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MENTAL DISEASE IN ARMIES.
306 its treatment unsatisfactory, and that much yet remained to be discovered in these directions. A
METHOD OF PHOTOGRAPHING PLATE CULTIVATIONS WITHOUT REPRODUCING THE SCRATCHES OF THE DISH.
1,N photographing plate cultivations which have been made in scratched dishes the scratches are sometimes only too faithfully reproduced, interfering very much with the photographic detail of the cultivation. In valuable cultivations this is a source of considerable annoyance. Mr. Walter A. Mitchell, of the pathological laboratory at Cambrid-e, avoids the photographic reproduction of the scratches on the cultivation dish by cutting a drop of cedarwood oil thinned with zylol on the bottom of the dish after it has been thoroughly cleanserl with swabs of wool soaked, first, in hydrochloric acid and then in water. The oil is well It is important that the oil rubbed in with the finger-tips. should not be too thick and that it should be well rubbed in so that no scratches are visible. The best result is obtained when the oiling is done 20 minutes or so before the photograph is taken. We have received for inspection (1) a photograph of a gelatin culture in a dish which was purposely badly scratched and then thoroughly cleansed in the way indicated ; and (2) a xhot graph of the f-ame dish taken with the same lens, with the ame stop exposure and lighting arrangement but with one-half of the dish oiled. The aivantage of this simple method is obvious from the latter pho10graph, the scratches being quite eliminated. Every bacteriologist knows how easily cultivation dishes are scratched, .and in research with mixed culture. it i impossible, as Mr. Mitchell points out, to r7uplicate a plate should it be scratched and a photograph of it be desired.
THE TREATMENT OF RELAPSING PLEURAL EFFUSIONS BY GASEOUS INJECTIONS. AT the meeting of the Société Médicale des Hopitaux of Paris on May 23rd M. Vaquez and M. Qui.’erne called attention to the value of gaseous injections in the treatment of recurring pleural eSusions. Their method is directly derived from that of the late Professor Potain. It consifts in pro- ducing an artificial pneumothorax which checks the incessant reproduction of fluid observed in certain case< of chronic pleurisy. They suppose that the mode of action is purely mechanical. The choice of the ga’- u-ed depend. on its greater or less absorbability rather than on any antiseptic In January, The following case i< an example. power. 1902 a man had been under treatment for left tnber- culous pleurisy t-ince May, 1901. Paracentesis had been performed 12 times, 1000 to 1500 grammes of fluid being removed on each occasion and the effusion being reproduced in from three to five weeks. The general condition of the patient was not bad ; he had no fever and took food well. He could go about except during the eight or ten days when increasing dyspnoea, kept him in bed. On Jan. 7t,h a litre of serous fluid was removed. On the 21-t the effusion was reproduced and a litre of fluid was again removed, and with the apparatus devised by Professor Potain about three-quarters of a litre of air were injected. The pleura was evidently very thick and hard, for it offered great rtsi.-.tance to t.he passage of the trocar. An hour later the temperature was elevated to 104°F. and the patient felt ill, but in the evening the temperature returned to normal. Immediately after the injection all the of signs hydro-pneamothorax were present. Pneumothorax persisted until April 28th-more than three months. Only a small quantity of fluid at the base of the lung could be demon-trated. Further intervention does not seem to be necessary. In another case a man had culous pleurisy which began in October, 1901. In March,
preceding paracentesis,
tutier- I
I
1902, paracentesis had been performed five times. On March 27th paracentesis was performed and three-quarters of No reaction followed. a litre of sterilised air were injected. lasted for two weeks. At the end of pneumothorax Signs of April the patient left the hospital greatly improved. For the injection of ga-! into the pleura a trocar connected with a Y-shaped indiarubber tube is required. One branch of the tube is connected with a Potain’s syphon, the other remains free and is provided with an ampulla of gla"s filled with sterilised cotton-wool. Before use the tubes are carefully boiled. The free branch of the Y is clamped with an artery forceps while the paracente-is thoracis is perThen the forceps is transferred to the other formed. arm of the Y and an air pump is connected with the free arm. Air is injected slowly into the pleural cavity and is sterilised in passing through the cottonIf it is desired to injct any other gas that wool. can be easily done from a bag filled with it. The quantity of gas to be injected depends on the amount of fluid withdrawn ; in most ca<-es half a litre is s-ufncifnt. The capacity of the pump being known the number of strokes of the piston shows the quantity injected. As to the question of the gas to be injected air appears to answer very well in the majority of cases. As shown in the first case it is slowly absorbed. But if the effusion is rapidly reproduced nitrogen, which is very slowly absorbed, may be used. It has been ascertained that after air is injected into a serous cavity only carbonic acid and nitrogen remain. The impermeability of the pleura to nitrogen is shown by a case of relapsing .taphyloconcio pleurisy under the care of M. Widal. After the injection of air the pneumothorax lasted only 10 days ; after the injection of nitrogen, at least 25 days. M. Vaquez and M. Quiserne xugget that the injection of air into the pleural cavity may prevent by its mechanical action certain untoward complications of paracentesis thoracis, such as rapid extension of tuberculosis in the compressed 1 lung after it is released from pressure. MENTAL
DISEASE
IN
ARMIES.
