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OVERCROWDING ON THE DISTRICT RAILWAY.
1124 Dr. Alan Randle records a case in the present issue ’of THE LANCET, p. 1111, which is a good illustration of this difficulty. The patient, 43 years of age, a multipara six months pregnant, was thought to be suffering from eclampsia, but at the post-mortem examination was found to have a large cerebral haemorrhage filling both ventricles and extending to the medulla, the patient dying from respiratory failure. The urine contained a considerable quantity of albumin, but there was no paralysis or true ansesthesia. The kidneys were of the red granular type, the liver was congested, and the heart was hypertrophied. The patient had suffered from lassitude and headache for ten days, but there was no history pointing to any previous renal trouble and there was no oedema. She was confined of a six months’ partly macerated foetus, and as the condition improved after her delivery the diagnosis of eclampsia was thought to be confirmed. It is very probable that not a few of the cases of so-called eclampsia without fits may in reality be instances of cerebral haemorrhage simulating eclampsia. Among the more striking features, as N. C. Carver and J. S. Fairburn have pointed out,l in cases where eclampsia is complicated by severe cerebral hemorrhage, especially when it involves the pons, is the youth of the patients, the absence of any fit, or the occurrence of only one or two followed by the onset of deep coma with respiratory stertor and in many cases CheyneStokes breathing. A correct diagnosis is of the utmost importance if an accurate prognosis is to be made, but only too often the cerebral hemorrhage is only discovered at a post-mortem examination, and in. such cases the question as to whether the case is one of pure cerebral hemorrhage or cerebral haemorrhage complicating eclampsia will depend on the discovery of the characteristic lesions of eclampsia in the kidneys and the liver. Luckily, cases of extensive cerebral hemorrhages, contrary to the general opinion, are in reality rare in eclampsia ; thus in 216 cases collected by various writers in only seven did there appear to have been any large cerebral haemorrhage. In an attempt to arrive at a correct diagnosis of eclampsia in a comatose patient stress must be laid on the previous history, the age of the patient, usually a youthful primipara, the discovery of a large quantity of albumin in the urine, the presence of cedema, the absence of hemiplegia or rigidity in the limbs of one side, and the It is obvious that where occurrence of repeated convulsions. a large area of the brain substance is destroyed by the hemorrhage the diagnosis, as in Dr. Randle’s case, may present almost insuperable difficulties, and it must be borne in mind that in some cases of hemorrhages into the pons convulsions are not uncommon.
diagnosis impossible.
OVERCROWDING ON
THE
DISTRICT RAILWAY.
IT is a commonly expressed opinion that what are called facilities for locomotion lessen overcrowding both in the conveyances themselves and in the streets. As a matter of fact, the exact opposite seems to be the case as regards London. The discomfort and in some cases the dangers of overcrowding trains and the like have of recent years become notorious, and it cannot be wondered that numerous questions are asked in Parliament on the matter. On April 6th various members of the Labour Party attacked the Metropolitan District Railway Company on account of overcrowding. Mr. C. W. Bowerman pointed out that the overcrowding took place at morning and night, which is an undoubted fact. Mr. W. Thorne, on the other hand, argued that a great deal of the overcrowding happened in the middle of the day, because fewer carriages were run. Mr. H. J. Tennant, on behalf of the Board of Trade, promised 1
Proceedings of the Royal Society of Medicine, vol. i., p. 90.
to make
representations. That overcrowding does exist indubitable, but it is just as obvious and just asannoying upon the municipally owned tramcar as on the capitalist railway carriage. As the " thousands of working men and women," to whom Mr. W. Hudson, is
for Newcastle, referred upon the say nothing of a few thousand not grant the title more persons to whom he would of working man, all have to get to their work between the hours of 5 A.M. and 10 A.M., and all strive to. get home between 5 P’.M. and 8 P.M’., we do not see The modern body how overcrowding is to be averted. politic is just as complicated as the natural body, and all these difficulties are part and parcel of modern industrialism. When the worker lived over his shop or the rich tradesman had a few apprentices who lived in the house, while the journeyman lived only a few doors, away, the need for travel did not exist. But under modern conditions no one in a great city lives near his or her work. Moreover, a great part of the overcrowding is due to pleasure-seekers and the hordes of surburban dwellers who It is evident from a come up for" sales " and theatres. remark of Mr. Thorne, " Are railways run for shareholders only," that the outcry against overcrowding on railways is. not solely due to anxiety in the interests of passengers, but is partly inspired by the wish for the nationalisation of railways. But the state in London of the municipally owned tramcar forms a poor argument in this direction. At present there would appear to be no remedy, although such a state of matters is both dangerous to life and injurious- to health. the Labour same
Member
occasion,
to
____
RUPTURE OF THE ŒSOPHAGUS. WouDS and ruptures of the oesophagus are by no means. Phthisical patients occasionally rupture the oesophagus and in inveterate alcoholics constant vomiting sometimes results in the walls giving way. Of course, also, injuries to the neck may, though they very rarely do, involve the oesophagus. What is probably an unique case of rupture by violent distension has recently occurred in Sweden, which is reported by Dr. G. Petren, assistant in the clinic of Professor J. Borelius in the University of Lund. The patient was a vigorous, healthy man, 27 years of age, who was employed as a cleaner and working by means of compressed air conveyed through an indiarubber tube. As he wished to move he doubled up the tube with his hands and seized the end between his teeth. While doing so he slipped and lost his hold on the tube which delivered its contenta at a pressure of seven atmospheres directly into his mouth. He fell down complaining of a severe pain in the chest and vomited a small quantity of mucus when adtinged with blood. Three hours of the the the mitted to hospital neck, thorax, integuments and the chin were emphysematous, the pulse was small, rapid, and irregular, respiration painful, and the general aspect, very bad. The pain was referred to the epigastrium. The man could not stand or lie down but had to keep a sitting posture. A few hours later the emphysema had encroached on the face, the eyelids, and the arms. The dyspncea became more and more pronounced and the heart’s action grew weaker and weaker, death occurring the next morning. At the necropsy a vertical clean rent in the oesophagus was found 6 centimetres in length, the upper extremity being 1’ 5 centimetres from the bifurcation of the trachea; the surrounding connective tissue was infiltrated with pus. Thus the rupture in this very special case occupied the same position as ruptures due to vomiting generally do-that is, the lower end of the oesophagus, sometimes even involving the cardia. They are generally longitudinal and present clean common.
