593. THE HEALTH OF THE INDIGENOUS RAND MINER.

and the casual searcher gains the impression that thequalification registered is of a different quality or

standard, which is, of course, not the case. We hopethat the matter may be rectified when next the MedicalActs come up for revision in Parliament, for it is justsuch insularities as this which stand in the way of com-

plete professional reciprocity with the self-governingDominions. In the table of registrable degrees arenow included the M.B., B.Ch. of the three universitiesin the Union of South Africa. The Medical Registercontains the full text of the Dentists Act, 1921. TheDental Register, which is presumably issued for thelast time by the General Medical Council, contains5831 names, 277 having been added by registrationduring the year 1921. Here the pages are franldyheaded " United Kingdom Dentists," " ColonialDentists," and " Foreign Dentists," although a

number of these so-called colonial dentists have longbeen practising in London and provincial towns. Onewonders whether the holder of an English dentaldiploma practising in Sydney is described as an

" English Dentist." The Dental Register also containsthe text of the new Dentists Act, along with the namesof the Dental Board, but not the Dental Regulations,which have appeared since the volume went to press.A notice on the title-page states that after the publica-tion of the names in the printed Dentists’ Register,the Register alone is the legal evidence of registration.Three pages of warning notices are printed identicallyin the two Registers, Medical and Dental. The list ofMedical and Dental students registered during the year1921 contains the names of 1808 medical students-who entered respectively in England, 833 ; in Scotland,602; in Ireland 373-and the names of 371 dentalstudents; the numbers in each case being less by one-quarter than those for the preceding year.

INDIAN SCIENCE CONGRESS HANDBOOK.

WE publish in this issue of THE LANCET a brief account of the Indian Science Congress held atMadras from Jan. 30th to Feb. 4th ; we have recentlyreceived a copy of the excellent handbook preparedunder the direction of Captain CLIVE NEWCOMB, I.M.S.,one of the local secretaries of the Congress, andissued in order to provide members of the Congresswith information of interest concerning the city ofMadras and its immediate surroundings. Seventeenshort articles, each the work of some officialor scientific authority qualified to deal with specialpoints, are contained in the handbook; no completeguide has been aimed at, but the subjects rangethrough the history, archaeology, anthropology,zoology, and geology of the Presidency, besidesincluding matters of medical and public health interest. Lieut.-Colonel F. F. ELWES, I.M.S., principal of the Imedical college. writes of Medical Education in iMadras, tracing the history of the medical schoolfrom its opening in 1836 ; in 1851 it became a college,securing affiliation to the University of Madras in1877, and it is now the leading institution for medicaleducation in the Presidency, with seven departments-three of which are for post-graduate training-containing upwards of 550 students. Major J.CUNNINGHAM, 1.M.S., director of the King Institute,describes the institution, which was opened in 1903as a lymph dep6t for the supply of the Presidencyalone, but which is’now one of the three large provinciallaboratories in India. It is divided into a vaccinesection, manufacturing lymph for vaccination againstsmall-pox, and a microbiological section, which dealswith laboratory diagnosis and treatment and withpublic health work. Under a separate heading MajorCUNNINGHAM discusses the chlorination of the Madraswater-supply. A map of the city adds to the valueof this interesting little handbook.

Annotations.

THE HEALTH OF THE INDIGENOUS RAND

MINER.

"Ne quid nimis."

DuRiNG the recent disturbances on the Rand thenative mine labourers appear to have maintained anattitude of neutrality in spite of considerable provo-cation. This may be in part due to their appreciationof the conditions of work, pay, and leave open tothem and to confidence that the Government willprotect their interests. The Native Labour Regula-tions are indeed the subject of earnest considerationon the part of General Smut,s’s Government, and areconstantly being amended and revised. Elaborateprecautions are taken to maintain the health andgeneral welfare of the native miners. The concretesheds which form the compounds are kept veryclean ; every native has his own berth and usually atin trunk for his personal belongings, and plenty of hotwater is available. On nearly every mine there arewhole-time medical officers whose duty it is to super-intend the health of the native workers and to treatthose reporting sick ; incidentally the Mine MedicalOiRcers’ Association, though of fairly recent formation.is one of the most active of the medical societies of theTransvaal. The nursing in the local native hospitalsis done by male attendants, and in some hospitals anattempt to train Kaffir girls as nurses is apparentlymeeting with success. Workers are medically exam-ined on application for a job and periodically duringtheir stay on the mines, with special regard to earlypulmonary signs. It is obvious that even from thepurely commercial and recruiting point of view itpays better to keep the native in good health andspirits than replace or compensate him for diseaseor injury acquired at his work.Probably the most important factor in the con-

