A CERTIFICATE OF THE CAUSE OF DEATH FOLLOWED BY AN INQUEST.

243 The furnished by the University of London contingent of the tthis useful reform will be indefinitely postponed. The Hon. W. F. D. Smith, M.P., cobject of the Bill is to impose an obligation upon asylum Officers’ Training Corps. s to grant superannuation allowances to their chairman of the committee, and the generous donor of the authorities c and servants upon a fixed scale. At present the 12 acres of land on which the new hospital will stand, pre- officers of such allowances is sented an address to His Majesty, stating that 600 beds willgranting i discretionary, and though which will in the new also have it is those felt concerned that it would building, widely practised by be:accommodated 30 ( a of acres of people’s park adjoining its distinctly improve the status of asylum workers and attract the:advantage side. The approval of the King Edward’s Hospital Fund1the right sort of individual to the service of the insane if the were not at discretion but of statutory obligation. for the removal scheme had been shown by a gift of .637,000. grants j1 His Majesty, replying in his usual felicitous terms, fully en-By the provisions of the Bill the amounts of the grants will dorsed the action of the Fund associated with his name. differ according to the nature of the employment and the " Your committee’s decision to abandon the old building,"he period of approved service, while provision is made for consaid, " and to remove the scene of your labours to a poorer tributions from officers and servants. The supporters of the and more populous district, where the need for a hospital was Bill are of opinion that no additional burden will be put great and the field for its work wide, was a b old step, but I upon the rates, and indeed that the system of contribution believe it was a wise and right one, and I congratulate the will materially reduce the expenditure upon pensions. The medical and nursing staff on the great opportunity thus Bill was referred to at the eleventh annual meeting of the given them for increased usefulness. The generous response Asylum Workers’ Association which was held on July 14th, made to the committee’s appeal for funds shows how their and at which Sir William Collins, who was in the chair, was In moving the decision has been appreciated by the public." He recalled with re-elected President of the Association. of the he himself report expressed strongly in gratitude the past work of the hospital and mentioned with adoption honour the great career of Lord Lister within its walls, "who, favour of the Bill, which was supported even more strongly in introducing the antiseptic methods in surgery, rendered an by his seconder, Mr. C. Roberts, M.P., an honorary Cominestimable service to England and to all mankind." After missioner in Lunacy, who said that the whole of the commending the financial needs of the hospital to the Lunacy Commission was in favour of its adoption. A benevolent, His Majesty concluded his speech with these Bill that at once confers a boon upon a highly deserving words: "Iassure you of my continued interest in your class and is likely to reduce the rates appears to us one hospital and of the sympathy with which I shall watch worthy of high commendation, and we hope that a few its future progress. I cannot doubt that the blessing ofminutes of the public time may be spared to effect the will attend the work to be done by it in itsI passage of so excellent a measure. Almighty God " The King then laid the foundation-stone and new home." the Benediction was pronounced by the Bishop of Southwark, CERTIFICATE OF THE CAUSE OF DEATH FOLLOWED BY AN INQUEST. the ceremony concluding with a number of presentations to His Majesty. The committee of King’s College Hospital is to) A DISCUSSION of an unusual kind has taken place at be warmly congratulated on having passed such an importantG Newcastle-upon-Tyne between a medical practitioner and milestone on the path of its long and anxious labours, and1 a coroner, and has been accorded publicity by the local we cannot doubt of the wisdom of the steps it has taken. The3 newspapers. Dr. F. C. Coley was consulted by a man, removal of the hospital will not only be the means of renderingS aged 70 years, a builder by trade, who described his its benefits easily accessible to a far larger poor populationn symptoms to him and submitted himself to examinathan it serves conveniently at present, but the extension off tion. Dr. Coley saw his patient twice during a period its beds will form a noteworthy addition to the alreadyy of 12 months, the last occasion being on May 28th, unrivalled field of clinical opportunities at the disposal ofIf and formed the opinion that he had suffered from the London student. This educational function of a generall mild attacks of angina pectoris. On June 28th the hospital had always been kept in mind by the governing relatives informed the medical man that his patient body of King’s, which, indeed, was founded by the councilII had been found dead in his bed, adding particulars ’s of King’s College with that end chiefly in view, as witness to the effect that he had been fatigued on the )r the following extract from the council’s minute book for previous day and had had to hurry to catch a train. In 1839: "The council of King’s College, finding that hossthese circumstances Dr. Coley gave a certificate assigning pital practice in connexion with and in the vicinity of)f angina pectoris as the cause of death. The attention of the the said college was indispensable for the complete Ge coroner was called to the case, and he decided to hold an ir education of its medical students, did, in the year inquest, being apparently of the opinion that owing to the 1839, take measures for the formation, in the parish of St.t. interval of a month which had elapsed since the last visit to Clement Danes, in the county of Middlesex, of a public ic the medical man a certificate ought not to have been granted. hospital for the relief of poor, sick, and infirm persons, to b{due At the inquest Dr. W. F. Wilson, who had made a postsupported by voluntary contributions, and to which th{e mortem examination, expressed the opinion that death was students of medicine and surgery belonging to the sai( id due to "heart failure brought on by heart disease," and college might, under proper regulations, for ever havlve the jury returned a verdict of Death from heart failure," access." These objects have not been forgotten, and thosl further expressing the opinion that Dr. Coley was not justified who support liberally the appeal for a further sum of S75,00< 00 in giving a certificate of the cause of death in the circumwhich the committee is now making will not only assist a stances. It is hardly necessary to point out that Dr. Coley worthy charity but will be forwarding the interests of a,an was perfectly within his rights in giving a certificate if the important school of medicine of the University of London. conditions described to him under which his patient died coincided with the state of his health observed a month ASYLUM OFFICERS’ SUPERANNUATION BILL. before, and that the blame which the coroner allowed the jury THE Asylum Officers’ Superannuation Bill has passed t( impute was quite undeserved. The case is unusual because led to t] far more frequent cause of complaint against medical men its second reading in the House of Commons and is now the ow arises out of the withholding of certificates which cannot before a Select Committee. In the present condition of a it House seems c in the little that tiat business conscientiously be granted, but which in the opinion of the likely public or the jury would save the necessity of an inquest. and too c coroner become will hat the Bill law, only probable

