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WORK OF THE ROCKEFELLER FOUNDATION.
707
Food Economics. IT is not enough to produce food. We must also see to its storage and preservation, unless we are content ourselves to go short at some period of the seasonal cycle and to allow others to starve all the
Investigation Board has long been dealing with the problem of perishable food and its preservation, and a brief outline of its work for the year 1919-20 is given in the report just issued of the Department for Scientific and Industrial Research. Economical storage and transit can only be determined by knowing the physics and chemistry of foodstuffs inside and out, and every step should be taken to speed up the study of bio-chemistry and bio-physics to produce results available in practice and to enable us to balance the lean years against the fat years. The projected new laboratory at Cambridge should help in this direction. Fortunately, the engineering problems of cold storage and of carrying fresh meat and fruit are being solved, and the bacteriologists are getting to know which moulds and yeasts must be carefully locked time.
The Food
up in the Pandora box and which are harmless enough to be let roam about. The question of
transport affects the fishing industry in a peculiar degree, for the miraculous draught avails little unless it can be transported to its consumers, and small progress towards economical national housekeeping can be made so long as the glut of fish is
Annotations. " Ne quid nimis."
ROCKEFELLER FOUNDATION. IN a handy and attractive volume Mr. George E. Vincent reviews the work in 1919 of the Rockefeller Foundations of which he is president. During this year the Foundation participated in activities of public health and medical education in 39 different governmental areas. Yellow fever control was successfully extended in Ecuador, Nicaragua, Honduras, and Salvador. In 1918 Guayaquil was selected as the most favourable centre for a fresh attempt to discover the organism which incites the disease, and Dr. Hideyo Noguchi, bacteriologist of the Rockefeller Institute, accepted an invitation to undertake research work in the city. He was at length able to cultivate from the blood of infected animals a minute, delicate, threadlike, spiral organism to which he gave the name Leptospira icteroides. Although Noguchi did not claim to have discovered the inciting germ of yellow fever, he was able to prepare a serum which has been administered in a number of cases with apparently favourable effect; the trial was, however, on too small a scale to decide the actual value of the serum. It seems likely that a means of identifying yellow fever has thus been found. The average number of cases annually reported in Guayaquil for the years 1912-18 inclusive, was 259, the toifal reaching 460 in 1918. At the end of that year a representative of the International Health Board of the Foundation arrived in the city to organise a campaign of eradication. Nothing was left undone by the Government and the city authorities which might ensure success. The aims of the campaign were: (1) The earliest possible discovery of cases of the disease, which were promptly isolated and screened from mosquitoes; (2) elimination of the stegomyia by denying the females access to water in which to deposit their eggs. Receptacles for water were protected in various ways ; minnows were used to destroy mosquito eggs in supplies which could not be covered. By January, 1919, the control work was far advanced ; since June,1919, no case has been reported. Vigilance will not be relaxed for at least a year. Meanwhile, offers of similar assistance were welcomed by the Governments of Honduras, Nicaragua, and Salvador, and the Foundation despatched a group of experts, headed by the late General Gorgas. In each country government commissions were created to take charge of control measures, and these several commissions cooperated in an international programme for the protection of all the areas concerned. By the middle of October yellow fever had been practically banished from Central America. The Foundation proceeded with diversified attacks of malaria; experiments in control were continued in six towns in Mississippi and Arkansas, and begun in four others. Anti-mosquito measures were chiefly relied upon. The practical aims in view were : (1) to eliminate anopheles by preventing their breeding; (2) to screen houses against this mosquito; (3) to sterilise by quinine the blood of human malaria carriers. A reduction of 67 per cent. in the prevalence of malaria was secured. In June, 1919, a conference was held to plan a concerted campaign against malaria in the Southern States. The International Health Board of the Foundation conWORK OF THE
