- Email: [email protected]
THE NATIONAL PHYSICAL LABORATORY.
24 A report of the work has been made by department. Dr. C. KAYE A. OWEN. It
different shades of thought. Some of those prominent in civic life have held that, whatever the nature of the infectious exanthem prevalent in the town, nothing should be done about it in a public way, in order not to spoil the trading facilities and other amenities of the place-a natural but not very long-sighted form of local patriotism. Another section has regarded the diagnosis of chicken-pox almost in the nature of an article of faith not amenable to disproof by ordinary scientific criteria ; for a considerable number of cases notified as chicken-pox, actually 31
G. W.
and Dr. E. contains the protection afforded by such substances as sheet lead, lead-impregnated rubber, lead glass, and barium-sulphate plasters. The lead equivalent-that is, the thickness of lead equivalent in absorption power to unit thickness of the material-has been determined, and the figures given in the report will be of great convenience to radiologists. Of the many interesting comparisons in the week ending June 23rd, have been rediagnosed given the following may be cited. The lead equivaas small-pox by medical officers of the Ministry of lent of a 12-in. solid concrete floor is about 3 mm. Health and of the Metropolitan Asylums Board, The masses of a steel and a lead plate which afford whose knowledge as experts would receive immediate equal protection against X rays excited by 100,000 acceptance in a calm atmosphere. Difficulty seems to volts are in the ratio of 4 to 1. Different makes have arisen in regard to the distinction between of lead rubber are found to differ by as much chicken-pox and small-pox, largely owing to insufficient as 100 per cent. in protective value. Among the stress being laid on the distribution and simultaneous substances used for tube boxes sheet lead appears to be appearance of the rash and too much importance on the lightest protective material to use, lead rubber the presence of constitutional symptoms ; for, as we being anything from 5 to 25 per cent. heavier. The have already noted, and are glad still to be able to open lead glass bowl, commonly used with X ray note, there has, so far, not been a single fatal case is
interesting
data
concerning
criticised by the authors, who state : " In experience, where this type of shield is aloneemployed, it is often possible to take a radiograph in any part of a room where a tube is working." Concurrently with this research on X ray protection the department has carried out investigations on the intensity of X rays emitted by Coolidge and gastubes when operated by various types of high-tension generator. The work has shown that the intensity of the radiation emitted by an X ray tube is not in all cases proportional to the mean current passing through the tube, when the applied voltage is kept constant. Further, the investigators are led to state that : Considerations of voltage and current wave-forms point to the conclusion that for a given voltage, and when the maximum current is in phasewith the maximum voltage, the intensity of radiation emitted by an X ray tube, whether of the gas or of the hot cathode type, is roughly proportional to the maximum or peak current passing through the tube. This is true both for coil and transformer discharges.’y’ The radiology department is fully alive to the increasing application of higher voltages in medicine and in the study of metallic structures, as is shown by recent acquisition of a 200 kilo volt machine. Doubtless many of the problems involved in the practice of deep therapy will receive due attention at the hands of the director and his assistants. The department of’ sound is growing, and among the exhibits many were THE NATIONAL PHYSICAL LABORATORY. of medical interest-in particular an apparatus for the AT the invitation of the President of the Royal production of sounds of constant intensity and Society a large company gathered at Teddington last telephonic methods for the measurement of sound
this year among all the notified cases of small-pox. This admirable mildness of the disease it is which has encouraged still another local view-namely, that the disease is small-pox, but that it does not matter, the mildness being such as to render the outbreak unimportant from a public health point of view, making it therefore unnecessary to impose limitations on personal liberty in connexion with it. We are glad to think that there is no body of medical opinion included in the first and third groups which we have mentioned, and that the doubt in regard to the diagnosis is honest doubt, bred of the lack of experience in seeing actual cases of small-pox, which is the heritage of the last two generations of medical men. Dr. W. McC. WANKLYN spoke very appropriately to Guy’s medical students last week on this alleged inability of the medical profession to diagnose smallpox, and he laid before them the results of the consultative system of small-pox diagnosis in London and some solid proof of what this system of diagnosis has effected. It is something for which humanity be thankful that one of the worst of infectious may plagues betrays itself early by a characteristic skin eruption which it is not-to use the phrasing of the National Health Insurance Act-beyond the ability of the practitioner of ordinary competence and skill to discover.
