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THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE ADMINISTRATIVE COUNTY OF LONDON

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47 THE HEALTH OF THE ADMINISIRMTVE COUNTY OF LONDON. Pharmacology and Therapeutics. ESSENTIAL OILS. THE relation of essential oils to the British Pharmacopoeia ! 1 and to trade purposes has lately been considered by Mr. ( J. C. Umney in the Pharmaceutical Journal. He thinks the ( use of the following so limited that they might be excluded from a new Pharmacopoeia : chamomile, copaiba, rue, savin, ( and perhaps spearmint ; but he recommends the inclusion of J the following oils : bergamot, bitter orange, rose, and pos- sibly synthetic winter-green oil (methyl- salicylate). He objects to the present restriction "distilled in Britain," I thinking that it is only in exceptional cases that climate and soil influence for the better the character of the oil obtained from plants of the same species, and he maintains that it would be better for the I pharmacopoeial description, characters, and tests to include the source and the range of specific gravity at convenient temperatures. He also desires to see the following included: optical rotation, solubility in alcohol or other solvents, boiling point, and qualitative and quantitative chemical tests. The chief difficulty in the way of including the various essential oils in the Pharmacopoeia lies in the fact that they are only to a relatively small extent employed in medicine, while enormous quantities are used for soap scenting, culinary and other industrial purposes by others than pharmacists. This has necessarily led to the importation of quantities of cheap and more or less impure oils. If these are required for trade purposes only, and not for employment by medical men, it is difficult to realise the need for their inclusion in the Pharmacopoeia. Mr. Umney’s paper contains a very careful summary of the characters of the principal essential oils handled by pharmacists, and it therefore calls for, and will doubtless receive, full consideration from those engaged upon the work of revision. ARGENTAMIN AND ARGONIN. As substitutes for ordinary aqueous solutions of nitrate of silver two organic compounds have been recently introduced which are said to have a still greater microbicidal action and to be less irritating than the nitrate. Argentamin consists of a solution of ten parts of phosphate of silver with an equal quantity of ethylene- diamine, C2’H4(NH2)2’ in a hundred parts water. This does not throw down chloride of silver when mixed with a solution of common salt, nor does it precipitate albumen. Clinically it is said by Dr. Scbiiffer of Breslau to act more energetically than a common nitrate of silver solution of the same strength, both destroying microbes of a pathogenic character better and also penetrating more deeply into the tissues. He found it especially valuable in the form of injections for gonorrhoea, and Lang has used it with good results in a large number of cases of abscesses of glands and of. the connective tissue. Sometimes its irritant action is too great, but inconvenience from this may be avoided with due care. Another organic combination of silver has just been prepared by Dr. Rohmann and Dr. Liebrecht with casein. This new preparation, which they style argonin, contains only one quarter the amount of silver that the nitrate does. It is soluble in water, the solution being, however, opalescent and of a yellowish colour. It is said to be far less irritating to the tissues than argentamin. Like it, too, it forms no precipitate when common salt is added in solution, and according to Dr. R. Meyer of Breslau it has a remarkable microbicidal action, especially on the gonococcus. GALLICINE IN OPHTHALMIC PRACTICE. Gallicine, which is the methylic ether of gallic acid, is a white crystalline substance, soluble in hot water, in warm spirit, and in ether. Chemically it presents certain analogies with resorcin and with pyrogallol, and as these substances are of use in catarrhal and some cutaneous affections, it occurred to Dr. Mellinger, assistant to the Basle Professor of Ophthalmology, Dr. Schiess, to try the effect of gallicine in catarrhal conditions of the conjunctiva and in eczema of the eyelids and some other affections of the eye. The powdered substance, which is very light, is dusted into the eye or applied to the cutaneous surface by means of a brush, according to circumstances, in the same manner as calomel is employed. The application, which is made once or twice a day, is usually followed by a smarting sensation, which, however, soon passes off, but can )e relieved by cold water compresses or entirely prevented )y the previous use of cocaine. From an experience of some- !00 cases Dr. Mellinger warmly recommends this remedy as iuperior in a good many eye affections to dermatol and ;allinol. Conjunctivitis, whether catarrhal, suppurative, or jhlyctenular, yielded to the gallicine treatment in a few lays, and superficial keratitis, which had resisted the appli ation of nitrate of silver, acetate of lead, compresses saturated with lead lotion, white precipitate ointment, ltropin drops, &c., rapidly improved under gallicine. In phlyctenular affections gallicine has the advantage of being. suitable, even when there is hyper-secretion, which, according bo Dr. Mellinger, is a contraindication to the employment of calomel. THE EXTERNAL APPLICATION OF PILOCARPINE IN NEPHRITIS. Dr. Humbert Molliere has made some interesting researches on the value of pilocarpine applied externally in cases of nephritis. The treatment consists in rubbing into the skin an ointment composed of white vaseline (100 gr.) and nitrate of pilocarpine (5 to 10 centigrammes), and then covering up the part with cotton-wool and securing with bandages. The patient generally soon experiences a feeling of comfort,. dyspncea abates, and respiration becomes more regular, and only in very rare cases is the treatment badly borne. Per- spiration quickly occurs, and is very profuse, in spite of the small quantity of alkaloid used, and at the same time there is abundant diuresis, and Dr. Molliere has drawn up interest- ing charts, showing a rise and fall in the quantity of urine corresponding to the pilocarpine applications. All varieties of nephritis have been treated by this method, but the best results have been obtained in acute cases, where the albumen has often quickly disappeared and a general amelioration or symptoms rapidly taken place, these good results being chiefly attributed to diminished congestion caused by the, drug. Less favourable cases are naturally those in which the cardio-vascular system has already become secondarily affected. Where actual uraemia has set in this method is not so satisfactory, but is found to be successful if applied after the more pressing symptoms have been relieved by more energetic methods. The physiological action of pilocarpine. when thus applied is found to be almost entirely local, and does not cause excessive secretion of the salivary and other glands, as it does when given by the hypodermic method. We noticed in this column recently a preparation called sirol, mentioning that it had been used with success as an antiseptic and styptic dressing. We are asked to say that the sole agents for this substance are Messrs. R. W. Greeff and Co., of 3, Eastcheap, E.C., to whom inquiries should be directed. THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE ADMINISTRATIVE COUNTY OF LONDON. IlL1 THE only other topic in Mr. Shirley Murphy’s report- to which space permits allusion is a special report to his authority on the water-supply of London. On the issue of the report of the Royal Commission on Metro- politan Water-supply the County Council referred it to their medical adviser for his opinion ; and this, when received, was held to be of so great public interest as to render expedient the printing of it for general circulation. It accordingly appears as an appendix to the annual report. before us. The general drift of the conclusions arrived at by the Commission as to the wholesomeness of the London drinking water is matter of common information; it is far otherwise, however, with regard to the evidence upon which these conclusions are supposed to have been. based, and this evidence has therefore been subjected to detailed and searching criticism in the appendix referred to. Mr. Shirley Murphy passes in review much of the: 1 Parts I. and II. were published in THE LANCET of June 22nd and 29th respectively.
Transcript
Page 1: THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE ADMINISTRATIVE COUNTY OF LONDON

