2
900 an Egyptian midwife sitting in an expectant attitude before the supposed patient. We say "supposed" because, as the author of the note points out, it is obvious that the woman is not in labour neither is she quite in the correct position. Examples of the amusing and curious letters that reach the hospital from time to time are given in this number of the Gazette. One correspondent wishes to know whether the hospital has the necessary appliances for testing the specific gravity of a child. The correspondent’s reason for asking this question is that the child is about to be put upon a mixed (meat, &c.) " diet after having been brought up as a ’’ s<7’tc< vegetarian. " Westminster Hospital Gazette for 1’chruar.-In this issue, which seems to have been produced under a new editor, there is an amusing parody on the "House that Jack Built " which has for its theme a certain state of things relating to the office of coroner and medical men. We regret to see the pages of this magazine disfigured by the use of an epithet usually applied to Ananias. That the word is indorsed by the editor is evident from the fact that in one place it appears with the letters (Ed.) placed after it. Manchester Medical Students’ Gazette for March.-The most interesting paper in this issue is ’’ Days of My Youth," by Dr. Frederick Melland, who gives reminiscences dating from the coronation of George IV. Speaking of the surgery of the medical man to whom he was apprenticed Dr. Melland says : : " Our surgery with its multitudinous array of drawers, jars, and bottles (large and small) had served several generations of surgeons, and contained medicines that had not been used for at least 150 years, such as prepared bear-lice, amber, crab’s eyes, coral, robs or the inspissated juice of different fruits and herbs." New Inventions. A PURE ENAMEL FOR BATHS FOR MEDICAL AND DOMESTIC USE, AND FOR SINKS, URINALS, OR VESSELS LIABLE TO CONTAIN CORROSIVE FLUIDS. IT must be admitted that a pure white enamel for baths I for medical and domestic use, hospital sinks, &c., is a de- sideratum and many attempts have been made to produce such an article which would supplant expensive porcelain. We have recently examined a number of model iron baths and basins submitted to us by, and enamelled by the process of, the Pure Enamel Bath Co., Limited, of the Imperial Works, Bromley-by-Bow, E., and we are bound to say that as far as our experiments have gone the results are very satis- factory. It is well known that hitherto there has been great difficulty in making a glaze which will not craze" or crack and which at the same time will resist the action of certain medicated fluids that are extensively employed in special balneological practice. Certain strong saline natural mineral waters, for example, have sooner or later a powerful action upon the ordinary enamels in use. The knowledge of these facts has suggested the institution of a series of experiments upon the new enamel with such agents dissolved in water as corrosive sublimate, carbolic acid, iodine, sulphuretted hydrogen, sulphurous acid, calcium chloride, carbonate of soda, common salt, salts of iron, and a mixture of bicarbonate of soda and hydrochloric acid, which forms the artificial Nauheim bath. Experiments on these lines were ultimately made and with the single exception of sulphurous acid no action upon the surface of the enamel was exhibited, and in this case the acid was in decided excess. With iron salts rust readily deposited upon the enamel which, however, was completely removed by rubbing with moist silver sand with- I out injury to the glaze. In the Nauheim bath it is important to use the bicarbonate of soda in excess, as otherwise the acid is likely to have a corrosive effect upon the enamel. When tablets were used for the production of an effervescent bath there was no action upon the glaze. A so-called sulphur bath (H2S) had no effect whatever upon the enamel ; it preserved a pure white shining surface. It is obvious from this satisfactory result that the enamel is free from lead, as otherwise it would sooner or later show signs of blackening. As a matter of fact, the glaze is entirely free from poisonous metals, and it is important to add that the process of glazing thus involves no injury to the health of the operatives and therefore special regulations which apply to those working with lead glazes have no application. Soap or washing soda is without the slightest deteriorating effect upon the enamel and therefore it is calculated to withstand all domestic usage. Carbolic acid and mercuric chloride are also without any visible effect. Throughout the experiments no sign of "crazing" was observed. The enamel, in fact, does not readily chip owing to the way in which it is welded to the iron. The process of welding the enamel involves a great heat, so that the iron approaches its softening point-the enamel so to speak enters into the iron and the iron into the enamel. Sections of the iron show that this is so-it does not seem possible to detach the enamel or to splinter it ; it is practically indestructible. We are informed that ordinary domestic iron baths may be enamelled by this process within a few hours, so that not more than two days need elapse from the time the bath has been taken away from the house to the time it is returned, finished with a white and brilliant glaze. The method seems to be applicable to a very large number of useful and sanitary purposes The soap tray of the bath may be of cast iron enamelled white by this process, so that it is not distinguishable from solid porcelain, and the tray is so formed and attached, as shown in the accompany- ing illustration, as to allow of the parts being kept thoroughly clean and to obviate the accumulation of the soapy matter which is often a source of trouble and unsightliness. In special cases the pure white enamel may be replaced by an exactly similar process with an enamel of a pea-green tinge which, according to our experiments, is proof against either concentrated boiling acids or alkalies. We found that not the slightest action was evidenced when even concentrated sulphuric acid or caustic soda was boiled in vessels prepared with this greenish enamel. It is therefore acid- and alkali-proof. Fresh urine as well as urine in a state of decomposition also had no effect upon it. Moreover, the enamel appeared to be proof against "crazing." " The unenamelled face of a piece of cast iron was attacked by sulphuric acid but the enamelled side was not acted upon. It would therefore appear that this acid- and alkali-proof glaze will be of great value for sanitary ware ; the sinks in operating theatres, for example, urinals, flushing pans, wash- basins, and, in fact, an infinite number of applications are suggested in which a receptacle with an acid- or alkali-proof surface is required. The appearance of the white enamel is quite brilliant and equal to highly glazed porcelain, while the greenish enamel has the same brilliance but from the point of view merely of appearance it is slightly inferior. Its property, however, of resisting the action of the corrosive fluids mentioned is certainly remarkable.

