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REPORT TO THE HOSPITALS SUB-COMMITTEE OF THE MANCHESTER SANITARY COMMITTEE ON THE OUTBREAK OF ARSENICAL POISONING NOW IN PROGRESS IN MANCHESTER.
1752
THE
OUTBREAK
and her daughters have also be present on this occasion.
accepted
OF ARSENICAL POISONING IN MANCHESTER.
an
invitation to
of health made cases
next
Workhouse
day on
an
at
appointment with Dr. Reynolds to see the Crumpsall. On visiting the Crumpsall
Nov. 21st he saw, in company with Dr.
Reynolds and Dr. H. G. Brooke, a large number of cases presenting special and fairly uniform symptoms. Dr. Brooke
THE death is announced of Mr. R. G. Glenn, the Recorder of Croydon. He was born in 1844 and was a stated that he had seen for some time a number of cases "Grecian" of Christ’s Hospital. His name should be with eruptions of a peculiar nature and such as to give rise ultimately to a suspicion of arsenical poisoning. widely known to medical men, for he was the author of The medical officer of health at once saw Mr. Rook, the "A Manual of the Laws affecting’ Medical Men" and of of the Sanitary Department, and they superintendent the Legal Abstract published in Churchill’s " Medical 12 that arranged samples of beer (sixpenny and fourpenny from each) should be obtained from six tied houses. fhese Directory." samples were accordingly obtained and submitted to the DR. D. E. ANDERSON of Paris, a graduate of the London public analyst. Meanwhile, Dr. Tattersall, the medical and Paris Universities and former physician’s and obstetric officer of health for Salford, had submitted samples of beer assistant at University College Hospital, has been elected to to Professor Delepine, who, in the absence of Professor Dixon undertook an into the nature of these the post of visiting physician to the Hertford British Mann, which had investigation rise to symptoms of samples apparently given Hospital, Paris. poisoning in Salford. Your medical officer of health could not move further in the matter until on Nov. 23rd Dr. AT a general monthly meeting of the Members of the Kelynack called to inform him that he and Dr. Kirkby had Royal Institution held on Dec. 3rd Dr. Allan Macfadyen that day discovered the arsenic present in the beer to arise On the same day Profesor Delépine informed was announced to have been appointed Fullerian Professor from glucose. medical officer of health that on Nov. 22nd he had disof Physiology for three years, the appointment dating from your covered the presence of a considerable amount of arsenic in Jan. 14tb, 1901. particular saccharine matters used in brewing, and that he at once communicated with Dr. Tattersall. IT is announced that the Queen has granted to the Royal Dr. Tattersall on Nov. 23rd went down to Liverpool (as medical officer of health was informed by a reporter) the for of a national science your Society, purposes physical to procure a sample of the sulphuric acid used in making the the House, laboratory, Bushey Bushey Park, formerly incriminated glucoses and inverts. It did not appear to residence of the Duc de Nemours. your medical officer of health necessary to obtain samples of the materials at that time from the glucose manufacturers, DURING the week ending Dec. 6th 46 fresh cases of as these had already been procured by Dr. Tattersall at the earliest time, and the results of the investigation plague were registered at Mauritius, 26 of which were fatal. which bepossible knew was being conducted by Dr. Tattersall with The total deaths from plague during the week numbered 33. equal energy and skill would be available at an,- arly date for our own procedures. It did, however, seem -ecessary THE London Gazette of Dec. llth contains new rules made to act with all possible speed administratively. On Nov. 23rd, therefore, samples of the saccharine materials employed by the Home Secretary for retreats licensed under the were obtained from two breweries implicated by the patients. Inebriates Act. On Nov. 24th your medical officer of health improvised a laboratory in his room, aided by the assistant medical officers Mr. W. H. BATTLE, F.R.O.S. Eng., has been elected sur- of health, Dr. Coates and Dr. McCleary, and by Mr. R. M. geon to St. Thomas’s Hospital in the room of the late Mr. Rowe of the Sanitary Department, a gentleman of consirlerable chemical experience, whose services have been most W. Anderson. valuable. Two samples of beer and one of stout were procured and examined on Nov. 24th. A trace of arsenic was believed to be found in a samp e of beer, and the same REPORT TO THE material was believed to have been found in one of the HOSPITALS SUB-COMMITTEE OF THE saccharine matters. Your medical officer of health then consulted Professor Delepine who, with his usual courtesy MANCHESTER SANITARY COMMITTEE and kindness, showed him the methods which he had ON THE OUTBREAK OF ARSENICAL employed and the quantities of the materials used in the analyses. On Nov. 26th the examinations were POISONING NOW IN PROGRESS in the methods renewed at the office, and, being