;9(22; Jun 3):702-706 PubMed http://www.ncbi.nlm.nih.gov/pubmed/13200153 English translation of this paper was arranged by Harri Hemilä in 2016 [email protected] https://www.mv.helsinki.fi/home/hemila This report was translated as background material for research on vitamin C and the common cold by Harri Hemilä and Elizabeth Chalker, eg. https://doi.org/10.1002/14651858.CD000980.pub4 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8078152 https://hdl.handle.net/10138/225864 The scanned German text is at the end of this translation. More interesting parts of the text are indicated by yellow Volkswerft Stralsund: https://de.wikipedia.org/wiki/Nordic_Yards_Stralsund https://en.wikipedia.org/wiki/Volkswerft Page 702 RENKER/WEGNER, VITAMIN C PROPHYLAXIS ISSUE 22 From the Speranski company polyclinic of Volkswerft Stralsund (chief physician: Dr Karlheinz Renker) Vitamin C Prophylaxis at Volkswerft Stralsund By K. RENKER and S. WEGNER Graupner already reported that the feeling of exhaustion and feebleness is a disease of civilization. He literately says: “The man who is tied to the treadmill of his profession and in addition has to go out a lot in the evenings, so the typical city slicker, knows this most of all. He is not surprised if his energy decreases at the end of a day. After all, he took on too much and the workload all at once had to have an effect on the body.” Therefore, he compensates for his work, e.g. through sports or gymnastics. He swims or plays tennis. Of course, this should not be underestimated, but the long-term effect fails to set in and he becomes resigned and reluctant through progressive work during the course of the year, irritated and exhausted and the vacation, to which he longingly looks forward to for weeks, is his sole salvation. Now, everyone tries something different to fight this loss of energy. We also have to thank Graupner’s notes for our following statements. Is it not strange that precisely when we feel like going for a walk, especially in March or April when the sun is shining, fatigue or low energy stop us – often for weeks. We would like to go outside, because the sun and the first signs of green are luring us, but we prefer the couch. Those are the known symptoms of spring fever. Volume 9 RENKER/WEGNER, VITAMIN C PROPHYLAXIS Page 703 Graupner literarily says: “The effects of spring on our health are manifold and are still not fully clarified today. Mortality increases in the months March and April as folk wisdom has long recognised in a proverb. That there are many more victims of cold, flu and catarrhs in spring than in autumn is already not comprehensible. Children grow slower in the spring months. In addition, there is spring fever, during which the shins hurt already after short walks, the extremities ache, the appetite is lacking despite hunger and sometimes even gum bleeds occur.” These gum bleeds indicate the primary cause of spring fever. We can observe them to a great extent in scurvy, the old seamen’s disease. It is known that scurvy is a vitamin deficiency disorder. Scurvy can be healed with administrations of vitamin C. It is after all not surprising that this deficiency especially occurs in the spring. We consume vitamin C through fresh vegetables and fruit and these are lacking in winter and spring. Our organism does not like an adverse vitamin C balance lasting several months. The small vitamin depots have long been used up. The effects manifest in form of spring fever. The primary cause is vitamin C deficiency, even if other causes are of course involved. No matter to what extent we stuff ourselves with vegetables and fruit in the summer months, our organism does not store vitamin C. Graupner already [was] prompted to draw conclusions from these observations and he made these observations in the year 1939. We must already prevent a vitamin C deficiency in the winter through the skilful composition of our nutrition and in particular do everything possible from February onwards. We refer to oranges, rose hip jam, black currants, in the “small kitchen” also to the preparation of dandelion, in the spring stinging nettles, watercress, sorrel or yarrow. These wild vegetables can be very tasty and their consumption does not mean that one goes back to a ridiculous nature state in the sense of bearded, barefooted prophets. One should eat them rather as vegetable or side salad to meat dishes. There are numerous possibilities for a vitamin C rich nutrition. There are many parallels between spring fever and exhaustion of overworked professionals. Of course, lack of sleep and exercise, hormonal imbalances, hidden diseases or other vitamin deficiencies can also often be involved. But often enough, the lack of vitamin C is the culprit. The nutrition of our people is often still insufficient. During their short lunch break, they run to the dining hall of the company, the canteen or the cafeteria and eat dishes that are not always wholesome. Very often – especially also in our canteen – these are reheated dishes or other non-wholesome food. What does non-wholesome mean? Food is not wholesome if although it contains enough nutrients – so fats, carbohydrates and protein – it does not contain enough vitamins. Our social structure is increasingly undergoing a change. The canteen food