VITAMINS IN MARGARINE

622 the total figure receiving " colony treatment," Others will probably question the criteria which which is in actual fact the only sound individual type you advance for distinguishing benign from leptoof treatment they can get, was 6000, less than 3 per spiral jaundice. cent. of the estimated figure-namely, 200,000 for the You conclude with a subject of great interestcolony. The effect of endemic venereal or other con- Findlay’s recommendation of the administration of tagious associated non-venereal disease on the glucose to all cases of infective hepatitis as a prophycurrent living standards is very great, owing to loss lactic against acute necrosis of the liver. Research in of labour time and so on. This aspect is also worthy America into the causes of arsphenamine jaundice of consideration in relation to improvements recently revealed that a high carbohydrate diet was, surprissuggested by the Colonial Office. ingly, a predisposing cause of this type of liver If therefore Sobisminol is to be established as a necrosis, and that the liver could be fortified by a diet specific for the treatment of both yaws and syphilis rich in fats. Since you indicate that arsphenamine by the mouth, it could prove of great value. Not jaundice may come to be classed as an infective least important perhaps is the fact that injection necrosis of the liver, you may consider the matter of therapy may never become very popular in some sufficient importance to merit an amplified account of Mahommedan areas on deeply-felt religious grounds, the present position in this dietetic conflict. on account of the possibility of scarring or in the case I am, Sir, yours faithfully, of intramuscular injections even of mutilation. This R. E. HOPE SIMPSON. The Lizard, Cornwall. partly explains the fact that in Nigeria syphilis, which is very common among the Mahommedan MINERS’ NYSTAGMUS Hausa, is not nearly as fully treated as is yaws, which defined so is common in though geographically SiR,-With reference to the recent discussion of the the south. Syphilis is comparatively uncommon in the aetiology of miners’ nystagmus, the following observaGonorrhoea is widespread throughout the tions of miners on the Bengal and Bihar coalfields south. whole of Nigeria, an index, like tuberculosis, of faulty may be relevant. In connexion with health investiliving standards. gations carried out for the Government of India I had the opportunity of examining a large number of I am, Sir, yours faithfully, Indian miners, but never saw any sign of nystagmus D. FITZGERALD MOORE. Parkstone, Dorset. nor could obtain any record of the condition having been noted by others. The men were generally INFECTIVE HEPATITIS AND CATARRHAL drawn from primitive agricultural communities, and JAUNDICE came to the coalfields for a period of several months the annotation on this SIR,-In opening subject in at a time. They were often unwilling to work more than four days a week. A less cramped posture of 23 issue March "It is now your (p. 558) you say: accepted that there are two forms of mild jaundice in was maintained while at work than in this country, since the seams of coal were of greater depth. The this country, one due to a catarrh of the common bile-duct associated with duodenitis, the other to lighting was very poor. The people with whom I talked had never heard of compensation for a statement So well stir hepatitis." dogmatic may nystagmus amongst miners. up controversy. The division you quote is due largely to Hurst and Simpson and is by no means generally I am, Sir, yours faithfully, accepted. Cullinan2 and Picklesreject the division DAGMAR CURJEL WILSON. Oxford. as applied to epidemic benign jaundice. The clinical pictures described as characteristic of the two types4 VITAMINS IN MARGARINE may both appear in a single epidemic, and Quick finds biochemical evidence of mild hepatic necrosis in SiR,—Medical men incur a certain amount of cases clinically diagnosed catarrhal jaundice. responsibility towards their patients in recommending As long ago as 1912 Cockaynecast doubt on the to them special articles of diet. It was announced theory of an upward spread from a primary duoden- that from Feb. 5 all margarines would contain an itis, and a comparison of those icterogenic diseases added amount of vitamins A and D equal to that in whose pathology is better understood brings into butter. Certain brands have for some time had these evidence the rarity of the ascending route to the liver. vitamins added, to an amount, according to the manuAscaris may occasionally occupy the common bile-duct, facturers’ statements, equal to that in summer butter. but ascending cholangitis seems very rare except as a Now that many other manufacturers of margarine, not complication of gross calculous cholecystitis or necessarily possessing laboratories, are included in the advanced malignant disease. Even when, as in enteric general statement issued by the Ministry of Food, one and some cases of spirochaetosis icterohsemorrhagica, would like to know whether the process of manufacthe virus is first ingested, jaundice is caused after ture destroys the activity of added vitamins, and by invasion of the blood-stream. The conception of what tests of the finished article and methods of jaundice resulting from simple biliary catarrh is inspection the standard is maintained. steadily losing favour. I am, Sir, yours faithfully, Not everyone will agree with your statement that ROGER N. GOODMAN. Great Kimble. infective hepatitis is spread from one person to another by droplet infection. The evidence is as yet The impression that the disease is inconclusive. ** We understand that it is not a difficult matter to dissolve the vitamin concentrates in part of one of commonest in partially closed communities may well result from the greater readiness with which such the oils used for the fatty mixture which is the basis of margarine. In this way thorough mixing is obtained outbreaks are studied. and the subsequent emulsification makes it certain that the whole blend is uniform. The known stability of 1. Hurst, A. F. and Simpson, C. K. Guy’s Hosp. Rep., 1934, 84, the added vitamins A and D justifies the assumption 173. 2. Cullinan, E. R. Proc. R. Soc. Med. 1939, 32, 933. that under ordinary conditions there is no appreciable 3. Pickles, W. N. Lancet 1939, 1, 893. deterioration during the period between manufacture 4. Quick, A. J. Brit. med. J. 1938, 2, 683. and retail sale.-ED. L. 5. Cockayne, E. A. Quart. J. Med. 1912, 6, 1.

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