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1269 UNITED STATES OF AMERICA.-SCOTLAND health.-Lord SNELL in responding remarked (with intentional bluntness), " You came here to hear about the medical profession ; well, you are going to hear about it," and speaking as part of the raw material without which doctors could not live at all he told them what the patients thought of them. He went on to express his warm recognition of what the administrative staff of our public bodies do for the community. These bodies are the guardians of the nation’s health and it is the doctors who give them the assurance they need. The municipality which neglects their advice is gambling on the future. When anything goes wrong it is the doctor who is blamed, when it may well be that what has happened is the result of his advice not having been taken.- The company adjourned early to dancing and cabaret. UNITED STATES OF AMERICA (FROM OUR OWN CORRESPONDENT) TREATMENT OF PNEUMONIA THE committee on public health relations of the New York Academy of Medicine have just issued a report on " Community provision for the serum treatment of pneumococci pneumonia." They point out that specific serum therapy for pneumonia is making its way slowly and suggest as reasons for delay : (1) the lingering of the dictum that the disease is self-limited ; (2) hesitation on the part of general practitioners to employ serum intravenously ; (3) the difficulty in obtaining serums and their high cost ; (4) lack of facilities for the differentiation of pneumo- cocci ; (5) failure on the part of health authorities, except in New York, Massachusetts, and several other communities, to recognise the communicable character of the pneumonias, and to urge appropriations for the free distribution of the antipneumococcus serum. The average number of pneumonia cases in New York City during the last few years has been 26,000 per annum, and the committee estimate that about 10,000 per annum would be benefited by specific serum therapy. They recall that New York State prepared type I serum for general distribution in 1915 and in 1917 included sputum-typing among the procedures that must be undertaken by labora- tories wishing to qualify for State approval. An intensive study carried on in Massachusetts from 1931 to 1935, with financial aid from the Common- wealth Fund, paved the way for an effective plan of administrative organisation. The use of serum requires expert knowledge. The committee recommend a consulting service in the health department under a physician well trained in the technique of serum therapy. Since the effective- ness of serum depends upon its early administration facilities for rapid free diagnostic laboratory service should be provided. They recommend further that pneumonia patients treated in hospitals should be properly " segregated and cubicled." Pneumonia should be treated as an emergency and the admission policy and the service policy for pneumonia cases should be on the same basis as for surgical emer- gencies. The full report will be found- in the Bulletin of the New York Academy of Medicine for October and in the Journal of the American Medical Associa- tion for Oct. 23rd. WHEN IS A FEVER SCARLET A paper read to the epidemiology section of the American Public Health Association by E. L. Stebbins, Eel S. Ingraham, and Elizabeth Reed, all of the New York State department of health, described seven milk-borne epidemics, three of them classified as " scarlet fever" and four as "septic sore-throat." Six of the seven epidemics were traced to strepto- coccal mastitis in members of the producing herds. In five cases a history strongly suggestive of strepto- coccal infection in milk-handlers, antedating the bovine infection, was also obtained. In the one case where no mastitis was found in the producing herd the milk had been bottled by a man with a sore- throat. All of the milk involved was raw. The only observable clinical distinction between " septic sore-throat " and " scarlet fever " in the victims of these seven epidemics was that in 60 per cent. of cases classified as scarlet fever there was seen a rash almost always followed by desquamation. Complications were similar in nature and frequency in both classes. The authors observe also that the cases in all epidemics would clinically be indistin- guishable (except for the rash) from cases which in the absence of any epidemic are usually diagnosed as severe tonsillitis. A previous attack of scarlet fever appeared to have given no immunity to subsequent streptococcal infection but it did confer a relative immunity to the skin manifestations of streptococcal infection. Stebbins and his colleagues were too cautious to suggest-though at least. one member of their audience could not help reflecting-that their observations tend to cast doubt upon the value of active immunisation against scarlet fever by the present accepted method. RESIGNATION OF HON. JOSEPHINE ROCHE Few will disagree with Surgeon-General Parran when he says that " with the resignation of Assistant Secretary Roche, the Government loses its ablest and most sincere advocate of public health." The resig- nation was accepted by President Roosevelt on Oct. 28th " with the greatest reluctance." At the same time Secretary of the Treasury Morgenthau announced that her post would be held open for her for an indefinite period in the hope that she would find it possible to return. She became assistant secretary of the Treasury in November, 1934, being the first woman to hold this office. Assigned to take charge of the United States public health service, she was appointed to serve on the President’s cabinet committee on economic security, and took an impor- tant part in the formulation of the social security programme as a whole. Her resignation is said to be dictated by the need of her personal supervision of the affairs of the Rocky Mountain Fuel Company of which she was formerly president. SCOTLAND (FROM OUR OWN CORRESPONDENT) DIET AND DYSPEPSIA IN the fifth of the series of Honyman Gillespie lectures delivered to post-graduates in Edinburgh Dr. John D. Comrie said that epithelial degeneration, especially of the alimentary tract, due to lack of vitamin A is often a cause of dyspepsia. The vitamin-B complex contained in cabbage, tomato, and other vegetables has a positive value in diabetes since it helps in oxidation, especially of carbohydrates. It has been shown experimentally, and in north Russia in practice, that sour milk is a most valuable