IN MANCHESTER. which we adopted for the Marsh test, on the 27th we were in a position to proceed. Samples of the saccharine DR. JAMES NiVEN, Medical Officer of Health of Man- matters stated to have been used by the brewers were rapidly chester, has presented the following report to the Hospitals obtained by the medical officers and we commenced an Sub-committee of the city on the outbreak of arsenical examination of all the saccharine matters furnished to us as being those in use by 23 Manchester breweries visited, poisoning in Manchester :— as well as of three glucoses used in the manufacture of cheap The medical officer of health begs to present to this sub- sweets and jams. As regards the latter it may at once be committee a report on the outbreak of arsenical poisoning said that not a trace of arsenic was found in them. As now running its course. On Nov. 20th Dr. Reynolds called regards the saccharine matters which were furnished to us at the Health Office and informed the medical officer of by the brewers as being used by them, and which included health that he had obtained well-marked reactions of arsenic Home and American glucoses and inverts, we examined them in a sample of beer which he had examined. For some all to the number of 46 specimens from 20 breweries. In months there had been a large number of patients coming not one did we find a trace of arsenic except in the glucoses into the Union Infirmary with well-marked and fairly and inverts emanating from one firm, in which it was present uniform symptoms, and there were at present a very large apparently in considerable amount. Unfortunately, five number of these cases in the wards. They were all beer- out of the 20 breweries were using this material to our drinkers and drank the cheaper kinds of beer and stout. For knowledge, or had just discontinued it, while in another some time he had suspected the presence of some deleterious .nstance its use had been discontinued for two months. It agant in the beer and latterly the symptoms had suggested .s possible that there are other breweries in which it has been arsenic. He had therefore procured a sample of a beer which lsed where we have not been informed of the fact. As soon was pointed to by many of the cases, tested it, and found as we knew that the examination of a saccharine material arsenic. He also informed your medical officer of health :evealed the presence of arsenic, information was sent to the that another sample of beer submitted to Professor Dixon nanager of the brewery concerned with a request that all Mann had been found to contain arsenic, thus confirming his )eer now on the market in which the incriminated sugar Previous to Dr. Reynolds’s intimation on lad been used should be immediately recalled. observation. Nov. 20th your medical officer of health was aware of nothing Meantime on Nov. 27th a circular letter was sent to all indicating either an outbreak of a fresh form of disease or the practitioners in the city asking for certain information, the existence of impurities in the beer. The medical officer pased on the symptoms of the cases at Crumpsall. The -
-
-
___
’
=
THE OUTBREAK OF ARSENICAL POISONING IN MANCHESTER. .
1
replies
to these are most valuable and instructive.
1753
Basing
these reports and on the information which they afiorded, and in pursuance of an instruction from the meeting of the Sanitary Committee of Nov. 27th, we have obtained samples from a number of public-houses. Instructions were given by the Sanitary Committee on Nov. 28th that this course should be pursued, and it is considered that ample opportunity has been given to get rid of any poisonous beer or stout. Some samples since taken from public-houses and examined unofficially have been found to contain an appreciable amount of arsenic. The number of samples of beer and stout examined unofficially since the instruction of the committee has been 45, of which 11 have been found to contain arsenic. Subsequent samples from the same houses have been sent to the public analyst.
our
action
on
City of Maneltexter.
j)eaths f,,,oiit
:
After the exhaustive investigation carried out by Dr. Tattersall and Professor Delepine there remains very little to be said on the subject except on matters of detail. There are, nevertheless, some points on which the committee would probably wish to be informed, especially what has been the nature and magnitude of the evil. Nature of the disease.-There is a class of disease known to medical men as alcoholic neuritis. As a few good observers state that they see no difference between these fresh cases and those which they have previously known as alcoholic neuritis this will sufficiently indicate the nature of the outbreak to medical men. Tn the slighter cases there may or may not be nausea and sickness and irritation of the eyes, followed by a feeling of pins and needles in the tips of the fingers and toes ; the calves are painful on pressure, and the hands presently become numb and useless. Wasting of
1754
THE WAR IN SOUTH AFRICA.
