578 REPORT OF THE GROUSE DISEASE ENQUIRY -COMMITTEE.

Rover is an ideal car for a doctor, especially if fitted withartillery wheels, heavy tyres, and a Cape cart hood and afront mica curtain. In fact, I was so impressed with herthat if I had not three others I should be strongly temptedto invest in one. ,

A good many motorists have asked me regardinginsurance. Well, if they drive themselves I thinkthat they could take the risk of damaging their own

machine, but if they injure a human being, even

though it be not their fault, they might be liable, forclaims I strongly recommend covering third-party risks for,say, .E500 for any one accident and without limits as to thenumber. Personally, I am glad to say that I have not hadin my ten years more than one claim made against me andthat was before I was insured, and I manged to square itfor .61. Quite recently I had under me a couple of coster-mongers in the local cottage, hospital who had been knockeddown by a ear on Shooter’s Hill, and I believe the driver wasgrateful when he settled the claim at about .6200. Arecent case at Chislehurst shows how some of the publicwill try to bleed motorists. In the case in question thedriver by his careful steering managed to go between a

costermonger’s barrow and a van without touching either.

Still, the costermonger brought a case in the Bromley countycourt for personal and material damages. Luckily in thisinstance the owner was able to produce evidence that therehad been no collision and that the plaintiff had not been" hurled" " by the car against an iron fence and the judgein giving judgment for the defendant said that it was a

trumped-up case. Still, if the owner had been alone hemight not have been able to rebut the claim, and a

sympathetic jury might have awarded substantial damages,so even this case shows how essential it is to cover third

party risks.However good springs may be they may as a result of

bad roads and sudden jars fracture. Last year I had this

experience and luckily I had a couple of small clamps inmy tool kit and so was able to get home with one

tyre lever above and one below the injured spring ;still, it was but a chance that I was able to applythis temporary "first aid," so I welcome a little

novelty which has just been put on the market. It is the

Triumph spring repairer. It consists of a forged plate anda pair of adjustable clamps by means of which the platecan be attached over any broken spring in a very short

space of time. For our profession, to whom a crackedspring might mean an unpleasant delay, this seems a

most useful addition to the tool kit. And speaking oftool kits reminds me of a most useful arrangement for

carrying tools which was recently described in the A1ltocar.The idea consists in first separating the upholstery from thewoodwork over one of the car’s side doors ; a tool-carryingstrip with loops is then fitted and in each loop a tool can becarried and the upholstery can be replaced so as to form aflap to cover all over. Beneath the row of tools pockets canbe made to carry ° spares," &c. The advantage is that whena tool or " spare " is needed it can be found at once withouteven having to undo a roll.

Seemingly there is now on the market a more than usualnumber of second-hand powerful cars, automobiles of 20 h.-p.and more, and as the price is low many medical men maybe tempted to invest, for as a colleague remarked to merecently, "Look at the price and the extra horse-power."

" Iadmit that many second-hand cars advertised are bargainsand that they are in a very good condition, but I seriouslyquestion if they are bargains for general practitioners whoneed a car for daily use in their work. Will the extra powerbe of service to them ? Rather will not this extra power be acontinual unnecessary additional expense ? A second-handhigh-powered car may be the thing for, say, a commercialtraveller who has to travel long distances and to take withhim half a ton or so of samples, but a medical manneeds but a small bag. A high-powered machine meansa heavy one and likewise a heavy tyre and petrolbill, every patient visited means a stop and a start,and each stop and start means wear of tyres and

machinery, wear which is needless, for it would not occurwith a light car. So though the cost of a new light two-seater may be as much or may be more than the price of areally good open-to-all-inspection second-hand 20 or 30 h.-p.,I am sure the embryo medical motorists will find it muchcheaper to invest in a new light two-seater. Personally,

I was always hankering after a four-cylinder with a roomybody. Well, I have now got one, though few of my friends orpatients know that I have, as I merely use it for holidaytouring. My nearly five-year-old little 6 h.-p. Wolseley stilltakes me on my round and, what is more, in spite of itsnoise and age it carries me round nearly as quickly and forless than one-fourth the cost that my 18-24 h.-p. would.From actual experience I know that the extra power andweight mean an enormous addition to tyre and petrol bills,with, anyway in a town and to a law-abiding citizen, noextra saving of time or even any additional speed. So if I

may advise I should recommend all medical men to beginwith a light two-seater instead of a heavy, though cheap,

second-hand high-powered machine.

REPORT OF THE GROUSE DISEASE

ENQUIRY COMMITTEE.

