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378 upon the London County Council in accordance with the objects of that association. ROYAL COLLEGE OF PHYSICIANS OF LONDON. Dr. Horace Dobell of Parkstone Heights, Dorset, formerly of Harley-street, London, has presented Z500 in Consols (cumulative) to the Royal College of Physicians of London, for the promotion of original research into the ultimate origin, evolution, and life-history of bacilli and other pathogenic micro-organisms. The conditions are that the President and Censors of the College shall select a lecturer once in every two years who shall give a lecture recording original researches on the above subject made by himself and others and that he shall receive a fee of .B50 for so doing. These lectures are to be continued biennially so long as a sufficient amount of the 9500 and its accumulated interest remains. The first lecture will be delivered in November, 1904, by Dr. E. Klein. The Milroy lecturer for 1905 is Dr. Thomas Morison Legge, one of His Majesty’s inspectors of factories, who has taken as his subject Industrial Anthrax. THE ADULTERATION OF COD-LIVER OIL. WE are indebted to Mr. E. J. Parry, B Sc., F.I.C., for a communication in which he states that the great scarcity of cod-liver oil during the past year or so, accompanied by famine prices on the market, has been responsible for an enormous amount of adulteration in this product. Various adulterants have from time to time been recorded but at the present time " low-grade fish oils other than the genuine cod-liver oil are almost universally found in adul- terated samples. There is at present, Mr. Parry states, and he is a well-known authority on the subject, a very brisk demand for empty cod-liver oil barrels and he has been able o trace enormous numbers in one place. The original marks are obliterated and the barrels are re-painted and re- marked and eventually three barrels of genuine cod-liver oil re-appear on the market as five and the stock of shark oil is correspondingly diminished. Such transactions he has been able to trace from beginning to end. As regards examination a trained nose is of considerable help. The ,tests given by the British Pharmacopoeia are practically useless except in so far as they bring the adulterants within a certain group on account of a specific gravity limit and they exclude oils which freeze at 32° F. in two hours. Again, the specific gravity, the saponification value, and the iodine absorption figure give no useful indica- tions except when taken in conjunction with other figures. The amount of free acid present in the samples, the index of refraction, and certain colour reactions do give in some cases most valuable information. Mr. Parry has found that of the 58 samples examined by him during the past year 21 proved to be pure, nine doubtful, and 28 were clearly adulterated. Altogether the results show that there is an enormous amount of adulterated cod-liver oil on the market and Mr. Parry’s experience is in complete agreement with that of other analysts. A large proportion of this adulterated oil is undoubtedly used in preparations of cod- liver oil, such as cod-liver oil and malt extract and emulsions. The percentage of cod-liver oil in such preparations has been found to be as low as from 7 to 9. Mr. Parry suggests that this adulteration of cod-liver oil gives an admirable opening to physicians to consider, in view of the difficulty of depending on the supplies of cod-liver oil, whether its virtue as a medicine is really existent in any special sense, or whether it is more or less traditional and therefore much exaggerated, or, in other words, whether it is not as a fat of animal origin that cod-liver oil enjoys a reputation which it ought to share with other animal fats. It is open to question, we think, whether cod-liver oil has any specific virtues other than those of an easily digested fat. All the same, we trust that our authorities who are responsible for the practical application of the Sale of Food and Drugs Act will make a prompt inquiry into this matter and take steps to stamp out yet another barefaced imposition. THE TEACHING OF HYGIENE IN SCHOOLS. A CIRCULAR letter signed by most of the leaders of the medical. profession in Great Britain and Ireland has been issued to the medical practitioners of these islands inclosing a petition for signature. The petition is to the central education authorities of the United Kingdom and asks them "to consider whether it would not be possible to include in the curricula of the public elementary schools and to encourage in the secondary schools such teaching as may, without developing any tendency to dwell on what is unwholesome, lead all the children to appreciate at their true value healthful bodily conditions as regards cleanliness, pure air, food, drink, &c." The petition goes on to state that in the opinion of the petitioners the most prominent subject is "the question of the nature and effects of alcohol." " We are quite at one with the signatories of the circular as to the necessity for teaching children these matters, for the children of the present day will be the fathers and the mothers of the next generation, and it is well to make a beginning, but the task at present seems rather hopeless. Those classes of society which at the present time are most injuriously affected by unhealthy conditions are the very classes which are most prolific. They live in the most unhygienic circumstances, they sleep seven or eight of all ages and sexes in one small room, and as for alcohol, who can wonder that they try to drown sorrow for at least a few hours in the temporary euphoria which gin produces ? 7 We wish all success to the petition and hope that the educational authorities will take favourable notice of it. But we must own that we are not sanguine of any good results at least in the lifetime of this generation. THE METROPOLITAN ASYLUMS BOARD AND ITS ASSISTANT MEDICAL OFFICERS. WE commented in our issue of Jan. 16th, p. 175, upon the abrupt dismissal by the Metropolitan Asylums Board of certain of its assistant medical officers. That the Board in its action has in the main been actuated by motives of economy we do not doubt, but even if these motives were reasonable and pure-and we are not certain that this is the case-they would be inadequate. The assistant medical officers were invited to serve the Board when the Board was in sore need and should not have been dismissed without proper consideration unless the expense of retaining them bore some impossible relation to general ex- penditure, while their inutility was also not to be denied. The Board ought to be in a position, before taking drastic and ungracious action, to show that it has at the present moment a plethora of medical officers, a thing which does not seem at all clear to those who know the public health of London. It should also be able to foretell that it will not in the near future require again emergency assistants and there is no reason to regard the members of the Board as sound prophets in the least. A complication has now arisen in that certain of the assistant medical officers who have been dismissed with grave want of courtesy at a month’s notice are actually in possession of agreements which may make the action of the Board illegal. Certain of the dismissed officers have taken legal advice on their position under their contracts with the Board, with the result that they are, we believe, prepared to test the course pursued by the Board in a court of law. If they are driven to this extremity they will be right to exact from the Board

