J~ULY 27, .>y1901I.j190l@]27, ROYAL COMMISSION ON ARSENICALABSENICAL POISONING. LM3DICA.L[M.Tuz Blart'sJOURNAL 2'.!3-) Public Medical Services," observed that it seemed to be a matter of course that after everywar an inquiry into the ROYAL COMMISSION ON ARSENICAL -medical arrangements should be held. The Royal Commis- POISONING. sion sent to South Africa had found some minor defects, but [FIRST REPORT.] on the whole its report was most favourable. But incom- THIS Commission-which is composed of Lord Kelvin, Sir petent critics were not satisfied, and the effect of the injustice William Hart Dyke, Bart., Professor T. E. Thorpe, Mr. Henry with which the service had been treated was shown by the Cosmo Orme Bonsor, Sir Wm. Selby Church, Bart., M.D., and fact that there was at the present moment not a single Dr. Whitelegge, Chief Inspector of Factories-was invited to eandidate applying for admission to His Majesty's Medical ascertain, with respect to and Wales, the amount of Service. He thought it was impossible too say too much in sickness and death caused by arsenic, and how much of the the way of admiration of how Surgeon-General Jameson had sickness and death might have been due to arsenic in beer or met every requirement that had been made on him, and it other articles of food and drink; also how far it was possible seemed to him passing strange that the Government had to safeguard these in the future. The Commission sat allowed that man to leave the ranks of the army, not only eighteen times in London and in Manchester, and examined without the customary recognition given to every one of fifty-one witnesses. Of these witnesses, sixteen were hos- his predecessors, but also without one word of thanks or one pital physicians and medical officers of health, the remainder line of acknowledgement. included chemists, public analysts, brewers' managers, and This toast was responded to by Sir JOSEPH FAYRER, who members of the Chamber of Agriculture. Its conclusions are was followed by Sir THOMAS GALLWVEY, Wh1o gave the toast of summarised under eight headings, which deal with the extent -The Chairman." of the illness caused by arsenic, both in its medical and The names of those present were: Dr. Allchin, Lieutenant- toxicological aspects; the means by which arsenic gains Colonel Anderson, Professor McCall Anderson, J. Anderson, entrance into beer and other articles of food and drink. Lieutenant-Colonel Babtie, V.C., Sir Tllomas Barlow, Bart., A. The extent to which arsenic caused serious ill-health and E. Barker, W. H. Battle, Surgeon-Lieutenant-Colonel Beatson, death may be gauged by the fact that in Manchester and Brigade Surgeon-Lieutenant-Colonel Beattie, F. D. Bennett, Salford alone 3,000 persons suffered. In some districts the Sir W. H. Bennett, L. A. Bidwell, Dr. Barry Blacker, Major poisoning assumed an epidemic form. That the illness was due Bond, Captain Booth-Clarkson, Lieutenant-Colonel Bourke, to drinking beer contaminated by arsenic there is now no Woodhouse Braine, Sir Lauder Brunton, Thomas Bryant, Dr. longer room for doubt. To Dr. E. S. Reynolds, of Manchester, Dudley Buxton, Colonel Cayley, Dr. Paul Chapman, Professor belongs the credit of having demonstrated the presence of J. Chiene, A. H. Cheatle, G. L. Cheatle, Professor W. W. arsenic in beer that had issued from particular breweries. Cheyne, Sir William Church, Bart. (Chairman), Colonel Gor- Immediately steps were taken by the brewers and sanitary don Cleather, H. H. Clutton, R. W. Collum, Lieutenant- authorities to withdraw the beer from sale, and when Colonel Colman, Alfred Cooper, J. Couper, R. M. Cowie, Sur- this was done the epidemic of poisoning came to geon-GeneralMcD.Cuffe, Professor Cunningham, Clinton Dent, an end. Only a few breweries fortunately were inculpated, Surgeon-General De Renzy, Lieutenant-Colonel J. R. Dodd, and to them brewing sugars had been supplied by a single Major A. Dodd, Work Dodd, Dr. Conan Doyle, Lieutenant- firm named in the report. In using the term "brewing Colonel Drake-Brockman, Sir Dyce Duckworth, Bart., Dr. A. sugar," the Commissioners mean glucose and invert sugar, Duncan, General Dunne, Dr. Dunsmure, A. Elliot, Dr. Philip either of which takes the place, partly or entirely, of malt, Frank, Dr. Robert Farquharson, Sir Joseph Fayrer, G. Field, Dr. or it is in the "priming" solution added after the wort has Finlayson, Sir John Furley, Sir Thomas Gallwey, Dr. Clement