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GOITRE IN NEW ZEALAND.
768
Puja, or ritual of the goddess of small-pox, excluded visitors, prohibited the sale of milk, forbade members of the family to attend public functions, and ordained a fire of resin, camphor, and sandalwood at the door of
the
room. Vaccination of contacts small and inconsiderable addition if part of the religious obligation.
patient’s
would be introduced
a as
GOITRE
which stipulates that iodised salt must contain one part of potassium iodide in 250,000 parts of salt. The use of this salt, however, is as yet largely confined to the table, and Prof. Hercus is in favour of the compulsory iodising of all cooking and table salt introduced into the country. The minimum amount for the functional requirements of the thyroid gland appears to be 0-005 mg. of iodine per day, and this quantity is considered to be far too small to be a factor in the production of hyperthyroidism. The amount of salt consumed either in cooked foods or directly as a condiment varies so greatly with individual or skilled taste that it may be found difficult in practice to ensure that each person gets enough and not too much extra iodine. But in a country where about one child out of every three has a goitre, it is probably worth giving this convenient form of universal administration a prolonged trial.
IN NEW ZEALAND. is well known to be prevalent in New goitre Zealand, and toxic goitre occurs sufficiently often to present a difficult problem. During the past few years we have had occasion to notice several articles on the aetiology and prevention of goitre emanating from the medical school of the University of Otago ; five of these have now been collected in a " Goitre Number " of the Proceedings of this Medical Schoo1,1 under the editorship of Prof. D. W. Carmalt-Jones. Most of the work done has been concerned with simple goitre. There are at least half a dozen theories current purporting to account for the occurrence of endemic goitre : faecal contamination of water, radio-activity of water, salts dissolved in drinking water, general diet, geological formation, and iodine deficiency in diet. The last of these, and in a special sense the geological formation, appear to be the essential causes of the endemic goitre in New Zealand. This is well brought out in an exhaustive survey by Prof. C. E. Hercus, Prof. W. N. Benson, and Mr. C. L. Carter, who, as bacteriologist, geologist, and chemist respectively, studied goitre in the whole country. The percentage ,of goitre among school-children was taken as a basis, and these authors divided the Dominion into 33 .districts, each as far as possible homogeneous in its geological and physiographical circumstances. The average amount of iodine in the soil and the average incidence of goitre among school-children within each district were then ascertained, standard methods of soil-analysis and diagnosis of goitre being applied. Roughly the incidence of the disease was found to be inversely proportional to the amount of iodine in the soil and an actual formula of the relationship could be defined : " percentage of incidence of goitre among school-children is equal to 6 plus the quotient of 60 divided by the amount of iodine in ten million parts of soil, so long as this does not exceed 50." ’The conclusion reached is that " though there are certain points unexplained, the whole body of facts is too large, and the relationship too consistent, to be fortuitous." This work on the aetiology of the disease is separated from a discussion on prophylactic measures by an informative paper by C. E. Hercus and K. C. Roberts on the iodine content of certain foodstuffs. Here some important results are recorded. It is shown that soil-iodine is accurately reflected in food-iodine, that there is a definite difference in the daily iodine intake in the food-supply of typical goitrous and non-goitrous districts, that commercial salt is an unreliable source of iodine-supply, and that the iodine content of human milk in the goitrous woman is lower than in the non-goitrous. These facts having been established, prevention still remains fraught with difficulties. According to Prof. Hercus the greatest of these is the danger which attends the indiscriminate use of iodine in a community containing a large number of people with potentially toxic goitres. The problem is to supply the iodine deficiency in a universal, simple, and harmless manner. This could be done by increasing the use of foods rich in iodine or, since the initial deficiency lies in the soil, by using iodine-rich manures. In practice, however, there are objections to both these methods, and the two measures in vogue consist in giving iodine in medicinal form to school-children and in adding iodine to some article of diet in universal use throughout the country. Extensive medicinal treatment of school-children has given highly satisfactory results in New Zealand with no untoward effects, but this method of prophylaxis is too limited in scope to
SIMPLE
1 No. 5.
1928.
