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THE PROBLEM OF TRACHOMA.
1140
repeated claims, rather than to abnormally long periods of respiratory illnesses. Other forms of
evil in that country seems to be much graver than had been realised, for though among the general population trachoma is less prevalent now than formerly, yet in several institutions under the direct control of a public authority no attempt to prevent the spread of the infection among children has succeeded. This is shocking, and we trust that Dr. Lavery’s revelations will prove a spur to the authorities to take action in the direction indicated by him. In civilised countries trachomatous pannus and entropion from inverted lids ought never to be seen, for trachoma is a disease which, if diagnosed in its early stages, and treated efficiently for a sufficient length of time, can be cured without material injury to the sight. In countries where the disease is rife the routine examination of all school-children by oculists skilled in detecting its early signs is the first condition for its eradication.
sickness were not in excess. Men of the ages mentioned must have been employed as youths under the conditions prevailing before exhaust appliances were installed, and so may then have received On the other hand, up to age 30 no excess damage. respiratory sickness was found. This would suggest that modern conditions of work are satisfactory, I were it not that some years of exposure to the dust is nearly certainly necessary before the effect of environment can become manifest in sickness-absenteeism. Undoubtedly the extreme conditions of the past no longer exist, and no longer are advanced cases of asthma being produced, but years must yet elapse before the question can finally be answered as to whether exposure to dust and fibre is to-day below the threshold of harm. This report establishes that, sickness records statistical treatment, by adequate can be used to disclose the existence of some occupaFOOD FUMIGATION. tional hazard, which is in itself no small advance in PRUSSic acid is being used not only for ridding ships method; but it also makes apparent how much time must often have to pass before the benefit accruing of rats but for the destruction of insects of various from some measure of betterment can be demonstrated. kinds in imported dried fruit and other foods. The absence of any destructive effect on structures and fittings gives it an advantage over most other poisonous THE PROBLEM OF TRACHOMA. gases, and it possesses the further advantage of being removed by ventilation. If we knew exactly FOR more than a century the causation of trachoma easily the extent to which foods of various kinds may absorb -or Egyptian ophthalmia, as it was called after it should then have the answer to the was disseminated among the British garrison in hydrogen cyanide,we whether, and in what circumstances, the gas question Egypt during the Napoleonic wars-has been one of may safely be used for the destruction of vermin and the standing puzzles in ocular pathology. As is well insect pests. A monograph by Dr. G. W. Monierknown, it commences insidiously and runs an Williams just issued by the Ministry of Health, extremely chronic course ; untreated cases eventually collates and discusses the available data. It appears get involvement of the cornea (pannus) and from this very interesting report that of recent years such scarring and contraction of the tissues of the the generation of hydrogen cyanide from potassium upper eyelids, involving inturned eyelashes, as is or sodium cyanide and sulphuric acid has been irremediable except by operation, and not always abandoned and either the liquefied acid (its boiling by that. The disease is rife throughout the east of point is 25° C.) is used from cylinders or, mixed with a Europe, Egypt, and the whole of Asia, and among lachrymatory, is absorbed in kieselguhr and stored in It sealed tins. A crude calcium some of the Indian tribes of North America. cyanide is also used. appears to be favoured by conditions of dirt and bad Foods retain varying amounts of hydrogen cyanide hygiene, and it is undoubtedly contagious. The after treatment and part with what is retained at problem of its pathology, after having eluded the rates; retention depends on such factors as labours of more than one generation of investigators,. varying moisture content, the nature of the surface, closeness appeared to have been solved a few years ago at the of packing; probably also on the formation of not very Rockefeller Institute in New York by Noguchi, who stable combinations of some constituents of the food discovered a Gram-negative aerobic bacillus with which with hydrogen cyanide. Milk, fresh or dried, he succeeded in infecting chimpanzees with what and dried fruits appear to retain relatively large was acknowledged, even by his critics, to be, at any amounts of the gas ; as to cheese some doubt exists. rate in some cases, true trachoma. More recent Cooking is likely to decrease the amount retained. investigations have, however, failed to confirm his Dr. Monier-Williams suggests the need for special care findings, and experiments are still being carried out in cases where high concentrations of gas or long at the Rockefeller Institute. The appalling fact is that, exposures are adopted, and he considers 20 parts of taking the world over, there are more people blinded hydrogen cyanide per million a reasonable maximum as the result of trachoma than from any other single for fumigated food when exposed for sale. He also cause. calls attention to the toxic action of hydrogen cyanide In the struggle to cope with the evil the experi- on the respiratory enzymes of plants and its results in ence of two countries is especially notable : Egypt, the treatment of stored fruit. From the point of view where, owing to the liberality of the late Sir Ernest of vitamin retention so closely associated with Cassel and the initiative of English ophthalmo- freshness, he considers caution desirable. Chapter logists, the ravages of trachoma are being to some and verse are given for all his conclusions. extent checked by a system of travelling tenthospitals ; and England, where the problem has never been present except on a comparatively small WE regret to learn the death of Dr. Ewan scale, but in London at any rate, was far This Richards Frazer, which occurred on Nov. 15th: more serious 30 years ago than it is now. improvement is to be attributed to the isolation of His pathological work and generous benefactions are well known to the medical infected cases until they are cured. This policy to science is described by Dr. Francis Lavery in his Montgomery profession. lecture on trachoma in Ireland,an abstract of which Reports on Public Health and Medical Subjects. No. 60. appears on p. 1163 of this issue. The extent of the H.M. Stationery Office. 1930. 6d. 1
repeated claims, rather than to abnormally long periods of respiratory illnesses. Other forms of
evil in that country seems to be much graver than had been realised, for though among the general population trachoma is less prevalent now than formerly, yet in several institutions under the direct control of a public authority no attempt to prevent the spread of the infection among children has succeeded. This is shocking, and we trust that Dr. Lavery’s revelations will prove a spur to the authorities to take action in the direction indicated by him. In civilised countries trachomatous pannus and entropion from inverted lids ought never to be seen, for trachoma is a disease which, if diagnosed in its early stages, and treated efficiently for a sufficient length of time, can be cured without material injury to the sight. In countries where the disease is rife the routine examination of all school-children by oculists skilled in detecting its early signs is the first condition for its eradication.
