834 THE NATIONAL PHYSICAL LABORATORY.

TRENDELENBURG’s operation, and at the lecture he pre-

sented a table showing the present condition of the patientsin all the cases operated on since, so far as they had beenseen or reported on. These were 50 in number, and they-showed clearly the beneficial effect of the operation in most,cases. Except in two instances all the patients expressedthemselves as being in less pain than before the operation ;.in no case had any increase of the varix occurred, and the

tendency to thrombosis was greatly lessened. The lecturer

summed up his remarks on treatment by saying that in

TRENDELENBURG’S operation we have a simple and safe pro-ceeding and one very useful in nearly all cases of varix.

In conclusion we may add that the lecture was an excellent

illustration of the light which may be thrown on a subject-generally supposed to be fully understood by a careful con-sideration of facts and logical deductions from them.

Annotations." Ne quid nimis."

THE NATIONAL PHYSICAL LABORATORY.

RATHER more than 30;years ago the suggestion was made’by Lord Kelvin that the nation should possess a physicallaboratory in which standards could be preserved and thework of standardisation carried on. The opening of

the National Physical Laboratory at Teddington by thePrince of Wales on Wednesday, March 19th, marks the

consummation of this valuable suggestion, although theequipment of some departments is not yet complete for wantof funds. The work which this institution will under-take is of the most important kind. It will relate chieflyto the standardisation and verification of instruments

and the determination of physical constants. Amplescope for the investigation of certain industrial problems inwhich the application of scientific study and research isindicated will be afforded as the income of the institutionwill allow. The Government has granted £14,000 for fittingup Bushy House (an old Royal residence) for the purpose anda maintenance of 4000 a year. It is believed that the houseis remote from external physical disturbances, special atten-tion having been given to isolating the building for thepurpose of conducting electrical and magnetic measure-ments. It is to be hoped that the lack of funds owing towhich the equipments in some respects are deficientwill soon be made up and that the nation will by its

practical help realise the importance of such an institutionbeing maintained in an efficient state.

THE METROPOLITAN WATER-SUPPLY.

THE report of the Water Examiner on the condition of

the metropolitan water-supply during the month of Januarylast has at length been published. The Thames water at

Hampton, Molesey, and Sunbury was " more or less

coloured " from the first to the seventh day of the monthand was described as of "indifferent" " quality during thatperiod by the engineer to the Chelsea Company. The

-height of the river varied between a point one foot aboveand one seven inches below the average summer level. The

daily average amount of water distributed by the eight com-panies was 198,233,165 gallons for a population estimatedat 6,314,223, which represents a daily consumption per head

. of 31’39 gallons. The companies which deliver less thanthis amount daily per individual are the Kent, the New River,and the East London ; the others deliver more. During

the month of January, 1902, the New River and the Lambethcompanies distributed a larger quantity of water per head totheir customers than they did in the corresponding monthof the year 1901 ; each of the other companies deliveredless per head than during the earlier period. The Lambeth

Company’s water on Jan. lst, 3rd, 6th, and 8th was slightlyopalescent. The water of the Lambeth Company also

exhibited "the deepest average tint of brown." Dr. T. E.

Thorpe, F.R.S., the analyst to the Local Government

Board, reports that he made a full analysis of one specimeneach of water derived from the mains of each company.The samples were taken on Jan. 20th-a date on which theThames water was not in a "bad" " or "indifferent " condi-

tion. The proportional amount of organic impurity foundin the samples examined is numerically represented as

follows :-Kent Company 1-1, New River 1-4, Lambeth 3-4,Southwark 3’6, Grand Junction 4’3, West Middlesex 4’5,East London 5 ’0, and Chelsea 5 ’3. There is one paragraphof the Water Examiner’s report which as it stands is

incomprehensible or incomplete. It is as follows (p. 5) :’’ The river intake of the filters of the Southwark and

Yauxhall Company at Hampton was closed from the lst tothe 8th of the month inclusive "-that is readily understood:the engineer to the Southwark Company preferred not tointroduce flood water directly to the filter-beds. The

paragraph continues, "And the intake of the Lambeth

Company was also closed from the 6th to the 18th in-clusive." " If this be so the intake was closed for 13 days.The reservoir storage capacity possessed by the LambethCompany is stated on the next page (p. 4) to besufficient only to contain a supply for 4’6 days-indeed,not sufficient for that time, because (p. 4) "for several

reasons the reservoirs cannot be drawn down to the

limit of their capacity, and the available storage maybe taken at about 15 per cent. less than that abovestated." " For over a year this little explanation has appearedmonthly-perhaps it is not too much to hope that someday the Water Examiner may give as accurately as possiblethe available capacity of the reservoirs of each of the metro-politan water companies. The question which more imme-diately excites our curiosity is, Where and by what meansdid the Lambeth Company obtain water from the 6th to the18th of January last (both days inclusive) ?

UNAVOIDABLE ERROR.

