998 REPORT OF CHIEF INSPECTOR OF FACTORIES AND WORKSHOPS FOR 1900.

-of King’s College, and the Rev. A. Robertson, the presentPrincipal, were also present, and among the old students of.more recent years were Sir John Alexander Cockburn,K.C.M.G., and Captain C. Vipan, D.S.O., gentlemen whohave abandoned the practice of medicine and gained distinc-tion in other fields, the former as a statesman in Australia-and the latter as a combatant officer with the 3rd Buffsin South Africa. The members of the present staff of the’.hospital were nearly all present, while one or two of the.old students had become qualified during the present year..{n his speech the chairman alluded to the great past ofKing’s College Hospital, as proved by the fact that each of.,the following old students, Mr. Christopher Heath, Mr. G.Lawson, Mr. N. C. Macnamara, Mr. W. Rose, and Mr. A. B.Barrow, is now senior surgeon to a London hospital, and as.evidence that the eminence of the present staff is equal to,that of their predecessors he mentioned the distinction ofC.B. which has just been conferred on Mr. Watson Cheyne.and Mr. G Lenthall Cheatle for their work in South Africa,and that Dr. G. F. Still has been appointed GulstonianLecturer at the Royal College of Physicians of London.Middlesex Hoqpital.-On Oct. 1st, at the Trocadéro

Restaurant, Piccadilly, a large and enthusiastic gathering- of the past and present students of this institution washeld. Of about 200 guests who accepted the invitation ofthe school council 174 were actually present. The chair,vas taken by Mr. J. Bland-Sutton who was supported byLord Howard de Walden, who had distributed the prizes in’the afternoon, and also by Alderman Sir William Treloar.. After the loyal toasts had been honoured the toast of "The.Services" was responded to by Lord Howard de Walden,-who had taken an active part in the South African cam-paign, including the relief of Kimberley and subsequentoperations. His Lordship spoke in high praise of the magnifi--cent pluck and stoical endurance of the British soldier and the- ever-ready skill and resourcefulness of the medical depart-ment. In speaking of the Middlesex Hospital and MedicalSchool the chairman alluded with warm approval to the,energy and grasp of modern requirements evinced by theWeekly Board and School Council in the equipment, main-- tenance, and extension of the hospital and school. This was

.emphasised in detail by the replies of Mr. G. B. Hudson,M.P., and the Dean. The former dwelt in his speech uponhe recent opening of the new wing for the treatment andinvestigation of cancer and the enlargement of the wards in’the north-east portion of the hospital. The Dean, thoughdeploring the falling-off in the number of students which.affected most, if not all, the London medical schools, con-gratulated those present on the quality of the men nowturned out, alluding to the greater number attaining thehigher degrees and recording the attainment of gold medalsin medicine and anatomy in London University in the past

.-year. The toast of "The Past and Present Students" was

.responded to by Mr. John Ackery, President of the Odonto-logical Society of Great Britain, and by Mr. T. W. Scott,the senior Broderip Scholar of the year. The toast of"The Visitors" was proposed by Dr. William Duncan andresponded to by Mr. Wilhelm Ganz who, with the assistance

>of Sencr Guetary and Herr Kolni-Balozky, rendered an

.exquisite musical programme which added greatly to thesuccess of the evening. The proceedings closed with the-proposal of the Chairman’s health by Dr. Sidney Coupland’who alluded to his successive attainments in anatomy,.morphology, and pathology.

