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ARSENIC IN BEER : ACTION FOR DAMAGES.
379 to which they are legally entitled for wrongful dismissal and for public discredit, while the public will turn an observant eye on the manner in which the affairs of the Metropolitan Asylums Board are managed. We all know of the grave waste of money that has taken place in certain of the building operations of the Board and can quite understand that economy is a necessity, but we do not appreciate in what way the cause of economy will be served by under-staffing the hospitals of the Board or by ’, attempting to obtain the unpaid assistance of young gentlemen who cannot have had any opportunities of learning I their duties. The economy of the Board will appear very doubtful when, as may be likely if the present course is persisted in, it is again compelled to invite the assistance of the medical profession, only to find that no one cares to go to the aid, at any rate without very high pay, of a body the gratitude of which is so fleeting. The Board will presumably take legal advice about the claims of those of its assistant medical officers who know that they have been treated illegally as well as meanly. Even if the Board should be recommended by its lawyers to contest the claims we hold that it would be wiser to reinstate the dismissed officers. For otherwise we foresee that the Board will find it very difficult to obtain medical service.
everything
THE SURGERY OF CEREBRAL TUMOURS. THE reaction which followed the indiscriminate resort to for cerebral tumours 15 years ago which was stimulated by the publication of the successful cases of Horsley and Godlee, has led to an ultra-conservative attitude towards operation by many neurological surgeons and physicians. The proportion of cases of cerebral tumour suitable for radical surgical treatment has been estimated by various writers at from 2 to 12 per cent. According to Allen ’Starr about 7 per cent. of all cases of cerebral tumour are operable. With improvements in the methods of cerebral localisation and of technique during recent years operation has become safer and the proportion of operable cases has increased to a slight extent. In the American Journal of the Medical Sciences for December, 1903, Dr. George Woolsey of New York gives an account of the lessons to be drawn from the recorded cases of cerebral tumours (including five cases personally observed) operated on and reported during the past five years-a total of 101 cases-with a view to determine whether the results do not justify a less conservative attitude towards their operative treatment. The cases reported in the five years (since 1898) indicate, adds Dr. Woolsey, "that a more hopeful view may be taken of the surgery of cerebral tumours." In the series of 101 collected cases 12 showed the presence of cerebral tumours in the frontal region, including the so-called motor area. In eight of these the tumours were in the prefrontal lobe and presented the characteristic group of physical and mental symptoms, of which a ’special account was given in THE LANCETsome years ago. Since then Schuster has published an analysis of 775 cases of tumour of the brain accompanied by psychic disturbances and has shown that tumours of the pre-frontal lobe produce dementia and moral deterioration more often than tumours elsewhere in the cerebrum. Gianelli and von Bruns have also referred to the special mental disturbance accompanying such lesions of the All of the eight cases of tumour limited to the brain. prefrontal lobe only, which were collected by Dr. Woolsey, showed, irrespectively of the side involved, symptoms of Jnental disorder and moral perversion. In the parietal five of All these cases tumour were recorded. region presented definite localising symptoms and in four of them these symptoms included astereognosis. Three cases of
operation
1
The
THE
Symptoms of Tumours of the Frontal Lobe LANCET, June 29th, 1901, p. 1848.
of the
Brain,
tumour occurred in the occipital lobe of the brain. In all there was homonymous hemianopsia which, says von Bruns, alone or associated with signs of visual irritation or hallucinations or of word-blindness is characteristic of tumour of the occipital lobe. This is confirmed by the cases collected by Dr. Woolsey who sums up his conclusion in terms to the effect that tumours in the prefrontal, parietal, and occipital areas are as localisable and operable as tumours of the Rolandic or " motorarea, and that the results of operation in the former have been quite as
three
in the latter.
