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Saturday and the chief offenders against the law are

members of the Jewish community or else such bakers as

cater for the wealthy classes. As, however, the vast

majority of the inhabitants of this country agree that

Sunday should be the day of rest it is urged that the

minority must conform to this custom. From the practicalpoint of view there is much to be said in favour of this

contention, for it greatly simplifies the task of inspec-tion. But from the health point of view all that is

needed is the strict observance of one day’s complete restin the seven, and if the Jews desire to select Saturday forthat purpose it is only in keeping with the modern spirit ofreligious toleration to allow them to have their own way,even at the risk of creating denominational bakehouses.

Perhaps a compromise might be possible. A law is alwaysbetter enforced when all parties concerned approve of thelaw and we believe that the Jews would assent to compulsoryrest on the Saturday. In any case rest there must be andwe hope that the Home Secretary, who has been asked toreceive a deputation on this subject, will see his way torealise this principle.

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THE ETIOLOGY AND PATHOLOGY OF GRAVES’S

DISEASE.

PROFESSOR CHARLES DANA of New York contributes an

interesting article to the New York Medical Journal of

June 14th last which throws some light on the vexed ques-tion as to whether exophthalmic goitre, or Graves’s disease,is a neurosis or a glandular disorder associated with hyper-secretion of the thyroid gland. Professor Dana concludesthat the primary seat of the disease is in the nervous centresconcerned with the innervation of the thyroid gland. An

etiological factor the importance of which has been re-

cognised only recently-viz., infection-also plays, saysProfessor Dana, a part in the production of the disease.

Thus a study of reported cases will show strikinginstances of Graves’s disease following upon fevers,sepsis, operative procedures, and pregnancies. In hisown experience Professor Dana has seen three cases of

exophthalmic goitre which developed after typhoid fever.One of the curious and instructive facts connected with

the pathology of this disease is, according to Professor

Dana, that in its acute fatal forms the nervous centres

in the medulla oblongata or bulb seem to be exhaustedand even paralysed. Of interest, too, are the changesfound in the bulbar nuclei in old cases of the disease.Both these facts are shown in the following two

cases, the second of which also illustrates the very rare

incident of embolism in Graves’s disease. In the firstcase the patient was a woman, aged 23 years, who wasadmitted to the Bellevue Hospital with severe headache andrausea. Inquiry showed nothing of importance in the

family history. She was of nervous temperament but hadbeen well generally with the exception that for the six yearspreceding her admission to hospital she suffered from occa-sional "fainting spells " but no convulsions. The symptomsof headache and nausea were attended with attacks of

vomiting. She was found on examination to be quiteanasmic and there were distinct exophthalmos and enlarge-ment of the thyroid gland, especially of its right lobe. The

carotids were unduly pulsatile and a thrill could be felt overthe gland. The pulse was rapid and varied from 90 to 108(tachycardia) and the respirations were 26 per minute.

The temperature was 99.5° F. The left ventricle of the

heart was somewhat enlarged and there was an intense

anaemic murmur at the apex. The liver, the kidneys, andthe urine were normal. Her nervousness now increased,tremors, at first slight, now became frequent and distressing,and the tachycardia became more pronounced. On the

seventeenth day after admission she passed into a stuporous

condition and was unable to swallow food or to talk dis-

tinctly. There were also a slight ptosis of the left eyelidand other symptoms which led to the belief that therewas some lesion of the pons. The pulse-beats increasedin frequency and the temperature rose to 107°, death

occurring on the nineteenth day. The post-mortem exa-

mination disclosed a normal condition of the heart, the

lungs, the kidneys, and of the other organs with the

exception of the brain and the thyroid. The left crus

cerebri was the seat of softening, but there was no

haemorrhage, and the sections showed that the lesion musthave been due to thrombosis or embolism. The blood-vessels showed no evidence of atheroma or of syphilis.The second case was that of a woman, aged 45 years, withtypical symptoms of Graves’s disease, terminating fatallyfour months and one week after admission to hospital. The

necropsy disclosed in this case striking degenerative changesin the bulbar nuclei of the hypoglossal, pneumogastric, andother nerves in the form of pigmentation and vacuolationof the cell bodies and a moderate degree of chromatolysis orloss of the Nissl granules of the nerve-cells. The foregoinghistories show, adds Professor Dana, that Graves’s diseaserat times runs an acute course, and that in cases of someduration decided changes are found in the nerve-cells of thepneumogastric, the hypoglossal, and other nerves within thebulb.