I THE following story, which we quote from the Timesof March 10th, was told at the Thames Police-

court. It is quite probable that upon investigation it

may have been found inaccurate in its details, but it

suggests some of the hardships that arise almost unavoid-ably when dangerous infectious disorders break out

among the poor. A man had been living at some

model dwellings at Bow and some time ago was suffer-

ing from a cold, but by some means it got about that hewas suffering from small-pox. By order of the local alithori-ties he was removed to the small-pox hospital and after beingdetained there for some days he was allowed to go as therewas nothing the matter with him. On returning to his roomshe found that all his things had been removed and destroyedand he now wanted to know who was responsible for theloss which he had sustained. The magistrate is reported assaying that he was unable to answer the question, but that headvised the applicant to see the local authorities. ProbablyMr. Dickinson felt that, as we have suggested, the factsof the case were not fully before him. The PublicHealth and Infectious Diseases (Notification) Acts containprovisions designed with a view to protect the publicat large when individuals are found to be sufferingfrom dangerous infectious disorders, but certainly withoutany desire to inflict unnecessary hardship on the sick

835

persons. The local authority may direct the destruction

of bedding, clothing, or other articles which have been

exposed to infection from any dangerous infectious dis-

order, but it is also empowered to give compensation for thedestruction so wrought. We do not believe that such com-

pensation would or could be refused because it was discoveredthat the destruction was not required owing to there havingbeen in point of fact no exposure to infection. With regardto any distress or inconvenience entailed upon the individual

wrongly suspected and removed, but not in fact sufferingfrom a dangerous infectious disorder, some distress and

inconvenience must necessarily, we fear, be borne at

times by individuals if the public is to be protected. Those

locally responsible for the public health have certain powersgiven to them which enable them to take charge of personssuffering from specified disorders who are without properlodging and accommodation. In such cases action is onlytaken on the certificate of a legally qualified medical prac-titioner, and, apart from any negligence, it is not easy to seeany legal grounds upon which compensation might beclaimed from the sanitary authority as such. On the other

hand, members and officials of local authorities and personsacting under the directions of local authorities are pro-tected from personal liability for acts done by them

bona fide for the purpose of executing their duties

under the law, and, apart from negligence, we do not under-stand how the person in whose case a mistake has beenmade can have any claim against individuals. Still, suchcases as that to which we have referred are hard cases

when they occur, and it is dispensing cold comfort tohint to the man who has been taken from his home unneces-

sarily that he owes it to vaccination that he has been ina small-pox hospital without contracting small-pox. That

mistakes in the diagnosis of small-pox must inevitably occurneeds no demonstration, but we may call attention to ananswer given by Mr. Long to a question in the Houseof Commons on March 10th. The right honourable

gentleman stated that in Bethnal Green in Januaryand February 136 cases were reported, which pre-

sumably means certified, as small-pox, and that in 13cases it was found that mistakes had been made. This,however, does not imply that the cases so reported weredealt with as small-pox cases before the error was discovered,nor does it mean that there was any negligence or default ofany kind on the part of those by whom, or through whom,the reports were made. Such mistakes, moreover, howevermuch they are to be regretted, are, to use a popularexpression, "mistakes on the right side," and are not so

dangerous to the community at large as are those whichleave persons who are suffering from small-pox to be sources I,of infection to all around them.

LIGHT AND MALARIA.

THE demonstration of the plasmodium as the vera ca1lsa ofmalarial fevers and the successive sporulations of the parasiteas the exciting causes of the paroxysms have exploded manypopular and traditional beliefs and have explained thosethat experience has established as to the conditions underwhich these diseases prevail and the means by which theymay be prevented, as being simply such as are most favour-able to the multiplication of the anopheles and such as tendto its extermination. But there are still some facts hitherto

unexplained pointing to conditions connected with solar

phenomena, and not unnaturally ascribed to the sun’s heatas the most obvious and palpable of these. But it is not easyto imagine how the parasite can be influenced by externaltemperatures, since it is itself in a medium, the blood,which is not affected thereby, the pyrexia of the paroxysmbeing the effect, not the cause, of its intermittent activity.In the American Journal of the Medical Seience.s for

February Dr. A. F. A. King of New York puts forward aningenious suggestion that the actual factor in question is thelight, not the heat, of the sun, and that the relative im-

munity of the very dark and black races of man is due tothe lesser translucency of their skins. Celli and Tacchini hadnoticed that the years in which the fevers were most severein Italy were by no means the hottest, though the number ofcloudless days was above the average. Jackson remarked

that in Jamaica a camp over which a fog hung all daysuffered less than did those apparently better situated, andthe beneficial effects of several days of heavy rain haveoften been noticed. Flint states that paroxysms very

rarely occur at night and that, recurring some hours latereach successive day, when they fall after dark they areusually deferred to the following morning, when they maysometimes be avoided by the patient lying in bed throughthe day. The experiments of Harrington and Leamingon the common amoeba lend considerable support to thishypothesis, for they found that the amoebae ’’ streamed "

.under the influence of bright sunshine, but still more

actively when exposed to red light, whereas the process wasarrested in the darkness and was completely inhibited by theviolet and ultra-violet rays. Since the skin of all but theblackest races, and especially that of white men, is more orless translucent, it is evident that blood parasites may besusceptible to the influence of the light of the sun, thoughprotected by the constant heat of the body from that

of external temperature, and that it is chiefly the red

rays that can reach them through the medium of the

blood. Until it shall have been proved that the blood of thenegro is darker than is that of the white man, and that thecolour of the latter can be perceptibly altered by practicabledosage with methyl blue or can be made fluorescent by theadministration of quinine, we must forbear following Dr.

King in his speculations on these points, but we think thathe has made out a fair case for his light theory and for thetrial of what may be called ’’ scoto-therapy " in the treat-ment of malarial fevers-that is, of keeping the patientin a dark room and in the intervals between the attacksof clothing him in garments with linings impenetrable bylight.

-

OLD MEDICAL PUFFS.