THE interim report of the Grouse Disease Enquiry Com-mittee has now been published and furnishes most interest.ing reading, not only to the sportsman but also to those wholook upon the more scientific aspect of the work that it hasaccomplished. The Committee, under the chairmanship ofLord Lovat, with Mr. A. S. Leslie as secretary, was appointedby Lord Onslow in 1905, and consisted of a number of

gentlemen acquainted with the management of grouse moorswho not only had knowledge of the natural conditions

affecting the health of grouse but who could put the expertsemployed by the Committee in touch with those in actualcharge of the moors and so arrange for the organisation ofinformation and for the investigation of grouse disease, if

any occurred, upon the spot.Before the appointment of this Committee, with the

exception of the work done by Professor Klein at theinstance of the lield, no ordered inquiry or no inquiry basedon any systematic policy of scientific research has ever beenattempted, though many independent observers have recordedtheir individual observations and opinions upon the subjectof what has been called grouse disease. The report pointsout that according to the earlier investigators certain patho-logical lesions were usually associated with the disease.The present inquiry has not wholly confirmed those resultsand the question still arises whether there may not be twoforms of grouse disease, which, for the sake of convenience,may be spoken of as the chronic and the acute.

1. The chronic form may be described as a wasting andusually fatal illness, in which the parasitic worms-found inall red grouse-are, apparently through the lowering of theresistance by outside agency, given opportunity to work hurt-fully on the bird’s health. The characteristics given are:(1) loss of weight; (2) redness and congestion of the innersurface of the cseca ; and (3) irregular moult and slowfeather replacement, resulting often in bare legs and dingyplumage. In the earlier stages the bird becomes less

vigorous, its habitat is changed from the heather to the

green or lower grounds, and loss of weight continues untilthe bird dies. Post-mortem examination discloses thenematode worm Trichostrongylus pergracilis crowded in thecaeca, and this part of the gut is, as a rule, in a state ofintense redness and congestion. It is pointed out that

though this form of the disease may not be infectious it isoften locally severe when contributory causes have loweredthe power of resistance of birds over a specified area.

2. The acute form of the disease, which was described byProfessor Klein who considered it to be an acute infectious

pneumonia caused by an organism probably belongingto the colon" " group and found chiefly in the lungs.The outward signs of this disease are said to be that thebirds die in full plumage without loss of weight; that thecourse of the disease is rapid and its action locally severe.The post-mortem changes are described by Professor Kleinin his book Grouse Disease " as congestion of one or bothlungs, comparable with the red hepatisation of true pneu-monia ; the liver, spleen, kidneys, and intestines are con-gested and present signs of an acute and rapidly fatal fever.

, Keepers also, almost without exception, testify to a diseasein which birds die rapidly without loss of weight.

I Unfortunately for the purposes of this investigation, butfortunately for sportsmen, no instance of this form of disease

ji

579OCCUPATIONAL MORTALITY..has come under the notice of the Committee during the years1905, 1906, and 1907, notwithstanding the large number ofcorrespondents and keepers who have helped them in theirwork. The bacteriological work was intrusted to Dr. C. G.Seligmann; he had to leave for Ceylon during the pastwinter, but the work has been carried on by Dr. LouisCobbett and Dr. Graham Smith.Good work has been done in the investigation of the chronic

form of the disease and the pathological symptoms of thosebirds that have been found dead or dying on the moors havebeen carefully recorded. It is, of course, impossible to givefinal results in an interim report, while the subject of inquiryis still under investigation. Even if what may at first appearto be final results have been arrived at they could not bepublished before the finished report appears in order to giveample time for verification. But there is reason to believe thatthe committee may have already discovered more than theyat present think themselves justified in placing before thepublic without being satisfied that those results are correct.The bacteriological research has been hampered by no caseof the acute disease having been noticed during the lastthree years. But investigation has shown (1) that ProfessorKlein’s organism belonged to the widely distributed colongroup, and according to the limited cultural and morpho-logical tests then used differed in no way from other

organisms of the colon group found in the grouse ; and (2)members of the colon group, apparently culturally and mor-phologically identical with Professor Klein’s organism, canbe isolated from the heart, blood, lungs, and liver of bothhealthy and emaciated grouse that have been dead for aperiod of from 12 to 24 hours, the actual time varying withsuch factors as temperature and moisture.The examination and the pathology of the birds dying

from the chronic form of the disease has engaged and is stillengaging the careful attention of the committee, as is alsothe manner in which the disease is believed to be spread.This work has been the care of Dr. A. E. Shipley, F.R.S.,and Dr. E. A. Wilson, and in their appendices to the reporta fuller description of the work done will be found thanwould come within the scope of this article. Dr. Wilsondeals at first with the life-history of the grouse and describesthe different variations in the plumage of the bird accordingto its geographical distribution, the moulting of the twosexes at different periods of the year, and the various plantsand seeds eaten by the grouse. Dr. Wilson has had oppor-tunities of examining many hundreds of grouse shot at alltimes of the day and is therefore able to go a long waytowards settling the vexed question as to whether grouse feedall day or only towards evening, his evidence being in favourof the former theory. The whole of Dr. Wilson’s work is notyet published, but anyone who reads the report will see fromhis published tables what a vast amount of ground has beencovered by him