turns more and more into the main source of meals for a majority of professionals. The company kitchens are a decisive factor for the maintenance of the health and performance capacity of our employees. We reached the point today that we can also demand that food in the canteen contains the sufficient amounts of vegetables and fresh fruit. But we will not manage without vitamin C in tablet form due to the existing adverse vitamin C balance. This is especially the case because vitamin C is very sensitive and therefore easily destroyed. Of course, we must constantly strive to eat vitamin C rich food. Prof. Dr Dr Scheunert points out these important facts in his article “About the vitamin C requirement” in the journal “Ernährung und Verpflegung” [Nutrition and Food] in the year 1949, issue 1. In this article, Scheunert discusses the daily vitamin C requirement. He comes to the conclusion that there is no daily requirement that applies for all cases but that the optimum supply is much higher than previously presumed. He says: “The only important thing in the human nutrition is to ensure optimum nutritional conditions. A preferably high vitamin C supply should therefore be sought. A requirement of 50 mg is too low. Only a supply of 100 to 150 mg will prevent all obvious deficiencies. 125 mg ascorbic acid are therefore suggested as average daily dose for an optimum supply for healthy adults.” Tests with vitamin C administrations were carried out repeatedly but have mostly not led to conclusive results. For example, there are no generally applicable results regarding the vitamin C prophylaxis carried out in schoolchildren in Germany. Scheunert reports of British tests on schoolchildren in the years 1941-1942 with administrations of 50 mg vitamin C that did not lead to any conclusion. Scheunert reports: “Amongst several foreign articles, a Dutch study from Oskam on 392 employees of a clothing factory should be especially pointed out, in which the effect of prophylactic administrations of quinine and vitamin C (alone and combined with 90 mg daily each) on the resistance against colds has been studied from January to April 1942. For this, the test subjects were in parts saturated beforehand, which means they received a significant excess amount of vitamin C. The study indicated that an administration of 90 mg vitamin C had a pronounced positive effect. Page 704 RENKER/WEGNER, VITAMIN C PROPHYLAXIS ISSUE 22 The most favourable effect was achieved with the combined administration of vitamin C and quinine. The results of these tests clearly spoke in favour of high vitamin C administrations and these are actually the first well founded tests of this kind even though the duration appears a bit short and the number of test persons rather low.” Scheunert also refers to a whole series of other studies. Further clarification was provided by a large-scale study, which was carried out on approximately 4,000 persons of a modern factory participated from 1.11.1942 – 30.6.1943 at the request of Scheunert, by Wagner and Liebert. Scheunert reports that the test persons, who received different additional dosages of vitamin C, worked together in groups of 240-380 persons in halls of a factory and received constant medical care. The disease incidence and the number of missed days were recorded. They were documented on index cards managed for each person, registered by the statistics office of the plant and processed in accordance with Hollerith’s method. Those groups are relevant for Scheunert’s considerations in which the effects of an additional supply of 20-50, 100-300 mg vitamin C were compared to a control group not receiving an additional supply. 78 of 100 persons in the control group became ill during the eight-month trial period. Even more cases of illness occurred in the groups receiving 20-50 mg vitamin C (79.2-141.9). However, a clear and significant reduction of the sickness rate could be observed in the groups receiving higher vitamin C doses of 100-300 mg. The optimum effect was already achieved under the 100 mg dose with 32 cases of illness, because the 300 mg group indicated an equal number of diseases, namely 33.6. The same picture resulted if the diseases were divided. If, for example, colds (diseases of the upper respiratory tract, angina episodes, flu, rheumatic disorders) were regarded separately, then the groups with 20-50 mg vitamin C again featured an even higher sickness rate than the comparison group, while administrations of 100-300 mg vitamin C led to a very significant decrease of the sickness rate. These results were also confirmed by observations on other test groups that also received other vitamins as well as quinine and other agents in addition to vitamin C. It is unnecessary to go into the details of this study. Scheunert also omitted the critical assessment of the statistical survey. However, he points out that the two groups with high vitamin C dosages also showed the least number of workdays missed in the calculation of the sick days. A successful cooperation had been developing between the Speranski company polyclinic of the Volkswerft and Prof. Dr Dr Scheunert since 22.12.1952. We would like to declare at this point that we are very grateful to Prof. Scheunert for the support of these tests that are based