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EMPLOYERS' LIABILITY AT THE DOCKS.
1268 1892 is 3312 (2031 males and 1281 females). The total number ago he demonstrated to his own satisfaction the fact the register in the report for 1891 was 3134 (1912 males that organised creation had been formed on a single plan
on
and 1222 females). The increase for the year, therefore, is no less than 178 (119 males and 39 females), and on looking at the figures in the similar reports for the past ten years we find that (1) the increase for 1892 is 50 beyond that of any other year, and (2)-which is more significant-that it is 87 in excess of the average for the previous ten years. This increase means that the proportion of insane to population in the colony has risen from 1 in 371 to 1 in 361. InspectorGeneral Norton Manning attributes the increase almost entirely to the general commercial depression, which has not only increased the worries and anxieties of the responsible classes and so directly caused insanity, but has also driven into the institutions for the insane many persons who, although demented and imbecile, would in more prosperous times have been supported by their friends. This view is proved by the figures, which show that the number of aged and demented cases admitted has been unusually large.
and that lower animals represented permanent examples of types through which higher animals had passed. Over a century ago he wrote (as Mr. Bryantin his eloquent Hunterian Oration for this year told us) : ’’ The first and most simple idea of life is its being the principle of selfpreservation." These things really constitute a prophecy of the main doctrines of Evolution, and no one but a person in whom the imaginative faculty was as well developed as the industrial could have made it at that epoch. As Dr. Fitzpatrick says, "it would almost seem as if the lapse of a long period had been needed to enable the human mind to grow familiar with the full extent of Hunter’s discoveries and to penetrate to the solid basis on which his far-reaching speculations rest." -
EMPLOYERS’ LIABILITY AT THE DOCKS.
I Employers’ Liability
proceeding in connexion with the Bill have revived, as they were bound to do, associated controversies which now form a part of the THE PREVALENCE OF INFLUENZA. ACCOUNTS reach us from various sources of the increased annals of manual industry. Among other such discussions we observe that the question of personal risks involved in dock prevalence of influenza throughout the country, but forlabour occupies a prominent position. It forms the subject tunately the type does not up to the present appear to be of of an article in this month’s issue of the Nineteenth Century, a very severe character, though some deaths are said to have occurred. In Blackburn the disease is reported to be so in which allusion is made to certain observations published us in the years 1888 and 1889. Needless to say these widespread that considerable difficulty is experienced in by were not then, and still are not, regarded with comments keeping the mills at work, while at Birmingham hundreds of favour or even with tolerant unconcern by the official repre persons are said to he suffering from the disease. Some idea the dock It is not quite a new thing sentatives of companies. of its prevalence in this city may be drawn from the fact some who do not share our views that THL to told be by that of sixty-nine officials in the post-offlte department LANCET is totally wrong. Accordingly we are not surprised twenty-nine are suffering from influenza. The children in to find that our original and entirely impartial estimate do not seem to have been schools much the elementary which placed the average number of accidental injuries attacked, though many of the teachers are confined to their incurred by dock labourers during five years at 50 per cent. homes with the disease. Relapses appear to be very common, of those employed is again somewhat scornfully repudiated. and when they occur the manifestations are in many cases of it remains uncontroverted. A year’s total of 800 Nevertheless a more severe nature than in the initial attack. In the is taken to represent the sum of inj ury known accidents Llanelly rural sanitary district the disease prevails generally, reported to have sustained been by persons of all kinds employed in but more especially in Bury Port and the suburbs of Llanelly. the docks. A fourth of these casualties is allotted to the Our Northern Counties’ correspondent reports a remarkable dock of whom there are said to be from 4000 to labourers, outbreak both in Newcastle and Sunderland. 