fermented. The amount of arsenic detected as arsenious Godson, H. Norman Goode, Dr. John Hall, Harford Hartland, oxide in different glucoses varied from O.OI5 per cent. to 0.095 Dr. J. Harper, Lieutenant-Colonel Harris, R. Harrison, Sur- per cent. (I .05 gr. to 6.6 grs. per lb.); in other instances geon-Colonel Harrison, Dr. Hawksworth, H. Herring, Dr. from o.08 to O.I3I per cent. (o.56 to 9.I7 grs. per lb.). In- Hepenstal Ormsby, Dr. Heron, Dr. A. Hillier,' Surgeon- vert sugar contained arsenious oxide, 0.02 per cent., or 1.4 grs. General Hooper, Lieutenant-Colonel Howard, R. C. Jameson, per lb. to o.o62 per cent., or 4.34 grs. per lb. The brewing Surgeon-General Jameson, Major Jerome, Oolonel Johnston, sugar had all become contaminated by arsenic in the Lieutenant-Colonel Keir, C. B. Keetley, Lieutenant-Colonel process of manufacture through using sulphuric acid Kirwan, Sir Ralph Knox, Colonel Latchford, J. Langton, supplied by one firm. This acid contained from I.s Lieutenant-Colonel Leake, Captain Lewis, Dr. Ligertwood, to 2.6 per cent. of arsenious oxide. The firm that Dr. James Little, J. MacAlister, Sir William Mac Cormac, supplied the adulterated acid admitted in evidence that Bart., Dr. Shaw-Mackenzie, Major Macpherson, G. H. Makins, the acid contained arsenic, but stated they had no knowledge Howard Marsh, Surgeon-General Marston, Surgeon-Colonel as to the use to which it was put. The amount of sugar used Martin, Dr. Valentine Matthews, W. E. Miles, Lieutenant- varied in different brews, but it is believed that in the process Colonel Moberley, Captain Moore, John Morgan, C. Morris, of brewing, if the contaminated sugar is added before fermen- Surgeon-General Muir, H. W. Nevinson, Sir Christopher tation takes place, a portion of the arsenic is removed by the Nixon, T. W. Nunn, Dr. George Ogilvie, T. Open- aetion of the yeast, whereas if sugars are introduced as priming shaw, Edmund Owen, W. Owen, W. H. Page, agents, that is after fermentation, the whole of the arsenic Dr. Pardoe, Dr. Pavy, Dr. E. V. Poore, Deputy remains in the beer. The amount of arsenic in beer there- Inspector - General Porter, Surgeon - General Preston, fore varied from I21 to 3 gr. per gallon, but oftener it contained Major Ratton, Surgeon-General Reade, Lieutenant-Colonel J. only 2 gr. Reynolds, Arthur Ricketts, Dr. Frederick Roberts, Mayo Rob- Dr. Tunnicliffe, who gave evidence, drew the attention of son, W. Rose, T. L. Rogers, Major-General Russell, Captain the Commission to the fact that in addition to arsenic, beer Samman, Major B. H. Scott, J. Scharlieb, Dr. Shore, Sir sometimes contained selenium, and to which he was disposed Thomas Smith, Bart., Colonel Stevenson, C. Stonham, Dr. to attribute some of the poisoning. This subject requires Stott, Charters Symonds, Sir Frederick Treves, Lynn Thomas, apparently further consideration. H. H. Tooth, H. A. Tom-Fairbank, Major Trewman, E. R. All the evidence went to show that it was the heavy beer Turner, W. Turner, Edgcombe Venning, W. L. Wainwright, drinkers who suffered most. The symptoms produced re- T. Wakley, jun., H. R. Walker, Cuthbert Wallace, F. C. sembled those that are observed in alcoholic peripheral Wallis, Dr. Washbourn, Dr. Heron Watson, Dr. Whitfield, neuritis. Although arsenicated beer had been drunk, it was A. Willett, Major Wilson, Sir John Williams, A. E. Wynter. not alwaysclearto the Commissionersthat thepoisonous effects were due to arsenic, for peripheral neuritis is known to have THE will of the late Dr. Thomas Bond has recently been occurred long prior to the recent epidemic of poisoning in proved. He left personalityof thenetvalue0of£21,359 I5. sd. consumers of beer in whose drink at that time there was no THE ETHICS OF OPERATION.-An American judge has re- reason to suspect arsenic. The report deals with the various cently ruled that in the case of a surgeon, while performing ways by which arsenic may gain entrance into beer. It may an operation under an ansesthetic, finds that another opera- be by the brewing sugars and malt, or possibly by the fuel tion not previously contemplated is necessary, he has the used in drying the malt. It is reassuring to learn that in no right to perform the second operation without waiting to instance were hops found to contain arsenic, but in the drying obtain the consent of the patient. of hops care should be exercised lest they become contaml- tIBJ 232 Mz COUNTY OF DURHAM MEDICAL UNION. [JULY 27, 190t. nated by the fume from fuel. There is no reason why arsenic Election of Of.wers.