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COMPULSORY MATRIMONY IN TURKEY.
THE PATHOLOGY OF BLACKWATER FEVER.
In 24 patients with acholuric jaundice, Meulengracht found that haemolysis began at 0-76-0-60 per cent. (one case 0-88 and one case 0-56) and was complete at 0-44-0-32 per cent., the average point for half haemolysis being 0-49 per cent. NaCl. In the examinations on five patients from whom the spleen had been removed from one week to eight months previously, haemolysis began at 0-62-0-56 per cent., and was complete at 0-36-0-32 per cent., the average 0-49 per cent. NaCl. point for half haemolysis being In acholuric jaundice there is a much wider range of variation and the greatest change is in the concentration of sodium chloride at which haemolysis begins, than this.
and the least change in the concentration at which it is complete. The average mid-point is considerably raised. The third group of figures shows conclusively that although splenectomy produces brilliant clinical results, the fragility of the red cells does not return to normal. Indeed, there is little change in the mid-point and end-point, but the haemolysis does not start at such abnormally high concentrations. We have found these same facts to be true in two cases seen recently more than a year after splenectomy. This throws considerable light on the aetiology. Operation results suggested that the spleen was the organ essentially at fault, but as the red cells do not become normal after splenectomy, it is more probable that the primary factor in the disease is an abnormality of the red cells. The other point of great interest about the disease is its inheritance. From the families whose histories Meulengracht has collected, he concluded that the disease is transmitted from parent to child, as a dominant character in the Mendelian sense of the word. This means that a healthy parent cannot transmit the disease, and though this seems to be the general rule, exceptions have been noted in this country. Perhaps no family has yet been under observation for long enough to allow dogmatism about this point. THE PATHOLOGY OF BLACKWATER FEVER. IN a critical review1 of Recent Work on the Pathology of Blackwater Fever, Prof. Warrington Yorke points out that communications dealing with blackwater fever can be grouped under four headings : 1. Papers of an essentially clinical nature written by those visiting the tropics for the first time, whose interest has been aroused by this impressive disease. Their observations and impressions simply repeat what has been abundantly emphasised during the past 20 years. 2. Papers, mainly concerned with the endemicity of the disease, attempting to show by statistics the relationship between malaria or various kinds of malaria infection, and quinine, or length of sojourn in the tropics. These statistics are usually deficient in one 3. Papers dealing mainly with the or more essentials. treatment of the disease. Yorke considers that in the main these are without any value, and the claims made quite unjustifiable. 4. Papers dealing with the pathology of the disease. One of the most important of these is by Plehn (1920), who argues that owing to repeated destruction of the parasites during the febrile attacks, the body becomes supersensitive to the malaria parasite protein, so that eventually the dissolution of quite a small number of these organisms may precipitate the crisis. In most cases the decisive cause of this destruction is quinine. Plehn obtained no evidence that haemolysis takes place in the bloodstream, neither is hsemolysin found in the blood of blackwater fever patients. The evidence points to the kidneys as the seat of haemolysis, but the origin of the cylindrical plugs in the renal tubules is not clear. The inability to excrete bilirubin is important, as in the most severe icterus this substance is present in the blood serum. With regard to the production of jaundice, the evidence is not clear ; in the worst cases the blood destruction is so great as to result in death without the supervention of icterus. Authorities are divided as to whether a hsemoglobinaemia occurs in 1 Tropical Diseases Bulletin, vol. xix., No. 8, October, 1922
1137
blackwater. Christophers and Bentley, Barratt and Yorke are of the opinion that it does occur, and L. S. Dudgeon (1920) remarks that the evidence of haemoglobinsemia rapidly disappears from the blood and may be overlooked unless the examination is made at the correct moment. There appears to be no justification for the general statement that the specific gravity of the urine in blackwater fever is abnormally low. The bulk of pathological and experimental evidence is against Plehn’s theory of a primary renal lesion with hasmoglobinuria as a secondary phenomenon. Nothing is known about the mechanism by which the haemolysis in blackwater is produced; in the case of paroxysmal hsemoglobinuria haemolysis takes place in the peripheral blood and cold is the exciting cause ; no autolysin has been found in the blood of blackwater fever.
COMPULSORY
MATRIMONY IN TURKEY.