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Page 1: New Inventions

900

an Egyptian midwife sitting in an expectant attitude beforethe supposed patient. We say "supposed" because, as theauthor of the note points out, it is obvious that the woman isnot in labour neither is she quite in the correct position.Examples of the amusing and curious letters that reach thehospital from time to time are given in this number of theGazette. One correspondent wishes to know whether thehospital has the necessary appliances for testing the specificgravity of a child. The correspondent’s reason for askingthis question is that the child is about to be put upon amixed (meat, &c.) " diet after having been brought up as a’’ s<7’tc< vegetarian.

"

Westminster Hospital Gazette for 1’chruar.-In this issue,which seems to have been produced under a new editor,there is an amusing parody on the "House that Jack Built

"

which has for its theme a certain state of things relating tothe office of coroner and medical men. We regret to see thepages of this magazine disfigured by the use of an epithetusually applied to Ananias. That the word is indorsed bythe editor is evident from the fact that in one place it appearswith the letters (Ed.) placed after it.

Manchester Medical Students’ Gazette for March.-Themost interesting paper in this issue is ’’ Days of MyYouth," by Dr. Frederick Melland, who gives reminiscencesdating from the coronation of George IV. Speaking of thesurgery of the medical man to whom he was apprenticedDr. Melland says : : " Our surgery with its multitudinous

array of drawers, jars, and bottles (large and small) hadserved several generations of surgeons, and containedmedicines that had not been used for at least 150 years,such as prepared bear-lice, amber, crab’s eyes, coral, robs orthe inspissated juice of different fruits and herbs."

New Inventions.A PURE ENAMEL FOR BATHS FOR MEDICAL ANDDOMESTIC USE, AND FOR SINKS, URINALS, ORVESSELS LIABLE TO CONTAIN CORROSIVE

FLUIDS.IT must be admitted that a pure white enamel for baths I

for medical and domestic use, hospital sinks, &c., is a de-

sideratum and many attempts have been made to producesuch an article which would supplant expensive porcelain.We have recently examined a number of model iron bathsand basins submitted to us by, and enamelled by the processof, the Pure Enamel Bath Co., Limited, of the ImperialWorks, Bromley-by-Bow, E., and we are bound to say that asfar as our experiments have gone the results are very satis-factory. It is well known that hitherto there has been greatdifficulty in making a glaze which will not craze" or crackand which at the same time will resist the action of certainmedicated fluids that are extensively employed in specialbalneological practice. Certain strong saline natural mineralwaters, for example, have sooner or later a powerful actionupon the ordinary enamels in use. The knowledge of thesefacts has suggested the institution of a series of experimentsupon the new enamel with such agents dissolved in water ascorrosive sublimate, carbolic acid, iodine, sulphurettedhydrogen, sulphurous acid, calcium chloride, carbonate of

