the treatment of incipient phthisis in east london

2
458 and particularly of Sir Thomas Barlow, the chairman, and Lord Ilkeston, the treasurer, there is good pro- spect that the sum required to carry this project through without the Government will be collected in time. Support has already been received from several corporations, notably those of Glasgow, Manchester, and Liverpool, from several of the City Companies, and from many prominent scientific firms. Much still remains to be done, and there is but little time to do it ; but no w that nearly one-third of the amount has been secured the officials are confident that the remainder will be forthcoming. The appeal which is being made calls on all to subscribe small or large amounts to uphold the reputation of Great Britain as the pioneer and leader in hygiene and to further feelings of real friendship between England and Germany, which have already been questioned by the German press. Cheques should be made payable to Lord Ilkeston, treasurer of the British Executive Committee, International Hygiene Eghibi- tion, and sent to 47, Victoria-street, London, S.W. HÆMOLYTIC JAUNDICE WITH HÆMOGLOBINURIC CRISES. To the brief series of cases hitherto recorded in which the production of jaundice associated with paroxysms of hæmo- globinuria has been traced to harmolysis an important addition has been made by Dr. A. A. Hijmans van den Bergh of Rotterdam, and recorded in the Revue de Médecine for January. The subject of this observer’s investigations was a man aged 47, whose family history was innocent of any similar event and who had never suffered from any serious illness. In 1899 he first consulted a medical man on account of an attack which was pronounced to be a catarrhal jaundice, though the fasces were normal in colour and the urine contained much urobilin but no bilirubin. In 1904 he expectorated blood, but no other evidences of pulmonary disease were manifest. The first bout of hæmoglobinuria occurred in 1905, and since that date the attacks have returned at irregular intervals and with a widely varying intensity. No cause for these attacks could be discovered ; they were not confined to cold weather and they did not follow the ingestion of any particular food. They lasted one day in some instances, in others several days. Each attack was accompanied by an aggravation of the ansemia and jaundice, which persisted in some degree even between the attacks, by a sense of oppression in the præcordium, and by pain referred to the hypogastrium during the passage of the hasmoglobinuric urine. For some days after a paroxysm the urine contained albumin and casts. The excretion of urobilin, always supernormal, was also increased during the attack and immediately after it. The spleen was not enlarged. Examination of the blood showed a hemoglobin content of 50 per cent., an erythrocyte count of 2,970,000 per cubic millimetre, and a corpuscular picture characterised by no changes other than those of a secondary ansemia. In one of the attacks the haemoglobin stood at 40 per cent. and the red corpuscles at 1,156,000 per cubic milli- metre. The patient’s corpuscles showed a normal resistance to the ordinary hæmolytic tests, and at the same time the serum was proved to contain no abnormal hæmolysins. Dr. van den Bergh therefore had recourse to certain methods of hæmolysis which he had found useful in the investigation of hæmoglobinuria ’’a frigore." These experiments yielded results of some interest. The first series of tests showed that the corpuscles of the patient were destroyed by the patient’s serum and also by a normal serum at body temperature in the presence of carbon dioxide vapour, but not in the presence of air or at laboratory . temperature (except in one test where the normal serum exercised a haemolytic action at 16° C. in the presence of CO2). Another series of similar tests gave the same result as far as the action of the patient’s serum was con- cerned ; but the control serum showed a hæmolytic action in air or in 002 at 16° C. as well as at 370 C. These experiments prove that for the case under consideration the hsemolytic factor was corpuscular fragility ; and they suggest the advisability of further investigations bearing on the activation of this tendency to haemolysis Sllch as was achieved in Dr. van den Bergh’s experiments by the sub- stitution of carbon dioxide for air, and the use of a tempera- ture raised to that of the body. A FALLACY ABOUT COFFEE. IN looking about for an explanation of the recent cases of poisoning at Dalkeith, in which the poison was conveyed through drinkiug coffee, the suggestion has been made and widely circulated that there is a certain coffee-bean which in given circumstances throws off a deadly poison. This information will come as a surprise to all toxicologists. We know of no such coffee-bean, and we very much doubt its existence. It is a great pity that newspapers cannot guard themselves against such statements. The confidence of the public is thereby seriously disturbed and a needless fear is sown in their minds. Apart from scientific investigation, the evidence of experience is completely opposed to the notion that sometimes coffee beans are met with which give off a deadly poison. If coffee contained a volatile poison at all in the sense that the original disseminator of this scare probably had in his mind, it would be thrown off obviously in the roasting. As is well known, a strong infusion of coffee has proved most useful to counteract the effect of poisons, and its use is particularly enjoined when an overdose of a narcotic-e.g., morphia- has been taken. Coffee, in common with most articles of food, may disagree with some people, who soon find that fact out and take care to exclude it from their dietary. But it is innocent of poison and to a great number of people is an undoubted boon. Such people may continue to enjoy their favourite beverage without the slightest fear that for some mysterious reason Nature makes some of the beans poisonous. The widespread publication of the fallacy has been most unfair to the public, besides constituting an obvious injustice to the coffee trade. THE TREATMENT OF INCIPIENT PHTHISIS IN EAST LONDON. IN a report recently presented to the Public Health Com- mittee of the Borough of Poplar, Mr. F. W. Alexander, the medical officer of health, has suggested a scheme for pre- venting the spread of tuberculous infection, and benefiting, with the hope of curing, cases of pulmonary tuberculosis in subjects who have work to do and are able to undertake it. He suggests the purchase of two or more large houses in the borough with open spaces in the rear, so that huts may be erected in the grounds, and the rooms of the houses utilised for open-air treatment by adaptation of the windows for such a purpose. The rooms could be fitted with apparatus for keeping the air charged with ozone, and used by persons in the incipient stage of phthisis for sleeping purposes at night, whilst attending their work during the day. A short time ago Mr. Alexander put forward a proposal for the purchase by the local public, as a memorial to the late King Edward, of the City of London Union Infirmary (now disused), a building standing upon five acres of ground, conveniently situated in a main thoroughfare of the East-end of London, immediately upon the borders of the boroughs of Poplar and Stepney and within easy reach of Bethnal Green, Hackney,