Allgemeine Zeit,,?chq4ft fiir ’syr7iatrie (Heft 4, 1902) Dr. Ewald Stier furni-hes interesting facts and statistics concerning the graver forms of In military statistics, nervous and mental disease in armies. writes Dr. Stier, a history of ]ues is almost invariahly found to have preceoecl cases of tabes c1or"aJis and of general paralysis of the insane in officers. This is especially shown as regards the armies of France. Germany, and Great Britain. The observations of Dr. Stier regarding the almost invariable association of syphilis with general paralysis confirm the conclusions already arrived at by Rieger of Wiirzburg, and in this country by Dr. W. J. Mickle, concerning the not infrequent occurrence of these associated affections in military Ix
a
recent
issue
of
the
In many, but not in all cases, adds Dr. Stier, may also be found—viz , alcoholism and, to a less extent, trauma. Hysteria in males was a rare occurrence in the armies f Europe a quarter of a century ago, but now it is not uncommon, especially, according to Dr. Stier, in the armies of central Europe. The traumatic psychoses are found to reach a high proportion only during wars, the chief causes being cranial and other injuries caused by shot or shell, accidents, and shocks sustained in moments of intense cerebral excitement. Thu-, in the course of the Franco-German war (1870-1871) the proportion of ca’-e-i of traumatic psychosis in the German army reached to 13 per cent. of the total number of soldiers engaged in fighting. Medical statistics as regards armies are, in Dr. Stier’s opinion, as yet very inadequately drawn up, but
officers.
other
causes
1
Galliard :
Semaine Médicale, 1897.
307 this defect will, it M hoped, be soon removed, as a knowledge of nervous and mental disease and the passing of an examination in the same are now compulsory in the
German army. THE
THE
-
BENEFITS OF THE
ANNUAL REPORT OF THE CHIEF INSPECTOR OF FACTORIES AND WORKSHOPS FOR THE YEAR 1901.
BICYCLE TO PART I. REPORTS. MEDICAL MEN. MEDICAL men who have experienced the benefits of the THIRD AND CONCLUDING NOTICE.’ bicycle may be glad to be reminded of the movement which LEAD is not only the mineral poison which causes the has been started for the establishment of a memorial to the mortality greatest among,-t those engaged in factories and K. late Mr. J. Starley who introduced the "safety"bicycle but there can be little doubt that of all metals it The secretary to the workshops, in 1885 and who died lat October. causes the greatest number of deaths amongst mankind in fund is Mr. R T. Lang of 27, Chancery-lane, W.C., and any Plumbers and lead-painters who do not work in medical men who would like to express their appreciation of general. factories do not come under the care of the Home Office, and those benefits in a practical form are invited to communicate there are no tl utworthy data to go upon to render it possible with that gentleman. Donations have been received from to make even an approximate estimate of the number of those several notable persons, including the Prime Minister, the who are slowly killed by the insidious action of lead. It is, Right Hon. A. J. Balfour, M. P. The fund now amounts nevertheless, certain that the records of the metropolitan to about .6200. There is no doubt that the bicycle is hospitals show clearly enough that a very large proportion of the cases of gout and of granular kidney occur in painters useful to the country practitioner whose patients especially and plumber... the hoube-painter pleases himself as to It is swift and inexpensive, occasions whether he shall wash his hands before reside miles apart. taking his meals but little trouble, and has many advantages in these and it is the business of no one to provide him with soap or respects over the horse and carriage with their inevi- with a nail-bruh. In the case of the industries which necestable appurtenances. The modern medical man is enabled ,itate working in lead in a factory or workshop the employes are under supervision. Of these industries a few words to carry a dispensary and surgery outfit within the compass said. The smelting of lead has been found to be a. may be of a bicycle knapsack. The medical man who needs a particularly injurious occupation. At some ,mall works near needs one which is bicycle thoroughly trustworthy, respect- Dublin, of 12 men seven showed a blue line on the gum ; five able, and reasonably priced. The bright partsshould, if woeanaemic ; five had suffeied, some motethan once, from of the wrists, and in two of ; three had weakness possible, be unt.1rnishable, in order to thwart the small colic the:.e cases loss of