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THE ROMANCE OF INDUSTRIAL MEDICINE.
THE ROMANCE OF INDUSTRIAL MEDICINE.
that in long-standing obstruction in which patients show clinical evidence of back pressure, there is often Where this is so, however, pyelono reflux at all. graphy reveals conspicuous dilatation of both ureters and renal pelves. Even in patients with reflux on one side he demonstrated the presence of dilatation of the upper urinary tract on the side in which reflux had not occurred. The conclusions drawn from his cystograms and pyelograms are as follows : (1) The cause of upper urinary tract dilatation in obstructive lesions of the neck of the bladder and of the urethra in adults is a stenosis of the intramural portion of the ureter. (2) This constriction is due to hypertrophy of the musculature of the bladder. (3) When reflux is present, the increased intravesical pressure tends to keep the upper urinary tract dilated to its maximum. (4) After removal of the urethral obstruction, the wall of the bladder loses its hypertrophy, the stenosis disappears, drainage is improved, and the ureters and renal pelves return to normal. Kreutzmann’s explanation of back pressure in the kidneys is, therefore, different from that of Tandler and Zuckerkandl. These investigators laid stress on the anatomical fact that the vas deferens passes in front of the ureters, between the ureter and bladder. They suggested that as the prostate enlarges and pushes up the floor of the bladder the vas deferens remains as a fixed point around which the ureter becomes looped. Amongst reasons why Kreutzmann finds this explanation unsatisfactory is his observation that relief from back pressure is always gained by the use of an indwelling catheter. If the ureteral obstruction were due to the pull of the vas on the ureter such relief would not be. expected. Moreover, Tandler and Zuckerkandl’s explanation could not possibly apply to cases of median bar formation without general enlargement of the prostate and to obstruction from urethral strictures, as in those cases there is no change in the relation of the vas to the ureter.
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marbles into ginger-beer bottles, and the human hand was still needed for that. Trade-union officials have helped in many other departments of industrial medicine. It was a secretary who demanded of a professor of botany in Liverpool what it was in African box-wood that made the shuttle-makers mazy and sleepy at their work. With the help of Prof. Sherrington, an alkaloid powerfully depressant to the heart was isolated from the wood and Gonomia kamassi poisoning was scheduled as an industrial disease. It is a rare one now, for the publicity of scheduling it led to the substitution of other woods in the shuttle industry. A trade-union officer, again, first drew attention to the skin cancer of the briquettemakers. Miners’ ailments account for 90 per cent. of the cases receiving compensation for the 36 scheduled diseases ; nystagmus, beat hand, beat elbow, and beat knee, together with silicosis, by many hundreds head the list of cases receiving compensation. Nystagmus alone costs over a million pounds in compensation, for about 1 per cent. of our million miners have nystagmus. We compensate always ; some continental countries do not compensate at all, others only if there is total incapacity. Sir Thomas Legge upheld the views of J. S. Haldane, that the disorder is due to the strainending in psychoneurosis-of having to look at the black coal face, which absorbs over 90 per cent. of the light that falls on it, and that men might well be better continuing at work than worrying over their eyes above ground. For nystagmus no remedy is as yet in sight. Next in order of frequency come lead poisoning and dermatitis, and these at least are preventable by The trouble is that too many workpeople care. demand cure when cure is impossible, and will not ensure prevention when prevention is easy. Sir Thomas Legge illustrated vividly how familiarity breeds contempt, and emphasised his second maxim : unless and until the employer has done everything in his power, the employee can do nothing to protect himself. How far that " can " should read " will " is perhaps open to argument, but the fact remains nevertheless true. Several kinds of industrial disease, such as trinitrotoluene poisoning and grindstone silicosis, are fine examples of what can be done to workers by the cooperation of scientific investigators and employers, but others remain almost unaltered during many years. New risks are appearing with every new industry ; when the Commission sat, poisoning by manganese and tetrachlorethane were unknown. Mr. Ben Tillett, the chairman, hoped to see the time when names like Haldane and Collis were more revered by the workers than that of any politician ; Sir Thomas Legge looked to the day when there should be no industrial disease. The one might well be the means of bringing about the other. Meanwhile there is a wide field of urgent work for all concerned.