Published by Budget, Ltd., Dunedin, N.Z.
acceptable as a national scheme. The preparation of iodised salt has therefore come to be regarded as the method of choice. In 1924 the Department of Health introduced into the Food and Drugs Act a definition be
____
PRESERVATIVES IN FOOD. THE use of boric acid in food was the subject of an address delivered before the Edinburgh Rotary Club a few days ago by Dr. Andrew Rutherford, lecturer in pathology at the Edinburgh Medical School. The public mind had, he said, been made anxious by accounts in the press of illness arising from alleged food poisoning, coupled with the suggestion made by a distinguished chemist that the prohibition of boric acid as a food preservative had brought a definite risk to the community " because it limits the period during which food can be kept free from contamination." But, said Dr. Rutherford, attacks of food poisoning had not been more frequent of late than in former years; actually fewer outbreaks had occurred this year than previously, and none at all in Scotland-they had merely received more press publicity. The causes of food poisoning had been known for many years ; they were specific disease-producing germs which become implanted in food, stale or fresh. The illnesses they brought about were neither new nor mysterious to pathologists or to the medical advisers of the Government. They had nothing whatsoever to do with the presence or absence of weak chemicals like boric acid as preservatives in food ; no chemist, however distinguished, could competently express an opinion on the broad question of food preservatives in relation to disease. That was the domain of physicians, pathologists, and public health experts. Ptomaine poisoning in man, Dr. Rutherford reminded his hearers, was in fact exceedingly rare ; the vast majority of cases of food poisoning were due to living specific microbes which in various ways might become implanted on food or drink. Small quantities of boric acid would neither prevent the access of those germs nor kill them if they were present. Food such as sausages and pork pies, containing preservatives, had often been associated with acute gastro-enteritis. A preservative might keep food looking fresh and smelling fresh when dangerous microbes were growing in it. Certainly boric acid would keep it, in the popular phrase, " free from taint," but in doing so might mask a far greater danger than mere taint. Generally speaking, food was handled in this country with far too little regard to the possibilities of contamination, and much stricter cleanliness than obtained at present was desirable in the handling, storage, and cooking of food. The recent regulations dealing with preservatives tended to lessen and not to increase food poisoning outbreaks. The Meat Inspection Regulations and the Milk and Dairies Acts - irksome as they might be at times to traders-served a similar purpose. Wherever food was kept or cooked the utmost efforts should be made to prevent the access of flies, mice, or rats. Milk should be pasteurised and cold storage provided. Employees who handled or cooked food in large concerns like bakeries, hotels, restaurants, and clubs, should be proved not to be carriers of the typhoid or food-poisoning germs before
Puja, or ritual of the goddess of small-pox, excluded visitors, prohibited the sale of milk, forbade members of the family to attend public functions, and ordained a fire of resin, camphor, and sandalwood at the door of
the
room. Vaccination of contacts small and inconsiderable addition if part of the religious obligation.
patient’s
would be introduced
a as
GOITRE
which stipulates that iodised salt must contain one part of potassium iodide in 250,000 parts of salt. The use of this salt, however, is as yet largely confined to the table, and Prof. Hercus is in favour of the compulsory iodising of all cooking and table salt introduced into the country. The minimum amount for the functional requirements of the thyroid gland appears to be 0-005 mg. of iodine per day, and this quantity is considered to be far too small to be a factor in the production of hyperthyroidism. The amount of salt consumed either in cooked foods or directly as a condiment varies so greatly with individual or skilled taste that it may be found difficult in practice to ensure that each person gets enough and not too much extra iodine. But in a country where about one child out of every three has a goitre, it is probably worth giving this convenient form of universal administration a prolonged trial.
