INDUSTRIAL DANGERS IN THE TRANSVAAL.

ANTECEDENTS AND TERMINATIONS OF EPILEPSY. some alleviation shed upon their misery. With reference to the last-named class of sufferers-the blind-we wish to draw the attention of our readers to the Home Teaching Society for the Blind, a society whose benevolent efforts, successful though they are in adding pleasure to the scant enjoyment of hundreds of the poor blind, might be still more so but for the need of funds. A letter from the president of the society, Viscount Midleton, appears in the Times of June 16th and contains this sentence : "Want of money alone limits the extent of its work." As the letter points out, the Home Teaching Society has a centre for exchange as well as a complete organisation for free distribution.of books. We cordially agree with the society’s president in thinking that the philanthropic who wish to commemorate the Coronation in a special way in connexion with those who suffer from blindness will be better advised in aiding the established society than in seeking to found an additional free circulating library, and we can imagine no more suitable object for such specially directed charity than the Home Teaching Society for the Blind.

the heart, and 8 per cent. to pneumonia. Under proper treatment-i.e., under conditions which enabled the physician to control absolutely the habits of the patients-from 8 to 10 per cent. of epileptics, if taken in time and treated long enough, might be made to recover. The most discouraging symptom was mental enfeeblement or dementia which affected fully 90 per cent. of all cases of epilepsy when thedisease had been in existence some years. Treatment comprised the giving of bromides and a simultaneous withdrawal of all sodium chloride from the patient’s food (salt starvation). The sedative action of the bromides was thus enhanced -almost doubled. The addition of opium (Flechsig) or of adonis vernalis (Bechterew) facilitated recovery in some cases. Epileptics should be promptly treated in case of constipation, with aperients, and beta-naphthol or salol in five-grain doses should be given with the aperient. Status epilepticus should be treated with a mixture of chloral, opium, and bromides. The diet of epileptics should be always plain and unseasoned -e.g., milk, eggs, rice and cereals, and fruit. Meat or fish should be taken sparingly at noon and the evening meal always be light.

at least

should ANTECEDENTS AND TERMINATIONS EPILEPSY.

1785

INDUSTRIAL

OF

-

DANGERS

DR. THOMAS OLIVER,

IN

THE

TRANSVAAL.

