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SUPPLEMENT TO THE ANNUAL REPORT OF THE CHIEF INSPECTOR OF FACTORIES AND WORKSHOPS FOR THE YEAR 1900.
43 For nine years Florence Nightingale scientific progress. herself up wholly to the exhaustive study of gave her subject, which she systematically divided under three heads-the needs of the sick, the qualities and requirements of sick attendants, and the essentials of hospital It is no wonder, therefore, that she should construction. have proved herself capable of completely transforming the British ambulances in the Crimea and of thereby reducing the mortality from 60 to 2-21 per cent. A member of the French Academy2 once ventured to say that it was owing to the advice of the chief medical officer of the French troops that the success of Florence Nightingale was due, but this statement is utterly and entirely unjustifiable. From the first it was demonstrable that the young English "lady in chief " could reorganise and manage hospitals after so improved a fashion that the renovated establishments became in reality refuges for the sick and wounded, and were no longer deserving of condemnation such as that which was pronounced by Dr. Uytterhceven who, on hearing of the death of 67,000 French soldiers while under treatment, felt constrained to’exclaim : "These hospitals are but ante-chambers to the cemetery."" But, great and glorious though it was, the work of Florence Nightingale in the Crimea is surpassed by her achievements in her own country, where she completely revolutionised the hospitals and infirmaries, opened up the nursing profession for ladies of gentle birth, and established schools for nurses. The fact that in the United Kingdom at the present time there are no less than 505 of these schools will serve to show the magnitude of the results which have attended on the labours of Florence Nightingale. The authors of "Les Gardes-Malades "-of whom on it may be
mentioned, is
a medical woman-have paid due homage to the eminent lady whose Notes on Hospitals " are still most valuable to the architect, the engineer, and the medical officer, but they make no mention of the statesman who gave effect to her recommendations and threw himself heart and soul into the work of sanitary reform. The name of Sidney Herbert, first Baron Herbert of Lea, should never be omitted when the history of sanitation is discussed.
URÆMIA AS A CAUSE OF ACUTE DELIRIUM.
were
normal, the heart
were
small
slightly fatty, the kidneys atrophy, the cortical substance and contracted, and weighing being congested, granular, There was no macroscopic not more than 80 grammes. lesion of the cerebral hemispheres, but an unusual abundance of cerebro-spinal fluid was present in the skull. as
was
the result of
Professor Cullere considers that the attacks of acute delirium in this case were associated with the chronic nephritis which was in progress and that they were therefore of urasmic origin. The diarrhoea also, in combination with the other symptoms, probably indicated a ursemic condition of the system. Case 2.-The patient was a man, aged 4 years, with a family history of melancholia and suicidal propensities in both the maternal and paternal branches. was of temperate habits. He became insane, the mental disorder taking the form of maniacal excitement, incoherence of speech, and religious utterances. He then passed into a condition of apathy with mutism and refused to take food. He was thin, pale, and with foetid breath and obstinate constipavery haggard, tion. The pulse was soft and slow, the beats being 50 per minute or less. For several weeks his attitude and manner were those of katatonia, marked by contortions, grimaces, and persistent poses indicative of fear and repugnance. Four months later this state was succeeded by a melancholic phase with suicidal impulses. His insanity lasted 16 months, at the end of which time he. began to improve and finally recovered. Nine years afterwards, in June, 1897, he had a fresh attack and was admitted under treatment with melancholia agitans and violent impulses to homicide and suicide. He refused food, became feverish, and passed into a state of prostration with restless muttering delirium, algidity, and coma ending in Anuria and frequent vomiting marked the later death. The stages. symptoms all pointed to uraemia. Professor Cullere believes that the katatonic symptoms with attitudes of ecstasy and catalepsy were due to toxaemia—a view supported by Kraepelin and other modern observers. Venesection and saline transfusion would thus seem to be indicated in
He
grave
cases. -
SUPPLEMENT TO THE ANNUAL REPORT OF THE CHIEF INSPECTOR OF FACTORIES AND WORKSHOPS FOR THE YEAR 1900.
