EDITORIALS 645

health movements, serving on boards and engaging in many other activities for
the public good. He was President of the State Board of Health of Maryland
from 1896 to 1922. He was a charming host, and delighted in entertaining
distinguished men who visited this country, but always included among his guests
not only those closely connected with him in his work, but other young scientists
who might be available.
His life has been a striking example of devotion to science for science's sake.
Commercialized, his salary could have been easily more than a hundred thousand
dollars annually; yet for practically all his life, it was only the modest stipend
of a professor.
During the World War he was one of the first to go into the service of the
countrv in 1917, as a Major in the Medical Corps, being advanced in 1918 to the
grade of Colonel. He spent much of his time in Washington, where his advicc
to the Medical Department of the Army was invaluable. The soldiers who were
engaged in the World War owe much to his wise counsel for the care taken of
them.
He has been a member of the Laboratory Section of the Association since 1917,
and was made a Charter Fellow in 1923. The Association as a whole mourns
his loss and pays tribute to his memory.
REFERENCE
1. Progress and Drift in Pathology, Med. Record, 57, 1900, pp. 397-405.

THE MEDICAL EXAMINATION OF FOOD HANDLERS

THE outbreak of amebic dysentery in the City of Chicago in the summer of
1933 has excited unusual interest. Nothing was published about it until
October 9, when a paper was read before our Laboratory Section at Indianapolis.
Cases have been traced to more than 200 cities, including some in Canada, which
had their origin in Chicago. The Public Health Service was called on and two
news letters were sent out regarding it. In February, an article on the subject
appeared in the Public Health Reports.' It is known that carriers of the
Endameba histolytica are found fairly commonly, and one great question which
comes up for discussion is the advisability of examining food handlers. On this
there is diversity of opinion. Some health officers believe it to be ineffective and
that the expense is not warranted by the results. Extravagant statements are
made against it by some, one former health commissioner going so far as to call
it a " worn out superstition of public health."
In the article referred to there is a good deal about the examination of food
handlers, especially in regard to those carrying amebae. The tone is negative,
and every possible difficulty and objection is pointed out. The author speaks
of the inadequacy of methods, the number of examinations necessary to give a
conclusive answer, the intermittency of the carrier condition, the time, effort and
expense involved, and the difficulty of controlling carriers when detected. The
danger of carriers is recognized. The opinions of the two schools of proto-
zo6logists are spoken of. The difficulty of, and errors in, diagnosis are mentioned,
but do not seem to be a good reason for not trying to prevent the ailments from
which those infected suffer. Finally, the author states that even a positive report
will be misleading, since a cyst carrier may be suffering from a condition not
related to the presence of the protozoa. In the face of conditions which exist, we
646 AMERICAN JOURNAL OF PUBLIC HEALTH
believe that the positive and not the negative side of the question should be
taken.
We cannot but recall the outbreak 2 on the Steamship " Rochester " in 1913-
300 passengers; 235 traced; 122 cases of gastroenteritis, 42 cases typhoid-like; 5
deaths. Cause-a meat cook with profuse diarrhea in febrile stage of typhoid.
We remember also Typhoid Mary, who according to the last accounts which we
have, has been the cause of 57 cases of typhoid fever, with 3 deaths, and there
are some who believe that she was responsible for the infection of water which
caused the epidemic in Ithaca, N. Y., in 1903. We also recall the case of
" H.O." who though not a food handler, infected the water supply of a ship by
using the common water supply. In regard to all of these cases,.we would ask
whether or not the examination of- food handlers would have been worth while?
There is no doubt that the examination for amebae offers greater difficulties
than does the examination for bacteria, and there is recent evidence that carriers
do not play as important a part as they do in bacterial diseases, but the general
principle remains unchanged. A recent survey of 2,000 food handlers in New
York City 3 shows a total of 35 cases of latent adult tuberculosis, and 46 cases
of active pulmonary tuberculosis. Can the employment of people with active
pulmonary tuberculosis in such callings be justified? Can they be detected
without examination?
As to the carrier condition, we know of no better statement than that made by
the late Dr. Henry J. Nichols.4 The article under discussion indicates that there
is nothing to do with food handlers except to educate them in personal hygiene,
which all recognize would be a valuable means of prevention, but the question is
raised as to whether they can be made sufficiently conscious of the menace to make
this measure effective. Dr. Nichols says that carriers may be instructed in
personal hygiene, but that if they do not respond to social obligations, restrictive
measures must be applied. In the instance of Chicago, in spite of the recent
report of the special committee, it would have paid handsomely to have had an
officer stationed in the toilet rooms to enforce observance of the rules laid down
by the committee.
On the question of the results justifying the expense and trouble, Nichols
points out that " as scientific knowledge increases, there is an increasing demand
for its application in the amelioration of human life." In regard to the difficulties
on the administrative side, he says: " But one point should be kept clear. The
interests of the group of [or] race are supreme over those of the individual. This
decision has been handed down by Nature and by Society and other decisions
must conform."
We have recently spoken of the movement in New York City, where a com-
mittee is urging the public to demand cleanliness in eating places. This move-
ment will be carried out largely through education of the public. While the
public may be apathetic in many cases, there is no question that when there is
proper education there is a growing demand for the application of scientific facts
to public health.
The article also questions the advisability of treating all food handlers with
amebicides in the present state of our knowledge, though recognizing the necessity
of treatment of recognized clinical cases, even though mild.
From the scientific standpoint there is perhaps nothing in this article which
can be found fault with, but published in the official organ of the Service, we
believe it is liable to do a great deal of harm. Similar difficulties have confronted
 LETTER FROM GREAT BRITAIN 647
us in the control of all contagious diseases, and if we had sat with our hands in
our laps looking only at the difficulties and not for means of overcoming them, we
would be in a sorry condition today, whereas the advances we have made constitute
one of the great features of which the medical profession has good reason to be
proud. We look for leadership in progressive measures for the protection of
health, rather than a negative attitude or a recital of difficulties.
REFERENCES
1. McCoy, G. W. Amebic Dysentery, Pub. Health Rep., Feb. 2, 1934, p. 141.
2. Pub. Health Rep., Feb. 19, 1913, p. 2761.
3. Martin, Pessar & Goldberg. A Tuberculosis Survey Among 2,000 Food Handlers in New York City,
Am. Rev. Tuberc., Feb., 1934.
4. Nichols, Henry J. Carriers in Infectious Diseases. Williams & Wilkins, 1922.

