DEATH FROM TAKING 60 GRAINS OF ACETANILIDE.

243 of the goods that he sells. Exemplary vaccination. It is believed that many persons who have 1 the other hand, warns him and others that the been recently revaccinated fail to submit themselves to i retail trader should be, in relation to his customers, an expert medical inspection, as they should do, a few days after the who can and must protect them against deception.. Beycnd coperation, but assume from the appearance of the arm either this we should hardly have thought thatgolden syrup"" tthat the operation had been successful or that they are i to small-pox. These assumptions, however, needed definition. Those persons, not being entirely ignorant, insusceptible who ask for "golden syrupknow that, roughly speaking,are not always correct, and it is highly important that all it is a by-product of sugar, and that sugar is derived fromwho are revaccinated, especially during the prevalence of sugar-cane or beetroot by processes into which they do not ismall-pox, should be inspected by a qualified medical man.’" inquire. The entirely ignorantexpect to get "golden ’The returns for the week are slightly better as regards. syrup"such as their parents gave them when they werenumbers. On Saturday, Jan. - 18th, 22 fresh cases were young, or such as they have been in the habit of consuming,notified and removed ; on Sunday, the 19th, there were 25 and neither the well-informed nor the ignorant ask forfresh cases ; on Monday, the 20th, there were 37 fresh cases ; starch glucose at their grocers’. If they did ask for it by on Tuesday, the 21st, there were 26 fresh cases ; and on name-an exceedingly unlikely contingency-they would Wednesday, the 22nd, there were 35 fresh cases. The City be entitled to have it, and if it was sold to them of Westminster has taken the very wise course of making diluted with the product of the sugar-cane or the beet- chicken-pox a temporarily notifiable disease under Sections root the vendor would be liable to prosecution under 55 and 56 of the Public Health (London) Act, 1891. The the Food and Drugs Act for selling that which was not of order of the Mayor, Aldermen, and Councillors comes into the nature, substance, and -quality of the goods demanded. force to-day (Friday), the 24th. We think that this is a A standard definition of what ordinary beer should contain very sensible decision on the part of the City of Westminster and one calculated to lead to the diagnosis of many a case was not required in order to enable magistrates to convict under the Sale of Food and Drugs Act persons who sold of small-pox which might very likely have. passed unnoticed beer containing appreciable quantities of arsenic, the! otherwise. We may add that Westminster makes the eighth presence of which, by the way, was accounted for by the use borough in which chicken-pox must be notified, the others of glucose in brewing. It is, no-doubt, possible to draw up) being Hampstead, St. Pancras, Hackney, Holborn; Bethnal definitions of the elements that all articles of diet should Green, Greenwich, and Paddington. The Local Government. contain, in anticipation of. the ingenuity that may be} Board has issued a circular to extra-metropolitan guardians. exercisedby ingenious traders in diluting them, but it calling to mind former circulars issued in February, 1893, These circulars deal with small-pox in would not be easy to- make such a list complete, andL and July, 1895. the case of the beer referred to, which was argued before the; casual wards and workhouses. When such a case occurs High Court on appeal, has shown that it is not necessary measures should at once be taken to secure as far as pracfrom a legal point of view. We observe that Mr. Paul Taylorr ticable vaccination or revaccination of the other inmates. is reported, in giving his decision, to have said that he supposed that there