south

A

Ise

that

244 It is

Rochester, New York, Boston, and Washington, in. Bordeaux, Paris, Berlin, and Frankfort-on-the-Main the mortality from this disease is very considerable. It is also said to be specially common in Bengal, Ceylon, Siam, andTunis. Certain races appear specially liable to suffer, notably Jews, Hindus, and Maltese ; on the other hand, the

matter of regret that the coroner at Newcastle-uponashould have allowed the jury to append the rider t(;0 Tyne their verdict, although in holding an inquest he acted witl,h perfect propriety if he considered that there was reason t( suspect the death to be a sudden one of which the cause Wa! unknown. Possibly he would not have held it if he hacd first consulted the medical man. By doing so he would,i, no doubt, have obtained information which would have e explained the case, but which would have been out of placee in the death certificate. The circumstances, however, aree peculiar, as generally a death certificate cannot be safelyy given by a medical man when some time has elapsed sincee the deceased was last seen professionally. a

THE STATE OF BRENTFORD HIGH STREET. WE have received the first number of the West London lllust’l’ated Advertiser, an enterprising little paper devoted to) the affairs of the western suburbs, and we have had our attention specially called to an article concerning the state off Brentford High-street under the heading"A National Disgrace." We are able to endorse this estimate of an importantt road, which is one of the main arteries of traffic outt of London. The article in question contains reproductions9 of photographs showing the intolerable state of congestion1 which is a daily, almost an hourly, occurrence in the long and narrow High-street that forms the chief feature ofE Brentford town. They show a confusion of vans, motorcars, private carriages, and electric tram-cars, which1 utterly defies the authority of the policeman’s regulating arm, and which, in the event of any circumstance that may attract an extraordinary amount of traffic, renders’ the road nearly impassable. The street had always been a bad one, but since the electric cars have monopolised the greater part of its surface it has become a grave danger to’ the foot passenger who has to cross it, and since it gives’ access to the Staines and Windsor district it interferes withI the comfort and safety of many cyclists. There is, moreover, a considerable risk of damage to any private motor-car or carriage that may becom e involved in the nielie that nominally exists. But perhaps the most serious danger to the public during these continual impaqses is that of fire, for if the services of the fire-brigade should be needed in the Highstreet no engine could make its way through such a block. The West London illustrated Advertiser has done a good service in calling attention to the existing state of affairs in so graphic a manner. We learn that the people of Brentford met five years ago to discuss a remedy, and it is certainly high time that they found one.

f -

-

THE GEOGRAPHICAL DISTRIBUTION OF MELLITUS.