long been known to be a condition capable of producing slight cerebral disturbances such as temporary attacks of giddiness or momentary loss of speech or of IN the annual report of the Factory Department of the consciousness. In the Archives de Nettrologie for December Home Office for 1900 which was noticed in our columns some Professor A. Cullere of Lyons refers to the recent view months ago1 it was announced that a supplement dealing with expounded by Dr. Carrier at the Congress of French Alienists the fourth and fifth annual returns of persons employed in and Neurologists held at Limoges in August, when he pre- factories in the United Kingdom would be issued at a later sented a remarkable report on insanity of ursemic origin, date. We have recently received a copy of this supplement, showing that acute mental disorder may be the outcome of in which Dr B. A. Whitelegge points out that under Section uraemic poisoning. Professor Cullere has recently had under 34 of the Act of 1895 the occunier of every factory and workobservation two cases which appeared to confirm the above shop was required to make each year a return of the persons view and to throw light on this important question. employed, and three such series of returns for the Case 1.-The patient was a woman, aged 55 years, who United Kingdom have already been tabulated and pubwas subject to hallucinations and delusions, under the influIt has been found, however, that the heavy lished. ence of which she persistently refused food so that she had and continuous labour of collecting and compiling an annual to be fed by the cesophageal tube. She was slightly febrile census of this magnitude not only fails to yield any resets of when she came under the care of Professor Cullere in April, commensurate value, but stands in the way of more prac1897, and was suffering from a profuse and foetid diarrhoea. tical application of the mass of material thus accumuHer condition was so serious that saline transfusion (serum lated every year. Accordingly the statutory requirement de Cheron) was employed. Slight improvement resulted and has now been modified by the Factory and Workshop Act her ideas, which hitherto were confused, gradually began to of 1901, and in future the return will be called for at interbecome clear. In May there was a recrudescence of sym- vals not exceeding three years. In dealing with the fourth ptoms with fever, delirium, and diarrhoea as before. She and fifth annual returns of employment in 1898 and 1899 it passed into a low typhoid condition, a bed-sore developed was decided to combine them and to narrow the field and over the sacrum, and she died in a state of coma. The to increase the detail in directions which will be helpful in The lungs necropsy revealed the following conditions. URaeMIA has
1
2
Maxime du
Camp :
La
Croix-Rouge de France.
Paris, 1892, p.
20.
THE
LANCET, Sept. 28th (p. 868), Oct. 12th (p. 998), and Oct. 26th
(p. 1145), 1901.
’
44 administration of the Acts. A distinction is drawn for the by any person registered under the said Act, provided first time between those employes who are under and those such medicine be distinctly labeled with the name and who are over 14 years of age. It thus appears that while in address of the seller and the ingredients thereof be entered, textile factories the former are far outnumbered by the with the name of the person to whom it is sold or delivered, " half-timers"" under 14 years of age, in non-textilfactories in a book to be kept by the seller for that purpose." Therethe balance inclines so far in the other direction that, fore, to our minds Vulneratus,"or any other qualified taking both classes of factories together, more than half of medical man, is at perfect liberty to sell or to deliver the persons under 14 years of age are employed full time. medicines to his patients containing scheduled poisons, The total number of returns and also the total number of provided that he labels the bottles, or pots, or packages But the Act, we take it, persons employed in 1898-99 were greater than in any of the with his name and address. preceding years. The advance was relatively greatest in forbids a medical man or anyone else not registered under Scotland and least in Ireland, while in absolute increase the Pharmacy Act to keep a shop and to supply scheduled England and Wales head the list. As regards textile poisons to anyone who asks for them other than on preindustries as a whole, the present return compared with sentation of a prescription duly signed by a qualified medical that for 1897 shows a decrease in the numbers employed in man. It will be seen from the report of the meeting of the each of the three main divisions of the United Kingdom. Glasgow Southern Medical Society which appears at p. 29, In non-textile factories there was an increase in each of the that the society is angry with the General Medical Council, age- and sex-groups except female "half-timers." This But according to the Pharmacy Acts the Council appears to increase refers mostly to gas factories, electricity-generating have been legally right in its resolution. stations, sawmills, tanneries, quarries, glass factories, and foundries. In regard, however, to the industries in which the TRAUMATOL IN THE TREATMENT OF SUPPURATIVE PROCTITIS. galvanising and finishing of metals are concerned the better separation of departments in recent occupiers’ returns has IN the Gazette des Hôpitauae of Nov. 14th, 1901, M. Suzor to be taken into account. There was a decrease only under calls attention to the value of traumatol in the treatment of the heads of flax-scutching, rubber, leather, ivory, bone, He has used this for several
shell, and jet.