THE ROMANCE OF INDUSTRIAL MEDICINE. THERE can be few more romantic chapters in the tale of human advance than that of the inception and growth of medicine in industry, and Sir Thomas Legge made an enthralling story of his " Thirty Years’ Experience of Industrial Maladies " in three Shaw lectures to the Royal Society of Arts, ending last Monday. The most exciting day of his life, he said, was that on which he was able to connect posterior cortical cataract with the exposure to glare in a glass-blowing factory. Yet in that he was only confirming the observations of a half-blind tradeunion official. Among 513 glass-blowers he found that 64 had cataract in the right eye and 72 in the left; among 278 workers not exposed to glare, 14 had it in the right and 13 in the left. The left eye of the glass-blower is more often turned to the " glory hole " than the right, so the inference of occupational disease was obvious. The proof was yielded by an INFECTION IN MULTIPLE ARTHRITIS. investigation into the incidence of cataract among RELATIVELY few cases of multiple infective Hearts of Oak members-0-6 per cent.-and among the Yorkshire Glass Bottle Makers’ Society-30 per arthritis are due to specific infection, gonococcal, cent.—and the North of England Glass Bottle Makers’ luetic, or tuberculous; in the great majority no Society—66.6 per cent. Sir William Crookes threw specific germ can be found. Cultures from the himself into the problem with immense enthusiasm, synovial fluid and periarticular spaces of infected and at last succeeded in finding a glass which would joints rarely yield positive findings ; cultures from cut off the injurious rays. But here, at once, is an the blood, even when taken during febrile attacks, example of one of Sir Thomas Legge’s two cardinal are usually negative. L. G. Hadjopoulos and precepts of industrial medicine ; unless you can bring E. Burbankascribe this non-success to the presence something external to bear on the workman-some- of antibody in the blood,?and state that by neutralising thing over which he has no control-you will not this antibody they have obtained positive cultural succeed. For the workmen soon got tired of wiping findings in 29 out of 145 arthritic cases. In 15 cases their sweat-fogged spectacles, and Crookes lenses streptococci were obtained ; these were injected into little used. were Then came the " something rabbits, guinea-pigs, and mice, and after one or two external"" with the perfection of an automatic months joint swellings took place. X ray photobottle-maker, which gathers up the molten glass, and graphs of the affected joints show atrophy of cartilage blows it into bottle shape at the rate of 40 a minute, and periarticular infiltration of the soft tissues. No enabling three men to do the work of forty. A deaths occurred, so that no histological data are delightful coda to the story is the fact that the odd available, and until more convincing evidence is 37 men were not thrown out of work, for the machine, 1 with all its magic powers, failed to insert the glass Journal of Bone and Joint Surgery, 1927, ix., 278.
protect
that in long-standing obstruction in which patients show clinical evidence of back pressure, there is often Where this is so, however, pyelono reflux at all. graphy reveals conspicuous dilatation of both ureters and renal pelves. Even in patients with reflux on one side he demonstrated the presence of dilatation of the upper urinary tract on the side in which reflux had not occurred. The conclusions drawn from his cystograms and pyelograms are as follows : (1) The cause of upper urinary tract dilatation in obstructive lesions of the neck of the bladder and of the urethra in adults is a stenosis of the intramural portion of the ureter. (2) This constriction is due to hypertrophy of the musculature of the bladder. (3) When reflux is present, the increased intravesical pressure tends to keep the upper urinary tract dilated to its maximum. (4) After removal of the urethral obstruction, the wall of the bladder loses its hypertrophy, the stenosis disappears, drainage is improved, and the ureters and renal pelves return to normal. Kreutzmann’s explanation of back pressure in the kidneys is, therefore, different from that of Tandler and Zuckerkandl. These investigators laid stress on the anatomical fact that the vas deferens passes in front of the ureters, between the ureter and bladder. They suggested that as the prostate enlarges and pushes up the floor of the bladder the vas deferens remains as a fixed point around which the ureter becomes looped. Amongst reasons why Kreutzmann finds this explanation unsatisfactory is his observation that relief from back pressure is always gained by the use of an indwelling catheter. If the ureteral obstruction were due to the pull of the vas on the ureter such relief would not be. expected. Moreover, Tandler and Zuckerkandl’s explanation could not possibly apply to cases of median bar formation without general enlargement of the prostate and to obstruction from urethral strictures, as in those cases there is no change in the relation of the vas to the ureter.
