897

any specific diagnostic value in this disease, since it mayobviously occur under many diverse conditions. In 30 cases

of purulent and septic conditions, such as appendicularabscess and gangrene, pelvic abscess, empyema of the gall-bladder, hepatic abscess, purulent peritonitis, and generalseptimmia, the reaction was positive in all, its intensityapparently depending rather upon the virulence of the

.pathogenic organism than upon its identity or upon theextent of the associated suppuration. Iodophilia was found intwo cases of catarrhal inflammation of the appendix, as wellas in all the cases of purulent and gangrenous appendicitis,so that it does not serve to distinguish between the catarrhaland suppurative forms of the disease. In croupous pneu-

,monia the seven cases tested all gave positive results

during the height of the febrile period of the disease, andin no other disease, not even in grave streptococcussepticmmia, was so marked a reaction observed. After

the crisis the iodophilia rapidly begins to disappear anddoes so completely within 48 hours in uncomplicated casesbut persists when delayed resolution, pulmonary abscess, or

empyema follows the pneumonia. Four cases of gonorrhcealarthritis gave a positive reaction to the iodine test and thereaction was observed in cases of acute pneumonic phthisis,carcinoma, pernicious anaemia, myelogenous leukaemia,diabetes mellitus, and amyloid liver, while negativeresults were obtained in rheumatic fever, endometritis,cholelithiasis, biliary cirrhosis, malarial splenomegaly,ovarian cyst, rickets, and acetanilid poisoning. From

a careful critical and statistical analysis of his results

Dr. DA COSTA derives the following general conclusions.

In the dry blood film intracellular iodophilia indicates a

form of leucocyte degeneration of toxic origin, due pre-sumably to an abnormal affinity of the cell glycogen for

iodine, the same reaction in the wet fresh blood beingphysiological. Extracellular masses in the plasma stainingwith iodine have apparently no pathological significance.The toxic factor in the production of the reaction may be

readily demonstrable, as in pyogenic septicaemia and pneu-monia, or it may be indefinite, as in pernicious anaemia andin cachectic states. The reaction is found to be restricted

to the cytoplasm of the leucocytes, never affecting the nuclei.In 98 per cent. of all reactions the polymorphonuclear neutro-

phile leucocytes are implicated ; in about 20 per cent. other

cells, notably the lymphocytes and less commonly the myelo-.cytes, while it is only in exceptional instances that iodophilouseosinophiles are noted. The number of cells staining withiodine is found to correspond roughly with the colour

intensity of the reaction, 50 per cent. or more of iodophilesbeing found in a decided, and about 25 per cent. in a feeble,,reaction. Iodophilia apparently shows no definite relation to

leucocytosis, to anaemia, or to pyrexia. Dr. DA COSTA con-

cludes that from a clinical standpoint iodophilia is often ahelpful, though in no circumstances a diagnostic, sign,and specifically states that in differentiating various

clinical entities extreme caution must be exercised in

accepting it as a criterion, although he has found it of

value as corroborative evidence in distinguishing both

gonorrhceal arthritis and osteomyelitis from rheumatic

fever, pure tuberculosis from tuberculosis with secondarypyogenic invasion, and amyloid liver from fatty cirrhotic

liver.

The Workmen’s CompensationAct, 1906.1

IN THE LANCET of Jan. 26th we suggested that as thecost of a copy of the new Workmen’s Compensation Act isbut 4d. many of those most concerned would before longpurchase and make themselves acquainted with its pro-visions. They may consider it with or without the assist-

ance of a legal text-book and they will find their attentiondirected to the points of interest to medical men in

the articles and letters which we have published. The

questions which are likely to arise, but which are not pro-vided for conclusively under the Act, can to some extentbe predicted ; but special prescience is hardly required inorder to foretell that others will present themselves fromtime to time which have not been anticipated and

with regard to which the interpretation of the law will

be found to be doubtful. We note that the insurance

companies are making full provision against this con-

tingency for such as like to avail themselves of policiesframed against all risks, and that those willing to incur the

necessary cost can without any very large outlay protectthemselves against the new liabilities now imposedupon them, as well as against those which existed

before but which so seldom made themselves felt

that insurance was not usually deemed necessary. Those

possible instances also are not forgotten where the servantmay become affected by a disablement not due to a causefor which his master or anyone else is liable, but for whicha prudent and kind-hearted employer will often wish to

provide if it is made easy for him to do so. The questionof insurance is one for the serious consideration of all, butfor medical men it is especially so because they are

employers of persons whose risks are to some extent peculiarowing to the circumstances of the medical profession, andbecause also they are employers of persons whose work,dangerous or otherwise, like that of their masters, is carriedon constantly without the limitation of regular hours of labouror of any fixed place of employment. The servant of the

medical man, for instance, employed in keeping clean his

surgery or his dispensary, is liable to accidents which maybe rare but which differ from those occurring in other

domestic service. The coachman of the lay employer has hishours of work which in some families imply night work, butwhich, as a rule, are of more or less fixed duration. The

coachman of the medical man, particularly when his practicelies in a country district, never knows when his day’s workwill begin or end, and it takes him along rougher roads thanthat of the man who drives his master or his mistress merelyfor their pleasure.We have before us a cheap but serviceable explanatory

guide to the new Act, published by the Daily Chronicle at 1d.,and we note some practical advice given on its last page inrelation to insurance, where it recommends that care should

be taken to see that the policy provides against every con-tingency possible in the master’s service. It calls particularattention to extra servants casually employed and to the pos-sible requirement in a policy of notice to the office of such

1 See also THE LANCET, Oct. 13th, 1906, p. 1012; Nov. 10th, 1906,

p. 1306; Dec. 8th, 1906, p. 1612; Jan. 12th, 1907, p. 112; Jan. 26th, 1907,p. 240.

