Document JN8XOOK6dq4ZdrgzYmwyNjwnr

807 J BUREAU OF HYGIENE AND TROPICAL DISEASES. i" ISBULLETIN OF HYGIENE PLAINTIFF'S EXHIBIT Volume 18, No..8. August, 1943. PUBLIC HEALTH ADMINISTRATION*. <5- Sch.vrft, J. \v.; Wn.u.uts. Cicely D. With a Preface by Hon. G. A. de C. de Moubray. [Condensed by Jean Bigger,j Preventive Paediatrics : as Account of Health Work in Trenggann, Malaya. Indian .'if. Gas. 1942. Sept. & Xov., v. 77. Xus. 9 & 11. 552-3; 689-96. An introductory paragraph to this article states that, as printed, it is a condensed form of a report-of a study which, in ordinary times, would have been issued as a Government publication. It certainly deserves to reach a wider circle of readers than that of any single medical journal, even so influential a one as the Indian Medical GaztUc. The writer of the Preface notes with regret that ever since the State came under British advice expenditure and effort have been con centrated on clinical medicine to the compara tive neglect of the preventive side. Money spent on young children with a view to proeducing an A l population is largely wasted if "the health of others in the family is neglected so tliat reinfection is facilitated, in fact, three branches of medicine need to be intimately correlated if the best results are to be attained : (1) The hospital or short-term approach. (2) Preventive medicine, or middle-term approach. (3) Education, the long-term approach. Dr. Williams, in Section I, gives a very clear and succinct, though condensed, account of the conditions in Trengganu, and the aims of the Health Programme are stated, namely : (a) To discover the causes of the large infant mortality and . prevalent ill-health, (6; to deal with these conditions, (C) to do this as economically as possible, consistent with thoroughness. She describes the area of the State (5,1)50 square miles), the population (about 200.000, ninetenths Malays), the industries, occupations, finance, vital statistics, nutrition, and the chief diseases. The last are: malnutrition and its sequelae; helminthiasis, chiertv '* round worm." which is said to infest 9o fxsr cent, of the inhabitants [presumably Ascaris is meant, as other Xematodes are mentioned separately]; yaws, though less common than in former days, still remains ouc of the major health problems : malaria varies in seriousness in different areas, hut the spleen-rate in school-children is under 4* per cent., and, though 3.503 deaths were ascrilxxi to '* malaria ami uitsjxscifted fever '* in 1940, only 76. or 2 percent., could be certified as due to malaria.. Tuberculosis, especially the pulmonary ,form, is a serious scourge. Examination of medical reports showed that (1) Though 90 per cent, of the population is Malay, they make less than 30 per cent, of the admissions to hospital and most arc cases of accident or chronic ulcer. (2) Relatively few of the women and children come to hospital for treatment. (3) The chief jiersons tu take advantage of the Government Maternity Ser vice are the Chinese, though they form hut a small projiortion of the female )*>puiuttnii. Tor these reasons hospital returns would In- very misleading as statistics of disease. In Section 11. the Scheme for Health Work. Dr. Scharrt indicates the three most imjjortant aims, belter feeding, malaria prevention, and infant welfare. Under the first the main proi>lem was to prevail upon the people to use un polished rice--not an easy matter, Ixrcause the polished product keeps longer and is more profitable to the shopkeej>ers. Tlie next point was to stimulate interest in home gardening and in general sanitation, the digging of bore-hole latrines and organizing sanitary squads. Under the second came the large-scale application of ** naturalistic" methods. The third is dealt with in detail by Dr. Williams. She writes of the need for studying local conditions ; for let ting prevention and cure go hand in hand and be accompanied by unceasing explanation, encouragement and health teaching; for mak ing allowances and, if well, for making use *>f rav ,*o. S. * INDUSTRIAL HYGIENE. 651 xj&son. analyses of a portion of one silicotic , obtained from a Mansfeld miner. No -tils of morbid anatomy or of the histological ' ition of this lung, however, arc given. The )j of these analyses are sot suitable for abstraction. The dust encountered showed par- tides of numerous different substances includ ing limestone, kaolin, silica, quartz, felspar, mica, scricite and rutile. These varied in size from less than 2u up to more than 50p. S. Roodhonse Cloyne. Bohme, A. Untersuchungen an den Arbeitcm einer Asbestfabrik. [Examination o! Workers In an Asbestos Factory.