5000 in permanent employment-that is, a proportion of rather more than 5 per cent. Colonel Martindale in 1889, while JOHN HUNTER AS PROPHET. giving evidence for the dock authorities, fixed the estimate LAST month, in his address at Newton Hall on "The at an even lower figure. In former articles dealing with Centenary of the Death of John Hunter," Dr. Fitzpatrick this subject we have shown that our own calculation joined the goodly band of lecturers who have used the life was based upon opinions freely expressed by the dock and work of " The Founder of Scientific Surgery " as a text employes themselves and by the house surgeon who commonly upon which to hang edifying precepts. The subject appears treated them when injured. We have shown, too, that in to be inexhaustible, for fifty-seven orations specially delivered many cases the effects of an accident are not at once apparent, in its honour have not served to wither or stale its infinite though really serious ; or, if recognisable, they are for variety. John Hunter was the tenth child of a humble obvious reasons not acknowledged even by the sufferer. In Scotch farmer, upon whose education not even ordinary care a matter like this, which admits of such wide discrepancies He was plain-featured, in early life delicate of calculation and where so much must still be left to conwas bestowed. in physique, and not very happy in his manner, apparently jecture, it is clear that there is ample scope for an impartial possessing none of the suavity that would be likely to statistical inquiry. We should welcome this. We are conmake him popular. This, indeed, he never became ; and vinced that, whatever the outcome, one result would be the Dr. Fitzpatrick’s view that in his own day Hunter was more careful definition of the mutual responsibility of masters misunderstood, and that time, which is fatal to so and men. Until it is carried out we must be content to many pretensions, is now placing him in his proper abide by conclusions which are founded upon what may position, is quite a correct one. What most strikes all fairly be regarded as unbiased evidence. When we come of us when one of the numerous accounts of Hunter’s to consider the causes of accidents we are astonished life is placed before us must be the boundless imagination to find how little effort has been made by the dock of the man ; and it is to this quality that Dr. Fitzpatrick officials to exonerate themselves from an apparent liability. indirectly testifies when he points out the extraordinary range The critical calculation to which we have already referred of Hunter’s work. His industry and patience have before contains hardly a serious attempt to deal with this part of now been seen in great men, but it is rare to find these Are we, then, to suppose that the hardship our allegations. qualities coupled with a vivid imagination. Yet, at his day, and risk implied in overloading and overworking men weak he could not have arrived at the biological conclusions from want of good food, in the faulty management of upon which his surgery was founded without a power 1 THE Over a century of intuition amounting to prophecy. LANCET, Feb. 18th, 1893. THE discussions
now
1269 apparatus and the like, are tacitly admitted? If so, what about The attack of tetanus was typical, the only clinical points the casualty minimum ?7 Five per cent. is low-the character of interest being the maintenance of a low temperature of the work being considered, it could not easily be reduced. throughout, marked symptoms of congestion of organs, We must, in the absence of more convincing explanations by extreme sensibility to cold and, finally, the commencement of the dock directors, admit an uneasy scepticism as to its muscular contractions at the site of inoculation. The incureputed accuracy. The whole subject is one which will repay bation period was four days, during which the patient was investigation, and no time could, in our opinion, be more perfectly well, although the injected fluid contained all the opportune than the present, while we are on the eve of wit- soluble products of the culture ; this would confirm the nessing the fate of a measure intended to determine the limits theory of Drs. Courmont and Doyen that this poison in itself of that needful precaution which must ever constitute one of is not toxic, but produces the ° strychnine-like " substance the elementary duties of an employer of workmen. independently of lthe’ organism. This phase necessary for "fermentation" constitutes the period of incubation. It may be remembered that the patient recovered. FINED FOR FALSE PRACTITIONER CERTIFICATE. A MR. NEVILLE HOLLAND of Green-street, Bethnal-gTeen, has been fined E3and has to pay 22s. costs for giving a certificate saying that he had attended Emily Hewitt, who died in less than twenty-four hours after childbirth, whereas it was stated that he had admitted to not having attended the deceased. She was attended by Mr. Davis. The nurse said that Mr. Holland and Mr. Davis were in the same surgery. The husband went to fetch Mr. Holland and was under the impression that Mr. Davis, who returned with him, was that gentleman. It is amazing that a medical practitioner should allow himself to be placed in such a false position. THE
DIFFUSION
OF SMALL-POX.
SUPPURATION
IN
CEREBRAL VENTRICLES.
