lead poisoning in the pottery districts
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879LEAD POISONING IN THE POTTERY DISTRICTS.
exist to the number of 18 in Greater London or the parts ofWater London outside Greater London. Sir AlexanderBinnie thought that the metropolitan councils would findthemselves driven to take water in bulk from the LondonCounty Council. The difficulties attending this course havebeen already stated, and the representatives of the metro-politan counties, moreover, insist on being severed fromLondon both with regard to the supply and to the distribu-tion of water in case of the purchase of the present under-takings by the London County Council. The difficultieswhich have been pointed out having led the Commissionersto advise that the London County Council should not be thepurchaser, they proceed to report as to what authorityif the policy of purchase be adopted should acquire theundertakings. It is not desirable that several authoritiesshould become the purchaser. Any advantage which mightobtain from the purchase, whether financial or administra-tive, will arise only from amalgamation of the sources
of supply and distribution so that they may be usedeconomically and with a view to the needs of every part ofWater London. The feeling against purchase by a WaterBoard formed on the basis of population and rateable valueis emphasised by the metropolitan counties on severalgrounds, and the practical difficulty of creating any watertrust based on strictly representative principles was
shown by the history of a Government Water Bill intro-duced in the year 1896, which, owing to the opposition ofthe metropolitan counties, was so modified in Parliamentthat a clause enabling any county to take itself out of thewater trust was inserted and the Bill was dropped. The Com-missioners appreciate the great difficulty in advising as tothe constitution of a Water Board which will be accepted bythe various interests concerned and by Parliament, but con-sidering the importance and intricacy of questions relatingto future water-supply, the large amount of works which willhave to be undertaken, the difficulty of obtaining from eightseparate companies that unity of action which is necessaryfor bringing such works to a successful issue, the importanceof bringing about absolute coalescence of the water com-panies’ undertakings,-all these things lead to the conclusionthat the purchase and management by a single publicauthority will solve the question satisfactorily. The sug-gestions which are made with regard to the constitution of awater authority which should undertake these vast dutiesare as follows: the Water Board should be a permanentbody consisting of not more than 30 members; its
proceedings should be brought under the observationof Parliament automatically and periodically ; and itshould include delegates from the Local Government Board.The suggested composition ie that the London County Councilshould appoint 10 members, the Conservators of the Thamesfour members, the County Councils of Middlesex, Surrey,Essex, Hertford, and Kent, the Lee Conservancy Board, andthe Common Council of the Borough of West Ham twomembers each. The chairman and vice-chairman should beappointed by the Local Government Board. The appointingauthorities should be empowered to fill any vacancy causedby the death or the resignation of a representative. Theoffices should be held for a definite (unspecified) number ofyears. The chairman and vice-chairman should receiveadequate salaries. The other members of the board shouldbe paid according to their attendances (as is now done inthe case of the Conservators of the river Thames). Theboard should be required to acquire the undertakings of themetropolitan water companies by agreement or by arbitra-tion. The boroughs of Croydon and Richmond are reason-ably entitled, if they wish it, to be made independent ofthe board. The board should be entitled to issue 3 percent. stock secured on the water charges of the whole area ;this should be made a trustee investment transferable atthe Bank of England. The Chamberlain of the City ofLondon should transfer all the money which has accumu-lated as the result of the sinking fund clauses, andthese clauses should be repealed at and from the date ofpurchase of the undertakings. The price of purchase shouldbe payable in cash at the option of either the vendors or thepurchasers. The vendors may be paid in the stock of theboard should the shareholders agree to that course. Shoulda sinking fund be required the probability of a deficit willarise and this will make it necessary to empower the Boarcto increase the water charges which the companies are
entitled to demand if the interest on the stock cannot bEotherwise paid. In any case the Commissioners think sucla precaution would be a prudent one. It would not b,
unreasonable to empower the board in case of deficit to levya rate in aid. A rate in aid supplements the insufficiency ofcharges and is unjust to those ratepayers who have providedthemselves with a water-supply and take nothing trom thecompanies as in the case of breweries and other industrialestablishments: but there are public purposes, such as
extinguishing fires, street-watering, the supplies for publicbaths, &c., which benefit all ratepayers whether they takewater or not, and in consideration of them all ratepayersmay be called upon to make some contribution for theservices rendered. Possibly the Water Board would haveoccasion to look to the rates for further assistance. It isthis possibility which arouses the fears and excites theopposition of counties such as Middlesex and Kent.The Commissioners make a suggestion by which thisopposition may be quieted." Assuming, they say, that theWater Board has to borrow .610,000,000 at an annual charge,say of 300,000, for interest, if that charge were distributedamong the six counties concerned in the proportion of thenumber of supplies they are respectively taking, the con-tribution asked from time to time will be roughly proportionedto their own needs and not to the needs of other counties.The Commissioners suggest that the contribution shouldbe demanded by precept issued by the Water Board to thecounty authorities when the money would be raised by thelocal authorities either by an equal rate or by rates leviedin the parishes affected in the proportion of the number ofwater supplies given.As to whether it would be better to enable the proposed
Water Board to meet deficiencies of revenue by recourse tothe rates or by making an increase in the water charges is" a question of policy " which the Commissioners decide it is
not for them to determine, and they content themselves byemphasising the possibility or probability that suchdeficiencies will arise should the proposed Water Board comeinto being on the lines suggested, and by pointing outalternative means of raising the money which is likely to beor may be wanted. The Water Board should be required todraw up an annual report of the statement of accounts.This should be audited by an independent auditor. The
report and the account should be included in the annual
report of the Local Government Board.