certain small muscles of the hand is almost invariable. Tables have also been prepared for 1897 and 1898 and the Many cases get dropped wrist or walk unsteadily. In the results may be thus summarised :most severe cases the paralyses advance quickly, the patient cannot stand, has perhaps delirium, and sinks into a comatose state from which he does not recover. A prominent feature of many of the cases is pigmentation of the kin. which in some cases has been very deep, the patient being almost like a mulatto. It is impossible in a report of this kind to do more than indicate the kind of illness to which our figures relate, although the courtesy of the medical officers at Crumpsall and Withington in allowing the medical officers to see the The medical officer of health cases must be acknowledged. has received information of about 1003 cases of the above class of illness from 90 medical men. These do not include the cases which have been sent into the union hospitals during the last few months which will probably come to 700 or so more. Allowing over 300 cases to medical men who have not answered the circular there have thus been at least 2000 cases who have been seen by a medical man. There will, no doubt, be a good many more with minor degrees of illness which have not been seen by a medical man. An important question is whether there is any appearance of improvement in the outbreak. Many medical men state that the cases still continue to come in, as they will do for a little time even if the incriminated beer is entirely stopped. since it takes some time to produce the wasting observed in these cases. The general impression conveyed by the statements of medical practitioners is that the worst has passed and that the worst period of all was towards the -end of October. What do our statistics say ?7 The statistics should throw some light on the question whether this -is or is not an entirely new phenomenon, and I have, therefore, had the deaths excerpted week by week under these headings : peripheral neuritis ; neuritis ; alcoholism ; cirrhosis of the liver ; other disease of the liver ; gastritis in adults. These deaths are then added up to make .a total for the week. The result is shown on the table given on the previous page and the figures are sufficiently remarkable. The number of total weekly deaths from the enumerated causes suddenly shoots up in the last week of May and thenceforward, generally speaking, remains high up to the present time. We may suspect that some alteration took ,place in the quality of the beer used about the beginning of May. This we have not yet time to inquire into. The same ,period-viz., the end of May-also marks a slight increase in the number of deaths ascribed to peripheral neuritis, which Yet even in the last ,now furnishes about one death a week. two weeks of September no death is ascribed to this cause. In October, however, there is a very slight increase, sufficient at all events to show that some observers were now becoming alive to the character of the cases. We may at the same time confidently assume that, in the absence of this suspicion, most of the few cases added to peripheral ,neuritis in October would have appeared in the column ,alcoholism. This your medical officer of health has ascertained both as the result of conversations and from the - reports sent in. How do the figures of 1900 compare with the figures for a corresponding period of 1899 ? The deaths from peripheral neuritis have nearly doubled in 1900. The difference is, however, confined to recent months, since up to the end of May there were in 1900 only five deaths from this cause, as compared with eight in 1899 from Jan. lst to May 31st. Many medical men have regarded this outburst as an outbreak of alcoholism due to the war fever. It is therefore of considerable interest to see whether in 1899 there occurs any change in the number of deaths from the causes enumerated similar to that which appears in the present year. It will be seen from the table that the figures for July and August of 1899 seem to indicate a similar increase of this class of case on a smaller scale, the increase being observable under both alcoholism and cirrhosis of the liver. These figures suggest ,to your medical officer of health that the recent occurrence does not stand quite alone and that previous mischief in connexion with alcohol has occurred in an epidemic fashion. The suggestion is that there may have been arsenic present ,in the beer formerly. There is, indeed, reason to suspect that’ the same phenomenon may have been going on for years, though in a slighter degree. This would justify some delay in recognising the nature of the disease, since the cases would be regarded as ordinary alcoholic cases of a recognised type with an unusual proportion of certain
striking though not unknown features.