___

THE death is announced, on July 21st, of Dr. Carl Gerhardt.He died on his estate of Damberg in Baden. Dr. Gerhardt,was a well-known authority on diseases of the lungs and ondiseases of children. He was one of those who attended theCrown Prince of Germany, afterwards the Emperor Frederick,in his fatal illness. He it was who discovered the laryngealgrowth early in March, 1887. He was the editor of "A Handbook of Children’s Diseases," by various writers, which waspublished at Tiibingen in 1877, his own contribution beingan article on Abdominal Typhoid.

THE BUNGAY MEDICAL PRACTITIONERSAND THE HOME OFFICE.

WE have already commented upon the situation producedby the action of the medical men in the district of Bungay,Suffolk, refusing to examine a child stated to have been

indecently assaulted, on the ground that the fees for medicalwitnesses were totally inadequate. At the opening of theBungay petty sessional court on July 17th (there beingpresent Mr. H. Rider Haggard, in the chair, Mr. C. G.

Kemball, and Mr. R. C. Mann), the matter was carried astage further.Superintendent ANDREWS handed to the Chairman a letter.The CHAIRMAN asked if the Chief Constable wished that the letter

should be read from the bench, and on Superintendent Andrewsanswering that this was so, said : The matter is this. Some two monthsago a case came before this bench of criminal assault upon a childnamed Alice Jefferies by a man named Howes. In the course of theevidence that was offered it appeared that the child had not beenexamined by any medical man in the town because the medical men towhom application was made refused to carry out an examination-Ultimately the case was committed for trial; it went to trial and Ibelieve that the man was convicted. The police communicated withthe authorities upon the matter of the refusal of the medical men toexamine the child. The authorities appear to have communicatedwith the Home Secretary and the Home Office has written a letter tothe Chief Constable of East Suffolk who has now formally requestedme to read this letter in court. I need hardly say that this bench hasnothing to do with the question at issue between the medical men andthe Home Office. The business of this bench in the question is only totry to arrange that the course of justice shall not be interfered with infuture in any such cases that may be brought before it. The letter is.as follows :-

Whitehall, 17th June, 1902.SIR,-In reply to your letter of the 17th ultimo respecting the

refusal of certain medical men to examine a child alleged to have beenindecently assaulted on the ground that if called as witnesses in acriminal prosecution their remuneration would be insufficient, I amdirected by the Secretary of State to say that there is no means ofcompelling a doctor to make the examination. Such refusals as those

1 THE LANCET, July 12th, p. 85.

238

.-to which your letter refers must, in Mr. Ritchie’s opinion, be consideredas very discreditable to the medical men concerned, but he is glad to ibelieve that such incidents are very rare. Doctors are, as a rule,

. perfectly willing to undertake an examination of this sort thoughaware that they will only be paid their expenses as witnesses.Mr. Ritchie would suggest that in an exceptional case where, owing

to the refusal of a medical man to make such an examination. theremight be danger of a serious miscarriage of justice, you should com-municate with the Director of Public Prosecutions who could, ifnecessary, emplov an expert to make the examination.As a general rule, however, such expenses ought not to be thrown on

.Imperial funds. I am, Sir, your obedient servant,CHARLES S. MURDOCK.

The Chief Constable of East Suffolk, Ipswich.

The CHAIRMAN: It only remains for the Bench to discover what is,-the attitude of the medical faculty in this town upon the subject-whether they still decline to deal with such cases or not ?Superintendent ANDREWS That I am not in a position to say, sir.

