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HOOKWORM IN GOLD-MINES
51 common complication of this disease. My argument is somewhat weakened by the fact that joint troubles are not uncommon in myxcedema. However, cartilage is very prone to undergo mucoid degeneration and perhaps the arthopathy of myxcedema may be due to degenerative softening of articular cartilage. I am well aware of the perils of drawing .conclusions a
as
from circumstantial evidence, and I am not rash to suggest that the thyroid plays more than small a part in the pathogenesis of arthritis as a whole. But it seems to me that direct measurements of the effect of thyroxine on the viscosity and mucin content of synovial fluid might yield useful I am, Sir, yours faithfully, information. F. B. BYROM. London Hospital, July 3rd.
enough
HOOKWORM IN
To the Editor a
GOLD-MINES
of THE
LANCET
SIR,-In the current issue of THE LANCET there is leader on Hookworm in Gold-mines, based on a
by J. H. Hodgman, to which I am, somewhat reluctantly, bound to refer. I have been intimately concerned with the hookworm problem on the mines referred to, and have no knowledge of a " J. H. Hodgman " ever taking an important part in this work. Presumably, therefore, he writes from second-hand knowledge, and, like most knowledge so acquired, his information is decidedly inaccurate. Within the scope of a letter it is impossible to deal with the matter fully, and I will therefore draw attention only to outstanding paper
errors :-
(1) seen
In 20 years’ work on the gold-mines I have never cockroaches in any notable numbers under-
ground. (2) Although it was suggested that viable ova may pass through rats, repeated experiments with rats caught underground failed to confirm the suggestion. (3) It is true that about 40 per cent. of East Coast natives arrive on the mines infected with hookworms, but these constitute less than one-third of the
present labour force.
Among the remaining twothirds infection is rare. (4) The infection rate decreases with residence the mines, although no mass treatment is on undertaken. (5) It is the grossest possible exaggeration to describe the latrine conditions as appalling. I say this on the ground of personal knowledge which is as wide and intimate as anyone’s could be. I am. Sir. vours faithfullv. A. J. ORENSTEIN, Chief Medical Officer, Central Rand Mines. Weymouth-street, W., June 30th.
Mining,
LECTURES AND PAMPHLETS ON MENTAL HYGIENE To the Editor of THE LANCET
SIR,-I have just finished reading the challenging article of Dr. Edward Mapother in your issue of May 26th, and am astounded at his concluding sentence. As to the giving of collective counsel upon details of mental hygiene directly to the public by lectures and
pamphlets (as opposed to urging resort to expert advice), in view of all the possibilities of misunderstanding and misapplication, it seems to me likely that on the whole this will do more harm than good. Earlier in the lecture Dr. Mapother writes experience and sex education) :
(regarding
"
the
sex
The first
general prophylactics
needed
are
steady
growth of a morality that is rational rather than traditional, honesty among adults, and proper education of the child." If lectures and pamphlets do more harm than good how does he propose to apply, for example, the above Does he condemn all excellent prophylactics ? pamphlets ? Specifically, would he condemn this booklet issued by the U.S. Children’s Bureau : " Are you training your child to be happy " ?‘ Or does he really mean that there are some pamphlets and some lecturers that do more harm than good ? One can easily agree to that. Indeed, how else has our traditional morality been popularised t I am. Sir. vours faithfullv. ROSSLYN EARP. Santa Va., N.M., June 17th.
PUBLIC HEALTH The Infectious
Stranger
IT is the duty of local authorities to provide hospital treatment for the infectious diseases of inhabitants of their own area, but apparently they have no such legal obligation as regards visitors who normally live elsewhere. Similarly, they are not obliged to arrange or pay for the care of those of their own residents who develop infectious diseases while staying in some other district. Thus no one is really responsible for patients who are unwise enough to fall ill while absent from their own locality, and, as one might expect, there have been cases in which a good deal of trouble has arisen from authorities
disclaiming responsibility
and
sending
infectious patients back to the reluctant care of the bodies under whose auspices they ordinarily dwell. It is to obviate any further disputes of this kind that the Minister of Health has now issued the Public Health (Treatment of Infectious Diseases)Regulations, 1934. In an accompanying memorandum it is pointed out that the primary public purpose of the hospital treatment of infectious disease is to
prevent
exposed
which the disease is discovered, " it is generally that the proper course is for the authority of that district ... to provide the necessary treatment." To send people back to their homes when they -clearly require hospital care is detrimental to public health both by delaying treatment and risking dissemination. The regulations accordingly provide that authorities shall have the same powers and duties (in relation to the provisions of hospitals, &c.) in respect of strangers as in respect of their own inhabitants. This will not, of course, affect the right of an authority to decide on the advice of its medical officer what cases shall be treated in hospital, but it is intended to secure that the decision shall be based on medical considerations alone, with a view to the most effective control of the disease and the best use of the accommodation available.
