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THE STING OF THE BEE AND THE WASP.
THE STUDENTS’ NUMBER.-THE STING OF THE BEE AND WASP.
presents the following X ray appearances: (1) It is one-half to one-quarter smaller than usual; (2) its form is entirely regular; (3) its architecture cannot be recognised, the cortex and spongy portion running together; (4) its density is increased two- to four-fold. The prognosis is invariably good, and recovery takes place independently of treatment, though the disease may last two or three years. Rest or support in some form is usually employed. THE STUDENTS’
NUMBER.
445
ill-effects resulted when they were driven as deep as possible into the flesh. We have ourselves observed that water in which wasp-stings had been immersed becomes distinctly alkaline, and, further, that the prompt application of vinegar as the nearest acid in domestic service will prevent Onion juice, which is acid, acts inflammation. similarly, and no doubt other acid vegetable or fruit juices would answer equally well. That the bee-sting is acidic and the wasp-sting basic is an interesting differentiation which should be widely known, for not uncommonly the sting proves to be not a simple puncture but the beginning of a toxic A wasp-sting on the process sometimes fatal. moist mucosa, as in the mouth, invariably leads to serious inflammation, with most distressing If the simple gargling or washing of results. the attacked spot with an acid fluid in such a case keeps down the swelling lives may well be saved. The season of wasps is with us, and these observations are therefore opportune. Amongst gardeners there is the belief that the wasp draws its venom from young laurel leaves, which are rightly reputed to contain prussic acid. Wasps certainly are fond of the laurel leaf, but while it seems certain that prussic acid is not the business element of their sting this acid may be the foundation of basic nitrogenous bodies of It will a toxic nature passed on by the sting. remembered also that wasps, different from bees, are voracious flesh eaters, and meat materials easily enough give rise to basic substances.
WE wish to thank all those who helped us so the production of the Students’ Number of THE LANCET, which appeared last week. We desired to revert at the earliest opportunity to our practice for the last 60 years of issuing shortly before the commencement of the October session an educational guide to the medical profession for the use alike of those who are joining it, those who Circumstances will are in it, and their relatives. compel us from time to time to add to the statements made in the last Students’ Number, as many things were in course of deliberation and rearrangement at the time of issue. For example, there were published on Saturday last from the India Office new announcements concerning appointments to the Indian Medical Service. The announcements include the new rates of pay, and those are the same as we were able to publish; while the information in respect of the vacancies and of the circumstances qualifying the applications are now published in another column. We regret as THE death is announced of Dr. Alexander yet to be unable to publish the new rates of pay in Macalister, F.R.S., professor of anatomy in the the Army Medical Service. The following corrigendum has been brought to University of Cambridge, and a member of the our attention. The Branch Medical Council office Senate of Dublin University. for Scotland of the General Medical Council is now situated at 20, Queen-street, Edinburgh, and Mr. Two cases of rabies have occurred in the T. H. Graham has succeeded Mr. James Robertson Colchester borough, one on August 15th and one as Registrar. on August 17th, and a third suspected case is now reported. No case of rabies has occurred in the THE STING OF THE BEE AND THE WASP. administrative county of Essex. THE grave symptoms which sometimes follow the sting of a wasp or bee render the observations THE Ministry of Health were notified on of Mr. Edward R. Speyer, M.A., F.E.S., Investigator 19th by the deputy medical officer of August of Diseases of Trees at Oxford University, in a the Port of London Sanitary Authority health of letter in the Times, of great interest. Little is of the poison of these that a member of the crew of the s.s. Clan Lamont known really of the suffering from plague. The vessel was then insects, but it was for long accepted that the chief was in but has since been taken into the river dock, and that, therefore, the toxic agent was formic and fumigated. The clinical symptoms of the an alkali to neutralise the of prompt application are those of plague, but the bacteriologist acid, such as ammonia or the blue bag, avoided patient of the Ministry has been unable to verify the serious consequences. However effective that method may be in the treatment of a bee-sting, it is diagnosis, and no plague-infected rats have been not only unsound in the case of a wasp-sting, found on the vessel. No further cases of illness but is likely to the toxic effects of the have occurred on board, and the ship has sailed subcutaneous injection, for Mr. Speyer now shows from the Port of