736

constitute for the careful reader something of a liberal educa- bE

tion," conveying much useful, if recondite, knowledge, ar

historical and social, and conducing to the masculine and S(

robust development of character traditionally associated with tb

the English name. ____

w

KING EDWARD’S HOSPITAL FUND FOR LONDON. be

THE annual meeting of the President and GeneralCouncil of King Edward’s Hospital Fund for London was

held at Marlborough House on March 10th, His RoyalHighness the Prince of Wales, President of the Fund,being in the chair. In order that there may be as little

delay as possible in the distribution of the money at the

disposal of this Fund a meeting of the council, which isreally a preliminary annual meeting, is held at the

end of each year, and the salient points of the pro-ceedings on Thursday last will be found in our Annus

Medicus for 1909 (THE LANCET, Dec. 25th, p. 1927) andin our issue for Jan. 1st of the present year (p. 59). The

total receipts for the year 1909 were 258,926 3s. 2d. This

sum was made up as follows: Donations, £12,145 bs. 11d. ; Icontributions to capital, £ 279 3s. 10d together with ’,£13,782 5s. 8d. net profit on realisation of securities ; annualsubscriptions, £23,615 2s. 7d. ; contrioution of the League ofMercy, £19,000 ; from the Lewis estate (exclusive of interest),S75.000; legacies (including interest on Lewis legacy),£46,401 18s. 5d. interest from investments, £68,502 5s. 9d. ;together with £200 from the trustees of the Bawden fund.The amount distributed was £150,000, being an increase of£10,000 over the sum distributed in 1908. The total sumdistributed amongst hospitals, convalescent homes, and con-sumption sanatoriums since the foundation of the Fund nowexceeds £1,000,000, the exact figure (after deducting grantsto the extent of £4659 16s. 7d. that have been allowed to

lapse) being £1,134,916 8s. 5d.

PURPURA HÆMORRHAGICA DUE TO BENZOLPOISONING.

IN the Bulletin of the Johns Hopkins Hospital forFebruary, Dr. R. Selling has reported a remarkable seriesof cases of benzol poisoning, which show the danger to

which workers with this substance are exposed and that

removal from its influence may not be sufficient to preventa fatal result. The cases occurred among workers em-

ployed in the "coating room" of a factory for the manu-facture of tin cans. A mixture of rubber, resin, and

colouring matter dissolved in commercial benzol was usedas a substitute for solder. 23 hands were employed inthe room : 5 men as machinists, 4 girls as inspectors, and 14girls between the ages of 14 and 16 at the coating machines.Amongst the latter most of the cases, and all the seriousones, occurred. One half of these girls fed the can coversto the machines, which automatically coated them about

the margin with a thin layer of the mixture, while theother half removed the covers. The covers were then piledin trays, inspected, and allowed to dry by the evaporation ofthe benzol. Ten gallons of benzol a day were used. In

spite of wide open windows and excellent ventilation a strongodour of benzol pervaded the neighbourhood of the machinesand a weaker odour the rest of the room. The following isan outline of one fatal case. A medical practitioner noticedon June 1st, 1909, that a girl, aged 14 years, whose mother hewas attending for pneumonia, had marked pallor and a purpuriceruption, though she felt well. Soon afterwards haemorrhagesoccurred from the mouth and nose, and she was admittedinto the Johns Hopkins Hospital on June 28th. She hadbeen working at the coating machine for about four monthsduring which she had no symptoms. She ceased work inconsequence of her- mother’s illness. About a month

before admission she noticed blue spots on her arms.

and legs which came out slowly, a few at a time.

Soon afterwards bleeding from the gums, nose, andthroat commenced. A few days before admission therewas severe haemorrhage from the throat, which was con-trolled with difficulty. For a week she had been in.

bed, the chief symptoms being weakness and giddi-ness. On admission she was well nourished, but her skinshowed a waxy pallor, and her mucous membranes were verypale. There was a general eruption of macules from 1 to a.millimetres in diameter, varying in colour from purplish-redto blue. On each shin was a large ecchymosis. The gums.were slightly bleeding, but were not spongy. Extending fromthe left tonsil to the right anterior pillar of the faeces wasa brown necrotic-looking mass surrounded by an inflamedborder. This had been the site of severe haemorrhage, whichwas controlled by the application of ferrous sulphate.The edge of the liver was felt 2 centimetres below

