INDUSTRIALISM AND DISEASE.

INDUSTRIALISM AND DISEASE.

896

of raisin wine; having previously given him bath two hours before taking; apply a warm bottle to the feet, and cover him up with blankets. Draught sweet for liver patients : flag 1 dr. [the Acorus and the calamus, probably KXtt/M! apcv,uarmds of 1 Dioscorides] ; opopanax, ob. ; spikenard, 1 ob. ; parsnip, 2 dr. ; to be drunk slowly with raisin wine or honey. Another-tolerably strong : cinnamon myrrh, 10 dr. ; 6 dr. spikenard, dr.; aethiopian seseli, 6 [Laserpitium siler rub smooth separately with egg and work up with juice of centaury [Erythræa centaurium], and give a dose of the size of an Egyptian bean in warm honey and water." "Draught for dropsy patients: mountain parsley ......." myrtle, 8 dr. ; bitter almonds, 4 dr. ; parsnip seeds, 6 dr." Although these medical memoranda are preserved upon a papyrus in Egypt, and probably were the notes of a local practitioner, it is quite possible that they are copied from the work of some Greek medical author who resided elsewhere.

cotyle a

......

TERMINATION OF PULMONARY TUBERCULOSIS BY SUBCUTANEOUS AND MEDIASTINAL EMPHYSEMA. IN the Progres lIediecl of August 17th M. Léon Bernard and M. A. Cain have reported a case of pulmonary tuberculosis which terminated in an unusual manner-by mediastinal and subcutaneous emphysema without pneumothorax. A dressmaker, aged 14 years, was admitted into hospital on May 24th, 1912. In the previous September she began to cough. Emaciation and pains in the chest followed, and she became so weak that she had to give up work on May 9th. For a week before admission she had expectorated. On examination she was much wasted and pale, and the extremities were slightly cyanosed. The temperature was irregular and in the evening ranged from 103 - 20 to 104° F. All over the chest sonorous and sibilant rhonchi and subcrepitant rules were heard. The apices of the lungs were dull on percussion. Tubercle bacilli could not be found in the sputum. The emaciation and weakness rapidly increased. On the morning of June 8th the patient was found in an asphyxial state with a subnormal temperature. The respirations were 50 and the pulse was 160 and almost imperceptible. There were orthopnoea and suprasternal and substernal retraction. The cyanosis was intense; the face was violaceous and the lips and extremities of a blackish tint. The face was agitated by convulsive spasms and the lips were bitten. There was slight rigidity of the lower limbs with exaggeration of the reflexes and ankle clonus. The neck was the seat of a considerable tumefaction which extended into the upper part of the chest and the right parotid region. Around the tumefaction crepitation was felt, symptomatic of subcutaneous emphysema, which extended all over the chest and front of the abdomen and to the lumbar region behind, and also involved the left upper limb throughout. On auscultation the respiratory sounds were obscured by fine crepitations There were no signs of which occurred under the ear. pneumothorax. The dyspnoea increased and the patient died on that morning. At the necropsy, performed 36 hours after death, subcutaneous emphysema of the upper limbs, neck, chest, and abdomen was found. The anterior mediastinum was distended by considerable emphysema. Beneath the visceral pleUl’ae were air bullaa. On section the lungs were found congested and oedematous and showed disseminated tubercles and emphysematous areas. In the right lower lobe was a cavity of the size of a cherry opening into a dilated bronchus. The liver and kidneys contained tubercles. The subcutaneous emphysema was an extension of the mediastinal, which in turn originated in interlobulai emphysema consecutive to rupture of pulmonary vesicles.

This curious condition did not escape the penetrating observation of Laennec. He wrote : " When intoftobular emphysema is near the root of the lung it soon invades the mediastinum and thence the neck and subcutaneous tissue of the whole body." Subcutaneous emphysema may in

diphtheria, laryngitis stridulus, whooping-cough, pneumonia, and broncho-pneumonia. Why it occurs exceptionally in cases of tuberculosis, which present nothing exceptional in the lesions, cannot be explained. occur

INDUSTRIALISM AND DISEASE. TWO

aspects

of modern industrialism neea

urgent

anct.