power I amounted to definite paralysis." boy who never loses an opportunity or a pretext to hail the Printerb are mentioned as men particularly liable to rider of a machine which fails to come up to his criticall suffer from usually but it does not plumbi-,m, appear that the number standard of refulgency with the epithet of "old iron." of cases occurring amongst them is very great In the year 1899 the number of reported cases amounted to 26. in 1900 there were 18, and in 1901 there were 23 ca.es. In the ca-e WE have been informed of the army medical arrange- of compositors more than one of the a-signed causes of ments in connexion with the postponed Coronation of their poisoning are removeable. It is said that some compositors Majesties on Saturday next, Augu-t 9th, and they do notb put type in their mouths. This is not a commendable habit. differ greatly from those which we described as having It is stated, also, that wi en the type is getting low-that is to i-ay, when there is little left in the type box-there exists. been made for the Coronation at the original date (ee: a practice amongst compositors of shaking up the type and THE LANCET, June 21st, p. 1789). The number of ambu- that thi5 causes a fine dust of metal to be raised and inhaled. lance stations had been reduced from 18 to 12, of dressing- It is also stated that in some printing works no washing constations from six to five, and of field hospitals from 10 to) veniences are provided and that, to quote the wu5ds of a. six, while only four general hospitals-viz., St. George’s,’ report, "cleansing of the hands before meals is not done." File-cutters suffer from inhalation of lead dust. Tinners and Charing Cross, St. Thomas’s, and We&tminster—are reserving’’ enamellers have suffered much in the past, but it may be beds for casualties of a severe nature among the troops. hoped that in the future fewer cases of plumbism will occurThe abundonment of the second ]Jrocession with its extended1 amongst them. In a case quoted in the report a manufacturer was using an enamel powder which contained no lessroute accounts for all the change;-. than 67 per cent. of lead oxide. The work-people were evidently injured in health by its use. The manufacturer Mr. M. H. Taylor, J. P , L.R.C.P., L. R. C. S. Edin., deputyr refused to alter his process. The inspector applied for a 1 closing order-that is to say, an order from the magistrate coroner for the Kingston district of Surrey, hd.s been appointed that the whole business ,hould be discontinued. An adjourncoroner in place of the late Mr. A. Braxtun Hicks ; and Mr. R. Henslowe Wellington, L.R.C.P. Lond, MRC.S.Eng., ment was applied for and granted and in the course of a. few days an enamel free fiom lead and from arsenic was ha- been appointed deputy coroner for the City and Libertyf substituted for the injurious compound which had been of Westminster and for the south-western district of London1 previously used. under the London County Council. Workers in white lead have always been prominent amongst the sunders from plumbism, but it is pleading to ’
’
. ,
’
"
r
’
-
-
,
’
DR. A E. SANSOM, having resigned the post of physician1 to the London Hospital, has been appointed con-ulting31 physician and has been unanimously elected by his colleaguess a member of the London Hospital Medical Council.
’
note that the number of the cases is diminishing to a markedThe number of repute,i cases fur the years 1898, extent.
1899, 1900, and 1901,
was Je"pectively 332, 399, 358, and rapid diminution in the number of cases cannot be expected to progress at the same rate, for the lessenedincidence of the reported cases for the last of these years ischiefly due to improvements in the arrangement;-, of two large THE KING has been pleased to appoint Sir Frederick factoriesin which, during the previous year, there had been Treves, Bart., K.C.V.O., C.B., F. R. C. S. Eng. , one of His an enormous number of cases. DUI ing the year 1900, these two firms had their workpeople 111 and 62 cases respec-Majesty’s Honorary Serjeant Surgeons, to be a Serjeantt tively, andamongst the year 1901 the numbers were reduced to during Surgeon-in-Ordinary to His Majesty. 58 and 16 respectively. A considerable decrease has taken place in the number of WE are asked to state that medical men are requiredi cases of lead poisoning which have occurred ill workers in the china and earthenware trades. The number of reported for plague duty in India. Application for appointments should be made to the Secretary, Revenue and S*-atitics 1 The first and second notices were published in THE LANCET of
189.
Thi"
,
Department,
India Office.