THE recent controversy on the impropriety of advertisingthe name of a medical man without his knowledge raisesagain the whole question of medical advertisements. In

certain of its aspects, at least, medical etiquette is un-

doubtedly in process of growth even now, and in the absenceof definite evidence wonder may be expressed whether, as awhole, it has arisen, like the Common Law, from humbleAnglo-Saxon beginnings, or whether, like a creed, its essen-tials come to us stereotyped out of Latin and Hellenic

antiquity. Supposing the medical code of honour to be, soto speak, progressive, then it follows that there was a time

when medical ethics permitted puffery. Certain it is that old

newspapers abound in medical puffs which in many casesemanate from seemingly respectable sources. The questionis, How were these puffs viewed by the medical men of theday ? Were they considered venial or disgraceful ? Dr.

James’s "Fever Powders" were regularly vaunted in print,as poor Dr. Goldsmith found to his cost when he insisted

on taking them contrary to his apothecary’s advice.Oliver Goldsmith died from fever, and James’s powders wereespecially recommended as " a most effectual Remedy for allinternal Inflammations, Pleurisies, Quincies, acute Rheu-

matisms, and the Lowness of Spirits, and Uneasinesses

proceeding from slow and latent Fevers, which are generallymistaken for Vapours and Hysterics."

" Thus ran Dr. James’sadvertisement as set forth by the firm of Newbery. Dr.Johnson said of James, who was a Fellow of the Royal College

836

of Physicians and a Doctor of Medicine of Cambridge Uni-versity, that no man brought more mind to his profession,"and it is a question whether the man thus appraised reallylost caste, as his biographers aver, by first patenting andthen advertising a drug. Certain it is that he -was struck

off no books, and Dr. Johnson, that model of scrupuloushonour, was his friend to the last. Was he even censured for

making a false specification in his patent ’t And what was

the state of professional feeling which permitted a Doctorof Medicine to publbh a ‘ Vindication of his powders ? ’?In the seventeenth century advertisements setting forth themerits of medical graduates and other apparently reputablepersons were common in the journals. In the True Domestick

Intelligence for March, 1680, we find Thomas Kyrle issuingan extraordinary manifesto which begins, " The old and trueway of practising Physick revived and published for the

publick good." The puff, which is very long, describes hissystem of charging fees only in case of cure, his readinessto treat the poor for" thanks " only, and so on. The priceof his doses is given and his address, I I the first balcony"

"

in a certain city lane. And this man, Thomas Kyrle, or

Kirleus, was no quack, but Charles II.’s "sworn phisitian inordinary," and he issued his statement, as he avers, underthe seal of the College of Physicians and with their

approval. In the "twenties" " and "thirties" " of the centuryjust passed these medical declarations to the public seemto have been still quite in vogue. An old newspaper cuttingnow lying before us "respectfully informs the public" thata Member of the Royal College of Surgeons in London"has had more than 30 years’ practice in midwifery, and haspaid particular attention to the operative department ofsurgery," including the successful treatment of hare-lip andulcers in the legs. On the other hand, it is noticeable thatseveral satirists in the eighteenth century and earlier makeno mention of printed advertisements. In his brilliant"Dose for the Doctors" (1789) "Gregory Glyster, an OldPractitioner," most maliciously and wittily suggests a dozenways in which a medical man may puff himself without

seeming to do so, but print is not one of them, though orna-mental door-plates and exaggerated medical degrees are dulyrecommended. Again, writing in 1651, Robert Record

reprints in a slightly modernised form A Detection of Un-skilfull Physitians," which is reported to be the work of aSalisbury doctor in Queen Elizabeth’s reign. And here

.ag1Ïn printed puffery is not hinted at, although the countryis said to be infested by a " sort of fellows, which nowadaysalmost in all places so rashly, so fondly, and so wickedly doabuse the noble Art and Science of Physick."

WOOLWICH AND THE HOUSING OF THEWORKING-CLASSES.

DR. SIDNEY DAVIES, the medical officer of health of theborough of Woolwich, has issued a " Further Report to

Housing of Working-Classes Committee on Overcrowding andthe Population requiring Re-housing in the Borough of

Woolwich." " The facts disclosed by this report are by nomeans creditable to the civili6ation of the twentieth century.Houses are difficult to obtain in the district under Dr.

Davies’s charge for two reasons. First, there is a definite

lack of houses, and, secondly, people with large families arevery often refused as tenants, even though they can pay.the high rents demanded. This lack of houses reacts

unfavourably on sanitation because, says Dr. Davies,’’ Landlords who only look to their rents are careless as tothe complaints of tenants as to defects in a house, knowingthat however bad its condition it is sure to be reoccupied.as soon as it is empty. The health authority and its officershesitate to take steps for closing a house which is sanitarilyunfit for occupation, knowing that the displaced tenants

.may be unable to find adequate accommodation elsewhere.

’A bad house,’ it is sometimes said, is better than nohouse at all.’" It may be said that there is a certain

class of tenants who are most destructive and who

think nothing of tearing down sanitary fittings for

the purpose of selling them as old metal. The damagedone by such is, however, in no way comparable to thatdone by the bad landlord. He it is to whom are due the

horrible overcrowding, the one-roomed tenements and the

immorality and vice which are the inevitable accompani-ments of such overcrowding. For a four-roomed house hewill draw over .E30 per annum in rent and a court or street ofsuch houses will be a veritable focus of disease affecting theneighbourhood far and wide. When matters get to such apitch that after great difficulties his property is ordered to bedestroyed he is bought out at a high rate and goes away tobuy or to build further fever dens.

VACCINATION DIFFICULTIES.