513
marbles into ginger-beer bottles, and the human hand was still needed for that. Trade-union officials have helped in many other departments of industrial medicine. It was a secretary who demanded of a professor of botany in Liverpool what it was in African box-wood that made the shuttle-makers mazy and sleepy at their work. With the help of Prof. Sherrington, an alkaloid powerfully depressant to the heart was isolated from the wood and Gonomia kamassi poisoning was scheduled as an industrial disease. It is a rare one now, for the publicity of scheduling it led to the substitution of other woods in the shuttle industry. A trade-union officer, again, first drew attention to the skin cancer of the briquettemakers. Miners’ ailments account for 90 per cent. of the cases receiving compensation for the 36 scheduled diseases ; nystagmus, beat hand, beat elbow, and beat knee, together with silicosis, by many hundreds head the list of cases receiving compensation. Nystagmus alone costs over a million pounds in compensation, for about 1 per cent. of our million miners have nystagmus. We compensate always ; some continental countries do not compensate at all, others only if there is total incapacity. Sir Thomas Legge upheld the views of J. S. Haldane, that the disorder is due to the strainending in psychoneurosis-of having to look at the black coal face, which absorbs over 90 per cent. of the light that falls on it, and that men might well be better continuing at work than worrying over their eyes above ground. For nystagmus no remedy is as yet in sight. Next in order of frequency come lead poisoning and dermatitis, and these at least are preventable by The trouble is that too many workpeople care. demand cure when cure is impossible, and will not ensure prevention when prevention is easy. Sir Thomas Legge illustrated vividly how familiarity breeds contempt, and emphasised his second maxim : unless and until the employer has done everything in his power, the employee can do nothing to protect himself. How far that " can " should read " will " is perhaps open to argument, but the fact remains nevertheless true. Several kinds of industrial disease, such as trinitrotoluene poisoning and grindstone silicosis, are fine examples of what can be done to workers by the cooperation of scientific investigators and employers, but others remain almost unaltered during many years. New risks are appearing with every new industry ; when the Commission sat, poisoning by manganese and tetrachlorethane were unknown. Mr. Ben Tillett, the chairman, hoped to see the time when names like Haldane and Collis were more revered by the workers than that of any politician ; Sir Thomas Legge looked to the day when there should be no industrial disease. The one might well be the means of bringing about the other. Meanwhile there is a wide field of urgent work for all concerned.
THE ROMANCE OF INDUSTRIAL MEDICINE. THERE can be few more romantic chapters in the tale of human advance than that of the inception and growth of medicine in industry, and Sir Thomas Legge made an enthralling story of his " Thirty Years’ Experience of Industrial Maladies " in three Shaw lectures to the Royal Society of Arts, ending last Monday. The most exciting day of his life, he said, was that on which he was able to connect posterior cortical cataract with the exposure to glare in a glass-blowing factory. Yet in that he was only confirming the observations of a half-blind tradeunion official. Among 513 glass-blowers he found that 64 had cataract in the right eye and 72 in the left; among 278 workers not exposed to glare, 14 had it in the right and 13 in the left. The left eye of the glass-blower is more often turned to the " glory hole " than the right, so the inference of occupational disease was obvious. The proof was yielded by an INFECTION IN MULTIPLE ARTHRITIS. investigation into the incidence of cataract among RELATIVELY few cases of multiple infective Hearts of Oak members-0-6 per cent.-and among the Yorkshire Glass Bottle Makers’ Society-30 per arthritis are due to specific infection, gonococcal, cent.—and the North of England Glass Bottle Makers’ luetic, or tuberculous; in the great majority no Society—66.6 per cent. Sir William Crookes threw specific germ can be found. Cultures from the himself into the problem with immense enthusiasm, synovial fluid and periarticular spaces of infected and at last succeeded in finding a glass which would joints rarely yield positive findings ; cultures from cut off the injurious rays. But here, at once, is an the blood, even when taken during febrile attacks, example of one of Sir Thomas Legge’s two cardinal are usually negative. L. G. Hadjopoulos and precepts of industrial medicine ; unless you can bring E. Burbankascribe this non-success to the presence something external to bear on the workman-some- of antibody in the blood,?and state that by neutralising thing over which he has no control-you will not this antibody they have obtained positive cultural succeed. For the workmen soon got tired of wiping findings in 29 out of 145 arthritic cases. In 15 cases their sweat-fogged spectacles, and Crookes lenses streptococci were obtained ; these were injected into little used. were Then came the " something rabbits, guinea-pigs, and mice, and after one or two external"" with the perfection of an automatic months joint swellings took place. X ray photobottle-maker, which gathers up the molten glass, and graphs of the affected joints show atrophy of cartilage blows it into bottle shape at the rate of 40 a minute, and periarticular infiltration of the soft tissues. No enabling three men to do the work of forty. A deaths occurred, so that no histological data are delightful coda to the story is the fact that the odd available, and until more convincing evidence is 37 men were not thrown out of work, for the machine, 1 with all its magic powers, failed to insert the glass Journal of Bone and Joint Surgery, 1927, ix., 278.
protect