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TROPICAL ULCER
ARSEN1URETTED HYDROGEN POISONING
oxygen to the great benefit of the patient. In general practice where no gas-oxygen apparatus is available, it is still possible to use this method with open ether, regarding the proximal end of the catheter as the end of an artificial airway. I am in entire agreement with Dr. Robson as to the advantages derived from maintaining a stomachtube in position during the operation. I am, Sir, yours faithfully, C. LANGTON HEWER. Queen’s-road, N.W., Jan. 3rd, 1933. ARSENIURETTED HYDROGEN POISONING
of THE LANCET SIR,-Since I am the certifying surgeon to the works at which the two cases reported by Dr. R. R. Bomford and Dr. Donald Hunter (Dec. 31st, p. 1446) occurred, I may perhaps be allowed to add a fewT To the Editor
57
haemoglobinuria. urine the
The presence of haemoglobin in the gave required hint, and on visiting the factory I found that both men had been treating zinc with hydrochloric acid, and had been suddenly overcome with the fumes. Analysis showed the presence of arsenic which had been given off in the form of arseniuretted hydrogen. The case at the London Hospital was not reported, but I believe arsenic was subsequently found in the urine. These cases suggest that the certifying surgeon should take a wider view of his duties than is contemplated in the regulations ; at present this is only possible in those firms which take a deep interest in the health of their employees. I am, Sir, yours faithfully, W. H. F. OXLEY. Poplar, Jan. 1st, 1933.
TROPICAL ULCER To the Editor of THE LANCET SiR,-The paper of Dr. L. J. A. Loewenthal on Tropical Ulcer as a Deficiency Disease (THE LANCET, Oct. 22nd, p. 889) and that of Dr. Clifford James on Excision and Skin Graft for the same condition (Ibid., Nov. 19th, p. 1095), together with your annotation on p. 1121 of the same number, focus attention on this important cause of disablement in the tropics. With a view to supplementing the information given in these communications, I venture to submit references to investigations carried out in Kenya Colony. It is difficult to keep touch with the literature of even so limited a subject, but I trust that others having experience to record may find the following of service.
remarks to their excellent article. The necessity of the early diagnosis of such cases! is rightly stressed, but it should be noted that the official duties of certifying surgeons provide only for the periodic examination of workmen employed in certain dangerous trades, and do not include the’ immediate examination of men who may be taken ill Had it not been for the between those visits. enlightened action of the firm in question in making voluntary arrangements extending the certifying surgeon’s official duties, this outbreak might have Thus I was assumed more serious proportions. enabled to see the first of these men as soon as it was known that he was ill, to suggest his immediate The researches of Dr. J. B. Orr, F.R.S., of the Rowett removal to the London Hospital for biochemical Institute, and Dr. J. L. Gilks, F.R.C.S., Director of Medical investigation, to visit the factory and advise the and Sanitary Services in Kenya, on the Nutrition of African Tribes, will be found in Special Report No. 155 of the analysis of the dross, and to keep the other men who Medical Research Council. This investigation, undertaken had been working near under observation. It is not at the instance of the Economic Advisory Committee, paid the duty of the certifying surgeon, but of the doctor special attention to ulcus tropicum and its possible relationwho is treating the case, to notify it to the Home ship to nutrition. Numerous references are given to previous work. Dr. Loewenthal will also find that on Office ; and since this doctor probably has no special several occasions Dr. Harvey, of the research laboratory has of disease and free not industrial experience at Nairobi, has made communications on calcium metabolism access to the works at which his patient has been in the Kenya and East African (now East African) Medical same journal there have appeared the employed, it is not unlikely that cases may be missed. Journal. In the contributions on the subject of tropical following special The two cases now reported, together with two ulcer and its treatment : others which occurred some years ago, show the Fisher, V., vol. i., p. 295, on labour employed in railway great diversity in the physical signs and in the construction. Procter, R. A. W. vol. vii., p. 276, on the same subject. severity of the poisoning which may follow inhalation