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1269UNITED STATES OF AMERICA.-SCOTLAND

health.-Lord SNELL in responding remarked (withintentional bluntness), " You came here to hearabout the medical profession ; well, you are going tohear about it," and speaking as part of the rawmaterial without which doctors could not live at allhe told them what the patients thought of them.He went on to express his warm recognition of whatthe administrative staff of our public bodies do forthe community. These bodies are the guardiansof the nation’s health and it is the doctors who givethem the assurance they need. The municipalitywhich neglects their advice is gambling on the future.When anything goes wrong it is the doctor who is

blamed, when it may well be that what has happenedis the result of his advice not having been taken.-The company adjourned early to dancing andcabaret.

UNITED STATES OF AMERICA

(FROM OUR OWN CORRESPONDENT)

TREATMENT OF PNEUMONIA

THE committee on public health relations of theNew York Academy of Medicine have just issued areport on " Community provision for the serumtreatment of pneumococci pneumonia." They pointout that specific serum therapy for pneumonia ismaking its way slowly and suggest as reasons for

delay : (1) the lingering of the dictum that the diseaseis self-limited ; (2) hesitation on the part of generalpractitioners to employ serum intravenously ; (3) thedifficulty in obtaining serums and their high cost ;(4) lack of facilities for the differentiation of pneumo-cocci ; (5) failure on the part of health authorities,except in New York, Massachusetts, and several othercommunities, to recognise the communicable characterof the pneumonias, and to urge appropriations for thefree distribution of the antipneumococcus serum.The average number of pneumonia cases in New

York City during the last few years has been 26,000per annum, and the committee estimate that about10,000 per annum would be benefited by specificserum therapy. They recall that New York Stateprepared type I serum for general distribution in1915 and in 1917 included sputum-typing amongthe procedures that must be undertaken by labora-tories wishing to qualify for State approval. Anintensive study carried on in Massachusetts from1931 to 1935, with financial aid from the Common-wealth Fund, paved the way for an effective plan ofadministrative organisation.The use of serum requires expert knowledge. The

committee recommend a consulting service in thehealth department under a physician well trained inthe technique of serum therapy. Since the effective-ness of serum depends upon its early administrationfacilities for rapid free diagnostic laboratory serviceshould be provided. They recommend further thatpneumonia patients treated in hospitals should beproperly " segregated and cubicled." Pneumoniashould be treated as an emergency and the admissionpolicy and the service policy for pneumonia casesshould be on the same basis as for surgical emer-gencies. The full report will be found- in the Bulletinof the New York Academy of Medicine for Octoberand in the Journal of the American Medical Associa-tion for Oct. 23rd.