liable to be returned to the sea which gave it or rot on the land. From the land food has to be wrested by the sweat of man’s brow, and he cannot afford to forego the free offerings of the sea. The Engineering Committee of the Food Board is now busied with the construction of refrigerator wagons suited for use in this country ; while the Board’s Fish Preservation Committee has completed its report on the freezing of fish in time of plenty, based upon experiments carried out both at Billingsgate Market and University College, London. Progress is also recorded in the means for preserving meat, milk, and fruit, and in avoiding the moulds and spots which tend to spoil animal food while in - the refrigerating chambers. Beef, it appears, may soon be preserved by freezing without altering the muscle substance; heretofore the frozen fibres in thawing lost a’ large part of their nutritive material in the form of haemoglobin-stained fluid. Experiments on the storage of fruit, recorded in the report, are of peculiar interest. By the employment of certain artificial atmospheres in the storage chambers the life of the fruit may be greatly extended. The respiratory metabolism of fruit at low temperatures has been studied, and search made for the oxidising enzymes responsible for the discolouration of certain fruits when bruised. The use of chemical preservatives is not discussed in the report, although this method of preserving in 1919 work food is tempting to the producer. We may tinued its measures of hookworm control; was carried forward in 25 different States and countries, assume that the control over such preservatives suspended in two countries, and inaugurated in eight in food as boracic, salicylic, or benzoic acid, and new areas. The antituberculosis campaign begun in the fluorides, to quote examples, which suggest France in 1917 was extended. Its definite objects possible injury to health, is carefully maintained were: (1) the setting up in typical urban and prounder the Sale of Food and Drugs Acts. Pre- vincial areas of standard demonstrations of systematic control methods; (2) the training of public health the smoke on the kipper and the deposit sumably clinicians, lecturers, and organisers ; (3) the nurses, in impregnated salt pickled beef come outside the of communities to the need of creating local arousing of treated foods. The category chemically report agencies, governmental and voluntary; (4) the educa. as a whole, upon which we have touched but tion of the public ; (5) the gradual transfer of responsilightly, is certainly cheering for the consumer. bility to French agencies and the organisation of these
placed to
1
Cmd. 905. H.M, Stationery Office. 1s.
agencies
on a
national basis.
Progress
was
made in
.
708 each of these directions. During the year the Com- and disappears about the seventh day. This is immission added to its educational devices the Guignol, portant, for at that time the vesicles are more the French Punch and Judy, which was seen by or less ulcerated and a prey to secondary infection. 67,000 children. Twenty-eight departments and 293 Spontaneous recovery is thus the natural terminatowns were visited by the Commission’s exhibits, tion and suppuration does not occur. Nothing can In the be more simple than its value as a positive sign. and 700,000 people were reached directly. United States the School of Hygiene and Public But the secondary adenopathy, whether of herpes Health at Johns Hopkins University, established zoster or of herpes simplex, due to infection of the by the Foundation and opened in 1918, continued to vesicles, must be distinguished. This is rare, and is give instruction and encourage research, and established not a symptom of zoster but a complication due to relationships with the community and the field. In infection of the vesicles, and therefore appears late. China the Peking Union Medical College, which is con- The adenopathy generally affects only one gland. It trolled by a board of trustees chosen by the Foundation voluminous and clearly inflammatory, with tendency and six cooperating British and American missionary to suppuiation. There are periglandular swelling, societies, has recently been opened, and is being built alteration of the skin, and often lymphangitis. The and maintained by Foundation funds. A sum of same holds for the adenopathy of zosteriform erup$5,000,000 was recently set aside for use in Canada. In tions. Uncomplicated simple herpes and uncompliorder to provide expert direction for the growing work cated zosteriform eruptions are not accompanied by of the Foundation, the board created a division of adenitis. Hence its value in differential diagnosis. Medical Education. During the year fellowships and The adenitis of zona, being independent of secondary scholarships were provided for 85 persons resident in infection, seems to be due to the still unknown universities in the United States ; 13 research fellows pathogenic agent of the disorder. The primary lesion in physics and chemistry were also supported. The evidently occurs in the ganglion of the posterior root of Foundation continued from time to time to provide the nerve supplying the affected area. This lesion may funds to standing or special committees for surveys or act directly on the gland or indirectly through the studies. The report closes with a summary of the intermediary of the cutaneous lesions. How the lesion receipts and expenditures for the fiscal year 1919, and of the_distant ganglion can produce the acute inflammaa note on the organisation of the Foundation. The tion of the skin, which is now well established, or the complete annual report, to include details of the work lymphadenitis MM. Raymond and Lebel did not discuss. of the International Health Board and the China Pain or degenerative or even vaso-motor changes is Medical Board, will be issued during the autumn, but easily comprehensible, but the production of acute enough has already appeared to give the reader inflammation is a curious pathological fact which stands alone. a good insight into the output of a most beneficent ’
is
.
undertaking.