Dr. Shipley’s paper is very interesting and deals with boththe entozoal parasites and the ectoparasites of the grouse.He enumerates and describes the insects, flies, ticks, andmites found on the grouse. He also describes the wormsfound in grouse, both cestodes and nematodes, especiallythe Trichostrongylus pergracilis, the worm to which Dr.Cobbold attributed the mortality in grouse as far back as1873. A great deal of combined work has been done byDr. Shipley and Dr. Wilson and Mr. J. C. Fryer searchingfor the intermediate hosts of the parasites that infest grouse,but unfortunately up to the present no definite results havebeen obtained.A paper is added by Mr. H. Hammond Smith describing the

work carried out on the experimental area in Surrey, wheregrouse have been kept not only in health but where the com-mittee have been able to hatch, and it is hoped will be ableto rear, birds bred under very artificial conditions. With thispaper is published an account of a collection of the gritsfound in gizzards of game birds, made by Mr. HammondSmith, and this is accompanied by a valuable report on theirpetrology by Mr. R. H. Rastall of Christ’s College, Cam-bridge. At present the investigation is not complete but isbeing diligently carried on ; but as the secretary in his reportpoints out funds are urgently needed to bring the work toa successful termination. No help is given from publicfunds and all the money expended has been found by thosewho are specially interested in the subject. But the matteris one of such general importance to the public that thereshould be a generous response to the appeal made for help inthe secretary’s report. ,

OCCUPATIONAL MORTALITY.1

111.

EVEN a cursory reading of those portions of Dr. Tatham’sreport which have already been reviewed in THE LANCETwill suffice to show that a large proportion of the loss of lifesustained by industrial workers is due to a group of condi-tions which, although etiologically dissimilar, have unavoid-ably been grouped together for present purposes under thehead of " pulmonary disease," because of the impractic-ability of discriminating among the various types of suchconditions, and, in particular, of distinguishing tuberculousfrom non-tuberculous affections of the lungs.From the point of view of the public health it is important

that special preventive measures should be applied to thoseoccupations in which these diseases, or either of them, causeexceptional fatality. Reference to the tables in this reportshows that pulmonary tuberculosis and diseases of therespiratory system, taken together, account on the averagefor more than a third part of the total mortality of men inthe main working time of life, and that, as will hereafter

appear, the proportion in some industries is much greaterthan this. That pulmonary diseases as here defined are

largely preventable may be gathered from the fact that themortality occurring therefrom has fallen very substantiallyin recent years. That this is the case may be seen by refer-ence to the successive reports of the Registrar-General duringthe last quarter of a century, and there is little doubt thatthe saving of life thus secured is the direct result of sanitaryimprovement generally and especially of the amendment ofthe conditions of labour which has been brought about byfactory legislation.

In the present report there appears a section in whichaccount is given of an attempt to ascertain the effect of con-tinuous labour under adverse sanitary conditions of variouskinds. In the first place, the injurious effects are set forthof inhaling an atmosphere laden with irritating particles ofdust or otherwise seriously contaminated, "pulmonarydisease " having been chosen as the criterion of the relativedegrees of unhealthiness suffered by the workers in thoseindustries that are specially prejudicial to health. Before

entering into details on this subject Dr. Tatham invitesattention to some of the difficulties that apparently areinseparable from investigations of this kind. Prominent

among these is the difficulty of apportioning to each causeits true share in producing the aggregate of ill health andloss of life in a given industry.As regards the stated causes of death, certain inaccuracies

are known to exist in the registers which impair the value ofoccupational statistics. It must be remembered, in the firstplace, that medical certificates are available respecting onlya portion of the recorded deaths, about 6 per cent. of thembeing registered on the authority of coroners and an addi-tional 2 per cent. being uncertified ; secondly, that in thecompilation of vital statistics only one cause can be tabulatedrespecting each death ; and thirdly, that even in cases

where a medical certificate has been obtained the languagetherein employed does not always determine the etiology ofthe condition causing death. As regards the inquiry in

hand, it is obviously necessary to know how much of theloss of life referred to diseases of the lungs depends ontuberculous infection, and yet on this important point theinformation derivable from the death certificates is in greatpart defective. Whilst duly appreciative of the great im-provement that has recently taken place in the certificationof causes of death, Dr. Tatham is still confronted with thedifficulty of classifying deaths which are referred to such con-ditions as abscess of the lungs," " congestion of the lungs,"

"

"pleurisy," " haemoptysis," or to other indefinitely describedlung diseases. From inquiries addressed to medical practi-tioners he learns that a considerable number of the deaths soreturned are tuberculous in origin, although the originalmedical certificates had contained no intimation of the fact.The appendix to this report contains a table in which thechief industries are arranged in graduated lists with refer-ence to their mortality from pulmonary disease " and also

1 Letter to the Registrar-General on the Mortality in Certain Occupa-tions in the Three Years 1900,1901, 1902. By John Tatham, M.A., M.D.Fellow of the Royal College of Physicians. Darling and Sons. 1908.

2 Previous notices of this report appeared in THE LANCET of

August 8th, p. 408, and 15th, p. 497.