London. that the sting of the bee is decidedly acid, while that of the wasp is distinctly alkaline. If, thereNATIONAL PHYSICAL LABORATORY. -The Lord fore, the toxic factors are an acid in one case and President of the Council has appointed Professor Joseph Ernest Petavel, D.t3c., F.R.S., M.I.Mech.E., &c., to be an alkali in the other, the choice of a neutralising ctor of the National Physical Laboratory in succession agent is clear, depending upon the particular insect Dirt to Sir Richard Glazebrook, C B., F.R.S., who retires on which discharged the venom. But it is doubtful reaching the age limit on Sept. 18th next. Professor whether the issue is as simple as this, for toxins, Petavel is professor of engineering and director of the Laboratory in the University of Manchester. He apart from any question df alkali or acid, though Whitworth a member of the Advisory Committee for Aeronautics of these may respectively be effective vehicles of toxins, is the Air Ministry. He was educated at University College, are not negatived by simple acid or alkaline appliLondon, and undertook scientific research at the Royal cations. The case of the toin of the serpent fang Institution and at the Davy Faraday Laboratory until 1898. was elected John Harling Fellow of the Owens College, Still, th evidence is interest- He may be quoted. Manchester, in 1900, and was scientific manager of the Low ing that by extracting stings of wasps and Temperature Exhibit of the British Royal Commission for immersing them for a shot time in an acid no the St. Louis Exhibition, 1904.
promptly in
be
mature ;acid
aggravate
the
446
AMERICAN MEDICAL GATHERINGS.
AMERICAN MEDICAL GATHERINGS.
There should be could be reached by no other means. cooperation between public health workers and industrial
physicians.
Dr. D. L. EDSALL (Boston) stated that at the MassaTHREE important medical gatherings were held in thechussets General Hospital a survey of patients attending the United States of America during the month of June. Thecoccupational clinic showed that in 5000 cases, or one-tenth seventieth annual session of the American Medical Associa-of the total attending, occupation had something to do with 1 tion, which took the form of a "victory meeting"at the disability. The average industrial worker was said to Atlantic City, from June 9th-13th, has already been reported lose ] eight days in the year from sickness. The opportunity in THE LANCET.1 There remain for brief comment thefor community service by the industrial physician was twentieth annual meeting of the American Therapeuticalillimitable. 1 Dr. C. HASTINGS (Toronto) gave his experience of the Society, the sessions of which, on June 6th and 7th, preceded the victory meeting at Atlantic City, and the,department of industrial hygiene started four years ago in Congress of American Physicians and Surgeons, of which1that city. Show," he said, " the employers of labour how the eleventh triennial session occupied June 16th and 17th ithe loss of 10 to 15 per cent. of efficiency in the employee at the same city. ,could be saved, and they would be willing to put in good At the American Medical Association the afternoon of or any other desired improvement." ventilation June llth was devoted to various aspects of industrial Dr. A. WADSWORTH (Albany, New York) spoke of the hygiene and their relation to public health, and this dis- need for industrial physicians to avail themselves of the cussion, at which Dr. H. E. MOCK (Chicago) presided, merits facilities offered by the State for laboratory examinations. attention. , examinations in the venereal diseases would be of Dr. W. J. CLARKE (Worcester, Mass.) dealt with industrial service, but if a demand for the work arose Preventit’e Surgery as Demornstrated by Indlbstrial Practice. there was no doubt that the legislature would see fit to appropriate the proper funds. In the treatment and repair of hernia the question often Dr. SCHERESCHEWSKY enumerated six lines along which arose whether the condition was to be classed as an federal management of industrial medicine had been industrial accident. He had found that the sac was often :congenital, and there was a distinct racial suscepti- planned Extension of health service in industries to determine extent and (1) The of a recurrence was difficult one. He bility. question means of correcting health hazards; (2) development of system of often saw a sac adherent to the cord, with a small neck, and medical and surgical supervision of employees ; (3) securing reports of after amputation of the sac, although the repair appeared to the prevalence of disease among employees and sanitary conditions in be without a flaw, yet the patient was apt to come backindustrial communities; (4) establishment of minimum standards of industrial hygiene and prevention of occupational diseases ; (5) improvelater with a recurrence. No man with a definite bulge shouldment of sanitation of industrial communities by cooperating with State be put to do heavy work. : and local health authorities and other agencies ; (6) medical and sanitary Dr. W. S. SHERMAN (Pittsburgh, Pa.) said employers wereIsupervision by public health service of industrial establishments