,
----’--
LYMPHADENITIS OF HERPES ZOSTER. meeting of the Societe Médicale des Hopitaux of Paris, MM. Louis Ramond and Roger Lebel made a THE
AT
a
communication on a most interesting sign of herpes zoster which has been observed only in recent yearsprimary enlargement of the lymphatic glands of the affected area. It was first pointed out in 1892 by a French dermatologist, Barthelemy, and has now been briefly described in the text-books. MM. Ramond and Lebel have never found it absent in the course of ten years, during which they have looked for it systematically. They consider that it merits greater attention than has been bestowed on it, and shouldrank with the pain and eruption in the definition of herpes zoster. Into the symptomatic triad thus formed it brings a new element, clearly infective, and more useful than the fever, which is often absent or overlooked, in distinguishing zoster from zosteriform eruptions. This primary adenitis must be distinguished from the adenitis secondary to infection of the ulcerated vesicles. The enlarged glands are those into which the lymphatics from the affected area drain. To feel them the axilla must be explored in zona of the upper limb or of the trunk above the umbilicus, and the groins in zona of the lower limb or of the trunk below the umbilicus. In ophthalmic zona the preauricular gland is engorged ; in occipital, the suboccipital glands; in maxillary (superior or inferior), the submaxillary and suprahyoid glands ; and in cervical, the superficial cervical. Sometimes adenopathy may be observed in glands lying outside the main group. Thus in a case of intercostal zona a gland of the size of a small filbert was found at the angle of the scapula. Like the eruption the adenitis is unilateral, but Barthelemy has observed one case of intercostal zona in which the glands were affected on both sides, but more so on the side of the eruption. MM. Ramond and Lebel have found that the adenopathy appears early and accompanies the slightest eruption whatever its stage, even when only erythematous. Clinically the adenitis is characterised by tumefaction and tenderness-never by spontaneous pain. Hence in regions not likely to be rubbed, such as the axilla and groin, it is overlooked. On the other hand, in exposed situations it may be the symptom for which the patient seeks advice, when the eruption is slight or concealed by the scalp. The adenitis is at its height when the vesicles appear. It then diminishes
MENTAL NURSING. IF the supply of probationers in the training hospitals is inadequate, the temporary disfavour into which nursing has fallen as a profession for educated women is causing even greater inconvenience in those institutions which cannot offer a general training. Staff recruiting for fever hospitals is difficult ; for mental hospitals it is almost desperate. Leaving out of account the general nursing problem, the causes of the relative shortage of candidates for these two services are not far to seek. They include the geographical situation of fever and mental hospitals, which is usually isolated, and the diminished opportunity of social intercourse caused thereby, and also by the dislike of the lay public to enter such places, however accessible. Indeed, the fever nurse is not very welcome as a visitor outside the hospital walls, while the mental nurse is regarded with what may amount to a curious dread. Not only is the social status of workers in these specialised branches of nursing less secure, but the actual work seems to be-found less interesting in the one case and more depressing in the other, besides appealing less to the immature imagination. Service in a general hospital is felt to be offered to the sick poor, and only indirectly to the whole community; patients are there entirely for their own benefit. In the-fever hospitals patients on the whole need less varied individual attention, and often remain after they are apparently well because their detention is still necessary in the interests of In the mental hospitals reports of the others. tediousness of the cases and the small proportion of cures do not encourage the prospective nurse, and her duties under present-day conditions appear to be concerned ,mainly with the protection of the public by helping to segregate the insane. - In his annual report of The Retreat at York Dr. Bedford Pierce, the medical superintendent, touches on this subject, and attributes the unpopularity of the mental service not to questions of pay or of long hours, but partly at least to the rarity of good posts and the poor prospects of developing a career. The avenue of promotion is often closed because it is convenient to bring in general hospital-trained nurses as matron and assistant matron. Dr. Pierce chronicles the purchase of a home for the treatment of ’patients suffering from nervous and mild forms of mental disorder in connexion with The Retreat, but emphasises that the nursing staffs will be quite distinct. This seems an unfortunate arrangement, as an occasional period of service with uncertified
Food Economics. IT is not enough to produce food. We must also see to its storage and preservation, unless we are content ourselves to go short at some period of the seasonal cycle and to allow others to starve all the
Investigation Board has long been dealing with the problem of perishable food and its preservation, and a brief outline of its work for the year 1919-20 is given in the report just issued of the Department for Scientific and Industrial Research. Economical storage and transit can only be determined by knowing the physics and chemistry of foodstuffs inside and out, and every step should be taken to speed up the study of bio-chemistry and bio-physics to produce results available in practice and to enable us to balance the lean years against the fat years. The projected new laboratory at Cambridge should help in this direction. Fortunately, the engineering problems of cold storage and of carrying fresh meat and fruit are being solved, and the bacteriologists are getting to know which moulds and yeasts must be carefully locked time.