on his experiences. The good results that we were able to achieve in this field at the Volkswerft Stralsund would not have been possible without this consultation and constant help. We also would like to point out that the positive results could only be achieved because the entire collective of the occupational health services of the Volkswerft campaigned for the implementation of the vitamin C prophylaxis, and not only this collective but the large collective that developed beyond that in the entire Volkswerft for meeting the requirements of the tasks of the prophylaxis. Accordingly, we carried out a large-scale study of vitamin C prophylaxis at Volkswerft Stralsund that started on 12.1.1953 and is currently still ongoing. The time period from 12.1.1953 – 31.10.1953 was specified for the evaluation of the vitamin C prophylaxis. 1,200 employees from the departments electrode welding, interior construction and shipbuilding participated in the vitamin C prophylaxis. The 1,200 colleagues belonged to the departments with the most difficult work conditions at Volkswerft. Of course, control groups were also established in all three departments as in Scheunert’s study. Apart from these, none of the other departments of Volkswerft were involved. However, it has to be mentioned here that the control groups could not always be clearly maintained because the colleagues in the control group asked for vitamin C for themselves because they did not want to be left out. It is a fact however that a large part of the colleagues not receiving vitamin C had the same work conditions. While the intermediate assessment already provided extraordinarily illuminating material, the final assessment revealed a surprising result. First to the intermediate evaluation. The intermediate evaluation comprised a time period from 1.1.1953 – 30.4.1953, i.e. 10 days prior to the performance of the vitamin C prophylaxis until the end of the flu epidemic. In all future reports, flu patients include all patients diagnosed with febrile diseases, influenza, upper respiratory infections, etc. 1,119 employees were registered as sick during the intermediate reporting period. 490 [sic!] = 43% of them were flu patients. Sick persons who did not receive vitamin C Total sicknesses Thereof flu 633 345 = 55% Sick persons who had received vitamin C Total sicknesses Thereof flu 486 136 = 28% The duration of the flu was 10 days in the patients without vitamin C and 9 days in those with vitamin C. It was characteristic that 112 of 162 patients were sick with the flu in the control group which received no vitamin C. That is 68 percent. Volume 9 RENKER/WEGNER, VITAMIN C PROPHYLAXIS Page 705 Of the 108 persons became ill at the payroll office, 87 of them had the flu, which is 87%. Although, the work conditions are significantly better here than in the group receiving vitamin C. In the interior construction only 52 of 216 patients had the flu, i.e. 24% and 53 of 162 patients suffered from the flu amongst the electrode welders. That is 32%. Now to the final report. 3,751 employees registered as sick and were unable to work during the reporting period with all types of diagnoses. The reporting period was from January to October 1953. The sick reports were not assessed in relation to the entire workforce as that was not interesting in the context of this topic. Total number of sicknesses Thereof the flu 3,751 825 = 22% Without vitamin C 2,077 = 56% 864 = 41% With vitamin C 1,674 = 44% 240 = 14% The question presents itself if this result presents a realistic relationship as we had a flu epidemic in April 1953. Therefore, an intermediate evaluation from April 1953 was compared to the following results: (comparison of departments where colleagues receiving vitamin C always had poorer work conditions) “Employees” (without vitamin C, work conditions: Barracks but significantly better work conditions than in the interior construction department.) Total number of sicknesses Thereof the flu 574 213 = 37% Intermediate assessment in May 1953 108 87 = 87% Final assessment from April until the end of October 1953 466 109 = 21% Interior construction department (with vitamin C, work conditions: outdoor workspace as well as work inside the hall, very unfavourable work conditions.) Total number of sicknesses Thereof the flu 543 79 = 14% Intermediate assessment after flu epidemic (January - April) 216 52 = 24% Final assessment (April – October) 327 27 = 8% Or a different example: Control group (without vitamin C, work conditions: good) Total number of sicknesses Thereof the flu 415 165 = 40% Intermediate assessment after flu epidemic (January - April) 162 112 = 68% Final assessment (April – October) 253 53 = 20% In contrast electrode welding workshop (with vitamin C, work conditions: very difficult, outdoor workspace, hall, poor ventilation and air supply, sweating alternating with drafts) Total number of sicknesses Thereof the flu 597 96 = 17% Intermediate assessment (January - April) 162 53 = 32% Final assessment (April – October) 435 38 = 8% In comparison of genders there was no notable difference between male and female. The patients became sick proportionally to the ratio of women employed at the shipyard, whereby the number of sick women was also higher in those departments that employed