afterwards
diagnosis impossible.
OVERCROWDING ON
THE
DISTRICT RAILWAY.
IT is a commonly expressed opinion that what are called facilities for locomotion lessen overcrowding both in the conveyances themselves and in the streets. As a matter of fact, the exact opposite seems to be the case as regards London. The discomfort and in some cases the dangers of overcrowding trains and the like have of recent years become notorious, and it cannot be wondered that numerous questions are asked in Parliament on the matter. On April 6th various members of the Labour Party attacked the Metropolitan District Railway Company on account of overcrowding. Mr. C. W. Bowerman pointed out that the overcrowding took place at morning and night, which is an undoubted fact. Mr. W. Thorne, on the other hand, argued that a great deal of the overcrowding happened in the middle of the day, because fewer carriages were run. Mr. H. J. Tennant, on behalf of the Board of Trade, promised 1
Proceedings of the Royal Society of Medicine, vol. i., p. 90.
to make
representations. That overcrowding does exist indubitable, but it is just as obvious and just asannoying upon the municipally owned tramcar as on the capitalist railway carriage. As the " thousands of working men and women," to whom Mr. W. Hudson, is
for Newcastle, referred upon the say nothing of a few thousand not grant the title more persons to whom he would of working man, all have to get to their work between the hours of 5 A.M. and 10 A.M., and all strive to. get home between 5 P’.M. and 8 P.M’., we do not see The modern body how overcrowding is to be averted. politic is just as complicated as the natural body, and all these difficulties are part and parcel of modern industrialism. When the worker lived over his shop or the rich tradesman had a few apprentices who lived in the house, while the journeyman lived only a few doors, away, the need for travel did not exist. But under modern conditions no one in a great city lives near his or her work. Moreover, a great part of the overcrowding is due to pleasure-seekers and the hordes of surburban dwellers who It is evident from a come up for" sales " and theatres. remark of Mr. Thorne, " Are railways run for shareholders only," that the outcry against overcrowding on railways is. not solely due to anxiety in the interests of passengers, but is partly inspired by the wish for the nationalisation of railways. But the state in London of the municipally owned tramcar forms a poor argument in this direction. At present there would appear to be no remedy, although such a state of matters is both dangerous to life and injurious- to health. the Labour same
Member
occasion,
to
____
RUPTURE OF THE ŒSOPHAGUS. WouDS and ruptures of the oesophagus are by no means. Phthisical patients occasionally rupture the oesophagus and in inveterate alcoholics constant vomiting sometimes results in the walls giving way. Of course, also, injuries to the neck may, though they very rarely do, involve the oesophagus. What is probably an unique case of rupture by violent distension has recently occurred in Sweden, which is reported by Dr. G. Petren, assistant in the clinic of Professor J. Borelius in the University of Lund. The patient was a vigorous, healthy man, 27 years of age, who was employed as a cleaner and working by means of compressed air conveyed through an indiarubber tube. As he wished to move he doubled up the tube with his hands and seized the end between his teeth. While doing so he slipped and lost his hold on the tube which delivered its contenta at a pressure of seven atmospheres directly into his mouth. He fell down complaining of a severe pain in the chest and vomited a small quantity of mucus when adtinged with blood. Three hours of the the the mitted to hospital neck, thorax, integuments and the chin were emphysematous, the pulse was small, rapid, and irregular, respiration painful, and the general aspect, very bad. The pain was referred to the epigastrium. The man could not stand or lie down but had to keep a sitting posture. A few hours later the emphysema had encroached on the face, the eyelids, and the arms. The dyspncea became more and more pronounced and the heart’s action grew weaker and weaker, death occurring the next morning. At the necropsy a vertical clean rent in the oesophagus was found 6 centimetres in length, the upper extremity being 1’ 5 centimetres from the bifurcation of the trachea; the surrounding connective tissue was infiltrated with pus. Thus the rupture in this very special case occupied the same position as ruptures due to vomiting generally do-that is, the lower end of the oesophagus, sometimes even involving the cardia. They are generally longitudinal and present clean common.
afterwards