would be no objection to the sale of the comDEATH FROM TAKING 60 GRAINS OF pound described before him under the name of "treacle." ACETANILIDE. Not being aware of the learned magistrate’s reason for this Toxic symptoms have frequently followed the administraremark, we can only say that in our opinion to sell starch even in medicinal doses, but, tion of acetanilide glucose as treacle would be as objectionable as to sell it as cases of fatal (antifebrin) must be very rare. One is poisoning golden syrup. The term "treacle"was originally, in described Dr. in Amertean. Brown the by Philip King accordance with its derivation, a medicinal term -used for certain antidotes for the poisonous bites of wild beasts and Journal of the Medical Sciences for December. A man, aged. Of its derivation and the meanings which it 37 years, was given 60 grains of acetanilide in six powders snakes. has borne in mediaeval times those who ask for "treacle"" for headache, and he took them all within a few hours. in small grocers’ shops are entirely ignorant. They are not When seen by his medical attendant (after what interval in the position either of manufacturers who, we believe, of time is not stated) he was slightly delirious and complained of pain in the head and in the left. distinguish by the terms "treacle," "golden syrup," and umbilical There were pyrexia, region. rapid heart, ’ ’molasses"fluid products obtained at different stages or marked nausea, and vomitjaundice, constipation, slight of when the is different commerce processes sugar by being Calomel in small doses followed by salts produced prepared. The persons who ask their grocers for treacle, ing. a copious but bloody motion and the urine was dark golden syrup, or molasses all, in our opinion, mean the he was admitted to hospital. The red. On the following day same thing, and they certainly do not mean or desire to pulse was 78, soft and compressible ; the temperature was. have any such compound as that which has been described. 100-2° F.; the lips and nails were extremely cyanotic ; and there was slight jaundice. He complained of pain in the left. SMALL-POX IN LONDON. side of the abdomen and there was tenderness in the epigasTHE Local Government Board has issued the following trium and in the region of the left kidney. The skin was. notice for the information of the public : ’’ There is reason to moist and the gums were bluish. The urine was strongly believe that the spread of small-pox in London is very alkaline and deep red-nearly black. The colour was shown materially aided through the instrumentality of persons who, to be due to hæmatoporphyrin. There was a small sediment though not recognised as attacked by the disease, are which contained granular casts. On boiling a large coagulum nevertheless suffering from a modified form of it and are formed. On the day after admission only 150 cubic centiconveying its infection to others. The Local Government metres of urine were passed ; after this there was comBoard are advised that it is important that where! plete suppression. There was great thirst which was. persons, especially adults, develop what is supposed to quenched with milk, but soon everything that was given was be chicken-pox no time should be lost before authori- rejected and rectal feeding had to be adopted. Though tative medical opinion is obtained as to the nature of, nothing was given by the month for days the vomiting conthe malady, and that as respects anyone brought into tinued. Cough and expectoration were persistent. There was relationwith a case which is regarded. as one of, slight delirium and the reaction of the pupils to light became: chicken-pox steps should at once be taken to obtain or more and more sluggish ; in the end the pupils were widely renew that protection against small-pox which is afforded by dilated. The reflexes were first exaggerated, then they