THE Joul’nal des Debats, one of the most highly esteemed daily papers of France, is our authority for stating that the Turkish National Assembly is so anxious in regard to the population of the New Turkey, now in course of formation, that it is preparing a law to render matrimony a duty which, like a compulsory military service, must be enforced on all. No conscientious objectors will be tolerated. If a man reaches the age of 25 then the police will take note of him and medical authorities will examine him ; if he is physically fit, marry he must ; if he refuses, he will be treated as a deserter, deprived of all his civil rights and emplcyment. If he has private means a quarter of the amount will be taken and given to the poor. Thus celibacy becomes an article of luxury, confined to those who can sacrifice a quarter of their income. If a recalcitrant husband seeks to avoid his obligations by travelling he must obtain a special permission ; and, if he remains away too long, then he must marry a second time and bring his second wife home when he returns. Here we have a law enforcing not only matrimony but bigamy, the repopulation of Turkey being the one and only social duty recognised. If a man has performed his obligations to the State by keeping a wife for 25 years, should he then become a widower, he will not be absolutely forced to marry again ; but, in that case, he must adopt one or more orphans. The one exception to the general compulsion on the male population to assume marital and parental responsibilities is that of the student ; he may postpone his marriage till he has finished his studies. From one point of view the proposed legislation is sound ; it insists on medical examination, and should, therefore, prevent the compulsory marriage of the unfit.
SCHOOL ABSENCE ON ACCOUNT OF SICKNESS. A PRELIMINARY survey of 3786 children in the State of Missouri has been analysed by Dr. S. D. Collins, of the U.S. Public Health Service. Total attendances possible, absences due to sickness, and absences from other causes were recorded. With the exception of the 11 cases of trachoma the disorders and defects are very similar to those found among English children. A comparison was made of the amount of absence from school of children with no physical defect as against children with recorded physical defect. The numbers have been classified, quite correctly, into sex and age groups, but as all the observations are on the same children, for the sake of brevity the totals may be considered. Percentage absence from sickness is stated after each group, and absence from other Total absences were, causes placed in brackets. boys 3-3 (2-7), girls 3-6 (2-2), the difference mainly being due to the adenoid and tonsil group, boys 3-8 (2-5), girls 4-7 (2-4). Again taking all children, the percentage absence of those with no recorded defect was 3-2 (1-8), with defects of any kind 3-9 (2-8), with one or more decayed teeth 3-3 (2-4), with defective
In 24 patients with acholuric jaundice, Meulengracht found that haemolysis began at 0-76-0-60 per cent. (one case 0-88 and one case 0-56) and was complete at 0-44-0-32 per cent., the average point for half haemolysis being 0-49 per cent. NaCl. In the examinations on five patients from whom the spleen had been removed from one week to eight months previously, haemolysis began at 0-62-0-56 per cent., and was complete at 0-36-0-32 per cent., the average 0-49 per cent. NaCl. point for half haemolysis being In acholuric jaundice there is a much wider range of variation and the greatest change is in the concentration of sodium chloride at which haemolysis begins, than this.
and the least change in the concentration at which it is complete. The average mid-point is considerably raised. The third group of figures shows conclusively that although splenectomy produces brilliant clinical results, the fragility of the red cells does not return to normal. Indeed, there is little change in the mid-point and end-point, but the haemolysis does not start at such abnormally high concentrations. We have found these same facts to be true in two cases seen recently more than a year after splenectomy. This throws considerable light on the aetiology. Operation results suggested that the spleen was the organ essentially at fault, but as the red cells do not become normal after splenectomy, it is more probable that the primary factor in the disease is an abnormality of the red cells. The other point of great interest about the disease is its inheritance. From the families whose histories Meulengracht has collected, he concluded that the disease is transmitted from parent to child, as a dominant character in the Mendelian sense of the word. This means that a healthy parent cannot transmit the disease, and though this seems to be the general rule, exceptions have been noted in this country. Perhaps no family has yet been under observation for long enough to allow dogmatism about this point. THE PATHOLOGY OF BLACKWATER FEVER. IN a critical review1 of Recent Work on the Pathology of Blackwater Fever, Prof. Warrington Yorke points out that communications dealing with blackwater fever can be grouped under four headings : 1. Papers of an essentially clinical nature written by those visiting the tropics for the first time, whose interest has been aroused by this impressive disease. Their observations and impressions simply repeat what has been abundantly emphasised during the past 20 years. 