-Dr. J. F. ARMSTRONG () should be in beer at all if ordinary precautions are taken. An said he had very great pleasure in moving the re-election of arsenicated beer will be in the future inadmissible. Beers Dr. Jepson, who nad been a great power and help to the will have to conform to a standard test. Although many foods Society. He had spared neither time or trouble in furthering and other kinds of drinks were analysed they were found to its interests.-Dr. W. GALLOWAY () seconded the be free from arsenic. motion, which was carried unanimously.-The PRESIDENT, In this country we learn by experience s1owly, and our in returning thanks, said that he did not believe in repeated! legislation is apt to be piecemeal. Parliamentary powers re-elections, but he could not resist their kindness, and would exist at present whereby county and borough councils, town do all in his power to help on the Union.-On the motion of and district councils can through their medical officers of Dr. WARDLE (Bishop Auckland) and Dr. ATTWATER (Whick- health deal with suspected articles of food. Officers under ham), Dr. James Murphy () was unanimously re- the Food and Drugs Act and Public Health Acts possess the elected Vice-President. The following were elected Members power to obtain samples, but so far as beer is concerned only of the Council:-Dr. Armstrong (South Shields), Dr. Cox when it is an article of sale. These gentlemen are no better (), Dr. W. Galloway (Low Fell), Dr. J. H. Hunter off in this respect than other people. It would appear that (South Shields), Dr. R. S. Hubbersty (Sunderland), Dr. R. public authorities have no effective power as against sugar E, Ingram Johnson (South Moor), Dr. Mann (Washington), manufacturers or brewers, hence they are obliged to proceed Dr. Miller (Stockton), Dr. A. MacRay (Crook), Dr. Taylor against retailers. It is now felt that there should be some (Chester-le-Street), Dr. R. Stuart (Durham), Dr. Wardle standard test for arsenic that could be adopted by all public (Bishop Auckland), Dr. Davis (Hartlepool), Dr. Arthur (Win- analysts. The Public Health Acts, while empowering gate), Dr. Stephen (West Auckland), Dr. Hill (), Dr. authorities to condemn and destroy unsound articles of food, Charles (Stanley), Dr. Attwater. (Whickham), Dr. Anderson do not enable them to act thus in regard to poisoned beer. (Spennymoor), Dr. McIntyre (Blackhill), Dr. Wilson (Birt- Statutory power will have to be obtained. The Revenue Acts ley), Dr. Parker (Easington), Dr. Taylor taking the place of neither cover the ground sufficiently, nor do they offer Dr. H. Lyon Smith who was leaving the district; Dr. Davis adequate protection. Some improvement in administrative the place of Dr. Risbet (Thornley), who had retired from measures is therefore called for. The Commissioners think practice; and Dr. Arthur the place of Dr. Gordon Russell, that the Board of Inland Revenue should be empowered to who, it was stated, was at the war. Messrs. Graham and specify the individual ingredients of beer liable to be con- Shepherd (Sunderland), were re-elected joint secretaries, taminated by arsenic, " to prescribe for every such ingredient, treasurers, and solicitors. Drs. C. D. Hill Drury and Hern and for the different materials used in their preparation, an (Darlington), David V. McIntyre (Brandon), and Davis adequate test which should ensure their freedom from arsenic ; (Hartlepool) were elected members. and to prohibit, under penalty, the use in a brewery of any Reports.-The Treasurer's statement showing a balance of material which infringes the prescribed test." To these words £66 38. id. in favour of the Union was submitted and Dr. Whitelegge takes exception, on account of the wide terms adopted. A sum of £50 was ordered to be paid to the secre- of the recommendation. His opinion is tnat at the present stage taries on account of the balance due to them. Reports were of the inquiry the reference of administration and standards made by representatives from the Sunderland, Chester-le- to the Boarl of Inland Revenue should be limited to the Street, Stanley, Jarrow and , Consett, Trimdon, and materials found upon the premises visited for revenue pur- Stockton which were generally very satisfactory. poses. TJnless, for example, excise officers supervise malt- Midwifery Fees: Assistants.