preceded it, points the way to a national food and national health policy in conformity with 'modern advances in the knowledge of nutrition'; a policy which must include the greater production in this country, and the more equal distribution amongst the people, of those foodstuffs now known to be essential to health." In the same issue the British Medical Journal16 says that the Ministry of Health "lost no time in taking action on the main recommendation of the report"--that is, providing pregnant women, nursing mothers, and young children a sufficient supply of milk. Maternity and child welfare authorities have been asked to review their arrangements in this field, and to eliminate such time, age, and quantity limitations as are at present applied in various localities. Barbara Drake, 17 in her New Fabian Research Bulletin, "Nutrition: A Policy of National Health", goes much farther than the recommendations of the Ministry in her proposal that the economies of collective feeding under the supervision of medical officers justify the public provision of full meals for school children under 15 years of age. She recommends that this policy be adopted in addition to the provision of milk for mothers and young children. Mrs. Drake states that by lightening the economic burden of adequately nourishing the children, adults would benefit by having more to spend for their own nourishment. We believe that our present knowledge of nutrition does not permit a health officer to be dogmatic on the subject of diet. He is in duty bound, rather, to take into consideration the many factors influencing the choice of diet among his constituents--availability of foods, climate, economic conditions, dietary habits--and to educate for a better understanding of the present knowledge on nutrition. Throughout the world today, special conferences are being called to bring about a "marriage of agriculture and public health" through a better understanding of nutritional needs and how to meet them. It is to this broad approach that we would turn the mind of the health officer, rather than to the advantages of hazards of any rigid form of diet. The experts attending these conferences hold no brief for special curative systems or regimes; theirs the problem of extending existing knowledge of the science of nutrition through research, and of spreading that knowledge so that it may best be applied for the creation of positive health and happiness. 1. Druitt, A. E. 2. 3. REFERENCES "Health", Public Health (London) 50:6, 179-182 (March, 1937). Friend, G. E. "Diet in Relation to Physical Efficiency". British Medical Journal 3944: 276-278 (August 8, 1936). M'Gonigle, G.C.M. and Cowell, S.J. "Nutritional Factors in the Prevention of Diseases." Public Health (London), 49:11, 376-381. 8. Report on the Physiological Bases of Nutrition: Technical Commission Appointed by the Health Organization, League of Nations. Series of League of Nations Publications, III: 6, 1935. 9. Dietary Suggestions. by C. D. Christie, A. J. Beams, and E. M. Geraghty. American Medical Association. Chicago, 1930. 10. Report of the British Medical Association Committee on Nutrition. London, 1935. p. 11. Rose, Mary Swartz. "Racial Food Habits in Relation to Health." Scientific Monthly. March 1937. pp. 257-267. 12. 13. 14. 15. 16. 17. (11) 12 Boudreau, F. G. The International Campaign for Better Nutrition." Milbank Memorial Ministry of Health. Advisory Committee on Nutrition. First Report. London: H. M. 757-58 (April 10, 1937). The National Diet. British Medical Journal, 3979: MENTAL HYGIENE IN PUBLIC HEALTH DEPARTMENTS CHARLES E. SHEPARD, M. D. (CONDENSED WITH THE AUTHOR'S PERMISSION FROM AN ADDRESS GIVEN AT THE PUBLIC HEALTH NURSING INSTITUTE, MARCH 23, 1937-WASHINGTON, D. C.) Health departments are becoming interested in the subject of mental hygiene particularly as it offers a means of preventing mental illness affecting the social group and as it offers recognized methods for doing so. Unfortunately, in some respects, the term mental health has had magnetic attraction to many lay people so that popular interest and information in the subject have exceeded scientific fact. Progress in the field must wait upon the completion of certain "debunking procedures" and upon the development of preventive methods of proven scientific worth. This is the attitude which public health departments are assuming toward the acceptance of mental hygiene as a recognized activity. Progress in the preventive aspects of mental hygiene will follow the advance of preventive medicine of which it is a part. Because physical illness has been studied scientifically for a much longer period than mental illness, we have discovered many more causes of physical diseases and methods of prevention than exist for mental illness. Very few causes of mental illness are known as compared especially with parasitic born physical illness and we shall probably never have such opportunities to perfect immunization measures in the mental field. Yet even now, a few causes of acute mental illness are known and certain methods of prevention for them are recognized. I refer to some of the organic psychoses such as general paresis which makes up almost 10 percent of our state hospital admissions and to certain other types of organic mental illness which may be prevented. Much progress is also being made in discovering at least contributory causes of the