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generally and was chemical in its nature. It had beenconcluded that bone formed in young people working atphosphorus was much denser in character than it wouldotherwise be. It was therefore to be held that changesdid take place in bone-tissue from inhalation of phosphorusfumes, and it was reasonable to explain ’’ phossy jaw " asarising from local irritation through a carious tooth actingon bone already damaged as the result of a general infec-tion. The principle upon which all general precautions mustbe based aimed at a minimum exposure of the worker to thefumes, thus preventing the general: infection of the system,and personal hygiene for the avoidance of local irritation byprocuring as perfect a condition of the teeth as possible.

Dr. G. REID (Stafford) read a paper on theInfant Mortality and the Employment oj lJ-Iar1’ied Women in

]i’actories.Dr. Reid, after discussing the prominent place which mustbe given to ignorance on the part of mothers regarding theessentials of infants’ diet as one of the factors for the con-tinued high rate of infant mortality, passed on to the

question of the marked difference in the infant mortalityrate of the northern and southern towns of the county ofStafford. The northern towns in question contained largenumbers of married women engaged in factories. Heclassified the purely artisan towns in the county into threegroups: (1) many married women workers ; (2) a goodnumber of married women workers ; and (3) practically nomarried women workers. He found that the diversity in theinfant mortality rate based merely upon the geographicaldivision was intensified, and that there was a very markedgradation in the rate which accorded with the relative pro-portion of married women workers. There had been a

general increase in the infant death-rate in recent years andpractically the same relative proportion had been maintainedin the three groups of towns. They had to devise means forwiping out an increase in the infant mortality of nearly27 per cent. in those artisan towns in which married womenwere largely engaged in factory labour. Would it be an-

’

reasonable to have a condition made in such cases that thechild should during the absence of the mother be placed undersuch care as should afford a reasonable prospect of its wantsbeing provided for ? The present law imposed certain restric-tions, but those in effect benefited the mother rather than thechild. It was illegal for the mother to return to work withinone month of her confinement, but it was hardly likely thatshe would commence suckling her child if she intended toengage in work again after so short a period. Dr. Reid sug-gested that this time limit should be extended to threemonths because the probability was that the mother in mostcases would then suckle her child until she returned to workand thus the most precarious period in the life of the childwould be tided over and the chances of subsequent survivalwould be considerably increased. Dr. Reid concluded byadvocating the establishment of erèches by local authorities.

Dr. C. A. GREAVES (Derby) communicated a memorandum,entitled,

Plumbism Cases in Carriage Works.Dr. Greaves had reported 60 cases of plumbism in the lastthree years, of which number 42 cases were in carriage-building works. 14 of these were workmen not employed inthe paint-shops but working as coach body-makers. Theyused a good deal of paint for coating the parts of the wood-work and some white lead to fill in crevices. A point whichhe considered of importance was the advisability of clearingthe nasal passages by blowing the nose well before meals, ashe had found reason to believe that the workmen who had toburn off old paint were liable to take in a good deal ofvolatilised lead in the fumes and dust which they inhaled.Dr. Greaves protested against lemonade being considered apreventive of plumbism ; the fallacy arose because a drinkcontaining a dilute sulphuric acid forming an insolublesulphate of lead had been foolishly called lemonade, whereasreal lemonade contained citric acid which was useless,because citrate of lead was fairly soluble. He had seen afew cases of plumbism in brass-finishers traceable to thefiling of soft brass castings containing as much as 5 percent. of lead.

Dr. C. R. DRYSDALE (London) contributed a paper onL01ver Birth-rates considered as the Real Cause of Loroer

Death-rates.Dr. Drysdale quoted statistics to show that the high death-rates of the poorest classes were due to their very high birth-rate, which forced them to crowd into purlieus and exposed

them to semi-starvation. He considered himself entitled to.say that the real cause of high death-rates in this countrywere high birth-rates, and that if they really wished to-improve the health of the classes at the bottom of societythey must in future endeavour to persuade them to have-families of not more than four children as a maximum, or,better still, to content themselves with two children or-

thereabouts until the mortality of the worst-paid classesshould fall to 12 per 1000, the present death-rate in well-to-do-Hampstead.

Dr. A. K. CHALMERS (Glasgow) proposed and Dr. G. REID-(Stafford) seconded the following motions which were-

carried :-That this section expresses its satisfaction with the provisions in the

Factory and Workshop Bill now before Parliament which requires themedical officer of health of every district council in his annual reportto them to report specifically on the administration of the Factory and.Workshop Act and to send a copy of the report to the Secretary of’State-for the Home Department.That inasmuch as notice has been given of amendment of the pro-

visions referred to, the effect of the amendment being to put this dutyon other ofhcers than the medical officers of health, and inasmuch as,such reports wilt deal with questions affecting the health of the-workers, the section recommends the Association to adopt the aboveresolution and to communicate it to the Secretary of State for the-Home Department.The work of the section concluded with the reading of a

paper by Mr. P. TARGETT ADAMS, late assistant port health’officer at Bombay, onPort Sanitary Administration and the Oontrol of Pla{J1te in.

