TOXIC EFFECTS OF LEAD, ARSENIC, MORPHINE, COCAINE, ETC. 205

a gastro-enterostomy when obstruction ispresent.For the favourable case an extensive

gastrectomy, with special attention to thelymph glands in the subpyloric region, andthose along the lesser curvature to thecoronary artery, is the operation of choice.The omentum should also be removed.

SOME POINTS IN CONNEC-TION WITH THE TOXICEFFECTS OF LEAD, ARSENIC,MORPHINE, COCAINE,ETC.1

By SIR WILLIAM WILLCOX,K.C.I.E., C.B., C.M.G., M.D.

LADIES AND GENTLEMEN,-- I was asked togive a lecture in this course, which I under-stand to be a post-graduate course especiallyarranged for the M.R.C.P. examination.The subject I have chosen for it is "Somepoints in connection with the toxic effectsof lead, arsenic, morphine, cocaine, &c."

1 do not propose to go over the ordinarytoxicological features which you see detailedin the textbooks relating to these subjects;what I propose to do is to deal with somemore recent researches and developments inthe toxicological aspects of the subjects.And I shall not speak of anything which isnot of very great importance at the presenttime; I shall not deal with anything in theway of abstruse scientific investigation;everything I shall tell you will be of realimportance.

First of all with regard to lead. A greatdeal of knowledge has been gained duringthe last twenty years with regard to leadpoisoning. You are all familiar with the

symptoms and the modes by which it isacquired. There is acute lead poisoningand chronic lead poisoning. Acute leadpoisoning is caused by the swallowing of a

large quantity of some salt of lead. Leadis an irritant poison, and the symptoms,when a large quantity of lead has beentaken by the mouth are: acute gastro-enteritis, vomiting, diarrhoea, pain in theabdomen, a metallic taste in the mouth.In the case of lead this condition is followedby constipation. Many of the mineralpoisons cause gastro-enteritis and a lastingdiarrhoea. Lead causes constipation as anafter-effect. Whenever any large quantity ofpoison is taken, whether it be arsenic orlead, you get the acute effects of the lead,and afterwards there may be such symptomsas occur in the chronic poisoning. There-fore sometimes after taking one dose of leadthe patient gets the acute symptoms of gastro-enteritis, and then these symptoms may befollowed by those of chronic lead poisoningwhich I will deal with directly.Chronic lead poisoning is a very common

disease; it is one of the notifiable industrialdiseases. It has to be notified to the HomeOffice, that is, every case of it which occursin industry. And the causes of industriallead poisoning have been very thoroughlyworked out in this country. Sir ThomasLegge, who was formerly a Medical Inspectorfor the Home Office, devoted a great deal oftime and research to the subject, and as a

consequence, the occurrence of industriallead poisoning has become very much lessthan it was formerly. Chronic lead poison-ing may occur from accidental causes dueto contamination of water, as has occurredin the North of England, such as in theSheffield district, where a soft plumbo-solvent water has been used as the watersupply, and outbreaks of chronic leadpoisoning have occurred in that way. Andsometimes food becomes contaminated withlead, in consequence of it being wrappedin lead wrappers, or being stored in leadvessels, or through contact with lead in any

1 A lecture delivered in connection with theFellowship of Medicine and Post-Graduate MedicalAssociation (M.R.C.P. special course) at the roomsof the Medical Society of London, on Tuesday,June 3, 1930.

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other way; for example, beer drawn throughlead pipes from the barrels to the bars.

Lead has not been very much used crimi-nally. The commonest use of it in that wayis for purposes of procuring abortion.Diachylon is a lead plaster, i.e., oleate oflead, and formerly in certain districts it wasused largely, being rolled into pills andswallowed, in that way taking perhaps Io to20 grains a day. Lead oleate is a lipoid-soluble substance, and a lipoid-soluble sub-stance can travel to the central nervoussystem. Diachylon caused a large numberof. deaths when it was used for criminalabortion; it caused the condition known aslead encephalopathy. It caused symptomsof mental disturbance, irritability, thendelirium, stupor, convulsions, and comaand commonly this train of symptoms wouldterminate in death. And the lead would notonly act on the brain and central nervoussystem, but on the kidneys causing nephritis,and the symptoms of lead encephalopathywould be partly accompanied by uraemicconditions.

