971

existence of lead ingestion as a toxic factor at oneperiod in the man’s history, was at variance over itsbearing on his present condition.The applicant was a man of 23, who had been

employed at Melton Constable Station, from April,1911, to January, 1919, in painting engines, using whitelead and sand-paper. In December, 1915, he had anattack of lead poisoning, as certified by the late Dr. J.Skrimshire, who attended him for six weeks. For awhile after this he was given other work to do, butreturned to the painting in June, 1916, when hedeveloped a second attack of lead poisoning afterscraping the inside of carriage roofs. On thisoccasion he was laid up for four days. Hehad a third attack in January, 1919, which totallyincapacitated him until the following March; sincethen he had only been able to do light work, andhe now stated that he suffered from weakness inthe arms and legs and pain in the abdomen. Therailway company had accepted the man’s statementand the doctor’s certificate of lead poisoning, and hadpaid him compensation for loss of work during the threeattacks specified. But on being sent to see Dr. BarfootMills, of Norwich, in March, 1919, Dr. Mills certifiedthat he was not suffering from lead poisoning, and thecompensation was accordingly stopped.

existence of lead ingestion as a toxic factor at oneperiod in the man’s history, was at variance over itsbearing on his present condition.The applicant was a man of 23, who had been

employed at Melton Constable Station, from April,1911, to January, 1919, in painting engines, using whitelead and sand-paper. In December, 1915, he had anattack of lead poisoning, as certified by the late Dr. J.Skrimshire, who attended him for six weeks. For awhile after this he was given other work to do, butreturned to the painting in June, 1916, when hedeveloped a second attack of lead poisoning afterscraping the inside of carriage roofs. On thisoccasion he was laid up for four days. Hehad a third attack in January, 1919, which totallyincapacitated him until the following March; sincethen he had only been able to do light work, andhe now stated that he suffered from weakness inthe arms and legs and pain in the abdomen. Therailway company had accepted the man’s statementand the doctor’s certificate of lead poisoning, and hadpaid him compensation for loss of work during the threeattacks specified. But on being sent to see Dr. BarfootMills, of Norwich, in March, 1919, Dr. Mills certifiedthat he was not suffering from lead poisoning, and thecompensation was accordingly stopped.When the case came on for trial Dr. Mills gave

evidence that he had found no sign of lead poisoning,but that the man was suffering from neurasthenia andweakness of the heart, and that the best thing he coulddo was to get back to work. The idea of leadpoisoning had been so drilled into the man’s mindthat- he put all his troubles down to that cause.

In cross-examination Dr. Mills admitted that if Dr.Skrimshire was right in certifying the man to besuffering from lead poisoning he would assume

the neurasthenia to be due to that. Dr. H. J.

Starling, assistant physician to the Norfolk and NorwichHospital, who examined the applicant on March 24thlast, found him in a very excitable condition, with dis-ordered action of the heart but no organic disease. Thecondition of the abdomen was not due to actual pain,but to nervous contraction in anticipation of pain. Therewas no sign of lead poisoning, but if the convictionremained in the man’s mind that he was suffering fromit, the probability of his cure was very slight, and thebest thing for-him was work. Dr. R. T. Hales, of Holt,certifying factory surgeon, said he had examined theman, but found no evidence of lead poisoning, thoughfrom his story he presumed he was convalescing froman attack of lead poisoning. On the other hand, Mr.S. H. Burton, consulting surgeon to the Norfolk andNorwich Hospital, said he examined the plaintiff onDec. 16th last, and again on the morning of the

trial, and considered that his condition was compatiblewith the story he gave of his history. At the presenttime the man was neurasthenic, and in Mr. Burton’sopinion light work in the open would do him good.Although he found no trace of lead poisoning present,yet he considered that the excited action of the heartfrom which he suffered was brought about by the man’slowered tone due to the lead poisoning.The judge, in summing up, commented on the great

importance of the case, lead poisoning being one of thediseases which under the Workmen’s CompensationAct were placed under the same category as accidents,and compensated accordingly. There was, he said, aconsiderable difference of opinion in the medicalevidence which he had heard, but he found as a factthat Dr. Skrimshire was right when he said the manwas suffering from lead poisoning, and he acceptedwithout hesitation the evidence of Mr. Burton that hispresent condition was due to the lead poisoning. Thedoctors had all agreed in saying that the plaintiff wasneurotic and that he would not recover so long as hebrooded on his illness. He could not go back to paint-ing, but there was plenty of other work suitable forhim. He awarded the plaintiff 12s. a week, to com-mence from Nov. 1st, with costs.The problem presented to the judge in this case

was a difficult one, and in our opinion he decided

When the case came on for trial Dr. Mills gaveevidence that he had found no sign of lead poisoning,but that the man was suffering from neurasthenia andweakness of the heart, and that the best thing he coulddo was to get back to work. The idea of leadpoisoning had been so drilled into the man’s mindthat- he put all his troubles down to that cause.