WHEN IS A FEVER SCARLET

A paper read to the epidemiology section of theAmerican Public Health Association by E. L. Stebbins,

Eel S. Ingraham, and Elizabeth Reed, all of the NewYork State department of health, described sevenmilk-borne epidemics, three of them classified as

" scarlet fever" and four as "septic sore-throat."Six of the seven epidemics were traced to strepto-coccal mastitis in members of the producing herds.In five cases a history strongly suggestive of strepto-coccal infection in milk-handlers, antedating thebovine infection, was also obtained. In the one casewhere no mastitis was found in the producing herdthe milk had been bottled by a man with a sore-throat. All of the milk involved was raw.The only observable clinical distinction between

" septic sore-throat " and " scarlet fever " in thevictims of these seven epidemics was that in 60 percent. of cases classified as scarlet fever there wasseen a rash almost always followed by desquamation.Complications were similar in nature and frequencyin both classes. The authors observe also that thecases in all epidemics would clinically be indistin-guishable (except for the rash) from cases which in theabsence of any epidemic are usually diagnosed as

severe tonsillitis. A previous attack of scarlet feverappeared to have given no immunity to subsequentstreptococcal infection but it did confer a relative

immunity to the skin manifestations of streptococcalinfection. Stebbins and his colleagues were toocautious to suggest-though at least. one member oftheir audience could not help reflecting-that theirobservations tend to cast doubt upon the value ofactive immunisation against scarlet fever by thepresent accepted method.

RESIGNATION OF HON. JOSEPHINE ROCHE

Few will disagree with Surgeon-General Parranwhen he says that " with the resignation of AssistantSecretary Roche, the Government loses its ablest andmost sincere advocate of public health." The resig-nation was accepted by President Roosevelt on

Oct. 28th " with the greatest reluctance." At thesame time Secretary of the Treasury Morgenthauannounced that her post would be held open for herfor an indefinite period in the hope that she wouldfind it possible to return. She became assistant

secretary of the Treasury in November, 1934, beingthe first woman to hold this office. Assigned to takecharge of the United States public health service,she was appointed to serve on the President’s cabinetcommittee on economic security, and took an impor-tant part in the formulation of the social securityprogramme as a whole. Her resignation is said tobe dictated by the need of her personal supervisionof the affairs of the Rocky Mountain Fuel Company ofwhich she was formerly president.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

DIET AND DYSPEPSIA

IN the fifth of the series of Honyman Gillespielectures delivered to post-graduates in EdinburghDr. John D. Comrie said that epithelial degeneration,especially of the alimentary tract, due to lack ofvitamin A is often a cause of dyspepsia. The vitamin-Bcomplex contained in cabbage, tomato, and other

vegetables has a positive value in diabetes sinceit helps in oxidation, especially of carbohydrates.It has been shown experimentally, and in northRussia in practice, that sour milk is a most valuable

Page 2: SCOTLAND

1270 AUSTRALASIA

source of vitamin C and is very efficacious in the treat-ment of scurvy. Only recently has the importanceof vitamins in the treatment of gastro-intestinalulceration been realised. Dr. Comrie pointed outthat variations of tolerance to articles of diet are dueto variations in body chemistry and to psychologicalfactors. Though starvation for a short period is notharmful, prolonged starvation leads to loss of weightand efficiency and to poor digestion. Many normalpeople do not drink enough water, but excessivefluid intake, as in excessive beer-drinking, leads towater-logging, flabbiness, and general inefficiency.A census of the weights of females admitted to theRoyal Infirmary showed that 30 per cent. were grosslyover-nourished-probably owing to a small dailyexcess combined with want of exercise. Too frequentmeals, unhealthy mouths, and constipation are verycommon causes of gastritis and indigestion.

Dr. Comrie said that investigations at the MayoClinic show that acid secretion in the stomachincreases up to the age of forty, after which it fallsoft, while after sixty there is complete achlorhydriain 1 person out of 4. Achlorhydric patients are tobe regarded as candidates for anaemia, either hypo-chromic or hyperchromic, and for carcinoma of thestomach. Subnormal HC1 leads to slow digestion andmild dyspepsia ; hyperchlorhydria leads to indigestionof the well-known type and to ulceration. Fractionaltest-meals have shown that belladonna does notdiminish hypersecretion but merely delays it.

Dyspepsia due to chronic cholecystitis and gall-stones is most commonly found in over-nourishedmiddle-aged females.