47THE HEALTH OF THE ADMINISIRMTVE COUNTY OF LONDON.

Pharmacology and Therapeutics.ESSENTIAL OILS.

THE relation of essential oils to the British Pharmacopoeia ! 1and to trade purposes has lately been considered by Mr.

(

J. C. Umney in the Pharmaceutical Journal. He thinks the (

use of the following so limited that they might be excludedfrom a new Pharmacopoeia : chamomile, copaiba, rue, savin,

(

and perhaps spearmint ; but he recommends the inclusion of Jthe following oils : bergamot, bitter orange, rose, and pos-sibly synthetic winter-green oil (methyl- salicylate). He

objects to the present restriction "distilled in Britain," Ithinking that it is only in exceptional cases that climateand soil influence for the better the character ofthe oil obtained from plants of the same species,and he maintains that it would be better for the I

pharmacopoeial description, characters, and tests to includethe source and the range of specific gravity at convenienttemperatures. He also desires to see the following included:optical rotation, solubility in alcohol or other solvents,boiling point, and qualitative and quantitative chemical tests.The chief difficulty in the way of including the variousessential oils in the Pharmacopoeia lies in the fact that theyare only to a relatively small extent employed in medicine,while enormous quantities are used for soap scenting,culinary and other industrial purposes by others than

pharmacists. This has necessarily led to the importation ofquantities of cheap and more or less impure oils. If theseare required for trade purposes only, and not for employmentby medical men, it is difficult to realise the need for theirinclusion in the Pharmacopoeia. Mr. Umney’s paper containsa very careful summary of the characters of the principalessential oils handled by pharmacists, and it therefore callsfor, and will doubtless receive, full consideration from thoseengaged upon the work of revision.