suppurative proctitis. dressing
years in the
-
DANGEROUS CIRCULARS. IN commenting upon the methods adopted by certain people in selling shoddy jewellery Truth recently referred to the practice of leaving handbills from door to door, the advertiser calling for them after a certain lapse of time. That this is not an isolated instance of a reprehensible method of advertising we have proof in the fact that a few weeks ago we found in a letter-box a ragshop circular
half of which was soaked in grease and the other half covered with dirty finger marks. It was subsequently called for. We have also in our possession the circular of a marine stores dealer, a term which the wording of the circular shows to be synonymous with ragshop keeper," bearing the words, "Please show this to the Master or Mistress and when he calls. We do not state return it only to that disease been spread by this practice, but has positively at a time when small-pox and other diseases of an infectious nature are prevalent no stone should be left unturned in seeking to eliminate every possible cause of infection. Such handbills should be burnt as soon as they are found, and the man when he returns should be told that this has been done. Medical men might do a great deal by warning their patients against the danger of returning these handbills, especially when there is illness in a house, and if the measure which we have suggested be adopted it will generally be found to be effective. "
-
drug
of
wounds ; it is less odorous than
iodoform and also appears to have the advantage of superiority in drying up purulent secretion and hastening cicatrisation. He reports two cases in which iodoform failed and traumatol brought about rapid cure. In one a woman, aged 36 years, who was addicted to morphia, suffered from obstinate cnstipation which had caused rectal irritation and for more than a year profuse suppuration. Treatment consisted in various antiseptic douches followed by iodoform suppositories. Only diminution in the suppuration resulted. Traumatol powder, about a gramme, was insuffiated twice a day after administering a large enema. The result was remarkable : complete recovery ensued in eight days. In the second case a man, aged 35 years, had suppurative proctitis with anal fistula. The proctitis persisted after the operation for, and relief of, the fistula. Traumatol suppositories were used, but the result was imperfect. After eight days insufflations of traumatol powder were used and the suppuration disappeared in six days. THE
MOTOR AND THE MICROBE.