week to view the various departments of the National Physical Laboratory. The opportunity of seeing the research and testing departments in full working order and of meeting experts in every branch of physical science, which the occasion afforded, was widely appreciated, and the spacious department of aero-dynamics, with its huge wind tunnels, formed a pleasant setting for the reception. Among the many branches of science flourishing at the laboratory there is, perhaps, none so interesting from the medical point of view as that of radiology. The recommendations of the X Ray and Radium Protection Committee for the better protection and general improvement of the working conditions of X ray operators have resulted in a large number of X ray materials being submitted for test to this
tubes, our
"
intensity.
Certain workers in this field claim that variations of intensity of one million fold can be by the ear, and further by the use of these methods it can be demonstrated that the ear is, incapable of detecting a 10 per cent. change in the intensity of sound. The research in this direction contemplated by the department will be awaited with interest, and might eventually be applicable to stethoscopy. In the multitude of routine tests which are carried out in the various sections there is. evidence in all directions of the ingenuity and thought expended on the minutest details of even the simplest physical determinations. For example, in tests made upon the clinical thermometer, despite the fact that less than 2 per cent. of the number received are rejected, each thermometer is tested at four different;
detected
25
temperatures between 95° and 110° F., its readings at these points being compared with a standard thermometer. The comparison is carried out in an electrically heated water thermostat, in which the " Ne quid nimis." water is kept in very rapid circulation. After the comparison has been made for any one temperature, THE POSTPONED BIRTHDAY HONOURS. the water is raised in temperature a further two-tenths LAST week-end was published the list of honours, of a degree, and readings of the thermometers are again, taken to ensure that they are responsive to conferred on the occasion of the King’s birthday, slight temperature changes. At the present time announcement of which was postponed on account about 1200 thermometers are tested daily in this of the change in Prime Minister. A baronetcy has been conferred upon Sir Anthony Bowlby, K.C.B., manner. Many fascinating exhibits were displayed by the K.C.M.G., K.C.V.O., President of the Royal College of optics division. The colour effects obtained with the Surgeons of England, and knighthoods upon Dr. George Nutting colorimeter were as pleasing as the methods Francis Blacker, C.B.E., Dean of University College for measuring the radii of curvature of microscope Hospital Medical School, and on Lieut.-Colonel objectives were ingenious. The polarimetric and Ewen John Maclean, chairman of the Consultative saccharimetric equipment, together with the apparatus Council of the Welsh Board of Health. A Com-for lens testing, was particularly attractive. Though in mandership of the Order of the British Empire has three fascinating hours only a small part of the been conferred upon Lieut.-Colonel John Southey activities of the laboratory could be witnessed, it was Bostock, R.A.M.C., Director of Medical Services possible to estimate the magnitude of the work of the Ministry of Pensions. To these gentlemen we efficiently dealt with. In the National Physical offer hearty congratulations in the name of the medical Laboratory the nation has an asset of incalculable profession. Other n ames in the list familiar to medicine are those of Sir William Plender, who has done excelvalue.
Annotations.
A SPA FOR THE T.B.M. HARROGATE is making a push to become the place of healthy resort for the tired business man, that ill-defined but frequent product of our present-day city life. With its pleasant subalpine situation and its abundant facilities for the application of the healing virtues of waters and sunshine and fresh air, it is not unreasonable to suppose that the early stages of this real and destructive fatigue may be treated with success. Common experience, indeed, points in this direction, and medicine is primarily concerned with selecting the appropriate cases and eliminating those in which there is already the foundation of serious organic disease. For this Harrogate is well equipped, for it has clinical facilities which can easily be turned into team-work and pathological facilities to detect the early stages of organic malady during a period of time devoted to rest and recreation. Nor does Harrogate cater only for those of abundant means, for, through the Royal Bath Hospital, which has a considerable endowment and is largely supported by the more wealthy visitors, pass every year 2000 or more patients from all parts of England, and arrangements have been made by the local medical profession for the complete examination of cases of moderate means at an inclusive fee. A new Pullman car service has been inaugurated bringing- the bracing northern spa within easy reach of comfortable travel from London and, contrary to foreign practice, two-thirds of the train is put at the disposal of modest purses.