July 19th (p. 172)
and 26th
(p. 238),
1902.
METHOD OF PHOTOGRAPHING PLATE CULTIVATIONS WITHOUT REPRODUCING THE SCRATCHES OF THE DISH.
1,N photographing plate cultivations which have been made in scratched dishes the scratches are sometimes only too faithfully reproduced, interfering very much with the photographic detail of the cultivation. In valuable cultivations this is a source of considerable annoyance. Mr. Walter A. Mitchell, of the pathological laboratory at Cambrid-e, avoids the photographic reproduction of the scratches on the cultivation dish by cutting a drop of cedarwood oil thinned with zylol on the bottom of the dish after it has been thoroughly cleanserl with swabs of wool soaked, first, in hydrochloric acid and then in water. The oil is well It is important that the oil rubbed in with the finger-tips. should not be too thick and that it should be well rubbed in so that no scratches are visible. The best result is obtained when the oiling is done 20 minutes or so before the photograph is taken. We have received for inspection (1) a photograph of a gelatin culture in a dish which was purposely badly scratched and then thoroughly cleansed in the way indicated ; and (2) a xhot graph of the f-ame dish taken with the same lens, with the ame stop exposure and lighting arrangement but with one-half of the dish oiled. The aivantage of this simple method is obvious from the latter pho10graph, the scratches being quite eliminated. Every bacteriologist knows how easily cultivation dishes are scratched, .and in research with mixed culture. it i impossible, as Mr. Mitchell points out, to r7uplicate a plate should it be scratched and a photograph of it be desired.
THE TREATMENT OF RELAPSING PLEURAL EFFUSIONS BY GASEOUS INJECTIONS. AT the meeting of the Société Médicale des Hopitaux of Paris on May 23rd M. Vaquez and M. Qui.’erne called attention to the value of gaseous injections in the treatment of recurring pleural eSusions. Their method is directly derived from that of the late Professor Potain. It consifts in pro- ducing an artificial pneumothorax which checks the incessant reproduction of fluid observed in certain case< of chronic pleurisy. They suppose that the mode of action is purely mechanical. The choice of the ga’- u-ed depend. on its greater or less absorbability rather than on any antiseptic In January, The following case i< an example. power. 1902 a man had been under treatment for left tnber- culous pleurisy t-ince May, 1901. Paracentesis had been performed 12 times, 1000 to 1500 grammes of fluid being removed on each occasion and the effusion being reproduced in from three to five weeks. The general condition of the patient was not bad ; he had no fever and took food well. He could go about except during the eight or ten days when increasing dyspnoea, kept him in bed. On Jan. 7t,h a litre of serous fluid was removed. On the 21-t the effusion was reproduced and a litre of fluid was again removed, and with the apparatus devised by Professor Potain about three-quarters of a litre of air were injected. The pleura was evidently very thick and hard, for it offered great rtsi.-.tance to t.he passage of the trocar. An hour later the temperature was elevated to 104°F. and the patient felt ill, but in the evening the temperature returned to normal. Immediately after the injection all the of signs hydro-pneamothorax were present. Pneumothorax persisted until April 28th-more than three months. Only a small quantity of fluid at the base of the lung could be demon-trated. Further intervention does not seem to be necessary. In another case a man had culous pleurisy which began in October, 1901. In March,
preceding paracentesis,
tutier- I
I
1902, paracentesis had been performed five times. On March 27th paracentesis was performed and three-quarters of No reaction followed. a litre of sterilised air were injected. lasted for two weeks. At the end of pneumothorax Signs of April the patient left the hospital greatly improved. For the injection of ga-! into the pleura a trocar connected with a Y-shaped indiarubber tube is required. One branch of the tube is connected with a Potain’s syphon, the other remains free and is provided with an ampulla of gla"s filled with sterilised cotton-wool. Before use the tubes are carefully boiled. The free branch of the Y is clamped with an artery forceps while the paracente-is thoracis is perThen the forceps is transferred to the other formed. arm of the Y and an air pump is connected with the free arm. Air is injected slowly into the pleural cavity and is sterilised in passing through the cottonIf it is desired to injct any other gas that wool. can be easily done from a bag filled with it. The quantity of gas to be injected depends on the amount of fluid withdrawn ; in most ca<-es half a litre is s-ufncifnt. The capacity of the pump being known the number of strokes of the piston shows the quantity injected. As to the question of the gas to be injected air appears to answer very well in the majority of cases. As shown in the first case it is slowly absorbed. But if the effusion is rapidly reproduced nitrogen, which is very slowly absorbed, may be used. It has been ascertained that after air is injected into a serous cavity only carbonic acid and nitrogen remain. The impermeability of the pleura to nitrogen is shown by a case of relapsing .taphyloconcio pleurisy under the care of M. Widal. After the injection of air the pneumothorax lasted only 10 days ; after the injection of nitrogen, at least 25 days. M. Vaquez and M. Quiserne xugget that the injection of air into the pleural cavity may prevent by its mechanical action certain untoward complications of paracentesis thoracis, such as rapid extension of tuberculosis in the compressed 1 lung after it is released from pressure. MENTAL
DISEASE
IN
ARMIES.