In cross-examination Dr. Mills admitted that if Dr.Skrimshire was right in certifying the man to besuffering from lead poisoning he would assume

the neurasthenia to be due to that. Dr. H. J.

Starling, assistant physician to the Norfolk and NorwichHospital, who examined the applicant on March 24thlast, found him in a very excitable condition, with dis-ordered action of the heart but no organic disease. Thecondition of the abdomen was not due to actual pain,but to nervous contraction in anticipation of pain. Therewas no sign of lead poisoning, but if the convictionremained in the man’s mind that he was suffering fromit, the probability of his cure was very slight, and thebest thing for-him was work. Dr. R. T. Hales, of Holt,certifying factory surgeon, said he had examined theman, but found no evidence of lead poisoning, thoughfrom his story he presumed he was convalescing froman attack of lead poisoning. On the other hand, Mr.S. H. Burton, consulting surgeon to the Norfolk andNorwich Hospital, said he examined the plaintiff onDec. 16th last, and again on the morning of the

trial, and considered that his condition was compatiblewith the story he gave of his history. At the presenttime the man was neurasthenic, and in Mr. Burton’sopinion light work in the open would do him good.Although he found no trace of lead poisoning present,yet he considered that the excited action of the heartfrom which he suffered was brought about by the man’slowered tone due to the lead poisoning.The judge, in summing up, commented on the great

importance of the case, lead poisoning being one of thediseases which under the Workmen’s CompensationAct were placed under the same category as accidents,and compensated accordingly. There was, he said, aconsiderable difference of opinion in the medicalevidence which he had heard, but he found as a factthat Dr. Skrimshire was right when he said the manwas suffering from lead poisoning, and he acceptedwithout hesitation the evidence of Mr. Burton that hispresent condition was due to the lead poisoning. Thedoctors had all agreed in saying that the plaintiff wasneurotic and that he would not recover so long as hebrooded on his illness. He could not go back to paint-ing, but there was plenty of other work suitable forhim. He awarded the plaintiff 12s. a week, to com-mence from Nov. 1st, with costs.The problem presented to the judge in this case

was a difficult one, and in our opinion he decided

wisely and judicially. Upon the evidence putbefore him it. would seem clear that the applicanthad certainly had three attacks of lead poisoning,and that he had quite rightly been paid compensa-tion for these. All the medical evidence pointed tothe fact that the present condition of the man wasone of neurasthenia with excitable or disorderedaction of the heart. The judge accepted the viewthat the man’s condition was a sequel of his attacksof lead poisoning, and at the same time recognisedthat light work of a different character would bebeneficial to him morally, physically, and mentally.We may express the hope that enlightened decisionsof this kind may become the rule in cases whereneurasthenia figures in compensation cases afteraccident, injury, or industrial disease.

wisely and judicially. Upon the evidence putbefore him it. would seem clear that the applicanthad certainly had three attacks of lead poisoning,and that he had quite rightly been paid compensa-tion for these. All the medical evidence pointed tothe fact that the present condition of the man wasone of neurasthenia with excitable or disorderedaction of the heart. The judge accepted the viewthat the man’s condition was a sequel of his attacksof lead poisoning, and at the same time recognisedthat light work of a different character would bebeneficial to him morally, physically, and mentally.We may express the hope that enlightened decisionsof this kind may become the rule in cases whereneurasthenia figures in compensation cases afteraccident, injury, or industrial disease.

EPSOM COLLEGE: THE RISE IN EXPENSES.