owned or operated by Government: coming to realise the impcrtance of keeping their workers Dr. GEORGE A. SOPER (Sanitary Corps, U.S. Army) dealt and the immense entailed to loss illness. industry by fit; Fortunately, injuries received in the steel mills were often with sterile, as éoal, coke, and iron did not produce infection. The Etfiaacy of Heasuresfor the Prevention of Disease. Dakin’s hypochlorite solution, used according to the Carrel Of the three great lines of effort-namely, sanitation, technique, had been found a useful solvent of necrotic public health administration, and personal precautionstissue. the first two had been developed. Respiratory infeconly Dr. 0. P. GEIER (Cincinnati) indicated how the industrial tions were ten times as numerous as the exanthemata, and surgeon might stimulate the patient to seek early advice personal precautions were the largest factor in this question. an from outside surgeon-e.g., in cases of neoplasm or Disinfection had come to take a secondary place, and proper appendicitis. ventilation and a high standard of cleanliness had been The PRESIDENT said that the timely examination and The soldier had been taught found of first importance. removal of diseased tonsils might save such complications how to take care of himself. The time to study respiratory as appendicitis and gall-bladder invasion, and even rheuinfections was before the attack appeared. It was for the matisms. This was an important side of industrial preindividual to learn that the lessons of the Army were not vention. but to be appropriated by the whole world in Dr. J. W. SCHERESCHEWSKY (U.S. Public Health Service, for the Army, times of peace. Washington, D.C.) stated his belief that intra-abdominal Colonel KRAMER (U.S. Army) feared that unless the pressure was the result of opposition to contraction of abdo- medical profession approached industrial hygiene in a more minal muscles. The development of musculature had much and thorough manner they might lose control scientific to do with the prevention of hernia and its recurrence. With as the work was being done most efficiently by altogether, tonus must take impaired relapse place. sanitary engineers. Dr. C. E. FORD (New York) dealt with Dr. L. I. HARRIS (New York) said it was a pity that after ResoluIndl18trial Medical Practice and Sickness Prevention as a many enthusiastic meetings nothing was done. Factor in Public Health. tions ought to follow the matters discussed and the advice Some years ago the employment of a physician was obtained carried out. Dr. SCHERESCHEWSKY said that the responsibility rested regarded as benevolence on the part of the employer. It with the community itself. The State and national boards was now beginning to be understood that industry would best be benefited by the employment of qualified physicians. were there for guidance and control. The individual citizen Part-time service was of little use. Men adapted to under- must play his part in demanding the best conditions. Dr. SOPER, in closing the debate, regretted that only about take this work were those who had seen at least five years’ of the population were included in the vital general practice, had had experience in health department 70 per cent.the United States. and dispensary work, with opportunity of acquiring the statistics of social view-point. Sanitation, nuisances, garbage disposal, The scientific section of the American Therapeutic Society sewage disposal, flies, housing, prevention of infection The on June 6th opened with an address by Dr. DOUGLAS were all subjects of great educational importance. frank discussion of venereal disease, the control of tuber- VANDER HOOF (Richmond, Va.), the President, on culosis, the necessity of rest, and the like, were all matters Therapeutics and Gastro-Intestinal Disorders. of vital importance. Educational films could now be obtained In making a diagnosis of gastro-intestinal disorders the at a very moderate cost. In a survey of the funds spent internist, the roentgenologist, the oculist, the by 99 leading industries he found that$2.50 was being spent services of the or the surgeon, were, he said, often required. neurologist, head in this annually per way. Dr. W. A. SAWYER (Philadelphia) said that there were 1000 private cases (excluding definite lesions of the tract) in which the patients complained of I I indiapproximately 30 million industrial workers in the United alimentary " States, and industrial medicine served to reach a class that gestion were studied and the causative factors tabulated. Laboratory analyses and X ray pictures were made in 1 THE all cases, and a Wassermann test was performed. Where LANCET, July 12th, 1919, p. 78. "
’
Systematic great
’
presents the following X ray appearances: (1) It is one-half to one-quarter smaller than usual; (2) its form is entirely regular; (3) its architecture cannot be recognised, the cortex and spongy portion running together; (4) its density is increased two- to four-fold. The prognosis is invariably good, and recovery takes place independently of treatment, though the disease may last two or three years. Rest or support in some form is usually employed. THE STUDENTS’
NUMBER.