Allgemeine Zeit,,?chq4ft fiir ’syr7iatrie (Heft 4, 1902) Dr. Ewald Stier furni-hes interesting facts and statistics concerning the graver forms of In military statistics, nervous and mental disease in armies. writes Dr. Stier, a history of ]ues is almost invariahly found to have preceoecl cases of tabes c1or"aJis and of general paralysis of the insane in officers. This is especially shown as regards the armies of France. Germany, and Great Britain. The observations of Dr. Stier regarding the almost invariable association of syphilis with general paralysis confirm the conclusions already arrived at by Rieger of Wiirzburg, and in this country by Dr. W. J. Mickle, concerning the not infrequent occurrence of these associated affections in military Ix
a
recent
issue
of
the
In many, but not in all cases, adds Dr. Stier, may also be found—viz , alcoholism and, to a less extent, trauma. Hysteria in males was a rare occurrence in the armies f Europe a quarter of a century ago, but now it is not uncommon, especially, according to Dr. Stier, in the armies of central Europe. The traumatic psychoses are found to reach a high proportion only during wars, the chief causes being cranial and other injuries caused by shot or shell, accidents, and shocks sustained in moments of intense cerebral excitement. Thu-, in the course of the Franco-German war (1870-1871) the proportion of ca’-e-i of traumatic psychosis in the German army reached to 13 per cent. of the total number of soldiers engaged in fighting. Medical statistics as regards armies are, in Dr. Stier’s opinion, as yet very inadequately drawn up, but
officers.
other
causes
1
Galliard :
Semaine Médicale, 1897.
307 this defect will, it M hoped, be soon removed, as a knowledge of nervous and mental disease and the passing of an examination in the same are now compulsory in the
German army. THE
THE
-
BENEFITS OF THE
ANNUAL REPORT OF THE CHIEF INSPECTOR OF FACTORIES AND WORKSHOPS FOR THE YEAR 1901.
BICYCLE TO PART I. REPORTS. MEDICAL MEN. MEDICAL men who have experienced the benefits of the THIRD AND CONCLUDING NOTICE.’ bicycle may be glad to be reminded of the movement which LEAD is not only the mineral poison which causes the has been started for the establishment of a memorial to the mortality greatest among,-t those engaged in factories and K. late Mr. J. Starley who introduced the "safety"bicycle but there can be little doubt that of all metals it The secretary to the workshops, in 1885 and who died lat October. causes the greatest number of deaths amongst mankind in fund is Mr. R T. Lang of 27, Chancery-lane, W.C., and any Plumbers and lead-painters who do not work in medical men who would like to express their appreciation of general. factories do not come under the care of the Home Office, and those benefits in a practical form are invited to communicate there are no tl utworthy data to go upon to render it possible with that gentleman. Donations have been received from to make even an approximate estimate of the number of those several notable persons, including the Prime Minister, the who are slowly killed by the insidious action of lead. It is, Right Hon. A. J. Balfour, M. P. The fund now amounts nevertheless, certain that the records of the metropolitan to about .6200. There is no doubt that the bicycle is hospitals show clearly enough that a very large proportion of the cases of gout and of granular kidney occur in painters useful to the country practitioner whose patients especially and plumber... the hoube-painter pleases himself as to It is swift and inexpensive, occasions whether he shall wash his hands before reside miles apart. taking his meals but little trouble, and has many advantages in these and it is the business of no one to provide him with soap or respects over the horse and carriage with their inevi- with a nail-bruh. In the case of the industries which necestable appurtenances. The modern medical man is enabled ,itate working in lead in a factory or workshop the employes are under supervision. Of these industries a few words to carry a dispensary and surgery outfit within the compass said. The smelting of lead has been found to be a. may be of a bicycle knapsack. The medical man who needs a particularly injurious occupation. At some ,mall works near needs one which is bicycle thoroughly trustworthy, respect- Dublin, of 12 men seven showed a blue line on the gum ; five able, and reasonably priced. The bright partsshould, if woeanaemic ; five had suffeied, some motethan once, from of the wrists, and in two of ; three had weakness possible, be unt.1rnishable, in order to thwart the small colic the:.e cases loss of power I amounted to