lent work in connexion with the National Health Insurance Act and who becomes a baronet, Mr. Walter Schroder, coroner for Central London, who becomes a Knight Commander of the British Empire, the Rev. Canon Frederick Charles Davies, vicechairman of the Consultative Council of National Health Insurance, Mr. Walter Davies, chairman of the Manchester Hospitals Voluntary Committee, and Mr. Ernest Tom Neathercoat, President of the Pharmaceutical Society (for work in connexion with the Dangerous Drug Regulations), who become Commanders of the Order of the British Empire.
TUBERCULOSIS IN CHILDHOOD. IN the July number of Tubercle there are several original articles and reviews dealing with tuberculosis in childhood. It has been said that if the problem of tuberculosis in childhood were solved, the problem of tuberculosis in the adult would practically cease to exist. In a paper by Dr. C. D. S. Agassiz and Dr. S. Roodhouse Gloyne an account is given of investigations undertaken with a view to determining whether or not the tubercle bacillus can be detected in the blogd-stream in children at or about the time of the primary infection. In the cases chosen for this investigation the signs varied from those of slight involvement of the lymphatic glands to those of disease of the peritoneum or lungs. In the control cases the diagnosis of pulmonary tuberculosis was supported by extensive physical signs and the finding From 1-5 to of tubercle bacilli in the sputum. 10 c.cm. of blood were drawn from a vein, were mixed with a 1-5 per cent. solution of sodium citrate, and were in each case injected into two guinea-pigs. In no case did they develop tuberculosis, although blood obtained from these patients was drawn off INDEX TO " THE LANCET," VOL. I., 1923. both apyrexial and pyrexial periods. It THE Index and Title-page to Vol. I., 1923, which would during thus appear that infection of the blood-stream was completed with the issue of June 30th, will tubercle bacilli in children suffering from tubershortly be published. A copy will be sent gratis to by culosis is not easily demonstrable by the method subscribers on receipt of a post-card addressed to and the following alternative conclusions the Manager of THE LANCET, 1, Bedford-street, described, drawn : That (a) the number of bacilli circulating are Strand, W.C. 2. the blood is too small to be thus demonstrated, (b) they are discharged into the blood-stream only at SMALL-POX IN ENGLAND AND WALES.-During the intervals, or (c) extension of the disease takes place some other route, such as the lymphatic system. week ending June 23rd 141 cases of small-pox were notified by A paper by Prof. P. Bull, of Christiania, contains a in England and Wales, the distribution being as follows : Derbyshire 12 (Alfreton 1, Belper 1, Heanor 4, Long Eaton 5, tale of an instructive mistake. A boy, aged 3, was C’lown R.D. 1) ; Durham 1 (Stockton-on-Tees) ; Gloucester- supposed to be suffering from malignant disease of shire 90 (Gloucester 79, including 31 cases notified as chicken- one testicle and metastases in the abdominal cavity. pox but rediagnosed as small-pox, Cheltenham 1, Stroud 2,Laparotomy revealed no free peritoneal cavity; Westbury-on-Severn 1, East Dean R.D. 4, Gloucester R.D. 3); wherever he explored, Prof. Bull only found a curious Herefordshire 1 (Hereford) ; Nottinghamshire 21 (Kirkby-ingreyish substance which seemed to have permeated Ashfield 6, Warsop 15) ; Warwickshire 1 (Birmingham) ; the peritoneum, omentum, and neighbouring struc1 Worcestershire 1 (Martley R.D.) ; Yorks North Riding Still thinking that the case was one of malignant tures. (Middlesbrough); Yorks West Riding 12 (Bentley-withand therefore practically hopeless, he thrust , disease, Arksay 2, Doncaster R.D. 10); Monmouthshire 1 (Risca).