of the physicians to the Roya? DR. WILLIAM SPRATLING, medical superintendent of theInfirmary, Newcastle-upon-Tyne, sends us an interesting we have had pleasure Craig Colony for Epileptics, New York, contributes an(communication on this subject which in reproducing in our columns.1 Dr. Oliver speaks with to Medical article the Journal the American of interesting on industrial dangers. He is the confidential ê Association of May 3rd on some points connected with the authority ecirc; of the British Government on these matters and has antecedents and terminations of epilepsy, information con-&adviser cerning which is not usually given in text-books. Therecently publishedthe best English work of recent years article is based upon observations made during several yearson this important branch of State Medicine. It appears at the Craig Colony for Epileptics, an institution offeringthat many of our north-country colliers who had previously exceptional opportunities for the study of the disease in its ’emigrated to South Africa in search of lucrative employment ]have during the last two years returned to their homes in various aspects. In the United States, says Dr. the population suffers from Northumberland and Durham owing to the closing of the one person in every 500 of epilepsy, a ratio which is about the same as that pre-South African mines and the continuance of the war. These From a study of 1100 cases miners, we are told, present the appearance of men broken vailing in England. in health who sooner or later succumb to pulmonary the six past during years in regard to etiology it down return to their homes in this country " only tcdisease-they appeared that in 15 per cent. of males and 17 per cent. of females epilepsy existed in and was inherited from die of phthisis." As Dr. Oliver has in the course of his the parents (similar heredity). Among other important out-patient practice become familiar with the form of was causes alcoholism present among the parents in disease presented by the Transvaal miners, he has been at. 16 per cent. of males and 12 per cent. of females, insanity considerable pains to write a very useful description of the in the immediate ancestors was met with in 7 per cent. of symptoms and physical signs of the malady as it .occurs males and 10 per cent. of females, while parental tuberculosis among these workers and has suggested rational principles for its prevention. He has done this public service with a was found in 15 per cent. of males and 12 per cent. of factors above menview, if possible, of inducing those in authority to bring females. Taking the chief hereditary tioned it was found that they could be traced in 56 per cent. about improved and more sanitary methods of mining in the Cerebral palsies Transvaal, as well as of advocating the necessity for revising of the entire number of cases observed. sustained during childhood were recognised as the cause in the mining regulations of that recent addition to the British 117 cases, or 11 per cent. of the total cases, while head- Empire with a view to the saving of life and the promotion injury during birth or childhood accounted for a few more. of health among the miners. To those who are especially The fevers ankl infections of childhood-measles, scarlet fever, interested in this question no better text-book could be diphtheria, and obscure forms of intestinal disease- recommended than that which Dr. Oliver himself has proprobably assisted in the production of epilepsy in vided in his recently-published Treatise on Dangerous some cases but no exact conclusions could be reached Trades, which embodies several contributions by eminent regarding their etiological value. Epilepsy arising from authorities at the Home Office and elsewhere in England hereditary sources almost invariably manifested itself and Scotland. In particular we would refer to the chapter during childhood, puberty, or early adolescence, but on the Regulation of Injurious or Dangerous Occupations in when appearing for the first time after adolescence it was Some of the Chief European Countries, and also to the secprobably due to syphilis, traumatism, or some form of tion on the Vital Statistics of Miners and Others Engaged in toxasmia such as resulted from alcohol, absinthe, or lead Dust-producing Occupations, which forms an important part poisoning. Epilepsy tended to shorten life, the greatest; of the earlier pages. It is, of course, true that in Great danger being the occurrence of the status epilepticus, a con- Britain there is no industry precisely analogous to the dition which was likely to develop in any form of epilepsy gold mining of the Transvaal and therefore that the experience of this country cannot supply complete instruction as at any time and which was the cause of death in 25 per cent. of all deaths among epileptics. Epileptics were unusuallyr to the best methods by which the health and life of gold prone to disease of the heart and lungs. Thus of the deaths 1 THE LANCET, June 14th. 1902, p. 1677. in Craig Colony during six years 24 per cent. were due 2 Dangerous Trades, by Thomas Oliver, M.D. Glasg., F.R.C.P. Lond. to pulmonary phthisis, 10 per cent. to organic disease of London : John Murray. 1902.

Spratling,

,

,

’

.

one

1786 miners may be that gold

DINNER OF THE OPHTHALMOLOGICAL SOCIETY.

safeguarded ; nevertheless, Dr. Oliver tells

among the

mining is, inter alia, a dust-producing occupation-that "gold miners’ disease" is essentially a slowly-developing pneumoconiosis due to the inhalation of dust ; it is therefore a malady akin to stonemasons’ or steel grinders’ phthisis. In using the term phthisis" to describe this particular malady we are pleased to note that Dr. Oliver is careful to distinguish miners’ phthisis from the tuberculous infection to which, unfortunately, the still indiscriminately applied, even here same name is in England. In the miners’ phthisis of gold workers there are few of the well-known signs of the tuberculous malady. Hasmoptysis, for example, although it some4is

times occurs, cannot be said to be a symptom of the disease. There is no night-sweating; it is essentially an afebrile disease, and until towards the approach of death there is no rise of temperature, and even then it may not ,be very marked. In all these respects, and also in regard to the physical signs which accompany it, gold miners’ phthisis contrasts strongly with pulmonary tuberculosis and shows a striking similarity to the fibroid lung disease or pneumoconiosis of this country. On the question of treatment Dr. Oliver has few suggestions to offer. If any good at all is to be got by treatment he thinks that this can only be attained by the gold miners renouncing their work in the very earliest stages of the illness and following outdoor employHe is, however, of opinion that until a larger ments. experience of the disease has been gained it would be better to send the patients for change of air, not to the seaside but inland to fairly high altitudes-say, 700 feet or more above It is therefore mainly to preventive science that sea level. we must look for a reduction of the evils which South African miners suffer as a consequence of their avocation, and Dr. Oliver’s thoughtful essay will not have been written in vain if it awakens in the right quarter the convic,tion that something in the direction of prevention is prac’ticable and therefore ought to be attempted forthwith.

