THE LIGHT TREATMENT AT THE LONDON HOSPITAL

286 THE LIGHT TREATMENT AT THE LONDON HOSPITAL.

workshop. The case, therefore, of a man who had con-tracted lead poisoning in coach-painting, or in burning offor removing old paint (one of the sources of dangermentioned in the report), in a factory or workshopshould’ be notified, but that of a man poisoned in pur-suing in the ordinary way the trade of a house-painteror a plumber should not. These do not come within theterms of the Factory Acts, except in so far as they may havecontracted lead poisoning while performing such processesas grinding lead pigment in factories and workshops, andsome friction has arisen through the necessary refusal togrant fees not authorised by the Act when lead poisoninghas been reported and investigation has shown that it didnot arise in a factory or workshop. The present practiceat the Home Office is stated to be to assume that the

practitioner can say that the patient is employed in a factory,

or workshop in which risk of lead poisoning may reasonablybe anticipated and that he will not notify cases in which hecannot affirm this.The extent to which lead poisoning is to be anticipated

among house painters and plumbers is shown by the fact thatunder the conditions of limited notification mentioned 100cases have been notified, while in addition information hasbeen received from the district registrars of 18 cases inwhich lead poisoning was directly or indirectly the cause ofdeath.

Before leaving the subject of the reports from which theseuseful statistics are compiled we observe that 63 certifyingsurgeons appointed under the Factory and Workshop Act of1891 failed to make the report required of them under Section19 of that Act, and that of 37 of these the appointment wascancelled owing to no satisfactory explanation of theomission being forthcoming. It is stated that the returnsultimately missing would not materially affect the figuresgiven in the tables, so no doubt these cases arose where thecertifying surgeons were seldom, if ever, called upon toperform their duties, but at the same time it is to beregretted that such returns as those before us shouldnot be as complete and as accurate as possible. Withregard to so much of the summary of the Chief Inspectorof Factories and the reports of his subordinates as referto dangerous processes and manufactures there is one

matter which appears to us to be highly satisfactory. The

stringent regulations which have been framed from timeto time in order to minimise the danger of the workers inparticular trades have evidently in many cases had the effectof abolishing the danger entirely. The regulations are

possibly irksome, while the infringement of them may beattended with penalties, and either ingenuity is exercisedwhich before lay dormant in order that the dangerous workmay be done by machinery instead of by the hand of theworkers, or else the process in which the employment ofa poisonous substance was formerly regarded as necessaryis found to be equally possible with the help of an agentthat is innocuous. Match-making affords an instance ofeach of these changes, for we are informed in a singleparagraph that in some match factories machinery is takingthe place of hand labour in dangerous processes, while inone the firm has announced its intention to discard yellowphosphorus as it has succeeded in making 11 strike-any-where" matches without it. Match-making, however, doesnot stand alone in its increasing safety ; the use of lead forglazing earthenware and china lingers, the glazing being, asa rule, applied under conditions which protect the workers asfar as they can be protected while lead is used, but thedisuse of lead and the substitution of other glazes equallyeffective which do not contain it appear to be consider-ably on the increase and, indeed, form a hopeful featurein the report. Again, under the heading of "Industrialmercurial poisoning" " we note a paragraph which informs usthat the silvering of mirrors by means of an amalgam ofmercury and tin (water-gilding), which was in former yearsthe chief industrial source of mercurial poisoning, has beensuperseded in this country by the nitrate of silver andammonia process. It will be seen from these instances thatlegislative interference with manufacturing processes with aview to protecting the health of the workers does not neces-sarily imply the undoing of the trade or manufacture inter-fered with merely because the interference is at first sightarbitrary and irksome. On the contrary, it stimulates theinvention and adoption of better and safer methods, whichbetter and safer methods must of necessity attract workmenof a better class who were deterred before by the danger ofthe employment.

THE LIGHT TREATMENT AT THELONDON HOSPITAL.

MORE than three years have now elapsed since Finsen ofCopenhagen introduced to the profession his method of

treating lupus by means of light, and the favourable evidenceobtained at his clinic is amply sufficient to justify amore extended employment of this valuable agent in

the treatment of this troublesome disease. AlthoughProfessor Finsen has used his method for three years, yet itis only a little more than six weeks since any public institu.tion in this country has been in a position to employthis therapeutic aid. The London Hospital is the

pioneer in this matter, and this is due partly to the giftto the hospital by the Princess of Wales of some ofthe apparatus needed for its working and partly to.the praiseworthy energy of the authorities of the LondonHospital who have done all that can be required for theefficient working of the method. The "light cure" is carriedon under the superintendence of Dr. Stephen Mackenzie andmore immediately under the direction of Dr. J. H. Sequeirawho attends for several hours daily for that purpose. A fair-sized ward has been set apart for the treatment and it includesdressing-rooms for the patients. The apparatus consists ofan arc light surrounded by a shade so as to prevent the eyesof those present being dazzled. From this light there radiatefour or more telescopes, each telescope conveying the lightto one patient. The telescope contains lenses composed ofquartz which has less obstructive effect on the active raysthan any other refractive medium. The space between two,of the constituent lenses of the telescope is filled withdistilled water to moderate the temperature and an