The Food
up in the Pandora box and which are harmless enough to be let roam about. The question of
transport affects the fishing industry in a peculiar degree, for the miraculous draught avails little unless it can be transported to its consumers, and small progress towards economical national housekeeping can be made so long as the glut of fish is
Annotations. " Ne quid nimis."
ROCKEFELLER FOUNDATION. IN a handy and attractive volume Mr. George E. Vincent reviews the work in 1919 of the Rockefeller Foundations of which he is president. During this year the Foundation participated in activities of public health and medical education in 39 different governmental areas. Yellow fever control was successfully extended in Ecuador, Nicaragua, Honduras, and Salvador. In 1918 Guayaquil was selected as the most favourable centre for a fresh attempt to discover the organism which incites the disease, and Dr. Hideyo Noguchi, bacteriologist of the Rockefeller Institute, accepted an invitation to undertake research work in the city. He was at length able to cultivate from the blood of infected animals a minute, delicate, threadlike, spiral organism to which he gave the name Leptospira icteroides. Although Noguchi did not claim to have discovered the inciting germ of yellow fever, he was able to prepare a serum which has been administered in a number of cases with apparently favourable effect; the trial was, however, on too small a scale to decide the actual value of the serum. It seems likely that a means of identifying yellow fever has thus been found. The average number of cases annually reported in Guayaquil for the years 1912-18 inclusive, was 259, the toifal reaching 460 in 1918. At the end of that year a representative of the International Health Board of the Foundation arrived in the city to organise a campaign of eradication. Nothing was left undone by the Government and the city authorities which might ensure success. The aims of the campaign were: (1) The earliest possible discovery of cases of the disease, which were promptly isolated and screened from mosquitoes; (2) elimination of the stegomyia by denying the females access to water in which to deposit their eggs. Receptacles for water were protected in various ways ; minnows were used to destroy mosquito eggs in supplies which could not be covered. By January, 1919, the control work was far advanced ; since June,1919, no case has been reported. Vigilance will not be relaxed for at least a year. Meanwhile, offers of similar assistance were welcomed by the Governments of Honduras, Nicaragua, and Salvador, and the Foundation despatched a group of experts, headed by the late General Gorgas. In each country government commissions were created to take charge of control measures, and these several commissions cooperated in an international programme for the protection of all the areas concerned. By the middle of October yellow fever had been practically banished from Central America. The Foundation proceeded with diversified attacks of malaria; experiments in control were continued in six towns in Mississippi and Arkansas, and begun in four others. Anti-mosquito measures were chiefly relied upon. The practical aims in view were : (1) to eliminate anopheles by preventing their breeding; (2) to screen houses against this mosquito; (3) to sterilise by quinine the blood of human malaria carriers. A reduction of 67 per cent. in the prevalence of malaria was secured. In June, 1919, a conference was held to plan a concerted campaign against malaria in the Southern States. The International Health Board of the Foundation conWORK OF THE
liable to be returned to the sea which gave it or rot on the land. From the land food has to be wrested by the sweat of man’s brow, and he cannot afford to forego the free offerings of the sea. The Engineering Committee of the Food Board is now busied with the construction of refrigerator wagons suited for use in this country ; while the Board’s Fish Preservation Committee has completed its report on the freezing of fish in time of plenty, based upon experiments carried out both at Billingsgate Market and University College, London. Progress is also recorded in the means for preserving meat, milk, and fruit, and in avoiding the moulds and spots which tend to spoil animal food while in - the refrigerating chambers. Beef, it appears, may soon be preserved by freezing without altering the muscle substance; heretofore the frozen fibres in thawing lost a’ large part of their nutritive material in the form of haemoglobin-stained fluid. Experiments on the storage of fruit, recorded in the report, are of peculiar interest. By the employment of certain artificial atmospheres in the storage chambers the life of the fruit may be greatly extended. The respiratory metabolism of fruit at low temperatures has been studied, and search made for the