St. Mary’s Hospital Annual -Dinner.-The St. Mary’s- Hospital annual dinner took place on Oct. 3rd in theWhitehall Rooms of the Hotel Metropole. The guests of the- evening were those members of the hospital, some 24 in- number, who have recently returned from service in the SouthAfrican war, and nearly 200 of the past and present studentswere there to do them honour. The chair was taken by Brigade-Surgeon-Lieutenant-Colonel A. B. R. Myers, who ’was supported by Sir William Broadbent, Mr. Edmund Owen, Mr. Herbert Page, Dr. D. B. Lees, Mr. G. A.- Critchett, Mr. G. P. Field, Mr. H. E. Juler, Dr. M.Handfield-Jones, Mr. J. Ernest Lane, Mr. H. G. Plimmer, :and Dr. H. A. Caley. The toasts of "The King" and then.of "Queen Alexandra, the Duke and Duchess of York,and the rest of the Royal Family" were proposed bythe Chairman in a few well-chosen words and were duly fhonoured. Mr. Page, who met with a great welcome,-then proposed the toast of "The Imperial Forces." Heremarked that this was the first occasion on which he had --given the greater toast of "The Imperial Forces " ; hitherto

it had always been ’’ The Navy, Army, and AuxiliaryForces." This signalised a new phase in the expansion ofour empire, the union of men of every country under oneKing. He referred with approbation to the new scheme forthe reform of the Royal Army Medical Corps and declaredthat the medical schools must do their part : there must beno more boycotting of the service. St. Mary’s, he said, hadsent of her best to South Africa, and it was a great pleasureto him to propose the toast.—Fleet-Surgeon T. J. Preston

responded for the Navy, Lieutenant-Colonel G. M. Giles,1. M.S., for the Army, and Mr. H. Stansneld Collier, V.M.S.C.,for the Auxiliary Forces.-The Chairman then proposedthe toast of ’’ Prosperity to St. Mary’s Hospital MedicalSchool. " He alluded to the honoured names of formermembers of the hospital staff and paid a gracefultribute to the exertions of Sir William Broadbent and Mr.Field on behalf of the school. He complimented the presentstaff on their success as teachers, and the students of to-dayboth on their achievement in the examination hall and ontheir prowess in the athletic field.--The Dean (Dr. Caley)responded for the school, and alluding to the effort on footto complete the Clarence wing said that the board of

management looked forward with every confidence to an

early consummation of their endeavours. He also spoke inhopeful terms of the negotiations now in progress to providea sports ground for the students.-Mr. Owen, in a character-istic speech, gave the health of those who had served inSouth Africa and paid an eloquent tribute to those who hadfallen.-Thanks were returned by Mr. Wallace Ashdowne,surgeon to the Imperial Yeomanry Base Hospital; Alr.V. Warren Low, civil surgeon ; and Mr. E. L. Jenkins, one

of the dressers of the Welsh Hospital. A most successful

evening was brought to a close by the toast of the health ofthe Chairman which was given by Sir William Broadbentand drunk with great enthusiasm.

(To be continued.)

THE ANNUAL REPORT OF THE CHIEFINSPECTOR OF FACTORIES AND

WORKSHOPS FOR THEYEAR 1900.

SECOND NOTICE.1

ATTENTION has been directed to a curious practice whichhas sprung up amongst the manufacturers of textile fabrics bywhich they habitually defrauded their workpeople by payingthem for a smaller quantity of work than that which theyactually performed. In this case we were glad to be ableto record the fact that by means of a statutory provisionspecially passed for the purpose this nefarious custom hasbeen practically abolished. At the present time, however,it appears that the workn:en in many cotton-mills suffer

greatly from the dishonesty of their employers, who exactfrom them an amount of work considerably in excess ofthat for which they are actually engaged. Two inspectors,Mr. Crabtree of Oldham and Mr. Dodgson of Bury, call atten-tion to this matter. The practice is an old one in the cottontrade, for Mr. Crabtree himself when a boy 30 years ago wassubjected to the treatment. He points out, however, that thecustom has become more general and that at the present time" nearly every cotton-mill cribs time." " Time-cribbing" is awell-known expression in the districts of Oldham and ofRochdale. The method adopted by the manufacturers isthus described : "In these defaulting factories the manu-facturing process too often begins at 5.30 to 5.55 A.M., con-tinues to 8.5 A.M., is resumed at 8.25 A.M., and stops at 12.35to 12.37 P.M. ; it begins again at 1.25 P.M.. and continues to5.35 P.M. There is thus over 30 minutes deliberate illegalovertime put in on each of five days in the week, and about15 minutes on Saturday, or about 160 minutes per week.That is to say, the day hands in these factories have to worktwo and a half hours per week more than should bedemanded of them, and for this illegal demand they do noteven receive the recognition of payment." Mr. Dodgsonsays that the evil is almost entirely confined to the cottonfactories and that in the Rochdale district the manufacturersof cotton fabrics are greater offenders than the spinners ofyarns. In commenting on these reports Mr. H. S. Richmond,

