1005THE PREVENTION OF SMOKE IN LONDON AND IN PROVINCIAL TOWNS.

to this digestive disturbance. Mr. REGINALD HARRISON I

confirmed this statement by a recountal of his personal : a

experience, for even in small doses and taken with milk 1

or butter it had given rise to an acute attack of indigestion. E

So constant was the association that Mr. HARRISON was able 1

to recognise the presence of boric acid in food by the occur- irence of a sudden attack of dyspepsia. We may accept it l

therefore as proved that boric acid can cause indigestion (

with the production of much flatulence. Mr. HARRISON has 1

written us a second article, appearing in THE LANCET of 4

Sept. 22nd last, p. 787, in which he argues that this dyspepsia iand this flatulence are extremely likely to be exciting causesof appendicitis, for the distension of the caecum will stretchopen the mouth of the appendix and so may enable fsecal I

matter and micro-organisms to enter it. In the annual reportof the medical officer of health of the borough of Stepneysimilar arguments are used in favour of the assistance whichboric acid may give in the production of appendicitis. It

may be agreed firstly that boric acid can cause dyspepsia andsecondly that a severe dyspepsia may act as an excitingcause of appendicitis. The only link needed is the proofthat foods are liable to contain sufficient boric acid to set upan irritative dyspepsia. What quantity of boric acid mayfoods contain ? 7 The Departmental Committee appointedto inquire into the use of preservatives and colouringmatters in the preservation and colouring of food issued

a report in 1901, though no action has been taken bythe legislature to introduce a Bill to carry out the recom-mendations of the Committee. It was therein suggestedthat the only preservatives used in butter should be boricacid which should not be used in a larger proportion than0’5 per cent. In one case examined in Stepney there wasover 1 per cent. of boric acid in butter, and if two and ahalf ounces of butter were eaten in the day more than12 grains of boric acid would be taken. Dr. WILEY Of the

United States Board of Agriculture has come to the con-clusion from experiments which he has made that eight

, grains a day are too much for an average man to ingestregularly. It is, however, not only in butter that we

find boric acid, it is found in milk and cream, in

ham, bacon, and sausages. So that the total amount of

boric acid taken may be very great. In milk especially isit very common. The farmer adds some so that the milk

may travel well; the wholesale dealer adds some more thatit may not turn while in his possession ; and the retailercontributes his portion also. In the Times of Sept. 7th

there appeared a report of a case in which a Bradford

fishmonger was charged with selling shrimps which con-tained 105 grains of boric acid to the pound. Whether a

man is likely to eat as much as half a pound of shrimps,as was suggested by the medical officer of health, we hardlylike to determine, but we can well believe that he could takesufficient boric acid to disturb his digestion.

It must be confessed that all observers are by no meansMianimous in ascribing harmful effects to boric acid. A

few maintain that boric acid and borax exert no

harmful influence on the alimentary canal and foremostamongst these is Professor OSCAR LIEBREICH of Berlin. In

1899 he published a treatise on this subject and he madea further contribution in 1902. In these works he adduced

amch experimental proof that both of these drugs were

harmless and he criticised the evidence brought forward

against boron compounds. While allowing that some of

the cases cited against these substances will not stand

examination we do not think he has succeeded in disprovingthe statement that in many cases boric acid does give riseto disturbance of the alimentary canal. Professor W. D.

HALLIBURTON, in giving evidence before the departmentalcommittee appointed to- inquire into the use of preserva-tives and colouring matters in the preservation and

colouring of food, stated that the ideal course would be

to prohibit all preservatives, and though this is perhapsUtopian the greatest care should be taken that onlythose preservatives are employed which are likely to

do the least harm and the percentage should be

strictly limited by law. At the present time many

magistrates decline to convict unless the prosecution canbring forward evidence that the amount of preservativefound must be injurious to health. This proof is often

impossible though the probability of harm following may be

very great. Without agreeing that the connexion betweenthe increasing use of boron compounds in food and the

increase in the frequency of appendicitis has been provedwe may yet acknowledge that the suggestion has much to

support it and deserves further examination.

Annotations.11 Ne quid nimis."

THE PREVENTION OF SMOKE IN LONDON ANDIN PROVINCIAL TOWNS.