the Port of Bombay.Mr. Adams described the methods adopted at Bombay foi-the preventing of the spreading of plague to ports out ofIndia. No small measure of praise was due to Colonel,Macartie and Major J. Crimmin, LM.S., V.C., for so far pre-venting the extension of plague from a city saturated with the,infection of plague and in such constant intercommunicationwith ports all over the world and Europe in particular. He-believed he was correct in saying that from the port of

Bombay plague had rarely been shown to have been,

imported at all and in no case by means of rats. In those,few cases in which importation in a sporadic form occurred.it had been due to the conveyance of the infective materialfrom Bombay by means of infected clothing or an infected.patient. Important as the transmission of plague by means.of rats and their parasites was it was equally necessary toremember that filthy clothing charged with moisture andorganic matter and stuffed into a filthy box in the very warm-.atmosphere of a forecastle was probably as dangerous and.certain a means for the successful importation of plague as therat and its fleas.The proceedings of the section terminated with a vote of

thanks to the President, Mr. Shirley Murphy. In the.

passing of this vote of thanks Mr. W. C. C. PAKES (London)pointed out that the President had never delegated the.

chairmanship for one instant during the whole course of the.meeting.

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PSYCHOLOGICAL MEDICINE

FRIDAY, AUGUST 2ND.

Dr. FRANCIS WARNER (London) opened a discussion onThe Diagnosis and Treatment of ’eeble-nzinled Oltildren.

The Elementary Education (Defective and Epileptic Children))Act of 1899 had directed attention in many quarters to the-necessity of provision for the care and training of children.of defective brain-power. The Act was permissive and the:children to be provided for were defined as not imbecile and.not merely dull or backward, but defective-that was to say,children who, by reason of mental or physical defect, were:incapable of receiving proper benefit from the instruction inthe ordinary public elementary schools, but were not in-capable by reason of such defect of receiving benefit from.instruction in special classes or schools as were in the Act men-tioned, &c. There was great need of a wider knowledge andstudy of defective children so that the mental physician mightbe able to afford help to parents and teachers. Of the schoollchildren between the ages of three and 13 years in Englancbit was estimated that about 1 per cent. were feeble-minded..In the diagnosis of brain-defect they had to look for certainsigns-e.g., developmental and physiognomical features,nerve-signs or attitudes and movements, the condition of the-organs of special sense, and the state of general bodilyhealth. In the process of examining and questioning thechild some general estimation should also be made of its.

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mental grade. The volume and shape of the head, irregularity and asymmetry of the skull, disproportion betweCl.cranial and facial development, defective’ developmenof the nares and palate with obstruction of nasa

breathing, malformations of the ears, eyes, and mouthwere all significant. In the face expression might bE

wanting, twitchings of the muscles and "tics" might bf

conspicuously present, an incapacity for fixation of the eye1and of attention, and a lack of control and coordination in th(movements of the hands might be observed. Spontaneity oj

movement, which was so essentially characteristic of normalchildren, might be wanting and might be replaced bymonotonous grinning, grimaces, athetoid movements, shrug-gings and swayings of the body, and the like. Emotional re-action to a stimulus might be excessive, as in chorea. It wasthe coordinated movements seen, first under direction, butlater as a self-contained power, that mostly indicated goodbrain power. As regarded treatment the aim was to removeabnormal nerve-signs and to promote the normal processes ofspontaneity and controllability of movements-i.e., to

.implant modes of action and response which were essentialto self-help and social life. Play, games, general activity,and the prevention of loafing encouraged spontaneity andvariety in movements and tended also to remove the awk-- ward habits or repetitive "automatic actions" which werefrequent among defective children. Imitation of the teacher’smovements was most useful in early training, far more so- than clay modelling and drawing. Exercises in hand andfinger movements cultivated facility for mental action and- the appreciation of numbers. Writing should follow as anatural sequel. Eye movements needed training to bringthem under such control as was necessary in acts of attention.The cultivation of the muscular sense in estimating the

weights, sizes, and shapes of objects, and in comparing andcontrasting objects was a point of the highest practicalimportance. Speech and articulation should be taught by.close imitation of the teacher’s method of producing elemen-tary sounds, and breathing exercises should be practised asan aid to voice-production. The recognition and naming ofcolours and the reading of time by the clock would often belearnt by practice. Myopia or deafness should be corrected.Obstructions in the nose and throat might be a cause of

stupidity.In the discussion which followed the above paper,Dr. G. E. SHUTTLEWORTH (Richmond) said that in

,drawing conclusions too much stress should not be laid onany single sign. Regard should be had to physiognomy,developmental features, nerve signs, defects of bodily- nutrition, and the manner of response to questions or orders.Idiocy, imbecility, and weak-mindedness were three grades,of mental defect which shaded into each other. If markedmental incapacity and faulty habits existed so that the childwas regarded as more properly requiring medical care andnursing supervision it was better to certify such a case asimbecile, which would exempt the child from school and

help to gain his admission to an asylum for imbeciles, where,in addition to medical care, training suitable to the casewould be applied. Defective children of the" Mongol" " typewere found by experience to be imbecile and incapable ofbenefiting by instruction, especially as in many such casesmarked incapacity for instruction was present though theyhad imitative tendencies in some degree. Children withinherited syphilis proved unsatisfactory pupils as a rule, andmost unsatisfactory of all were children of the morallydefective type. Imitation of the teacher was useful, but- the teacher should not be fatigued and worn out or he wouldbe a bad model.