soda, common salt, salts of iron, and a mixture of bicarbonateof soda and hydrochloric acid, which forms the artificialNauheim bath. Experiments on these lines were ultimatelymade and with the single exception of sulphurous acid noaction upon the surface of the enamel was exhibited, and inthis case the acid was in decided excess. With iron saltsrust readily deposited upon the enamel which, however, wascompletely removed by rubbing with moist silver sand with- Iout injury to the glaze. In the Nauheim bath it is importantto use the bicarbonate of soda in excess, as otherwise theacid is likely to have a corrosive effect upon the enamel.When tablets were used for the production of an effervescentbath there was no action upon the glaze. A so-called

sulphur bath (H2S) had no effect whatever upon theenamel ; it preserved a pure white shining surface. It isobvious from this satisfactory result that the enamel isfree from lead, as otherwise it would sooner or later showsigns of blackening. As a matter of fact, the glaze is entirelyfree from poisonous metals, and it is important to add thatthe process of glazing thus involves no injury to the healthof the operatives and therefore special regulations whichapply to those working with lead glazes have no application.Soap or washing soda is without the slightest deterioratingeffect upon the enamel and therefore it is calculated towithstand all domestic usage. Carbolic acid and mercuricchloride are also without any visible effect. Throughoutthe experiments no sign of "crazing" was observed. Theenamel, in fact, does not readily chip owing to the way inwhich it is welded to the iron. The process of welding theenamel involves a great heat, so that the iron approaches itssoftening point-the enamel so to speak enters into the ironand the iron into the enamel. Sections of the iron show thatthis is so-it does not seem possible to detach the enamel orto splinter it ; it is practically indestructible.We are informed that ordinary domestic iron baths may be

enamelled by this process within a few hours, so that notmore than two days need elapse from the time the bathhas been taken away from the house to the time it isreturned, finished with a white and brilliant glaze. Themethod seems to be applicable to a very large number ofuseful and sanitary purposes The soap tray of the bathmay be of cast iron enamelled white by this process, sothat it is not distinguishable from solid porcelain, and thetray is so formed and attached, as shown in the accompany-ing illustration, as to allow of the parts being kept thoroughly

clean and to obviate the accumulation of the soapy matterwhich is often a source of trouble and unsightliness. In

special cases the pure white enamel may be replaced byan exactly similar process with an enamel of a pea-greentinge which, according to our experiments, is proof againsteither concentrated boiling acids or alkalies. We foundthat not the slightest action was evidenced when even

concentrated sulphuric acid or caustic soda was boiled invessels prepared with this greenish enamel. It is thereforeacid- and alkali-proof. Fresh urine as well as urine in astate of decomposition also had no effect upon it. Moreover,the enamel appeared to be proof against "crazing."

" Theunenamelled face of a piece of cast iron was attacked bysulphuric acid but the enamelled side was not acted upon.It would therefore appear that this acid- and alkali-proofglaze will be of great value for sanitary ware ; the sinks inoperating theatres, for example, urinals, flushing pans, wash-basins, and, in fact, an infinite number of applications aresuggested in which a receptacle with an acid- or alkali-proofsurface is required. The appearance of the white enamel isquite brilliant and equal to highly glazed porcelain, whilethe greenish enamel has the same brilliance but from thepoint of view merely of appearance it is slightly inferior. Its

property, however, of resisting the action of the corrosivefluids mentioned is certainly remarkable.

Page 2: New Inventions

901THE MEDICAL MAN, THE CORONER, AND THE PATHOLOGIST.

The Medical Man, the Coroner, andthe Pathologist.

THE LANCET.

-LONDON: .STURDA; MiRCH,8, 1903.

WE publish in another column a paper by Dr. H. H.

