Case of Brassworkers' ague

416

CASE

OF

B R A S S W O R K E R S ' AGUE.

Of outbreaks of innocent syphilis connected with lactation there are many instances. Perhaps the most pathetic is one in ~8z6 at Wilbedessen in Westphalia, where many mothers who gave of their milk to suckle a strange child were rewarded for their Christian charity by this horrible disease. A strange nurseling, the bastard of a soldier, was brought to the village by its mother, and as she could net nurse it, a number of other nursing mothers undertook this, with the result that over 20 acquired syphilis. Glass blowing and Eustachian catheterisation have also caused small outbreaks of syphilis. The outbreaks of syphilis due to tattooing and skin grafting are too well known to need more than mention, After describing the various .epidemics of innocent syphilis, Dr. Bulkley gives a most interesting description of 16 endemic diseases in different parts of the world which, he states, have been shown to be caused by the syphilitic poison. Among these figure Frambcesia or Yaws, and the Aleppo Evil or Delhi sore. Infection by surgical instruments has been already mentioned under the head of tattooing and cupping. In these instances the operator's saliva is the infecting medium. Unclean surgical in struments may convey infection from one patient to another. Cases in which denta! instruments have done this are described. The application of nitrate of silver to buccal lesions has had a like effect. Probably in this case the caustic holder rather than the caustic was the means of infection. We have read Dr. Bulkley's proposals for the legal control of syphilis with great interest. H e urges that in view of the large number of cases of innocent syphilis, it can no more be described as a "venereal" disease than any other contagious disease. He adds, " t h e time has come to place it under the control of the proper health officers, and to make it quite as criminal to transmit syphilis wittingly as it is to communicate small-pox, scarlatina, or diphtheria." H e urges that if syphilis were ineluded with these infectious diseases, the keepers of brothels would for their own protection, and for that of the women kept therein, have the latter voluntarily examined, and further "would also be very careful that no one entering the place should introduce the disease." This necessitates examining the men instead of the women. Whether such a system is practicable we are not prepared to say. We heartily wish it were, and that the onus could be transferred from the women to the men. One point is, however, clear to our minds. In order to bring to justice any syphilifer, it will be necessary to make it criminal to transmit syphilis wittingly or unwittingly. Even in regard to scarlet fever, small.pox, etc., the insertion of tbe Word " wilfuUy" in the penal cIauses of the Public

Health Act as to exposure to infection, renders them almost inoperative. How much more would this be true for syphilis ! We heartily commend this work to all who are interested in its subject matter. The analytical bibliography, covering nearly rSo pages, is alone worth much more than the cost of the entire book.

CASE OF B R A S S W O R K E R S ' A G U E . By LEONARDWILDE, M.D., D.P.H.~ Medical Adviser, Bedfordshire County Council I one of the Medical Officers cf Health, Croydon County Borough. THE following case is interesting as belonging to the class of occupational diseases to which much attention has of late been directed; Whether the disease is due to the fumes of deflagrating z i n c - Z n O - - o r to those given off by the copper in the process of brass founding is still a matter for discussion, the symptoms produced by the two metals being somewhat similar. The fact that zinc may be administered internally for long periods in medicinal doses would, however, seem to indicate copper as the toxic agent. The process of brassfounding is briefly as fol10ws: The copper is put into covered cr~cibles and plunged into a sunken furnace. When the copper is perfectly molten, zinc is added together with small quantities of lead and tin. Rapid chemical reaction takes place, and when the cruel. bles are opened and the metals stirred the zinc deflagrates, and a dense white smoke is given off, which fills the atmosphere of the casting shop, and is rapidly converted into a fine white powder, consisting of oxide of zinc, which, unless special means of ventilation are adopted, is finally deposited upon the rafters and ceiling in the form of a white incrustation. At the same time the colour of the flames arising from the crucibles indicates the presence of copper, and the inhalation of the fumes is said to give rise to a coppery taste in the mouth. Dr. Greenbow describes a typical case as presenting a preliminary stage with pain in the chest and joints, headache, vomiting, and shivering, lasting three or four hours, and terminating in febrile reaction, and profuse sweating. Dr. Simon regards it as an acute manifestation of a chronic disease, consisting of colic, constipatidn, and disorders of the gastro-intestinal system, not general among regular workers, but affecting those new to the work, or who resume i~ after an absence. It differs from true ague in having no periodicity. T. F., aged 3 o, a brassfounder~ was admitted into the London Temperance Hospital on May roth, I893. H e stated that three years previously he had a similar attack consisting of shivering, vomiting, and diarrhoea, with abdominal pain. H e

