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SULPHUR MINERS AND PHTHISIS.
1134 and some evidence of Kernig’s sign. Two years later he was of the class among whom such a crime as suicide is of most able to conduct his business and there was no sign of frequent occurrence. A large number of poisonous subthat the that Dr. Pitfield considers fact he was stances are sold in the meningitis. ’’ pashari’s " shop and in the bazar an adult and infected with a low-grade form of tuberculosis without restriction or licence, and it is much to be generally contributed to his recovery. Perhaps the most interesting regretted that these poisons, especially opium, are so easily case of recovery from tuberculous meningitis is one reported procurable by ordinary persons who might want them for at the Aerztlicher who exunlawful purposes. As Major Moses says, the question Verein, Hamburg, by Rumple, hibited the brain of a boy who died from phthisis. At the resolves itself into the framing of a regular Sale of Poisons age of 9 years he had acute meningitis, with retraction of Act, whereby the State would do all that lies in its power to the head, hyperasstbesia, absence of knee-jerks, double optic restrict the procuring of poisonous substances and to neuritis, ptosis, and palsy of the external recti. Lumbar diminish the incidence of crime at any rate by such means. puncture yielded a fluid containing tubercle bacilli. The boy Amongst the native races, however, this would probably be a was treated by repeated lumbar puncture and recovered. matter of great difficulty. Though for some months dull and stupid, he eventually THE OHIO AND MISSISSIPPI FLOODS. recovered his normal mental powers and was able to keep pace with other children at school, while all physical WHEN the great floods of March and April occurred in the signs disappeared. For four years his health remained United States this year in the valleys of the Ohio River and good. He then developed a tuberculous abscess in the the Mississippi an immediate call was made for help from axilla, phthisis followed, and he died eight years after the the National Guard, which parallels our Territorial Force, onset of the meningitis. At the necropsy it was found that and Major Charles Lynch, of the Medical Corps, United the membranes over the fissure of Sylvius on either side of States Army, has given in the Military S’2crgen for August an the brain were thickened and glued together, but no miliary account of the work then done by the medical department. It tubercles wera visible. Another case was reported in our was real active service. Conditions changed rapidly; a town columns last year by Dr. W. Tyrrell Brooks and Dr. A. G. in safety one day and helping others was on the next day in tGibson.1 Dr. Pitfield gives 29 cases (including the one under dire distress. Railways and roads were cut, and to bring help ’his care) of undoubted tuberculous meningitis in which required enthusiasm and ingenuity. There was plenty of -recovery took place. In 10 a necropsy confirmed the dia- initiative, and the help given was most valuable. To begin .gnosis, and in 18 tubercle bacilli were found. In 4 tubercles with, many were saved from drowning and also from starvaHe estimates that recovery were seen in the choroid. tion, but the work of the medical department appeared most takes place in 1 in 200 cases of tuberculous meningitis. conspicuously in the prevention of disease. When a city, In several of the Reports of the Phipps Institute McCarthy being flooded, was taken in hand little could be done beyond states that he frequently found evidence of healed tuberproviding food and shelter till the water fell, then the ,-culosis of the nervous system in persons who eventually place was divided into districts, in each of which the died from phthisis. As to treatment, Dr. Pit field recommends sanitary personnel went round as organising inspectors feeding by the nasal tube, administration of morphine for and filled out forms reporting conditions of houses and -the pain, and of urotropin, as this is decomposed into offices, presence of sick, especially of infectious disease, ’ formaldehyde which is found in the cerebro-spinal fiuid. and measures This had to be done -
required.
MEDICO-LEGAL
WORK IN CALCUTTA.
WE have received a reprint from the Indian 1’iledieal Gazette, Vol. XLVIII., of a paper by Major O. St. John Moses, I.M.S., entitled "Review of a Year’s Medico-legal Work in the Calcutta Morgue, 1912 (including Comparative Figures for the Triennium 1910-1912)." There is much that is interesting in medico-legal work in India, as certain - forms of death are met with which are peculiar to that - country and are rarely if ever met with in England. -During the year 1912 252 cases were sent up by the - police for post-mortem examination as cases in which death appeared to occur under more or less suspicious circumstances. Under the heading of natural causes was one of cerebral apoplexy in a young Mahomedan male, aged 12; the boy was to all external appearances quite healthy, and there was Another case an entire absence of all history of violence. of interest was that of a Hindu male, aged 48, who died from cerebellar apoplexy. Each hemisphere of the cerebellum was ploughed up by a blood-clot, which in the case of the right hemisphere was of about the size of a small orange. Spontaneous rupture of the spleen has been stated to occur fairly frequently in India. One case came to Major Moses’s notice in 1912, but it was the only instance of this nature met with in the three years 1910 to 1912. The remarks on opium poisoning are of interest. There was, as in previous years, a great preponderance of opium cases over all other cases of poisoning. Major Moses is emphatic in urging that everything possible should be done to place such a convenient and apparently popular means of self-destruction out of reach 1
THE
LANCET, Sept. 21st, 1912, p. 815.
quickly.