enclosing water-jacket serves still more to abstractthe heat. The lenses are so arranged as to renderconvergent the divergent rays proceeding from the arc

light, and they are brought to a focus by anotherlens which is held in position by a nurse. This lens is com-posed of two plates, which may be of quartz or even of glass,and the space between them is filled with water and may beconnected with a supply so that there is a continuous

replacing of the water which may have become heated bywater which is cold. This cooling lens is held by the nurseand pressed by her fairly firmly on to the affected part. The

object of this pressure is to render ansemic the part to betreated, as it has been found by experience that the thera.peutic efEect is much greater if the tissues are bloodless thanif the circulation in them is proceeding normally. Theactive rays seem to be those which are usually calledactinic, and are ultra-violet in the spectrum ; they are there-fore the most refractive rays, and they are accuratelyfocussed on the part, the pressure being so adjusted thata red halo is seen surrounding a colourless centre of a

little less than a shilling in size. The lens pressing on theskin may be held in position by rubber bands, but it is thusliable to shift and the employment of an intelligent nursegives much more satisfactory results. It is, however,necessary that the nurse’s eyes should be protected bycoloured spectacles, as the light reflected from the lenspressed on the skin is intensely brilliant. Whenever it is

necessary to readjust the position of the patient a red clothcap is placed over the lower end of the telescope. The

patient lies on a raised table or is seated in an

adjustable chair the position of which can be varied sothat the rays of light shall fall perpendicularly on

to the skin. Each application or séance lasts about an hourand as each patient is treated only once a day and thedepartment is open from 9 A.M. to 12 30 P.M. three setsof patients are under treatment every day, an interval ofa few minutes being allowed between two sittings. Thenurses after a little practice do not find it at all tediousto keep the compressing lens in position, exerting pressureat the same time, even though it lasts three hours eachday. Great care is taken against sepsis ; in order to

prevent any such accident a separate pressure lens iskept for each patient and also separate parts of any otherportion of the apparatus which comes in contact with him.These are kept in a series of lockers inscribed with thepatients’names. Care is taken to protect the eyes and theunaffected parts of the patients’ skin from the effects of thelight rays. The light is provided by an arc lamp taking EOto 80 amperes of current. This is obtained in the following

287THE METROPOLITAN HOSPITAL SUNDAY FUND.

way: the public electric main is employed to work a con-verter which increases ’the amperage of the current from 10to 60 or 80, while reducing its voltage from 140 to 60. The

present converter is quite capable of supplying two such arclamps as that employed at present, so that the capacity ofthe department could be doubled if necessary.The same treatment can be carried out by the employment

of the direct rays of the sun, and a small portion of thegrounds has been shut off by a high paling from which canbe hung curtains so as to exclude the gaze of the curious. Theparallel rays of the sun are focussed on to the part by a largehollow lens containing an ammoniacal solution of copperwhich absorbs a large proportion of the heat rays. A

separate lens has to be employed for each patient and apressure lens, like that used with the electric light, is heldagainst the affected part. There is no essential differencein the results obtained by the two methods.The effect on the patient is in no way painful ; the

application itself causes no discomfort, and in so faras it is felt at all it is said by the patients to givea sensation of gentle warmth. But a few hours after thefirst application there is a certain amount of " reaction ";the part swells, becomes reddened, and is tender, but eventhen there is no real pain. This reaction varies in degree indifferent cases and is always seen in lupus vulgaris, but doesnot occur in cases of lupus erythematosus, so that it may beof some diagnostic value. As a rule it may be said that thegreater the reaction there is the better the result. Thebeneficial effect of the treatment is often manifested withina few days, and one or two cases have occurred in whichrecovery ensued after only a few applications. Generallyabout 15 to 20 or 25 applications have to be employedbefore a satisfactory result is obtained. At one time anarea not larger than the size of a shilling can be treated,so that if the diseased patches are extensive a prolongedcourse of treatment is required. The results, however,are eminently satisfactory: the skin becomes smooth,soft, and pliable, and what scar there is attracts littlenotice. The cases that are the most suitable are thosewith small recent patches of disease, but extensive chroniccases are improved, though not so rapidly. Lupus vulgarisseems to be the only disease in which the results are

marked; in lupus erythematosus there is a little beneficialaction, and one case of this disease is now under treatmentat the London Hospital. It is early yet to speak of thepermanence of the result, but Professor Finsen finds thatrecurrence occurs in only a small proportion of the cases, andin those a little further treatment removes the recurrentdisease. When each patient is first admitted to this treat-ment at the London Hospital a photograph is taken and anelaborate system of notes has been devised. At the endof the treatment a second photograph is taken, and we hopein a few months’ time to show the results when sufficientinterval has occurred to render it probable that recovery ispermanent. It is intended in a short time to provide anafternoon séance for paying patients if a sufficient numberpresent themselves. Whatever may be the ultimate verdictof dermatologists on the Finsen treatment no one can denythe striking beneficial effects in lupus of this variety ofphototherapy.

