1052 SMALL-POX IN LONDON.-LIVERPOOL SCHOOL OF TROPICAL MEDICINE.

attitude of the medical officer of health towards acceptedmedical teaching was very unfortunate, and some six monthslater, during all of which time diphtheria had been presentin Colchester, the town council arrived at the same con-clusion. For the members resolved unanimously that itwas advisable where the antitoxin treatment had not beenadministered to diphtheria patients before admission

to the hospital that it should be administered on

admission. A report has now been made by Dr. Louis

Cobbett and Dr. G. S. Graham Smith on the measures takento check the outbreak of diphtheria in Colchester last yearand from this report the value of the antitoxin treatmentbecomes manifest. At a special meeting of the SanitaryCommittee of the town council it has been agreed to appointa medical officer of health and public analyst to the townwho shall devote his whole time to the duties of his office.

ON SOME OF THE SYMPTOMS OF CEREBRALSYPHILIS IN REGARD TO DIAGNOSIS.

DR. WILLIAM LESZYNSKY of New York has stated in the

Medical Nercs of March 22nd last that the nature of the

symptoms in cerebral syphilis was such as to make a practicaldiagnosis difficult in some cases and has supplied two illustra-tive instances of the same. The first case was that of a

woman, aged 22 years, who denied all history of syphilis. Onseveral occasions prior to her coming under observation shehad had transitory paresis of the left arm and leg, severe

headaches, vertigo, and a slight febrile temperature. On

admission to hospital there were marked ptosis of the lefteye and a vertical diplopia of the same eye associated withparesis of the superior rect.us muscle. Vision was normal inboth eyes. A slight right-sided facial paralysis was alsopresent. In pite of the patient’s denial of syphiliticinfection the symptoms pointed suspiciously to cerebral

syphilis and the results of treatment with mercury and

iodides justified the diagnosis. The diplopia and ptosisdisappeared under the above treatment. Later she developedptosis on the right side, the levator palpebrse muscle onlybeing affected. This also responded to anti-syphilitic treat-ment and disappeared in four weeks. A month later the

left eye was again affected and she also suffered from

headaches and temporary attacks of inability to speak(aphasia) or to swallow (dysphagia) which improved under z’

anti-syphilitic treatment-20 grains of iodide of potassiumthree times a day. Dr. Leszynsky considers that the cerebralaffection was a syphilitic basal meningitis in the form of

patches involving the cranial nerves combined possibly witha slight degree of endarteritis. The second case was that ofa man, aged 33 years, who had enjoyed good health up toAugust, 1899. He then developed numbness and slight localmuscular twitchings on the left side of the face. In October

there followed dimness of vision and diplopia of the righteye. In December the molar teeth in the right upper jaw" became so loose that they were removed with the fingers."He was the father of six children reputed to be healthy.He admitted having had a chancre many years previouslybut had no marked secondary symptoms. The pupils weremyotic and failed to react to light or to accommodation, butvision and the funduses of the eyes were normal. Mer-

curial ointment and iodide of potassium were used in treat-ment and strychnine was also given as a tonic. At the endef two months he was much improved and disappeared fromobservation. He reappeared in June, 1901, suffering fromalmost total blindness and advanced primary optic atrophy ofboth eyes. The pupils were rigid and the oculo-motor nervewas paralysed in all its branches. He was now treated with

strychnine without benefit and Dr. Leszynsky stated that

this albo was his experience with other patients sufferingfrom cerebral syphilis in its later stages. There were no

sensory disturbances in this patient and the tendo Achillisreflexes were preserved-in short, tabes dorsalis could be

excluded in this case. The original diagnosis of cerebralsyphilis was confirmed but owing to the advanced state ofthe disease there was no prospect of successful treatment.

SMALL-POX IN LONDON.

THE returns of small-pox for the past week show a decreasein the number of cases. On Saturday, April 5th, there were46 fresh cases notified and removed ; on Sunday, the 6th,there were 32 fresh cases ; on Monday, the 7th, there were

57 fresh cases ; on Tuesday, the 8th, there were 36 freshcases ; and on Wednesday, the 9th, there were 26 freshcases.

LIVERPOOL SCHOOL OF TROPICAL MEDICINE.

