TRACHOMA IN SOUTH AUSTRALIA

422 can hardly have much appeal for men and possibly introduced with the Afghan camel-drivers who who have spent long years in postgraduate train- were brought to Australia about a century ago, and a ing, and may indeed have been senior registrars. More- milder one spread from South-east Asia by Chinese and Indonesians. Flynn2 seems no need for such an explanation. ever, the medical-assistant grade looks as though it were going to perpetuate the two characteristics that have made He points out that both the benign and the destructive disease begin with a florid infection; but, whereas in so many people sorry to be a S.H.M.o. First, it is not designed as the ordinary stepping-stone between the favourable conditions this may subside with hardly any senior registrar and the consultant, but will instead bear sequels, in unfavourable conditions-e.g., secondary the old welcoming inscription " Abandon hope, most of infection, or exposure to hot dry wind and dust-the results may be disastrous. you who enter here ". And it also seems likely to preserve That trachoma may have suddenly become epidemic in the enormous disadvantage, for a career grade, that its maximum salary will always be a little below the minimum Adelaide is suggested by the fact that one ophthalmologist salary of the consultant. Who, one may ask, is willingly (Mr. D. 0. Crompton) has seen 18 cases in his private going to become a medical assistant-except possibly a practice in a single month. Believing that the incidence few general practitioners, or some married women, who of clinical trachoma in South Australia is quite high and might take such an appointment part-time ? Before any is rapidly increasing, he is very properly pressing for a such terms of service are settled, we hope those concerned survey in schools and other institutions, and is urging that will at least reconsider the possibility of overlapping scales all suspected cases shall be examined by a virologist, and of salary-so that a senior doctor who has worked for, kept under observation so that the effect of treatment can be judged. Fortunately the Institute of Medical and say, twenty-five years in the intermediate grade will earn more (not less) than a young doctor who has just won his Veterinary Science at Adelaide is able to undertake the consultant spurs.4 necessary cytological studies; and it had investigated some whether what is in is the 600 patients up to last November. Unfortunately, on the new Essentially, question to or of the is be senior We other remain hand, it cannot go on with this work unless a small grade junior. opinion To a career of this kind should be senior. that additional unit can be created for this special purpose. grade carry the appropriate prestige it would need a title less depress We hope this can be done, not only for reasons of public ing than either " senior hospital medical officer " or health but also because the Adelaide institute is capable " medical assistant "; and we still favour the title of of making a positive contribution to the virology of this " specialist " which we have so often proposed.4 But disease. whatever the grade is called for administrative purposes, SPREAD OF VIRUS HEPATITIS the actual appointments in it should be those of assistant THE two types of acute viral hepatitis differ in the way they physician, assistant surgeon, assistant pathologist, assistant psychiatrist, and so on. The fact that some of spread: infective hepatitis is almost always an enteric these titles are at present attached to certain consultant infection, whereas serum hepatitis is conveyed only by appointments seems to us insufficient reason for preventing the parenteral route. As might be expected of an infection a change which would generally be consistent with the conveyed from fasces to mouth, infective hepatitis is far realities of hospital life. If it became usual for prospective commoner in children. The incubation period of infective consultants to move into this intermediate grade as soon hepatitis is 15-60 days and that of serum hepatitis is as their training was finished, the grade would lose its 50-160 days. But in other respects-clinical course, biodead-end character. And actually, of course, even doctors chemical derangements in serum and fxces, and histowho had spent many years in it should still be able to logical changes in the liver-they are very similar. The qualify for a consultant appointment by showing their majority of sufferers, especially children, have a mild fitness for consultant work and their readiness to assume form of the disease without jaundice, and this anicteric its responsibilities. hepatitis may need sensitive liver-function tests for its recognition. The agents responsible have not been TRACHOMA IN SOUTH AUSTRALIA isolated with certainty; so there are no specific serological The evidence for infectivity of THE discovery of active trachoma in quite a number of tests for antibodies. people in Adelaide, including doctors, has caused surprise; specimens and transmission of the disease are based on for in Australia this infection was thought to be virtually human transmission experiments-a very unsatisfactory confined to the outback. Though the disease may seldom state of affairs. Thus, any data collected from epidemics are of the greatest value in piecing together the true or never be serious unless hygienic conditions are bad, it is important enough to justify full investigation of any picture of spread. Foremost in these laborious epidemiological endeavours flare-up. are Moseley and his co-workerswho have recently Until about 1942 the general belief was that Australia studied two epidemics in Des Moines, Iowa. These had little or no active trachoma; but subsequent surveys showed that this was certainly not true of the aborigines.1-3 epidemics came in cycles; they tended to reach a peak in the winter; there was a slow rise and fall in the epidemic Thus in one investigation in the Northern Territory 3051 curve; and the attack-rate was high in the 5-14 agewere affected out of 4876 examined, while in a smaller attributable to person-to-person spread. group-features study, of about 500, 90% showed evidence of infection An intestinal-oral route was suggested by the lower and 7 °% were blind in one or both eyes. In other surveys, attack-rate that accompanied better sanitation, iman equally high proportion of the people showed signs of socioeconomic status, coupled with better sewage past or present infection, but eyesight was seldom seriously proved and of privies, and the lessening of removal impaired. This raised the question whether Australia may disposal household congestion. Since hepatitis is primarily a have two strains of trachoma organism-a virulent one disease of schoolchildren, particular attention was paid to 1. R. C. Aust. 460.

seniority,

women

2. 3.

Webb, Flynn,

Med. J.

1957, i,

F. ibid. 1957, ii, 269. Yates, P. C. ibid. 1963, i, 828.

4.

Moseley, W. H., Speers, J. F., Chin, T. 53, 1603.

D. Y.

Amer. J. publ. Hlth, 1963,