less acute mental illnesses particularly those of childhood. Both these general types of mental trouble warrant the at tention of health and welfare agencies since their causes and methods of prevention tend to involve the whole community. That health agencies are interested in mental hygiene is revealed by a recent preliminary study of over fifty State and local health departments in the United States and Canada. These departments responded to an inquiry either by stating that mental hygiene programs were already accepted activities or by indicating that no present need for incorporating such programs existed. Many described means by which they were cooperating with existing mental hygiene agencies. Very few have set up these programs as operating activities except where the state hospitals and clinics are under the direction of the health department or where these departments and welfare agencies combined in conducting such programs. The Provincial Health Department of Ontario controls the administration of state hospitals and directs travelling mental clinics devoted chiefly to the discovery and care of mental illness. The San Joaquin Health District has two psychiatrically trained social workers and a part-time psychiatrist whose interests are given to these problems in the schools and in the health department. A few States have psychiatric consultants as members of the department or as members of the boards of health. Many of the health departments contacted have expressed interest in the subject and are cooperating with existing mental hygiene agencies such as: mental hygiene societies, clinics or state hospitals, school or state departments of mental hygiene, and guidance clinics. This relationship for the most part is nominal with little sharing in the operating expense. The widespread popular interest in mental hygiene calls for a clearer definition of the field and a frank expression of its present limitations. In the extent to which methods of prevention are learned and instruments which are effective are developed, it should receive growing support from public health agencies. Meanwhile health departments should maintain an interest in the field, keep in touch with scientific progress and cooperate with mental hygiene agencies pending greater opportunities to adopt it as a recognized activity for improving the welfare of the social group. One of the most remarkable developments of recent years is the increased HOW WOULD YOU ANSWER THIS ONE? Daily the United States Public Health Service becomes the confidante of the Great American Public. Its health problems and scientific aspirations are poured out in the form of unsolicited correspondence such as the letter published below. Some are referred to the Service from the White House and from Federal agencies. Far more are written directly to the Public Health Service. All are answered. All are letters such as might come to any community health officer. From time to time The Health Officer will publish one of these letters, selected from the files as illustrative of types of misinformation, of types of human problems and health needs in the general public. These letters are published to remind us again of the great need for health education, for biological knowledge. Even those letters which come to us from the mentally ill should serve to keep alive in our thoughts the need for education in mental hygiene. How would you answer this one? Dear Sir and Brother: Referred by the White House--Addressed to the I sincerely hope that I am not offending by addressing you as above. April 14 I wrote you concerning an "idea", now I am pleased to acknowledge a reply from your son James. I hope that my "idea" is new to science as I would dislike taking up your time on a subject which has no merit. On the other hand should the experiment be tried and prove a success I prefer that my glory go to you and that my name is kept secret. When a boy my mother told me to use "first spit" on a wound or whatever was ailing me at the time. I have followed that advice from time to time and believe received benefit from it. From that old suggestion I have made the following deduction. If animals, birds, and wild life can cure their own wounds by licking themselves etc., why couldn't a serum be made from the "first spit" in the morning or from saliva taken from ailing persons from time to time. Infantile paralysis, cancer, tuberculosis, etc., etc., would be treated in a manner similar to the way in which I imagine snake bite poisoning is treated with snake virus. If my "idea" is original and proves successful, as I hope it will, I ask for no publicity, please, If experiments are made naturally I would be interested to know of any progress and would be pleased to have you write me at my business address. Owing to the nature of your Public position should this correspondence become known, I realize that I would be annoyed by the curious, therefore, I prefer not to be known even though it may turn out to be a miracle. Most people I presume would endeavor to capitalize on a thing of this kind, so do not think I am "tetched" in the head for not doing otherwise. Let it be my contribution to the world of sufferers. Wishing you and yours everything which is good. Sincerely and fraternally, Can we conscientiously dismiss this communication with the comment--"nut letter"? Let the health officer recall that only a few months