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HÆMATOPORPHYRINURIA AS PART OF A. FAMILIAL SYNDROME.
960
samples of tobacco was examined with a view whether they conformed to the legal limits as finding and moisture oil, but the results are not recorded. regards seem of on the whole to be correctly declared Samples sugar as regards rating purposes. Certain samples of tea were as sand or other foreign matter, or as rejected containing on other unfit for human consumption. being grounds "Bush tea"was found to be neither botanically nor commercially the substance referred to in the tariff as tea. Coffee and chicory, cocoa and chocolate, appear to give little trouble from a revenue point of view. Seventy-eight samples of medicines were examined during the year in connexion with the Medicine Stamp Acts. These Acts impose duties upon preparations advertised for the cure or relief of human ailments. There are, however, certain exemptions, and in these cases an analysis is required. In one case pills were advertised as a remedy for obesity, and proceedings were taken. It was held that obesity was an ailment within the meaning of the Acts, and the seller was convicted of an offence. The record of work done for the various Government departments is full of interesting information, and even cases under the Old Age Pensions Act are referred to the Government laboratory in connexion with entries of births in Bibles or prayer-books produced as evidence of the age of the applicant. In the course of the year 13 documents were submitted for examination on account of their suspicious appearance. In six of these cases it was found that the writing was of recent date, or that it had recently been tampered
number of to
Under the
with.
Sale of Food and Drugs Act 93 referred by the magistrates to the Government chemists for opinion. In 73 cases the result of analysis given by the public analyst was confirmed, while in three cases (of milk) no certificate was issued. From all this it is evident that the Government laboratory is a great and important department of the State, and the annual reports issued by its principal deal with a branch of statistics of the utmost concern to the community. It is an interesting collocation of fiscal matters and scientific records.
samples
were
NEO-MALTHUSIANISM AND EUGENICS.
the
part of the population. The pamphlet: does, indeed, suggest that such a condition of things is. realised in Paris, but the only evidence given for themore
prosperous
statement is
a comparison regarding birth-rate and ini-aiitile-the Elysées quarter and the poorer ar1’OIlbetween mortality dissements for one single year-a test so obviously fallacious, that it only brings into relief the weakness of the position it is designed to defend. Nor is the pamphlet more fortunate in the evidence adduced to support the’ view that the free dissemination of neo-Malthusian teaching would equalise the operation of restrictive methods," There is taken as a "definite confirmation" of opini:o&bgr;. this point the case of Holland, where, it is. on " said, as the " result of such teaching."the birthrate has fallen in all classes of society, and the deathrate and infantile mortality have also fallen more rapidly than in any other country,"while "there seem HttÞe signs. of race degeneration." No proof, however, is given of the regular distribution of the fall in the death-rate, and the only evidence for the statement as to the rarity ofindications of race degeneration appears to be the personal impressions o the author during visits to the country. As; for the other phenomena which it is sought to bring into" relation with family restriction, it may be remarked that the statistical tables given in the paper tend to contradict rather than to support the author’s view. They show, for instance, that after some 15 years of energetic neo-Malthusian teaching the infantile death-rate in Holland in 1900 was practically the same as in England and Wales, where, we aretold, family restriction was up to that year confined to the educated classes. And even now the infantile mortality in the Netherlands is considerably above what is found irr. Ireland, a country where the absence of Malthusian practices. is notorious. In view of such facts as these it cannot be said that the author has made out his case. The question, of course, is an exceedingly complex one, and further evidence is needed before a definite conclusion can be arrived at, but the facts at present available certainly go to confim thefear that neo-Malthusianism is exercising a real and serious. anti-selective influence. Efforts to conceal this unpleasant. probability can only be productive of mischief, for they, breed a sense of false security and disguise the dangers incident to the social and economic policy which has fostered’ and must continue to foster the spread of restrictivepractices in the educated and provident classes of thepopulation. On this ground, if on no other, the neoMalthusian doctrine is detrimental to the, interest of the,