ARGENTAMIN AND ARGONIN.

As substitutes for ordinary aqueous solutions of nitrate ofsilver two organic compounds have been recently introducedwhich are said to have a still greater microbicidal action andto be less irritating than the nitrate. Argentamin consists ofa solution of ten parts of phosphate of silver with an equalquantity of ethylene- diamine, C2’H4(NH2)2’ in a hundred

parts water. This does not throw down chloride of silverwhen mixed with a solution of common salt, nor doesit precipitate albumen. Clinically it is said by Dr.Scbiiffer of Breslau to act more energetically than a

common nitrate of silver solution of the same strength, bothdestroying microbes of a pathogenic character better and alsopenetrating more deeply into the tissues. He found itespecially valuable in the form of injections for gonorrhoea,and Lang has used it with good results in a large number ofcases of abscesses of glands and of. the connective tissue.Sometimes its irritant action is too great, but inconveniencefrom this may be avoided with due care. Another organiccombination of silver has just been prepared by Dr. Rohmannand Dr. Liebrecht with casein. This new preparation, whichthey style argonin, contains only one quarter the amount ofsilver that the nitrate does. It is soluble in water, the solutionbeing, however, opalescent and of a yellowish colour. It issaid to be far less irritating to the tissues than argentamin.Like it, too, it forms no precipitate when common salt isadded in solution, and according to Dr. R. Meyer of Breslau ithas a remarkable microbicidal action, especially on thegonococcus.

GALLICINE IN OPHTHALMIC PRACTICE.

Gallicine, which is the methylic ether of gallic acid, is awhite crystalline substance, soluble in hot water, in warmspirit, and in ether. Chemically it presents certain analogieswith resorcin and with pyrogallol, and as these substancesare of use in catarrhal and some cutaneous affections, itoccurred to Dr. Mellinger, assistant to the Basle Professor ofOphthalmology, Dr. Schiess, to try the effect of gallicinein catarrhal conditions of the conjunctiva and in eczemaof the eyelids and some other affections of the eye.The powdered substance, which is very light, is dustedinto the eye or applied to the cutaneous surface bymeans of a brush, according to circumstances, in thesame manner as calomel is employed. The application,which is made once or twice a day, is usually followed by asmarting sensation, which, however, soon passes off, but can

)e relieved by cold water compresses or entirely prevented)y the previous use of cocaine. From an experience of some-!00 cases Dr. Mellinger warmly recommends this remedy asiuperior in a good many eye affections to dermatol and;allinol. Conjunctivitis, whether catarrhal, suppurative, orjhlyctenular, yielded to the gallicine treatment in a fewlays, and superficial keratitis, which had resisted the appliation of nitrate of silver, acetate of lead, compressessaturated with lead lotion, white precipitate ointment,ltropin drops, &c., rapidly improved under gallicine. Inphlyctenular affections gallicine has the advantage of being.suitable, even when there is hyper-secretion, which, accordingbo Dr. Mellinger, is a contraindication to the employment ofcalomel.

THE EXTERNAL APPLICATION OF PILOCARPINE INNEPHRITIS.

Dr. Humbert Molliere has made some interesting researcheson the value of pilocarpine applied externally in cases ofnephritis. The treatment consists in rubbing into the skinan ointment composed of white vaseline (100 gr.) and nitrateof pilocarpine (5 to 10 centigrammes), and then covering upthe part with cotton-wool and securing with bandages. Thepatient generally soon experiences a feeling of comfort,.dyspncea abates, and respiration becomes more regular, andonly in very rare cases is the treatment badly borne. Per-spiration quickly occurs, and is very profuse, in spite of thesmall quantity of alkaloid used, and at the same time thereis abundant diuresis, and Dr. Molliere has drawn up interest-ing charts, showing a rise and fall in the quantity of urinecorresponding to the pilocarpine applications. All varieties ofnephritis have been treated by this method, but the bestresults have been obtained in acute cases, where the albumenhas often quickly disappeared and a general amelioration orsymptoms rapidly taken place, these good results beingchiefly attributed to diminished congestion caused by the,drug. Less favourable cases are naturally those in whichthe cardio-vascular system has already become secondarilyaffected. Where actual uraemia has set in this method is notso satisfactory, but is found to be successful if applied afterthe more pressing symptoms have been relieved by moreenergetic methods. The physiological action of pilocarpine.when thus applied is found to be almost entirely local, anddoes not cause excessive secretion of the salivary and otherglands, as it does when given by the hypodermic method.We noticed in this column recently a preparation called