There has, therefore, not been much change in the aggregate number of deaths in 1897 to 1899, while it has greatly increased in the present year (1900). There has been an increase year by year since 1897 in the number of deaths from peripheral and other neuritis, very much accentuated in 1900. The deaths from alcoholism have increased progressively since 1898, and in 1900 are more than double the number in 1898. They were, however, more numerous in 1897 than in 1898. The number of deaths from cirrhosis of the liver have increased progressively since 1898. In 1897, however, they were more numerous than in 1898. From other diseases of the liver than cirrhosis the number of deaths was greater in 1897 and 1898 than in 1899 and 1890. From gastritis the same relation very angularly holds, with the addition that the deaths in 1900 number more than twice The far larger number of deaths as many as those in 1899. from alcoholism and cirrhosis of the liver in 1897 than in 1898 taken along with their distribution in weeks is striking and calls for future inquiry. On the whole, the complete figures do not remove the impression that this is not an
entirely new phenomenon.
In accordance wita the instructions of the Sanitary Committee a vigorous search is being made for arsenical beers and stouts sold in public-houses, and suspected samples have been submitted officially to Mr. Estcourt. It is desirable that a quantitative analysis should be made for one of these samples, but it is probable that the qualitative tests carefully carried out will suffice for a prosecution under the Food and Drugs Acts. Still, one quantitative analysis is advisable. To the assistant medical officers, Dr. Ooates and Dr. McCleary, I am indebted for the accounts of individual cases which they have collected and for the pains which they have taken to collect facts. Mr. R. M. Rowe of the sanitary department has conducted the qualitative analysis of samples with his usual care and skill and with ungrudging zeal. My statistical clerk, Mr. Ross, has prepared the statistical tables which have entailed considerable labour.
THE WAR IN SOUTH AFRICA. NOTWITHSTANDING the assurance of Lord Roberts that the war is over it cannot be said that Boer resistance has ended or that there is any immediate prospect of its being ended. The war has, as we all know and regret, degenerated into a desultory kind of marauding and surprises, varied by vigorous and exhausting pursuits of De Wet. As a rule, the efforts of the British to repel the attacks of the more or less disorganised and scattered bodies of Boers acting independently of one another have been very successful, but it is still far from being the fact that all dangerous opposition has been stamped out. Lord Roberts bas resigned his command in South Africa and has handed it over to Lord Kitchener, who is generally thought to be admirably suited to deal with the present phase of the war and to bring it to an end. It will be remembered that while in a military sense the conquest of Burma proved a comparatively easy task, the real subjection of that country and the suppression of the system of dacoity was a very difficult one, and the Boers are a very different and far more tenacious foe than the Burmese. Such is, briefly summarised, the present position of affairs in South Africa. The capture of
THE
OUTBREAK
and her daughters have also be present on this occasion.
accepted
OF ARSENICAL POISONING IN MANCHESTER.
an
invitation to
of health made cases
next
Workhouse
day on
an
at
appointment with Dr. Reynolds to see the Crumpsall. On visiting the Crumpsall
Nov. 21st he saw, in company with Dr.
Reynolds and Dr. H. G. Brooke, a large number of cases presenting special and fairly uniform symptoms. Dr. Brooke
THE death is announced of Mr. R. G. Glenn, the Recorder of Croydon. He was born in 1844 and was a stated that he had seen for some time a number of cases "Grecian" of Christ’s Hospital. His name should be with eruptions of a peculiar nature and such as to give rise ultimately to a suspicion of arsenical poisoning. widely known to medical men, for he was the author of The medical officer of health at once saw Mr. Rook, the "A Manual of the Laws affecting’ Medical Men" and of of the Sanitary Department, and they superintendent the Legal Abstract published in Churchill’s " Medical 12 that arranged samples of beer (sixpenny and fourpenny from each) should be obtained from six tied houses. fhese Directory." samples were accordingly obtained and submitted to the DR. D. E. ANDERSON of Paris, a graduate of the London public analyst. Meanwhile, Dr. Tattersall, the medical and Paris Universities and former physician’s and obstetric officer of health for Salford, had submitted samples of beer assistant at University College Hospital, has been elected to to Professor Delepine, who, in the absence of Professor Dixon undertook an into the nature of these the post of visiting physician to the Hertford British Mann, which had investigation rise to symptoms of samples apparently given Hospital, Paris. poisoning in Salford. Your medical officer of health could not move further in the matter until on Nov. 23rd Dr. AT a general monthly meeting of the Members of the Kelynack called to inform him that he and Dr. Kirkby had Royal Institution held on Dec. 3rd Dr. Allan Macfadyen that day discovered the arsenic present in the beer to arise On the same day Profesor Delépine informed was announced to have been appointed Fullerian Professor from glucose. medical officer of health that on Nov. 22nd he had disof Physiology for three years, the appointment dating from your covered the presence of a considerable amount of arsenic in Jan. 14tb, 