DINNER OF THE OPHTHALMOLOGICAL SOCIETY OF THE UNITED KINGDOM. Ox June 13th, following the delivery of the Bowman Lecture Professor Fuchs of Vienna, the above society celebrated its majority by a dinner at the Trocadcro, Piccadilly, the members and guests numbering nearly 100. In the absence of the President, Dr. David Little, through illness, the chair was worthily filled by Dr. D. Argyll Robertson of Edinburgh. The Royal Toast having been honoured Dr. W. H. Allchin, President of the Medical Society of London, proposed " The Welfare and Prosperity of the Ophthalmological Society." Specialism, he said, had come to stay, and ophthal.mology more particularly justified itself owing to the time necessarily devoted to special study and technique. Before the establishment of that society ophthalmic subjects and ’cases were brought before the Medical Society of London and he cited some remarkable instances of the heroic treatment adopted in former days. He observed that the on ophthal10 no communications during past years mic subjects had been received by it. Many Fellows of the Medical Society of London were original members of the Ophthalmological Society of the United Kingdom, the comprehensive title of which, as well as the eminence and number of its members, some of whom were present from India and the Colonies, testified to its extent and prosperity. Sir Anderson Critchett, who proposed in graceful terms The Health of the Bowman Lecturer," said that it was as difficult to praise a friend before his face as it was to disparage,an adversary behind his back. Professor Fuchs was known as the writer of the most popular work on ophthalmology in the whole world, as well as a most successful teacher and practitioner. He was worthily numbered

,by

’

men in medicine whom Vienna had Professor in reply, referred to a statement Fuchs, produced. that "hospitality was most developed in primitive countries and disappeared with the progress of civilisation." England, maintaining its primitive hospitality, welcomed men who were sometimes driven from their own countries on account of advocating new ideas, and maintained her tradition of freedom in science as in government. In his younger days he had studied in London and was greatly indebted to Bowman and Critchett for their teaching and work. He congratulated Sir Anderson Critchett on having so well maintained the honour of a celebrated name. Mr. H. R. Swanzy (Dublin). who proposed "The Health of the Guests" in a

speech society

at on

pre-eminent

and in

good taste, congratulated the maintaining good fellowship among its members,

once

witty

and welcomed the guests, among whom he mentioned Sir William Church, Bart., President of the Royal College of Physicians of London ; Dr. Landolt of Paris ; Dr. Allchin ; and Mr. H. W. Page, President of the Neurological Society. Sir William Church and Dr. Landolt replied, and after a tribute to the chairman and secretaries a most enjoyable entertainment was brought to a close. THE APPROPRIATE FORM OF LENS FOR CONICAL CORNEA. M. J. JANSSEN read a paper on this subject on May 5th before the Académie des Sciences, an abstract of which appears in the Comptes Rendus of May 20th. He proposes the use of a deep meniscus lens, the inner surface of which is concave to such an extent that it is approximately parallel to the convex surface of the conical cornea while the outer surface is convex to the extent of a normal cornea. Mention is made of only one case for which such lenses were made 10 years ago and succeeded in restoring sight almost to normal (une vue très sensiblcnzent normale). It is obvious that the effective area of the meniscus must not measure more than half an inch from side to side, or the weight of these deep menisci would be intolerable. Further, such glasses would be exceedingly costly if the inner surface were made to correspond exactly with the conical cornea of each individual. Practically very deep concave plano-spherical lenses of known curvature might be kept in stock by opticians. On finding the biconcave trial lens which gives with a patient the best visual result it would be an easy matter to determine the requisite additional curvature that would have to be ground on the outer surface which would make the meniscus of the same strength as the trial lens. A lens made in this way should be more suitable for a conical cornea than the ordinary biconcave lens, while the cost of its manufacture would not be excessive. AN

OUTBREAK OF RABIES.

THE strong manner in which the Rabies Order was enforced and the Muzzling Order carried out in the face of so much bitter outcry and opposition on the part of the fanatical section of the dog-owning community has borne good fruit in England, but that it is still necessary not to relax any precautionary measure is shown by the fact that even within the past few days a case of rabies has been reported from Wales. The rabid animal was a Scotch collie belonging to a farmer in Pembrokeshire and it commenced its wanderings one Sunday evening. On the following

Wednesday it was seen, and, unfortunately, ran amongst a lot of children who were coming out of school, biting one of them. Eventually it was shot, and a post-mortem made examination, by the county council veterinary inat Haverfordwest, revealed evidence of rabies, spector this being subsequently confirmed by inspectors sent from London by the Board of Agriculture. Unluckily, during the three days when the collie was away, its