THE METROPOLITAN ASYLUMS BOARD AND ITS ASSISTANT MEDICAL OFFICERS

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378

upon the London County Council in accordance with the

objects of that association.

ROYAL COLLEGE OF PHYSICIANS OF LONDON.

Dr. Horace Dobell of Parkstone Heights, Dorset,formerly of Harley-street, London, has presented Z500 inConsols (cumulative) to the Royal College of Physicians ofLondon, for the promotion of original research into the

ultimate origin, evolution, and life-history of bacilli and

other pathogenic micro-organisms. The conditions are thatthe President and Censors of the College shall select a

lecturer once in every two years who shall give a lecturerecording original researches on the above subject made byhimself and others and that he shall receive a fee of .B50for so doing. These lectures are to be continued bienniallyso long as a sufficient amount of the 9500 and itsaccumulated interest remains. The first lecture will bedelivered in November, 1904, by Dr. E. Klein. The Milroylecturer for 1905 is Dr. Thomas Morison Legge, one of HisMajesty’s inspectors of factories, who has taken as his

subject Industrial Anthrax.

THE ADULTERATION OF COD-LIVER OIL.

WE are indebted to Mr. E. J. Parry, B Sc., F.I.C., for acommunication in which he states that the great scarcity ofcod-liver oil during the past year or so, accompanied byfamine prices on the market, has been responsible for anenormous amount of adulteration in this product. Variousadulterants have from time to time been recorded but at

the present time " low-grade fish oils other than the

genuine cod-liver oil are almost universally found in adul-terated samples. There is at present, Mr. Parry states,and he is a well-known authority on the subject, a very briskdemand for empty cod-liver oil barrels and he has been ableo trace enormous numbers in one place. The originalmarks are obliterated and the barrels are re-painted and re-marked and eventually three barrels of genuine cod-liveroil re-appear on the market as five and the stock of sharkoil is correspondingly diminished. Such transactions he hasbeen able to trace from beginning to end. As regardsexamination a trained nose is of considerable help. The,tests given by the British Pharmacopoeia are practicallyuseless except in so far as they bring the adulterants

within a certain group on account of a specific gravitylimit and they exclude oils which freeze at 32° F. in

two hours. Again, the specific gravity, the saponificationvalue, and the iodine absorption figure give no useful indica-tions except when taken in conjunction with other figures.The amount of free acid present in the samples, theindex of refraction, and certain colour reactions do givein some cases most valuable information. Mr. Parry hasfound that of the 58 samples examined by him during thepast year 21 proved to be pure, nine doubtful, and 28 wereclearly adulterated. Altogether the results show that thereis an enormous amount of adulterated cod-liver oil on themarket and Mr. Parry’s experience is in complete agreementwith that of other analysts. A large proportion of thisadulterated oil is undoubtedly used in preparations of cod-liver oil, such as cod-liver oil and malt extract and emulsions.The percentage of cod-liver oil in such preparations has beenfound to be as low as from 7 to 9. Mr. Parry suggests thatthis adulteration of cod-liver oil gives an admirable opening tophysicians to consider, in view of the difficulty of dependingon the supplies of cod-liver oil, whether its virtue as a

medicine is really existent in any special sense, or whether itis more or less traditional and therefore much exaggerated,or, in other words, whether it is not as a fat of animal originthat cod-liver oil enjoys a reputation which it ought to sharewith other animal fats. It is open to question, we think,whether cod-liver oil has any specific virtues other than those

of an easily digested fat. All the same, we trust that our

authorities who are responsible for the practical applicationof the Sale of Food and Drugs Act will make a promptinquiry into this matter and take steps to stamp out yetanother barefaced imposition.