IN the Birminglta’ln JTedical Review Mr. Berlyn reports a case under the care of Mr. Barling-that, namely, of a child three and a half years of age who was admitted on account of frontal headache. The child had had a discharge from its right ear since it was six months old, and fourteen days before admission it had fallen on some bricks and injured the right side of its head. On admission there was found to be retraction of the head without paralysis or strabismus, and the temperature was 101 ’6° F. There was no optic neuritis. During the next week the child was very irritable, vomiting frequently, and the temperature remained about normal. There was tenderness over the right mastoid, and operation The bone was chiselled away, was thought to be justifiable. but no cavity existed ; the right lateral sinus was freely exposed and was found to be healthy. The wound remained quite aseptic, but the child became more drowsy, there was a discharge of pus from the left ear, and it sank rapidly. At the necropsy the pial surface of the brain was found to be much injected, and on section a large quantity of pus was present in both lateral ventricles, which had also penetrated the Sylvian aqueduct and distended the fourth ventricle. The sinuses were normal except that they contained some secondary clot ; the dura mater and bone over the tympana were normal, and the other organs revealed no focus of inflammation or other abnormal appearance.
ominous strides during the week and it is still making progress. In in Bradford cases were recorded, (where the disease is spreading fast) there were 80, in Walsall 59, and in London 55. Amongst other recorded attacks were the following : Aston Manor, 13 ; West Ham, 8; Bristol, 7 ; Handsworth, 4 ; Willesden, 3; Southport, 2; West Bromwich, 2; and in a number of other places, including Leicester, isolated attacks took place. Other outbreaks have occurred as to which the data are less precise. Thus a substantial prevalence of the disease has occurred at Leadgate, in Durham, and in an adjoining place called "Happy Land," and some cases are reported from New Quay, Aberavon, Lower Gornal, and Kidderminster. The number of cases under isolation in the hospital ENORMOUS CEREBRAL TUMOUR. ships and at Gore Farm had reached 149 on the 13th inst., IN a recent number of the -1-&2v York Medical Journal but the Kensington outbreak is now limited to single attacks Dr. Conroy gives a brief report of a case of probably the per diem, and as these are at once dealt with and removed it largest cerebral tumour on record. We do not remember may be hoped that it is checked. Amongst other parishes to have read of one in which such an enormous size was involved are Stepney, Poplar, St. Saviour’s, Wandsworth and reached. The patient was a young man aged twenty, whose Clapham, Lewisham, and Mile-end Old Town. head had been injured when he was about fourteen. A year later he had become paralysed on the right side. His speech ACCIDENTAL INOCULATION OF TETANUS. was gradually affected and his sight became impaired, and A CASE is recorded by Dr. Nicolas of Lyons (in the he had also suffered from occasional convulsive attacks. Union Médicale, Oct. 26th, 1893) of tetanus occurring after His head had been noticed to be larger, but his the accidental inoculation of a small quantity of the filtered intelligence was good, and until the time when he had culture of the bacillus, recently described by Nicolaier in become nearly blind he read much and with enjoyment. connexion with that disease. The case was fully reported in After a consultation an operation was carried out, but the THE LANCET of Nov. 4th, but it is so interesting that we are tumour was found to be so large that an attempt at its glad to be able to give Dr. Nicolas’s account. The culture, removal was thought to be unjustifiable. The patient died which was an extremely virulent one, had been used by Drs. forty-eight hours after the operation. At the necropsy the Courmont and Doyen in their experiments on fowls. The left half of the intra-cranial cavity seemed to be filled with accident occurred from a simple prick in the left hand,’made the tumour. The surface of this presented an appearance with the needle of a Pravaz syringe, which had been strongly resembling a normal hemisphere, being lobulated sterilised and dipped into the filtered culture, with which ’, and fissured so as to offer a very strong superficial resemblance it was intended to inoculate a fowl. None of the fluid to a brain. It was invested in a strong fibrous membrane, was forced out of the syringe, and the needle was therewhich sprang from the falx cerebri and had no other fore merely wet with the fluid ; thus a typical attack attachment than this. The left hemisphere, after the tumour of tetanus ensued consequent upon the subcutaneous injection had been removed, was found lying on the base of the skull of an infinitesimal dose of the filtered culture of the bacillus flattened to the size and shape of the palm of a man’s hand. of Nicolaier. Dr. Nicolas remarks that from this case Two smaller tumours were found, one on each side of the he would assume that man stands before any animal in foramen magnum and attached to the dura mater there. The his susceptibility to the soluble products of this bacillus. principal tumour weighed 1 lb. 11 oz. avoirdupois, its long
SMALL-POX made
some
ending the llth inst., Birmingham 70 fresh
--
on
and 1222 females). The increase for the year, therefore, is no less than 178 (119 males and 39 females), and on looking at the figures in the similar reports for the past ten years we find that (1) the increase for 1892 is 50 beyond that of any other year, and (2)-which is more significant-that it is 87 in excess of the average for the previous ten years. This increase means that the proportion of insane to population in the colony has risen from 1 in 371 to 1 in 361. InspectorGeneral Norton Manning attributes the increase almost entirely to the general commercial depression, which has not only increased the worries and anxieties of the responsible classes and so directly caused insanity, but has also driven into the institutions for the insane many persons who, although demented and imbecile, would in more prosperous times have been supported by their friends. This view is proved by the figures, which show that the number of aged and demented cases admitted has been unusually large.