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Page 1: THE TREATMENT OF INCIPIENT PHTHISIS IN EAST LONDON

458

and particularly of Sir Thomas Barlow, the chairman,and Lord Ilkeston, the treasurer, there is good pro-

spect that the sum required to carry this projectthrough without the Government will be collected in

time. Support has already been received from several

corporations, notably those of Glasgow, Manchester, and

Liverpool, from several of the City Companies, and frommany prominent scientific firms. Much still remains to be

done, and there is but little time to do it ; but no w that nearlyone-third of the amount has been secured the officials are

confident that the remainder will be forthcoming. The

appeal which is being made calls on all to subscribe smallor large amounts to uphold the reputation of Great Britain asthe pioneer and leader in hygiene and to further feelings ofreal friendship between England and Germany, which havealready been questioned by the German press. Cheques should be made payable to Lord Ilkeston, treasurer of theBritish Executive Committee, International Hygiene Eghibi-tion, and sent to 47, Victoria-street, London, S.W.

HÆMOLYTIC JAUNDICE WITH HÆMOGLOBINURICCRISES.

To the brief series of cases hitherto recorded in which the

production of jaundice associated with paroxysms of hæmo-globinuria has been traced to harmolysis an importantaddition has been made by Dr. A. A. Hijmans van den Berghof Rotterdam, and recorded in the Revue de Médecinefor January. The subject of this observer’s investigationswas a man aged 47, whose family history was innocent of anysimilar event and who had never suffered from any seriousillness. In 1899 he first consulted a medical man on accountof an attack which was pronounced to be a catarrhal

jaundice, though the fasces were normal in colour and theurine contained much urobilin but no bilirubin. In 1904 he

expectorated blood, but no other evidences of pulmonarydisease were manifest. The first bout of hæmoglobinuriaoccurred in 1905, and since that date the attacks have

returned at irregular intervals and with a widely varyingintensity. No cause for these attacks could be discovered ;they were not confined to cold weather and they did notfollow the ingestion of any particular food. They lastedone day in some instances, in others several days. Each

attack was accompanied by an aggravation of the ansemiaand jaundice, which persisted in some degree even betweenthe attacks, by a sense of oppression in the præcordium, andby pain referred to the hypogastrium during the passage ofthe hasmoglobinuric urine. For some days after a paroxysmthe urine contained albumin and casts. The excretion of

urobilin, always supernormal, was also increased during theattack and immediately after it. The spleen was not

enlarged. Examination of the blood showed a hemoglobincontent of 50 per cent., an erythrocyte count of 2,970,000per cubic millimetre, and a corpuscular picture characterisedby no changes other than those of a secondary ansemia. In

one of the attacks the haemoglobin stood at 40 per cent.

and the red corpuscles at 1,156,000 per cubic milli-metre. The patient’s corpuscles showed a normal resistanceto the ordinary hæmolytic tests, and at the same time theserum was proved to contain no abnormal hæmolysins.Dr. van den Bergh therefore had recourse to certain methodsof hæmolysis which he had found useful in the investigationof hæmoglobinuria ’’a frigore." These experiments yieldedresults of some interest. The first series of testsshowed that the corpuscles of the patient were destroyedby the patient’s serum and also by a normal serum

at body temperature in the presence of carbon dioxide

vapour, but not in the presence of air or at laboratory. temperature (except in one test where the normal serum

exercised a haemolytic action at 16° C. in the presenceof CO2). Another series of similar tests gave the same

result as far as the action of the patient’s serum was con-cerned ; but the control serum showed a hæmolytic actionin air or in 002 at 16° C. as well as at 370 C. These

experiments prove that for the case under consideration

the hsemolytic factor was corpuscular fragility ; and theysuggest the advisability of further investigations bearing onthe activation of this tendency to haemolysis Sllch as was

achieved in Dr. van den Bergh’s experiments by the sub-stitution of carbon dioxide for air, and the use of a tempera-ture raised to that of the body.