1901. particular saccharine matters used in brewing, and that he at once communicated with Dr. Tattersall. IT is announced that the Queen has granted to the Royal Dr. Tattersall on Nov. 23rd went down to Liverpool (as medical officer of health was informed by a reporter) the for of a national science your Society, purposes physical to procure a sample of the sulphuric acid used in making the the House, laboratory, Bushey Bushey Park, formerly incriminated glucoses and inverts. It did not appear to residence of the Duc de Nemours. your medical officer of health necessary to obtain samples of the materials at that time from the glucose manufacturers, DURING the week ending Dec. 6th 46 fresh cases of as these had already been procured by Dr. Tattersall at the earliest time, and the results of the investigation plague were registered at Mauritius, 26 of which were fatal. which bepossible knew was being conducted by Dr. Tattersall with The total deaths from plague during the week numbered 33. equal energy and skill would be available at an,- arly date for our own procedures. It did, however, seem -ecessary THE London Gazette of Dec. llth contains new rules made to act with all possible speed administratively. On Nov. 23rd, therefore, samples of the saccharine materials employed by the Home Secretary for retreats licensed under the were obtained from two breweries implicated by the patients. Inebriates Act. On Nov. 24th your medical officer of health improvised a laboratory in his room, aided by the assistant medical officers Mr. W. H. BATTLE, F.R.O.S. Eng., has been elected sur- of health, Dr. Coates and Dr. McCleary, and by Mr. R. M. geon to St. Thomas’s Hospital in the room of the late Mr. Rowe of the Sanitary Department, a gentleman of consirlerable chemical experience, whose services have been most W. Anderson. valuable. Two samples of beer and one of stout were procured and examined on Nov. 24th. A trace of arsenic was believed to be found in a samp e of beer, and the same REPORT TO THE material was believed to have been found in one of the HOSPITALS SUB-COMMITTEE OF THE saccharine matters. Your medical officer of health then consulted Professor Delepine who, with his usual courtesy MANCHESTER SANITARY COMMITTEE and kindness, showed him the methods which he had ON THE OUTBREAK OF ARSENICAL employed and the quantities of the materials used in the analyses. On Nov. 26th the examinations were POISONING NOW IN PROGRESS in the methods renewed at the office, and, being IN MANCHESTER. which we adopted for the Marsh test, on the 27th we were in a position to proceed. Samples of the saccharine DR. JAMES NiVEN, Medical Officer of Health of Man- matters stated to have been used by the brewers were rapidly chester, has presented the following report to the Hospitals obtained by the medical officers and we commenced an Sub-committee of the city on the outbreak of arsenical examination of all the saccharine matters furnished to us as being those in use by 23 Manchester breweries visited, poisoning in Manchester :— as well as of three glucoses used in the manufacture of cheap The medical officer of health begs to present to this sub- sweets and jams. As regards the latter it may at once be committee a report on the outbreak of arsenical poisoning said that not a trace of arsenic was found in them. As now running its course. On Nov. 20th Dr. Reynolds called regards the saccharine matters which were furnished to us at the Health Office and informed the medical officer of by the brewers as being used by them, and which included health that he had obtained well-marked reactions of arsenic Home and American glucoses and inverts, we examined them in a sample of beer which he had examined. For some all to the number of 46 specimens from 20 breweries. In months there had been a large number of patients coming not one did we find a trace of arsenic except in the glucoses into the Union Infirmary with well-marked and fairly and inverts emanating from one firm, in which it was present uniform symptoms, and there were at present a very large apparently in considerable amount. Unfortunately, five number of these cases in the wards. They were all beer- out of the 20 breweries were using this material to our drinkers and drank the cheaper kinds of beer and stout. For knowledge, or had just discontinued it, while in another some time he had suspected the presence of some deleterious .nstance its use had been discontinued for two months. It agant in the beer and latterly the symptoms had suggested .s possible that there are other breweries in which it has been arsenic. He had therefore procured a sample of a beer which lsed where we have not been informed of the fact. As soon was pointed to by many of the cases, tested it, and found as we knew that the examination of a saccharine material arsenic. He also informed your medical officer of health :evealed the presence of arsenic, information was sent to the that another sample of beer submitted to Professor Dixon nanager of the brewery concerned with a request that all Mann had been found to contain arsenic, thus confirming his )eer now on the market in which the incriminated sugar Previous to Dr. Reynolds’s intimation on lad been used should be immediately recalled. observation. Nov. 20th your medical officer of health was aware of nothing Meantime on Nov. 27th a circular letter was sent to all indicating either an outbreak of a fresh form of disease or the practitioners in the city asking for certain information, the existence of impurities in the beer. The medical officer pased on the symptoms of the cases at Crumpsall. The -
-
-
___
’
=
THE OUTBREAK OF ARSENICAL POISONING IN MANCHESTER. .