} Arch. f. Gewerbepath. it. Geu-erbehvg. 194'i. Nov. 10, v. 11, No. 4, 433-52, 8 figs. , / Dus is a record of clinical and radiological i observations made in an asbestos factory during ] the years 1936-1937 and the year 1940. The factory* handled raw absestos and manufactured a variety of asbestos products. It employed up to 500 workers. Of 132 persons examined. ` '29 per cent, showed radiological evidence of asbestosis. Correlating these findings with exposure, it is seated chat there were in workers with lea than three years of exposure 5 per cent, of cases, in those with 3-5 years of expo sure 12 per cent., in 5-10 years 56 per cent., and in over 10 years 79 per cent.. Five cases of pulmonary* tuberculosis were noted. The clinical histories of these are recorded. S. Roodhottse Gloyne. ^ Welz, A. Weitere Beobachtungen ueber den OBerufskrebs der Asbestarbeiter. [Further Observations on Occupational Carcinoma in Asbestos Workers.] Arch. /. Gewerbepath. u. Gewerbekyg. 1942, Nov. 10, v. 11, No. 4. 536-50, 6 figs. [I4 6.J This article is a record of two cases of asbes tosis complicated by cancer of the lung. The first patient was aged 43. with an exposure of | 11 years in an asbestos factory ; death was due to squamous ceil carcinoma. The second worker had had 30 years' experience in asbestos work and showed at autopsy an atypical epi thelial cell new growth. The author suggests there is a causal relation ] ship between asbestosis and carcinoma. 5. Roodhousc Gloyne. Goralewski, G. Weitere Erfahrungen rum KrankheitsbildderAluminiumlunge. [Fur ther Knowledge on the Clinical Picture of the Aluminium Long.] Deut. TuberhUouBlatt. 1943, Jan., v. 17, No. 1, 3-10, 5 figs. This article is based upon data collected by t the author from the examination of some 700 : workers exposed to aluminium dust in German war industries. The examinations were pri marily radiological and clinical but included also 325 vital capacity and sputum tests, and 100 blood counts. The chief complaints recorded in the personal medical histories of these workers were dry* cough with stitch-like pains in breath ing, dyspnoea, failing appetite and dragging gnawing pains in the alxJuincn, There were no ' pathognomonic findings on clinical examina tion. The blood counts exhibited a relative lymphocytosis and eosinophil colls were some what increased up to 5--10 per cent. Total leucocyte counts tended to be low, whilst red cell counts produced no significant changes. Blood sedimentation tests were aL*o normal. Vital capacity tests showed a reduction in capa city. Four cases of spontaneous pneumothorax wore noted, onu of them fatal. Radiologically the earliest sign consisted of focal shadows in the apical regions with, later, an increase (often one-sided) of the normal bronchial markings in the upjvr and middle thirdsof-the lung, giving a reticular appearance. There was also sometimes an increase in these markings in the lower lobes suggesting increased drainage to the hilum glands. Retraction of the diaphragm and distortion of the heart shadow werefound. At a later stage the focal shadows tended to increase and become confluent [unfor tunately the radiograms reproduced have been much reduced in size and do not bring out all the finer points mentioned]. One case came to autopsy. On microscopical examination the connective tissue elements of . the lung showed coarse, branching hyaline collagenous fibres enclosing phagocytes contain ing fine and coarsely granular particles which differed from carbon particles by their jagged outlines. In parts of the lung these hyaline collagenous fibres were also found surrounding the wails of the alveoli, which contained phago cytes. These changes were most marked in the right upper lobe. [No illustrations are given.} The regional lymph glands exhibited a few of these dust cells King chiefly in small groups. It is suggested that these histological changes result from a colloidal reaction between the aluminium dust particles and the tissue fluids. 5. Rood/touse Gloyne. Gardner. L. U. & Delahant, A. B. Action of finely Divided Magnesium upon the Lungs. Atner. J. Pub. Health. 1943, Feb., v. 33, No. 2. 153-6. 3 figs. Small particles of magnesium embedded in living tissues dissolve with the evolution of hydrogen and the production of " gas tumours ", due to an irritating alkaline hydroxide. When the metal has dissolved, the resulting inflamma tion subsides and healing ensues. Experiments