Barley-Mason, R. J., vol. iv., p. 350. of arseniuretted hydrogen. The man, A. B., when McNabb, J., vol. vii., p. 216, on labourers in Magadi Soda work. seen by me on the day following exposure was eviBrennan, C. H., vol. vii., p. 203, on excision and grafting. he was the dently seriously ill; deeply jaundiced ; T. F., and Roberts, M. W., vol. ix., p. 79. Anderson, urine obtained at this early visit contained free Excision and grafting. Records of 154 cases. Length of haemoglobin, confirmed by spectroscopic examina- residence after grafting averaged 19-6 days. Enzer, J., vol. ix., p. 148. Record of 112 cases treated tion, and arsenic was later found in it (by Dr. A. T. excision and grafting. Similar rapid results. by biochemist to Charlotte’s to Fuller, Queen Hospital) Esler, A. R., vol. viii., p. 176, and ix., p. 237. Treatment the extent of 0-5 mg. per 100 c.cm. C. D. was kept by strapping after Dickson Wright’s method. 272. Treatment by strapping under observation until June 7th-that is, 14 days McLean, N., vol. ix., 16 he in felt his usual after exposure ; during that time Dr. Loewenthal also contributed a paper to the health and showed no physical signs on ordinary same journal (vol. ix., p. 136) based upon the facts clinical examination. He then developed an illness and figures published later in THE LANCET. which appeared clinically to be a slight attack of I am. Sir. vours faithfullv. lead poisoning. Some years ago I was asked to visit JAMES H. SEQUEIRA. Makuyu, Kenya. a man working for the same firm who had been sent home seriously ill. I found him lying in bed semiSEAHAM HALL TUBERCULOSIS SANATORIUM.-A conscious, with a spastic condition of all limbs and increased deep reflexes. The urine was normal and new wing and nurses’ home of this institution, which cost nearly z25,000, was formally opened on there was no jaundice. I was unable to obtain any have Dec. 17th. The extensions provide accommodation history and was puzzled as to what he was suffering for 50 additional patients, and it is hoped so to reduce from, but hearing that his mate was also ill and had the waiting-list of 91 women and 24 girls that it will no been admitted to the London Hospital I went there. longer be necessary to send patients outside Durham Seaham Hall was given to the Durham county On arrival I found the visiting physician giving a county. council by Lord Londonderry in 1928, and was opened clinical lecture upon the case as one of paroxysmal with 28 beds. .
oxygen to the great benefit of the patient. In general practice where no gas-oxygen apparatus is available, it is still possible to use this method with open ether, regarding the proximal end of the catheter as the end of an artificial airway. I am in entire agreement with Dr. Robson as to the advantages derived from maintaining a stomachtube in position during the operation. I am, Sir, yours faithfully, C. LANGTON HEWER. Queen’s-road, N.W., Jan. 3rd, 1933. ARSENIURETTED HYDROGEN POISONING
of THE LANCET SIR,-Since I am the certifying surgeon to the works at which the two cases reported by Dr. R. R. Bomford and Dr. Donald Hunter (Dec. 31st, p. 1446) occurred, I may perhaps be allowed to add a fewT To the Editor
57
haemoglobinuria. urine the
The presence of haemoglobin in the gave required hint, and on visiting the factory I found that both men had been treating zinc with hydrochloric acid, and had been suddenly overcome with the fumes. Analysis showed the presence of arsenic which had been given off in the form of arseniuretted hydrogen. The case at the London Hospital was not reported, but I believe arsenic was subsequently found in the urine. These cases suggest that the certifying surgeon should take a wider view of his duties than is contemplated in the regulations ; at present this is only possible in those firms which take a deep interest in the health of their employees. I am, Sir, yours faithfully, W. H. F. OXLEY. Poplar, Jan. 1st, 1933.
TROPICAL ULCER To the Editor of THE LANCET SiR,-The paper of Dr. L. J. A. Loewenthal on Tropical Ulcer as a Deficiency Disease (THE LANCET, Oct. 22nd, p. 889) and that of Dr. Clifford James on Excision and Skin Graft for the same condition (Ibid., Nov. 19th, p. 1095), together with your annotation on p. 1121 of the same number, focus attention on this important cause of disablement in the tropics. With a view to supplementing the information given in these communications, I venture to submit references to investigations carried out in Kenya Colony. It is difficult to keep touch with the literature of even so limited a subject, but I trust that others having experience to record may find the following of service.