IN the discussion of social questions from the eugenic standpoint, which has been very much the fashion of late, a good deal of attention has been given to the effect on racial quality produced by the growing practice of limiting offspring ; and though opinion on the matter is, of course, very much divided, the more prevalent view would certainly appear to be that this practice, as was predicted many years community. ago by Darwinian critics of neo-Malthusianism, has tended HÆMATOPORPHYRINURIA AS PART OF A. to diminish the reproduction of the more intelligent members FAMILIAL SYNDROME. of the community, while the inferior stocks have continued The advocates of neo-Malthusian to propagate freely. Professor Lewellys F. Barker and Dr. NV-. L. Estes havedoctrines have recognised the necessity of meeting this had under their care a patient exhibiting symptoms of such; grave objection, and the task has been attempted in peculiar interest that they have thought it worth while tCY a pamphlet just published under the title of "Neo- publish a preliminary account, which will be arnplwed and! Malthusianism and Eugenics." To the criticism that perhaps illuminated when the laboratory investigations which’. the limitation of offspring operates chiefly on the are now in progress have been completed. The patient,, best stocks and little, if at all, on inferior stocks, whose case is reported in the Journal of the 4wM’c the answer given is, first, that, even if this be true, Medical Association, August 31st, 1912, was an unmarried the higher birth-rate of the unfit is in a great measure woman, 18 years old, who for over a year had been passing counterbalanced by the higher infantile mortality in the dark urine, losing weight, and suffering from attacks of’ poorer classes ; and, secondly, that if restrictive methods nausea and vomiting, with pain in the right lower abdomen. are not used by these classes it is only because of the During the weeks spent in hospital the hsematoporphyrinin the of the neo-Malthusian obstacles put way propaganda. which rendered the urine dark was still excreted, except these is of Neither pleas, however, satisfactorily established. during certain convulsive attacks which supervened. These-! The infantile mortality amongst the former classes is, no attacks, the onset of which was preceded by swelling doubt, relatively high, but except under very abnormal cir. of the thyroid, exophthalmos, tachycardia, and slight cumstances it is never so high as to reduce their rate of fever, were characterised by bilateral clonus and loss natural increase to a level approaching that which rules in of consciousness ; each fit lasted about two’ minutes" ____
961 and they occurred in short series or groups. The urine contained acetone, but no diacetic acid, and the hsematoporphyrinuria ceased for the time. There were no evidences of tetany. As the attacks passed off it was found that the patient was developing signs of acute polyneuritis of the upper and lower limbs. Meantime an exploratory laparotomy had failed to disclose anything positive except a very distinct dilatation of the stomach and duodenum; this was subsequently confirmed after the patient’s death, about six months after her admission to hospital. At this also hsemorrhagic erosions were noted in the gastric mucosa. Perhaps the most interesting feature of this case, which seems to hold a key to the pathology of hasmatoporphyrinuria, is that the syndrome had already been noted in other members of the One of the patient’s sisters died four same family. years before with the same symptoms; at the necropsy dilatation of the stomach and duodenum was disclosed. Another sister was suffering similarly at the time of report; the patient’s father showed signs of hyperthyroidism, and other members of the family had suffered from symptoms which might possibly be compared with those noted in Professor Barker’s patient. His suggestion is that some fault of development may have been responsible for the gastro-duodenal dilatation ; and that thus a source of toxin was provided by which the other symptoms—hsematoporphyrinuria, fits, and polyneuritis-were provoked. The writers state that though in no case hitherto recorded has dilatation of the stomach and duodenum been discovered, yet in several instances the remainder of the syndrome was complete and there were symptoms of gastro-intestinal disturbance such as were probably due to gastro-duodenal
be worth the while of producers of cream above the 35 per cent. limit, who do not add to it any preservative substance, to make it known that their product is above the
standard strength. The new regulations, therefore, prepare a way for the establishment of official limits of fat for cream which, in spite of the contrary view of the Departmental Committee, is desirable and not wholly impracticable. As was pointed out in THE LANCET in a comment on the draft regulations, the Departmental Committee of 1901 recommended that only boron preservatives should be allowed in cream in an amount not exceeding 0-25 per cent. ; in their final form the regulations do not place any limit on the quantity of any of the three preservative substances the use of which is permitted, but they require the percentage of boric acid to be stated on the declaratory label-a plan which will encourage producers to limit the use of the preservative to the smallest amount
possible.