and that lower animals represented permanent examples of types through which higher animals had passed. Over a century ago he wrote (as Mr. Bryantin his eloquent Hunterian Oration for this year told us) : ’’ The first and most simple idea of life is its being the principle of selfpreservation." These things really constitute a prophecy of the main doctrines of Evolution, and no one but a person in whom the imaginative faculty was as well developed as the industrial could have made it at that epoch. As Dr. Fitzpatrick says, "it would almost seem as if the lapse of a long period had been needed to enable the human mind to grow familiar with the full extent of Hunter’s discoveries and to penetrate to the solid basis on which his far-reaching speculations rest." -
EMPLOYERS’ LIABILITY AT THE DOCKS.
I Employers’ Liability
proceeding in connexion with the Bill have revived, as they were bound to do, associated controversies which now form a part of the THE PREVALENCE OF INFLUENZA. ACCOUNTS reach us from various sources of the increased annals of manual industry. Among other such discussions we observe that the question of personal risks involved in dock prevalence of influenza throughout the country, but forlabour occupies a prominent position. It forms the subject tunately the type does not up to the present appear to be of of an article in this month’s issue of the Nineteenth Century, a very severe character, though some deaths are said to have occurred. In Blackburn the disease is reported to be so in which allusion is made to certain observations published us in the years 1888 and 1889. Needless to say these widespread that considerable difficulty is experienced in by were not then, and still are not, regarded with comments keeping the mills at work, while at Birmingham hundreds of favour or even with tolerant unconcern by the official repre persons are said to he suffering from the disease. Some idea the dock It is not quite a new thing sentatives of companies. of its prevalence in this city may be drawn from the fact some who do not share our views that THL to told be by that of sixty-nine officials in the post-offlte department LANCET is totally wrong. Accordingly we are not surprised twenty-nine are suffering from influenza. The children in to find that our original and entirely impartial estimate do not seem to have been schools much the elementary which placed the average number of accidental injuries attacked, though many of the teachers are confined to their incurred by dock labourers during five years at 50 per cent. homes with the disease. Relapses appear to be very common, of those employed is again somewhat scornfully repudiated. and when they occur the manifestations are in many cases of it remains uncontroverted. A year’s total of 800 Nevertheless a more severe nature than in the initial attack. In the is taken to represent the sum of inj ury known accidents Llanelly rural sanitary district the disease prevails generally, reported to have sustained been by persons of all kinds employed in but more especially in Bury Port and the suburbs of Llanelly. the docks. A fourth of these casualties is allotted to the Our Northern Counties’ correspondent reports a remarkable dock of whom there are said to be from 4000 to labourers, outbreak both in Newcastle and Sunderland. 5000 in permanent employment-that is, a proportion of rather more than 5 per cent. Colonel Martindale in 1889, while JOHN HUNTER AS PROPHET. giving evidence for the dock authorities, fixed the estimate LAST month, in his address at Newton Hall on "The at an even lower figure. In former articles dealing with Centenary of the Death of John Hunter," Dr. Fitzpatrick this subject we have shown that our own calculation joined the goodly band of lecturers who have used the life was based upon opinions freely expressed by the dock and work of " The Founder of Scientific Surgery " as a text employes themselves and by the house surgeon who commonly upon which to hang edifying precepts. The subject appears treated them when injured. We have shown, too, that in to be inexhaustible, for fifty-seven orations specially delivered many cases the effects of an accident are not at once apparent, in its honour have not served to wither or stale its infinite though really serious ; or, if recognisable, they are for