I in
different shades of thought. Some of those prominent in civic life have held that, whatever the nature of the infectious exanthem prevalent in the town, nothing should be done about it in a public way, in order not to spoil the trading facilities and other amenities of the place-a natural but not very long-sighted form of local patriotism. Another section has regarded the diagnosis of chicken-pox almost in the nature of an article of faith not amenable to disproof by ordinary scientific criteria ; for a considerable number of cases notified as chicken-pox, actually 31
G. W.
and Dr. E. contains the protection afforded by such substances as sheet lead, lead-impregnated rubber, lead glass, and barium-sulphate plasters. The lead equivalent-that is, the thickness of lead equivalent in absorption power to unit thickness of the material-has been determined, and the figures given in the report will be of great convenience to radiologists. Of the many interesting comparisons in the week ending June 23rd, have been rediagnosed given the following may be cited. The lead equivaas small-pox by medical officers of the Ministry of lent of a 12-in. solid concrete floor is about 3 mm. Health and of the Metropolitan Asylums Board, The masses of a steel and a lead plate which afford whose knowledge as experts would receive immediate equal protection against X rays excited by 100,000 acceptance in a calm atmosphere. Difficulty seems to volts are in the ratio of 4 to 1. Different makes have arisen in regard to the distinction between of lead rubber are found to differ by as much chicken-pox and small-pox, largely owing to insufficient as 100 per cent. in protective value. Among the stress being laid on the distribution and simultaneous substances used for tube boxes sheet lead appears to be appearance of the rash and too much importance on the lightest protective material to use, lead rubber the presence of constitutional symptoms ; for, as we being anything from 5 to 25 per cent. heavier. The have already noted, and are glad still to be able to open lead glass bowl, commonly used with X ray note, there has, so far, not been a single fatal case is
interesting
data
concerning
criticised by the authors, who state : " In experience, where this type of shield is aloneemployed, it is often possible to take a radiograph in any part of a room where a tube is working." Concurrently with this research on X ray protection the department has carried out investigations on the intensity of X rays emitted by Coolidge and gastubes when operated by various types of high-tension generator. The work has shown that the intensity of the radiation emitted by an X ray tube is not in all cases proportional to the mean current passing through the tube, when the applied voltage is kept constant. Further, the investigators are led to state that : Considerations of voltage and current wave-forms point to the conclusion that for a given voltage, and when the maximum current is in phasewith the maximum voltage, the intensity of radiation emitted by an X ray tube, whether of the gas or of the hot cathode type, is roughly proportional to the maximum or peak current passing through the tube. This is true both for coil and transformer discharges.’y’ The radiology department is fully alive to the increasing application of higher voltages in medicine and in the study of metallic structures, as is shown by recent acquisition of a 200 kilo volt machine. Doubtless many of the problems involved in the practice of deep therapy will receive due attention at the hands of the director and his assistants. The department of’ sound is growing, and among the exhibits many were THE NATIONAL PHYSICAL LABORATORY. of medical interest-in particular an apparatus for the AT the invitation of the President of the Royal production of sounds of constant intensity and Society a large company gathered at Teddington last telephonic methods for the measurement of sound
this year among all the notified cases of small-pox. This admirable mildness of the disease it is which has encouraged still another local view-namely, that the disease is small-pox, but that it does not matter, the mildness being such as to render the outbreak unimportant from a public health point of view, making it therefore unnecessary to impose limitations on personal liberty in connexion with it. We are glad to think that there is no body of medical opinion included in the first and third groups which we have mentioned, and that the doubt in regard to the diagnosis is honest doubt, bred of the lack of experience in seeing actual cases of small-pox, which is the heritage of the last two generations of medical men. Dr. W. McC. WANKLYN spoke very appropriately to Guy’s medical students last week on this alleged inability of the medical profession to diagnose smallpox, and he laid before them the results of the consultative system of small-pox diagnosis in London and some solid proof of what this system of diagnosis has effected. It is something for which humanity be thankful that one of the worst of infectious may plagues betrays itself early by a characteristic skin eruption which it is not-to use the phrasing of the National Health Insurance Act-beyond the ability of the practitioner of ordinary competence and skill to discover.