445
ill-effects resulted when they were driven as deep as possible into the flesh. We have ourselves observed that water in which wasp-stings had been immersed becomes distinctly alkaline, and, further, that the prompt application of vinegar as the nearest acid in domestic service will prevent Onion juice, which is acid, acts inflammation. similarly, and no doubt other acid vegetable or fruit juices would answer equally well. That the bee-sting is acidic and the wasp-sting basic is an interesting differentiation which should be widely known, for not uncommonly the sting proves to be not a simple puncture but the beginning of a toxic A wasp-sting on the process sometimes fatal. moist mucosa, as in the mouth, invariably leads to serious inflammation, with most distressing If the simple gargling or washing of results. the attacked spot with an acid fluid in such a case keeps down the swelling lives may well be saved. The season of wasps is with us, and these observations are therefore opportune. Amongst gardeners there is the belief that the wasp draws its venom from young laurel leaves, which are rightly reputed to contain prussic acid. Wasps certainly are fond of the laurel leaf, but while it seems certain that prussic acid is not the business element of their sting this acid may be the foundation of basic nitrogenous bodies of It will a toxic nature passed on by the sting. remembered also that wasps, different from bees, are voracious flesh eaters, and meat materials easily enough give rise to basic substances.
WE wish to thank all those who helped us so the production of the Students’ Number of THE LANCET, which appeared last week. We desired to revert at the earliest opportunity to our practice for the last 60 years of issuing shortly before the commencement of the October session an educational guide to the medical profession for the use alike of those who are joining it, those who Circumstances will are in it, and their relatives. compel us from time to time to add to the statements made in the last Students’ Number, as many things were in course of deliberation and rearrangement at the time of issue. For example, there were published on Saturday last from the India Office new announcements concerning appointments to the Indian Medical Service. The announcements include the new rates of pay, and those are the same as we were able to publish; while the information in respect of the vacancies and of the circumstances qualifying the applications are now published in another column. We regret as THE death is announced of Dr. Alexander yet to be unable to publish the new rates of pay in Macalister, F.R.S., professor of anatomy in the the Army Medical Service. The following corrigendum has been brought to University of Cambridge, and a member of the our attention. The Branch Medical Council office Senate of Dublin University. for Scotland of the General Medical Council is now situated at 20, Queen-street, Edinburgh, and Mr. Two cases of rabies have occurred in the T. H. Graham has succeeded Mr. James Robertson Colchester borough, one on August 15th and one as Registrar. on August 17th, and a third suspected case is now reported. No case of rabies has occurred in the THE STING OF THE BEE AND THE WASP. administrative county of Essex. THE grave symptoms which sometimes follow the sting of a wasp or bee render the observations THE Ministry of Health were notified on of Mr. Edward R. Speyer, M.A., F.E.S., Investigator 19th by the deputy medical officer of August of Diseases of Trees at Oxford University, in a the Port of London Sanitary Authority health of letter in the Times, of great interest. Little is of the poison of these that a member of the crew of the s.s. Clan Lamont known really of the suffering from plague. The vessel was then insects, but it was for long accepted that the chief was in but has since been taken into the river dock, and that, therefore, the toxic agent was formic and fumigated. The clinical symptoms of the an alkali to neutralise the of prompt application are those of plague, but the bacteriologist acid, such as ammonia or the blue bag, avoided patient of the Ministry has been unable to verify the serious consequences. However effective that method may be in the treatment of a bee-sting, it is diagnosis, and no plague-infected rats have been not only unsound in the case of a wasp-sting, found on the vessel. No further cases of illness but is likely to the toxic effects of the have occurred on board, and the ship has sailed subcutaneous injection, for Mr. Speyer now shows from the Port of London. that the sting of the bee is decidedly acid, while that of the wasp is distinctly alkaline. If, thereNATIONAL PHYSICAL LABORATORY. -The Lord fore, the toxic factors are an acid in one case and President of the Council has appointed Professor Joseph