definite paralysis." boy who never loses an opportunity or a pretext to hail the Printerb are mentioned as men particularly liable to rider of a machine which fails to come up to his criticall suffer from usually but it does not plumbi-,m, appear that the number standard of refulgency with the epithet of "old iron." of cases occurring amongst them is very great In the year 1899 the number of reported cases amounted to 26. in 1900 there were 18, and in 1901 there were 23 ca.es. In the ca-e WE have been informed of the army medical arrange- of compositors more than one of the a-signed causes of ments in connexion with the postponed Coronation of their poisoning are removeable. It is said that some compositors Majesties on Saturday next, Augu-t 9th, and they do notb put type in their mouths. This is not a commendable habit. differ greatly from those which we described as having It is stated, also, that wi en the type is getting low-that is to i-ay, when there is little left in the type box-there exists. been made for the Coronation at the original date (ee: a practice amongst compositors of shaking up the type and THE LANCET, June 21st, p. 1789). The number of ambu- that thi5 causes a fine dust of metal to be raised and inhaled. lance stations had been reduced from 18 to 12, of dressing- It is also stated that in some printing works no washing constations from six to five, and of field hospitals from 10 to) veniences are provided and that, to quote the wu5ds of a. six, while only four general hospitals-viz., St. George’s,’ report, "cleansing of the hands before meals is not done." File-cutters suffer from inhalation of lead dust. Tinners and Charing Cross, St. Thomas’s, and We&tminster—are reserving’’ enamellers have suffered much in the past, but it may be beds for casualties of a severe nature among the troops. hoped that in the future fewer cases of plumbism will occurThe abundonment of the second ]Jrocession with its extended1 amongst them. In a case quoted in the report a manufacturer was using an enamel powder which contained no lessroute accounts for all the change;-. than 67 per cent. of lead oxide. The work-people were evidently injured in health by its use. The manufacturer Mr. M. H. Taylor, J. P , L.R.C.P., L. R. C. S. Edin., deputyr refused to alter his process. The inspector applied for a 1 closing order-that is to say, an order from the magistrate coroner for the Kingston district of Surrey, hd.s been appointed that the whole business ,hould be discontinued. An adjourncoroner in place of the late Mr. A. Braxtun Hicks ; and Mr. R. Henslowe Wellington, L.R.C.P. Lond, MRC.S.Eng., ment was applied for and granted and in the course of a. few days an enamel free fiom lead and from arsenic was ha- been appointed deputy coroner for the City and Libertyf substituted for the injurious compound which had been of Westminster and for the south-western district of London1 previously used. under the London County Council. Workers in white lead have always been prominent amongst the sunders from plumbism, but it is pleading to ’
’
. ,
’
"
r
’
-
-
,
’
DR. A E. SANSOM, having resigned the post of physician1 to the London Hospital, has been appointed con-ulting31 physician and has been unanimously elected by his colleaguess a member of the London Hospital Medical Council.
’
note that the number of the cases is diminishing to a markedThe number of repute,i cases fur the years 1898, extent.
1899, 1900, and 1901,
was Je"pectively 332, 399, 358, and rapid diminution in the number of cases cannot be expected to progress at the same rate, for the lessenedincidence of the reported cases for the last of these years ischiefly due to improvements in the arrangement;-, of two large THE KING has been pleased to appoint Sir Frederick factoriesin which, during the previous year, there had been Treves, Bart., K.C.V.O., C.B., F. R. C. S. Eng. , one of His an enormous number of cases. DUI ing the year 1900, these two firms had their workpeople 111 and 62 cases respec-Majesty’s Honorary Serjeant Surgeons, to be a Serjeantt tively, andamongst the year 1901 the numbers were reduced to during Surgeon-in-Ordinary to His Majesty. 58 and 16 respectively. A considerable decrease has taken place in the number of WE are asked to state that medical men are requiredi cases of lead poisoning which have occurred ill workers in the china and earthenware trades. The number of reported for plague duty in India. Application for appointments should be made to the Secretary, Revenue and S*-atitics 1 The first and second notices were published in THE LANCET of
189.
Thi"
,
Department,
India Office.
July 19th (p. 172)
and 26th
(p. 238),
1902.