In Hamilton, Ohio, 4000 reports were on file in two days. The town was gone over four times while cleaning was going on busily. Leaflets were issued directing boiling of all removal of mud, and formation of temporary privies water, if needed. Dead animals were burned, but a shortage of fuel sadly impeded some of theorders. The precautions, however, averted the danger of an outbreak of typhoid fever, and the infectious disease that gave most trouble,was cerebro-spinal meningitis. Major Wadham describes the management of an epidemic of this disease amongst flooded All were living in out negroes at Deckerville, Arkansas. on a crowded railway wagons standing high embankment water. No the isolation was above possible, but the just four cases injected early with Flexner’s serum recovered; Preventive the two not seen till the fifth day died. limited the disease. extension also of the inoculation
SULPHUR MINERS AND PHTHISIS. IN the discussion at the Section of Hygiene and Preventive Medicine of the Seventeenth International Congress of Medicine on the Effects of Dust in Producing Diseases of the Lungs, Professor Carozzi, of Milan, is reported to have said that workers in the sulphur mines of Sicily, however seriously affected with pneumoconiosis and chronic lesions of the bronchi, hardly ever suffered from pulmonary tuberculosis. In this connexion the work recently published by Dr. Alfonso Giordano1 affords some interesting information. He holds 1 La Fisiopatologia e l’Igiene dei Minatori. By Dr. Alfonso Giordano, Professor of Mining Hygiene, University of Palermo. Issued by the Ministry of Agriculture, Industry, and Commerce. 1913. Published by G. Bertero and Co., Rome. Pp. 357. Price 3.50 lire.
1135 question whether sulphur possessing disinfectant theatres that are proved on investigation to be satisproperties can hinder or favour the growth of Koch’s factorily equipped in this matter will in future receive a bacillus is not yet decided. From remote times sulphur certificate to that effect to be displayed at the ticket office, has been burnt with resinous wood in the form of and the public are cautioned to patronise only those theatres incense at religious rites as a purifying substance. It showing this certificate. Below the certificate is a picture was also recognised as a disinfectant by the ancient Greeks, of two Petri plates taken respectively from an unventilated for, according to Homer, Ulysses fumigated with sulphur and a ventilated theatre, the first of which shows 250 bacterial the chambers in which lay the corpses of the Proci, and colonies, the latter 5 only. If it is not possible at the Pliny relates in his I I Natural History"that rock sulphur present stage of affairs to compel all cinematograph theatres was used in the ceremonial consecration of houses. Galen to obtain a licence to be granted only on evidence of their used fumigations of orpiment in the treatment of con- sanitary efficiency, at least those that on examination are sumptives, who in his time were also sent to Stabia, near found to be in such a state might be furnished, as is done in Vesuvius, in order that they might inhale the air im- the case of certified milk, with duly attested evidence of the pregnated with sulphurous vapours. On the other hand, fact to which all those who can obtain it would be only too sulphur has been blamed for producing conjunctivitis and glad to give prominent place as a special attraction to their causing irritation of the respiratory mucous membrane. prospective patrons. Piceinini from his observations of sulphur workers arrived at WE learn with much regret of the death at the early the conclusion that sulphurous vapours had a favourable influence on the general condition of the organism, and age of 43 of Major H. C. French, R.A.M.C. particularly on the respiratory system, while Dr. Burruana, in THE demonstration by Dr. Hideyo Noguchi which was to a report on the diseases of the Sicilian sulphur miners communicated to the first International Congress on Industrial have been held at the Royal Society of Medicine on Monday last has been postponed on account of Dr. Diseases, stated definitely that phthisis was not met withi afternoon illness until Monday next, Oct. 20th, at 5.30 P.M. among them for the reason that the sulphurous anhydride Noguchi’s inhaled by them prevented the development of Koch’s AT the opening meeting of the coming session of the bacillus. It has long been known that sulphur miners of Tropical Medicine and Hygiene, which is held Society expectorate a bluish-grey sputum, and Dr. Giordano, led by this evening, Friday, Oct. 17th, at 8.30 P.M., at 11, Chandosthis fact to investigate its pathological histology, had his z, street, W., Sir