1 The first notice appeared in THE LANCET of Sept. 28th, 1901, p. 868.

999

His Majesty’s superintending inspector of factories for (

the North-Western Division of England, suggests that the (duties of inspectors would be simplified and the practice of I

time-stealing reduced if a fixed and substantial penalty could <

be exacted should the main engines be set to work before, or allowed to run after, the legal hours. In favour of this

proposal he points out that "the engine-house is usually Imore accessible than the factory itself and the fact of its running more easy of proof than illegal wcrk by findividual hands." The matter appears to deserve the attention of the Chief Inspector. The present state of i

things seems to be most iniquitous. It is difficult at first 1

sight to see why it cannot be remedied, but Mr. Dodgson’s 1

report contains this cryptic sentence It [the evil] js difficult ]to detect because the whole community where it prevails is .

favourable to it." It is not easy to understand how thosemembers of the community whose time is stolen (or 1’’cribbed") without the ’recognition of payment" canreally be in favour of such a practice. The report of the medical inspector (Dr. T. M. Legge)

contains a table showing the number of cases of poisoningfrom lead which were notified. In this table the statisticsfor the last three years are given. The number of cases of

lead-poisoning reported in the year 1898 amounted to 1278,in 1899 to 1258, and in 1900 to 1058. These figures, themedical inspector points out, are strictly comparable. Secondnotifications of persons already included in the return withinthe preceding 12 months are not regarded as freshcases. In the year 1900 53 second notifications were

made in the case of people who had been previouslyreported. In the year 1899 there were 52 such instances.The object of notification of "industrial lead-poisoning" " isthe subject of a memorandum by Dr. Whitelegge (Appendix17, p. 119). This memorandum was issued in March, 1900,and is supplementary to one issued in December, 1898. Itdeals with the manner in which cases occurring in house

painters and plumbers should be treated by the Home Officeinspectors for statistical purposes and with the way in whichrecurring attacks of lead-poisoning should be notified. The

object of notification is to obtain a clue to those conditionswhich are not only prejudicial to health but which are also con-ditions over which the factory inspectors can exercise control.Under the present law only those cases which occur from theeffects of labour carried cut in a factory or workshop are ofinterest to the inspectors, for the Home Office hasno power beyond these limits. Lead-poisoning contractedin the course of any business which is not under thecontrol of the Factory Acts obviously cannot, therefore,be dealt with under those Acts. Dr Whitelegge justlypoints out that in the present circumstances it wouldbe practically useless for such cases to be reported as anyreports of the kind being non-statutory would be incompleteand would therefore have but little statistical value. Theconditions under which the notification of lead-poisoningshould be made are briefly that in the opinion of themedical practitioner (1) the patient is suffering from thedisease and (2) that it was contracted in a workshop. In

regard to the first of these points it may be well tomention that patients have been reported as suffering fromlead-poisoning when the only sign pointing to the clis-order has been the presence of a blue line on the

gums. The question as to whether lead-poisoning wasor was not contracted in a factory or workshop has