SOCIETY
-
OF MEDICAL
OFFICERS
OF
HEALTH.
THE State Sickness Insurance Committee of the British Medical Association, on the nomination of the Society of Medical Officers of Health, has coopted Mr. Herbert Jones a member of the committee. The council of the society has discussed the question of the administration of sanatorium benefit under the National Insurance Act from the point of view of medical officers of health, and has come to the con" clusion that the medical officer of health should be tha administrative officer within his area for dealing with tuberculosis under any county scheme, that tuberculosis officers should be on the staff and under the administrative control of the medical officer of health, except as regards clinical dilatation. duties, and that the position and responsibility of medical officers of health of county districts should be fully A CREAM STANDARD. recognised in any tuberculosis scheme. It was considered in THE regulationsprohibiting the use of preservatives impracticable as well as undesirable that tuberculosis officers milk and in cream containing less than 35 per cent. of milk should be prohibited from treating patients at dispensaries. fat, which came into force on Oct. 1st, will in all probability have the indirect effect of raising the standard of cream. The PATHOLOGICAL ENTOMOLOGY IN FIJI. Departmental Committee of 1901 came to the conclusion that ON account of the extensive damage done to the cocoanut the weight of evidence was not favourable to the establishpalm industry in Fiji by various kinds of insects a trained ment of official limits of fat for cream, but in view of the entomologist was appointed in 1909 to give his whole time wide range in the quality of cream on the market it would to this and other questions of economic entomology in seem desirable that the purchaser should be informed whether the Fiji group of islands. Mr. Frank Jepson is the first or not the cream is of high or low milk-fat content ; for it holder of this office, and he has recently submitted a very is obviously against the principles of domestic economy to interesting report on work carried out down to the middle of pay as much for an article containing, say, 20 per cent. of 1911. Though primarily directed to economic questions, milk fat as for one containing 50 or 60 per cent. The the investigations embraced matters of disease prevention experienced buyer would, of course, be able to form a rough as well, to which a brief reference may be made. Fiji at judgment of the value of the cream from its appearance ; present enjoys complete freedom from malaria owing but all buyers are not experienced. It has generally to the entire absence of flies belonging to the group been considered by experts that a cream of good average of There are, however, many persons in Anophelinas. quality should contain rather over than under 40 per cent. of the colony who have suffered from malaria elsewhere, milk fat, and in the regulations originally drafted by the and continue to harbour the malarial parasites in their Local Government Board40 per cent. was fixed as the so that if were introduced malaria blood, anophelines limit of strength for cream to which boric acid, borax, or become conditions favourable td endemic, provided might hydrogen peroxide could be added. After considering mosquito breeding were allowed to prevail. Conversely, representations from various interests the Board decided to Stegomyia fasciata is abundantly present in Fiji, so that if reduce the limit to 35 per cent., and the difference is yellow fever cases were introduced this disease might easily perhaps not of vast importance. The interesting point is be spread. Another mosquito-borne disease, elephantiasis, that producers of cream who desire-and in the summer is already rife in many of the islands. The vigorous action months most of them probably will so desire-to add a of the United States authorities in the neighbouring region preservative substance to their product will be obliged to of Hawaii is referred to. Fifteen inspectors are employed keep the cream up to a standard of 35 per cent. of milk fat, in Fiji, whose daily task it is to examine all houses in a given and a ° preserved cream"label on a receptacle will be area for likely breeding-places of mosquitoes. The inspection evidence that the contents are up to that standard. costs S200 monthly, and many millions of mosquitoes are It will not necessarily follow that a cream not so from reaching maturity. The importation from prevented labelled is below that standard, but it will certainly Texas of the small fish called has ____
top-minnows
1
THE LANCET, March 2nd, 1912, p. 592. 2 Ibid.