more women (clerical workers). These numbers thus reflect a great success. If the whole matter is reduced to a common denominator with two figures, then it can be said: Of those treated with vitamin C, only 14% of the persons reporting sick suffered from the flu during the entire reporting period, while 41% of all persons reporting sick in the group working without vitamin C suffered from flu-like symptoms. That is an enormous difference of 27%. If all persons at the shipyard would have been treated with vitamin C, then 560 fewer workers would have become sick. With an average duration of 10 days for flu-like diseases, this would translate into 5,600 working days or 44,800 working hours or DM 89,600 without taking the values into account that the colleague would have generated during that time and without consideration of the psychological question of the worry about the person. Accordingly, the net profit from the prophylaxis is a multiple of the amount stated. How we proceeded to secure this success. On 12.1.1953, Scheunert gave a presentation attended by hundreds of workers in the shipbuilding hall of Volkswerft with demonstrations and an accessible speech about the vitamin C prophylaxis. This introduction was already preceded by intensive work carried out by the company polyclinic. Flyers were distributed, company doctors gave presentations in short meetings in all departments. The significance of vitamin C was constantly pointed out in the shipyard bulletin and via the company radio. On 12.1.1953, Scheunert held a meeting with the foremen in whose departments the vitamin C prophylaxis was meant to start. The foremen continuously received vitamin C tablets through the company polyclinic. The company doctors controlled the implementation of the vitamin C prophylaxis. All company doctors and company dentists showed great effort. Each day, when the colleague handed his control coupon to his foremen, he received two tablets vitamin C, so a total of 100 mg. Reminders of the vitamin C prophylaxis were necessary during all of the months. Page 706 Issue 22 However, it occurred during the course of the vitamin C prophylaxis that the workers were criticising the foremen in the departments if they did not distribute the vitamin C tablets regularly and positive opinions were voiced about the vitamin C prophylaxis everywhere in the delegate meetings to the BKV. Now what are the conclusions from this vitamin C prophylaxis at Volkswerft? The great success of the vitamin C prophylaxis at Volkswerft was only possible because we were able to base it on the good preliminary tests and were able to assess the tests carried out in the past and their experiences. Especially the large amount of experience that Scheunert had regarding this issue was available to us. Please allow us to emphasise some principles for the vitamin C prophylaxis. 1. We consider a vitamin C prophylaxis with daily administrations of 100 mg to be the right one. 2. We are of the opinion that it is necessary to find a tablet form for the implementation of the vitamin C prophylaxis that is even more convenient that the one customary at the moment. We are thinking of a sugar-coated tablet. 3. The implementation of the vitamin C prophylaxis is only then secured if it is connected with ongoing medical educational work. 4. We think it is necessary that the vitamin C prophylaxis is not only implemented in the months November to March but is also regularly continued during the summer months, because vitamin C does not provide protection immediately but only when it is taken regularly. A vitamin prophylaxis that is implemented from November until March would already be something, but a continuous prophylaxis would be best in our opinion. 5. The organisation of the distribution and administration of the vitamin C must be arranged very carefully. We refer to our explanations regarding the distribution of the tablets through the foremen. 6. We consider the generalisation of the vitamin C prophylaxis to be absolutely necessary. Quite a few colleges at Volkswerft have become so used the vitamin C that they would experience the omission of the vitamin C prophylaxis as unpleasant. 7. We think it is necessary to address the questions of the vitamin enrichment of the canteen food (especially vitamin C rich nutrition and possibly also vitamin B1). 8. We think that there are other scientific possibilities – especially under application of Pawlow’s teachings – to increase the value of our studies at Volkswerft. We will therefore continue our work in this field. We hope that our work at the Volkswerft, which was possible through the scientific works of the friend of our company health service, Scheunert, will contribute to providing vitamin C with its due place in our vitamin and nutritional science but especially in our canteen kitchens. Please allow us to note that especially the German Democratic Republic, the State of Workers and Farmers permitted us the intelligence to conceive generous plans in healthcare. The workers and farmers are the ones that make it possible for us with their diligence, and through their initiative to realize ambitious plans for maintaining the health of the people. Address of the authors: Speranski company polyclinic of Volkswerft Stralsund [unrelated text]