THE HEALTH OF THE INDIGENOUS RAND MINER.

.

THE HEALTH OF THE INDIGENOUS RAND MINER.

and the casual searcher

gains

qualification registered

is of

the impression that the a different quality or not the case. We hope of which course, is, standard, that the matter may be rectified when next the Medical Acts come up for revision in Parliament, for it isjust such insularities as this which stand in the way of complete professional reciprocity with the self-governing Dominions. In the table of registrable degrees are now included the M.B., B.Ch. of the three universities in the Union of South Africa. The Medical Register contains the full text of the Dentists Act, 1921. The Dental Register, which is presumably issued for the last time by the General Medical Council, contains 5831 names, 277 having been added by registration during the year 1921. Here the pages are franldy

593

Annotations. "Ne quid nimis."

HEALTH OF THE INDIGENOUS RAND MINER. DuRiNG the recent disturbances on the Rand the native mine labourers appear to have maintained an attitude of neutrality in spite of considerable provocation. This may be in part due to their appreciation of the conditions of work, pay, and leave open to them and to confidence that the Government will protect their interests. The Native Labour Regulations are indeed the subject of earnest consideration headed " United Kingdom Dentists," " Colonial on the part of General Smut,s’s Government, and are Dentists," and " Foreign Dentists," although a constantly being amended and revised. Elaborate number of these so-called colonial dentists have long precautions are taken to maintain the health and been practising in London and provincial towns. One general welfare of the nativeminers. The concrete wonders whether the holder of an English dental sheds which form the compounds are kept very native has his own berth and usually a clean ; diploma practising in Sydney is described as an tin trunkevery for his personal belongings, and plenty of hot " English Dentist." The Dental Register also contains water is available. On nearly every mine there are the text of the new Dentists Act, along with the names whole-time medical officers whose duty it is to superof the Dental Board, but not the Dental Regulations, intend the health of the native workers and to treat which have appeared since the volume went to press. those reporting sick ; incidentally the Mine Medical A notice on the title-page states that after the publica- OiRcers’ Association, though of fairly recent formation. tion of the names in the printed Dentists’ Register, is one of the most active of the medical societies of the the Register alone is the legal evidence of registration. Transvaal. The nursing in the local native hospitals is done by male attendants, and in some hospitals an Three pages of warning notices are printed identically attempt to train Kaffir girls as nurses is apparently in the two Registers, Medical and Dental. The list of meeting with success. Workers are medically examMedical and Dental students registered during the year ined on application for a job and periodically during 1921 contains the names of 1808 medical students- their stay on the mines, with special regard to early who entered respectively in England, 833 ; in Scotland, pulmonary signs. It is obvious that even from the 602; in Ireland 373-and the names of 371 dental purely commercial and recruiting point of view it pays better to keep the native in good health and students; the numbers in each case being less by spirits than replace or compensate him for disease for than those the quarter preceding year. or injury acquired at his work. Probably the most important factor in the contented state of the native worker is the attention devoted to his diet. The official minimum ration INDIAN SCIENCE CONGRESS HANDBOOK. scale is constantly being amended and improved in the WE publish in this issue of THE LANCET a brief light of new knowledge on dietetics. The scale in use account of the Indian Science Congress held at since December, 1920, is comparable with that usually Madras from Jan. 30th to Feb. 4th ; we have recently recommended for Europeans doing hard work as received a copy of the excellent handbook prepared regards its essential constituents, while some of the under the direction of Captain CLIVE NEWCOMB, I.M.S., food-stuffs, such as the mealies, peanuts, and native one of the local secretaries of the Congress, and beer, are a direct concession to the habits and preissued in order to provide members of the Congress judices of the natives. Hot coffee, with a ration of with information of interest concerning the city of bread, is issued to the morning shift before they go Madras and its immediate surroundings. Seventeen down the mine, and on their return they have an short articles, each the work of some official ample hot meal consisting of meat and vegetables : a special warning is issued against the customor scientific authority qualified to deal with special points, are contained in the handbook; no complete convenient in practice-of keeping the latter for long guide has been aimed at, but the subjects range periods in steam-heated cauldrons. Dr. Marion Delf through the history, archaeology, anthropology, records this week (see p. 576) the results of experizoology, and geology of the Presidency, besides mental survey of available local foodstuffs for their including matters of medical and public health interest. antiscorbutic value, and her paper is in itself a proof Lieut.-Colonel F. F. ELWES, I.M.S., principal of the of the vigilance with which the interests of the medical college. writes of Medical Education in native workers are watched and opportunities Madras, tracing the history of the medical school seized of investigating prophylactic health measures. from its opening in 1836 ; in 1851 it became a college, Dr. Delf’s visit to South Africa, undertaken for other securing affiliation to the University of Madras in purposes, happened to coincide with an outbreak 1877, and it is now the leading institution for medical of scurvy in the mines, and on the representaeducation in the Presidency, with seven departments tions of Dr. A. J. Orenstein, the superintendent of -three of which are for post-graduate training- the Sanitation Department of the Central Mining containing upwards of 550 students. Major J. group, Dr. Watkins-Pitchford invited her to prolong CUNNINGHAM, 1.M.S., director of the King Institute, her stay in order to carry out investigations at describes the institution, which was opened in 1903 the South African Institute for Medical Research. as a lymph dep6t for the supply of the Presidency The problem set before her was the selection from the alone, but which is’now one of the three large provincial foodstuffs available a cheap antiscorbutic which laboratories in India. It is divided into a vaccine could be distributed without difficulty and which was section, manufacturing lymph for vaccination against sufficiently palatable to be consumed without supersmall-pox, and a microbiological section, which deals vision. The solution apparently varies with the with laboratory diagnosis and treatment and with seasons, as will be seen from her report. The quince public health work. Under a separate heading Major grows so luxuriantly in the Transvaal that it is CUNNINGHAM discusses the chlorination of the Madras surprising that no attempt was made to estimate its water-supply. A map of the city adds to the value antiscorbutic value. This fruit is not included in the of this interesting little handbook. comprehensive list of substances containing vitamin C, THE