I have not conferred with the medical men ; the matter has been in thehands of Inspector Steggles. but I understand from him that theyrefuse to act in all eases ot criminal assault because their remunerationis not sufficient.

The CHAIRMAN : Can yon ascertain what is the position?The CLERK: Mr. Tetlev is here.The CHAIRMAN : Then Mr. Tetley can speak for himself. (To Mr.

,Tetley.) Do you represent the feeling of the medical men in Bungay ?Mr, F. H. TETLFY: I am exceedingly obliged to you for allowing me to

have the opportunity of hearing this letter read. I want it to be plainlyunderstood on behalf of the medical profession in Bungay that thereason we objected to examine this case was as a strong protest againstthe miserably low fees which are offered to ns for attending the quartersessions or assizes to give evidence. The fee we get is a guinea a day andour railway ticket, and if detained over one day we get, 2s. 6d. for ourbed. I may state also that it is contrary to the ethics of the professionthat in any cases where either life or limb is involved or in cases whereit is a matter of alleviating human suffering the question of fee orreward scarcely ever-I hope never-enters the mind of a medical manin deciding whether he should give his services or not. But in these

-cases I certainly think that the State should remunerate us better thanit does. I hope the magistrates do not think that we sprang a mineupon the police in the case referred to, for immediately after the casewhich went from here to the assizes in November last we distinctly toldthe inspector of police that in future under no conditions whateveruntil the remuneration was altered would we attend to these sort of

. -cases. I may add that it is unfortunate that my colleague Mr. G. H.Ransome is away just now, but he is exactly of the same opinion asmyself, and unless the remuneration is altered we shall decline toexamine in any of these cases.The CHAIRMAN : That is your fixed determination?Mr. TETLPY: Yes ; and of the medical men in Bungay.Superintendent ANDREWS : Is it only the fee allowed for staying

over-night that you complain of ? Mr. TETLEY : No, the fees generally. :The CHAIRMAN : I should like to say that although we have heard

from Mr. Tetley that the police were given notice in Novemberlast that the medical faculty of the town refused to attend these cases of

criminal assault, and similar cases, so far as I am aware I never heardot any such notice. The bench knew nothing of it. and it thereforecame as a surprise to us when this child was brought up unexamined.We have listened to what Mr. Tetley has said and I again repeat thatwe have nothing whatever to do with the rights of the matter. The.question at issue is one for the Home Office to deal with.

Mr. TETLEY : Mr. Chairman, could I possibly have a copy of that:.letter to send to THE LANCET ? THE LANCET is our medical journal andit has taken up the matter.The CHAIRMAN : The letter having been read here by the request of

the police authorities is public property. May I make a suggestion ?Would it not be possible for a medical man to be appointed for thedivision to deal with such cases ?

Superintendent ANDREWS : I have been thinking the matter overseriously and I feel that the time has arrived when it should be so.

’:This matter was duly reported to me by the inspector here and in turnreported by me to my superiors. It is, however, a unique case andthere was a difficulty in dealing with it. But I do think the time hasarrived when a medical gentleman should be appointed for eachdivision so far as police matters are concerned.Mr. TETLEY : We have been driven to thisconclusion by degrees.The CHAIRMA.N: You have raised an important issue which has now

...got to be settled somehow.Mr. TETLEY: We get no fees from our police cases at all. We may be

rung up in the middle of the night for a man who may be hanged, butwe get no fee whatever.Superintendent ANDREWS : That is a matter for the coroner, except

in cases of paupers when it comes on the parish.Mr. KEM13ALL: You object rather to be taken away from all your work

for perhaps two or three days to the county assize (or sessions) at thepresent remuneration ?Mr. TETLEY : Yes.

SuperintendentAND-REWS: We are in the same position with regard to..architects and surveyors whose allowance is but 3s. 6d. a day.

The CHAIRMAN (to Superintendent Andrews) : Perhaps you will conveyto the Chief Constable the suggestion which the bench makes that theHome Office should te communicated with and asked if a medical mancould not be appointed for each division. The suggestion made by theHome Office that the Director of Public Prosecutions should be com-municated with scarcely seems to be adequate, ’because we all knowthat the delav might mean that any traces of an assault may havevanished by the time that any examination takes place at the instanceof the Director of Public Prosecutions.

