THE COAL SMOKE ABATEMENT SOCIETY.

THE ARBITRATION IN THE POTTERY TRADE.

1354

towards

From motives of sheer policy, if and cried out that she was being stifled. Under subcutaneous ot of right feeling, the offending third clause of the injection of ether, inhalation of oxygen, and a sinapism circular of the organising secretary of the Association of applied tothe back the ’symptoms diminished. The expectoand in a quarter of an hour the Public Vaccinators for England and Wales should at once be ration, however, continued, child had expelled 250 grammes of frothy sanguineous liquid. recast or, better still, withdrawn. On auscultating the chest behind, over the position formerly occupied by the elfusion, amphoric breathing was heard and the cough had an amphoric character. The percussion notehere was tympanitic. A quarter of an hour after the paracentesis the child was quiet. Half an hour later fits of coughing reappeared with the same sero-sanguineous expectoration. They Ne quid nimis." were assuaged by the sucking of ice and a hypodermic injection of morphine (one-seventh of a grain). In the evening she THE ARBITRATION IN THE POTTERY TRADE. was comfortable, but the temperature was 104° F., and every she moved she coughed ; in the afternoon she had time LORD JAMES oF HEREFORD, the umpire in this case, has ’, brought the proceedings to an abrupt termination by de- expelled about 250 grammes of the fluid. On June 18th the normal; about 190 grammes of the fluid claring that as it was shown that lead-poisoning had greatly temperature was On June 19th the cough had disappeared. were expelled. decreased under the last rules there was no need to impose the In region amphoric breathing perright infraspinous fresh ones, at all events for the present, as to the use of in the but sisted, part vesicular breathing was upper These fritted lead or as to the examination of adults. to heard. Percussion seemed show a small quantity of fluid questions, he added, might be postponed for 18 months, and in the but a succussion sound could not be cavity, pleural would be then again postponed if necessary. Was ever such obtained. On the following days large mucous rules were a ridiculous situation created in the teeth of the laborious in front on the right side and there was slightly heard the Government’s chosen inquiries and reports undertaken by foetid muco-purulent expectoration with fœtor of the Dr. T. in E. Thorpe, which the one experts, Dr. T. Oliver and On July 10th amphoric breathing was heard with breath. out before all clear recommendation standing others was She was sent to a convalescent home. On the adoption of definitely fritted lead. We learn that this difficulty. decision has given general satisfaction locally-that is, in August 26th sonorous f:11es were heard in both lungs. the pottery district at Hanley. We wonder whether this There was dulness of the lower two-thirds of ’the right satisfaction is shared equally by the workers and their chest with slight diminution of the vesicular murmur. On masters. We view the decision with the deepest dismay ; Sept. 4th there was some dulness of the lower third; and inspiration here was harsh and expiration slightly bronchial. it is premature and dangerous. In this case partial pneumothorax was evidently produced by the paracentesis. Dr. Variot and M. Roy insisted that the PNEUMOTHORAX FROM PARACENTESIS lung was not punctured by the needle, for not a drop of blood THORACIS. escaped with the aspirated fluid. The fact that 120 grammes PNEUMOTHORAX is a rare result of paracentesis thoracis. of fluid were removed shows .that the external air was’not At the meeting of the Societe M6dicale des Hopitaux of admitted to the pleural cavity. They think that in the Paris on Oct. llth Dr. Variot and M. Pierre Roy related the of the region pleurisy the lung tissue was diseased and following case. A girl, aged 11 years, was admitted to the fragile and was torn under the influence of the aspiration, Hopital des Enfants-Malades on May 29th. She was said perhaps by the strain on a pleural adhesion. The expectorato have had pneumonia in March and a relapse in April. tion was evidently due to the passage of the pleural effusion After this she had a cough and pain in the side, expectorated the through pleuro-pulmonary fistula so formed. some mucus, and lost about five pounds. Over the lower twothirds of the right lung behind vocal fremitus was absent, THE COAL SMOKE ABATEMENT SOCIETY. dulness was well marked, and the vesicular murmur was As we announced laet week, a public meeting will be lield almost abolished. At the level of the spine of the in support of the objects of this society at Grosvenor House scapula slight bronchial breathing was heard. The apex on Wednesday next, Nov. 20th. The following motions of the lung was normally resonant. The temperature was will be submitted to the meeting :-normal. There was evidently a slight pleural effusion, 1. That the pollution. of the air by coal smoke is an evil injurious t(, probably serous. Counter-irritation and the administration public health and that every effort should be made to secure the laws of squills proved useless. On June 17th two exploratory existing for its prevention being kept in effective operation.. That the rapid deterioration of works of art and vegetation punctures with a Pravaz syringe were made in the seventh in2.London due to the effects of coal smoke demands an immediate and and eighth intercostal spaces without result. Nevertheless comprehensive remedy. 3. That the darkness and impurity caused by smoke pollution have paracentesis was performed. The patient was placed in a directly demoralising effect upon the inhabitants of a great city. the dorsal decubitus position and the fine needle of Potain’s 4. That as a matter of private and public economy the escape oj smoke from coal fires is a preventable waste of energy and material. instrument was inserted in the seventh intercostal space 5. That this meeting, in recognising the practical results already in the axillary line. Serous fluid flowed slowly into achieved by the Coal Smoke Abatement Society with the limited resources at its disposal, and in approving its line of action, pledges the bottle and was mixed from the first with air itself to use its best endeavours to place it in a position to extend its bubbles. It was certain that no air was entering by operations. any of the tubes. The liquid flowed so slowly that in three We are not sure how far pollution of the atmosphere by cot3 or four minutes only 120 grammes were discharged. The smoke has played a determining part in the dense fog that child was then seized with persistent cough, and the needle enshrouded London during the first week of November. was rapidly withdrawn and the opening was closed with Probably no two experts would give exactly the same opinion collodion. There was no trace of blood at any time in the as to the influence that it played, but certainly no one can fluid. After the needle was withdrawn the coughing instead doubt that its share was considerable. An acute romeni.of stopping increased. Soon the child expelled by the mouth brance of the miseries of that week should be present in and nose a large quantity of sanguineous serous fluid whichthe minds of all those who attend the public meeting, same time’ the’ face became was a little which we trust will be a large one, and should impel the and Instant was them not only to pass the motions with acclaim but to cyanosed pulse thready. asphyxia with the Coal Smoke Abatement Society in finding feared. The child complained of acute pain in the right side inclined

