90 THE CONTROL OF MEAT.—TREATMENT OF CRETINISM.

tions is unreservedly accepted by most medical men ;it remains to be seen how the suspicions of the scepticmay best be quieted. ____ I

BICENTENARY OF GUY’S HOSPITAL.THE 200th anniversary of the opening of Guy’s

Hospital, on Jan. 6th, 1725, ten days after thefounder’s death, was commemorated on Tuesday bya service in Southwark Cathedral. The Prince ofWales, President of the hospital, was present, andDr. Burge, Bishop of Oxford, one of the governors,preached. It was a simple, short, and admirablyarranged service, consisting of hymns, a psalm, thecollect of St. Luke, a thanksgiving

" for our founderand benefactors," prayers for " our doctors andnurses," " our patients," and " past members of the i

hospital." The lesson, from Ecclesiasticus xxxviii.," Honour a physician with the honour due unto him,"was read by the Bishop of Southwark. The crowdedcongregation included many distinguished medicalmen and six former matrons of Guy’s Hospital.

THE CONTROL OF MEAT.

THE Departmental Committee on Meat Inspectionhas reason to be gratified by the early recognitionwhich its recommendations are receiving. Regulations Ireferring to meat inspection were issued some months ago and a supplementary series 1 has now been Iissued conferring additional powers on local authoritiesin respect of slaughter-houses and slaughtering, meatmarking, and control of sale of meat products. Aconsiderable weakness in meat control has alwaysbeen that the rural districts lacked some of the powersof urban authorities. The present regulations arereinforced by the Rural District Councils (Slaughter-houses) Order 2 of 1924, under which the Minister ofHealth directs that the provisions relating to theregulation of slaughter-houses shall be enforcedthroughout the rural districts. Meat marking hasnow become an acknowledged and approved procedure,but very rightly the Minister retains control of theprocess by requiring that authorities shall have anadequate and competent staff to ensure that theinspection prior to marking can be properly carriedout. As pointed out by Dr. W. J. Howarth in hisMilroy Lectures,3 a system of meat marking placesthe butcher in a better position, for the carcase

having been officially examined, the butcher can onlybe held responsible subsequently for what is knownas

" condition." If on cutting up the carcase signs ofdisease are discovered, then the discovery is regardedas one which the butcher can hardly be expected tohave observed. There is no reference to this in theregulations, but in the accompanying letter it issuggested that " if in any case evidence of disease isfound (in officially marked meat) the fact that themeat had been previously examined and passed bya competent authority should normally make itunnecessary to contemplate the institution of legalproceedings against the person offering it for sale."Provision is made in the regulations for notificationto the local authority of intention to slaughter, butno such notice is necessary where it is the regularpractice to slaughter at fixed times, and notificationof this arrangement has already been made to theauthority. In view of the fact that the slaughter-houseis the proper place in which to examine carcases,provision is made for the retention of internal organswith certain provisos. The blowing of carcases bythe breath is prohibited and restrictions are placedon the use to which a slaughter-house can be put.Further regulations controlling the sale of meat onstalls, in shops and stores, and the transport andhandling of meat have also been framed. These arereasonably comprehensive and if intelligently observedwill leave few grounds for complaint, though in certain

1 Public Health (Meat) Regulations, 1924. Statutory Rules and Orders. 1924. No. 1432. H.M. Stationery Office. 2d.

2 Circular 552. H.M. Stationery Office. 1d.3 THE LANCET, 1917, ii., 147, 225, 335.

instances it would not be difficult to make suggestionswhich might be regarded as an improvement althoughof necessity more restrictive. In London the method ofhandling meat has long been severely criticised bothby individuals and in the public press, and theCorporation of London since 1915 have pressed theMinistry to frame regulations which would enablethem and other metropolitan and provincial authoritiesto deal with this important matter. The new regula-tions will have a far-reaching effect in another way.Control of sale of food products being now acceptedin principle, other regulations of an associatedcharacter may be expected to follow.

Modern Technique in Treatment.A Series of Special Articles, contributed byinvitation, on the Treatment of Medical

and Surgical Conditions.

CIV.-TREATMENT OF CRETINISM.

I CRETINISM, according to the classification in generaluse, is divided into two varieties-endemic, which iscommon in the Alps and Himalayas, and sporadic,which is scattered all over the world. A classificationbased on external factors such as geographicaldistribution must of necessity be unsatisfactory,but there is justification for the temporary use ofthis particular division, in that the sporadic varietyusually presents the clinical picture which might beexpected from simple loss or diminution of thyroidsecretion in the individual himself, whereas theendemic form appears to be due to a, multiplicity offactors (more or less hypothetical), such as hypo-and dys-thyroidism in the mother, hypo- and dys-thyroidism in the individual, and pathogenicity ofone or other of the germ cells. Thus the endemiccretin shows a far greater diversity of symptoms.In some the brain is severely affected with a nearlynormal bony skeleton ; in others dwarfism is extremewith comparatively little mental defect ; and thedevelopment of the sexual organs is very variable.The causal distinction just made helps to remind

us that it is only in sporadic cases that we can expectto get a striking result through treatment of theindividual. In the endemic form efforts must bedirected mainly towards prophylaxis by treatment ofthe parents and especially of the mother. Probablycases which, although occurring sporadically, resisttreatment, are in their essential nature of the endemicvariety.Attempts have been made to distinguish between

sporadic cretinism and infantile (or juvenilemyxcedema. The distinction is an artificial one. Theage at first onset of the symptoms varies in different.cases, but there is no break in the series to enable usto distinguish between those in which the thyroid isfunctionless at birth and those in which the functionis lost at a later period. There is by no means alwaysa history of acute illness preceding the onset of thecretinism in the latter case. The treatment is identical.It has been stated that, the child being protected bythe maternal secretions, the cretinoid condition is.never patent at birth, symptoms being longer delayedin breast-fed infants. This statement is too strong.M. B. Gordon found that out of 113 cases in whichthe age of onset was noted symptoms were presentat birth in 13, and my own experience agrees with this.

Cretins and Mongols.--In spite of the many excellentdescriptions in text-books it is still necessary to stressthe radical difference between cretinism and Mongolianimbecility, the more so that certain scientific workershave assumed that the latter is partly at any ratedue to lack of thyroid secretion. The prognathousface of the cretin is just the opposite of the over-flattened face of the Mongol, and there is not a scrapof evidence in favour of there being any close relation-ship between the two diseases. The use of thyroid