sickness were not in excess. Men of the ages mentioned must have been employed as youths under the conditions prevailing before exhaust appliances were installed, and so may then have received On the other hand, up to age 30 no excess damage. respiratory sickness was found. This would suggest that modern conditions of work are satisfactory, I were it not that some years of exposure to the dust is nearly certainly necessary before the effect of environment can become manifest in sickness-absenteeism. Undoubtedly the extreme conditions of the past no longer exist, and no longer are advanced cases of asthma being produced, but years must yet elapse before the question can finally be answered as to whether exposure to dust and fibre is to-day below the threshold of harm. This report establishes that, sickness records statistical treatment, by adequate can be used to disclose the existence of some occupaFOOD FUMIGATION. tional hazard, which is in itself no small advance in PRUSSic acid is being used not only for ridding ships method; but it also makes apparent how much time must often have to pass before the benefit accruing of rats but for the destruction of insects of various from some measure of betterment can be demonstrated. kinds in imported dried fruit and other foods. The absence of any destructive effect on structures and fittings gives it an advantage over most other poisonous THE PROBLEM OF TRACHOMA. gases, and it possesses the further advantage of being removed by ventilation. If we knew exactly FOR more than a century the causation of trachoma easily the extent to which foods of various kinds may absorb -or Egyptian ophthalmia, as it was called after it should then have the answer to the was disseminated among the British garrison in hydrogen cyanide,we whether, and in what circumstances, the gas question Egypt during the Napoleonic wars-has been one of may safely be used for the destruction of vermin and the standing puzzles in ocular pathology. As is well insect pests. A monograph by Dr. G. W. Monierknown, it commences insidiously and runs an Williams just issued by the Ministry of Health, extremely chronic course ; untreated cases eventually collates and discusses the available data. It appears get involvement of the cornea (pannus) and from this very interesting report that of recent years such scarring and contraction of the tissues of the the generation of hydrogen cyanide from potassium upper eyelids, involving inturned eyelashes, as is or sodium cyanide and sulphuric acid has been irremediable except by operation, and not always abandoned and either the liquefied acid (its boiling by that. The disease is rife throughout the east of point is 25° C.) is used from cylinders or, mixed with a Europe, Egypt, and the whole of Asia, and among lachrymatory, is absorbed in kieselguhr and stored in It sealed tins. A crude calcium some of the Indian tribes of North America. cyanide is also used. appears to be favoured by conditions of dirt and bad Foods retain varying amounts of hydrogen cyanide hygiene, and it is undoubtedly contagious. The after treatment and part with what is retained at problem of its pathology, after having eluded the rates; retention depends on such factors as labours of more than one generation of investigators,. varying moisture content, the nature of the surface, closeness appeared to have been solved a few years ago at the of packing; probably also on the formation of not very Rockefeller Institute in New York by Noguchi, who stable combinations of some constituents of the food discovered a Gram-negative aerobic bacillus with which with hydrogen cyanide. Milk, fresh or dried, he succeeded in infecting chimpanzees with what and dried fruits appear to retain relatively large was acknowledged, even by his critics, to be, at any amounts of the gas ; as to cheese some doubt exists. rate in some cases, true trachoma. More recent Cooking is likely to decrease the amount retained. investigations have, however, failed to confirm his Dr. Monier-Williams suggests the need for special care findings, and experiments are still being carried out in cases where high concentrations of gas or long at the Rockefeller Institute. The appalling fact is that, exposures are adopted, and he considers 20 parts of taking the world over, there are more people blinded hydrogen cyanide per million a reasonable maximum as the result of trachoma than from any other single for fumigated food when exposed for sale. He also cause. calls attention to the toxic action of hydrogen cyanide In the struggle to cope with the evil the experi- on the respiratory enzymes of plants and its results in ence of two countries is especially notable : Egypt, the treatment of stored fruit. From the point of view where, owing to the liberality of the late Sir Ernest of vitamin retention so closely associated with Cassel and the initiative of English ophthalmo- freshness, he considers caution desirable. Chapter logists, the ravages of trachoma are being to some and verse are given for all his conclusions. extent checked by a system of travelling tenthospitals ; and England, where the problem has never been present except on a comparatively small WE regret to learn the death of Dr. Ewan scale, but in London at any rate, was far This Richards Frazer, which occurred on Nov. 15th: more serious 30 years ago than it is now. improvement is to be attributed to the isolation of His pathological work and generous benefactions are well known to the medical infected cases until they are cured. This policy to science is described by Dr. Francis Lavery in his Montgomery profession. lecture on trachoma in Ireland,an abstract of which Reports on Public Health and Medical Subjects. No. 60. appears on p. 1163 of this issue. The extent of the H.M. Stationery Office. 1930. 6d. 1