oxidising enzymes responsible for the discolouration of certain fruits when bruised. The use of chemical preservatives is not discussed in the report, although this method of preserving in 1919 work food is tempting to the producer. We may tinued its measures of hookworm control; was carried forward in 25 different States and countries, assume that the control over such preservatives suspended in two countries, and inaugurated in eight in food as boracic, salicylic, or benzoic acid, and new areas. The antituberculosis campaign begun in the fluorides, to quote examples, which suggest France in 1917 was extended. Its definite objects possible injury to health, is carefully maintained were: (1) the setting up in typical urban and prounder the Sale of Food and Drugs Acts. Pre- vincial areas of standard demonstrations of systematic control methods; (2) the training of public health the smoke on the kipper and the deposit sumably clinicians, lecturers, and organisers ; (3) the nurses, in impregnated salt pickled beef come outside the of communities to the need of creating local arousing of treated foods. The category chemically report agencies, governmental and voluntary; (4) the educa. as a whole, upon which we have touched but tion of the public ; (5) the gradual transfer of responsilightly, is certainly cheering for the consumer. bility to French agencies and the organisation of these
placed to
1
Cmd. 905. H.M, Stationery Office. 1s.
agencies
on a
national basis.
Progress
was
made in
.
708 each of these directions. During the year the Com- and disappears about the seventh day. This is immission added to its educational devices the Guignol, portant, for at that time the vesicles are more the French Punch and Judy, which was seen by or less ulcerated and a prey to secondary infection. 67,000 children. Twenty-eight departments and 293 Spontaneous recovery is thus the natural terminatowns were visited by the Commission’s exhibits, tion and suppuration does not occur. Nothing can In the be more simple than its value as a positive sign. and 700,000 people were reached directly. United States the School of Hygiene and Public But the secondary adenopathy, whether of herpes Health at Johns Hopkins University, established zoster or of herpes simplex, due to infection of the by the Foundation and opened in 1918, continued to vesicles, must be distinguished. This is rare, and is give instruction and encourage research, and established not a symptom of zoster but a complication due to relationships with the community and the field. In infection of the vesicles, and therefore appears late. China the Peking Union Medical College, which is con- The adenopathy generally affects only one gland. It trolled by a board of trustees chosen by the Foundation voluminous and clearly inflammatory, with tendency and six cooperating British and American missionary to suppuiation. There are periglandular swelling, societies, has recently been opened, and is being built alteration of the skin, and often lymphangitis. The and maintained by Foundation funds. A sum of same holds for the adenopathy of zosteriform erup$5,000,000 was recently set aside for use in Canada. In tions. Uncomplicated simple herpes and uncompliorder to provide expert direction for the growing work cated zosteriform eruptions are not accompanied by of the Foundation, the board created a division of adenitis. Hence its value in differential diagnosis. Medical Education. During the year fellowships and The adenitis of zona, being independent of secondary scholarships were provided for 85 persons resident in infection, seems to be due to the still unknown universities in the United States ; 13 research fellows pathogenic agent of the disorder. The primary lesion in physics and chemistry were also supported. The evidently occurs in the ganglion of the posterior root of Foundation continued from time to time to provide the nerve supplying the affected area. This lesion may funds to standing or special committees for surveys or act directly on the gland or indirectly through the studies. The report closes with a summary of the intermediary of the cutaneous lesions. How the lesion receipts and expenditures for the fiscal year 1919, and of the_distant ganglion can produce the acute inflammaa note on the organisation of the Foundation. The tion of the skin, which is now well established, or the complete annual report, to include details of the work lymphadenitis MM. Raymond and Lebel did not discuss. of the International Health Board and the China Pain or degenerative or even vaso-motor changes is Medical Board, will be issued during the autumn, but easily comprehensible, but the production of acute enough has already appeared to give the reader inflammation is a curious pathological fact which stands alone. a good insight into the output of a most beneficent ’
is
.
undertaking.