earnest attention at the hands of social economists and statesmen, and in each the special experience and know-ledge of the medical profession can be of the greatest assistance. These aspects refer to the psychical and the physical effects respectively of the novel conditions and environment that have been created by the rise of the factory system. Of these the physical aspect is forcibly dealt with by Sir Thomas Oliver in his admirable address onI I Dust and Fume, Foes of Industrial Life," delivered at the Congress of Hygiene e in Washington, and published in this issue. The effects of industrial occupations have to be considered, as Sir Thomas Oliver points out, first, in relation to their effect upon those employed, and, secondly, in regard to their influence on localities and on the persons dwelling therein. Dust, smoke, and fume, he says, are the products of industrial activity to be feared, dust being usually regarded as matter in a state of fine division (though from a medical point of view it is something more than this);, while smoke and fume differ from dust in being the products of heat, and from each other, in that smoke is the outcome of incomplete combustion of hydrocarbons, while fume is, first, the gaseous form of metallic or other elements and their compounds ; and, secondly, the return of these from the gaseous state as solid deposits. Convincing examples are given to show that in the smoky industrial centres a high non-tuberculous mortality from acute respiratory diseases predominates, while a high tuberculous death-rate is more common in towns devoted to, textile industries. A consideration of the harmful effects, both physical and chemical, of road dust on vegetation and animal life-effects that attain their maximum in the dust. of towns-leads Sir Thomas Oliver to take note of the "social influence of dust."" He states that in trying to combat the begriming effects of dust and fume we have become a wellwashed people. He inclines also to accept Saito’s conclusions. from his investigations in Lehmann’s laboratory, that in regard to the inhalation of dust, by far the larger part of it finds its way into the alimentary canal rather than into the respiratory tract ; and he unhesitatingly adds the testimony of his own experience-which is considerable -to von Behring’s opinion, that pulmonary tuberculosis of the adult is frequently the consequence of the lighting up of disease long latent in glands as the result of a probable intestinal infection contracted in childhood. The special dangers of coal-dust are now well recognised, and Sir Thomas Oliver devotes considerable space and attention to a consideration of the explosive effects ofsuch dust and to the methods suggested for the prevention of explosions in coal mines. He makes special reference to a method worked out in his laboratory by Hermann Belger, whereby the oxygen,. carbon dioxide, and other gases are removed from the coal dust and the dust is kept moist, so that it is converted into a colloid material and rendered uninflammable. By this means the whole mine can be kept free from dust by application of the treatment every four to ten weeks. Thesubject ’of phosphorus necrosis in relation to the manufacture of lucifer matches is considered, and Sir Thomas

AN UNUSUAL CASE UNDER THE WORKMEN’S COMPENSATION ACT.

897

to some extent with fat, there little or no increase of connective tissue between the fibres individually. The nuclei of the sarcolemmal sheaths were in most places normal. In discussing the significance of the pathological changes, Dr. Batten and Dr. Holmes view the evidence as strongly in favour of a myelopathic origin for the disease, mainly because it is well known that in true myopathy no such atrophy of the anterior cornual cells is typically present. They admit, however, that the conclusions are not absolute, for no sign of actual degeneration of these motor cells is apparent, though the disease is essentially progressive, and further, as has been hinted, some at least of the muscle changes are also seen in true myopathy. They think that THE PROGRESSIVE SPINAL MUSCULAR ATROPHY a distinction may be drawn from the facts that there OF INFANTS (WERDNIG-HOFFMANN TYPE). is so little connective tissue formation between the Ix the current number of l3raira are two papers containing individual muscle fibres and that increase of muscle sheath .a clinical and pathological description of this comparativelynuclei is not obvious-appearances frequently met with in On the other hand, it is expressly rare and not well recognised type of muscular atrophy. Themuscular dystrophies. first is by Dr. F. E. Batten and Dr. Gordon Holmes, of theremarked in the second of the two cases-that recorded by National Hospital, Queen-square, London ; the other by Dr. Parsons and Dr. Stanley-that the small muscle fibres Dr. Leonard G. Parsons and Dr. J. Douglas Stanley, of the showed an enormous increase in the number of nuclei, so The patient whose case that parts of the sections appeared to be swarming with ’Children’s Hospital, Birmingham. is described in the former of these two communications was nuclei, and further, that fine fibrous tissue could be traced between numbers of the fibres, and that many of them .a female infant of 14 months, who apparently enjoyed normal health up to the age of 6 months, when her parents seemed to pass imperceptibly into fibrous tissue. As their Ibegan to notice that she was gradually becoming weak and case clinically resembled the other closely it would seem helpless, and in the course of three or four months she that the criteria of distinction between the muscular eon. lost almost all power in her limbs, could not sit dition of the Werdnig-Hoffmann type and the primary up, and could nøt bold her head erect when it myopathies, advanced by Dr. Batten and Dr. Holmes, are was unsupported. On examination it was found that therefore possibly somewhat invalidated. Be this as it .all the limbs were weak, especially at their proximal may, these two papers are of considerable value in view of joints ; the muscles were flabby and toneless, but the the rarity of the disease and our ignorance of its exact exact of was difficult to gauge owing to classification.