frequently given rise to difficulty and to the expendi-ture of much time. The best example of such a case isthat of a house painter. In the case of any ordinary journey-man the difficulty of course does not arise, for he is outsidethe protection of the Home Office. But if a house paintershould spend part of his time in a factory or workshop, and isoccupied in such work as the grinding of lead or of pigments,or in mixing lead paints, he immediately comes under thecare of the Home Office and " the question may legitimatelyarise whether his case does not become reportable, seeing thatthe risk, though in minor degree, is incurred in the workshopas well as in the out-door work." In such cases an enormousamount of work which is .often fruitless is not infrequentlythrown upon the inspectors. It has happened that afterlaborious inquiry, not only by the inspectors but also by thecertifying surgeons, no ground has been discovered forassuming that the poisoning was effected at the factory.Several of the inspectors in their reports write feelingly ofthe loss of time which has been caused by investigations ofthe kind described. Here, for example, are instances.’’ Much valuable time was wasted in making inquiries into

cases of lead-poisoning occurring among house painters." (Mr. Johnson, West London, p. 156.) ’’ General work hasbeen much hindered by the necessity of investigatingcases of lead-poisoning, or alleged lead-poisoning." (Mr.Blenkinsopp, West London, p. 155.)During the year 1900 not less than 199 cases of lead-

poisoning amongst house painters and plumbers were

reported-these were of course excluded from the total

given by the medical inspector which contains only casesreported under Section 29 of the Act of 1895. It may be ofinterest to give the numbers of those affected in the case ofthe principal trades : china and earthenware, 200 (49 lessthan in the previous year); litho-transfer works, 10; glass-polishing, 7 ; smelting, 34; turning and enamelling, 16 ;file-cutting, 40 ; white lead, 358 (41 less than in the previousyear) ; paints and colours, 56 ; coachmaking, 70 ; ship- .building, 32 ; electric accumulation works, 33 ; otherindustries, 202. An excellent analysis of the reportson lead-poisoning by the certifying surgeons is givenby the medical inspector (p. 435). In this tableinformation is given as to the exact occupationsin which the poisoning was contracted, and the cases

are, as far as possible, classified as "severe," "moderate,"and "slight." There is also a tabular statement ofthe chief symptoms present, from which it appearsthat in the case of men 83’2 per cent. had gastric symptoms,12’9 per cent. suffered from ansemia, 4’7 per cent. from head-ache, 12 per cent. from paresis, 3’1 per cent. from cerebralsymptoms, and 5’9 per cent. from "rheumatic" symptoms.It seems curious that gout does not occur in the list. Thewomen suffered less from gastric symptoms, to about thesame extent from anaemia, to a much greater extent fromheadache, very much less from paresis, and more fromcerebral symptoms and from rheumatic pains. The medical

inspector is of opinion that the slower form of lead-poisoningbrought about by the absorption of metallic lead and of thelead salts in the form of paint produces a more serious cond’i-tion that that which is caused by the inhalation of dust orof fumes. Severe cases amongst file-cutters and coach- andship-painters are common. The importance of both the agedistribution and of the amount of time relatively spent bythe different classes of workmen in the respective tradesdeserves consideration in this connexion. The followingtable is quoted as the most ready method of making thesematters clear :&mdash;

A study of the table considered in the light of a knowledgeof the processes of the trades in which lead and its salts areused shows the preventive measures which should be

adopted. The immediate removal of the dust is theessential preventive measure in china and earthenwarefactories, in places at which processes connected withwhite and red lead are carried on, in paint and colourfactories, in all work-rooms in which operations of litho-transfer are conducted, and wherever iron plates are

enamelled. The medical inspector is of opinion that 90 percent, of the cases of poisoning which occur in these tradesare due to neglect in the immediate removal of the dust,some of which therefore is inhaled by the workers. In tradesin which metallic lead paints are used the essential pointis that the workmen should wash. In such trades Dr.