the ribs. The fundi were pale and showed numerous

haemorrhages and neuro-retinal oedema. Continuous but

slight oozing of blood from the mouth and throat took placeand a few fresh purpuric spots appeared. Blood examina-tion showed 1,090,000 red corpuscles and 480 white percubic millimetre, and 11 per cent. of hæmoglobin. The-

temperature ranged from 99.8° to 104.6° F. On July 3rdthe patient passed into a state of stupor, from which shecould not be roused, and death occurred on the 6th. The

necropsy showed fatty degeneration of the heart and liver-

and an aplastic condition of the bone marrow. Two other

girls were also admitted into the hospital with similar sym-ptoms, of whom one died. Examination of the other

employees of the coating-room showed that two men andtwo girls had a few purpuric spots but were free from othersymptoms. Blood examination revealed in them slightansemia and leucopenia (the leucocytes varying from 3900 to5200). A series of similar cases which occurred in a factoryat Upsala for the manufacture of bicycle tyres has beendescribed by Santesson. I Benzol was used as a solvent for

the rubber. In these cases there was a marked purpuriceruption and four were fatal. It is noteworthy that thedisease may progress in spite of the withdrawal from theinfluence of the poison.

--

THE MONTH OF FEBRUARY.

THE month of February of this year differed greatly fromthe corresponding period in 1909 both in England and on thecontinent of Europe, the temperature having been as muchas 40 or 50 higher in many parts of this country, about 70 atParis, Rome, Florence, and Biarritz, and 90 at Berlin.

Throughout England and the adjacent regions of France itwas also much wetter. rain falling with great frequency,and the total amount being far more than the normal. In

spite of the frequent rain, however, fine, clear intervals wereso numerous that over the kingdom generally the sunshineexceeded the average. In London (Westminster) the totalnumber of hours (54) was 30 hours in excess of the normalfor February. At Torquay, which appears to have been thebrightest spot in the kingdom and also one of the most rainy,the climatic conditions were still more remarkable. The

sun shone during 117 hours, which is only seven hours lessthan its record for February, while the total amount ofrainfall was as much as 5.91 inches. Only one day passedwithout a measurable quantity of rain, and the very appre-ciable amount of 0-04 inch or more fell on 23 days. Thetotal of 5’91 inches has only been exceeded in February onceduring the past 34 years. The Scilly Isles maintained theirunrivalled reputation for equability of temperature, the

1 Archiv für Hygiene, 1897, p. 336.

737

mean range between the day and night being only 60

and the highest temperature 520 in the shade. All the

resorts in Southern Europe experienced greater warmthduring the daytime, but the nights at Scilly were muchmilder than those at Nice, as mild as those at Biarritz andPalermo, and nearly as mild as those at Naples and Palma.The night, temperature on the south-west coast of Englandgenerally was about equal to that of Florence and Nice.At Lisbon, Algiers, and Malta the temperature of the nightswas as high as that of the afternoons in the warmest part ofthis country. Although Berlin was very mild for the timeof year, it was colder than any part of the English Midlands,and Brussels was colder than Harrogate. The driest resorts

in the southern regions were Lisbon, Nice, and Palma, thelast named recording rain on only three days, while the

wettest were Brussels and Biarritz, where rain fell on atleast 24 and 20 days respectively.

ALCOHOL AS A FOOD.

IN spite of an immense amount of experience and investi-gation the value of alcohol in the treatment of disease stillremains a subject of acute controversy. The modern ten-

dency is to restrict its field of utility, and some authoritieseven go so far as to deny that it is of any use as a stimulantand regard it simply as a narcotic. That in a limited quan-tity it is a food is open to less doubt. In the last few

years some important investigations have been made on

the subject, principally by German writers. They areembodied in a useful paper contributed to the Yale

Medical Journal for January by Dr. M. M. Scarbrough. The

combustion of a moderate amount of alcohol, say, a

quart of claret, 7 ounces of whisky, 12 quarts of beer, or2t ounces of absolute alcohol yield about 500 calories ofenergy, about a fifth of the energy required by a person atrest. The first question that arises is, What proportion ofalcohol taken by the mouth is utilised, and what wasted ?Recent American investigations show that when 6 or 7

ounces of whisky are taken 98 per cent. is oxidised and 2

per cent. escapes by way of the breath, urine, fasces,or skin. German investigators, such as Rosemann, assertthat as much as 13 ounces of whisky are thus consumed bythe body. How does the availability of the energy yieldedby alcohol compare with that of other foods ? In the case

of proteins 22 per cent. escapes in the urine as incom-

plete oxidation products, and 8 per cent. in the faeces,unused. Fats are oxidised to the extent of 95 per cent.