WE ordinarily count amongst micro-organisms friends as well as foes, and the former are probably in the majority. After all, we know but a few microbes which are specifically disease-producing, while we know of an enormous number which are concerned in the great economic processes of nature, working apparently in the interests of nature’s higher creatures. Though a very microscopic entity the microbe possesses enormous powers consistent with its MEDICAL PRACTITIONERS AND THE SALE OF property of growing and multiplying itself infinitely. The POISONS. scavenging of the world is thus the effectual work of countA LETTER which appears in another column from a corre- less microbes. The idea of microbes, however, as a source spondent signing himself "‘’ulneratus"sounds, we think, of motive power appears at first sight preposterous, but The recently passed regulation of a little reflection will show that indirectly even for this an unnecessary alarm. the General Medical Council refers, so far as we understand purpose micro-organisms may be very intimately concerned. it, to " doctors’ shops " into which any member of the public It is well known that if it were not for its powerful action as a drug and poison alcohol would be a cheap commodity. can go and buy two pennyworth of laudanum or other " to think seems scheduled poison. " however, Vulneratus, Sugars and starches grow in immense abundance in almost that it applies to medicines prescribed by medical men. all the civilised countries in the world, and it is but a The law for the sale of poisons is laid down in Section 17 short step to convert these into alcohol by fermentation, a of the Pharmacy Act of 1868, but in the Pharmacy Amend- process due to the agency of micro-organisms. All cereals ment Act of 1869 it is laid down in Section 3 that would thus serve and the roots containing sugar, such as the "nothing contained in Section 17 of the said recited maple, and even fruit such as the grape, in a time of plenty Act shall apply to any medicine supplied by a legally might easily be a cheap source of spirit. Alcohol possesses qualified medical practitioner to his patient or dispensedI excellent calorific value, it burns with a hot name, it is easily
mentioned, is
a medical woman-have paid due homage to the eminent lady whose Notes on Hospitals " are still most valuable to the architect, the engineer, and the medical officer, but they make no mention of the statesman who gave effect to her recommendations and threw himself heart and soul into the work of sanitary reform. The name of Sidney Herbert, first Baron Herbert of Lea, should never be omitted when the history of sanitation is discussed.
URÆMIA AS A CAUSE OF ACUTE DELIRIUM.
were
normal, the heart
were
small
slightly fatty, the kidneys atrophy, the cortical substance and contracted, and weighing being congested, granular, There was no macroscopic not more than 80 grammes. lesion of the cerebral hemispheres, but an unusual abundance of cerebro-spinal fluid was present in the skull. as
was
the result of
Professor Cullere considers that the attacks of acute delirium in this case were associated with the chronic nephritis which was in progress and that they were therefore of urasmic origin. The diarrhoea also, in combination with the other symptoms, probably indicated a ursemic condition of the system. Case 2.-The patient was a man, aged 4 years, with a family history of melancholia and suicidal propensities in both the maternal and paternal branches. was of temperate habits. He became insane, the mental disorder taking the form of maniacal excitement, incoherence of speech, and religious utterances. He then passed into a condition of apathy with mutism and refused to take food. He was thin, pale, and with foetid breath and obstinate constipavery haggard, tion. The pulse was soft and slow, the beats being 50 per minute or less. For several weeks his attitude and manner were those of katatonia, marked by contortions, grimaces, and persistent poses indicative of fear and repugnance. Four months later this state was succeeded by a melancholic phase with suicidal impulses. His insanity lasted 16 months, at the end of which time he. began to improve and finally recovered. Nine years afterwards, in June, 1897, he had a fresh attack and was admitted under treatment with melancholia agitans and violent impulses to homicide and suicide. He refused food, became feverish, and passed into a state of prostration with restless muttering delirium, algidity, and coma ending in Anuria and frequent vomiting marked the later death. The stages. symptoms all pointed to uraemia. Professor Cullere believes that the katatonic symptoms with attitudes of ecstasy and catalepsy were due to toxaemia—a view supported by Kraepelin and other modern observers. Venesection and saline transfusion would thus seem to be indicated in
He
grave
cases. -
SUPPLEMENT TO THE ANNUAL REPORT OF THE CHIEF INSPECTOR OF FACTORIES AND WORKSHOPS FOR THE YEAR 1900.