The number also of operations than the motor area has other regions in increased the last five largely years and the results justify the extension of surgical operation to regions outside the motor area. Summarising the diagnostic features of cerebral tumours Dr. Woolsey states that persistent headache is the most constant symptom and that it occurred in 90 per cent. of the collected cases. Early optic neuritis ("choked disc") was mentioned as present in 84 per cent. Vomiting and vertigo were present respectively in 33 per cent. and 22 per cent. of the cases. In addition to these general symptoms and to the special localising symptomslocal paralysis and tenderness to local pressure on the scalp -the importance of the x rays in diagnosis is insisted on. In many cases the results have been positive and justify the use of this method. The indications for operation are imperative, says Dr. Woolsey, when the tumour can be satisfactorily located in a region accessible to surgical operation and when there is no evidence that the growth is multiple or malignant in nature. The weight of evidence was also in favour of operation upon gummata of the brain, since antisyphilitic treatment might temporarily improve the symptoms but rarely, if ever, caused the entire absorption of the gumma. When severe headache and rapid loss of vision were noted, but localising symptoms were absent, trephining was advised as a palliative measure to give relief, which was often considerable, to the patient. But the temptation to make exploratory incisions or punctures in search of the tumour should, says Dr. Woolsey, be resisted. As regards prognosis the mortality in all cases operated on for cerebral tumour, according to the statistics of Chipault and of Allen Starr, was about 56 per cent. Selecting the cases in his records where an exact localisation was made Dr. Woolsey finds that the mortality was 22 7 per cent., as against 46 per cent. among the cases In palliative operations and where not exactly localised. the tumour cannot be found it is advised that the bone should be removed from the flap to relieve intracranial pressure and that a thin plate of celluloid should be introduced to prevent union of the scalp with the dura mater. The results varied, concludes Dr. Woolsey, from a nearly complete cure to the relief of the distressing pressure symptoms but in 6 per cent. of the cases no improvement followed.
good on
as
tumours in
____
ARSENIC
IN
BEER :
ACTION
FOR
DAMAGES.
IN the action brought by Messrs. Bostock. and Co. of firm who supplied sugar contaminated with arsenic to brewers for making beer which caused an epidemic of arsenical poisoning) against Messrs. John Nicholson and Sons of Leeds to recover damages for supplying sulphuric acid containing arsenic judgment was given in favour of the plaintiffs, but the questions of damages and as to how judgment should be entered were deferred. The case presents, of course, many points of interest in connexion with the supply of uncontaminated food which it will be proper for us to discuss at a future time. The award not having been given it is not possible to say to what in effect the judgment amounts. Mr. Justice Bruce decided that there was a contract for the
Liverpool (the
380 sale of "B.O.V." which meant between the plaintiffs They caused atrophy of the nerves involved. Sternberg,. and the defendants an acid free from arsenic, so that believed that these tumours arose from embryonic "rests" when "B.O.V."was delivered in March, 1900, containing of the dorsal cranial nerves-viz., the trigeminal, acousticoarsenic there was a breach of the implied condition. He facial, and vago glossopharyngeal-all of which arise in the further expressed the opinion, however, that the plaintiffs’ embryo from the dorsal lip of the neural ridge of epiblast. chemists ought, as part of their duties, to have discovered Early focal symptoms referable to a single cranial nerve arsenic in both the acid and the sugar, while the change in appear during the growth of such tumours, the symptoms the colour of the acid supplied in March, 1900, which led to being slight in intensity and long in duration owing to the the mischief, ought to have aroused suspicion. The con- benign nature of the growth. They include tinnitus aurium, sideration of these facts will no doubt affect his lordship’s progressive diminution of hearing, attacks of labyrinthine decision as to the damages awarded, the amount claimed vertigo, and occasional attacks of facial neuralgia. As the being 300,000. growth increases symptoms of pressure on the neighbouring parts are manifested, such as ataxia of the cerebellar or STREET