Volume 48 · Issue 07 · 1934

Since the late nineteenth century climatic bubo has been recognised in the tropical countries or the sub-tropics. It is usually limited to the inguinal glands and is characterised by a prolonged course of adenopathy, mild intermittent fever and a tendency to formation of multiple fistulae in the groin. Malaria and climate were thought to play a role in development of the condition. Its real mode of infection has remained obscure until 1913 when Heiner (1) first published 18 cases of the disease, in all of which a sexual exposure had occurred. In the same year M. Durand, J. Nicholas and M. Favre (2) described the condition and also indicated its probable venereal nature, designating it as sub-acute lymphogranuloma inguinale as they were apparently ignorant of climatic bubo.

The fourth venereal disease is a clinical entity so designated because though venereal in origin it bears no relation to chancroid, gonorrhea or syphilis. In recent literature, it is commonly referred to as lymphogranuloma inguinale or lymphopatnia venereum. The characteristics of this disease are in the lymph tissues which drain the genital organs. Its clinical manifestations therefore differ in the two sexes.

In the course of our studies on the calcium and phosphorus metabolism in osteomalacia, it seemed importment to us to determine not only the effect of vitamin D, but also the duration of its effect. Patients with obviously advanced osteomalacia were encountered, who on study showed marked ability to conserve calcium and phosphorus. These patients had often received cod liver oil or other vatamin D preparations previous to the study.

The literature concerning osteomyelitis of the jaw bones gives meagre information regarding the incidence of this condition. Most text books of general and dental surgery devote but a few lines to the treatment of this disease and some dental text books do not even include the word "osteomyelitis" in the index.

The study of the normal physiological condition of the Chinese seems to have been first stressed by Duncan Whyte (1). This author pointed out that there were apparent differences in this race from the physiological standards given in textbooks founded upon Western experience, and urged that the determination of these differences was an essential preliminary to medical work of any description in China. At the biennial conference of the China Medical Missionary Association held in Shanghai in 1915 (2) the Research Committee acted upon the suggestion made by Duncan Whyte and compiled a schedule of subjects requiring investigation, including the determination of blood, urinary, circulatory and alimentary system standards. It was not, however, until 1923 (3) that the study of the normal menstrual function in the Chinese was specified in the Research programme of the Association.

Manifestations of pregnancy "toxaemia" are protean and have all been summarily regarded as due to some unknown "toxin": but in none of them has the hypothetical "toxin" been isolated and identified. Under the heading "pregnancy toxaemia" are usually included pernicious vomiting, eclampsia, pregnancy anaemias, polyneuritis, etc. Just as in pernicious anaemia, sprue, pellagra and other diseases which were regarded as due to some "toxin" and which in the light of recent researches have become better known as "deficiency" diseases, so we may reasonably hope that under "pregnancy toxaemia" we may in future with better knowledge be able to place each in a category of more definitely known etiology. This hope is in fact coming to the lime light when we recognise that different forms of pregnancy anaemia have been shown by recent investigations to be due to dietary deficiencies m one form or another such as iron or vitamin B2 or the So-called anti-anaemic principle of Minot. In these conditions an adequate supply of the corresponding substances cures the disease.

The threefold aim of an ideal public health program should, when applied to any one disease (a) clear up existing cases, (b) stop the transmission of the disease to new cases, (c) prevent future outbreaks of 'this disease. In certain diseases all three measures may be applied. In the case of many other diseases our present ignorance of certain fsSentials limits our attaining to this ideal.

This is no report of a survey, rather only a collection of facts and experiences acquired while living in Kwangtung. It is the result of a growing conviction that modern medicine as now practised and taught is not wholly meeting the needs of the people nor does there seem to be any definite planning to do so.

In this city of Shaoshing, Chekiang, modern medicine has been practised less than thirty years and is still far from having established its hold on the majority of the people. Many conditions, notably various kinds of tumors, are neglected to an almost unbelievable extent, and for this reason a report of the successful removal of two large ovarian cysts may be of general interest.

Attention is called to the very valuable paper by Dr. Oldt in this issue of the Journal. There seems no doubt about the accuracy of the figures given and the picture they reveal is little short of tragic.