one-

I i

594 furnished by H. C. Sherman and S. L. Smith in their lesson we may draw from it is the great importance of recently published work,and there is no indication early and accurate diagnosis, both from the point of that it has ever been tested. Besides being of view of treatment and prognosis. In an article entitled practical local importance, Dr. Dtlf’s results include Modes de Début des Cancers de la Peau et de la points of remarkable interest-for example, her Bouchell he emphasised this point, and maintained observation that soya beans, unlike ’all other ger- that few, if any, should die of epithelioma of the skin minating pulses so far tested, have no perceptible and mouth, since accurate diagnosis is always possible antiscorbutic value. Whether this singular fact can in the earliest stages, at which time the disease is be connected with the high fat and almost negligible curable by proper treatment. It cannot be too strongly carbohydrate content of the soya bean, involving a impressed on students, medical men, and the public high energy value, further investigations will doubtless that early diagnosis and treatment in cutaneous cancer show. Her indifferent results with cane sugar is of supreme importance, and in every case a - experiments may point to excess of carbohydrate as microscopical examination of the growth should be a predisposing factor to scurvy ; according to some made in order to determine to which type it belongs. observers this is true of rickets. Moreover, the fact that natives at work on the mines, who receive a rich varied diet, appear to need more antiscorbutic THE MEDICAL SOCIETY OF LONDON. than those who for considerable periods live on dried JUDGING by its subsequent career the Medical .maize in their kraals is a matter of some interest. Society of London appears to have acted wisely in standing outside the scheme which united in one EPITHELIOMA OF THE SKIN. building and fellowship many of the other metroFor the debates and IF ever the problem of cancer-that curious and politan medical societies. insidious transition from physiological to pathological discussions are notable for the breadth of their scope cell-growth-is solved, it will surely be by the study and the fact that they draw together medical men of of cutaneous tumours, for in the skin we can trace the whom many would otherwise appear only at specialist pathological changes in their earliest stages. Dr. Jean gatherings. And this focus being social as well as Darier’s profound knowledge of cutaneous histo- academic, warmth is concentrated there. The 149th ,pathology, and his exhaustive studies during the past 30 anniversary dinner held at the Wharncliffe Rooms years of the various tumours of the skin, are familiar was no exception to the rule. Kindred societies were -not only to his confreres in dermatology, but also to represented there by their presidents and the three pathologists throughout the world, and thus his combatant Services by their medical chiefs. Mr. James illustrated lecture on’epithelioma of the skin, delivered Berry, who presided at the dinner, received something last week to the Section of Dermatology of the Royal like an ovation. Society of Medicine, was largely appreciated. After CARDIO-VASCULAR DISEASES. briefly alluding to the experimental production of cancer of the skin by excessive doses of the X rays or A SPECIAL cardio-vascular number2 of the New radium and by the continued application of substances York Medical Journal is of intimate interest to our such as tar, Dr. Darier pointed out that the different readers from the fact that, with two exceptions, all types of cutaneous epithelioma differ very markedly the original communications are by British authors. in their radio-susceptibility. Thus, whereas basal- We welcome this recognition of the special work on celled carcinoma is extremely radio-sensitive, the cardio-vascular diseases of our countrymen, and we prickle-celled growths are radio-resistant; and it is congratulate the New York Medical Journal upon _possible that when the explanation