IN NEW ZEALAND. is well known to be prevalent in New goitre Zealand, and toxic goitre occurs sufficiently often to present a difficult problem. During the past few years we have had occasion to notice several articles on the aetiology and prevention of goitre emanating from the medical school of the University of Otago ; five of these have now been collected in a " Goitre Number " of the Proceedings of this Medical Schoo1,1 under the editorship of Prof. D. W. Carmalt-Jones. Most of the work done has been concerned with simple goitre. There are at least half a dozen theories current purporting to account for the occurrence of endemic goitre : faecal contamination of water, radio-activity of water, salts dissolved in drinking water, general diet, geological formation, and iodine deficiency in diet. The last of these, and in a special sense the geological formation, appear to be the essential causes of the endemic goitre in New Zealand. This is well brought out in an exhaustive survey by Prof. C. E. Hercus, Prof. W. N. Benson, and Mr. C. L. Carter, who, as bacteriologist, geologist, and chemist respectively, studied goitre in the whole country. The percentage ,of goitre among school-children was taken as a basis, and these authors divided the Dominion into 33 .districts, each as far as possible homogeneous in its geological and physiographical circumstances. The average amount of iodine in the soil and the average incidence of goitre among school-children within each district were then ascertained, standard methods of soil-analysis and diagnosis of goitre being applied. Roughly the incidence of the disease was found to be inversely proportional to the amount of iodine in the soil and an actual formula of the relationship could be defined : " percentage of incidence of goitre among school-children is equal to 6 plus the quotient of 60 divided by the amount of iodine in ten million parts of soil, so long as this does not exceed 50." ’The conclusion reached is that " though there are certain points unexplained, the whole body of facts is too large, and the relationship too consistent, to be fortuitous." This work on the aetiology of the disease is separated from a discussion on prophylactic measures by an informative paper by C. E. Hercus and K. C. Roberts on the iodine content of certain foodstuffs. Here some important results are recorded. It is shown that soil-iodine is accurately reflected in food-iodine, that there is a definite difference in the daily iodine intake in the food-supply of typical goitrous and non-goitrous districts, that commercial salt is an unreliable source of iodine-supply, and that the iodine content of human milk in the goitrous woman is lower than in the non-goitrous. These facts having been established, prevention still remains fraught with difficulties. According to Prof. Hercus the greatest of these is the danger which attends the indiscriminate use of iodine in a community containing a large number of people with potentially toxic goitres. The problem is to supply the iodine deficiency in a universal, simple, and harmless manner. This could be done by increasing the use of foods rich in iodine or, since the initial deficiency lies in the soil, by using iodine-rich manures. In practice, however, there are objections to both these methods, and the two measures in vogue consist in giving iodine in medicinal form to school-children and in adding iodine to some article of diet in universal use throughout the country. Extensive medicinal treatment of school-children has given highly satisfactory results in New Zealand with no untoward effects, but this method of prophylaxis is too limited in scope to
SIMPLE
1 No. 5.
1928.
Published by Budget, Ltd., Dunedin, N.Z.
acceptable as a national scheme. The preparation of iodised salt has therefore come to be regarded as the method of choice. In 1924 the Department of Health introduced into the Food and Drugs Act a definition be
____
PRESERVATIVES IN FOOD. THE use of boric acid in food was the subject of an address delivered before the Edinburgh Rotary Club a few days ago by Dr. Andrew Rutherford, lecturer in pathology at the Edinburgh Medical School. The public mind had, he said, been made anxious by accounts in the press of illness arising from alleged food poisoning, coupled with the suggestion made by a distinguished chemist that the prohibition of boric acid as a food preservative had brought a definite risk to the community " because it limits the period during which food can be kept free from contamination." But, said Dr. Rutherford, attacks of food poisoning had not been more frequent of late than in former years; actually fewer outbreaks had occurred this year than previously, and none at all in Scotland-they had merely received more press publicity. The causes of food poisoning had been known for many years ; they were specific disease-producing germs which become implanted in food, stale or fresh. The illnesses they brought about were neither new nor mysterious to pathologists or to the medical advisers of the Government. They had nothing whatsoever to do with the presence or absence of weak chemicals like boric acid as preservatives in food ; no chemist, however distinguished, could competently express an opinion on the broad question of food preservatives in relation to disease. That was the domain of physicians, pathologists, and public health experts. Ptomaine poisoning in man, Dr. Rutherford reminded his hearers, was in fact exceedingly rare ; the vast majority of cases of food poisoning were due to living specific microbes which in various ways might become implanted on food or drink. Small quantities of boric acid would neither prevent the access of those germs nor kill them if they were present. Food such as sausages and pork pies, containing preservatives, had often been associated with acute gastro-enteritis. A preservative might keep food looking fresh and smelling fresh when dangerous microbes were growing in it. Certainly boric acid would keep it, in the popular phrase, " free from taint," but in doing so might mask a far greater danger than mere taint. Generally speaking, food was handled in this country with far too little regard to the possibilities of contamination, and much stricter cleanliness than obtained at present was desirable in the handling, storage, and cooking of food. The recent regulations dealing with preservatives tended to lessen and not to increase food poisoning outbreaks. The Meat Inspection Regulations and the Milk and Dairies Acts - irksome as they might be at times to traders-served a similar purpose. Wherever food was kept or cooked the utmost efforts should be made to prevent the access of flies, mice, or rats. Milk should be pasteurised and cold storage provided. Employees who handled or cooked food in large concerns like bakeries, hotels, restaurants, and clubs, should be proved not to be carriers of the typhoid or food-poisoning germs before