week to view the various departments of the National Physical Laboratory. The opportunity of seeing the research and testing departments in full working order and of meeting experts in every branch of physical science, which the occasion afforded, was widely appreciated, and the spacious department of aero-dynamics, with its huge wind tunnels, formed a pleasant setting for the reception. Among the many branches of science flourishing at the laboratory there is, perhaps, none so interesting from the medical point of view as that of radiology. The recommendations of the X Ray and Radium Protection Committee for the better protection and general improvement of the working conditions of X ray operators have resulted in a large number of X ray materials being submitted for test to this
tubes, our
"
intensity.
Certain workers in this field claim that variations of intensity of one million fold can be by the ear, and further by the use of these methods it can be demonstrated that the ear is, incapable of detecting a 10 per cent. change in the intensity of sound. The research in this direction contemplated by the department will be awaited with interest, and might eventually be applicable to stethoscopy. In the multitude of routine tests which are carried out in the various sections there is. evidence in all directions of the ingenuity and thought expended on the minutest details of even the simplest physical determinations. For example, in tests made upon the clinical thermometer, despite the fact that less than 2 per cent. of the number received are rejected, each thermometer is tested at four different;
detected
25
temperatures between 95° and 110° F., its readings at these points being compared with a standard thermometer. The comparison is carried out in an electrically heated water thermostat, in which the " Ne quid nimis." water is kept in very rapid circulation. After the comparison has been made for any one temperature, THE POSTPONED BIRTHDAY HONOURS. the water is raised in temperature a further two-tenths LAST week-end was published the list of honours, of a degree, and readings of the thermometers are again, taken to ensure that they are responsive to conferred on the occasion of the King’s birthday, slight temperature changes. At the present time announcement of which was postponed on account about 1200 thermometers are tested daily in this of the change in Prime Minister. A baronetcy has been conferred upon Sir Anthony Bowlby, K.C.B., manner. Many fascinating exhibits were displayed by the K.C.M.G., K.C.V.O., President of the Royal College of optics division. The colour effects obtained with the Surgeons of England, and knighthoods upon Dr. George Nutting colorimeter were as pleasing as the methods Francis Blacker, C.B.E., Dean of University College for measuring the radii of curvature of microscope Hospital Medical School, and on Lieut.-Colonel objectives were ingenious. The polarimetric and Ewen John Maclean, chairman of the Consultative saccharimetric equipment, together with the apparatus Council of the Welsh Board of Health. A Com-for lens testing, was particularly attractive. Though in mandership of the Order of the British Empire has three fascinating hours only a small part of the been conferred upon Lieut.-Colonel John Southey activities of the laboratory could be witnessed, it was Bostock, R.A.M.C., Director of Medical Services possible to estimate the magnitude of the work of the Ministry of Pensions. To these gentlemen we efficiently dealt with. In the National Physical offer hearty congratulations in the name of the medical Laboratory the nation has an asset of incalculable profession. Other n ames in the list familiar to medicine are those of Sir William Plender, who has done excelvalue.
Annotations.
A SPA FOR THE T.B.M. HARROGATE is making a push to become the place of healthy resort for the tired business man, that ill-defined but frequent product of our present-day city life. With its pleasant subalpine situation and its abundant facilities for the application of the healing virtues of waters and sunshine and fresh air, it is not unreasonable to suppose that the early stages of this real and destructive fatigue may be treated with success. Common experience, indeed, points in this direction, and medicine is primarily concerned with selecting the appropriate cases and eliminating those in which there is already the foundation of serious organic disease. For this Harrogate is well equipped, for it has clinical facilities which can easily be turned into team-work and pathological facilities to detect the early stages of organic malady during a period of time devoted to rest and recreation. Nor does Harrogate cater only for those of abundant means, for, through the Royal Bath Hospital, which has a considerable endowment and is largely supported by the more wealthy visitors, pass every year 2000 or more patients from all parts of England, and arrangements have been made by the local medical profession for the complete examination of cases of moderate means at an inclusive fee. A new Pullman car service has been inaugurated bringing- the bracing northern spa within easy reach of comfortable travel from London and, contrary to foreign practice, two-thirds of the train is put at the disposal of modest purses.