THE TEACHING OF HYGIENE IN SCHOOLS.

A CIRCULAR letter signed by most of the leaders of

the medical. profession in Great Britain and Ireland hasbeen issued to the medical practitioners of these islands

inclosing a petition for signature. The petition is to

the central education authorities of the United Kingdomand asks them "to consider whether it would not

be possible to include in the curricula of the publicelementary schools and to encourage in the secondaryschools such teaching as may, without developing anytendency to dwell on what is unwholesome, lead all thechildren to appreciate at their true value healthful bodilyconditions as regards cleanliness, pure air, food, drink,&c." The petition goes on to state that in the opinionof the petitioners the most prominent subject is "the

question of the nature and effects of alcohol." " We are

quite at one with the signatories of the circular as to

the necessity for teaching children these matters, for thechildren of the present day will be the fathers and themothers of the next generation, and it is well to make a

beginning, but the task at present seems rather hopeless.Those classes of society which at the present time are mostinjuriously affected by unhealthy conditions are the veryclasses which are most prolific. They live in the most

unhygienic circumstances, they sleep seven or eight of allages and sexes in one small room, and as for alcohol, whocan wonder that they try to drown sorrow for at least a fewhours in the temporary euphoria which gin produces ? 7 We

wish all success to the petition and hope that the educationalauthorities will take favourable notice of it. But we must

own that we are not sanguine of any good results at least inthe lifetime of this generation.

THE METROPOLITAN ASYLUMS BOARD AND ITSASSISTANT MEDICAL OFFICERS.

WE commented in our issue of Jan. 16th, p. 175, upon theabrupt dismissal by the Metropolitan Asylums Board ofcertain of its assistant medical officers. That the Board in itsaction has in the main been actuated by motives of economywe do not doubt, but even if these motives were reasonableand pure-and we are not certain that this is the case-theywould be inadequate. The assistant medical officers wereinvited to serve the Board when the Board was in sore

need and should not have been dismissed without

proper consideration unless the expense of retainingthem bore some impossible relation to general ex-

penditure, while their inutility was also not to bedenied. The Board ought to be in a position, before

taking drastic and ungracious action, to show that it hasat the present moment a plethora of medical officers, a

thing which does not seem at all clear to those who knowthe public health of London. It should also be able to

foretell that it will not in the near future require againemergency assistants and there is no reason to regard themembers of the Board as sound prophets in the least. A

complication has now arisen in that certain of the assistantmedical officers who have been dismissed with grave want of

courtesy at a month’s notice are actually in possession of

agreements which may make the action of the Board illegal.Certain of the dismissed officers have taken legal advice ontheir position under their contracts with the Board, with theresult that they are, we believe, prepared to test the course

pursued by the Board in a court of law. If they are drivento this extremity they will be right to exact from the Board

379

everything to which they are legally entitled for wrongfuldismissal and for public discredit, while the public will turnan observant eye on the manner in which the affairs of the

Metropolitan Asylums Board are managed. We all know ofthe grave waste of money that has taken place in certainof the building operations of the Board and can quiteunderstand that economy is a necessity, but we do notappreciate in what way the cause of economy will beserved by under-staffing the hospitals of the Board or by ’,

attempting to obtain the unpaid assistance of young gentle- men who cannot have had any opportunities of learning Itheir duties. The economy of the Board will appear verydoubtful when, as may be likely if the present course ispersisted in, it is again compelled to invite the assistanceof the medical profession, only to find that no one cares to goto the aid, at any rate without very high pay, of a body thegratitude of which is so fleeting. The Board will presumablytake legal advice about the claims of those of its assistantmedical officers who know that they have been treated

illegally as well as meanly. Even if the Board should berecommended by its lawyers to contest the claims we holdthat it would be wiser to reinstate the dismissed officers.For otherwise we foresee that the Board will find it verydifficult to obtain medical service.

THE SURGERY OF CEREBRAL TUMOURS.

THE reaction which followed the indiscriminate resort to

operation for cerebral tumours 15 years ago which wasstimulated by the publication of the successful cases of

Horsley and Godlee, has led to an ultra-conservative attitudetowards operation by many neurological surgeons and phy-sicians. The proportion of cases of cerebral tumour suitablefor radical surgical treatment has been estimated by variouswriters at from 2 to 12 per cent. According to Allen

’Starr about 7 per cent. of all cases of cerebral tumour are

operable. With improvements in the methods of cerebrallocalisation and of technique during recent years operationhas become safer and the proportion of operable cases hasincreased to a slight extent. In the American Journal of theMedical Sciences for December, 1903, Dr. George Woolseyof New York gives an account of the lessons to be drawnfrom the recorded cases of cerebral tumours (includingfive cases personally observed) operated on and reportedduring the past five years-a total of 101 cases-witha view to determine whether the results do not justify aless conservative attitude towards their operative treatment.The cases reported in the five years (since 1898) indicate,adds Dr. Woolsey, "that a more hopeful view may be takenof the surgery of cerebral tumours." In the series of 101collected cases 12 showed the presence of cerebral tumoursin the frontal region, including the so-called motor area.