THE METROPOLITAN HOSPITAL SUNDAYFUND.

THE following were among the principal amounts receivedat the Mansion House in aid of this Fund up to July 20th,when the total reached nearly ;M8,000 :-

2 8. d.1, z -1. z- 1.. 1.. . - . - B 8. d.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6486 births and 3662deaths were registered during the week ending July 21st.The annual rate of mortality in these towns, which hadbeen 14’5 and 15’6 per 1000 in the two preced-ing weeks, further rose last week to 16-4. In London thedeath-rate was 16’1 per 1000, while it averaged 16’7 in the32 provincial towns. The lowest death-rates in these townswere 10-0 in Huddersfield, 10’7 in Cardiff, 11-6 in Burnley,and 11-7 in Bristol; the highest rates were 21’0 in Manchester,22-2 in Salford, 23-0 in Sunderland, and 23’6 in Liverpool.The 3662 deaths in these towns included 555 which werereferred to the principal zymotic diseases, against 344 and 427in the two preceding weeks ; of these 214 resulted fromdiarrhoea, 118 from measles, 91 from whooping-cough, 69from diphtheria, 37 from " fever " (principally enteric), and26 from scarlet fever. No fatal case of any of these diseasesoccurred last week in Plymouth ; in the other towns theycaused the lowest death-rates in Burnley, Halifax, Bradford,and Gateshead, and the highest rates in Derby, Salford,Leeds, and Sheffield. The greatest mortality from measlesoccurred in Derby, Oldham, Huddersfield, and Sunderland;from scarlet fever in Blackburn; from whooping-cough inLiverpool, Bolton, and Blackburn ; and from diarrhoea inWest Ham, Birkenhead, Liverpool, Salford, Leeds, andSheffield. The mortality from "fever" showed no markedexcess in any of the 33 towns. The 69 deaths from diph-theria included 21 in London, 10 in Sheffield, six in Leicester,and five in Leeds. No fatal case of small-pox was registeredlast week either in London or in any of the 32 provincialtowns. The number of small-pox patients in the MetropolitanAsylums Hospitals, which had been 17 at the end of eachof the two preceding weeks, had declined to 14 on Saturdaylast, July 21st; one new case was admitted during theweek, against four in each of the two preceding weeks. Thenumber of scarlet fever patients in these hospitalsand in the London Fever Hospital at the end of theweek was 1877, against numbers increasing from 1754to 1861 on the six preceding Saturdays; 222 new cases

were admitted during the week, against 210. 229,and 208 in the three preceding weeks. The deaths referredto diseases of the respiratory organs in London, which hadbeen 140 and 160 in the two preceding weeks, furtherrose last week to 169, but were slightly below thecorrected average. The causes of 39, or 1’1 per cent.,of the deaths in the 33 towns were not certified eitherby a registered medical practitioner or by a coroner. Allthe causes of death were duly certified in Portsmouth,Bolton, Oldham, and 10 other smaller towns ; the largestproportions of uncertified deaths were registered in Leicester,Liverpool, Salford, and Hull.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 17-9, 17-7, and 17-2 per 1000 in the threepreceding weeks, rose again to 19-0 during the week

ending July 21st, and exceeded by 2-6 per 1000 the mean rateduring the same period in the 33 large English towns. Therates in the eight Scotch towns ranged from 13-5 in Perth and14-3 in Dundee to 19-7 in Greenock and 22-2 in Glasgow.The 588 deaths in these towns included 38 which werereferred to diarrhoea, 22 to whooping-cough, 18 to measles,11 to "fever;" six to diphtheria, five to scarlet fever, andtwo to small-pox. In all 102 deaths resulted from these -principal zymotic diseases, against 85 and 73 in the twopreceding weeks. These 102 deaths were equal to an annualrate of 3 3 per 1000, which was 0-8 per 1000 above the meanrate last week from the same diseases in the 33 largeEnglish towns. The fatal cases of diarrhoea, whichhad been 32 and 23 in the two preceding weeks, rose

again last week to 38, of which 23 were registered in

Glasgow, four in Edinburgh, and four in Dundee. Thedeaths from whooping-cough, which had been 22 and 21in the two preceding weeks, rose again to 22 last week, andincluded 16 in Glasgow, two in Aberdeen, and two in Paisley.The fatal cases of measles, which had been 20 and 17 inthe two preceding weeks, rose again last week to 18, ofwhich 10 occurred in Glasgow and six in Edinburgh.The deaths referred to different forms of "fever,"