Ernest Petavel, D.t3c., F.R.S., M.I.Mech.E., &c., to be an alkali in the other, the choice of a neutralising ctor of the National Physical Laboratory in succession agent is clear, depending upon the particular insect Dirt to Sir Richard Glazebrook, C B., F.R.S., who retires on which discharged the venom. But it is doubtful reaching the age limit on Sept. 18th next. Professor whether the issue is as simple as this, for toxins, Petavel is professor of engineering and director of the Laboratory in the University of Manchester. He apart from any question df alkali or acid, though Whitworth a member of the Advisory Committee for Aeronautics of these may respectively be effective vehicles of toxins, is the Air Ministry. He was educated at University College, are not negatived by simple acid or alkaline appliLondon, and undertook scientific research at the Royal cations. The case of the toin of the serpent fang Institution and at the Davy Faraday Laboratory until 1898. was elected John Harling Fellow of the Owens College, Still, th evidence is interest- He may be quoted. Manchester, in 1900, and was scientific manager of the Low ing that by extracting stings of wasps and Temperature Exhibit of the British Royal Commission for immersing them for a shot time in an acid no the St. Louis Exhibition, 1904.
promptly in
be
mature ;acid
aggravate
the
446
AMERICAN MEDICAL GATHERINGS.
AMERICAN MEDICAL GATHERINGS.
There should be could be reached by no other means. cooperation between public health workers and industrial
physicians.
Dr. D. L. EDSALL (Boston) stated that at the MassaTHREE important medical gatherings were held in thechussets General Hospital a survey of patients attending the United States of America during the month of June. Thecoccupational clinic showed that in 5000 cases, or one-tenth seventieth annual session of the American Medical Associa-of the total attending, occupation had something to do with 1 tion, which took the form of a "victory meeting"at the disability. The average industrial worker was said to Atlantic City, from June 9th-13th, has already been reported lose ] eight days in the year from sickness. The opportunity in THE LANCET.1 There remain for brief comment thefor community service by the industrial physician was twentieth annual meeting of the American Therapeuticalillimitable. 1 Dr. C. HASTINGS (Toronto) gave his experience of the Society, the sessions of which, on June 6th and 7th, preceded the victory meeting at Atlantic City, and the,department of industrial hygiene started four years ago in Congress of American Physicians and Surgeons, of which1that city. Show," he said, " the employers of labour how the eleventh triennial session occupied June 16th and 17th ithe loss of 10 to 15 per cent. of efficiency in the employee at the same city. ,could be saved, and they would be willing to put in good At the American Medical Association the afternoon of or any other desired improvement." ventilation June llth was devoted to various aspects of industrial Dr. A. WADSWORTH (Albany, New York) spoke of the hygiene and their relation to public health, and this dis- need for industrial physicians to avail themselves of the cussion, at which Dr. H. E. MOCK (Chicago) presided, merits facilities offered by the State for laboratory examinations. attention. , examinations in the venereal diseases would be of Dr. W. J. CLARKE (Worcester, Mass.) dealt with industrial service, but if a demand for the work arose Preventit’e Surgery as Demornstrated by Indlbstrial Practice. there was no doubt that the legislature would see fit to appropriate the proper funds. In the treatment and repair of hernia the question often Dr. SCHERESCHEWSKY enumerated six lines along which arose whether the condition was to be classed as an federal management of industrial medicine had been industrial accident. He had found that the sac was often :congenital, and there was a distinct racial suscepti- planned Extension of health service in industries to determine extent and (1) The of a recurrence was difficult one. He bility. question means of correcting health hazards; (2) development of system of often saw a sac adherent to the cord, with a small neck, and medical and surgical supervision of employees ; (3) securing reports of after amputation of the sac, although the repair appeared to the prevalence of disease among employees and sanitary conditions in be without a flaw, yet the patient was apt to come backindustrial communities; (4) establishment of minimum standards of industrial hygiene and prevention of occupational diseases ; (5) improvelater with a recurrence. No man with a definite bulge shouldment of sanitation of industrial communities by cooperating with State be put to do heavy work. : and local health authorities and other agencies ; (6) medical and sanitary