variety. John Hunter was the tenth child of a humble obvious reasons not acknowledged even by the sufferer. In Scotch farmer, upon whose education not even ordinary care a matter like this, which admits of such wide discrepancies He was plain-featured, in early life delicate of calculation and where so much must still be left to conwas bestowed. in physique, and not very happy in his manner, apparently jecture, it is clear that there is ample scope for an impartial possessing none of the suavity that would be likely to statistical inquiry. We should welcome this. We are conmake him popular. This, indeed, he never became ; and vinced that, whatever the outcome, one result would be the Dr. Fitzpatrick’s view that in his own day Hunter was more careful definition of the mutual responsibility of masters misunderstood, and that time, which is fatal to so and men. Until it is carried out we must be content to many pretensions, is now placing him in his proper abide by conclusions which are founded upon what may position, is quite a correct one. What most strikes all fairly be regarded as unbiased evidence. When we come of us when one of the numerous accounts of Hunter’s to consider the causes of accidents we are astonished life is placed before us must be the boundless imagination to find how little effort has been made by the dock of the man ; and it is to this quality that Dr. Fitzpatrick officials to exonerate themselves from an apparent liability. indirectly testifies when he points out the extraordinary range The critical calculation to which we have already referred of Hunter’s work. His industry and patience have before contains hardly a serious attempt to deal with this part of now been seen in great men, but it is rare to find these Are we, then, to suppose that the hardship our allegations. qualities coupled with a vivid imagination. Yet, at his day, and risk implied in overloading and overworking men weak he could not have arrived at the biological conclusions from want of good food, in the faulty management of upon which his surgery was founded without a power 1 THE Over a century of intuition amounting to prophecy. LANCET, Feb. 18th, 1893. THE discussions
now
1269 apparatus and the like, are tacitly admitted? If so, what about The attack of tetanus was typical, the only clinical points the casualty minimum ?7 Five per cent. is low-the character of interest being the maintenance of a low temperature of the work being considered, it could not easily be reduced. throughout, marked symptoms of congestion of organs, We must, in the absence of more convincing explanations by extreme sensibility to cold and, finally, the commencement of the dock directors, admit an uneasy scepticism as to its muscular contractions at the site of inoculation. The incureputed accuracy. The whole subject is one which will repay bation period was four days, during which the patient was investigation, and no time could, in our opinion, be more perfectly well, although the injected fluid contained all the opportune than the present, while we are on the eve of wit- soluble products of the culture ; this would confirm the nessing the fate of a measure intended to determine the limits theory of Drs. Courmont and Doyen that this poison in itself of that needful precaution which must ever constitute one of is not toxic, but produces the ° strychnine-like " substance the elementary duties of an employer of workmen. independently of lthe’ organism. This phase necessary for "fermentation" constitutes the period of incubation. It may be remembered that the patient recovered. FINED FOR FALSE PRACTITIONER CERTIFICATE. A MR. NEVILLE HOLLAND of Green-street, Bethnal-gTeen, has been fined E3and has to pay 22s. costs for giving a certificate saying that he had attended Emily Hewitt, who died in less than twenty-four hours after childbirth, whereas it was stated that he had admitted to not having attended the deceased. She was attended by Mr. Davis. The nurse said that Mr. Holland and Mr. Davis were in the same surgery. The husband went to fetch Mr. Holland and was under the impression that Mr. Davis, who returned with him, was that gentleman. It is amazing that a medical practitioner should allow himself to be placed in such a false position. THE
DIFFUSION
OF SMALL-POX.
SUPPURATION
IN
CEREBRAL VENTRICLES.