of this physical affording our writers an opportunity to express fact is forthcoming we may have made some advance their views directly to the American profession. not only in the prevention of cancer, but also in our The subjects dealt with in the 13 papers cover search for its essential cause. Apart, however, from a wide range and the writers have evidently been the two main types of epithelioma of the skin : (1) the selected with care, each writing on some matter malignant prickle-celled carcinoma, characterised by of which he has special experience. Space does the presence of keratinised cell-nests, rapid growth, not permit reference to all of them. Sir Clifford .involvement of lymphatic glands and other organs, Allbutt contributes the first paper entitled a Disand radio-resistance ; and (2) the basal-celled car- cussion of Angina Pectoris. He reaffirms his now cinoma, characterised by the absence of cell-nests, well-known view that this condition is in the large slow growth, local malignancy, non-involvement of majority of cases of aortic and not of primary cardiac Dr. Darier laid stress origin. He glands, and radio-susceptibility, regards death in the fatal cases as due to a " on the occurrence of metatypical forms to which he secondary inhibition set up by the pain or some other has recently devoted much attention. Of these there afferent influence, and not as the result of a primary are two kinds, one in which the cells of the growth are heart failure ; admitting that such inhibition is more intermediate between the prickle-celled and the basal- likely to be effectual in cases in which the myocardium celled types, and the other in which both types of cell is gravely diseased. He criticises in trenchant style ,occur. In these metatypical forms cell-nests are seen, other theories and claims that his views are now but they have a colloid appearance and are not formed achieving a wider acceptance, a claim fully justified. of keratinised cells. The growths resemble basal-celled Dr. J. Strickland Goodall contributes a useful note on ,carcinoma clinically, but they are far more radio- the Premature Contraction and its Significance. He resistant, and may eventually become generally malig- discusses the various causes and the different varieties nant, giving rise to secondary deposits. From a of extra-systoles. He points out the conditions under consideration of these different forms of epithelioma which, in his view, they may be of serious significance. Dr. Darier insisted on the imperative necessity of We may express the hope that the abbreviations differentiating between them by means of histological fibbing " and " non-fibbing " as applied to fibrillaexamination before deciding on the treatment to be tion will not achieve a wide currency. A notable paper adopted. For the prickle-celled and metatypical types is that contributed by Dr. Arthur Latham on the Heart early excision is required, since the use of X rays and in Pulmonary Tuberculosis. Among other matters radium is not only useless and unjustifiable, but may he considers the significance of the narrow vertically even lead to a more rapid extension of the growth. situated heart in regard to this disease. He is of In the purely basal-celled type he advocates treatment opinion that where there is doubt as to the diagnosis by radium or X rays, with which view several English of tuberculosis, the presence of this type of heart may dermatologists and surgeons will disagree, holding, as be an important factor in deciding upon treatment. they do, the opinion that complete excision is the and further he believes that its presence in an undoubted method of choice when possible. Dr. Darier’s lecture, delivered in French, was a model 1 Jour. de Méd. et de Chirurg. Prat., April 10th, 1921. 2 New York Medical Journal, a Semi-Monthly Review of of descriptive eloquence and incisive reasoning. The ____

"

"

1 The Vitamins.

Chemical Catalog Co., New York.

1922.

Medicine and Surgery. Cardio-Vascular Number, Feb. 15th. 1922. A. R. Elliott Publishing Co., New York, N.Y.