898

employment before the insurance company will hold itself re-sponsible. It also points out that the provisions of the policyas to change of servants are to be considered with care.We need only mention the locum-tenent, the assistant, andthe nurse in order to show that the medical man is

peculiarly liable to have in his employment persons with

regard to whom a liability may possibly arise and may be

disputed, whose employment may be temporary only, andwhose salaries forming the basis upon which the employer’sliability is calculated, are above the usual emoluments of the

ordinary workman or domestic servant. It is with regard tothe nurse again that questions may arise as to whether her

employment is " casual," and also as to who may be

her employer, and the same point will be mooted as to

humbler workers whom the medical man, according to

the exigencies of his profession and apart from his positionas an ordinary citizen, may call in to perform various

services. The accidents against which provision is to be made

by insurance have hitherto not attracted much attentionand are regarded as of infrequent occurrence, but we mustwait until the privileges of the Act have been enjoyed for afew years before we are able to appreciate the effect of thecompensation provided in increasing the occasions for seekingit. The schedule of the Act which lays down the scale andconditions of compensation contains more that is of specialinterest to the medical man in the exercise of his pro-fession than does the body of the statute. We are alreadyfamiliar with the claims of the workman against his master,all medical men having been brought into contact with

such cases, but under the new Act every general prac-titioner will find himself now and again summoned eitherby the employer or the employed in the large class of

domestic servants. Here accidents as a rule will not be

serious and the medical man may frequently be remindedthat " if the incapacity lasts less than two weeks no com-

pensation shall be payable in respect of the first week,"and we can foresee that where the period of incapacity hasto be fixed according to the medical man’s judgment he willoften have a difficult task.

In various ways the medical profession finds itself

expected to perform semi-judicial rather than healingfunctions under the new law, and we are confident that

it will not fail to do so with honourable impartiality.The occasions may increase on which the medical man

will be tempted " to take a side " involuntarily when form-

ing and declaring his opinion, but the augmented powers of Imedical referees will bring disputed medical questions underthe consideration of those qualified by their training todecide them. An instance of the medical referee’s powersis contained in the fifteenth paragraph of the schedule

referred to, which provides that " where no agreementcan be come to between the employer and the work-

man as to whether or to what extent the incapacityof the workman is due to the accident, the pro-visions of this paragraph shall, subject to any regu-lations made by the Secretary of State, apply as if the

question were a question as to the condition of the work-man ;" that is to say, this point, which in ordinary actionsis regarded as one well within the competence of a judgeor of a jury of laymen, is to be submitted to a medical

referee whose certificate shall be conclusive upon the matter.

It is to be hoped that before July 1st, when the Act willcome into force, and when, so far as medical referees are

concerned, it will apply to accidents occurring before thatdate, the rules of the Home Office for regulating the pro-ceedings of medical referees will have been long enoughbefore the medical profession to be studied carefully and forattention to be called to any points in which, as may easilyoccur upon such occasions, they may be defective and mayrequire amendment.

Annotations.

THE HOT CROSS BUN.

II Ne quid nimis."

DIETETICALLY considered the hot cross bun differs in

only one regard, but perhaps an important one, from bread,inasmuch as the Good Friday bun contains a fair sprinklingof spice, generally in the shape of allspice or pimento.Otherwise the ingredients are the same and the mode ofpreparation is the same-that is to say, a dough is prepared,yeast is added, and the " sponge " is then cut up into bunsand baked. The hot cross bun, in a word, is practicallybread plus a condiment. The role of spices and condimentsin food is important. They improve appetite and increasethe digestive power by inducing a flow of digestive juice.They are, as a rule, therefore, of service to those who, fromillness or other cause, have a dull appetite. The use of acondiment may almost be regarded as superfluous in the caseof persons with vigorous appetite and sound digestion, whilespices and sauces must be studiously excluded from thediet of any who are suffering from catarrh of the stomach orintestine, since, after all, condiments are in reality irritants.The custom of eating hot cross buns on Good Friday, whichis, of course, a day nearing the end of a fasting season,may be regarded as having for its object, perhaps, the

preparation for the feast day, or else the intensificationof the discipline which the partial abstinence fromfood entails. To sharpen the appetite during a periodof fasting is clearly calculated to make the ordeal of self-denial more severe. The spices would aggravate the cravingfor more food. Whether this was the original idea of thespiced bun for eating on Good Friday may be open to ques-tion, but such a view at all events suggests itself when wecome to consider the part played by spices in dietetics, andit is a significant fact that spices, as a rule, are rare con-stituents of buns.

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RECORDS OF SMOKE.

THE deleterious effects of coal smoke escaping into the

atmosphere have often been referred to in our columns andthe discharge of black smoke from a chimney has been madea statutory offence. The prosecution of offenders is, how-ever, not infrequently difficult on account of conflictsin the evidence as to the density of the smoke emitted.Writing on this subject in the Engineering Supplementof the Times of March 20th, Mr. James Swinburne points outthat the excellent smoke chart of the Institution of Civil

Engineers is imperfect, because it is almost impossible tocompare smoke seen against the sky with a shade on paperwhich is not only in close proximity to other darker andlighter shades but is not really comparable at all. He saysthat this difficulty may be overcome by having the smokescale made on glass or transparent celluloid which can beheld up in such a way that the smoke can be comparedwith the progressive series of tints forming the scale. Thesescales might be standardised so that different observers

might have exactly similar tints before them, and a further