NOISES. peduncular type, nystagmus, irregularities of size and AT length the legal worm has turned and in saying this we reaction of the pupils, ophthalmoplegia externa, dysarthria, hope that Mr. Sheil and Police-Constable 208 B will forgive dysphagia, facial paralysis, and disturbances of cardiac The diagnosis depends on the On Jan. 30th four able-bodied labourers appeared and respiratory functions. us. before Mr. Sheil charged by the constable in question with presence of the above symptoms combined with headache placing themselves in a public thoroughfare for the purpose and optic neuritis. Owing to their proximity to the vital of gathering alms. They had a barrel organ on which was centres in the bulb these tumours share the fatal prognosis suspended a card with the words "Out of workinscribed of other severe lesions of the posterior fossa. Hence rethereon. The constable took them into custody and Mr. Sheil moval by surgical methods offers the only hope of saving gave to each of them one month’s hard labour. He added life and Professor Fraenkel and Dr. Hunt state that their that if they came before him again they would have three necropsies have shown that in some cases such growths months. We do not in the least cavil at the sentence but would be accessible to surgical operation and that trephining in any case, even when the tumour is inaccessible, would we wish that the magistrate had made it more clear for what offence the men were sentenced. Organs, both piano give considerable relief of symptoms. Of the five cases two and barrel, are only too common and, as one of the were in males, aged 40 and 41 years respectively, and three prisoners pertinently remarked on being taken into custody," were in females, aged 40, 42, and 51 years respectively, all ’ The locality of the tumours was in all cases Russians. Why shouldn’t we play an organ as well as the Italians ? We confess that we can only repeat the question. If four nearly identical-viz., the recess formed by the junction of the pons, bulb, and lateral lobe of the cerebellum. The men can be arrested for going about with an organ bearalms a to solicit should not the Italian certainty of localisation, the essentially benign nature of why ing placard the growth, and the loose attachment of the tumours to the or Briton who does the same minus the placard be also arrested and get a month’s imprisonment ?7 Yet time cerebral meninges and nerve trunks, conclude Professor after time magistrates have told us that the aggrieved Fraenkel and Dr. Hunt, distinguish this group of intrabrain-worker cannot order an organ away unless he has cranial tumours as a most favourable one for surgical sickness in his house or is prepared to give some other interference. reason than that he simply does not want the organ to play. "THE WHITE MAN’S BURDEN." All persons who play organs in the streets 6°place themselves in a public thoroughfare for the purpose of gathering alms," THE acquisition of oversea dominions by the United States and we are quite willing to allow that in some places they of America has had the effiJct of rapidly increasing the But in the Strand, for instance, no one wants are welcome. of several administrative problems. Questions importance them and in the quieter residential districts it will be a of public health could not fail to be one of these, for the boon to the householder if he can ask a constable to arrest new possessions are entirely tropical and the political incontinently the player of a piano organ if he refuses to readjustments involve the maintenance of a considerable go away. Then London will be a somewhat less wearisome navy. It is true that most of the tropical diseases are place to live in than it is at present. But we must confess found in the Southern States, although the coast-line, with that Mr. Sheil’s action puzzles us. New Orleans and Galveston as the chief towns, lies well to the north of the geographical limit of the tropics, but NEURO-FIBROMATOUS TUMOURS OF THE the loss by invaliding and deaths from disease among the BRAIN. national forces during and since the war with Spain has Professor Joseph Fraenkel and Dr. J. Ramsay Hunt of considerably enlightened the -public mind as to some of the New York contribute to the Medieal Record of Dec. 26th, responsibilities which have been undertaken. An American 1903, an account of an interesting group of cases of cerebral Society of Tropical Medicine has been formed and its tumour characterised by the development of neuro-fibromata first public meeting was held at Houston Hall of the Union the cranial nerves situated in the ponto-bulbar region versity of