ago, one of our more expensive magazines, bearing "infinite riches in a little room", bore to its public the glad tidings that the Duncan system of autotherapy is at hand to perform miracles in hopeless cases of puerperal septicemia, gangrene, and other desperate conditions. Let him recall too, that Duncan got his "idea" from very much the same source as our correspondent--the observation that animals lick their wounds and recover without treatment. The Journal of the American Medical Association said of this contribution to the literature--"The promotion of Duncan and his system of autotherapy was, of course, utterly without any scientific warrant and disgusting besides." If this type of medical and health article is given to the lay public under such suptuous auspices, how then can we expect more knowledge in the individual? How then, shall we answer our correspondent? BOOK REVIEWS TUBERCULOSIS BACILLEMIA AND ITS RELATION TO MEDICINE* DIE TUBERKELBAZILLA IME IN IHRE AUSWIRKUNG AUF DE GESANT MEDIZIN: ERNEST LOEWENSTEIN. FRANZ DEUTICKE, WIEN, 1936, 388 PAGES. 23 MARKS. (GERMAN EDITION) lle Suppose a physician is asked to see a patient with high fever and acute polyarthritis. He will examine, of course, the inflamed swollen articulations, and also the heart. will learn that the patient had two weeks before an attack of acute angina. Now let us tell him that the patient has circulating tubercle bacilli in his blood. He will look at us bewildered and will either think that our statement is based on a technical error or at most that the finding is an accidental one having nothing whatever to do with the ailment present. The majority of physicians would take his attitude. Now ask the same physician to make, in spite of the patient's discomfort, a careful but thorough physical examination. He will find a general swelling of the lymph nodes, a palpable spleen, perhaps sounds indicating pleuritic friction, or even a small pleuritic exudate. In checking up the history of the patient and his family--looking for every detail that would indicate a tuberculous infection--he will be astonished to recognize a compelling picture, the etiology of which is not only connected with tuberculosis, but even with tuberculosis bacillemia. I have quoted almost verbatim the introductory phrases of a chapter in Loewenstein's book, entitled, "Tuberculosis Bacillemia and Polyarthritis", and written by Professor C. Reitter, a well known physician in Vienna, who devoted the last 20 years of his professional life to questions pertaining to the etiology and pathogenesis of rheumatic diseases. Reitter refers to the almost forgotten work of Poncet--a French author--who about 40 years ago emphasized the tuberculous origin of many rheumatic affections. Also to his own previous work, in which he succeeded in finding acid-fast organisms in the "punctate" of rheumatic joints, and to render guinea pigs tuberculous with the "punctate." Reitter considers himself fortunate to have been a co-worker with Loewenstein whose pioneering was ignored, ridiculed, and belittled for years. In 1928 Loewenstein succeeded in cultivating tuberculosis bacilli from the blood of a patient afflicted with "rheumatic" iridocyclitis. The same patient later came with an acute attack of rheumatism to C. Reitter's ward. Reitter asked Loewenstein to try the blood cultivation again and, lo! the experiment succeeded promptly. Since their first common case, Reitter sent (1930-1934) the blood of 240 acute polyarthritic cases to Loewenstein's laboratory and got not less than 165 cultures of bacillemia tuberculosis out of the blood specimens. These 68 per cent of positive findings do not represent the totality of positive probabilities because as proven in the skin ailments, in which the blood taking can be done with greater care than in polyarthritic patients--the tubercle bacilli circulate sporadically in the blood. The oftener one examines the blood the greater the chance of positive findings. 1 In former years some of Loewenstein's critics raised objections as to the bacteriological identity of his cultures; these objections do not hold good since every culture isolated from blood is examined as to its virulence by injection into animals. If Loewenstein in his first publications would have analyzed merely sure and acknowledged cases of tuberculosis, for instance, pulmonary, surgical, skin, visceral, his findings would not have met with such general disbelief. After all, students of tuberculosis have recognized for decades the metastatic origin of all kinds of surgical tuberculosis, acute disseminating forms of pulmonary tuberculosis, and miliary forms of tuberculosis meningitis. This leads us to the conception of circulating germs deposited in course of time in the different organs. Positive blood findings--mostly in grave, lethal cases, were described in quite early periods of tuberculosis research. The revolutionary ideas of Loewenstein, based on his personal findings can be summarized as follows: 1. The circulation of the blood of live and virulent germs has to be anticipated even in the earliest stages of tuberculosis. Circulation of tubercle bacilli is by no means a sign of unfavorable prognosis; just the contrary, it may happen and can be put in evidence in early and very mild forms of the disease. *A review presented at the Bi-Monthly Staff Meeting of the National Institute of Health November 6, 1936. |