IN THE LANCET of March 15th, p. 761, we commented uponsundry matters concerning vaccination and public vaccinatorsat Helston. The town council had issued bills pointing outthe advantages of vaccination and revaccination and in-

timating that anybody who wanted to be vaccinated could bevaccinated by the public vaccinator, whose name was given.It is obvious, as we noted, that in a case such as this everycare would have to be taken that the public vaccinatordid not attract other practitioner’s patients. In this

instance, however, the public vaccinator had nothing to

do with the issue of the circular. A correspondent hasforwarded for our inspection a circular signed by a prac-titioner who is medical officer of health of a certain urban

district council. The circular points out the advantagesof vaccination and revaccination. Our correspondent,though, writes to us that he considers the issue of the

circular very unfair to himself and to other men in the

district, for the medical officer of health in question is inprivate practice. We think it would have been better if

it had been made plain that the circular in questionhad been issued by the urban district council, for thoughit apparently only emanates from the medical man, yet wecan hardly suppose that he, not being a medical officerof health who is not allowed private practice, would sendout such a circular on his own initiative. Possibly thedifficulty might be got over by making every medical man apublic vaccinator, and this course has been recently urged bythe adoption of the following resolution by a meeting of thecouncil of the Lancashire and Cheshire branch of the British

Medical Association :-

That in the opinion of this council, seeing that vaccination is madecompulsory, in the interests of the public health, the parent or

guardian of a child should have the right to select any registeredmedical practitioner, who is willing to do so, to perform the vaccina-tion, and that the cost of the same should be defrayed by the State ata fixed rate, provided always that the work so done shall reach thestandard aimed at by the Local Government Board in the case of publicvaccinators, and that no work falling short of this standard should beaccepted for the purpose of public remuneration.

The matter is one which presents many difficulties. Vaccina-tion and revaccination should be indefatigably preached.It is the duty of all health authorities, of individual medicalmen, and of the clergy to impress people with the value ofthe practice ; but individual medical men must be carefulto avoid any appearance of wishing to draw away the

patients of their brother practitioners. With regardto the position at Helston, at the meeting of theHelston Board of Guardians held on March 15th it wasdecided to ask all the public vaccinators to continue to acton their old contracts. The guardians at first wished the

public vaccinators to provide all extra calf-lymph at theirown expense, but these gentlemen declined to accept theseterms and consequently the guardians decided to pay for allsuch extra lymph. The clerk was instructed to write to allthe public vaccinators rescinding the notice to determine

837

their existing contracts. A letter was received, signed byall the public vaccinators, drawing attention to some remarkswhich the chairman was stated to have made at the last

meeting and requesting an apology. The chairman stated he

had no intention of hurting the feelings of these gentlemenand he was very sorry if he had done so.

THE CHELTENHAM EAR, EYE, AND THROATHOSPITAL.

AT the annual general meeting of subscribers to the aboveinstitution held on March 5th two very important motionswere carried. The first was as follows : ’’ That the hospitalin future shall be a free hospital." " The motion for this

purpose was introduced by Mr. G. A. Cardew in an admirablespeech. " If," he said, "subscribers asked, ’What shall weget for our subscriptions ?’ we can reply, ’Exactly the

same as before, except that you will be able to send in

patients regardless of time and not have to tell them to

wait until your next stock of tickets arrives.’ " We likeMr. Cardew’s cheery optimism, for there is a class of sub-scriber who will think : " What good do I get by subscribingwhen anyone else who does not subscribe can recommend

patients as well as myself ?" "

However, this class of sub-scriber is rare. We congratulate the authorities of the

hospital on their decision. The other important reso-

lution at which the meeting arrived was to appoint aresident medical officer. The brunt of the work, exclusive ofdental matters, has hitherto been borne by Dr. J. A. Bower,the honorary surgeon, although he has had the assistance ofMr. C. E. Abbott as anaesthetist and in a measure as

assistant surgeon. Every hospital should, however, in ouropinion, possess a resident medical officer, and we earnestlyhope that the additional 200 per annum, which the appoint-ment of such an officer will involve, will not be sought for invain.

____

THE HEREDITARY SEQUELae OF ALCOHOLISM.

DR. T. D. CROTHERS of Connecticut contributes to the

January number of the Quarterly Journal of Inebr;ety avaluable preliminary report on Heredity and Alcoholism, con-taining some of the main conclusions reached by a committeeof physicians which was appointed at a Medical TemperanceCongress held in the United States in 1888 and of which hewas chairman. The collection of material for the report,says Dr. Crothers, has gone on during 13 years, and up tothe date of publication of the article fairly accurate

histories had been collected of 1744 cases of inebriety. The

majority of these cases (about 1300) had come under Dr.

Crother’s personal care and observation. The facts were

carefully ascertained and collected, and the inquiry was notlimited to heredity alone but included every condition andcircumstance which could have an etiological bearing in thedevelopment of inebriety."

" In a few cases the existence of

inebriety or of mental disorder in the parents was carefullyconcealed and had to be ascertained indirectly, or was at firstdenied and subsequently disclosed. " The central conclusion,which cannot be stated too strongly," says Dr. Crothers, "isthat the injury from alcohol to the cells and nerve-tissues istransmitted to the next generation with absolute certaintyin some form or other "-i, e. , as a drink craving, a neurosis,or a mental defect. Of the 1744 inebriates with trust-

worthy histories 1080 had a direct history of alcoholic

heredity; 390 cases were traceable to bodily diseases, injuries,or shocks ; 180 were attributable to starvation and poisoning ;while 85 cases were due to ignorance, bad surroundings, andimitation (mental contagion). In only the remaining ninecases were the causes so complex or so obscure that noclassification could be made of them. Regarding the1080 patients with a direct alcoholic heredity Dr.Crothers writes: " In most [of these] there seemed to be