Pennsylvania, Philadelphia, on Jan. 9th, Dr. within the posterior fossa of the skull. The occurrence of James M. Anders, a vice-president of the society, being in such tumours is uncommon and they have hitherto been the chair. A brief statement of the scope and workings of regarded as beyond the reach of surgical operation. It is the society was made by the secretary, after which the only recently that precise knowledge has been obtained of speaker of the evening, Dr. James Carroll, of the United these growths. Thus in 1902 von Monakow reported three States Army and a former member of the commission cases in which the anatomical and clinical features were appointed by the Surgeon-General of the United States to accurately stated and called attention to the possibility of investigate yellow fever at Havana, Cuba, gave an address surgical operation. Professor Fraenkel and Dr. Hunt record upon the Etiology of Yellow Fever. Dr. Carroll reviewed in five cases with necropsies of such neuro-fibromata. Three an interesting manner the early researches upon the etiology of these affected the auditory nerve on one side, one of the disease, giving special consideration to the work of affected the trigeminal nerve, and the fifth involved Freire, Sanarelli, and Finlay ; he then reviewed the work both auditory nerves. The tumours were encapsuled and of the commission, the res6ae;çbe,-, 9ft) BVhichJJIole,< )i.qpwn was no reason varied in size from that of a cherry to that of -a; lien’s egg.everywhere, and maintained *%hat’the
____
everything
THE SURGERY OF CEREBRAL TUMOURS. THE reaction which followed the indiscriminate resort to for cerebral tumours 15 years ago which was stimulated by the publication of the successful cases of Horsley and Godlee, has led to an ultra-conservative attitude towards operation by many neurological surgeons and physicians. The proportion of cases of cerebral tumour suitable for radical surgical treatment has been estimated by various writers at from 2 to 12 per cent. According to Allen ’Starr about 7 per cent. of all cases of cerebral tumour are operable. With improvements in the methods of cerebral localisation and of technique during recent years operation has become safer and the proportion of operable cases has increased to a slight extent. In the American Journal of the Medical Sciences for December, 1903, Dr. George Woolsey of New York gives an account of the lessons to be drawn from the recorded cases of cerebral tumours (including five cases personally observed) operated on and reported during the past five years-a total of 101 cases-with a view to determine whether the results do not justify a less conservative attitude towards their operative treatment. The cases reported in the five years (since 1898) indicate, adds Dr. Woolsey, "that a more hopeful view may be taken of the surgery of cerebral tumours." In the series of 101 collected cases 12 showed the presence of cerebral tumours in the frontal region, including the so-called motor area. In eight of these the tumours were in the prefrontal lobe and presented the characteristic group of physical and mental symptoms, of which a ’special account was given in THE LANCETsome years ago. Since then Schuster has published an analysis of 775 cases of tumour of the brain accompanied by psychic disturbances and has shown that tumours of the pre-frontal lobe produce dementia and moral deterioration more often than tumours elsewhere in the cerebrum. Gianelli and von Bruns have also referred to the special mental disturbance accompanying such lesions of the All of the eight cases of tumour limited to the brain. prefrontal lobe only, which were collected by Dr. Woolsey, showed, irrespectively of the side involved, symptoms of Jnental disorder and moral perversion. In the parietal five of All these cases tumour were recorded. region presented definite localising symptoms and in four of them these symptoms included astereognosis. Three cases of
operation
1
The
THE
Symptoms of Tumours of the Frontal Lobe LANCET, June 29th, 1901, p. 1848.
of the
Brain,
tumour occurred in the occipital lobe of the brain. In all there was homonymous hemianopsia which, says von Bruns, alone or associated with signs of visual irritation or hallucinations or of word-blindness is characteristic of tumour of the occipital lobe. This is confirmed by the cases collected by Dr. Woolsey who sums up his conclusion in terms to the effect that tumours in the prefrontal, parietal, and occipital areas are as localisable and operable as tumours of the Rolandic or " motorarea, and that the results of operation in the former have been quite as
three
in the latter.