Legge believes that 90 per cent. of the cases of

poisoning are due to the absence of this simple precaution.In this matter the workmen are often to blame. In somecases, however, the employers have been distinctly at fault.A rather interesting case to the point is reported by theinspector for the North-western division of England (p. 304),but unfortunately it was not fought out to the end. A brassfinisher brought an action in the Manchester County Courtbefore His Honour Judge Parry to recover damages from hisformer employers because he had become poisoned by lead

1000 ] ELECTION OF DIRECT REPRESENTATIVES: CANDIDATURE OF DR. GLOVER.

in the course of his work. He had in the ordinary course ofhis occupation to use white lead for the purpose of puttingfittings together. After the fittings were put together hehad to suck them with his mouth to see if they were air-tight or not. A pump ought properly to have been used forthis purpose but the one instrument provided was suit-able for large work only. Under the Factory Acts theemployers are required to provide suitable washing appliancesfor the use of the workpeople. The plaintiff in cross exami-nation admitted that a bucket was provided in which they.could wash and that they could have soap if they asked for itand there were some " fents " in the room to serve as towels.The judge remarked that the Act required suitable lavatoryaccommodation. " Suitable washing conveniences should besupplied," he said, "but there were nothing but incon-veniences apparently." The case ended by the payment tothe plaintiff of ;&45 and costs.The medical inspector has done much to bring the

importance of washing prominently to the notice of lead-workers. A leaflet on "Lead-poisoning : How Caused andHow Best Prevented," has been written, and no less than10,000 copies have been distributed to those chiefly interestedin the matter. The leaflet contains a great deal of excellentadvice clearly given. One paragraph might, perhaps, withadvantage have been put differently or omitted. It bearson the importance of not inhaling or swallowing lead andis preceded by an excellent sentence: "Carefulness whileat work and cleanliness offer the best means of escapingattacks of lead-poisoning." The writer of the pamphletthen proceeds to say, "Those who work in lead should keepin mind every hour of every working day the importance ofnot breathing lead-dust and not carrying lead to the mouthin any way." Such a constant thought would hardly lead toa happy mental state.

The number of printers who suffered from plumbism duringthe year 1900 was 17, eight less than the number affectedduring the preceding year. Of those affected 10 were com-

positors, four were linotypists, two were stereotypers, one wasa tyre rubber, and a case also occurred in a man employedin sweeping up the filings which dropped from a linotypemachine. The medical inspector deprecates the pernicious’habit which many compositors have of holding the typebetween their teeth." It is certainly a dangerous habit and’we may hope that it is not a common one amongst a mostcnteHigent class of men.

The incidence of cases of poisoning amongst workers in’white lead shows only a slight decrease, and periodical’medical examination is said to be ineffective as a means of’producing improvement partly because of (1) the low.-stratum of society from which the workers are drawn, and’partly because (2) the threat of suspension is not so deterrentas in other branches of industry in which lead is employed.White lead workers are often a casual shifting race, whereas’the skilled work employed in the Potteries is a well-paidprofession not lightly to be given up.A considerable improvement has been recently brought

.about in the earthenware and china industries. The numberof cases of lead-poisoning reported in the year 1899 was249, in the year 1900 it was 200. The statistics for the latter

year show that the total number of people employed inthe process of dipping amounted to 2265, and the numberof those engaged in other branches of the work to’6372. Of the dippers 123, a proportion of 5’4 per cent., wereaffected by lead-poisoning. Of the other workers 200 wereaffected, a proportion of 3’1 per cent. These figures comparefavourably with those of the previous year to the extentof 0’1 per cent. and 0’8 per cent. respectively. The principalimprovement has taken place amongst the more skilledworkers-the majolica-painters, the colour-dusters, and theglost-placers. The change for the better is seen throughoutthe whole of the districts engaged in the manufacture. A Jseparate return is given showing for the Potteries district the number of persons employed in the different works and the number of cases of lead-poisoning reported to have occurred amongst them. In this list it is seen that in the -case of majolica-painters the incidence of plumbism has been ’’

reduced from 4-7 per cent. in the year 1899 to 0-9 per cent. t

- in 1900. The number of the-e skilled artizans is, however, small ; it amounts only to 425, all of whom are womeii.The total number of people employed in this district in the a’various branches of the trade is 4857, and of these 165 tsuffered from plumbism, a proportion of 3’4 per cent., an 1

;improvement of 1 per cent. on the returns of the previousyear.