Oliver claims the abolition of the use of white phosphorus in most civilised countries---in regard to which it is gratifying to note that the United States has now fallen into line-as a ’victory obtained by the International Association for Labour Legislation, through the Berne Convention. He pleads for tthe adoption by all countries of a scheme of compulsory notification of industrial diseases, with agreement as to their ,definition, as a first step to the collection and arranging of statistics, and thus towards rendering practicable international cooperative effort in this direction. The whole .address is one of practical value, and will be studied carefull by all engaged in this sphere of work.

degree

although they were infiltrated was

atrophy

subcutaneous fat. The child was bright and intelligent, and remained so, but its helplessness continued to progress. At the age of18 months contractures were noted in the legs.

___

AN

UNUSUAL CASE UNDER THE WORKMEN’S COMPENSATION ACT.

At the age of 21 months, further examination showed that A CASE has been brought under our notice by a corre ,the movements of the facial and other head and throat spondent, which, as it affords material for reflection, we musculature were normal, but the neck muscles were present as follows : A man, aged 48, while working at an practically powerless ; the weakness of the trunk muscles electric crane stumbled and put his left hand on a live wire was extreme; the abdominal muscles were also very weak, of high voltage, receiving a severe shock, as was proved in the the contracted well. Movements at evidence. He experienced the natural consequences of such although diaphragm - shoulder were ’?M’7, at the elbows, very deficient; but the a shock-pain, numbness, and so forth. The arm became ,child could make small movements with the fingers, and progressively weaker, and in a few days paralysis set in, In the lower extremities voluntary with muscular atrophy and impaired sensibility. He was grasp objects feebly. movement at the hips was also ’ltil, as well as at the examined two months after the accident by a medical knees; but there was slight power of flexion and exten- man, who found the limb extended and especially the sion at the ankles and toes. In all the paralysed upper arm distinctly wasted. There was very obviously muscles no electrical response to faradism of medium motor and trophic paralysis, which had begun in the strength was obtainable, the tendon reflexes were abolished, hand, primarily in the median nerve distribution, rapidly ,and there was considerable general hypotonia, which was not, involving the forearm and subsequently the whole tract however, as marked as in the condition known by the name supplied by the brachial plexus. Slight ataxic symptoms The medical man, giving evidence ofamyotonia congenita. The little patient died at the age were present. of 2 years and 9 months, and a complete pathological in the county court in an action under the Workmen’s ,examination was made of the nervous system and the Compensation Act, testified that the patient’s condition was muscles. In the spinal cord the loss and atrophy of the undoubtedly due to the accident and that the prognosis was motor cells ofthe anterior cornua was very striking ; apart very grave. His fellow-workmen and his medical attendant, from the actual loss of cells, those that were left were who had known him for many years, gave evidence that notably reduced ’in size, but did not show signs of chroma- previously to the accident the man was thoroughly fit for tolytic changes.; in other words, they were cells in his work and showed no sign of ataxia. A medical man of miniature, cells reduced in dimensions, but not, apparently, eminence, who was also medical referee to the court in otherwise degenerating. The anterior roots were small and which the case was tried, appeared as a medical expert for poorly stained by comparison with the posterior roots. the defence, and gave it as his opinion that the man’s conThe majority of the muscle fibres, in the affected muscles, dition was due to locomotor ataxia, which had preceded the presented the appearance of a simple atrophy ; some were accident, and that the latter had no connexion with his abnormally large and cylindrical in outline, a condition condition. The judge gave judgment against the man usually found in true myopathy. Although bands of con- without assigning any reason. Assuming the facts to be nective tissue traversed the degeneratedmuscles, and precisely as stated, and, further, that nothing material has