proved very
successful in preventing mosquito development, and by the courtesy of the United States administration a number of
samples of tobacco was examined with a view whether they conformed to the legal limits as finding and moisture oil, but the results are not recorded. regards seem of on the whole to be correctly declared Samples sugar as regards rating purposes. Certain samples of tea were as sand or other foreign matter, or as rejected containing on other unfit for human consumption. being grounds "Bush tea"was found to be neither botanically nor commercially the substance referred to in the tariff as tea. Coffee and chicory, cocoa and chocolate, appear to give little trouble from a revenue point of view. Seventy-eight samples of medicines were examined during the year in connexion with the Medicine Stamp Acts. These Acts impose duties upon preparations advertised for the cure or relief of human ailments. There are, however, certain exemptions, and in these cases an analysis is required. In one case pills were advertised as a remedy for obesity, and proceedings were taken. It was held that obesity was an ailment within the meaning of the Acts, and the seller was convicted of an offence. The record of work done for the various Government departments is full of interesting information, and even cases under the Old Age Pensions Act are referred to the Government laboratory in connexion with entries of births in Bibles or prayer-books produced as evidence of the age of the applicant. In the course of the year 13 documents were submitted for examination on account of their suspicious appearance. In six of these cases it was found that the writing was of recent date, or that it had recently been tampered
number of to
Under the
with.
Sale of Food and Drugs Act 93 referred by the magistrates to the Government chemists for opinion. In 73 cases the result of analysis given by the public analyst was confirmed, while in three cases (of milk) no certificate was issued. From all this it is evident that the Government laboratory is a great and important department of the State, and the annual reports issued by its principal deal with a branch of statistics of the utmost concern to the community. It is an interesting collocation of fiscal matters and scientific records.
samples
were
NEO-MALTHUSIANISM AND EUGENICS.
the
part of the population. The pamphlet: does, indeed, suggest that such a condition of things is. realised in Paris, but the only evidence given for themore
prosperous
statement is
a comparison regarding birth-rate and ini-aiitile-the Elysées quarter and the poorer ar1’OIlbetween mortality dissements for one single year-a test so obviously fallacious, that it only brings into relief the weakness of the position it is designed to defend. Nor is the pamphlet more fortunate in the evidence adduced to support the’ view that the free dissemination of neo-Malthusian teaching would equalise the operation of restrictive methods," There is taken as a "definite confirmation" of opini:o&bgr;. this point the case of Holland, where, it is. on " said, as the " result of such teaching."the birthrate has fallen in all classes of society, and the deathrate and infantile mortality have also fallen more rapidly than in any other country,"while "there seem HttÞe signs. of race degeneration." No proof, however, is given of the regular distribution of the fall in the death-rate, and the only evidence for the statement as to the rarity ofindications of race degeneration appears to be the personal impressions o the author during visits to the country. As; for the other phenomena which it is sought to bring into" relation with family restriction, it may be remarked that the statistical tables given in the paper tend to contradict rather than to support the author’s view. They show, for instance, that after some 15 years of energetic neo-Malthusian teaching the infantile death-rate in Holland in 1900 was practically the same as in England and Wales, where, we aretold, family restriction was up to that year confined to the educated classes. And even now the infantile mortality in the Netherlands is considerably above what is found irr. Ireland, a country where the absence of Malthusian practices. is notorious. In view of such facts as these it cannot be said that the author has made out his case. The question, of course, is an exceedingly complex one, and further evidence is needed before a definite conclusion can be arrived at, but the facts at present available certainly go to confim thefear that neo-Malthusianism is exercising a real and serious. anti-selective influence. Efforts to conceal this unpleasant. probability can only be productive of mischief, for they, breed a sense of false security and disguise the dangers incident to the social and economic policy which has fostered’ and must continue to foster the spread of restrictivepractices in the educated and provident classes of thepopulation. On this ground, if on no other, the neoMalthusian doctrine is detrimental to the, interest of the,