IN the Birminglta’ln JTedical Review Mr. Berlyn reports a case under the care of Mr. Barling-that, namely, of a child three and a half years of age who was admitted on account of frontal headache. The child had had a discharge from its right ear since it was six months old, and fourteen days before admission it had fallen on some bricks and injured the right side of its head. On admission there was found to be retraction of the head without paralysis or strabismus, and the temperature was 101 ’6° F. There was no optic neuritis. During the next week the child was very irritable, vomiting frequently, and the temperature remained about normal. There was tenderness over the right mastoid, and operation The bone was chiselled away, was thought to be justifiable. but no cavity existed ; the right lateral sinus was freely exposed and was found to be healthy. The wound remained quite aseptic, but the child became more drowsy, there was a discharge of pus from the left ear, and it sank rapidly. At the necropsy the pial surface of the brain was found to be much injected, and on section a large quantity of pus was present in both lateral ventricles, which had also penetrated the Sylvian aqueduct and distended the fourth ventricle. The sinuses were normal except that they contained some secondary clot ; the dura mater and bone over the tympana were normal, and the other organs revealed no focus of inflammation or other abnormal appearance.
ominous strides during the week and it is still making progress. In in Bradford cases were recorded, (where the disease is spreading fast) there were 80, in Walsall 59, and in London 55. Amongst other recorded attacks were the following : Aston Manor, 13 ; West Ham, 8; Bristol, 7 ; Handsworth, 4 ; Willesden, 3; Southport, 2; West Bromwich, 2; and in a number of other places, including Leicester, isolated attacks took place. Other outbreaks have occurred as to which the data are less precise. Thus a substantial prevalence of the disease has occurred at Leadgate, in Durham, and in an adjoining place called "Happy Land," and some cases are reported from New Quay, Aberavon, Lower Gornal, and Kidderminster. The number of cases under isolation in the hospital ENORMOUS CEREBRAL TUMOUR. ships and at Gore Farm had reached 149 on the 13th inst., IN a recent number of the -1-&2v York Medical Journal but the Kensington outbreak is now limited to single attacks Dr. Conroy gives a brief report of a case of probably the per diem, and as these are at once dealt with and removed it largest cerebral tumour on record. We do not remember may be hoped that it is checked. Amongst other parishes to have read of one in which such an enormous size was involved are Stepney, Poplar, St. Saviour’s, Wandsworth and reached. The patient was a young man aged twenty, whose Clapham, Lewisham, and Mile-end Old Town. head had been injured when he was about fourteen. A year later he had become paralysed on the right side. His speech ACCIDENTAL INOCULATION OF TETANUS. was gradually affected and his sight became impaired, and A CASE is recorded by Dr. Nicolas of Lyons (in the he had also suffered from occasional convulsive attacks. Union Médicale, Oct. 26th, 1893) of tetanus occurring after His head had been noticed to be larger, but his the accidental inoculation of a small quantity of the filtered intelligence was good, and until the time when he had culture of the bacillus, recently described by Nicolaier in become nearly blind he read much and with enjoyment. connexion with that disease. The case was fully reported in After a consultation an operation was carried out, but the THE LANCET of Nov. 4th, but it is so interesting that we are tumour was found to be so large that an attempt at its glad to be able to give Dr. Nicolas’s account. The culture, removal was thought to be unjustifiable. The patient died which was an extremely virulent one, had been used by Drs. forty-eight hours after the operation. At the necropsy the Courmont and Doyen in their experiments on fowls. The left half of the intra-cranial cavity seemed to be filled with accident occurred from a simple prick in the left hand,’made the tumour. The surface of this presented an appearance with the needle of a Pravaz syringe, which had been strongly resembling a normal hemisphere, being lobulated sterilised and dipped into the filtered culture, with which ’, and fissured so as to offer a very strong superficial resemblance it was intended to inoculate a fowl. None of the fluid to a brain. It was invested in a strong fibrous membrane, was forced out of the syringe, and the needle was therewhich sprang from the falx cerebri and had no other fore merely wet with the fluid ; thus a typical attack attachment than this. The left hemisphere, after the tumour of tetanus ensued consequent upon the subcutaneous injection had been removed, was found lying on the base of the skull of an infinitesimal dose of the filtered culture of the bacillus flattened to the size and shape of the palm of a man’s hand. of Nicolaier. Dr. Nicolas remarks that from this case Two smaller tumours were found, one on each side of the he would assume that man stands before any animal in foramen magnum and attached to the dura mater there. The his susceptibility to the soluble products of this bacillus. principal tumour weighed 1 lb. 11 oz. avoirdupois, its long
SMALL-POX made
some
ending the llth inst., Birmingham 70 fresh
--