THE general increase in salaries and in thecost of living, as well as the alterations in theretiring grants to masters, on the lines of theSuperannuation Act of 1918, have compelled theCouncil of Epsom College to increase the schoolfees. The increases will date as from Septembernext, and will apply to all boys, whether enteringthe school for the first time or at present there.For the sons of medical men the fees will beincreased from 70 guineas to 100 guineas; for thegeneral boarders from 80 guineas to 120 guineas;and for day boys from 25 guineas to £40. We can

quite understand that the Council had no alter-native but to make these increases in the schoolfees, for the loss on the working of the school forthe past year has amounted to C3779 15s. 10d. Thecharitable contributions in aid of the Foundationcannot, of course, be expended in defraying any ofthe expenses of the school beyond paying for theeducation of the foundationers.

THE general increase in salaries and in thecost of living, as well as the alterations in theretiring grants to masters, on the lines of theSuperannuation Act of 1918, have compelled theCouncil of Epsom College to increase the schoolfees. The increases will date as from Septembernext, and will apply to all boys, whether enteringthe school for the first time or at present there.For the sons of medical men the fees will beincreased from 70 guineas to 100 guineas; for thegeneral boarders from 80 guineas to 120 guineas;and for day boys from 25 guineas to £40. We can

quite understand that the Council had no alter-native but to make these increases in the schoolfees, for the loss on the working of the school forthe past year has amounted to C3779 15s. 10d. Thecharitable contributions in aid of the Foundationcannot, of course, be expended in defraying any ofthe expenses of the school beyond paying for theeducation of the foundationers.

CATHETERISM OF THE URETER IN CALCULOUSANURIA.

IN the Progra Medical of March 20th’ ProfessorLeon Thevenot, of Lyons, has selected for com-mentary two cases of calculous anuria treated by amethod which, so far, has been seldom employed---ureteral catheterism.

’ A man, aged 35 years, was admitted into hospital onMay 31st, 1909. He was addicted to alcohol, and had’suffered for years from attacks of renal colic, duringwhich he did not pass urine. After an attack in 1907 hepassed two pieces of gravel of the size of a small pea.An attack of renal colic with anuria began three daysbefore admission, and only 50 g. of urine were passedon the previous evening. The left kidney was painful,but not palpable. Two days after admission the patientwas cystoscoped. On the left side the ureteral catheterwas arrested at a distance of 6 or 7 cm. from the orificeof the ureter; on the right side nothing abnormal wasnoticed. On the following day the patient passed alarge and irregular calculus, and the emission of urinebecame normal. On performing cystoscopy again theleft ureter was found permeable.In a second case . a man, aged 47 years, was

admitted on May 3rd, 1911. Since 1893 he had sufferedfrom attacks of renal colic, especially on the leftside, and hsematuria, and had passed phosphatic calculi.In 1903 lithotrity was performed for stone in thebladder. A large calculus was removed from theright kidney. In March, 1914, he was readmitted forcomplete anuria, following renal colic. A catheterwas passed into the left ureter as far as the renalpelvis without encountering resistance. On the follow-ing day 2 litres of urine were passed. Radiography

IN the Progra Medical of March 20th’ ProfessorLeon Thevenot, of Lyons, has selected for com-mentary two cases of calculous anuria treated by amethod which, so far, has been seldom employed---ureteral catheterism.

’ A man, aged 35 years, was admitted into hospital onMay 31st, 1909. He was addicted to alcohol, and had’suffered for years from attacks of renal colic, duringwhich he did not pass urine. After an attack in 1907 hepassed two pieces of gravel of the size of a small pea.An attack of renal colic with anuria began three daysbefore admission, and only 50 g. of urine were passedon the previous evening. The left kidney was painful,but not palpable. Two days after admission the patientwas cystoscoped. On the left side the ureteral catheterwas arrested at a distance of 6 or 7 cm. from the orificeof the ureter; on the right side nothing abnormal wasnoticed. On the following day the patient passed alarge and irregular calculus, and the emission of urinebecame normal. On performing cystoscopy again theleft ureter was found permeable.In a second case . a man, aged 47 years, was

admitted on May 3rd, 1911. Since 1893 he had sufferedfrom attacks of renal colic, especially on the leftside, and hsematuria, and had passed phosphatic calculi.In 1903 lithotrity was performed for stone in thebladder. A large calculus was removed from theright kidney. In March, 1914, he was readmitted forcomplete anuria, following renal colic. A catheterwas passed into the left ureter as far as the renalpelvis without encountering resistance. On the follow-ing day 2 litres of urine were passed. Radiography