IN the discussion of social questions from the eugenic standpoint, which has been very much the fashion of late, a good deal of attention has been given to the effect on racial quality produced by the growing practice of limiting offspring ; and though opinion on the matter is, of course, very much divided, the more prevalent view would certainly appear to be that this practice, as was predicted many years community. ago by Darwinian critics of neo-Malthusianism, has tended HÆMATOPORPHYRINURIA AS PART OF A. to diminish the reproduction of the more intelligent members FAMILIAL SYNDROME. of the community, while the inferior stocks have continued The advocates of neo-Malthusian to propagate freely. Professor Lewellys F. Barker and Dr. NV-. L. Estes havedoctrines have recognised the necessity of meeting this had under their care a patient exhibiting symptoms of such; grave objection, and the task has been attempted in peculiar interest that they have thought it worth while tCY a pamphlet just published under the title of "Neo- publish a preliminary account, which will be arnplwed and! Malthusianism and Eugenics." To the criticism that perhaps illuminated when the laboratory investigations which’. the limitation of offspring operates chiefly on the are now in progress have been completed. The patient,, best stocks and little, if at all, on inferior stocks, whose case is reported in the Journal of the 4wM’c the answer given is, first, that, even if this be true, Medical Association, August 31st, 1912, was an unmarried the higher birth-rate of the unfit is in a great measure woman, 18 years old, who for over a year had been passing counterbalanced by the higher infantile mortality in the dark urine, losing weight, and suffering from attacks of’ poorer classes ; and, secondly, that if restrictive methods nausea and vomiting, with pain in the right lower abdomen. are not used by these classes it is only because of the During the weeks spent in hospital the hsematoporphyrinin the of the neo-Malthusian obstacles put way propaganda. which rendered the urine dark was still excreted, except these is of Neither pleas, however, satisfactorily established. during certain convulsive attacks which supervened. These-! The infantile mortality amongst the former classes is, no attacks, the onset of which was preceded by swelling doubt, relatively high, but except under very abnormal cir. of the thyroid, exophthalmos, tachycardia, and slight cumstances it is never so high as to reduce their rate of fever, were characterised by bilateral clonus and loss natural increase to a level approaching that which rules in of consciousness ; each fit lasted about two’ minutes" ____
961 and they occurred in short series or groups. The urine contained acetone, but no diacetic acid, and the hsematoporphyrinuria ceased for the time. There were no evidences of tetany. As the attacks passed off it was found that the patient was developing signs of acute polyneuritis of the upper and lower limbs. Meantime an exploratory laparotomy had failed to disclose anything positive except a very distinct dilatation of the stomach and duodenum; this was subsequently confirmed after the patient’s death, about six months after her admission to hospital. At this also hsemorrhagic erosions were noted in the gastric mucosa. Perhaps the most interesting feature of this case, which seems to hold a key to the pathology of hasmatoporphyrinuria, is that the syndrome had already been noted in other members of the One of the patient’s sisters died four same family. years before with the same symptoms; at the necropsy dilatation of the stomach and duodenum was disclosed. Another sister was suffering similarly at the time of report; the patient’s father showed signs of hyperthyroidism, and other members of the family had suffered from symptoms which might possibly be compared with those noted in Professor Barker’s patient. His suggestion is that some fault of development may have been responsible for the gastro-duodenal dilatation ; and that thus a source of toxin was provided by which the other symptoms—hsematoporphyrinuria, fits, and polyneuritis-were provoked. The writers state that though in no case hitherto recorded has dilatation of the stomach and duodenum been discovered, yet in several instances the remainder of the syndrome was complete and there were symptoms of gastro-intestinal disturbance such as were probably due to gastro-duodenal
be worth the while of producers of cream above the 35 per cent. limit, who do not add to it any preservative substance, to make it known that their product is above the
standard strength. The new regulations, therefore, prepare a way for the establishment of official limits of fat for cream which, in spite of the contrary view of the Departmental Committee, is desirable and not wholly impracticable. As was pointed out in THE LANCET in a comment on the draft regulations, the Departmental Committee of 1901 recommended that only boron preservatives should be allowed in cream in an amount not exceeding 0-25 per cent. ; in their final form the regulations do not place any limit on the quantity of any of the three preservative substances the use of which is permitted, but they require the percentage of boric acid to be stated on the declaratory label-a plan which will encourage producers to limit the use of the preservative to the smallest amount
possible.