THE Liverpool School of Tropical Medicine having urgedHis Majesty’s Government to assist the expedition which is.at present endeavouring to improve the sanitary conditionof Freetown, West Africa, has received the following replyfrom the Colonial Office, dated March 27th, 1902. " am.

directed by Mr. Secretary Chamberlain to request you toinform the committee of the Liverpool School of TropicalMedicine with reference to the letter from this office of the

7th December last that the governor of Sierra Leone has now

reported on the subject of their suggestion that the ColonialGovernment should increase the number of the workmenlent by them to the malaria expedition which is now workingin Freetown under the superintendence of Dr. Logan Taylor.Sir C. King-Harman states that he is naturally anxious to giveevery possible assistance to Dr. Logan Taylor in the usefuband important operations which he is conducting in Freetown,but after consultation with him and with the principalmedical officer he has decided that the best form in whichthat assistance can be given is for the Government to under-take by degrees the surface drainage of those parts of thecity which are most infested by mosquitoes. In this pro-posal Dr. Taylor cordially concurs, recognising that such.work cannot be adequately performed by his staff and thatthe result cannot fail, not only to relieve him of engineeringresponsibility, but also to effect a permanent improvementin the sanitary condition of the infested areas. Arrange-ments have accordingly been made for the immediate sur-face drainage of a swampy portion of the grass fields districtin which Dr. Taylor has already operated to a considerableextent. The cost of the work is estimated at .S460 and theamount has readily been voted by the Legislative Council.Mr. Chamberlain has approved of the governor’s action andhas sanctioned the expenditure of E460.

"

THE FRENCH GOVERNMENT AND LEAD-POISONING.

IN seeking to defend the hardware manufacturers who uselead for their glaze Mr. Coghill, M. P., speaking in theHouse of Commons on Feb. 28th, made at least one goodpoint. He not only insisted that the cases of lead-poisoningin the Potteries had steadily fallen from 496 in 1897 to 106last year, but remarked that in other trades there had been1057 cases of lead-poisoning. It is certainly true that

the grievance is not limited to the Potteries ; for instance,house decorators are still victims to the needless employ-ment of lead in the paint which they manipulate. Sir Charles.Dilke said that in France many pottery manufacturers usedno lead at all and there is no reason why this good example-should not be generally followed in England, even thoughthe better precautions now taken have reduced the frequencyof saturnine symptoms among the pottery-workers. Butwhile the English manufacturers might follow the exampleof the French manufacturers so far as the Potteries are

concerned the British Government might also seek to

imitate the French Government in regard to other trades inwhich lead is used. The Minister of Commerce, M. Milleranel,

1053PHARMACOLOGICAL NOTES.

constituted by the decree of Dec. llth, 1900, a Commission Iof Industrial Hygiene, and the first work of this committee

of experts was to investigate the dangers resulting from the Irise of lead, especially in the manufacture of paint. Further

. legislation was then promised on the subject and to obtain thenecessary information a circular was sent to all the prefectsduring the month of March, 1901. The circular inquired

in Iwhat communes, public establishments, and administrative eoffices the use of lead paint had been forbidden. As a

result of this investigation it appears that in 384 com-munes lead paint was no longer employed. Thereupon a-decree was issued on March 25th, 1901, ordering that hence-forth no lead paint should be used on any premises belongingto the Ministry of Commerce and Industry of Posts andTelegraphs. This example was soon followed by otherMinisters. In August the Minister of Marine decided thatno lead paint should be used for any of the ships belongingto the French Navy. During the preceding month of Junethe Minister of Public Works adopted a similar rule for allthat concerned his department. The Minister of War and

(in November) the Minister of Public Instruction also issueddecrees forbidding the use of lead paint in all places undertheir control. This is preaching by example and it has

always been held that Governments should be model em-ployers. At the same time the Government issued specialinstructions to all the inspectors of factories and unwhole-some industries to exercise a particularly strict surveillanceover the lead industries. As a consequence statistics

already show that there has been a considerable decreasein the number of cases due to saturnine intoxication. In

the report of Professor T. E. Thorpe and Professor T. Oliveron the employment of compounds of lead in the manufactureof pottery, presented to the Government in a blue-book datedFeb. 21st, 1899, it was pointed out (vide THE LANCET,April 1st, 1899, p. 919) that much of the ware supplied tothe order of the various Government departments, such as thePost Office, the Office of Works, the Admiralty, the WarOffice, and the India Office, could be dipped in leadless glazewithout detriment to its character and with no increase to iits cost. We believe that the Government acted as far aswas possible in accordance with this suggestion and we trustthat it will maintain its energy in this very practical way.

, MR. HARRY MAULE CROOKSHANK, F. R. C. S. Edin., BritishController of the Daira Sanieh Administration, has receivedHis Majesty’s Royal licence to accept and to wear the Order tof the Medjidieh, Grand Cordon, which has been conferred <

upon him by His Highness the Khedive of Egypt, authorised c

by His Imperial Majesty the Sultan of Turkey, in recognition <of valuable services rendered to His Highness. r

<

HE annual dinner of the Royal Army Medical Corps willtake place on Monday, June 16th, at the Whitehall Rooms of *

the Hotel Metropole, London, at 7.45 P.M. The honorarysecretary of the dinner is Lieutenant-Colonel E. M. Wilson, cR.A.M.C., Junior Army and Navy Club, St. James’s-street, (

London, S.W. -

c

WE regret to announce the death of Professor Hans ‘

Buchner who died at Munich on April 5th in the fifty-second g

year of his age. Professor Buchner, who was president of ]:the Hygienic Institute at Munich, was an able bacteriologist s

and rendered valuable services in the field of preventive f

medicine. - i i

THE consideration of the Midwives Bill as amended by theGrand Committee has been put down for Wednesday,June 4th, when there is considerable possibility of its being Itaken. _

Pharmacological Notes.PREVENTION OF PITTING IN SJBIALL-POX BY THE USE OF

FORMALIN-GELATIN OR GLUTOL.