LEAD POISONING IN THE POTTERYDISTRICTS.
AT a meeting summoned by the Duchess of Sutherland atTrentham on Wednesday, March 14th, a conference of themedical men of the neighbourhood took place to consider themost thorough treatment of the cases of lead poisoningwhich occur in the Pottery districts. Dr. H. Lewis Jonesof the Electrical Department of St. Bartholomew’s Hos-
pital, London, had been invited to speak on the electricaltreatment of these cases from his experience of those epatients sent from the Potteries to be under his care.
The chair was taken by Dr. A. M. i4TcALnomE and themeeting was well attended, over 40 persons being present.In speaking of electricity in the treatment of paralysisdue to lead poisoning Dr. LEWIS JoxES said that cases
of lead poisoning were not particularly common in London,about a dozen cases a year applying for treatment atthe electrical department of St. Bartholomew’s Hospital,and the type of case seemed to differ from that sentfrom the Pottery districts in that the patients were
older and had the disease in a more chronic form. Theinteresting points about the cases from the Potterieswere the comparative youth of the patients and the
severity of their paralytic symptom, which though moreserious were more amenable to treatment by reason ofthe fact that the intoxication by the lead had gone onfor a shorter time. With regard to the mode of treat-
ment, ten years ago it was by the direct applicationof the constant current to the paralysed muscles bymeans of hand electrodes; from that it had been changedto treatment by means of electrical arm-baths; the
I current employed had also been changed from theconstant current to the induction coil with arm-bath and
: later to the current from the mains. With the presentI mode of application patients seemed to improve rather more! rapidly. It was difficult in all matters concerning emcacy
880 VITAL STATISTICS.
of treatment to bring forward absolute and conclusiveevidence that recovery was due to the treatment applied, butthis could be said, that on the commencement of electricaltreatment improvement began for the most part immediatelyand the progress of improvement coincided very closely withthe progress of the treatment. Wrist-drop from lead was aserious condition and was slow to yield to any treatment. Itwas often necessary to persevere with it for from three to sixmonths or even longer before the full benefit could be securedby the electricity. Because of this there was a tendency toregard electrical treatment as of little or no use and to thinkthat any improvement which might take place was due tolapse of time or to natural causes. In trying to estimate thevalue of electrical treatment there was the difficulty of under-standing exactly how the electricity worked. The question ofthe elimination of metals in various kinds of metallic poison-ing was an old one. Electric baths had been recommendedfor the extraction of lead, mercury, and other metals frompatients’ bodies, but these metals tended to natural and
spontaneous elimination in the ordinary course of events;the rate of elimination could be promoted or retarded bydrugs, but the treatment of the paralysis and the eliminationof the metal were independent of each other in so far as theone could be measured by the other and it was very difficult ,,to prove that lead could be extracted from a patient’s body by ’,,processes of electrolysis. Alternating currents were almostinvariably used in the treatment of lead poisoning at St. Bar-tholomew’s Hospital, therefore it was clear that electrolysisplayed no part in the recovery of such cases because electro-lysis was a property of the direct current. The electricityacted as a stimulant to the nerves and muscles involved andto the blood-supply circulated through them, and by stimulat-ing these parts the natural process of elimination was alsostimulated. The routine method of treating wrist-drop causedby lead was as follows : an arm-bath of stoneware was filledwith warm water and the forearms and hands of a patientwere immersed in it and a current was passed from oneend of the bath to the other through the water and thelimb between two electrodes placed at the ends of the bath.The alternating current was used in preference and the 100volts from the electric light mains were reduced by a trans-former to 12, 14, or 16 volts to suit the cases. It was,perhaps, unusual to find an alternating current advo- Icated for treating muscles which showed the reactionof degeneration and which were unable to respond by con-traction to rapidly alternating currents. But this was
part of a large question. Experience had shown over
and over again that alternating currents had a valu-able influence upon muscles which did not contractto them. For the treatment of the paralytic form of lead-poisoning electricity was undoubtedly the best, and for con-ditions other than paralysis, particularly the anaemia and
debility which were often met with, - electricity againrendered important service in assisting the natural elimina-tion of the poison and promoting the general activity of thetissues. To render electricity a practical method it was
necessary to make it easy of application. The arm-bathwith an induction coil represented the simplest electrical i
application possible and reduced the labour of treating a IIpatient to a minimum.-Dr. R. ALCOCK, Mr. W. ARMSTRONG,Dr. W. C. D. PRENDERGAST, and Mr. F. F. ARMYTAGE alsospoke, and the last-named gentleman showed three cases.