lent work in connexion with the National Health Insurance Act and who becomes a baronet, Mr. Walter Schroder, coroner for Central London, who becomes a Knight Commander of the British Empire, the Rev. Canon Frederick Charles Davies, vicechairman of the Consultative Council of National Health Insurance, Mr. Walter Davies, chairman of the Manchester Hospitals Voluntary Committee, and Mr. Ernest Tom Neathercoat, President of the Pharmaceutical Society (for work in connexion with the Dangerous Drug Regulations), who become Commanders of the Order of the British Empire.
TUBERCULOSIS IN CHILDHOOD. IN the July number of Tubercle there are several original articles and reviews dealing with tuberculosis in childhood. It has been said that if the problem of tuberculosis in childhood were solved, the problem of tuberculosis in the adult would practically cease to exist. In a paper by Dr. C. D. S. Agassiz and Dr. S. Roodhouse Gloyne an account is given of investigations undertaken with a view to determining whether or not the tubercle bacillus can be detected in the blogd-stream in children at or about the time of the primary infection. In the cases chosen for this investigation the signs varied from those of slight involvement of the lymphatic glands to those of disease of the peritoneum or lungs. In the control cases the diagnosis of pulmonary tuberculosis was supported by extensive physical signs and the finding From 1-5 to of tubercle bacilli in the sputum. 10 c.cm. of blood were drawn from a vein, were mixed with a 1-5 per cent. solution of sodium citrate, and were in each case injected into two guinea-pigs. In no case did they develop tuberculosis, although blood obtained from these patients was drawn off INDEX TO " THE LANCET," VOL. I., 1923. both apyrexial and pyrexial periods. It THE Index and Title-page to Vol. I., 1923, which would during thus appear that infection of the blood-stream was completed with the issue of June 30th, will tubercle bacilli in children suffering from tubershortly be published. A copy will be sent gratis to by culosis is not easily demonstrable by the method subscribers on receipt of a post-card addressed to and the following alternative conclusions the Manager of THE LANCET, 1, Bedford-street, described, drawn : That (a) the number of bacilli circulating are Strand, W.C. 2. the blood is too small to be thus demonstrated, (b) they are discharged into the blood-stream only at SMALL-POX IN ENGLAND AND WALES.-During the intervals, or (c) extension of the disease takes place some other route, such as the lymphatic system. week ending June 23rd 141 cases of small-pox were notified by A paper by Prof. P. Bull, of Christiania, contains a in England and Wales, the distribution being as follows : Derbyshire 12 (Alfreton 1, Belper 1, Heanor 4, Long Eaton 5, tale of an instructive mistake. A boy, aged 3, was C’lown R.D. 1) ; Durham 1 (Stockton-on-Tees) ; Gloucester- supposed to be suffering from malignant disease of shire 90 (Gloucester 79, including 31 cases notified as chicken- one testicle and metastases in the abdominal cavity. pox but rediagnosed as small-pox, Cheltenham 1, Stroud 2,Laparotomy revealed no free peritoneal cavity; Westbury-on-Severn 1, East Dean R.D. 4, Gloucester R.D. 3); wherever he explored, Prof. Bull only found a curious Herefordshire 1 (Hereford) ; Nottinghamshire 21 (Kirkby-ingreyish substance which seemed to have permeated Ashfield 6, Warsop 15) ; Warwickshire 1 (Birmingham) ; the peritoneum, omentum, and neighbouring struc1 Worcestershire 1 (Martley R.D.) ; Yorks North Riding Still thinking that the case was one of malignant tures. (Middlesbrough); Yorks West Riding 12 (Bentley-withand therefore practically hopeless, he thrust , disease, Arksay 2, Doncaster R.D. 10); Monmouthshire 1 (Risca).
I in