GLUTOL is a whitish powder prepared by exposing sheetsof gelatin to the vapour of formalin. This substance is the

subject of an article by Mr. John Moir 1 wherein its thera-peutic uses are described. In practice, by the solventaction of the living tissue to which this preparation is

applied, the gelatin is dissolved and thus liberates the

antiseptic factor, the formalin. The value of formalinas an antiseptic in cases of surgical tuberculosis has beenrecognised during recent years to such an extent that itis largely replacing iodoform-glycerin with its objectionableodour. The solvent action of glutol is facilitated by theaddition of lard or of soft paraffin. The following conditionsare mentioned in which its use is beneficial : stomatitis (bymeans of a syringe) ; suppurative conditions of the mouth,gums, and tongue ; carcinoma ; epithelioma ; tuberculosis ;severe burns ; and severe chronic ulcers. But it is of specialinterest to note the recommendation that glutol should beemployed, mixed with soft paraffin in the proportion of 1 to 4or 1 to 8, as a preventive of severe pitting and deep scarsfrom small-pox; this proportion has been found usefulin tuberculosis, in carcinomatous and epitheliomatous cases,as well as in severe burns. The addition of a blandemollient vehicle such as soft paraffin is in all cases prefer-able. With a protective covering of gauze glutol is aseptic.It is found that, generally speaking, the use of glutolprevents the development of exuberant granulations andscars ; it is useful in preventing the irritation, scratching,excessive swelling, and inflammation of the eyelids and ofthe mouth, especially as it is entirely harmless as an appli-cation in the mouth, even when swallowed in considerablequantity. Dr. Gustave Daniel of the City Hospital, Bielefeld,found in 1899 that glutol caused improvement in cases of manyepithelial diseases, warts, cancroid growths, and in sycosisvulgaris ; his observations were confirmed by Dr. Kranefuss,physician-in-chief at that hospital. They found the treat-ment absolutely trustworthy, although it took more timethan most of the remedies ; but it was easy to handle, didnot cause any special pain, and left no scar. The value of

glutol as a preparation for the treatment of wounds hasbeen dealt with by Dr. Heinrich Mohr,2 by Dr. HeinrichLobb of Mannheim, and by Dr. Robert Maguire.’ ‘

MEDICINAL TREATMENT OF TUBERCULOSIS.Dr. Hugo Winternitz, physician at the Royal Medical

University Hospital in Halle on Saale, in an article on thetreatment of tuberculosis in hospitals 5 states that hygienic-dietetic therapeutics alone are not sufficient for the treat-ment of pulmonary diseases. With regard to medicinaltreatment even Gerhard, in spite of his former expressionthat "medicinal treatment of tuberculosis has been a

complete failure," is now in favour of special medicinaltherapeutics as far as the employment of drugs isconcerned. Of these creasote alone has held its own.The use of this drug. however, is sometimes attended bydecrease of appetite, disturbed digestion, and diarrhoea. As9, result various substitutes for creasote have been introduced

-notably, guaiacol and thiocol and their preparations.Guaiacol, the principal constituent of beechwood creasote,nly reduced these difficulties without removing them.Various combinations of guaiacol and of creasote withcarbonic acid were then introduced-viz., creasotumJarbonicum (creasotal), guaiacolum carbonicum (duotal),creasotum valerianicum (eosote), the ester of valerianicicid and guaiacol (geosote), and, finally, thiocol, a

’ulphuric combination of guaiacol (ortho-guaiacol-sulpbate)f potassium). Thiocol contains 52 per cent. of guaiacolmd is a white micro-crystalline powder, unalterable

3y exposure to air, of a slightly bitter but not dis-

agreeable taste, and perfectly inodorous ; it is soluble in’our parts of cold water and has no corrosive effect evenn concentrated solutions, a circumstance which may account’or the fact that it does not irritate the digestive organs.

1 The Therapist, Feb. 15th. 1902. p. 25.2 The Therapist, July 15th and August 15th. 1901, pp. 145 and 169.

3 Ibid., August, 1901, p. 178.4 Ibid., p, 179.

5 Ibid., Feb. 15th, 1902, translated from the Deutsche Aertze Zeitung,Jan. 1st, 1902.