remarks to their excellent article. The necessity of the early diagnosis of such cases! is rightly stressed, but it should be noted that the official duties of certifying surgeons provide only for the periodic examination of workmen employed in certain dangerous trades, and do not include the’ immediate examination of men who may be taken ill Had it not been for the between those visits. enlightened action of the firm in question in making voluntary arrangements extending the certifying surgeon’s official duties, this outbreak might have Thus I was assumed more serious proportions. enabled to see the first of these men as soon as it was known that he was ill, to suggest his immediate The researches of Dr. J. B. Orr, F.R.S., of the Rowett removal to the London Hospital for biochemical Institute, and Dr. J. L. Gilks, F.R.C.S., Director of Medical investigation, to visit the factory and advise the and Sanitary Services in Kenya, on the Nutrition of African Tribes, will be found in Special Report No. 155 of the analysis of the dross, and to keep the other men who Medical Research Council. This investigation, undertaken had been working near under observation. It is not at the instance of the Economic Advisory Committee, paid the duty of the certifying surgeon, but of the doctor special attention to ulcus tropicum and its possible relationwho is treating the case, to notify it to the Home ship to nutrition. Numerous references are given to previous work. Dr. Loewenthal will also find that on Office ; and since this doctor probably has no special several occasions Dr. Harvey, of the research laboratory has of disease and free not industrial experience at Nairobi, has made communications on calcium metabolism access to the works at which his patient has been in the Kenya and East African (now East African) Medical same journal there have appeared the employed, it is not unlikely that cases may be missed. Journal. In the contributions on the subject of tropical following special The two cases now reported, together with two ulcer and its treatment : others which occurred some years ago, show the Fisher, V., vol. i., p. 295, on labour employed in railway great diversity in the physical signs and in the construction. Procter, R. A. W. vol. vii., p. 276, on the same subject. severity of the poisoning which may follow inhalation Barley-Mason, R. J., vol. iv., p. 350. of arseniuretted hydrogen. The man, A. B., when McNabb, J., vol. vii., p. 216, on labourers in Magadi Soda work. seen by me on the day following exposure was eviBrennan, C. H., vol. vii., p. 203, on excision and grafting. he was the dently seriously ill; deeply jaundiced ; T. F., and Roberts, M. W., vol. ix., p. 79. Anderson, urine obtained at this early visit contained free Excision and grafting. Records of 154 cases. Length of haemoglobin, confirmed by spectroscopic examina- residence after grafting averaged 19-6 days. Enzer, J., vol. ix., p. 148. Record of 112 cases treated tion, and arsenic was later found in it (by Dr. A. T. excision and grafting. Similar rapid results. by biochemist to Charlotte’s to Fuller, Queen Hospital) Esler, A. R., vol. viii., p. 176, and ix., p. 237. Treatment the extent of 0-5 mg. per 100 c.cm. C. D. was kept by strapping after Dickson Wright’s method. 272. Treatment by strapping under observation until June 7th-that is, 14 days McLean, N., vol. ix., 16 he in felt his usual after exposure ; during that time Dr. Loewenthal also contributed a paper to the health and showed no physical signs on ordinary same journal (vol. ix., p. 136) based upon the facts clinical examination. He then developed an illness and figures published later in THE LANCET. which appeared clinically to be a slight attack of I am. Sir. vours faithfullv. lead poisoning. Some years ago I was asked to visit JAMES H. SEQUEIRA. Makuyu, Kenya. a man working for the same firm who had been sent home seriously ill. I found him lying in bed semiSEAHAM HALL TUBERCULOSIS SANATORIUM.-A conscious, with a spastic condition of all limbs and increased deep reflexes. The urine was normal and new wing and nurses’ home of this institution, which cost nearly z25,000, was formally opened on there was no jaundice. I was unable to obtain any have Dec. 17th. The extensions provide accommodation history and was puzzled as to what he was suffering for 50 additional patients, and it is hoped so to reduce from, but hearing that his mate was also ill and had the waiting-list of 91 women and 24 girls that it will no been admitted to the London Hospital I went there. longer be necessary to send patients outside Durham Seaham Hall was given to the Durham county On arrival I found the visiting physician giving a county. council by Lord Londonderry in 1928, and was opened clinical lecture upon the case as one of paroxysmal with 28 beds. .