HEALTH OF ENGLISH TOWNS.
IN 33 of the largest English towns 6859 births and4525 deaths were registered during the week endingMarch 17th. The annual rate of mortality in these towns,which had declined from 25-8 to 20-4 per 1000 in the fourpreceding weeks, further decreased to 20-3 last week. InLondon the rate was 18-8 per 1000, while it averaged21’3 in the 32 provincial towns. The lowest death-rates inthese towns were 12 7 in Croydon, 14’9 in West Ham, 16’4in Brighton, and 16’5 in Bristol; the highest rates were25-7 Salford, 27-6 in Liverpool, 28-6 in Oldham, and 31-1 inPreston. The 4525 deaths in these towns included 423which were referred to the principal zymotic diseases,against 416 and 424 in the two preceding weeks ; of these,141 resulted from measles, 124 from whooping-cough, 77from diphtheria, 32 from "fever" (principally enteric), 28
from diarrhoea, 20 from scarlet fever, and one from small-pox.No fatal case of any of these diseases occurred last weekeither in Swansea, Birkenhead, or Huddersfield ; in the othertowns they caused the lowest death-rates in Croydon,Nottingham, and Sunderland, and the highest rates in
Plymouth, Wolverhampton, Salford, and Preston. Thegreatest proportional mortality from measles occurred inPlymouth, Cardiff, Wolverhampton, Salford, Preston, andHalifax ; and from whooping-cough in West Ham, Wolver-hampton, Birmingham, Liverpool, Leeds, and Newcastle.The mortality from scarlet fever and from "fever" showedno marked excess in any of the 33 towns. The 77 deathsfrom diphtheria included 35 in London, eight in Sheffield,seven in Leicester, five in Leeds, and four in Bristol. Onefatal case of small-pox was registered last week in Cardiff,but not one in any other of the 33 large towns. There werefive cases of small-pox under treatment in the Metro-politan Asylums Hospitals on Saturday, March 17th,against seven at the end of the two preceding weeks;two new cases were admitted during the week, againstthree, two, and one in the three preceding weeks.The number of scarlet fever patients in these hospitalsand in the London Fever Hospital at the end of theweek was 1760, against numbers decreasing from 3578 to1777 on the 17 preceding Saturdays ; 181 new cases wereadmitted during the week, against 160, 154, and 147 inthe three preceding weeks. Influenza was certified as theprimary cause of 26 deaths in London. The deathsreferred to diseases of the respiratory organs in London,which had declined from 527 to 378 in the four precedingweeks, rose again to 391 last week, but were 130 belowthe average. The causes of 64, or 1-4 per cent., ofthe deaths in the 33 towns were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in West Ham, Not-tingham, Leeds, and in 10 other smaller towns; thelargest proportions of uncertified deaths were registered inBirmingham, Liverpool, Preston, Hull, and Newcastle.
HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in the eight Scotch towns,which had been 31-7, 29-0, and 27-7 per 1000 in the threepreceding weeks, further declined to 22-7 during the weekending March 17th, but exceeded by 2-4 per 1000 themean rate during the same period in the 33 large Englishtowns. The rates in the eight Scotch towns ranged from15-9 in Leith and 18’6 in Dundee to 26-6 in Greenock and27-0 in Perth. The 700 deaths in these towns included18 which were referred to diarrhoea, 17 to measles, 15 towhooping-cough, five to scarlet fever, four to diphtheria, andfour to "fever." In all 63 deaths resulted from these
principal zymotic diseases, against 69, 74, and 92 in thethree preceding weeks. These 63 deaths were equal to anannual rate of 2-0 per 1000, which was slightly abovethe mean rate last week from the same diseases in the33 large English towns. The fatal cases of diarrhoea,which had been 18 and 25 in the two precedingweeks, declined again to 18 last week, and included five inEdinburgh, five in Aberdeen, three in Glasgow, and threein Dundee. The deaths from measles, which had been 20and 17 in the two preceding weeks, were again 17 last week,of which seven occurred in Glasgow, five in Dundee, and fourin Paisley. The fatal cases of whooping-cough, which hadbeen 15 and 24 in the two preceding weeks, declinedagain to 15 last week, and included five in Glasgow, fivein Edinburgh, and two in Perth. The deaths from scarletfever, which had been 10 in each of the two preceding weeks,declined last week to five, of which three were registered inGlasgow. The four fatal cases of diphtheria showed adecline of three from the number in the preceding week andincluded two in Glasgow. The deaths referred to differentforms of "fever," which had been six and nine in the twopreceding weeks, declined again last week to four, of whichthree occurred in Glasgow. The deaths referred to diseasesof the respiratory organs in these towns, which had been 362,324, and 259 in the three preceding weeks, further declinedto 189 last week, but showed an excess of 51 over thenumber in the corresponding period of last year. Thecauses of 27, or nearly 4 per cent., of the deaths in theseeight towns last week were not certified.
HEALTH OF DUBLIN.
, The death-rate in Dublin, which had been 34-3 and