sirol, mentioning that it had been used with success as anantiseptic and styptic dressing. We are asked to say that thesole agents for this substance are Messrs. R. W. Greeff andCo., of 3, Eastcheap, E.C., to whom inquiries should bedirected.

THE ANNUAL REPORT OF THE MEDICALOFFICER OF HEALTH FOR THE

ADMINISTRATIVE COUNTYOF LONDON.

IlL1THE only other topic in Mr. Shirley Murphy’s report-

to which space permits allusion is a special report tohis authority on the water-supply of London. On

the issue of the report of the Royal Commission on Metro-politan Water-supply the County Council referred itto their medical adviser for his opinion ; and this, whenreceived, was held to be of so great public interest as torender expedient the printing of it for general circulation.It accordingly appears as an appendix to the annual report.before us. The general drift of the conclusions arrived atby the Commission as to the wholesomeness of the Londondrinking water is matter of common information; it is farotherwise, however, with regard to the evidence uponwhich these conclusions are supposed to have been.

based, and this evidence has therefore been subjected todetailed and searching criticism in the appendix referredto. Mr. Shirley Murphy passes in review much of the:

1 Parts I. and II. were published in THE LANCET of June 22nd and29th respectively.

Page 2: THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE ADMINISTRATIVE COUNTY OF LONDON

48 MEDICAL CERTIFICATES FOR THE LONDON BOARD SCHOOLS.

expert evidence produced, his remarks upon this, andthe judgmelt of the Royal Commission thereupon, being.given by Mr. Shirley Murphy under the following headings:’(1) Dilution of polluting matter in water ; (2) viability ofthe typhoid bacillus ; (3) number of organisms in water

required to produce disease ; (4) storage and filtrationof water ; (5) evidence of experience as to typhoid feverprevalence (especially that dealt with by Dr. Barry in’his report on the typhoid fever epidemic in the Tees

Valley; and (6) definition of the term "emcient filtra-

tion" of drinking-water. Mr. Shirley Murphy’s remarks.and arguments under each of the above headings are clear,forcible, and apposite, and, whether they meet with generalacceptation in our profession or not, they certainly leave usin no doubt of their author’s determination to secure infuture and to maintain the utmost possible purity in thewater-supply of the metropolis. In many important pointsMr. Shirley Murphy traverses toe report of the Royal Com-mission and gives his reasons for so doing, which are in all,cases weighty and evince a thorough acquaintance on his

part with the minutest details of the subject.It is very obvious that the reason why the medical officer

.of the County Council regards the question of water-supplyas of primary importance from a public health point of viewis because of the admitted tendency of certain fatal diseases,especially typhoid fever and cholera, to disseminate them-selves through the agency of drinking water. We stronglysuspect, therefore, that the question of our water-supply isto Mr. Shirley Murphy very much on all fours with the

question of typhoid fever (and possibly cholera) prevalencein the metropolis. In this attitude towards the water

question he may rely upon the hearty support of the medicalprofession. It is probably immaterial to Mr. Shirley Murphywhether the water undertakings of the metropolis continue,.as at present, in the hands of a number of private companies,or whether these rights are acquired on behalf of the

public by the London County Council, as recent events

would seem to render it probable that they will be at.no very distant period from the present. But he would

have our complete sympathy did he contend, as he is

obviously entitled to do, that the officer upon whom devolvesthe chief guardianship of the public health of this vast

metropolis should enjoy every facility for satisfying himself’that those who provide the public with drinking-wateradopt every known device for protecting that com- i