tented state of the native worker is the attentiondevoted to his diet. The official minimum rationscale is constantly being amended and improved in thelight of new knowledge on dietetics. The scale in usesince December, 1920, is comparable with that usuallyrecommended for Europeans doing hard work as

regards its essential constituents, while some of thefood-stuffs, such as the mealies, peanuts, and nativebeer, are a direct concession to the habits and pre-judices of the natives. Hot coffee, with a ration ofbread, is issued to the morning shift before they godown the mine, and on their return they have anample hot meal consisting of meat and vegetables :a special warning is issued against the custom-convenient in practice-of keeping the latter for longperiods in steam-heated cauldrons. Dr. Marion Delfrecords this week (see p. 576) the results of experi-mental survey of available local foodstuffs for theirantiscorbutic value, and her paper is in itself a proofof the vigilance with which the interests of thenative workers are watched and opportunitiesseized of investigating prophylactic health measures.Dr. Delf’s visit to South Africa, undertaken for otherpurposes, happened to coincide with an outbreakof scurvy in the mines, and on the representa-tions of Dr. A. J. Orenstein, the superintendent ofthe Sanitation Department of the Central Mininggroup, Dr. Watkins-Pitchford invited her to prolongher stay in order to carry out investigations atthe South African Institute for Medical Research.The problem set before her was the selection from thefoodstuffs available a cheap antiscorbutic whichcould be distributed without difficulty and which wassufficiently palatable to be consumed without super-vision. The solution apparently varies with theseasons, as will be seen from her report. The quincegrows so luxuriantly in the Transvaal that it issurprising that no attempt was made to estimate itsantiscorbutic value. This fruit is not included in thecomprehensive list of substances containing vitamin C,

594

furnished by H. C. Sherman and S. L. Smith in theirrecently published work, and there is no indicationthat it has ever been tested. Besides being ofpractical local importance, Dr. Dtlf’s results includepoints of remarkable interest-for example, herobservation that soya beans, unlike ’all other ger-minating pulses so far tested, have no perceptibleantiscorbutic value. Whether this singular fact canbe connected with the high fat and almost negligiblecarbohydrate content of the soya bean, involving ahigh energy value, further investigations will doubtlessshow. Her indifferent results with cane sugar- experiments may point to excess of carbohydrate asa predisposing factor to scurvy ; according to someobservers this is true of rickets. Moreover, thefact that natives at work on the mines, who receive arich varied diet, appear to need more antiscorbuticthan those who for considerable periods live on dried.maize in their kraals is a matter of some interest.

EPITHELIOMA OF THE SKIN.

IF ever the problem of cancer-that curious andinsidious transition from physiological to pathologicalcell-growth-is solved, it will surely be by the studyof cutaneous tumours, for in the skin we can trace thepathological changes in their earliest stages. Dr. JeanDarier’s profound knowledge of cutaneous histo-,pathology, and his exhaustive studies during the past 30years of the various tumours of the skin, are familiar-not only to his confreres in dermatology, but also topathologists throughout the world, and thus hisillustrated lecture on’epithelioma of the skin, deliveredlast week to the Section of Dermatology of the RoyalSociety of Medicine, was largely appreciated. Afterbriefly alluding to the experimental production ofcancer of the skin by excessive doses of the X rays orradium and by the continued application of substancessuch as tar, Dr. Darier pointed out that the differenttypes of cutaneous epithelioma differ very markedlyin their radio-susceptibility. Thus, whereas basal- celled carcinoma is extremely radio-sensitive, theprickle-celled growths are radio-resistant; and it is_possible that when the explanation of this physicalfact is forthcoming we may have made some advancenot only in the prevention of cancer, but also in oursearch for its essential cause. Apart, however, fromthe two main types of epithelioma of the skin : (1) themalignant prickle-celled carcinoma, characterised bythe presence of keratinised cell-nests, rapid growth,.involvement of lymphatic glands and other organs,and radio-resistance ; and (2) the basal-celled car-

cinoma, characterised by the absence of cell-nests,slow growth, local malignancy, non-involvement ofglands, and radio-susceptibility, Dr. Darier laid stresson the occurrence of " metatypical