LETTER FROM GREAT BRITAIN

THE DROUGHT, THE WATER SUPPLY,
AND DISEASE
The description of the British climate
alleged to have been applied by a visit-
ing American as, in fact, no climate
at all but merely a series of samples,
is one that the average Briton accepts
as at once witty and accurate. Varia-
bility is undoubtedly one of the charac-
teristics of the weather, the variations
commonly suffered including as a rule
a rather generous allowance of rain.
Up till the last 12 months or so, at
any rate, this seems to have been the
case. During that period, however, the
variability has taken the direction of
an omission of rainfall, and as a result
the members of the population, con-
siderable in number, whose entire sub-
ject of conversation is the weather,
having to take a new line, find it less
easy to maintain an even flow than in
the days when the drip of falling water
was there to provide an accompaniment.
The absence of conversational open-
ings, the result of the drought, is, of
course, most noticeable in the urban
areas where precautions have been taken
to guard against shortage of supply.
In rural and outlying districts the situa-
tion is different, and in government and
official circles the view taken steadily
becomes more serious, and very real
efforts have been, and are being, made
made in order to assist in securing and
increasing supplies.
So far as the taking of serious views
is concerned, the lay press has tried
very hard to be helpful by indicating
the terrible things that are happening,
and predicting that though results even
more terrible will occur if the drought
continues, those that will ensue upon
its termination will be catastrophic.
Most of the effects, it is hardly neces-
sary to say, are or will be upon the
health of the people. The prevalence
of infectious disease, in particular, the
press believes to be certain to be
affected.
Curiously enough, in spite of all
journalistic effort, there has been little
evidence of increase in the amount of
infectious disease generally throughout
the country. In some areas the number
of cases of measles has been greater than
in 1933, but this had been anticipated,
and is in accordance with the character
of this disease and the normal course
of events. Scarlet fever in certain
places has also been slightly more prev-
alent, but the rise here again is the
ordinary periodic one. The fact that
there appears to be an increase in the
number of adults who have contracted
this infection is one that has been the
subject of mention. The explanation
suggested for this is, of course, that as
a result of the reduction in the amount
and virulence of the disease during
recent times, numbers of persons
escaped infection in childhood, or if