largely transmitted a special predisposition to find relief-in spirits, or a mental diathesis (instability) with want ofself-control, and often a species of psychical pain and unrestwhich found greatest relief from the use of spirits." In 430of these patients there was hereditary transmission of thedrink craving from the parents and in 224 from the grand-parents (atavic heredity), while in 290 cases some degree ofpsychopathic heredity or mental abnormality could also betraced in the parentage. While a study of the familyrecords of these cases show that some members of these-

families were endowed with ability and even brilliancy inthe fields of theology, politics, music, law, and art, manyothers showed criminal or vagrant tendencies or were other-wise mentally and morally defective, and sank rapidly ’into the lower strata of social life. In’ 49 instances.the inebriates belonged to the ’’ epileptoid" class bothas regards personal symptoms and hereditary antecedents.Such persons were characterised by "alcoholic outbreaks ofstormy or cyclonic development," not necessarily or strictly-periodic, developing suddenly and disappearing with little orno trace behind. "The ancestors of these persons were-

always noted for their sudden explosive nerve-energy ......persons whose whole conduct throughout life was an alter-

nation of wild extremes, ...... continually changing in

politics, in religion, and in business, ...... always leadingforlorn hopes and always defeated, physically suffering from

disease and making remarkable recoveries, at one time usingspirits, then changing to other remedies, and always underan obsession." Among the female members of these familieswere many neurotic individuals addicted to drugs, Christianscientists and faith-curers, and mental or moral invalids

given to secret drinking. Finally, various groups of inebriateswere met with who either took to drinking, as though driven.by fate, at the same ages when their parents took to drink,or who manifested precocious sexual instincts or an abnormalcraze for food as well as drink, or who readily becameaddicted to the morphia habit. The far-reaching morbideffects of alcoholism were thus clearly proved.

ARSENIC IN BEER AND IN REDUCED IRON.

ON March 10th Dr. E. S. Reynolds of Manchester gavesome interesting evidence, which we reported last week

(p. 786), before the Royal Commission on Arsenical Poison-ing. Manchester and its neighbourhood contain largenumbers of important breweries which used arsenical glucoseand invert sugar supplied during 1900 by Messrs. Bostock andCo., and, as is well known, Manchester suffered most severelyduring the epidemic of arsenical beer poisoning which thenoccurred. It was to be expected that during the intervalwhich has since elapsed no precaution would be omittedwhich Manchester brewers could take to eliminate arsenicnot merely from brewing sugars but from malt which in

certain neighbourhoods owing to the fuel used appears to

be capable of taking up arsenic. This seems to havebeen the case, and Dr. Reynolds testified that in some Man-

chester beers no arsenic can now be found by the most deli-cate test, while the highest quantity has been under yth ofa grain per gallon. Dr. Reynolds, to whom belongs the creditof first discovering the cause of the Manchester outbreakin 1900, informed the Commission that alcoholic neuritis, asunderstood for years in Manchester, has almost disappeared,and that skin pigmentation and herpes, formerly commonin cases where neither arsenic nor alcohol was suspected as acause, have largely diminished ; and he added the interestingobservation that cases of " alcoholic heart," to which a great.deal of attention has been paid in Manchester and which hasformed the subject of several monographs, can now no longerbe found at all. It is evident, however, from the factsreported by Dr. J. F. Hodgson regarding cases at Halifax,that similar freedom of beer from arsenic has not been.

838

secured everywhere in the country. Dr. Reynolds urgedthe necessity of very close observation of cases of peripheralmeuritis for the detection of two symptoms which may beconsidered specially to point to arsenic-pigmentation andkeratosis. He also drew attention to the large quantity of- arsenic sometimes present in reduced iron-B.P. ferrum

redactum in some cases having been found to contain as

much as 1 per cent. of arsenic. Many practitioners havefound special advantage from administering iron in this

form in cases of anasmia, and it is possible that this beneficialresult arises from the fact that with every grain of reducediron a dose equivalent to a minim of liquor arsenicalis is

administered. The possibility, at any rate, deserves to benoted.

____

THE INTERNATIONAL CONGRESS OF GYN/ECO-LOGY AND OBSTETRICS.

THE Fourth International Congress of Gynascology and’Obstetrics will be held in Rome under the patronage of theKing of Italy from Sept. 15th to the 21st, 1902. The

subjects on which papers are to be read are-(l) MedicalIndications for Interrupting Pregnancy ; (2) Hysterectomyfor Puerperal Infection ; (3) Genital Tuberculosis ; and

(4) Surgical Treatment of Cancer of the Uterus. The

general president is Professor Ercole Pasquali of

Rome ; the presidents of the obstetrical and gynmco-

logical sections are respectively Professor Morisani andProfessor Mangiagalli ; the general secretary is ProfessorErnesto Pestalozza, 60 Via Alfani, Florence ; the treasureris Dr. C. Micheli, 127 Via Rasella, Rome ; and the honorarysecretary for Great Britain and Ireland is Dr. William J.

Gow, 27, Weymouth-street, London, W. The membershipsubscription, including the right to receive the printedtransactions of the congress, is 25 lire (Ll). Relatives of

members will be admitted to the official entertainments onthe payment of 10 lire (8s.). These sums may be sent either

to Dr. Micheli or to the secretaries for the countries to whichmembers belong. The time assigned to each paper is notto exceed 15 minutes. Intending readers of papers are

requested to send the titles, and if possible short summaries,to the general secretary before the end of May.

THE COAL SMOKE ABATEMENT SOCIETY.