UNDER the above heading in an annotation in THE LANCETof Sept. 29th, p. 887, we drew attention to the appallingstate of the air in the manufacturing district known as" the Black Country," lying between Wolverhampton andBirmingham, owing to the constant wanton discharge ofblack smoke from the factory chimneys which aboundin that district. We asked why such a disregard for the

purity of the air and for the health of the people livingin the vicinity of these smoke-vomiting factories was

tolerated by the State. We learn that our remarks haveraised some indignant replies from those who are

responsible for this abomination. Their defence is that

they are exempt from the operations of the Public

Health Act, the 3;,4th section of which sets forth that

" nothing in this Act shall be construed to extend to

mines of different description so as to interfere with,or to obstruct, the efficient working of the same, nor tothe smelting of ores and minerals, nor to the calcining,puddling, and rolling of iron and other materials, nor to theconversion of pig-iron into wrought iron, so as to obstructor interfere with any of such processes respectively."But it is against this exempting clause that we urgentlyprotest. Surely a remedy can be found for this evil whichwill not serionsly interfere with trade interests. We ventureto think that if it were proved that these filthy outpouringswere a menace to the quality of mining products, foundryproducts, or any other of the products of the Black Countrythe nuisance would be speedily abated. The manufacturers’view seems to be that the intense pollution of the air withsmoke and noisome smells must be tolerated even at the

expense-ethe public health, because otherwise the in-

dustry and with it the labour of thousands must suffer.That is a view to which we cannot subscribe. Thatsmoke can be prevented without putting a stop to

1006 ADVERTISING AND DENTISTRY.

manufacturing processes has been proved by the resultsobtained by manufacturers elsewhere who show some regardfor the health and the well-being of their workpeople. Sofar as the manufacturers in the Black Country are con-cerned we were quite prepared to hear that our remarks

had fallen upon stony places but none the less we call uponthe legislature to rescue those who are obliged to live

in such places from breathing every day of their lives

an atmosphere made dark, filthy, and loathsome by the out-pourings of factory chimneys. We do not exaggerate thepicture, for we have received ample confirmation of our

remarks from those who have to live amongst these evilsand who witness their appalling effects on life and property.The following is an extract from a letter recently receivedfrom a correspondent living in the Black Country. He

writes :-

Your most useful article is going to be discounted and the wholematter ignored once again. But the summary of these interviews[our correspondent refers here to certain articles which appearedin the local press] with Midland manufacturers did to my mindmost certainly confuse several important issues. It is to con-

fuse our issue (1) to say that any action has been taken in theinterest of the health of the community when that action wouldnot have been taken at all if profits had been jeopardised ; (2) tosay in one place that steps had been taken to cleanse the airand in another to say that smoke-laden air is healthy and thereforeneeds no cleansing ; and (3) to suggest that smoky air and air ladenwith chemicals is healthy when modern medical science teaches withauthority that the best air is pure air. I will endeavour to illustrateby a few examples what occurs here (Oldbury, one of the places men-tioned in THE LANCET). With the barometric conditions favourableall cold and smooth surfaces (lamp-posts, &c.) are covered with aniridescent slime (due to the action of sulphuretted hydrogen on thepaint). Constantly in walking through the streets one’s eyes are

bombarded with little drops of hydrochloric acid. One smells chlorinegas, bisulphide of carbon, and various ammoniacal and sulphurby-products. Houses stand right under the chemical chimneys,the paint on these houses turns blue, the nails in their roofscorrode. Frequently the copper in my room turns black in a

night and the smell is extremely disgusting. The chief argumentin favour of the manufacturers is the low death-rate as com-

piled by the medical officers. Now it is a strange thing that allthe medical men are strongly against the present state of things andnever quote the low death-rate as a palliative. They consider that thedirty atmosphere by clogging the lungs decreases vitality and soby a cumulative process renders a man liable to the attacks ofdisease. It seems to me that this is certainly borne out bythe few really old people we bury; by the number of peoplewho die between 60 and 70; by the state of decrepitude into whicha man speedily falls if he exceeds the age of 65. I have not putthis argument into the form of a statistical table. I would do so ifyou like. There are plenty of people who would rejoice to see thematter carried further.

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ADVERTISING AND DENTISTRY.