MR. W. G. GRACE, M.R C.S.Eng., L.R.C.P.Edin.,. completed his fifty-fourth year on July 18th. Lately he hasbeen devoting some attention to the game of bowls and lastBweek he made his 200th three-figure score at cricket.

THE ANNUAL REPORT OF THE CHIEFINSPECTOR OF FACTORIES AND

WORKSHOPS FOR THEYEAR 1901.

PART I. REPORTS.

SECOND NOTICE.1

ONE of the most valuable parts of the chief inspector’sreport is the summary which he gives of the Factory andWorkshops Act, 1901. It may be remembered that two

Factory Bills were introduced concurrently into the Houseof Commons. Of these two Bills the first was framed with aview to consolidate the then existing Factory Acts of 1878,1883, 1891, and 1895, and the Cotton Cloth Factories Acts of1889 and 1896. The second Bill was drawn up to amendthe existing law in certain particulars. These Bills passedthrough Committee and received some amendments in theprocess. The provisions of the second Bill were then addedto the first Bill which proceeded in the form of a singlemeasure and received the Royal Assent in August, 1901. A

very important feature of the new Act is that the questionof ventilation can now in many cases for the first time beefficiently dealt with by the factory inspectors. In previousActs provisions had been made in regard to the amount ofair-space which had to be provided for the workpeople, butthere was no statutory provision to insure the supply offresh air. There was a requirement that the temperature ofthe air should be reasonable, but there was a completeabsence of any necessity on the part of the manufacturer totrouble himself about the purity of the air breathedby the workpeople. The manufacturer might, therefore,by any means he choose raise the temperature of theair at the expense of its purity. This is in fact whatactually happened. In the case Deane v. Beach it was

proved that the temperature of a room was raised ’’byheating it with gas jets and stopping up the chimneys." Themagistrate before whom the case was tried regretted thathe was obliged to dismiss the summons which was taken outunder the section of an Act which reads thus : "In everyfactory or workship adequate measures shall be taken forsecuring and maintaining a reasonable temperature in eachroom in which any person is employed." 3 It was held on

appeal at the High Court of Justice (King’s Bench Division)that the magistrate was right in his decision. Mr. Justice

Ridley held that temperature is clearly not the same thing asventilation and that the temperature, which in this case was610 Fahr., was reasonable and Mr. Justice Bigham pointedout that a reasonable temperature was the only thing aimedat in the section which was relied on by the prosecution.The magistrate who first tried the case gave it as his

opinion that "such an abominable and disgraceful state ofthings should be remedied." The Act of 1901 which hasaccomplished this reform provides that sufficient ventilationmust be maintained to render harmless all gases, vapours,and dust. Attention has been already called 3 to the

extremely unsatisfactory condition of the ventilation in manyof the cotton-weaving sheds, in which the air had beenexamined by Mr. W. Williams, the inspector of cotton clothfactories. In his introductory summary to the work done byhis department, the Chief Inspector hardly gives sufficient

prominence to the report on the cotton cloth factories and heomits to refer the reader to the part of the volume in whichthis report is to be found. The space at our disposalwill only admit of a brief summary of the work doneby the inspector who gives a full account of the investiga-tions which he made in regard to the quality of theair in certain factories and in weaving sheds. During theyear 1901 13 new cotton cloth factories were worked andthere were 12 additional cotton-spinning rooms. The regula-tion of the amount of moisture in the air has already been amatter of considerable importance in these factories. Ifthe air be too dry the process of weaving cannot be satis-factorily conducted, and if it be too moist the comfort ofthe workers is interfered with. On this question there wereformerly many complaints and until the year 1889 no legallimit was put on the amount of humidity permissible and it

1 The first notice appeared in THE LANCET of July 19th, 1902, p. 172.2 58 & 59 Vict. cap. 37.

3 THE LANCET, Oct. 29th, 1901, p. 1146.