LITTLEJOHN, which criticises the system under which

inquests are held and discusses at some length the questionof the efficient performance of post-mortem examinations

made by order of the coroner. No one contends that

the inquiries antecedent to the holding of an inquestare made by such persons or in such a manner as

to insure the holding of inquests in all cases where

inquests are ordered by the law ; and the majorityof our readers will assent to the proposition that the

cause of death should always be established by a

medical man before the burial of the body is permitted.We hold the view that a post-mortem examination

should be made in all cases where doubt exists which

cannot otherwise be resolved, but we are not in accord

with Dr. LITTLEJOHN when he discusses the competencyof medical practitioners in general to conduct the necropsieswhich the coroner may deem it necessary to order. The

writer’s position and experience give weight to his opinionsand being anxious to see all the aspects of the questionventilated we have pleasure in affording to his paper the

hospitality of our columns. We are not, however, able to

accept as matters of universal experience, in England atany rate, all the facts with which his individual observa-

tion has supplied him and from which he draws his

conclusions.

The views which we have ourselves expressed upon the

provisions of the Coroners Act of 1887 for the calling ofmedical witnesses and the holding of post-mortem exami-nations for the purposes of that Act do not implyany opinion on our part that the sections in questicn are

perfect or that they might not after due consideration be

improved. We have, however, pointed out what those sections

lay down and have urged that any alteration in the practiceprescribed should be brought about by Act of Parliament,after discussion in both Houses and after the advice of

the leading members of the medical profession has beenheard, and that radical changes should not be made bycoroners or by local bodies influencing the action of

coroners. The action of individual coroners, some of

whom are medical men and some of whom are lawyers,and all of whom are subject to the influence of

their own opinions, cannot produce the certainty and

consistency which are to be desired in such matters.

Under the existing law provision is made in terms which weneed not repeat for the making of post-mortem examina-tions by local medical men who in ordinary circum-

stances will be general practitioners admittedly of varying

qualifications and ability. Provision is also made for the

obtaining of further expert assistance should the cause ofdeath appear not to have been ascertained fully by those

primarily ordered to be employed. Dr. LITTLEJOHN appearsto consider that the incapacity of general medical prac-

titioners as a body is such that they should never

be intrusted by coroners with post-mortem examinations,and we lay his statements of fact with his deductions

before our readers. Like ourselves they may fail to re-

cognise as typical of the medical practitioner &deg;&deg; an excellent

physician" who "has never made a post mortem in his

life," and may question the accuracy of the assertion that

"very few" students when they obtain their qualification11 have personally performed a post-mortem examination."With regard to this, moreover, we submit that if medicalmen having obtained their right to enrolment upon the

Medical Register are not qualified to make ordinary post-mortem examinations with efficiency a defect has been

exposed in the course of training adopted in medical

schools which is not beyond remedy and which should bemade good.

In the course of his paper it will be observed that Dr.

LITTLEJOHN gives instances of actual necropsies and theirresults. Some of these support the propositions with whichfor the moment he is dealing but hardly lend force to othersof which he treats elsewhere. We may be, for example,in accord with him when he says that ’’ the external

inspection of a body can seldom give a true indica-

tion of the cause of death in cases where persons are

found dead" ; but we should hardly select the case which

he cites of carbolic acid poisoning to support the contention

that a specially qualified and appointed pathologist is neces-

sary in order that post-mortem examinations may be

efficiently held. In such instances as these the coroner

would fail in his duty if he neglected to hold an inquestand thus to establish the cause of death, and the nearestmedical practitioner would deserve all that Dr. LITTLEJOHNsays of him if he failed to supply the necessary information

after making the examination intrusted to him. If in cases

so simple, or in others of greater complexity, the medicalman does not express himself with certainty before the

coroner’s jury it is for the jury to ask for further assistance.We are not aware that medical men are in the habit of

expressing themselves as sure when they are not sure or

when they have no good cause to be sure, and we

do not admit, as Dr. LITTLEJOHN would have us do,that "the majority of medical men engaged in generalpractice are not fitted to conduct medico-legal post-mortemexaminations." We admit, however, on the one hand, thatin certain cases an expert is necessary, while on the other

we maintain that in the great majority of cases which comeunder the notice of the coroner the medical practitionerwho attended the deceased during life is the one who

should perform the necropsy. His knowledge of the

previous history of the case will lead him especially to

investigate certain points which an expert not possessing afull acquaintance with the clinical features observed duringlife might pass over. We see no analogy between this

and the patent absurdity suggested by Dr. LiTTTLEjOHX as aparallel-namely, ’’ that the physician who attends a patientduring the onset of an attack of appendicitis is the best