The following case report is thought worthy of recording because of the long clinical history and the autopsy findings. J. R. B.—, aet, 58 years, married, electrician. Mother died of yellow fever, father in accident. Has had three children, one dying of tuberculosis, and another now sick with it. Never drank to excess, denies venereal disease, Wasserman negative, typhoid 36 years ago, severe scarlet fever in childhood. About fifteen years ago for three consecutive winters had severe attacks of grippe, after the last attack noticed the paleness of his skin, teeth dropped out, gums became sore, heavy black mustache dropped out and was replaced by a few white stubby hairs. Three years ago had a severe accident, fracture of humerus and fore arm and possibly a small depressed fracture of the top of the skull. For the last five months has been feeling much worse, had to give up his position as foreman electrician and became a night watchman, fatigues easily, feels cold all the time, always sleepy. Five weeks ago gave up work entirely.
PHILADELPHIA Demonstrator of Morbid Histology, Jefferson Medical College; Pathologist to the Odd Fellows' Home; Assistant Pathologist to the Philadelphia Hospital.
Medical literature contains many references to cancer of the mouth in betelnut chewers.This sequence of events is cited in illustration of malignant growth developing as a result of chronic irritation (injury) of tissue.Statements regarding this subject are based largely on observations made in India, Africa and some of the islands in the Pacific Ocean.The receipt in the pathological laboratory of Siriraj Hospital of specimens of cancer of the lip from persons using betelnut, suggested an investigation of this question in Siam where the habit is exceedingly prevalent.It was soon found that the scarcity of systematic records in this country makes an extended statistical study of cancer impossible, but, as in other countries, very much that cannot be reduced to exact figures may be learned.The subject was accord- ingly taken up in a somewhat broader way, and this promptly led to the realization that another of its phases is of more practical importance than is its relation to cancer.As a part of this study, I sent a questionnaire to twenty-five physicians, including those at the various Mission stations, and the replies thereto represent all parts of the kingdom.Much of the data contained in this paper was furnished by these colleagues, for whose aid I am very grateful.Except in the larger cities, nearly all adult Siamese chew betelnut.Exceptions in the cities occur among those who have been in foreign countries or who have attended advanced Siamese or foreign-taught schools.In some of the provinces there is said to be a decrease in the habit in the younger generation, but this is not in all instances clearly demonstrable ; in Bangkok it apparently is true.It is said that habitual users in the south chew much greater quantities than do those in northern Siam.Chewing is more nearly universal among women than among men and, in general, women chew more of the substance.Some of the large numbers of Chinese here are addicted but the majority are not ; among them, women chewers are less numerous than are men.Betelnut chewing, as practised here, is a very complex procedure.In making up what tobacco devotees call a "chew," people use many substances.Of these at least four are of recognized medicinal value, thus contributing to the medical feature of the subject.
SWIMMING POOLS 1.Any person who has been exposed to or is suffering from a communicable disease (typhoid fever, diphtheria, scarlet fever, measles, etc.) should report the facts concerning the exposure to the person in charge of the pool and should not use the pool until permission is obtained from the proper authorities.2. Every person must take a thorough shower bath with the use of soap before entering the pool.3. Persons found polluting the water with their body dis¬ charges will be excluded from the pool.The trough along the side of the pool is provided as a place to expectorate.Do not expectorate in the water.4. The water in the pool is purified and is safe for bathing purposes, but is not a drinking water ; therefore, bathers are warned against swallowing any pool water taken into the mouth.
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)