A FALLACY ABOUT COFFEE.

IN looking about for an explanation of the recent cases ofpoisoning at Dalkeith, in which the poison was conveyedthrough drinkiug coffee, the suggestion has been made andwidely circulated that there is a certain coffee-bean whichin given circumstances throws off a deadly poison. Thisinformation will come as a surprise to all toxicologists. Weknow of no such coffee-bean, and we very much doubt itsexistence. It is a great pity that newspapers cannot

guard themselves against such statements. The confidenceof the public is thereby seriously disturbed and a

needless fear is sown in their minds. Apart from scientificinvestigation, the evidence of experience is completelyopposed to the notion that sometimes coffee beans are metwith which give off a deadly poison. If coffee containeda volatile poison at all in the sense that the originaldisseminator of this scare probably had in his mind, it wouldbe thrown off obviously in the roasting. As is well known,a strong infusion of coffee has proved most useful to

counteract the effect of poisons, and its use is particularlyenjoined when an overdose of a narcotic-e.g., morphia-has been taken. Coffee, in common with most articles offood, may disagree with some people, who soon find thatfact out and take care to exclude it from their dietary. But

it is innocent of poison and to a great number of people is anundoubted boon. Such people may continue to enjoy theirfavourite beverage without the slightest fear that for somemysterious reason Nature makes some of the beans poisonous.The widespread publication of the fallacy has been mostunfair to the public, besides constituting an obvious injusticeto the coffee trade.

__

THE TREATMENT OF INCIPIENT PHTHISIS INEAST LONDON.

IN a report recently presented to the Public Health Com-mittee of the Borough of Poplar, Mr. F. W. Alexander, themedical officer of health, has suggested a scheme for pre-venting the spread of tuberculous infection, and benefiting,with the hope of curing, cases of pulmonary tuberculosis insubjects who have work to do and are able to undertake it.He suggests the purchase of two or more large houses in the

borough with open spaces in the rear, so that huts may be

erected in the grounds, and the rooms of the houses utilisedfor open-air treatment by adaptation of the windows for

such a purpose. The rooms could be fitted with apparatusfor keeping the air charged with ozone, and used by personsin the incipient stage of phthisis for sleeping purposes atnight, whilst attending their work during the day. A short

time ago Mr. Alexander put forward a proposal for the

purchase by the local public, as a memorial to the late KingEdward, of the City of London Union Infirmary (now disused),a building standing upon five acres of ground, convenientlysituated in a main thoroughfare of the East-end of London,immediately upon the borders of the boroughs of Poplar andStepney and within easy reach of Bethnal Green, Hackney,

Page 2: THE TREATMENT OF INCIPIENT PHTHISIS IN EAST LONDON

459

Shoreditcb, and West Ham, which could be used for such a

purpose. It is unfortunate that so eminently practical aproposal has not received the local support necessary to putit on foot, for the building might be used also as a tuber-culosis dispensary. A combination of the early notificationof phthisis, with in suitable cases its immediate treatment,together with good hygienic sleeping accommodation, eachpatient under his own medical adviser, seems a promisingmethod of capturing and dealing with incipient phthisisamongst men in full and active employment, whom thehospitals and consumption sanatoriums do not reach.

THE CLIMATIC ADAPTATION OF THEIMMIGRANT.

RACE adaptation to climate has received at various timesconsiderable attention at the hands of Major Charles E.Woodruff, of the Medical Corps of the United States Army,whose views on the question of the harmfulness of excessivesunlight to blondes have met with much opposition, thoughhe appears to have adduced not a little primâ-facie evidencein their support. Probably the truth lies, as usual, midwaybetween two extremes. In the Eugenie8 Review for January,he writes some interesting remarks on ’’ The Eugenics of