AUSTRALASIA

(FROM OUR OWN CORRESPONDENT)

INFANT MORTALITY-RATE IN ADELAIDE

DURING the year ended March 3lst, 1937, Adelaidehas established a world record for a low infant

mortality-rate ; this figure, 23 per 1000 births, showsa remarkable improvement on the lowest figure forthe previous nine years, which was 55 per 1000

births, and is possibly a freak rate. New Zealand,the previous holder of the world record, last yearhad an infant death-rate of 32-15. South Australia’s

figures for the same year were 31-1, and the Queens-land rate was 36-2. It is believed here that the lowmortality-rate in Adelaide is partly due to the

emphasis placed on the provision of a sufficient

supply of milk for expectant mothers in necessitouscircumstances. An additional daily pint and a halfof milk is provided, where necessary, by the SouthAustralian Government. An educational campaign iscarried out by the Mother’s and Baby’s HealthAssociation of South Australia, an organisation whichalso arranges for adequate supervision of expectantmothers.The bituminisation of the highways is held to be

partly responsible for the diminution in frequencyof serious epidemics of summer diarrhoea. The flynuisance is less evident since the decrease in recentyears in the numbers of horses and stables. Closesupervision of the milk-supply by the MetropolitanCounty Board under the Food and Drugs Act, theefficiency of the many maternity homes, and thework of the local boards of health have all contributedto this happy result in South Australia. In viewof the rapidly falling birth-rate in Australia thereduction in the infant mortality-rate is heartening.

MEDICAL BOARD OVER-RULED BY COURT

An interesting legal point was raised in Melbournein July of this year when a decision of the MedicalBoard of Victoria, whereby a German doctor wasrefused registration, was over-ruled by a StateCourt.The applicant for registration, Dr. Moritz Meyer,

had practised in Germany as a surgeon and physicianuntil October, 1935. He had been obliged to leavethe country because of restrictions placed by theGovernment on the practice of medicine by personsof non-Aryan descent. At the time of his departurehe was a doctor of medicine at the University ofLeipzig and had since April, 1920, practised medicineand surgery in hospitals in Berlin and Dresden. Hehad also practised privately in Dresden. After his

departure from Germany he had gone to Scotlandand taken the triple qualification by examination.He had been told that his qualifications entitled himto registration in Victoria and so had decided topractise his profession there. The Medical Board ofAustralia based its refusal of registration on thegrounds that the evidence of the required courses ofstudy was inadequate, and that recognition of a

course in a foreign university, school of medicine, orcollege was expressly forbidden. Dr. Meyer placedhis case in the hands of the State Court, whichdecided that he was entitled to registration and aqualification from the Medical Board of Victoria.The Board proposes to contest the issue on thegrounds that the Court is not empowered to over-ruleits decision.

THE MYSTERY OF GROWTH

Given a normal pituitary and thyroid function,with a proper supply of vitamin B, amino-acids,ample food-supply, and physical exercise during theyears between five and twenty, the stature of a racemay be increased to the optimum of Greek per-fection. This statement was the keynote of the SirCharles Clubbe Memorial oration delivered at the

University of Sydney by Prof. J. C. Meakins, professorof medicine at McGill University. Prof. Meakinscame to Australia at the invitation of the New SouthWales Post-graduate Committee, but during hisvisit other States invited him to give lectures. Prof.Meakins said that in his opinion stature was influencedto a far greater extent by environment than byheredity. The most important factors in environ-ment were physical activity, the character and qualityof the food-supply, and the effects of parasitic andother diseases. Height was not necessarily a sign ofsuperiority. Shorter races might be equal to tallones in physical endurance and mental capacity.The consumption of milk, milk products, and meatdiffered with striking significance in races of varyingstature. The increased growth of Chinese childrenwho had migrated to Hawaii was attributable to theimprovement in their diet.

FATAL HYPERTHERMIA FOR GONORRJKEA

The conduct of a hospital at Napier, New Zealand,was recently investigated by a Royal Commission.The method of hyperthermia treatment developed atthe Mayo Clinic was used during an outbreak ofvulvo-vaginitis among the children of the hospital,although no proper hypertherm equipment was

available, nor did the hospital possess any means ofadequate control of the temperature. Hot baths, ata temperature of 100° to 108° F. continuing for aweek, were ordered for the affected children by amember of the honorary staff. The temperature of