long been known to be a condition capable of producing slight cerebral disturbances such as temporary attacks of giddiness or momentary loss of speech or of IN the annual report of the Factory Department of the consciousness. In the Archives de Nettrologie for December Home Office for 1900 which was noticed in our columns some Professor A. Cullere of Lyons refers to the recent view months ago1 it was announced that a supplement dealing with expounded by Dr. Carrier at the Congress of French Alienists the fourth and fifth annual returns of persons employed in and Neurologists held at Limoges in August, when he pre- factories in the United Kingdom would be issued at a later sented a remarkable report on insanity of ursemic origin, date. We have recently received a copy of this supplement, showing that acute mental disorder may be the outcome of in which Dr B. A. Whitelegge points out that under Section uraemic poisoning. Professor Cullere has recently had under 34 of the Act of 1895 the occunier of every factory and workobservation two cases which appeared to confirm the above shop was required to make each year a return of the persons view and to throw light on this important question. employed, and three such series of returns for the Case 1.-The patient was a woman, aged 55 years, who United Kingdom have already been tabulated and pubwas subject to hallucinations and delusions, under the influIt has been found, however, that the heavy lished. ence of which she persistently refused food so that she had and continuous labour of collecting and compiling an annual to be fed by the cesophageal tube. She was slightly febrile census of this magnitude not only fails to yield any resets of when she came under the care of Professor Cullere in April, commensurate value, but stands in the way of more prac1897, and was suffering from a profuse and foetid diarrhoea. tical application of the mass of material thus accumuHer condition was so serious that saline transfusion (serum lated every year. Accordingly the statutory requirement de Cheron) was employed. Slight improvement resulted and has now been modified by the Factory and Workshop Act her ideas, which hitherto were confused, gradually began to of 1901, and in future the return will be called for at interbecome clear. In May there was a recrudescence of sym- vals not exceeding three years. In dealing with the fourth ptoms with fever, delirium, and diarrhoea as before. She and fifth annual returns of employment in 1898 and 1899 it passed into a low typhoid condition, a bed-sore developed was decided to combine them and to narrow the field and over the sacrum, and she died in a state of coma. The to increase the detail in directions which will be helpful in The lungs necropsy revealed the following conditions. URaeMIA has
1
2
Maxime du
Camp :
La
Croix-Rouge de France.
Paris, 1892, p.
20.
THE
LANCET, Sept. 28th (p. 868), Oct. 12th (p. 998), and Oct. 26th
(p. 1145), 1901.
’
44 administration of the Acts. A distinction is drawn for the by any person registered under the said Act, provided first time between those employes who are under and those such medicine be distinctly labeled with the name and who are over 14 years of age. It thus appears that while in address of the seller and the ingredients thereof be entered, textile factories the former are far outnumbered by the with the name of the person to whom it is sold or delivered, " half-timers"" under 14 years of age, in non-textilfactories in a book to be kept by the seller for that purpose." Therethe balance inclines so far in the other direction that, fore, to our minds Vulneratus,"or any other qualified taking both classes of factories together, more than half of medical man, is at perfect liberty to sell or to deliver the persons under 14 years of age are employed full time. medicines to his patients containing scheduled poisons, The total number of returns and also the total number of provided that he labels the bottles, or pots, or packages But the Act, we take it, persons employed in 1898-99 were greater than in any of the with his name and address. preceding years. The advance was relatively greatest in forbids a medical man or anyone else not registered under Scotland and least in Ireland, while in absolute increase the Pharmacy Act to keep a shop and to supply scheduled England and Wales head the list. As regards textile poisons to anyone who asks for them other than on preindustries as a whole, the present return compared with sentation of a prescription duly signed by a qualified medical that for 1897 shows a decrease in the numbers employed in man. It will be seen from the report of the meeting of the each of the three main divisions of the United Kingdom. Glasgow Southern Medical Society which appears at p. 29, In non-textile factories there was an increase in each of the that the society is angry with the General Medical Council, age- and sex-groups except female "half-timers." This But according to the Pharmacy Acts the Council appears to increase refers mostly to gas factories, electricity-generating have been legally right in its resolution. stations, sawmills, tanneries, quarries, glass factories, and foundries. In regard, however, to the industries in which the TRAUMATOL IN THE TREATMENT OF SUPPURATIVE PROCTITIS. galvanising and finishing of metals are concerned the better separation of departments in recent occupiers’ returns has IN the Gazette des Hôpitauae of Nov. 14th, 1901, M. Suzor to be taken into account. There was a decrease only under calls attention to the value of traumatol in the treatment of the heads of flax-scutching, rubber, leather, ivory, bone, He has used this for several
shell, and jet.