1
replies
to these are most valuable and instructive.
1753
Basing
these reports and on the information which they afiorded, and in pursuance of an instruction from the meeting of the Sanitary Committee of Nov. 27th, we have obtained samples from a number of public-houses. Instructions were given by the Sanitary Committee on Nov. 28th that this course should be pursued, and it is considered that ample opportunity has been given to get rid of any poisonous beer or stout. Some samples since taken from public-houses and examined unofficially have been found to contain an appreciable amount of arsenic. The number of samples of beer and stout examined unofficially since the instruction of the committee has been 45, of which 11 have been found to contain arsenic. Subsequent samples from the same houses have been sent to the public analyst.
our
action
on
City of Maneltexter.
j)eaths f,,,oiit
:
After the exhaustive investigation carried out by Dr. Tattersall and Professor Delepine there remains very little to be said on the subject except on matters of detail. There are, nevertheless, some points on which the committee would probably wish to be informed, especially what has been the nature and magnitude of the evil. Nature of the disease.-There is a class of disease known to medical men as alcoholic neuritis. As a few good observers state that they see no difference between these fresh cases and those which they have previously known as alcoholic neuritis this will sufficiently indicate the nature of the outbreak to medical men. Tn the slighter cases there may or may not be nausea and sickness and irritation of the eyes, followed by a feeling of pins and needles in the tips of the fingers and toes ; the calves are painful on pressure, and the hands presently become numb and useless. Wasting of
1754
THE WAR IN SOUTH AFRICA.
certain small muscles of the hand is almost invariable. Tables have also been prepared for 1897 and 1898 and the Many cases get dropped wrist or walk unsteadily. In the results may be thus summarised :most severe cases the paralyses advance quickly, the patient cannot stand, has perhaps delirium, and sinks into a comatose state from which he does not recover. A prominent feature of many of the cases is pigmentation of the kin. which in some cases has been very deep, the patient being almost like a mulatto. It is impossible in a report of this kind to do more than indicate the kind of illness to which our figures relate, although the courtesy of the medical officers at Crumpsall and Withington in allowing the medical officers to see the The medical officer of health cases must be acknowledged. has received information of about 1003 cases of the above class of illness from 90 medical men. These do not include the cases which have been sent into the union hospitals during the last few months which will probably come to 700 or so more. Allowing over 300 cases to medical men who have not answered the circular there have thus been at least 2000 cases who have been seen by a medical man. There will, no doubt, be a good many more with minor degrees of illness which have not been seen by a medical man. An important question is whether there is any appearance of improvement in the outbreak. Many medical men state that the cases still continue to come in, as they will do for a little time even if the incriminated beer is entirely stopped. since it takes some time to produce the wasting observed in these cases. The general impression conveyed by the statements of medical practitioners is that the worst has passed and that the worst period of all was towards the -end of October. What do our statistics say ?7 The statistics should throw some light on the question whether this -is or is not an entirely new phenomenon, and I have, therefore, had the deaths excerpted week by week under these headings : peripheral neuritis ; neuritis ; alcoholism ; cirrhosis of the liver ; other disease of the liver ; gastritis in adults. These deaths are then added up to make .a total for the week. The result is shown on the table given on the previous page and the figures are sufficiently remarkable. The number of total weekly deaths from the enumerated causes suddenly shoots up in the last week of May and thenceforward, generally speaking, remains high up to the present time. We may suspect that some alteration took ,place in the quality of the beer used about the beginning of May. This we have not yet time to inquire into. The same ,period-viz., the end of May-also marks a slight increase in the number of deaths ascribed to peripheral neuritis, which Yet even in the last ,now furnishes about one death a week. two weeks of September no death is ascribed to this cause. In October, however, there is a very slight increase, sufficient at all events to show that some observers were now becoming alive to the character of the cases. We may at the same time confidently assume that, in the absence of this suspicion, most of the few cases added to peripheral ,neuritis