THE third annual report of this excellent society shows anincrease in good work of which the society may well beproud. We are pleased to see that the borough councils aremore alive to the nuisance of foul, dirty smoke than were theold vestries. Still, they might accomplish even more thanthey do. For instance, 225 nuisances were reported to thePublic Health Committee of Chiswick, but only eight sum-monses were issued. The Coal Smoke Abatement Societyat present has two inspectors working under it and the

council of the City of Westminster has appointed two

of its own. We advise everyone to join this societyand to read the report of Sir William Richmond’s speechat the annual meeting of the society which was held onNov. 20th, 1900, at Grosvenor House. There the reader willfind facts and figures, some of which we have quoted above,which will make him grateful to the society and profoundlydisgusted with magistrates and local authorities. The latter,though less apathetic than the vestries are still not as activeas they might be and the former inflict most inadequatefines. As we have pointed out over and over again theexcuse about not being able to get Welsh coal is nonsense.If manufacturers like they can easily make their furnacessmokeless. When they find that it is better for their pocketsthat the furnace should be so they take steps to make it

smokeless, as in the case of the Nottingham lace makers.If, then, magistrates will only fine all offenders as heavily aspossible the said offenders will manage to get smokeless

furnaces, and we shall be spared such days as March 6thand llth, when London resembled portions of the UndergroundRailway in its worst days. _

SMALL-POX IN LONDON.

THE returns for the past week show the followingfigures : on Saturday, March 15th, there were 43 freshcases notified and removed ; on Sunday, the 16th, there were45 fresh cases ; on Monday, the 17th, there were 82 freshcases ; on Tuesday, the 18th, there were 52 fresh cases ; andon Wednesday, the 19th, there were 71 fresh cases. ,

POST-MORTEM EXAMINATIONS IN UNIONHOSPITALS.

AT the weekly meeting of the Lurgan Board of Guardiansheld on March 6th one of the members of the board com-

plained that the medical officers of the workhouse had beenin the habit of making post-mortem examinations. The

medical officer of the workhouse hospital, Dr. J S.

Darling, having been sent for, said that post-mortemexaminations were occasionally held on patients who haddied there. He had no explanation to offer; if the cause

of death was a doubtful one and where the patient hadno friends he made a post-mortem examination. He hadmade six during the past six months and three duringthe past month. There might be months without such anexamination being made, but it was never done with annoy-ance to any friends. On being asked if he would refrainfrom making necropsies, Dr. Darling said that he wouldif the guardians made an order and the Local Govern-ment Board sanctioned it. If the board of guardians leftthe matter in his hands it would only be in exceptionalcases where there was a genuine need that he would

make a post-mortem examination. Notwithstanding this

extremely fair promise the guardians decided by a largemajority that no more post-mortem examinations shouldbe held unless with the consent of the board. It is a greatpity that the medical officer of the Lurgan workhouse hos-pital should be hampered in his efforts (in which, we are in-formed, he has always considered the feelings of the friendsof patients) to verify the diagnosis of disease by post-mortemexamination. Without such a method the science ofmedicine would soon come to a complete standstill.

ACHONDROPLASIA.

I IN the March number of the .PcZycKMM an interest-

ing account of a case of achondroplasia is contributed byMr. James Cantlie. The patient, a girl, aged 13 years, pre-sented the usual symptoms of conspicuously short upper andlower limbs. When she sat by the side of a healthy well-grown girl of normal development the two girls appeared tobe of about the same height, but when they assumed the erectposture there was a great disparity on account of the short-

ness of the patient’s lower limbs. Similarly her upper limbswere greatly wanting in length, the tips of the fingers, as thearms hung by the sides, hardly reaching below the iliac crests.Her head appeared to be relatively large, but it was to thedefective elongation of the limbs associated with a trunk ofapproximately normal size that she owed her peculiar aspect.Mr. Cantlie points out that achondroplasia, though some.times described as foetal rickets or foetal cretinism, is essen-tially distinct from either of these conditions. His patient,though helpless in many particulars because of the mal-

development of her limbs, was a very intelligent girl whosefacial aspect and general bearing were far removed from themental dulness of cretinism. Achondroplasia is an arresteddevelopment in certain portions of the bony skeleton, the ’

parts affected being those which are normally ossified in

cartilage during the earlier months of foetal life. Bones

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resulting from ossification in membrane are formed as usual, Iand the same is true of those which, formed in cartilage,remain mainly or entirely cartilaginous until after the sixth Imonth or so of foetal life. But the parts which are ossifiedin cartilage in early foetal life are stunted in their develop-ment, as if from premature arrest of the ossifying process.This defect applies to the long bones of the limbs, the ribs, Ithe pelvis, and the greater part of the base of the skull. I

THE DISTRIBUTION OF PLAGUE.

DURING the week ending March 2nd 15 cases and 8 deathsfrom plague have been reported throughout all Egypt. 7cases and 3 deaths occurred at Tantah, 1 case was admittedto hospital at Abusir, 1 at Kom-el-Nur, and one at Mit-

Ghamr. 4 cases and 4 deaths occurred in villages nearZifteh and 1 death out of hospital at Mehallet Abu Aly nearMehalla Kebir in the Gharbieh province. The disease showsa tendency to spread in some of the outlying villages of theprovince of Garbieh, but has assumed no serious proportions.Great difficulty is experienced, however, in obtaining earlyand trustworthy information, about suspicious cases of ill-

ness in the villages in which the sanitary authoritiesare obliged to rely on the information afforded by thesanitary barbers. These are recognised Government officials,but are unpaid, and it is to their interest to be on good termswith the omdehs, scheiks, and inhabitants of their villages.As they depend for their livelihood on the latter, who aregenerally more inclined to conceal any cases of infectiousdisease than to announce them, the barbers’ information, asmay be imagined, is not of a very trustworthy nature.