suppurative proctitis. dressing
years in the
-
DANGEROUS CIRCULARS. IN commenting upon the methods adopted by certain people in selling shoddy jewellery Truth recently referred to the practice of leaving handbills from door to door, the advertiser calling for them after a certain lapse of time. That this is not an isolated instance of a reprehensible method of advertising we have proof in the fact that a few weeks ago we found in a letter-box a ragshop circular
half of which was soaked in grease and the other half covered with dirty finger marks. It was subsequently called for. We have also in our possession the circular of a marine stores dealer, a term which the wording of the circular shows to be synonymous with ragshop keeper," bearing the words, "Please show this to the Master or Mistress and when he calls. We do not state return it only to that disease been spread by this practice, but has positively at a time when small-pox and other diseases of an infectious nature are prevalent no stone should be left unturned in seeking to eliminate every possible cause of infection. Such handbills should be burnt as soon as they are found, and the man when he returns should be told that this has been done. Medical men might do a great deal by warning their patients against the danger of returning these handbills, especially when there is illness in a house, and if the measure which we have suggested be adopted it will generally be found to be effective. "
-
drug
of
wounds ; it is less odorous than
iodoform and also appears to have the advantage of superiority in drying up purulent secretion and hastening cicatrisation. He reports two cases in which iodoform failed and traumatol brought about rapid cure. In one a woman, aged 36 years, who was addicted to morphia, suffered from obstinate cnstipation which had caused rectal irritation and for more than a year profuse suppuration. Treatment consisted in various antiseptic douches followed by iodoform suppositories. Only diminution in the suppuration resulted. Traumatol powder, about a gramme, was insuffiated twice a day after administering a large enema. The result was remarkable : complete recovery ensued in eight days. In the second case a man, aged 35 years, had suppurative proctitis with anal fistula. The proctitis persisted after the operation for, and relief of, the fistula. Traumatol suppositories were used, but the result was imperfect. After eight days insufflations of traumatol powder were used and the suppuration disappeared in six days. THE
MOTOR AND THE MICROBE.
WE ordinarily count amongst micro-organisms friends as well as foes, and the former are probably in the majority. After all, we know but a few microbes which are specifically disease-producing, while we know of an enormous number which are concerned in the great economic processes of nature, working apparently in the interests of nature’s higher creatures. Though a very microscopic entity the microbe possesses enormous powers consistent with its MEDICAL PRACTITIONERS AND THE SALE OF property of growing and multiplying itself infinitely. The POISONS. scavenging of the world is thus the effectual work of countA LETTER which appears in another column from a corre- less microbes. The idea of microbes, however, as a source spondent signing himself "‘’ulneratus"sounds, we think, of motive power appears at first sight preposterous, but The recently passed regulation of a little reflection will show that indirectly even for this an unnecessary alarm. the General Medical Council refers, so far as we understand purpose micro-organisms may be very intimately concerned. it, to " doctors’ shops " into which any member of the public It is well known that if it were not for its powerful action as a drug and poison alcohol would be a cheap commodity. can go and buy two pennyworth of laudanum or other " to think seems scheduled poison. " however, Vulneratus, Sugars and starches grow in immense abundance in almost that it applies to medicines prescribed by medical men. all the civilised countries in the world, and it is but a The law for the sale of poisons is laid down in Section 17 short step to convert these into alcohol by fermentation, a of the Pharmacy Act of 1868, but in the Pharmacy Amend- process due to the agency of micro-organisms. All cereals ment Act of 1869 it is laid down in Section 3 that would thus serve and the roots containing sugar, such as the "nothing contained in Section 17 of the said recited maple, and even fruit such as the grape, in a time of plenty Act shall apply to any medicine supplied by a legally might easily be a cheap source of spirit. Alcohol possesses qualified medical practitioner to his patient or dispensedI excellent calorific value, it burns with a hot name, it is easily