recognised
the spread of infection, and as the population to the risk is the population of the area in
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED JUNE 1934
23RD, VoYtcaOMS.—The following cases of infectious disease were notified during the week : Small-pox, 2 (last week 3) ; scarlet fever, 2363 ; diphtheria, 113 ; enteric fever, 17 ; acute pneumonia (primary or
as
from circumstantial evidence, and I am not rash to suggest that the thyroid plays more than small a part in the pathogenesis of arthritis as a whole. But it seems to me that direct measurements of the effect of thyroxine on the viscosity and mucin content of synovial fluid might yield useful I am, Sir, yours faithfully, information. F. B. BYROM. London Hospital, July 3rd.
enough
HOOKWORM IN
To the Editor a
GOLD-MINES
of THE
LANCET
SIR,-In the current issue of THE LANCET there is leader on Hookworm in Gold-mines, based on a
by J. H. Hodgman, to which I am, somewhat reluctantly, bound to refer. I have been intimately concerned with the hookworm problem on the mines referred to, and have no knowledge of a " J. H. Hodgman " ever taking an important part in this work. Presumably, therefore, he writes from second-hand knowledge, and, like most knowledge so acquired, his information is decidedly inaccurate. Within the scope of a letter it is impossible to deal with the matter fully, and I will therefore draw attention only to outstanding paper
errors :-
(1) seen
In 20 years’ work on the gold-mines I have never cockroaches in any notable numbers under-
ground. (2) Although it was suggested that viable ova may pass through rats, repeated experiments with rats caught underground failed to confirm the suggestion. (3) It is true that about 40 per cent. of East Coast natives arrive on the mines infected with hookworms, but these constitute less than one-third of the
present labour force.
Among the remaining twothirds infection is rare. (4) The infection rate decreases with residence the mines, although no mass treatment is on undertaken. (5) It is the grossest possible exaggeration to describe the latrine conditions as appalling. I say this on the ground of personal knowledge which is as wide and intimate as anyone’s could be. I am. Sir. vours faithfullv. A. J. ORENSTEIN, Chief Medical Officer, Central Rand Mines. Weymouth-street, W., June 30th.
Mining,
LECTURES AND PAMPHLETS ON MENTAL HYGIENE To the Editor of THE LANCET
SIR,-I have just finished reading the challenging article of Dr. Edward Mapother in your issue of May 26th, and am astounded at his concluding sentence. As to the giving of collective counsel upon details of mental hygiene directly to the public by lectures and
pamphlets (as opposed to urging resort to expert advice), in view of all the possibilities of misunderstanding and misapplication, it seems to me likely that on the whole this will do more harm than good. Earlier in the lecture Dr. Mapother writes experience and sex education) :
(regarding
"
the
sex
The first
general prophylactics
needed
are
steady
growth of a morality that is rational rather than traditional, honesty among adults, and proper education of the child." If lectures and pamphlets do more harm than good how does he propose to apply, for example, the above Does he condemn all excellent prophylactics ? pamphlets ? Specifically, would he condemn this booklet issued by the U.S. Children’s Bureau : " Are you training your child to be happy " ?‘ Or does he really mean that there are some pamphlets and some lecturers that do more harm than good ? One can easily agree to that. Indeed, how else has our traditional morality been popularised t I am. Sir. vours faithfullv. ROSSLYN EARP. Santa Va., N.M., June 17th.
PUBLIC HEALTH The Infectious
Stranger
IT is the duty of local authorities to provide hospital treatment for the infectious diseases of inhabitants of their own area, but apparently they have no such legal obligation as regards visitors who normally live elsewhere. Similarly, they are not obliged to arrange or pay for the care of those of their own residents who develop infectious diseases while staying in some other district. Thus no one is really responsible for patients who are unwise enough to fall ill while absent from their own locality, and, as one might expect, there have been cases in which a good deal of trouble has arisen from authorities
disclaiming responsibility
and
sending
infectious patients back to the reluctant care of the bodies under whose auspices they ordinarily dwell. It is to obviate any further disputes of this kind that the Minister of Health has now issued the Public Health (Treatment of Infectious Diseases)Regulations, 1934. In an accompanying memorandum it is pointed out that the primary public purpose of the hospital treatment of infectious disease is to
prevent
exposed
which the disease is discovered, " it is generally that the proper course is for the authority of that district ... to provide the necessary treatment." To send people back to their homes when they -clearly require hospital care is detrimental to public health both by delaying treatment and risking dissemination. The regulations accordingly provide that authorities shall have the same powers and duties (in relation to the provisions of hospitals, &c.) in respect of strangers as in respect of their own inhabitants. This will not, of course, affect the right of an authority to decide on the advice of its medical officer what cases shall be treated in hospital, but it is intended to secure that the decision shall be based on medical considerations alone, with a view to the most effective control of the disease and the best use of the accommodation available.
recognised
the spread of infection, and as the population to the risk is the population of the area in
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED JUNE 1934
23RD, VoYtcaOMS.—The following cases of infectious disease were notified during the week : Small-pox, 2 (last week 3) ; scarlet fever, 2363 ; diphtheria, 113 ; enteric fever, 17 ; acute pneumonia (primary or