R. Havelock Charles will deliver the attention fixed by the forms of the sulphur crystals, the sharp ’, Presidential address on Neurasthenia and its Bearings on points of which penetrate the pulmonary tissue and carry the Decay of Northern Peoples in India. there those pathogenic micro-organisms which happen to be in ’, the mucous membrane. He found Koch’s bacillus associated FOUR Gresham lectures on Harvey, Darwin, and Huxley with pneumoconiosis in the peculiar sputum in greater or less will be delivered on Tuesday, Oct. 28th; Wednesday, quantity. Considering the squalor and poverty of the miners it Oct. 29th ; Thursday, Oct. 30th ; and Friday, Oct. 31st, must be expected that there should be more or less tubercle by Dr. F. M. Sandwith, Gresham Professor of Physic, at the among them, but whether the sulphur acts as a preventive to City of London School, Victoria Embankment, E.C. The its development there is not enough evidence to show. In the lectures are free to the public and will begin each evening at air outside the mines 500 or more pathogenic organisms were 6 o’clock. found per litre, while in the deeper galleries the number diminished considerably to about 20 or less. While B. coli WE regret to record the death on Oct. 13th of the disand B. typhosus were plentiful, the tubercle bacillus was tinguished psychiatrist, Sir John Batty Tuke, M.D., repreabsent. Probably these facts and the well-known antiseptic sentative of the Royal College of Physicians of Edinburgh properties of sulphur have suggested what there are not on the General Medical Council, and formerly Member of Parliament for the Universities of Edinburgh and St. Andrews. enough available statistics to prove. An obituary notice will be published in our next issue. that the
I
____
THE SANITARY CONDITION OF THEATRES. THE
CINEMATOGRAPH
extraordinary multiplication of cinematograph which theatres, spring up with fungus-like proliferation, and often under conditions quite unwholesome for human life, renders it imperative that steps should be taken to safeguard the health of those who frequent them. We have already called attention to this subject in THE LANCET, and we repeat here that it is not to the cinema theatre as such that we take exception, but to the way in which many shops and other buildings totally unsuited to the purpose are being converted into these places of public congregation. From the sanitary point of view the most important aspects of the question centre in adequate opportunities for throwing open the building to the penetration of disinfecting light, in proper ventilation, and in the provision of a sufficient cubic airspace for the audience that assembles therein. In all these qualities many, if not most, of the converted shop cinema shows are wofully defective, and the problem of dealing with them is becoming daily more urgent. Chicago is wrestling with this problem with American resourcefulThe Bitlletin of the Chicago School of Sanitary ness. Instruction for Sept. 20th, published for free distribution by the Department of Health, announces that all picture
SCHOOL MEDICAL INSPECTORS.-A
meeting
of
assistant school medical officers and school medical officers engaged in the medical inspection of school children, convened by Dr. C. W. Hutt, was held on Oct. 10th at the offices of the Society of Medical Officers of Health, under the chairmanship of Dr. Herbert Jones. Those actually engaged in the work of medical inspection of school children were well represented. In the course of the discussion the advisability of school medical officers and assistant school medical officers joining the Society of Medical Officers of Health was suggested on the grounds that the society can place at the disposal of its members an organisation which is the result of the experience of many years; it has considerable funds at its disposal, in addition to a well-established journal. The chairman pointed out that the constitution of the Society of Medical Officers of Health permitted any medical practitioner, male or female, engaged in the medical inspection of school children to become a member. It was resolved to form a group within the Society of Medical Officers of Health of medical officers engaged in the school medical service in order that the views of medical inspectors of school children should be adequately placed before the Society of Medical Officers of Health. Dr. C. W. Hutt and Dr. A. Ashkenny were appointed to act as honorary secretaries for the group pro tem., and were instructed to inform the council of the society of the formation of the group, and to make arrangements for the first meeting of the group to take place on Nov. 7th.
required.
MEDICO-LEGAL
WORK IN CALCUTTA.