Mr. J. F. Arlidge has made a series of inquiries to deter-mine the effects of lead on pregnancies. He found that 239women before they were engaged in working in lead borp453 children, of whom 183 died. The total number of

pregnancies was 487 and the number of miscarriages was 34.At the time during which they worked and aiter they hadceased to work in lead these women bore 499 children, ofwhom 182 died ; the total number of pregnancies was 566 andthe number of miscarriages was 67.

It is. pleasant to be able to record the fact that a

leadless glaze is coming into general use for the enamellingof iron hollow-war e, and that the number of glass-cutters whosuffered from plumbism during the year 1900 was markedlyless than that of those who suffered from it during the previousyear (the exact numbers are seven and 19 respectively).On the other hand, the number of cases occurring amongstthe manufacturers of electric accumulators is one in excess

of that reported in the year 1899. Amongst those who workin the preparation of paints and colours the incidence of

lead-poisoning is still severe. 30 factories are used for thework and over 82 per cent. of the cases occurred in thoseengaged in grinding and mixing pigments. Coach-buildersalso still suffer greatly from plumbism. 34 cases occurredamongst railway employes, and of these 19 occurred amongstthe men of a large company on whose premises the facilitiesfor washing were bad." In making this statement it isreasonable to assume that the medical inspector desired toconvey the idea that facilities for washing were absent orinsufficient. In calico works it is stated that aniline dyesare taking the place of chromate of lead. A list of the fatal,cases of lead-poisoning is given, but the enumeration of thesymptoms from which the patients suffered is not suffi-ciently complete to make it of any clinical value.

ELECTION OF DIRECT REPRESENTA-TIVES: CANDIDATURE OF

DR. GLOVER.

A MEETING in support of the candidature of Dr. J. G. Gloverwas held on Oct. 4th at 1, Highbury-place, London, N. The

chair was taken by Dr. G. Danford Thomas, who in his

opening remarks urged the claims of Dr. Glover for re-

election to the General Medical Council.Dr. GLOVER said:-The importance of this meeting

will turn rather upon what my constituents say than onwhat I say. But I must do my part in asking you to renewyour support at another election. The General MedicalCouncil is one of the best abused bodies in the profes-sion. And it is all the better for a little criticism. Ifthe critics are censorious and unreasonable it is theywho suffer rather than the General Medical Council. Asto my own claim to represent you, if you are not convincedof it by this time hardly anything I can say will con-

vince you. But I trust that after hearing me youwill see your way to that expression of confidence whichhas always served me in the past. It is in the very natureof the case that I must speak somewhat egotistically. Ihave to justify my existence. You will forgive any appear-ance of vanity. Firt, I should not be worthy to be a DirectRepresentative if I did not try to make medical educationbetter. I believe that in its soundness and efficiency thegreat strength of the profession lies. Within a year or twoof my election I tried to show the Council that there were

gaps in medical education and that there were great groupsof diseases not much seen by the student and in which hewas not examined : that hospital practice was not generalpractice. In this I was fully supported by my then

colleagues the Direct Representatives. The Council, andespecially its leading members, gave us a fair hearing. Wesucceeded in getting the Government to throw the Metro-politan Asylums Board open to medical students. We secured,what I fear has been little acted on, the recognition of pupilageto a medical practitioner. Sir James Paget wrote to me on myviews and said, I see what you will do : you will add anotheryear to medical education." That year, of course, has beenadded and the Direct Representatives have a full share ofthe responsibility and, as I think, the credit of the change.I said to a medical student a few months ago, " You are at thestage of your education described as walking the hospital."He replied, I I I am walking five hospitals," and he made