Anthropologiai Közlemények 35. (1993)
1993 / 1-2. füzet - Tanner, J. M.: Human Auxology. Therapy of Individuals and Monitoring of Populations
something the mathematicians have a word for, infinite regress or endless recurrence, I think. There are even steps beyond this now: a pituitary-gonadotrophin-releasing hormone analogue can be given which stops puberty occurring. It is very successful in patients with genuinely pathologically early puberty. But if you postpone puberty by a couple of years in perfectly normal children perhaps that in itself confers some extra height, a prized possession. We could be entering the dangerous world of plastic endocrinology. At the same time, never forget, the treatments now available for children with, real growth disorders have caused a great diminuition of children's suffering and psychological disorientation. This side of auxology has seen great advances. So indeed has the other side, that of monitoring populations and subpopulations. Here the objective is to locate the disadvantaged groups of the population and recommend, not treatment of individuals, but alterations of the public health or even political variety: better sanitation, better roads perhaps, less lethal factories, better provision of maternal and child care and so on. This use of auxology goes back to two great pioneers of Public Health: Louis-Réné Villermé in France and simultaneously Edwin Chadwick in England. Villermé was a doctor whose concern for the suffering underdogs of society was nurtured by service in Napoleon's army in the war of the Spanish Peninsula (or, of Spanish Independence), that was described so accurately in Goya's horrific etchnigs. Chadwick was an administrator, no less horrified by the inhuman conditions of child labour in the textile factories of northern England. It was Villermé who first (in 1829) established the relation between the height of young adults (Army Conscripts of 1812—13) and the socio-economic circumstances of their childhood (he classified the arrondissementes of Paris according to the percentage of homes owned by the persons who lived in them). Villermé never studied children's growth, but Chadwick, in 1833, actually organized the first survey of children's heights specifically made for the purpose of demonstrating the poor conditions of work through the shortness of the children employed in that work. Nearly 2000 girls and boys aged 9 to 18 were measured. The result was striking indeed. The mean heights of the 1833 boys at age 9 was at the modem 3rd centile and all subsequent means were below the 3rd centile. Even the most disadvantaged children of the Third World are nearly all taller than that nowadays. From that time till today there is an unbroken tradition of population monitoring. The first comprehensive survey of schoolchildren's growth was made in the 1870's by Henry Bowditch, Professor of physiology at Harvard, who discovered that girls were normally, on average, taller than boys over the age range 11 to 13 or thereabouts. Since the received opinion, stemming from an error made by the great Belgian star, Quetelet, was exactly the opposite, this was a very important result and led to the understanding that girls were ahead of boys in rate of maturing. That particular finding led to the creation of methods for measuring what is called tempo of growth, notably by skeletal maturity or bone age. Two recent developments in this have a local and personal interest. Professor Eibens Hungarian survey included the largest number of bone ages ever done in Europe and seems likely to become the European standard; and my own development of an image analysis computer system for assigning bone age will make the task of analysing his huge material immeasureably easier. Some countries, such as Holland, carry out nation-wide surveys at about 10 year intervals. In the UK there has been since 1972 a continuous surveillance program, also nation-wide, though now only of children aged 5 to 11, in primary schools. In such a system the results are reported to government every six months, giving a swift feedback following policy changes. Disadvantaged groups of the population are specifically 4