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Annotations. "

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frothy. At the

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THE PHYSIOLOGY OF MARCHING.

1355

remedy for them. The excellent society, over which present and then only for a brief period. The nitrogenSir William Richmond presides, is a remarkably alert, containing’ substanceswere just the. same on the d4yii and active one. It has received but small support either of rest and of marching, so- that there was no increase from the public or the medical profession and deserves much of metabolism in the albumin of the body, nor was the wider noticeand much more generous help. Medical men composition of the contents of’ the intestine materially have many ways, perhaps more strictly medical in their different on days of work and days of rest. Subsequent direction, of .getting rid of their spare guineas, but this sections of the essay deal with the exchange of gases’ during society is one thatwould appeal with particular force to the work and while at rest, as well as the heat’ value of the taymindif the therapeutic nature of its work were under- work done. 70 per cent. of the heat generated is carried off stood. We wish all our London readers would impress by the sweat and the greater the amount of heat produced upon their patients the fact that to abate coal smoke in the by work the more abundant is the secretion of sweat, but metropolis is to improve the public health of the city in a many factors have to be considered, as the temperature and degree of moisture of the air, the velocity of the wind, and marked manner. a

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As the became moretrained exposure to the exercise the amount of sweat diminished. by sun.

THE PHYSIOLOGY OF MARCHING. " THE Physiology of Marching’" is the title of an essay by Herr N. Zuntz and Herr Schumburg recentlypublished in Berlin by Hirschwald and abstracted in the l’rntrrc.lblrrtt fiir