WE have received a reprint from the Indian 1’iledieal Gazette, Vol. XLVIII., of a paper by Major O. St. John Moses, I.M.S., entitled "Review of a Year’s Medico-legal Work in the Calcutta Morgue, 1912 (including Comparative Figures for the Triennium 1910-1912)." There is much that is interesting in medico-legal work in India, as certain - forms of death are met with which are peculiar to that - country and are rarely if ever met with in England. -During the year 1912 252 cases were sent up by the - police for post-mortem examination as cases in which death appeared to occur under more or less suspicious circumstances. Under the heading of natural causes was one of cerebral apoplexy in a young Mahomedan male, aged 12; the boy was to all external appearances quite healthy, and there was Another case an entire absence of all history of violence. of interest was that of a Hindu male, aged 48, who died from cerebellar apoplexy. Each hemisphere of the cerebellum was ploughed up by a blood-clot, which in the case of the right hemisphere was of about the size of a small orange. Spontaneous rupture of the spleen has been stated to occur fairly frequently in India. One case came to Major Moses’s notice in 1912, but it was the only instance of this nature met with in the three years 1910 to 1912. The remarks on opium poisoning are of interest. There was, as in previous years, a great preponderance of opium cases over all other cases of poisoning. Major Moses is emphatic in urging that everything possible should be done to place such a convenient and apparently popular means of self-destruction out of reach 1
THE
LANCET, Sept. 21st, 1912, p. 815.
quickly.
In Hamilton, Ohio, 4000 reports were on file in two days. The town was gone over four times while cleaning was going on busily. Leaflets were issued directing boiling of all removal of mud, and formation of temporary privies water, if needed. Dead animals were burned, but a shortage of fuel sadly impeded some of theorders. The precautions, however, averted the danger of an outbreak of typhoid fever, and the infectious disease that gave most trouble,was cerebro-spinal meningitis. Major Wadham describes the management of an epidemic of this disease amongst flooded All were living in out negroes at Deckerville, Arkansas. on a crowded railway wagons standing high embankment water. No the isolation was above possible, but the just four cases injected early with Flexner’s serum recovered; Preventive the two not seen till the fifth day died. limited the disease. extension also of the inoculation
SULPHUR MINERS AND PHTHISIS. IN the discussion at the Section of Hygiene and Preventive Medicine of the Seventeenth International Congress of Medicine on the Effects of Dust in Producing Diseases of the Lungs, Professor Carozzi, of Milan, is reported to have said that workers in the sulphur mines of Sicily, however seriously affected with pneumoconiosis and chronic lesions of the bronchi, hardly ever suffered from pulmonary tuberculosis. In this connexion the work recently published by Dr. Alfonso Giordano1 affords some interesting information. He holds 1 La Fisiopatologia e l’Igiene dei Minatori. By Dr. Alfonso Giordano, Professor of Mining Hygiene, University of Palermo. Issued by the Ministry of Agriculture, Industry, and Commerce. 1913. Published by G. Bertero and Co., Rome. Pp. 357. Price 3.50 lire.
1135 question whether sulphur possessing disinfectant theatres that are proved on investigation to be satisproperties can hinder or favour the growth of Koch’s factorily equipped in this matter will in future receive a bacillus is not yet decided. From remote times sulphur certificate to that effect to be displayed at the ticket office, has been burnt with resinous wood in the form of and the public are cautioned to patronise only those theatres incense at religious rites as a purifying substance. It showing this certificate. Below the certificate is a picture was also recognised as a disinfectant by the ancient Greeks, of two Petri plates taken respectively from an unventilated for, according to Homer, Ulysses fumigated with sulphur and a ventilated theatre, the first of which shows 250 bacterial the chambers in which lay the corpses of the Proci, and colonies, the latter 5 only. If it is not possible at the Pliny relates in his I I Natural History"that rock sulphur present stage of affairs to compel all cinematograph theatres was used in the ceremonial consecration of houses. Galen to obtain a licence to be granted only on evidence of their used fumigations of orpiment in the treatment of con- sanitary efficiency, at least those that on examination are sumptives, who in his time were also sent to Stabia, near found to be in such a state might be furnished, as is done in Vesuvius, in order that they might inhale the air im- the case of certified milk, with duly attested evidence of the pregnated with sulphurous vapours. On the other hand, fact to which all those who can obtain it would be only too sulphur has been blamed for producing conjunctivitis and glad to give prominent place as a special attraction to their causing irritation of the respiratory mucous membrane. prospective patrons. Piceinini from his observations of sulphur workers arrived at WE learn with much regret of the death at the early the conclusion that sulphurous vapours had a favourable influence on the general condition of the organism, and age of 43 of Major H. C. French, R.A.M.C. particularly on the respiratory system, while Dr. Burruana, in THE demonstration