In eight of these the tumours were in the prefrontal lobeand presented the characteristic group of physical andmental symptoms, of which a ’special account was given inTHE LANCET some years ago. Since then Schuster has pub-lished an analysis of 775 cases of tumour of the brain accom-panied by psychic disturbances and has shown that tumoursof the pre-frontal lobe produce dementia and moral deteriora-tion more often than tumours elsewhere in the cerebrum.Gianelli and von Bruns have also referred to the specialmental disturbance accompanying such lesions of the

brain. All of the eight cases of tumour limited to the

prefrontal lobe only, which were collected by Dr. Woolsey,showed, irrespectively of the side involved, symptoms ofJnental disorder and moral perversion. In the parietalregion five cases of tumour were recorded. All these

presented definite localising symptoms and in four of themthese symptoms included astereognosis. Three cases of

1 The Symptoms of Tumours of the Frontal Lobe of the Brain,THE LANCET, June 29th, 1901, p. 1848.

tumour occurred in the occipital lobe of the brain. In allthree there was homonymous hemianopsia which, saysvon Bruns, alone or associated with signs of visual irritationor hallucinations or of word-blindness is characteristic oftumour of the occipital lobe. This is confirmed by the casescollected by Dr. Woolsey who sums up his conclusion interms to the effect that tumours in the prefrontal, parietal,and occipital areas are as localisable and operable as

tumours of the Rolandic or " motor area, and that theresults of operation in the former have been quite asgood as in the latter. The number also of operationson tumours in regions other than the motor area has

largely increased in the last five years and the results

justify the extension of surgical operation to regionsoutside the motor area. Summarising the diagnostic featuresof cerebral tumours Dr. Woolsey states that persistent head-ache is the most constant symptom and that it occurredin 90 per cent. of the collected cases. Early optic neuritis("choked disc") was mentioned as present in 84 per cent.Vomiting and vertigo were present respectively in 33 percent. and 22 per cent. of the cases. In addition to these

general symptoms and to the special localising symptoms-local paralysis and tenderness to local pressure on the scalp-the importance of the x rays in diagnosis is insisted on.In many cases the results have been positive and justify theuse of this method. The indications for operation are

imperative, says Dr. Woolsey, when the tumour can be

satisfactorily located in a region accessible to surgicaloperation and when there is no evidence that the

growth is multiple or malignant in nature. The weightof evidence was also in favour of operation upon gum-mata of the brain, since antisyphilitic treatment mighttemporarily improve the symptoms but rarely, if ever,caused the entire absorption of the gumma. When severeheadache and rapid loss of vision were noted, but localisingsymptoms were absent, trephining was advised as a palliativemeasure to give relief, which was often considerable, to thepatient. But the temptation to make exploratory incisions orpunctures in search of the tumour should, says Dr. Woolsey,be resisted. As regards prognosis the mortality in allcases operated on for cerebral tumour, according to the

statistics of Chipault and of Allen Starr, was about 56 percent. Selecting the cases in his records where an exactlocalisation was made Dr. Woolsey finds that the mortalitywas 22 7 per cent., as against 46 per cent. among the casesnot exactly localised. In palliative operations and wherethe tumour cannot be found it is advised that the boneshould be removed from the flap to relieve intracranial

pressure and that a thin plate of celluloid should be intro-duced to prevent union of the scalp with the dura mater.The results varied, concludes Dr. Woolsey, from a nearlycomplete cure to the relief of the distressing pressuresymptoms but in 6 per cent. of the cases no improvementfollowed.

____

ARSENIC IN BEER : ACTION FOR DAMAGES.

IN the action brought by Messrs. Bostock. and Co. of

Liverpool (the firm who supplied sugar contaminated witharsenic to brewers for making beer which caused an

epidemic of arsenical poisoning) against Messrs. JohnNicholson and Sons of Leeds to recover damages forsupplying sulphuric acid containing arsenic judgmentwas given in favour of the plaintiffs, but the questionsof damages and as to how judgment should be enteredwere deferred. The case presents, of course, many points ofinterest in connexion with the supply of uncontaminatedfood which it will be proper for us to discuss at a futuretime. The award not having been given it is not possibleto say to what in effect the judgment amounts. Mr.Justice Bruce decided that there was a contract for the