die Medicinishen Wissenschaften for October. Theirinvestigations;, which have been carried on for some years, were undertaken to ascertain the limits of weight that a soldier on the march ’could’ advantageously carry. They experimented on five healthy students who had already seen service and who for a longperiod marched fully equipped about 15½miles daily.. Amongst the more important points noted were that sphygmograms taken before, during, and after the march showed that the increased work of the heart consequert upon the muscular exertion prolonged the systole of the heart and the ascending line of the pulse curve at the cost 4Jrthe diastole-an effect that was distinctly visible after a march, of only 12 miles. This prolongation of the systole rose,with the amount of weight carried to such a degree that when’the beats of the heart were between 140 and 150 per minute the duration of the systole was to that of the diastole as-1ie to. 1. So that the period of the rest of the heart became cot-tstaiitly less, indicating a not inconsiderable degree of increase in the work of the heart. An increase of the regulation weight carried by German soldiers from the ordinary amount of 48’4 pounds to 59-4 pounds produced the Mmc effect, whilst when the weight was raised to 78’4 pounds the danger of seriously injuring the heart was greatly increased as shown by a fall of the bloodpressure and of the arterial tension. Simultaneously an acute dilatation of the heart, recognisable by percussion, and enlargement of the liver in consequence of blood stasis and

accumulation of blood in that organ were observable. As a result of the dyspnoea from exertion the driving force of the heart became still further reduced, the volume of blood propelled into the aiteries was diminished, and the blood in the great veins re-entered the’ heart in smaller quantity and In healthy persons the dilatation of the heart more slowly. graduallydisappears and in the course of two or three hours the normal conditions are restored. Speaking generally the number of red corpuscles and the specific gravity of the blood increased during the march owing to the great loss of fluid by the lungs and skin. The frequency of the respirations was increased whilst marching, though after a short rest the number returned to the normal. The vital capacity was diminished. The heat of the increased on the to quite a remarksometimes march, body able extent and even though the weight increased and there was more or less physical exhaustion. In one case it amounted to 4u° C. (1040 F.) and more. In order to determine the consumption of food and the nature and quantity of the excreta the diet was kept as uniform as possible. It appeared, to the great surprise of the experimenters, that notwithstanding the abundant secretion of sweat the urine on marching days was more abundant and of less specific gravity than on the days when rest was taken. Albumin, indicated by a precipitate on boiling, was,rarely

men

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THE HOSPITALS AT ATHENS.

Phonographic Record for October Dr. G. F. Atchley (consulting surgeon to the Bristol General Hospital) gives am interesting account of a visit he recently made to the hospitals at Athens. The children’s hospital, about two and a half miles outside the city, "consists of one large ward containing 16 to 18 beds with a small isolation ward and nurses’ rooms. The original design contemplated six of these pavilions, but, as usual, want of funds has hitherto prevented further building. The situation is perfect; abundance of room for any possible extension or for playgrounds. The building has been ’scamped,’ the tiled floors are all going to pieces, the windows do not fit, and generally the work has IN the

been done in a very inferior manner. - I understand that more A care will be taken in future to secure better work. number of in bed with were various large patients forms of tubercle, especially tubercular peritonitis. The were nurses all English. It’ is found very difficnlt to get Greek nurses to stay ; they all want to be nearer Athens....... At present any cases which require operation are sent to the Evangelismos Hospital, where the facilities for operating are almost perfect. The Evangelismos is a over for 200 large general hospital patients and having both medical and surgical sides. Here I found everything’ in the highest state of efficiency. The practical part of medicine and surgery was up to date and in some respects even in advance of our best English hospitals." Dr. Atchley saw Dr. Tsakonas operate on a boy with stone and on a woman with ovarian tumour. "The operation chosen for the calculus was suprapubic. It was most successfully carried out, the wound in the bladder being stitched with catgut (continuous suture) and the outer wound being treated in the same manner." For the removal of the ovarian tumour "anew method of anaesthesia was used....... A needle, made especially for the purpose and like a long hypodermic needle, was connected with a syringe and inserted opposite the second lumbar vertebra just outside the backbone. It was made to penetrate the spinal canal and only a little cerebro-spinal fluid escaped. Then cocaine In about 20 minutes anaesthesia was prowas injected. duced over the whole lower half of the body below the umbilicus. Although in this instance not quite enough cocaine had been used and a little chloroform became’ necessary, Dr. Tsakonas told me that he had used it’ in 163 cases without a single accident. Usually the anaesthesia. is complete. The patient remains perfectly conscious all the’ time of the operation and there are positively no aftersymptoms whatever. The practical difficulty seems to be to ascertain exactly the amount of cocaine which should be allowed to enter into the spinal canal. Probably eucaine or one of the similar compounds would be less to be injurious should an overdose be injected. It has now become a customary practice in this hospital an

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