by Dr. Hideyo Noguchi which was to a report on the diseases of the Sicilian sulphur miners communicated to the first International Congress on Industrial have been held at the Royal Society of Medicine on Monday last has been postponed on account of Dr. Diseases, stated definitely that phthisis was not met withi afternoon illness until Monday next, Oct. 20th, at 5.30 P.M. among them for the reason that the sulphurous anhydride Noguchi’s inhaled by them prevented the development of Koch’s AT the opening meeting of the coming session of the bacillus. It has long been known that sulphur miners of Tropical Medicine and Hygiene, which is held Society expectorate a bluish-grey sputum, and Dr. Giordano, led by this evening, Friday, Oct. 17th, at 8.30 P.M., at 11, Chandosthis fact to investigate its pathological histology, had his z, street, W., Sir R. Havelock Charles will deliver the attention fixed by the forms of the sulphur crystals, the sharp ’, Presidential address on Neurasthenia and its Bearings on points of which penetrate the pulmonary tissue and carry the Decay of Northern Peoples in India. there those pathogenic micro-organisms which happen to be in ’, the mucous membrane. He found Koch’s bacillus associated FOUR Gresham lectures on Harvey, Darwin, and Huxley with pneumoconiosis in the peculiar sputum in greater or less will be delivered on Tuesday, Oct. 28th; Wednesday, quantity. Considering the squalor and poverty of the miners it Oct. 29th ; Thursday, Oct. 30th ; and Friday, Oct. 31st, must be expected that there should be more or less tubercle by Dr. F. M. Sandwith, Gresham Professor of Physic, at the among them, but whether the sulphur acts as a preventive to City of London School, Victoria Embankment, E.C. The its development there is not enough evidence to show. In the lectures are free to the public and will begin each evening at air outside the mines 500 or more pathogenic organisms were 6 o’clock. found per litre, while in the deeper galleries the number diminished considerably to about 20 or less. While B. coli WE regret to record the death on Oct. 13th of the disand B. typhosus were plentiful, the tubercle bacillus was tinguished psychiatrist, Sir John Batty Tuke, M.D., repreabsent. Probably these facts and the well-known antiseptic sentative of the Royal College of Physicians of Edinburgh properties of sulphur have suggested what there are not on the General Medical Council, and formerly Member of Parliament for the Universities of Edinburgh and St. Andrews. enough available statistics to prove. An obituary notice will be published in our next issue. that the
I
____
THE SANITARY CONDITION OF THEATRES. THE
CINEMATOGRAPH
extraordinary multiplication of cinematograph which theatres, spring up with fungus-like proliferation, and often under conditions quite unwholesome for human life, renders it imperative that steps should be taken to safeguard the health of those who frequent them. We have already called attention to this subject in THE LANCET, and we repeat here that it is not to the cinema theatre as such that we take exception, but to the way in which many shops and other buildings totally unsuited to the purpose are being converted into these places of public congregation. From the sanitary point of view the most important aspects of the question centre in adequate opportunities for throwing open the building to the penetration of disinfecting light, in proper ventilation, and in the provision of a sufficient cubic airspace for the audience that assembles therein. In all these qualities many, if not most, of the converted shop cinema shows are wofully defective, and the problem of dealing with them is becoming daily more urgent. Chicago is wrestling with this problem with American resourcefulThe Bitlletin of the Chicago School of Sanitary ness. Instruction for Sept. 20th, published for free distribution by the Department of Health, announces that all picture
SCHOOL MEDICAL INSPECTORS.-A
meeting
of
assistant school medical officers and school medical officers engaged in the medical inspection of school children, convened by Dr. C. W. Hutt, was held on Oct. 10th at the offices of the Society of Medical Officers of Health, under the chairmanship of Dr. Herbert Jones. Those actually engaged in the work of medical inspection of school children were well represented. In the course of the discussion the advisability of school medical officers and assistant school medical officers joining the Society of Medical Officers of Health was suggested on the grounds that the society can place at the disposal of its members an organisation which is the result of the experience of many years; it has considerable funds at its disposal, in addition to a well-established journal. The chairman pointed out that the constitution of the Society of Medical Officers of Health permitted any medical practitioner, male or female, engaged in the medical inspection of school children to become a member. It was resolved to form a group within the Society of Medical Officers of Health of medical officers engaged in the school medical service in order that the views of medical inspectors of school children should be adequately placed before the Society of Medical Officers of Health. Dr. C. W. Hutt and Dr. A. Ashkenny were appointed to act as honorary secretaries for the group pro tem., and were instructed to inform the council of the society of the formation of the group, and to make arrangements for the first meeting of the group to take place on Nov. 7th.