DIABETES

interesting paper by Dr. R. T. Williamson, of which a reprint, published in the Medical Chronicle for July, some noteworthy conclusions are arrived at as a result of the study of statistics of diabetes in various parts of the world. The mortality from diabetes has increased markedly in England during the last 30 years-in 1866 it was 32 per million living ; in 1886, 59 ; and in 1906, 97. The increase in mortality has been greater among women. In Oxfordshire the mortality appears to be a little higher than for the country generally. In Scotland and Ireland the mortality is less than in England, but the rate in Edinburgh is higher than in London, while that in Dublin is considerably lower. In some parts of the world the mortality from diabetes is much greater than in England-e.g., in Malta, where it reaches 37’8per 100,000, compared with 9-6in England and Wales. In many of the large towns of the United States of America-viz., Worcester, Syracuse, IN

we

an

have received

I

Chinese who adhere to their native diet and modes of life rarely suffer. In regard to the Jews, the statistics of Budapest, 23’ 5 per cent. of the population of which are. Jews, show that in 1906 53’ 6 per cent. of the deaths from diabetes occurred among them, or, expressed in another form, six deaths from diabetes occurred amongst the Jews to every one death from this disease amongst those of other faiths. In Frankfort-on-the-Main a similar preponderance of diabetes amongst the Jews is said to occur. It is chiefly among the Jews who are wealthy or in good circumstances and among those who are stout or well nourished that the disease occurs, but not exclusively. Negroes suffer less frequently than the white races. In Australia the mortality is greatest in the colony of Victoria, where it is 11 per 100,000; in New South Wales it is much less. Dr. Williamson gives many other interesting statistics of the disease in various parts of the world, and in reviewing them points out that they suggest various questions-as to the part played in the production of this increase in the disease and its mortality by the great mental strain of modern life, and the consumption of excessive quantities of sugar, sweet foods, wines, and alcoholic or temperance beers. He also asks if the use of beet sugar instead of cane sugar may be a factor since the manufacture of beet sugar has increased enormously during recent years. He admits that these questions cannot be answered at the present time, but expresses the hope: that his paper may lead to the collection and publica. tion of information likely to throw light on these matters by those with special opportunities of observing the disease, such as British medical men practising in foreign lands and distant colonies. ___

ANGINA PECTORIS. WE have received a brochure on angina pectoris from Dr. H. Walter Verdon. After a discussion of the innervation of the heart and blood-vessels, he arrives at the conclusion that whereas under the influence of increased pressure the cardiac muscle becomes hypertrophic and the muscles of the arterioles retain their power, the muscular tissue of the aorta suffers degenerative change and loss of its reserve force. As. a result of prolonged increase of pressure a stage " is reached when vaso-constriction in the cephalo-enteric region, accompanied by an excursion of blood pressure above the standard scale normal to the individual, results in strain of aortic muscle." This strain is regarded as acting upon the endings of antidromic nerves, resulting in the production of anginal’ pain. The strain is regarded as the effect of a disturbance in the ratio normally existing between the lateral pressure of£ the blood-stream and the " resistile " capacity of the, arterial’ wall, and therefore the relative pressure rather than the actual height of pressure is the determining factor. Dr. Verdon recognises two distinct classes of cases : one in which arterio-sclerosis of the visceral stream bed exists, constituting the organic type ; the other, in which there is no organic disease but disturbances of the nerve centres controlling the calibre of the vessels, leading to more or less maintained elevation of blood-vessels, the functional type. This latter type is said to be always associated with, and to result from, chronic acid dyspepsia. In the treatment of this class of case an " all-meat " dietary is advised ; in other words, the exclusion of sugars and starches. In conjunction with this diet, iodide of potassium is recommended, taken in small doses over long periods. The " all-meatdietary is justified