and carbohydrates to the extent of 98 per cent. Thus

alcohol stands on the same plane as sugar and starch in itsavailability for the production of energy. The question maybe asked, Does alcohol interfere with the digestion and

metabolism of other foods ? Chittenden and Mendel foundthat in dilute solutions it does not retard the digestion ofprotein. Admitting that alcohol is oxidised in the body likeother foods, is its energy utilised or wasted ? On substitut-

ing alcohol for an equivalent amount of fat or carbohydratein a diet just sufficient for the needs of the body wastingdoes not follow, showing that the alcohol is utilised. Thisis also proved by the fact that alcohol, like carbohydrate,has a fat-sparing action. When added to diet only sufficientto maintain weight it will cause the subject to gainweight. Further, like carbohydrate and fat, alcohol isa protein-sparer. This was proved last winter at Yale byexperiments made by Dr. Hilditch on himself under thedirection of Professor Mendel. Kochmann has recentlyshown that alcohol given subcutaneously in moderate

amounts to starving rabbits prolongs life, and therefore

suggests the subcutaneous administration of alcohol in

various diseases. Is alcohol a source of muscular energy ?Tht9 cannot be proved, but there is no reason to suppose that

However, there is evidence that strenuous muscular work,such as athletics, is better performed without alcohol. Thisis explained as due to the effect of alcohol on the nervoussystem. In what circumstances is alcohol valuable as a

food ? T Dr. Scarbrough thinks it is valuable in many con-ditions of malnutrition, as it does not require digestion andis easily and readily absorbed. Further, it is one of the fewfoods which can be given subcutaneously. Its administration

per rectum ought also not to be forgotten, as it is more

readily absorbed even than glucose and weight for weightyields more energy. Lastly, but of great importance,is the use of alcohol in severe diabetes. For yearsthis was known clinically, but whether the value of alcoholwas due to its action as a drug or as a food was not

known. In 1906 Benedict and Torok in studying the originof the acetone bodies in diabetes substituted alcohol for

fat in the dietary and found a marked decrease in the

excretion of acetone, sugar, and nitrogen. At the same

time Neubauer found alcohol of great use in severe

diabetes. He gave daily 12 to 24 ounces of a wine mn-

taining 10 per cent. of alcohol and found regularly adecrease in the output of sugar, acetone, oxybutyric acid, andammonia and total nitrogen. The value of the alcohol is

due to the fact that the organism utilises it as a food,sparing fat and protein, at a time when the tissues cannotutilise carbohydrates. But, apart from diabetes and a fewconditions of malnutrition, there is no evidence that

alcohol is a better food than carbohydrates, and there is

some evidence that it is inferior to them.

ENZYMES IN THE LAUNDRY.

THE word " laundry suggests to the minds of many

people "chemicals, and the laundryman, rightly or wrongly,is often blamed for the holes in our linen and other fabricson the assumption that he employs corrosive bleaches.

Bleaches, however, may be legitimately used for the purposeand without any harm to the fabric whatever so long as theyare scientifically applied and scientifically removed. In

many cases a fabric comes to pieces because of its own inferiorstructure and substance. Nowadays it is common enough tofind showy goods dependent upon mineral loading or otherforeign substances which form, so to speak, the skeleton-ofthe flimsy material. Should the skeleton yield, as it may

do, even to the bland influence of soap and water, the

fabric, having lost its "bones, readily disintegrates andthe laundryman is blamed for using " corrosive acids " or a

machine which attacks material like the devil" "-that

is to say, like the appliance which is used for

breaking up old carpets and cast-off clothing in the

manufacture of mattress stuffing. No doubt the laundry-man is at fault sometimes, but on the whole he is

liable to suffer severely from a misrepresentation of

facts. One of the latest applications of science to

laundry work, to which the stern critics of soda, chlorideof lime, or borax can raise no objection, is the use of diastaseof malt to dissolve out the starch in soiled starched goodspreliminary to washing. As is well known, diastase has thepower of rapidly liquefying starch, converting it into solubledextrin and ultimately malt sugar, which may readily bewashed out of the fabric. In these days, when such power-fully active preparations of enzymes are possible, themethod is likely to become general, and its adoptionwill relieve the laundryman of the odium of being a"chemicaliser." " Generally speaking, however, the hydro-lytic action of the enzyme is the same as that of an acid,but the latter is likely to injure the fabric unless very care-fully used. The biological process can do no harm, andsome day perhaps chemical, agents may be abandoned in