SOCIETY
-
OF MEDICAL
OFFICERS
OF
HEALTH.
THE State Sickness Insurance Committee of the British Medical Association, on the nomination of the Society of Medical Officers of Health, has coopted Mr. Herbert Jones a member of the committee. The council of the society has discussed the question of the administration of sanatorium benefit under the National Insurance Act from the point of view of medical officers of health, and has come to the con" clusion that the medical officer of health should be tha administrative officer within his area for dealing with tuberculosis under any county scheme, that tuberculosis officers should be on the staff and under the administrative control of the medical officer of health, except as regards clinical dilatation. duties, and that the position and responsibility of medical officers of health of county districts should be fully A CREAM STANDARD. recognised in any tuberculosis scheme. It was considered in THE regulationsprohibiting the use of preservatives impracticable as well as undesirable that tuberculosis officers milk and in cream containing less than 35 per cent. of milk should be prohibited from treating patients at dispensaries. fat, which came into force on Oct. 1st, will in all probability have the indirect effect of raising the standard of cream. The PATHOLOGICAL ENTOMOLOGY IN FIJI. Departmental Committee of 1901 came to the conclusion that ON account of the extensive damage done to the cocoanut the weight of evidence was not favourable to the establishpalm industry in Fiji by various kinds of insects a trained ment of official limits of fat for cream, but in view of the entomologist was appointed in 1909 to give his whole time wide range in the quality of cream on the market it would to this and other questions of economic entomology in seem desirable that the purchaser should be informed whether the Fiji group of islands. Mr. Frank Jepson is the first or not the cream is of high or low milk-fat content ; for it holder of this office, and he has recently submitted a very is obviously against the principles of domestic economy to interesting report on work carried out down to the middle of pay as much for an article containing, say, 20 per cent. of 1911. Though primarily directed to economic questions, milk fat as for one containing 50 or 60 per cent. The the investigations embraced matters of disease prevention experienced buyer would, of course, be able to form a rough as well, to which a brief reference may be made. Fiji at judgment of the value of the cream from its appearance ; present enjoys complete freedom from malaria owing but all buyers are not experienced. It has generally to the entire absence of flies belonging to the group been considered by experts that a cream of good average of There are, however, many persons in Anophelinas. quality should contain rather over than under 40 per cent. of the colony who have suffered from malaria elsewhere, milk fat, and in the regulations originally drafted by the and continue to harbour the malarial parasites in their Local Government Board40 per cent. was fixed as the so that if were introduced malaria blood, anophelines limit of strength for cream to which boric acid, borax, or become conditions favourable td endemic, provided might hydrogen peroxide could be added. After considering mosquito breeding were allowed to prevail. Conversely, representations from various interests the Board decided to Stegomyia fasciata is abundantly present in Fiji, so that if reduce the limit to 35 per cent., and the difference is yellow fever cases were introduced this disease might easily perhaps not of vast importance. The interesting point is be spread. Another mosquito-borne disease, elephantiasis, that producers of cream who desire-and in the summer is already rife in many of the islands. The vigorous action months most of them probably will so desire-to add a of the United States authorities in the neighbouring region preservative substance to their product will be obliged to of Hawaii is referred to. Fifteen inspectors are employed keep the cream up to a standard of 35 per cent. of milk fat, in Fiji, whose daily task it is to examine all houses in a given and a ° preserved cream"label on a receptacle will be area for likely breeding-places of mosquitoes. The inspection evidence that the contents are up to that standard. costs S200 monthly, and many millions of mosquitoes are It will not necessarily follow that a cream not so from reaching maturity. The importation from prevented labelled is below that standard, but it will certainly Texas of the small fish called has ____
top-minnows
1
THE LANCET, March 2nd, 1912, p. 592. 2 Ibid.
proved very
successful in preventing mosquito development, and by the courtesy of the United States administration a number of