,
----’--
LYMPHADENITIS OF HERPES ZOSTER. meeting of the Societe Médicale des Hopitaux of Paris, MM. Louis Ramond and Roger Lebel made a THE
AT
a
communication on a most interesting sign of herpes zoster which has been observed only in recent yearsprimary enlargement of the lymphatic glands of the affected area. It was first pointed out in 1892 by a French dermatologist, Barthelemy, and has now been briefly described in the text-books. MM. Ramond and Lebel have never found it absent in the course of ten years, during which they have looked for it systematically. They consider that it merits greater attention than has been bestowed on it, and shouldrank with the pain and eruption in the definition of herpes zoster. Into the symptomatic triad thus formed it brings a new element, clearly infective, and more useful than the fever, which is often absent or overlooked, in distinguishing zoster from zosteriform eruptions. This primary adenitis must be distinguished from the adenitis secondary to infection of the ulcerated vesicles. The enlarged glands are those into which the lymphatics from the affected area drain. To feel them the axilla must be explored in zona of the upper limb or of the trunk above the umbilicus, and the groins in zona of the lower limb or of the trunk below the umbilicus. In ophthalmic zona the preauricular gland is engorged ; in occipital, the suboccipital glands; in maxillary (superior or inferior), the submaxillary and suprahyoid glands ; and in cervical, the superficial cervical. Sometimes adenopathy may be observed in glands lying outside the main group. Thus in a case of intercostal zona a gland of the size of a small filbert was found at the angle of the scapula. Like the eruption the adenitis is unilateral, but Barthelemy has observed one case of intercostal zona in which the glands were affected on both sides, but more so on the side of the eruption. MM. Ramond and Lebel have found that the adenopathy appears early and accompanies the slightest eruption whatever its stage, even when only erythematous. Clinically the adenitis is characterised by tumefaction and tenderness-never by spontaneous pain. Hence in regions not likely to be rubbed, such as the axilla and groin, it is overlooked. On the other hand, in exposed situations it may be the symptom for which the patient seeks advice, when the eruption is slight or concealed by the scalp. The adenitis is at its height when the vesicles appear. It then diminishes
MENTAL NURSING. IF the supply of probationers in the training hospitals is inadequate, the temporary disfavour into which nursing has fallen as a profession for educated women is causing even greater inconvenience in those institutions which cannot offer a general training. Staff recruiting for fever hospitals is difficult ; for mental hospitals it is almost desperate. Leaving out of account the general nursing problem, the causes of the relative shortage of candidates for these two services are not far to seek. They include the geographical situation of fever and mental hospitals, which is usually isolated, and the diminished opportunity of social intercourse caused thereby, and also by the dislike of the lay public to enter such places, however accessible. Indeed, the fever nurse is not very welcome as a visitor outside the hospital walls, while the mental nurse is regarded with what may amount to a curious dread. Not only is the social status of workers in these specialised branches of nursing less secure, but the actual work seems to be-found less interesting in the one case and more depressing in the other, besides appealing less to the immature imagination. Service in a general hospital is felt to be offered to the sick poor, and only indirectly to the whole community; patients are there entirely for their own benefit. In the-fever hospitals patients on the whole need less varied individual attention, and often remain after they are apparently well because their detention is still necessary in the interests of In the mental hospitals reports of the others. tediousness of the cases and the small proportion of cures do not encourage the prospective nurse, and her duties under present-day conditions appear to be concerned ,mainly with the protection of the public by helping to segregate the insane. - In his annual report of The Retreat at York Dr. Bedford Pierce, the medical superintendent, touches on this subject, and attributes the unpopularity of the mental service not to questions of pay or of long hours, but partly at least to the rarity of good posts and the poor prospects of developing a career. The avenue of promotion is often closed because it is convenient to bring in general hospital-trained nurses as matron and assistant matron. Dr. Pierce chronicles the purchase of a home for the treatment of ’patients suffering from nervous and mild forms of mental disorder in connexion with The Retreat, but emphasises that the nursing staffs will be quite distinct. This seems an unfortunate arrangement, as an occasional period of service with uncertified