in October would have appeared in the column ,alcoholism. This your medical officer of health has ascertained both as the result of conversations and from the - reports sent in. How do the figures of 1900 compare with the figures for a corresponding period of 1899 ? The deaths from peripheral neuritis have nearly doubled in 1900. The difference is, however, confined to recent months, since up to the end of May there were in 1900 only five deaths from this cause, as compared with eight in 1899 from Jan. lst to May 31st. Many medical men have regarded this outburst as an outbreak of alcoholism due to the war fever. It is therefore of considerable interest to see whether in 1899 there occurs any change in the number of deaths from the causes enumerated similar to that which appears in the present year. It will be seen from the table that the figures for July and August of 1899 seem to indicate a similar increase of this class of case on a smaller scale, the increase being observable under both alcoholism and cirrhosis of the liver. These figures suggest ,to your medical officer of health that the recent occurrence does not stand quite alone and that previous mischief in connexion with alcohol has occurred in an epidemic fashion. The suggestion is that there may have been arsenic present ,in the beer formerly. There is, indeed, reason to suspect that’ the same phenomenon may have been going on for years, though in a slighter degree. This would justify some delay in recognising the nature of the disease, since the cases would be regarded as ordinary alcoholic cases of a recognised type with an unusual proportion of certain
striking though not unknown features.
There has, therefore, not been much change in the aggregate number of deaths in 1897 to 1899, while it has greatly increased in the present year (1900). There has been an increase year by year since 1897 in the number of deaths from peripheral and other neuritis, very much accentuated in 1900. The deaths from alcoholism have increased progressively since 1898, and in 1900 are more than double the number in 1898. They were, however, more numerous in 1897 than in 1898. The number of deaths from cirrhosis of the liver have increased progressively since 1898. In 1897, however, they were more numerous than in 1898. From other diseases of the liver than cirrhosis the number of deaths was greater in 1897 and 1898 than in 1899 and 1890. From gastritis the same relation very angularly holds, with the addition that the deaths in 1900 number more than twice The far larger number of deaths as many as those in 1899. from alcoholism and cirrhosis of the liver in 1897 than in 1898 taken along with their distribution in weeks is striking and calls for future inquiry. On the whole, the complete figures do not remove the impression that this is not an
entirely new phenomenon.
In accordance wita the instructions of the Sanitary Committee a vigorous search is being made for arsenical beers and stouts sold in public-houses, and suspected samples have been submitted officially to Mr. Estcourt. It is desirable that a quantitative analysis should be made for one of these samples, but it is probable that the qualitative tests carefully carried out will suffice for a prosecution under the Food and Drugs Acts. Still, one quantitative analysis is advisable. To the assistant medical officers, Dr. Ooates and Dr. McCleary, I am indebted for the accounts of individual cases which they have collected and for the pains which they have taken to collect facts. Mr. R. M. Rowe of the sanitary department has conducted the qualitative analysis of samples with his usual care and skill and with ungrudging zeal. My statistical clerk, Mr. Ross, has prepared the statistical tables which have entailed considerable labour.
THE WAR IN SOUTH AFRICA. NOTWITHSTANDING the assurance of Lord Roberts that the war is over it cannot be said that Boer resistance has ended or that there is any immediate prospect of its being ended. The war has, as we all know and regret, degenerated into a desultory kind of marauding and surprises, varied by vigorous and exhausting pursuits of De Wet. As a rule, the efforts of the British to repel the attacks of the more or less disorganised and scattered bodies of Boers acting independently of one another have been very successful, but it is still far from being the fact that all dangerous opposition has been stamped out. Lord Roberts bas resigned his command in South Africa and has handed it over to Lord Kitchener, who is generally thought to be admirably suited to deal with the present phase of the war and to bring it to an end. It will be remembered that while in a military sense the conquest of Burma proved a comparatively easy task, the real subjection of that country and the suppression of the system of dacoity was a very difficult one, and the Boers are a very different and far more tenacious foe than the Burmese. Such is, briefly summarised, the present position of affairs in South Africa. The capture of