2. Papers, mainly concerned with the endemicity of the disease, attempting to show by statistics the relationship between malaria or various kinds of malaria infection, and quinine, or length of sojourn in the tropics. These statistics are usually deficient in one 3. Papers dealing mainly with the or more essentials. treatment of the disease. Yorke considers that in the main these are without any value, and the claims made quite unjustifiable. 4. Papers dealing with the pathology of the disease. One of the most important of these is by Plehn (1920), who argues that owing to repeated destruction of the parasites during the febrile attacks, the body becomes supersensitive to the malaria parasite protein, so that eventually the dissolution of quite a small number of these organisms may precipitate the crisis. In most cases the decisive cause of this destruction is quinine. Plehn obtained no evidence that haemolysis takes place in the bloodstream, neither is hsemolysin found in the blood of blackwater fever patients. The evidence points to the kidneys as the seat of haemolysis, but the origin of the cylindrical plugs in the renal tubules is not clear. The inability to excrete bilirubin is important, as in the most severe icterus this substance is present in the blood serum. With regard to the production of jaundice, the evidence is not clear ; in the worst cases the blood destruction is so great as to result in death without the supervention of icterus. Authorities are divided as to whether a hsemoglobinaemia occurs in 1 Tropical Diseases Bulletin, vol. xix., No. 8, October, 1922
1137
blackwater. Christophers and Bentley, Barratt and Yorke are of the opinion that it does occur, and L. S. Dudgeon (1920) remarks that the evidence of haemoglobinsemia rapidly disappears from the blood and may be overlooked unless the examination is made at the correct moment. There appears to be no justification for the general statement that the specific gravity of the urine in blackwater fever is abnormally low. The bulk of pathological and experimental evidence is against Plehn’s theory of a primary renal lesion with hasmoglobinuria as a secondary phenomenon. Nothing is known about the mechanism by which the haemolysis in blackwater is produced; in the case of paroxysmal hsemoglobinuria haemolysis takes place in the peripheral blood and cold is the exciting cause ; no autolysin has been found in the blood of blackwater fever.
COMPULSORY
MATRIMONY IN TURKEY.
THE Joul’nal des Debats, one of the most highly esteemed daily papers of France, is our authority for stating that the Turkish National Assembly is so anxious in regard to the population of the New Turkey, now in course of formation, that it is preparing a law to render matrimony a duty which, like a compulsory military service, must be enforced on all. No conscientious objectors will be tolerated. If a man reaches the age of 25 then the police will take note of him and medical authorities will examine him ; if he is physically fit, marry he must ; if he refuses, he will be treated as a deserter, deprived of all his civil rights and emplcyment. If he has private means a quarter of the amount will be taken and given to the poor. Thus celibacy becomes an article of luxury, confined to those who can sacrifice a quarter of their income. If a recalcitrant husband seeks to avoid his obligations by travelling he must obtain a special permission ; and, if he remains away too long, then he must marry a second time and bring his second wife home when he returns. Here we have a law enforcing not only matrimony but bigamy, the repopulation of Turkey being the one and only social duty recognised. If a man has performed his obligations to the State by keeping a wife for 25 years, should he then become a widower, he will not be absolutely forced to marry again ; but, in that case, he must adopt one or more orphans. The one exception to the general compulsion on the male population to assume marital and parental responsibilities is that of the student ; he may postpone his marriage till he has finished his studies. From one point of view the proposed legislation is sound ; it insists on medical examination, and should, therefore, prevent the compulsory marriage of the unfit.
SCHOOL ABSENCE ON ACCOUNT OF SICKNESS. A PRELIMINARY survey of 3786 children in the State of Missouri has been analysed by Dr. S. D. Collins, of the U.S. Public Health Service. Total attendances possible, absences due to sickness, and absences from other causes were recorded. With the exception of the 11 cases of trachoma the disorders and defects are very similar to those found among English children. A comparison was made of the amount of absence from school of children with no physical defect as against children with recorded physical defect. The numbers have been classified, quite correctly, into sex and age groups, but as all the observations are on the same children, for the sake of brevity the totals may be considered. Percentage absence from sickness is stated after each group, and absence from other Total absences were, causes placed in brackets. boys 3-3 (2-7), girls 3-6 (2-2), the difference mainly being due to the adenoid and tonsil group, boys 3-8 (2-5), girls 4-7 (2-4). Again taking all children, the percentage absence of those with no recorded defect was 3-2 (1-8), with defects of any kind 3-9 (2-8), with one or more decayed teeth 3-3 (2-4), with defective