into the

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punishment,

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gradually disappeared. The extremities were constantly cold. people, and it may think that in doing this it has fulfilled The temperature fell slowly to normal on the fourth day and its office. But we say very decidedly that its duty is not was subsequently subnormal, reaching 95’50 in the rectum completed with this performance. It is .surely part of the on the evening before death which took place on the eighth obligation of a great body to see that nothing should be day of the illness. There was alternately constipation and lost of the material which it has at its disposal to further diarrhoea, and 48 hours before death and 27 hours after the ends which may eventually be of the greatest advantage to suppression of urine blood-colouring matter and broken- the people generally and to the insane population in pardown blood cells were constantly in the fæces, which pre- ticular. The patients of these district asylums are very viously were blood-stained only occasionally. The heart cheaply maintained, and certainly the medical element began to fail on the fourth day. The skin became more and does not figure largely in the expenses. It may be sufOn the fifth day after admission mucous ficient for carrying on the care and treatment of the more jaundiced. casts were passed. Examination of the blood showed destruc- patients, but to do more than this is out of the question, the tion of the -red corpuscles which finally were reduced to medical staff have not the time to devote to laborious 1,166,000 per cubic millimetre, while the leucocytes were scientific investigation, and the appointment of a pathologist 66,450 and the nucleated red cells 22,150. The alkalinity of who could work on the lines so successfully inaugurated by the blood was diminished by 80 per cent. At the necropsy Dr. Mott would, we feel sure, be a welcome addition to the acute nephritis and intestinal catarrh were found, but efforts that are now being made in London to place the teaching and the investigation of insanity on a proper basis. nothing to account for the melsena. Is it not somewhat of an anomaly that the administration of in London should be under two distinct boards each lunacy THE CHEMISTRY OF NERVE DEGENERATION. of the other ? The time seems to have arrived independent WE desire to call the attention of all neurologists, and when the whole lunacy system should be fused into one - of those specially interested in the treatment of insanity, more body, especially as there are in the district asylums -to a paper by Dr. F. W. Mott and Dr. W. D. Hallimany patients who are actually suffering from chronic wburton published in the Philosophical Transactions, insanity, as distinguished from mere imbecility, and who Series B, vol. cxciv, pp. 437-466. The title of the were at one time under the protection of the Lunacy Laws. paper is The Chemistry of Nerve Degeneration andFor instance, what a convenience would result, to say nothing t well merits study, not only as a model of the way of an economy, from having the maintenance, the administrain which researches of this kind should be conducted, but also because the writers draw conclusions of considerable practical value in the diagnosis of nervous disorders. The keystone of the paper is the importance of excess of choline in the blood in cases of nerve degeneration, not only in diseases such as general paralysis, but in various diseases of the central and peripheral nervous system. The detection of chcline, which is a product of the decomposition of lecithin, is effected by a chemical test, the obtaining of the yellow octahedral crystals from the blood, and also by a physiological test-viz., a temporary fall of pressure when injected intravenously in animals. The degenerated nerves in the animals were examined by the Marchi reaction which consists of a mixture of osmic acid and Muller’ss .fluid by which the degenerated nerve-fibres are stained an intense black, whilst the healthy fibres are not stained. We .do not propose to follow the writers in their various experiments. It is enough to say that the whole subject is clearly 7and scientifically worked out and that it forms a very valuable addition to our present knowledge of the chemistry of the blood in disease. There is good reason for saying that these valuable experiments were suggested by work previously done by Dr. Mott in the post-mortem rooms of the London County Asylums, and we take this opportunity of .asking why the appointment of a special pathologist is confined to the asylums under the jurisdiction of the London ’County Asylums. We should like to see the experiment .extended to the asylums under the control of the Metropolitan Asylums Board. At the imbecile asylums there is a profusion of material which is completely thrown away, .and material of the most valuable kind, for among the weak-minded degenerates who form the bulk of the population of these district asylums are examples of disease set up in more elementary conditions than are met with in the county asylums, and in these undeveloped types there may be found clues to the unravelling of the more complicated structure of better developed brains, and lesions of a congenital kind which may better elucidate the true nature of physiological as well as pathological processes. So far the District Asylums Board has not made any move in this direction ; it has carried out, more or less completely, its function of housing and maintaining a certain number of imbecile and demented

the distribution, and the classification in the hands of authority. The system would not be too large and it would be quite practical to work the strings from one centre. Moreover, convenience would ensue from the possibility of interdigitating one class of building with another in the

tion, one

matter of

classification and treatment, what. an opporfor the correct compilation of results and statistics and for the creation of a harmonised system where at present there is confusion. The Asylums Board may be very well left with the management of the infectious hospitals, work to which it has risen in a most praiseworthy manner, but it can well afford to delegate its functions in a part of the lunacy question to the County Council, and we think that the latter would willingly embrace the opportunity for a consolidation of these scattered units. It is true that the district asylums were constituted in 1870 by a special Act introduced by Mr. Gathorne Hardy, and most probably some fresh legislation might be necessary before the care of the imbeciles could be transferred to another body by the one to which it was first committed, but in view of the great advantage which would result from what we are now recommending no difficulty need be apprehended on the legal score. The subject of the best form of accommodation for the treatment of patients connected with London is still occupying the earnest thought of the County Council, and the various proposals for the erection of receiving houses, of a special building for the complete treatment of acute cases in London, and of other improvements are still 8tlb judice. Before final arrangements are made it is to be hoped. that the advisability of incorporating the existing separate units will be carefully considered.

tunity

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THE TRAINING OF STATE

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CHILDREN.

How to provide for the training and maintenance of children is a question which has occupied the minds of local authorities and of public-spirited philanthropists for more than one generation. It has given rise to a variety of schemes for its solution, which, nevertheless, if we are to judge from the practice of boards of guardians, remains to be found. The divergence of opinion which is thus indicated is most regrettable both from an economic and from a social standpoint. We seem to have as yet no

destitute