The number also of operations than the motor area has other regions in increased the last five largely years and the results justify the extension of surgical operation to regions outside the motor area. Summarising the diagnostic features of cerebral tumours Dr. Woolsey states that persistent headache is the most constant symptom and that it occurred in 90 per cent. of the collected cases. Early optic neuritis ("choked disc") was mentioned as present in 84 per cent. Vomiting and vertigo were present respectively in 33 per cent. and 22 per cent. of the cases. In addition to these general symptoms and to the special localising symptomslocal paralysis and tenderness to local pressure on the scalp -the importance of the x rays in diagnosis is insisted on. In many cases the results have been positive and justify the use of this method. The indications for operation are imperative, says Dr. Woolsey, when the tumour can be satisfactorily located in a region accessible to surgical operation and when there is no evidence that the growth is multiple or malignant in nature. The weight of evidence was also in favour of operation upon gummata of the brain, since antisyphilitic treatment might temporarily improve the symptoms but rarely, if ever, caused the entire absorption of the gumma. When severe headache and rapid loss of vision were noted, but localising symptoms were absent, trephining was advised as a palliative measure to give relief, which was often considerable, to the patient. But the temptation to make exploratory incisions or punctures in search of the tumour should, says Dr. Woolsey, be resisted. As regards prognosis the mortality in all cases operated on for cerebral tumour, according to the statistics of Chipault and of Allen Starr, was about 56 per cent. Selecting the cases in his records where an exact localisation was made Dr. Woolsey finds that the mortality was 22 7 per cent., as against 46 per cent. among the cases In palliative operations and where not exactly localised. the tumour cannot be found it is advised that the bone should be removed from the flap to relieve intracranial pressure and that a thin plate of celluloid should be introduced to prevent union of the scalp with the dura mater. The results varied, concludes Dr. Woolsey, from a nearly complete cure to the relief of the distressing pressure symptoms but in 6 per cent. of the cases no improvement followed.
good on
as
tumours in
____
ARSENIC
IN
BEER :
ACTION
FOR
DAMAGES.
IN the action brought by Messrs. Bostock. and Co. of firm who supplied sugar contaminated with arsenic to brewers for making beer which caused an epidemic of arsenical poisoning) against Messrs. John Nicholson and Sons of Leeds to recover damages for supplying sulphuric acid containing arsenic judgment was given in favour of the plaintiffs, but the questions of damages and as to how judgment should be entered were deferred. The case presents, of course, many points of interest in connexion with the supply of uncontaminated food which it will be proper for us to discuss at a future time. The award not having been given it is not possible to say to what in effect the judgment amounts. Mr. Justice Bruce decided that there was a contract for the
Liverpool (the
380 sale of "B.O.V." which meant between the plaintiffs They caused atrophy of the nerves involved. Sternberg,. and the defendants an acid free from arsenic, so that believed that these tumours arose from embryonic "rests" when "B.O.V."was delivered in March, 1900, containing of the dorsal cranial nerves-viz., the trigeminal, acousticoarsenic there was a breach of the implied condition. He facial, and vago glossopharyngeal-all of which arise in the further expressed the opinion, however, that the plaintiffs’ embryo from the dorsal lip of the neural ridge of epiblast. chemists ought, as part of their duties, to have discovered Early focal symptoms referable to a single cranial nerve arsenic in both the acid and the sugar, while the change in appear during the growth of such tumours, the symptoms the colour of the acid supplied in March, 1900, which led to being slight in intensity and long in duration owing to the the mischief, ought to have aroused suspicion. The con- benign nature of the growth. They include tinnitus aurium, sideration of these facts will no doubt affect his lordship’s progressive diminution of hearing, attacks of labyrinthine decision as to the damages awarded, the amount claimed vertigo, and occasional attacks of facial neuralgia. As the being 300,000. growth increases symptoms of pressure on the neighbouring parts are manifested, such as ataxia of the cerebellar or STREET NOISES. peduncular type, nystagmus, irregularities of size and AT length the legal worm has turned and in saying this we reaction of the pupils, ophthalmoplegia externa, dysarthria, hope that Mr. Sheil and Police-Constable 208 B will forgive dysphagia, facial paralysis, and disturbances of cardiac The diagnosis depends on the On Jan. 30th four able-bodied labourers appeared and respiratory functions. us. before Mr. Sheil charged by the constable in question with presence of the above symptoms combined with headache placing themselves in a public thoroughfare for the purpose and optic neuritis. Owing to their proximity to the vital of gathering alms. They had a barrel organ on which was centres in the bulb these tumours share the fatal prognosis suspended