THE question of advertising by certain dentists is a con-stant source of vexation to those who have the welfare oftheir profession at heart. The British Dental Association

has, we believe, on more than one occasion approached theGeneral Medical Council, urging that advertising by regis-tered dental practitioners should be considered " unpro-fessional conduct." The General Medical Council does not,however, appear to possess the power to prevent advertisingexcept when the advertisement is of an objectionablecharacter and when the individual claims a superiorityover other practitioners. There is another type ofadvertisement which is allowed to run rampant-namely,that in which some claim is made to the invention ofan instrument, the circulars ccntaining the information

being accompanied by testimonials. A circular of thischaracter has recently been brought to our notice, havingbeen pushed under a layman’s door in Bradford. Thecircular is issued by Messrs. Forshaw and Ellison, dentalsurgeons, and is the puff of a tooth forceps designedby "Mr. Chas. F. Forshaw, D.D.S.exam." Now this

I

advertisement sheet contains 13 testimonials, of which adozen are given by medical men, and in nearly all

cases the qualifications of the testimonial givers are

printed in addition to their addresses. We cannot helpfeeling that some of those who gave the testimoni Ûs wereunaware of the use to which they would be put and areprobably ignorant of the manner in which the advertise-ment is circulated. It is to be hoped for the dignity

of the medical profession that they will hasten to dis-sociate themselves from this vulgar publication. Perhaps,however, the givers of the testimonials are proud to.

be associated with Charles Frederick Forshaw, since

we find from the biographical notice which we have

received that he is D.C.L., LL.D., D.D.S., of what uni-

versity or universities we are not told. It would be of

interest to have this information as well as to know his

qualifications for being a member of the Dublin Society,a Fellow of the Irish Antiquarian Society, a Fellowof the Royal Historical Society, and so on. From his

biographical notice we find that amongst other things heis the author of numerous booklets, poems, ballads, andso forth, and that one of his pastimes is "rambling inpursuit of antiquities." Perhaps his forceps is the resultof such a ramble. We refer to this eloquent notice ofMr. Forshaw because we feel sure the scientific dentalworld must be curious to know more of a man concerningwhom " Who’s Who " has so much that is inspiring to say.By the bye, if we remember rightly the details for " Who’sWho" are generally obtained from a little form sent to a

person to fill in himself. -

A PERSONAL. EXPERIENCE OF POISONING BYFUMES FROM A CHARCOAL FIRE.

A PERSONAL experience of illness by a medical man isalways of interest and often of peculiar value. In an

ordinary case we have to rely upon the accuracy of the

patient in his description of his symptoms. But when the

patient is a medical man there is the great advantage thatthe symptoms can be described by a trained observer. Theinstances in medical literature in which members of the

profession have described their own cases are not numerous,.In the Edinburgh Medical Jo2crnccl for September Dr. R. A.Fleming has described a personal experience of poisoning bycharcoal fumes. He was stopping at a hotel in the smokinglounge of which there was a charcoal portable stove notconnected with the outer air by any pipe. He remained

up correcting proofs for two and a half hours after the otherguests had retired. On going upstairs he felt palpitationwhich he attributed to over-smoking. On awaking in themorning he had severe headache which rapidly passed off.On the following night he spent two hours in the loungeafter the other guests had retired and worked as before.The windows were all closed. At first he noticed a disagree.able feeling of choking suggestive of incipient pharyngitisand cold in the head. Although this did not pass away itwas followed by a sense of exhilaration. The work donewas up to the usual standard. When he rose palpitationbegan. This increased as he climbed two flights of stairson his way to bed. When he reached his room the palpitationwas most disagreeable and was accompanied by tinnitus.The heart was beating at great speed but graduallyseemed to beat more and more feebly until two or threeminutes after beginning to undress when he lost con-

sciousness and fell on his back. When he recoveredhis wife was bending over him and he had turnedround and was endeavouring to get up. He felt a

burning sensation in the face but had no feelingof sickness or of the clammy sensation which is sc-

commonly associated with ordinary fainting. His wife’saccount was that he lay on his back with staring eyes,flushed cheeks, and rapid and noisy breathing for one or two-minutes before regaining consciousness. With the help ofsome brandy he with difficulty got into bed. In bed he had

repeated attacks of palpitation and very rapid heart’s action,the speed and force soon diminishing. Towards the end ofeach attack there was an overwhelming feeling of impendingdeath. In all there were about a dozen attacks. The other

symptoms were severe frontal headache and after two or three