" forms to which hehas recently devoted much attention. Of these thereare two kinds, one in which the cells of the growth areintermediate between the prickle-celled and the basal-celled types, and the other in which both types of cell,occur. In these metatypical forms cell-nests are seen,but they have a colloid appearance and are not formedof keratinised cells. The growths resemble basal-celled,carcinoma clinically, but they are far more radio-resistant, and may eventually become generally malig-nant, giving rise to secondary deposits. From aconsideration of these different forms of epitheliomaDr. Darier insisted on the imperative necessity ofdifferentiating between them by means of histologicalexamination before deciding on the treatment to beadopted. For the prickle-celled and metatypical typesearly excision is required, since the use of X rays andradium is not only useless and unjustifiable, but mayeven lead to a more rapid extension of the growth.In the purely basal-celled type he advocates treatmentby radium or X rays, with which view several Englishdermatologists and surgeons will disagree, holding, asthey do, the opinion that complete excision is themethod of choice when possible.

Dr. Darier’s lecture, delivered in French, was a modelof descriptive eloquence and incisive reasoning. The

1 The Vitamins. Chemical Catalog Co., New York. 1922.

lesson we may draw from it is the great importance ofearly and accurate diagnosis, both from the point ofview of treatment and prognosis. In an article entitledModes de Début des Cancers de la Peau et de laBouchell he emphasised this point, and maintainedthat few, if any, should die of epithelioma of the skinand mouth, since accurate diagnosis is always possiblein the earliest stages, at which time the disease iscurable by proper treatment. It cannot be too stronglyimpressed on students, medical men, and the publicthat early diagnosis and treatment in cutaneous canceris of supreme importance, and in every case a

microscopical examination of the growth should bemade in order to determine to which type it belongs.

THE MEDICAL SOCIETY OF LONDON.

JUDGING by its subsequent career the MedicalSociety of London appears to have acted wisely instanding outside the scheme which united in onebuilding and fellowship many of the other metro-politan medical societies. For the debates anddiscussions are notable for the breadth of their scopeand the fact that they draw together medical men ofwhom many would otherwise appear only at specialistgatherings. And this focus being social as well asacademic, warmth is concentrated there. The 149thanniversary dinner held at the Wharncliffe Roomswas no exception to the rule. Kindred societies wererepresented there by their presidents and the threecombatant Services by their medical chiefs. Mr. JamesBerry, who presided at the dinner, received somethinglike an ovation.

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CARDIO-VASCULAR DISEASES.

A SPECIAL cardio-vascular number2 of the NewYork Medical Journal is of intimate interest to ourreaders from the fact that, with two exceptions, allthe original communications are by British authors.We welcome this recognition of the special work oncardio-vascular diseases of our countrymen, and wecongratulate the New York Medical Journal uponaffording our writers an opportunity to expresstheir views directly to the American profession.The subjects dealt with in the 13 papers cover

a wide range and the writers have evidently beenselected with care, each writing on some matterof which he has special experience. Space doesnot permit reference to all of them. Sir CliffordAllbutt contributes the first paper entitled a Dis-cussion of Angina Pectoris. He reaffirms his nowwell-known view that this condition is in the largemajority of cases of aortic and not of primary cardiacorigin. He regards death in the fatal cases as due to asecondary inhibition set up by the pain or some otherafferent influence, and not as the result of a primaryheart failure ; admitting that such inhibition is morelikely to be effectual in cases in which the myocardiumis gravely diseased. He criticises in trenchant styleother theories and claims that his views are nowachieving a wider acceptance, a claim fully justified.Dr. J. Strickland Goodall contributes a useful note onthe Premature Contraction and its Significance. Hediscusses the various causes and the different varietiesof extra-systoles. He points out the conditions underwhich, in his view, they may be of serious significance.We may express the hope that the abbreviations" fibbing " and " non-fibbing " as applied to fibrilla-tion will not achieve a wide currency. A notable paperis that contributed by Dr. Arthur Latham on the Heartin Pulmonary Tuberculosis. Among other mattershe considers the significance of the narrow verticallysituated heart in regard to this disease. He is ofopinion that where there is doubt as to the diagnosisof tuberculosis, the presence of this type of heart maybe an important factor in deciding upon treatment.and further he believes that its presence in an undoubted

1 Jour. de Méd. et de Chirurg. Prat., April 10th, 1921.2 New York Medical Journal, a Semi-Monthly Review of

Medicine and Surgery. Cardio-Vascular Number, Feb. 15th.1922. A. R. Elliott Publishing Co., New York, N.Y.