A DIRECTORY OF SOCIAL HYGIENE

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flow, there would appear to be adequate cause forcardiac pain, and no necessity to invoke anotherfactor. The fact that changes in the electrocardiogramsimilar to those occurring in spontaneous angina areproduced in normal men when they suffer from oxygenshortage suggests that there is a functional disturbanceof the muscle in both cases ; yet we do not know therelation between this defect and the sensation of pain,and cannot be surprised that it is not experienced inthe normal subject. At the present time the conceptionof angina as being in some way dependent on arelative ischaemia of the heart muscle rather than

purely on an anoxoemia appears more acceptable.A DIRECTORY OF SOCIAL HYGIENE

THE term social hygiene is sometimes used in arestricted sense to denote the efforts made to eliminatethe venereal diseases, sometimes in the wider senseof the application of biology, psychology, and sociologyto the promotion of health and racial well-being.It is in the broader sense that the British SocialHygiene Council has construed the term since thechange in its official title nine years ago, and evidenceof this wider scope is seen in the appearance of aYear-book 1 which is the first comprehensive surveyto be made of social hygiene. The book, which iscompiled from material made available to the Councilby the various Government departments concerned,contains recent information of the incidence ofvenereal disease, of the means taken to prevent it,and of the channels for its treatment in towns andcounties at home and throughout the Empire.This much would already be of much value, butthe net is spread to include the wider agencies forthe promotion of right thinking and action. Instruc-tive notes on the development of biological educationin the colonies are based on replies to a questionnairerecently issued by an advisory committee of theColonial Office. It is the plan of the Year-book totake one dominion or group of colonies for the subjectof a special survey, and Canada, the senior dominion,appears as the first study in this number. Thevolume also contains some general articles, includingone on the methods of propaganda and their resultsby Mrs. S. Neville-Rolfe and another by Colonel L. W.Harrison on the administration of venereal disease inGreat Britain, what has been done and what mightbe done in the future. Appendices contain a list ofvoluntary associations, British and international,and a few hints on what to choose for further study,whether in biology, physiology, or the social applica-tions of hygiene.

MONGOLISM AND MATERNAL AGE

MANY years ago it was observed that mongolianimbeciles are often the last children to be born ina long family, a fact which has suggested that thecondition may be a product of the exhaustion of thematernal reproductive powers. Evidence since thenhas accumulated to show that though affected childrenare not necessarily born at the end of the family,their birth rank is certainly, on the average, signifi-cantly later than that of normal children. At thesame time it has been clearly shown that thoughsome of these imbeciles have young mothers, thegreat majority of them are born after the motherhas reached the age of 35 years. This is the experienceof a recent survey2byDr.K.Rupilius at the Universitychildren’s clinic at Graz. Which of these twocorrelated factors, birth order and maternal age, is

1 Empire Social Hygiene Year-book 1934. London : GeorgeAllen and Unwin. Pp. 509. 15s.

2 Wien. klin. Woch., p. 1060.

the more important in the aetiology of the affectionhas not been determined. Indeed, with a limitedamount of material available it is no easy task todisentangle one from the other. To this problemDr. L. S. Penrose has recently addressed himself.sWorking in the research department of the RoyalEastern Counties’ Institution he has secured thematernal age at birth and the birth order for all

offspring in 217 sibships each containing one or moremongolian imbeciles-1031 persons in all, of which224 were affected. Upon these data he brings a

mathematical statistical battery to bear, and histwo different methods of approach agree in denyingany aetiological importance to order of birth. Infact they show that the numbers of imbeciles in eachbirth rank are very close to those which would beexpected on the assumption that the incidencedepends upon maternal age. Another factor whichsome writers have believed to be of importance isthe interval between the birth of a mongolian imbecileand the birth of the child immediately preceding it,an interval which has been found to be on the averageunduly long in comparison with that between normalbirths. According to the careful analysis of this studyit is not possible to assign any direct causal significanceto this factor either. The underlying influence is

again, probably, maternal age, an increase in whichtends slightly to lengthen intervals between births.

SCHOOL PHYSIQUE IN AUSTRALIA AND IN

ENGLAND

Dr. Jane S. Greig, who is chief medical inspectorto the education department of the State of Victoria,has recently paid a visit to this country and comparedthe conditions 4 she has found among the school-children here and those with which she is familiar.

Crippling conditions are less prevalent in Australia ;the figures she gives to illustrate this are : congenitalhip deformities, 1 in 2000 ; congenital talipes, 1 in1000 ; tuberculosis of bones and joints, 1 in 2000 ;deformities after infantile paralysis, 1 in 500. Thepercentage of children in Australia with defectivevision is much the same as what it is in Englandor Scotland, but " in the Old World," Dr. Greig says," cases of defective vision have to be taken veryseriously as the large proportion are due to myopia.This defect ... is so serious... that the childrenhave to be provided with special forms of education.In Australia, on the other hand ... a country ofsunshine, open-air life, and good food ... progressivemyopia is ... a rarity." While malnutrition hasbeen a problem in the State, "on the whole," Dr.Greig says, " the children have survived wonderfullythe ordeal of the period of depression and theconsequent unemployment of many fathers of families.Their weight has been maintained to a surprisingdegree, but I fear that later we will have evidenceto show that a large number of children of the

unemployed have suffered in stature and are belowthe average height for their age. This is probablydue both to lack of suitable food such as milk andvegetables, and to overcrowding, which is very markedin the more densely populated inner suburbs." It

surprises many to know, Dr. Greig goes on, that visiblemalnutrition is not the first or most noticeable evidenceof poverty. " In our experience it is dirt and neglect.Flea-bites, which had become almost a rarity, arebecoming prevalent again, for soap and hot wateris considered an unnecessary - expense when moneyis scarce." That heights and weights in future will be

3 Proc. Roy. Soc., Series B, cxv., p. 431.4 Health Bulletin, Victoria, Jan.-June, 1934.