During the week ending March 9th 12 cases of plague and4 deaths from the disease have occurred throughout all

Egypt. 1 case and 1 death occurred at Tantah, 1 case atAbusir, 2 cases and 1 death at Nahtai, and 8 cases and 2deaths at Kom-el-Nur. As regards The Mauritius telegramsfrom the Governor received at the Colonial Office on

March 7th and 14th state that for the week endingMarch 6th there were 19 cases of plague, of which five

proved fatal, and for the week ending March 13th therewere 10 cases of plague, of which seven were fatal.

ACETYLENE AS AN ILLUMINANT IN WARFARE.

A GOOD and easily managed illuminant, portable andyet capable of maintaining a clear and steady light for

lengthened periods in spite of wind and rain, is a

desideratum which medical officers have long soughtfor, though so far without any very conspicuous success.

On active service the surgeon’s duties are often heaviest

during the hours of darkness, and it would indeed be

a priceless boon if a lamp could be devised whichwould in the first place enable him to search rapidlyand effectually for the wounded after an engagement,and next would afford the indispensable light without

which it is utterly impossible for him to do justiceeither to his patients or to modern science. The subjectof acetylene as an active service illuminator was taken

up a year or two since by Dr. Nikolai who extolled an

apparatus consisting of a generator of the size of a haversackwhich was connected with a burner and reflector bymeans of a long rubber tube. This apparatus was describedat length in the Deutsohe ilitdrarztliclte Zeitsohrift forOctober, 1899, but in the number of that journal for Januarylast there is an article by Dr. Reh pointing out what he regardsas fundamental defects in the highly-praised invention. To

begin with it is far too large and too heavy, requiring theexclusive services of a bearer, and next, besides being veryfragile it is awkward to manipulate and by no means unlikelyto explode. According to Dr. Reh an acetylene campaignlamp ought to be very light and yet strong and be capable of

being carried either in the hand or attached to the waist-beltso that the bearer can at the same time fulfil his normal duty.After experimenting for over two years Dr. Reh has suc-

ceeded in constructing an acetylene lantern which, in his

opinion, has answered all requirements under the most severetests with regard to rain, wind, storm, and intense cold.

Every stretcher-bearer, he considers, should be provided with

one of these lamps, which are constructed so simply that anyperson of average intelligence can learn the management ina few minutes. When extra light is needed for an opera-tion or any other cause three or five of the lamps can beattached to portable stanchions, or if desired, larger lampscan be provided on the same principle, though Dr, Rehdoes not think that this is necessary.

WHAT IS WATERED BUTTER P

IT seems to us that further legislation in regard to the-control of the sale of butter is being attempted upon mostunsatisfactory lines. It has been recommended by a Depart--mental Committee of the Board of Trade that 16 per cent.of water shall be the limit of genuine butter. To this

recommendation the obviously weak-kneed rider is addedthat in the event of a disclosure being clearly made to thepurchaser that the butter contains more water than this

no offence shall be deemed to have been committed. In.that case obviously there would practically be no limitto the extent to which butter may be watered. We donot believe in this principle of "disclosure" at all. At.

any rate the principle is not calculated to save the pocketof the purchaser. Take the case of the so-called milk-blended butter which contains at least 25 per cent. ofwater derived, it is said, from the milk worked into it.

At first this was sold simply as "butter," but the HighCourt of Justice decided that it could no longer be soldas "butter" " and thereupon the term " milk-blendedbutter" was ingeniously introduced. The fact, however,that it contains 25 per cent. of water is disclosed onthe wrapper and the price is 18. per pound, and theaverage purchaser thinks that he is getting genuine butterso much cheaper than before. As a matter of fact heis the loser, for out of 16 ounces of the milk blend at leastfour ounces are water, and he who pays 18. a pound forwater is hardly wise in his generation. Of course,the "disclosure" does not help him out of the delusion ;the average member of the public is not educated sum-

ciently to understand it. The Food and Drugs Actwas intended to protect the consumer not only againstinjurious elements in his food but against fraud also, a factwhich even the Lord Chief Justice of England seems

to have lost sight of, for he ruled on one occasionthat glucose might be permitted in marmalade as it

was quite a harmless addition. So is water to milk.The only chance of affording the consumer effectual pro-tection seems to us to be by the adoption of standards bythe legislature. Genuine butter must be defined in the same

way as genuine milk has been defined, but we think that amistake is made in the case of the former by placing thelimit upon the amount of water. Why not, instead, demand astandard amount of butter-fat in genuine butter ? In other

words, butter containing less than a prescribed amount ofbutter-fat should be deemed not to be genuine. In the case

of milk the standard is not based upon the amount of water

permissible in it, but upon the amount of fat and the solidsnot fat respectively, and in the same way the proportion offat should determine the genuineness or not of butter.Provided that this standard was reasonably high "milk-blended butter " would obviously come outside the definitionof genuine butter. As it is our authorities seem chary toinitiate any definite action which shall put a stop to whatSir Edward Strachey has in a vigorous and timely letter to a

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contemporary described as "a fraud on the poor as it leadsthem to believe from its description that the addition of

milk enriches it [butter], instead of impoverishing it. " And

where is this >-art of thing, this mixing, to be stopped ? ‘!For as matters stand at present disclosure would permitthe addition of 40 or even more per cent. of water

if it could be successfully incorporated. Mr. JusticeWills has given his opinion that this incorporation of milkwith butter is done with the object of making ‘° a spuriousprofit." If that is so, surely the law needs to be amended inorder to stop this practice. Average milk contains 88 per,cent. of water, so that adding milk to butter is tantamountto adding water to it. The unjust difference is that the manwho adds water to his butter cannot get off by declaring thatsuch is the case, while the man who adds milk can, althoughby so doing he may raise the water to nearly 30 per cent.Anything more anomalous than that we cannot imagine.If something is not done soon the butter trade will be com-pletely demoralised by this regrettable concession.