Dr. F. M. POPE (Leicester) believed that conversation withthe child for a few minutes would afford a more correct- estimated of its capacities than the examination of its

physical "stigmata" or defects.Dr. FLETCHER BEACH (London) was of opinion that the

arrangements made in London, Leicester, and other townsfor the education of feeble-minded children should be.extended throughout the country. As regarded moralimbeciles, they were very difficult to deal with. They wereunsuitable for schools and should be placed in specialinstitutions, as recommended by Morel of Belgium. If per-mitted to be at large they propagated illegitimately andproduced a vicious criminal and neurotic offspring.

Dr. HENRY ASHBY (Manchester) thought that only the’oetter class of defective children should be sent to specialschools, as children on the borderland of imbecility weretunsuited.

Dr. LLOYD ANDRIEZEN (London) emphasised the im-

L portaiice of developing the kinmsthetic activities (manual5 and industrial training), and the excellent results obtainedl at Elmira and other places in the treatment of young

adult criminals and defectives between the ages of16 years and 30 years by perseverance in this. He

: cited instances of ."tics and faulty habits being acquired; by children imitating their mothers, &c., and was of opinion! that special institutions for moral imbeciles and lower grade, degenerates were necessary if they were to treat satisfactorily

such cases, which were unsuitable in school and dangerousto the community at large if allowed to go about to breed

offspring of an insane or mentally or depraved kind.Dr. EDWIN B. ANGELL (Rochester, New York) referred to

the significance of the- anatomical stigmata of degeneracyand to their importance when several were present in anychild. At Bicetre, Paris, he had seen remarkable resultsfor good in the long-continued and persevering teaching andtraining of imbeciles which Dr. Bourneville adopted.

Dr. T. CLAYE SHAW (London) read a paper onColitis or AsyZ2cm Dysentery.

He contended that only a certain small proportion of cases ofcolitis were primarily of bacterial origin and that ulcerationof the mucous membrane of the intestine was commonlymet with in the insane and was a trophic degenerationdependent upon the low nervous vitality of the patient,and that such ulcerations might be comparable to bedsores. The disease known as asylum dysentery seldomaffected the medical or nursing staff of asylums. The con-tinued occurrence of colitis in asylums did not imply thatsanitation was bad in the wards and buildings where itoccurred and cast no discredit on the medical or administra-tive staff.

In the discussion which followed,The PRESIDENT (Dr. J. B. SPENCE, Lichfield) asked how

the prevalence of colitis in asylums that had only been

recently constructed could be explained.Dr. LLOYD ANDRIEZEN agreed that two factors were

possible in the production of ulcerations of the bowelsgenerally in insane patients-namely, infection and trophicdegeneration. Colitis, however, was a special form charac-terised by the presence of blood, mucus, more or lessextensive sloughings of the mucous coats of the large bowel,and intense tenesmus.

Dr. EDWIN GOODALL (Carmarthen) believed that whilesome cases of asylum diarrhoea were not due to dysentery,others were of a specific dysenteric character. He believedthat overcrowding was by no means proved to be the cause.

Dr. HARRY CAMPBELL (London) asked whether theeliminations of toxins from the blood into the alimentarycanal might not be a cause of ulceration of the mucousmembrane of the bowel and whether right-sided colotomywould be advisable.

Dr. J. G. HAVELOCK (Montrose) had seen outbreaks ofdiarrhoea, but not of colitis, at Montrose Asylum. He

thought that the ulcerations and bowel lesions of dysenterywere the result of nerve degeneration.

Dr. R. H. STEEN (Chichester) contributed a paper on

Modern Plans in Asylums, referring more particularly tosuch matters as the provision for bathing, dining rooms, andas to the dispositions of the wards, whether they should beaggregated or built in detached blocks on the villa system.

Dr. LLOYD ANDRIEZEN contributed a paper on the

Psychology of the Degenerate with remarks on Treatment.The meeting of the section then closed with a vote of

thanks to the President. ____

PATHOLOGY AND BACTERIOLOGY.

FRIDAY, AUGUST 2ND.Mr. ALEXANDER G. R. FOULERTON (London) and Mr.

W. T. HILLIER (St. Albans) communicated a paper onThe Condition oftlw Urine in Tubermtlous Infection.1

Specimens of urine from 25 cases of chronic pulmonaryphthisis in the third stage had been examined, the presenceof bacillus tuberculosis in the sputum being verified in eachcase. Six chemical examinations were made of the dailysecretion in each case. Albumin was absent -in 16, present insmall indefinite quantities in eight, and present as more than

1 Towards the expenses of this research a grant was made by theBritish Medical Association on the recommendation of the ScientificGrants Committee of the Association.