-Some discussion took place as ing premises, they cannot see or sample the fuel used there; to the fixing of a minimum midwifery fee for the county, and and fume, as we have seen, is a possible source of arsenical Dr. ATTWATER (Whickham) gave notice that at the next poisoning. meeting he would move a resolution fixing the minimum midwifery fee at I58. Dr. Attwater also moved: THE COUNTY OF DURHAM MEDICAL UNION. That in consequence of the great difficulty frequently experienced in THIE third annual meeting of this Union was held in the obtaining a reliable assistant or locum tenens, we ask Messrs. Graham and Mayor's Chamber, Town Hall, Durham, on June 28th. There Shepherd to act as agents for the purpose, and also for negotiating the was a large attendance of members from Durham, South sale and purchase of medical practices. Shields, Whickham, Jarrow, Low Fell, Gateshead, Bishop Several members expressed themselves in favour of the Auckland, Sunderland, West Hartlepool, Stockton-on-Tees, desirability of such an agency being attached to the Union, Wingate, Stanley, Houghton-le-Wear Sedgefield, Wellington, and the resolution was carried unanimously. Ryton-on-Tyne, Washington, Sheikurn, Easington, and Canvassing.-The SECRETARIES having reported that the-reso- Spennymoor. lution unanimously passed at the general meeting on President's Addre8s.-The chair was taken by the President, February 5th, igoi, requesting the General Medical Council Alderman JEPSON, M.D.,J.P., who congratulated the members to remove from the Register any medical practitioner who on this being the third annual meeting. He said that some countenances or encourages canvassing b3y any union or asso- had predicted an early decline in the Union; but, rather than ciation of working men and others on his behalf, had been declining or showing signs of decay, there were indications brought before the Executive Committee of the General and evidences of more stability. It was true they were not Medical Council on June 3rd, but that no action was taken engaged in a sharp conflict at that time, but the Union had thereon, great disappointment was expressed at the lack of gradually asserted itself in many places, and a higher rate interest in matters affecting the general practitioner thus dis- of pay had become recognised in many parts of the county. played by the General Medical Council and it was unani- The position of those directly opposed to the Union was mously resolved, on the motion of Dr. XTTWATER, seconded becomingworse everyday. He and Dr.AlfredCox(Gateshead) by the VICE-PRESIDENT, and supported by Dr. ARMSTRONG, had been invited to a meeting of the Hartlepool Medical Dr. CHARLES, and Dr. ARTHUR: Society to explain to them the objects and aims of the Union That the resolution be again sent up to the General Medical Council, with a view to affiliation, and he had now received a letter and Drs. Brown, Horsley, and Glover be specially asked to give it their from Dr. Schmitz, the Secretary of the Hartlepool Society, support. stating that it had unanimously resolved to become affiliated Reports to Members.-A reprint of the rules, with the amend- to the Union. This he considered was very gratifying. He ments made since first issue, was ordered. On the motion of had repeatedly tried to induce the Darlington Society to be- the PRESIDENT, seconded by Dr. ARMSTRONG, it was agreed come affiliated, but hitherto without success. That day, how- that a half-yearly letter or report should be sent out in the ever, he had received a letter from Dr. Hern to say that the months of March and October to all the members, giving a matter would be further considered in October. There was short statement of the work being done and the meetings one more Society to be wooed and won, and that was the held and any resolutions, etc., passed, so as to keep the Society in Gateshead. When these two Societies joined, members in touch with what was going on. then the County Union will be nearly complete. In conclu- Indurance Fees.-Considerable interest was evinced in the sion, he thanked them for their kindness and courtesy during question of the fees paid by insurance companies for medical the past year, and in electing his successor he begged them examinations, and it was decided that the matter should be most earnestly to use a free and open mind. further considered at the next meeting, and the PRESIDENT