SMALL-POX AT CHARTERHOUSE SCHOOL.

THE alarming rumours of small-pox at Charterhouse

School, Godalming, and the startling statements that haveappeared in the press do not appear to have been fullyjustified by the facts. Upon inquiry into the circum-

stances we find the following to be the true history ofthe case. On Dec. 24th one of the boys while at home de.veloped spots which had all the characteristics of variola.An experienced physician pronounced the case to be oneof small-pox and it was so treated and registered as

such by the medical officer of health. The boy had

been vaccinated some three weeks before the appear-ance of the rash. On- Feb. 22nd the boy returned to

Godalming and on March 5th on account of some inflam-mation of the eye he was sent into the school sana-

torium, where on March 7th a rash was observed of exactlythe same character as that seen in December. In the

opinion of three skilled medical men these spots weredue to small-pox and, though the case was anomalous,there was nothing else to do but to treat the boy as a patientsuffering from variola. As a matter of course the most

rigorous precautions have been taken and in all cases revacci-nation, where required, has been enforced. The occurrence

has, naturally enough, excited some criticisms on the medicaland nursing conditions at Charterhouse School that may bemore or less disregarded, but we think that it would beadvisable for the authorities carefully to consider whether thematrons of the different houses are afforded sufficient skilled

help in nursing boys under their care.

THE PSYCHOLOGY OF ANARCHISM.

IN the Scottish Medical and Surgical Journal for MarchDr. George R. Wilson of Perth Asylum has published a briefand interesting paper on "Anarchism, the Insanity ofDelusive Expedient," in which, after referring to the medico-psychological aspects of the case of Czolgosz (the assassin ofthe late President McKinley), the question is raised as tothe " psychological significance of this social disease,anarchy, and whether we are quite justified in regarding it

as consistent with sanity." The intelligence of the anarchistwas, it is argued, probably above the average of those of

his class in society, but such intelligence was marred

by characteristic defects. Of these, the fundamental

defect was a morbid sense of injustice and oppression,a tendency to regard civilised institutions as wrong, unjust,and tyrannical. It was the creed of the weakling mindwhich found the conditions of life too hard and which

lacked courage and perseverance to face the situation and

to redeem itself from it. The anarchist regarded existinginstitutions and the accepted opinion and customs of societyas

" systematised engines of partiality and cruelty," an atti-tude of mind which closely bordered on that of the paranoiacand which readily developed delusions of persecution.Another " stigma was characteristic of the anarchist’s

mind-viz., an excessive tenacity of belief which was likeunto an insane delusion in that the mind was incapable ofseeing and examining the grounds for its creed or belief ;it found the doctrines of anarchy satisfactory to its own

inclinations and accepted them without thinking. Theanarchist was a reformer whose ideas ran counter to all the

tendencies of social evolution and who, finding his preach-ings and expedients futile to gain converts, did not

hesitate to kill. His criminality was found in his murderousinstincts and his insanity was obvious in its irrelevance, inI the ineptitude of the act in relation to the end desired."Moreover, the mind of the anarchist was unduly amenable to’’ suggestion" and depended for its existence upon inter.

course with like minds. When social inequality was great andthe ruling powers were corrupt and despotic anarchy mighttend to flourish as a social disease ; but with the progress ofsocial evolution, which, while it rendered the struggle forlife keener, tended also to make it more fair and just to thecompetitors and helped to shelter and to guard the weak-minded from the special vices and dangers to which they

’ might otherwise succumb, anarchy might be confidentlyexpected to diminish.

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i THE debate on the Nature and Origin of Cancer which

; was inaugurated by the Chelsea Clinical Society with greatI success on March llth is continued in our columns this. week, the debate having been resumed on Tuesday last,) March 18th. Owing to the amount of material at the. society’s disposal it has now been decided to hold a third- meeting on Tuesday next, March 25th, at which communi-r cations will be received from Professor Adami of McGill

; University, Montreal, and Mr. W. R. Gaylord of New York,; while Professor R. T. Hewlett and Mr. D’Arcy Power will

speak. The debate will then be closed by Dr. J. F. Payne.b All members of the medical profession will be welcomed att the third meeting as at the others.

I MR. HENRY N. CUSTANCE, who has been secretary to theMetropolitan Hospital Sunday Fund since 1873, has resignedthat post owing to ill-health. Sir Edmund Hay Currie, whoe was an originator of the fund and who has been one of its1 honorary secretaries since its formation, has consented to

act as secretary, and Mr. R. A. Owthwaite, who has beenassociated with Mr. Custance throughout his period ofservice, will continue his connexion with the fund under SirEdmund Hay Currie. -

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f THE Second International Congress for Electricity inMedicine and Radiography will be held at Berne from

, Sept. lst to the 6th, 1902, and the Second International

f Congress for the Prophylaxis of Syphilis and of Venereal

o Diseases will be held at Brussels between the same dates.

; We shall give further details of both meetings in a futureissue.

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f His MAJESTY THE KING has announced that at thedCoronation he will entertain at dinner 500,000 of his poorer.1 subjects at an expense of 30,000 from his privy purse.

i His MAJESTY THE KING has appointed Dr. James Harpertwo be an Esquire of the Order of the Hospital of St John ofjerusalem in England.