Migrants." He there points out that a character that is ofindispensable value in one environment may be so injuriousin another that migrants promptly perish. Nearly everyspecies is limited to a very restricted environment, and thosewhich change residence with the seasons are really morerestricted than those able to stay behind and resist the

changes of weather. The medical profession, he says, is

only just beginning to realise that man himself is governedby the same laws of adaptation, and that each type hasdeveloped characters which fit it for residence in the placeof origin. Four factors in the past have influenced migration.In the earliest times movement was naturally slow, so thatevolution could proceed pari passu; then social organisationadded its prevention of invasion. Later, however, militaryorganisation caused rapid migrations, which have becomegreatly increased by the rapidity of modern transportation.Major Woodruff discusses adaptation as shown in alteration ofpigmentation and weight, and cites the disappearance of thetype of northern invaders from the southern lowlands of

Italy-of the men, that is, from the north, who were thereal authors of the Italian renaissance, the significance ofwhose Italianised names is often contradicted by their extantportraits. He alludes also to the experience of America, wherethe blonde type, of which the women sent over from NorthernFrance almost entirely consisted, has nearly disappeared fromthe St. Lawrence Valley, and entirely so from New Orleans.The blondes in American cities and lowlands, he says, havea higher death-rate from certain diseases than the rest ofthe population, and tend to disappear, while those in themountains remain vigorous after many generations. Natureherself carries on among migrants the expensive eugenicmovement of killing off the least adjusted. In the mean.time those on the way to extinction are less able to strugglEfor existence, and so furnish more than their due proportiorof social parasites. This is the point that must be considere{in all eugenic discussions. Migrants should strive to hav1their children reared in a climate proper to their racia

characteristics, even though they themselves have to liv

elsewhere-a fact with which Anglo-Indians have becomfamiliar years ago. Major Woodruff suggests an investigatio:among the" failures," the "submerged tenth," in Londoand all large cities, not only of Europe, but also of AmericaAfrica, and Australia, to decide their prevailing characteristics in each case-whether tall or short, light or darl

over- or under-weight. This may demonstrate that certai

types are locally on the way to a final elimination that

cannot be prevented by eugenics. He alone is exgenes,well-bred, who is of the type adjusted to the place,and the migration streams must continue until each

type finds its proper adjustment. The production of a

higher mental type depends probably, at any rate in,

great degree, on first acquiring a physique perfectlyadapted to its climatic environment.

THE ACTION OF DRUGS.

IN a paper read at the February evening meeting of the Pharmaceutical Society Dr, W. E. Dixon, professor of materia medica and pharmacology at King’s CollegeLondon, discussed the action of various drugs, the objectof the paper being to explain the purpose of the phar-macological notes in the British Pharmaceutical Codex.He said that few drugs had attained more popularity latelythan compounds of calcium, but if a calcium effect is really,needed the drug must be injected under the skin. Similarly,the specific effects of potassium or ammonium salts couldonly be produced in this way, since their rates of eliminationcould more than keep pace with their absorption. The local

application of opium or morphine in any form was harmless;,though of little value in relieving local pain, since the seat ofaction of morphine was on the central nervous system. Pro-

ceeding, he said that quinine was not in any sense a

tonic ; it was rather an atonic drug ; it was a poison to all protoplasm and diminished metabolism. Referring to theorganic compounds with the metals, he said experimentsseemed to show that none of the organic compounds of silverwere superior to silver nitrate, and that the organic com-pounds of iron mostly derived from blood must first be

broken down and digested before absorption occurred. These

are a few of the examples selected by Dr. Dixon to give someidea of the scope of the pharmacological notes included inthe monographs-notes for which, in his view, some need was certainly felt by medical practitioners.

REPORT OF THE DEPARTMENTAL COMMITTEE

ON CORONERS.1

THIS report, which has just been issued as a Blue-book,contains the evidence of certain witnesses recalled and further examined, together with ten appendices, amongstwhich are a summary and analysis of replies to questionsaddressed by the committee to coroners of England and,Wales, a memorandum on behalf of the London CountyCouncil, a memorandum on behalf of the British Medical Association, and the returns for England and Wales ofreported deaths under anaesthetics during 1908. Thememorandum on behalf of the British Medical Associa-

tion, after certain introductory paragraphs, is dividedinto four parts, dealing respectively with death certifi-

cation, the procedure of coroners, deaths under anæs-

thesia, and the question of necessity for inquiry into

deaths following surgical operations. The memorandumsubmits a scheme of death certification providing means

:

whereby a medical certificate of death shall be obtained in’ most cases not certified by the medical practitioner in’ attendance, leaving the remainder to be dealt with by the

coroners, and points out the defects in the present procedure.Questioned upon this subject, 169 coroners replied that theywere satisfied with the present system, and 99 coroners stated

1 Second Report of the Departmental Committee appointed to inquireinto the Law relating to Coroners and Coroners’ Inquests, and into thePractice in Coroners’ Courts. Part III. Cd. 5492. London : Eyre andSpottiswoode, Limited. Pp. 109.