B R A S S C A S T I N G AS AN U N H E A L T H Y quickly recovered, and had been in regular employment since. H a d never been abroad. For six weeks previous to admission he had been ailing, and had had attacks of shivering, preceded by headache and followed by vomiting and diarrhoea, alternating with constipation. H e continued his occupation when he felt able, but was irregular in his attendances. On admission the temperature was normal, face flushed, tongue dirty, and breath offensive. His teeth had never been washed, the gums being spongy and white, with a reddish line round the edges. Bronchitic rules were heard all over the chest, the abdomen was tumid, with slight general pain and tenderness. The skin was very moist. Shortly after admission there was a slight rise of temperature, gradually subsiding in twentyfour hours, the gastro.intestinal disturbances quickly disappeared and he pronounced himself as feeling well, but rather weak. H e was allowed up for the first time at the end of a week, and two hours later had two distinct rigors accompanied by a temperature of ~or, and succeeded by vomiting and profuse perspiration, the whole attack lasting nearly twenty.four hours. After this there was no recurrence, and recovery was rapid and complete. The spongy gums and red lines soon yielded to cleanlines B R A S S C A S T I N G AS AN U N H E A L T H Y OCCUPATION. THE H o m e Secretary has issued notice that it is his intention to schedule brasscasting and mixing as an unhealthy occupation, and under the provisions of the Factory and Workpeople's Act of x89r to impose certain regulations for the carrying on of the industry upon masters and men. The proposed regulations are as follow : DUTIES O F OCCUPIERS. t. They shall provide washing conveniences, with a sufficient supply of hot and cold water, soap, and towels. e. They shall provide respirators for all persons when they are employed in pouring metal into moulds. 3- They shall provide suitable means for carrying off all noxious fumes and dust, 4. They shall provide a sufficient supply of milk or approved sanitary drink. 5. No food shall be eaten in any part of the works where brass mixing or casting is carried on. 6. All rooms in which brass mixing or casting is carried on shall be lime-washed every six months, DUTIES OF PERSONS EMPLOYED. Every person to whom is supplied a respirator shall wear the same when at the special work for which such is provided. Every person shall carefully clean and wash their h a m s and faces before meals and before leaving the works. No food shall be eaten in any part of the works where the mixing or casting of brass is carried on.

The J~irmin$~lam .Mail states, on the authority of the National Amalgamated Society of Brassworkers, that there are in Birmingham ~,2oo brasscasters subject to the unhealthy character of the trade, and that among them there are not ten persons who are over 60 years of age.

OCCUPATION.

417

The above-named society has forwarded an interesting report to the H o m e Secretary, quoted in the ~Birmingf~an~ 3irai[, from which the following summary is taken. They strongly confirm the interesting account of a case of brassworker's ague given in a preceding column by Dr. Wilde : After stating the constituents of brass to be copper and zinc, the report points out that in the process of mixing a square crucible of ten or twelve inches in diameter and ~4 inches deep is used. In this the copper is first put, and when it is melted the zinc is added, and the mixture stirred with a rod by the workman standing over it. During this process of mixing, and while the workman is pouring the melted brass into ingots, the zinc gives off a White zinc vapour, which is poisonous. In contact with the air it condenses as zinc oxide, which further contaminates the air of the pIace, and is to be seen deposited on all parts of the casting shop. In consequence of these conditions the men suffer from disorders of the digestive and respiratory organs. In proof of this the report quotes many medical and other authorities on the disorders to which brasscasters are subject. Dr. Greenhow, in a paper read before the Royal Medical and Chirurgical Society in I862, says, " F e w casters past middle life are entirely free from difficulty in breathing, attended by more or less cough and expectoration." Mr. C. Turner Thackrah, in a paper in I832, says, " Brasscasting affects the respiration, and less directly the digestive organs." Dr. Hogben, of the Queen's Hospital, Birmingham, in the Medical Review of I887, mentions colic, constipation, and dyspeptic troubles as the result of brasscasting. Mr. W. C. Aitken, in his " History of the Brass Trade," says, " Brasscasters are almost unanimously said to be short-lived," and the writer from practical experience, concurs in the verdict. Dr. Simon, of the General Hospital, thus describes the symptoms produced by brasscasting : " A f t e r working a few hours a man becomes languid, depressed, and feels very cold. H e is very pale, and almost in a state of collapse. His face is covered with a cold perspiration. H e shivers, his teeth chatter, and he is restless and anxious. His head aches, there is much nausea and complaints of muscular pains. The symptoms continue until he has vomited, either as the result of taking an emetic or independently of it. He recovers with more or less of debility and lassitude. The report then goes on to say that melting brass is also injurious, but in a modified form. In some small works the mixing and casting are done at one process, and by the same man. Then the unhealthy conditions are all present, with the addition of the fine dust from the face of the mould, which is composed of powdered loam, charcoal, coal, and bean flour. The society recommended that cast