Dr. W. S. SHERMAN (Pittsburgh, Pa.) said employers wereIsupervision by public health service of industrial establishments owned or operated by Government: coming to realise the impcrtance of keeping their workers Dr. GEORGE A. SOPER (Sanitary Corps, U.S. Army) dealt and the immense entailed to loss illness. industry by fit; Fortunately, injuries received in the steel mills were often with sterile, as éoal, coke, and iron did not produce infection. The Etfiaacy of Heasuresfor the Prevention of Disease. Dakin’s hypochlorite solution, used according to the Carrel Of the three great lines of effort-namely, sanitation, technique, had been found a useful solvent of necrotic public health administration, and personal precautionstissue. the first two had been developed. Respiratory infeconly Dr. 0. P. GEIER (Cincinnati) indicated how the industrial tions were ten times as numerous as the exanthemata, and surgeon might stimulate the patient to seek early advice personal precautions were the largest factor in this question. an from outside surgeon-e.g., in cases of neoplasm or Disinfection had come to take a secondary place, and proper appendicitis. ventilation and a high standard of cleanliness had been The PRESIDENT said that the timely examination and The soldier had been taught found of first importance. removal of diseased tonsils might save such complications how to take care of himself. The time to study respiratory as appendicitis and gall-bladder invasion, and even rheuinfections was before the attack appeared. It was for the matisms. This was an important side of industrial preindividual to learn that the lessons of the Army were not vention. but to be appropriated by the whole world in Dr. J. W. SCHERESCHEWSKY (U.S. Public Health Service, for the Army, times of peace. Washington, D.C.) stated his belief that intra-abdominal Colonel KRAMER (U.S. Army) feared that unless the pressure was the result of opposition to contraction of abdo- medical profession approached industrial hygiene in a more minal muscles. The development of musculature had much and thorough manner they might lose control scientific to do with the prevention of hernia and its recurrence. With as the work was being done most efficiently by altogether, tonus must take impaired relapse place. sanitary engineers. Dr. C. E. FORD (New York) dealt with Dr. L. I. HARRIS (New York) said it was a pity that after ResoluIndl18trial Medical Practice and Sickness Prevention as a many enthusiastic meetings nothing was done. Factor in Public Health. tions ought to follow the matters discussed and the advice Some years ago the employment of a physician was obtained carried out. Dr. SCHERESCHEWSKY said that the responsibility rested regarded as benevolence on the part of the employer. It with the community itself. The State and national boards was now beginning to be understood that industry would best be benefited by the employment of qualified physicians. were there for guidance and control. The individual citizen Part-time service was of little use. Men adapted to under- must play his part in demanding the best conditions. Dr. SOPER, in closing the debate, regretted that only about take this work were those who had seen at least five years’ of the population were included in the vital general practice, had had experience in health department 70 per cent.the United States. and dispensary work, with opportunity of acquiring the statistics of social view-point. Sanitation, nuisances, garbage disposal, The scientific section of the American Therapeutic Society sewage disposal, flies, housing, prevention of infection The on June 6th opened with an address by Dr. DOUGLAS were all subjects of great educational importance. frank discussion of venereal disease, the control of tuber- VANDER HOOF (Richmond, Va.), the President, on culosis, the necessity of rest, and the like, were all matters Therapeutics and Gastro-Intestinal Disorders. of vital importance. Educational films could now be obtained In making a diagnosis of gastro-intestinal disorders the at a very moderate cost. In a survey of the funds spent internist, the roentgenologist, the oculist, the by 99 leading industries he found that$2.50 was being spent services of the or the surgeon, were, he said, often required. neurologist, head in this annually per way. Dr. W. A. SAWYER (Philadelphia) said that there were 1000 private cases (excluding definite lesions of the tract) in which the patients complained of I I indiapproximately 30 million industrial workers in the United alimentary " States, and industrial medicine served to reach a class that gestion were studied and the causative factors tabulated. Laboratory analyses and X ray pictures were made in 1 THE all cases, and a Wassermann test was performed. Where LANCET, July 12th, 1919, p. 78. "
’
Systematic great
’