modity from contamination. This is not a matter of meresentiment. It is true that, according to the table publishedin another part of Mr. Shirley Murphy’s report, typhoid fevermortality has shown a continued decrease during the last twocomplete decennia, and, in fact, down to the end of 1892; butthe fact is a disquieting one that in the year 1893 a veryserious rise in the mortality from this disease was observed.There does not appear to have been any noteworthy changein the sanitary condition of London which could account forthis increase, and although the report contains no indicationof the kind it is at least conceivable that in searching for itscause the medical officer may have desired to examine care-

fully the relation of water-supply to the local and generalprevalence of the disease. Under existing arrangements it is<7ery evident that any effective supervision of the metropolitanwater-supply as a whole by the medical officer of the CountyCouncil is impracticable, and this for reasons which on

reflection will be sufficiently apparent.Returning now to the report of the Royal Commission, we

- Snd that the Commissioners insist very strongly on the neces-sity of proper treatment of the river water as a condition ofits admissibility for drinking purposes. They state explicitly- that the water which flows down to the intakes must be care-

fnlly subjected to certain processes of subsidence and filtra-tion before it is brought into a suitable condition for delivery

and consumption, and that the quality of the waterwhen delivered depends largely on the thoroughnesswith which these processes are carried out. They do not gothe length of prescribing exact regulations as regards theprocess of filtration, subsidence, &c., but they concludetheir report with the following incisive statement: "Wecannot shut our eyes to the fact that the provision for theseprocesses [filtration &s.] ] diffars enormously in the dif-ferent companies, and in some of them is, to our mind,inadequate. Regulations on these matters should be drawnup after competent inquiry, and adherence to these regula-tions should be strictly enforced." Of this important adg-ment Mr. Shirley Murphy pertinently remarks that "the

necessary corollary to the report of the Royal Commission onMetropolitan Water-supply is the issue of another Royal Com-mission to make such inquiry and such experimental investi.gation as may be required to determine the precise conditionsto which polluted streams must be subjected in order to maketheir water uninterruptedly fit for domestic use." Mr.. ShirleyMurphy closes his most valuable and interesting report withthese weighty sentences, which we give verbatim. &deg; In viewof the changes effected in the rivers, and subsequently in thefilters, the risk to Londoners is, I believe, small, and certainlyintermittent, and, indeed, may be thought of as comparableto those possibilities of injury from accident in the street towhich every human being is subject during the whole of hislife. The risk, indeed, is to each a possibility and not a pro-bability, but, such as it is, I believe it exists. If we recognise,as I believe we may, that the safety of London residents isdependent upon the efficiency with which deleterious matterin the London rivers is by artificial means removed from thewater supplied to the metropolis, the conditions under whichthis removal is to be continuously ensured must obviouslybe determined with absolute precision, and an administrationmust be provided to secure that the object in view shall beattained." This is the deliberate conclusion arrived at bythe medical officer of health of the administrative county ofLondon, writing under a keen sense of responsibility, and assuch we trust it will be appreciated as it deserves and actedupon by the administrative authority to whom this report isaddressed.

MEDICAL CERTIFICATES FOR THELONDON BOARD SCHOOLS.

THE School Board is developing a large amount of

casuistry. In our issue of June 8!’h we called attentionto the following resolution passed by the Board on

the motion of Mr. Sharp:- "That the West LambethDivisional Committee be authorised to appoint for one

year, upon the under-mentioned conditions, six doctorsin that division to examine cases in which the medicalcertificate produced is considered by the divisional superin-tendent to be doubtful, or in which it is desirable to havea definite medical opinion. (a) That each case be firstreferred to the divisional member in charge of the schoolwhere the child ought to attend. (b) That a payment of2s. 6d. shall be made for each case examined. (c) That thenumber of cases to be dealt with in this manner shall notexceed 100 in a year. (d) That the names of the doctorsselected shall be forwarded to the magistrates having juris-diction in the division." Mr. Athelstan Riley (whose amend-ment that all words after produced " in the first paragraphshould be struck out and not signed by a properly qualifiedmedical man" substituted was rejected) asked Mr. Sharpat the meeting of the Board on June 27th the followingquestions, amongst others :

1. The names of the doctors in the Tower Hamlets and East Lambethdivisions who have consented to examine medical certificates con-sidered by the divisional superintendents to be doubtful.2. Tae number of certificates signed by properly qualified medical

men in the above divisions which, being considered by the divisionalsuperintendents to be doubtful, have been submitted for examinationto the aforesaid doctors.


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