a card with the words "Out of workinscribed of other severe lesions of the posterior fossa. Hence rethereon. The constable took them into custody and Mr. Sheil moval by surgical methods offers the only hope of saving gave to each of them one month’s hard labour. He added life and Professor Fraenkel and Dr. Hunt state that their that if they came before him again they would have three necropsies have shown that in some cases such growths months. We do not in the least cavil at the sentence but would be accessible to surgical operation and that trephining in any case, even when the tumour is inaccessible, would we wish that the magistrate had made it more clear for what offence the men were sentenced. Organs, both piano give considerable relief of symptoms. Of the five cases two and barrel, are only too common and, as one of the were in males, aged 40 and 41 years respectively, and three prisoners pertinently remarked on being taken into custody," were in females, aged 40, 42, and 51 years respectively, all ’ The locality of the tumours was in all cases Russians. Why shouldn’t we play an organ as well as the Italians ? We confess that we can only repeat the question. If four nearly identical-viz., the recess formed by the junction of the pons, bulb, and lateral lobe of the cerebellum. The men can be arrested for going about with an organ bearalms a to solicit should not the Italian certainty of localisation, the essentially benign nature of why ing placard the growth, and the loose attachment of the tumours to the or Briton who does the same minus the placard be also arrested and get a month’s imprisonment ?7 Yet time cerebral meninges and nerve trunks, conclude Professor after time magistrates have told us that the aggrieved Fraenkel and Dr. Hunt, distinguish this group of intrabrain-worker cannot order an organ away unless he has cranial tumours as a most favourable one for surgical sickness in his house or is prepared to give some other interference. reason than that he simply does not want the organ to play. "THE WHITE MAN’S BURDEN." All persons who play organs in the streets 6°place themselves in a public thoroughfare for the purpose of gathering alms," THE acquisition of oversea dominions by the United States and we are quite willing to allow that in some places they of America has had the effiJct of rapidly increasing the But in the Strand, for instance, no one wants are welcome. of several administrative problems. Questions importance them and in the quieter residential districts it will be a of public health could not fail to be one of these, for the boon to the householder if he can ask a constable to arrest new possessions are entirely tropical and the political incontinently the player of a piano organ if he refuses to readjustments involve the maintenance of a considerable go away. Then London will be a somewhat less wearisome navy. It is true that most of the tropical diseases are place to live in than it is at present. But we must confess found in the Southern States, although the coast-line, with that Mr. Sheil’s action puzzles us. New Orleans and Galveston as the chief towns, lies well to the north of the geographical limit of the tropics, but NEURO-FIBROMATOUS TUMOURS OF THE the loss by invaliding and deaths from disease among the BRAIN. national forces during and since the war with Spain has Professor Joseph Fraenkel and Dr. J. Ramsay Hunt of considerably enlightened the -public mind as to some of the New York contribute to the Medieal Record of Dec. 26th, responsibilities which have been undertaken. An American 1903, an account of an interesting group of cases of cerebral Society of Tropical Medicine has been formed and its tumour characterised by the development of neuro-fibromata first public meeting was held at Houston Hall of the Union the cranial nerves situated in the ponto-bulbar region versity of Pennsylvania, Philadelphia, on Jan. 9th, Dr. within the posterior fossa of the skull. The occurrence of James M. Anders, a vice-president of the society, being in such tumours is uncommon and they have hitherto been the chair. A brief statement of the scope and workings of regarded as beyond the reach of surgical operation. It is the society was made by the secretary, after which the only recently that precise knowledge has been obtained of speaker of the evening, Dr. James Carroll, of the United these growths. Thus in 1902 von Monakow reported three States Army and a former member of the commission cases in which the anatomical and clinical features were appointed by the Surgeon-General of the United States to accurately stated and called attention to the possibility of investigate yellow fever at Havana, Cuba, gave an address surgical operation. Professor Fraenkel and Dr. Hunt record upon the Etiology of Yellow Fever. Dr. Carroll reviewed in five cases with necropsies of such neuro-fibromata. Three an interesting manner the early researches upon the etiology of these affected the auditory nerve on one side, one of the disease, giving special consideration to the work of affected the trigeminal nerve, and the fifth involved Freire, Sanarelli, and Finlay ; he then reviewed the work both auditory nerves. The tumours were encapsuled and of the commission, the res6ae;çbe,-, 9ft) BVhichJJIole,< )i.qpwn was no reason varied in size from that of a cherry to that of -a; lien’s egg.everywhere, and maintained *%hat’the
____