Lead is an extraordinary poison as regardsits selective action. It acts on the nervoussystem, it may act on the central nervoussystem, as I have told you, when it acts inthe more acute type of case, causing acutecerebral symptoms; but it also acts on theperipheral nervous system. This you see,often, in chronic lead poisoning, the leadcausing peripheral neuritis. And the dis-tribution of this peripheral neuritis is veryremarkable. It affects the arms rather thanthe lower extremities, and the extensormuscles of the forearm are affected, though,curiously enough, the supinator longus isgenerally spared. Lead will also affect themuscles of the shoulder, and may causedeltoid and biceps paralysis. One seespersons suffering from lead poisoning ableto walk about, as they have little weaknessin the legs, and yet who have the character-istic wrist-drop. Alcohol, diphtheria andarsenic, when they cause neuritis, affect thelegs equally with the upper extremities, and

there may be foot-drop as well as wrist-drop,and a symmetrical distribution. But inlead, as I say, you have only the hands andshoulders affected. And I have seen casesin which only one side has been affected.

In chronic lead poisoning there is a blueline on the gums, or there may be. But itis curious that you do not often see thatblue line when lead is given intravenously.One does not often see the blue line nowa-days. If the teeth are absent a blue linedoes not occur; it is due to the formationof lead sulphide in the tissues from decom-position of the material between the gumand the teeth. If people keep the teethclean they will not develop the blue line.Lead causes a sallow complexion. It hasa curious action on tlhe blood. Peoplesuffering from lead poisoning have anaemia,as lead destroys the red blood-cells, and itcauses such changes in those cells as poiki-locytosis, and there may be some nucleatedred cells. And with lead, too, you get apunctate basophilia in the red cells; thereis a stippling of those cells. But thatstippling is not absolutely diagnostic, for itcaln occur in other conditions; but it showswell the effect of lead on the blood. Andthe red blood-cell stains a slaty colour, aso-called polychronasia.As to the white cells, lead causes a mild

leucocytosis, and the eosinophiles are in-creased, often being present to the extentof 5 per cent. or 6 per cent. The leucocytesare not altered appreciably in the differentialcount, but there is some granulation of theleucocytes. So much for the action of leadon the blood.With regard to the joints, lead may cause

gout, " poor man's gout," as it is often called;it occurs in plumbers; they also get pain inthe joints, arthralgia. It affects the kidneys,causing chronic nephritis, and these patientsdevelop high blood-pressure and all thesymptoms of chronic interstitial nephritis.Lead also acts on the blood-vessels, causingarteriosclerosis. It is a deadly poison; itgets fixed in the tissues, and if a person gets

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lead in his tissues he is never the same again.In 'the case of a person who has had histissues saturated with lead a year will elapse,at least, before it disappears from his urine.

Lead, as you know, has been used for thetreatment of cancer. Professor Blair Bell,of Liverpool, is a great advocate of the useof lead in cancer. But I am not here to-dayto talk about cancer, and most of you, nodoubt, have your views as to the value oflead in the treatment of cancer. Suffice itto say now that it has not come into generaluse by the medical profession. I knowProfessor Blair Bell very well; I know heis a very earnest worker, and I have been toLiverpool and seen his cases and all hiswork. For the treatment of cancer lead isgiven intravenously in the form of acolloidal solution, of 0'5 per cent. strength,it is suspended in a solution of gelatine. Ishow you a solution which Professor BlairBell made himself. Lately they have beenusing lead selenide. That is rather moretoxic, and so 0'2 per cent. is used. Whetherlead has done any good for cancer I am notgoing to say, but its use has been of somevalue in toxicology. We have learnedsomething about the toxic effects of leadfrom the use of lead in the treatment ofcancer. Blair Bell gives, as a fatal dose oflead, given intravenously, o'2 of a grain,and that would be 40 c.c. of colloidal leadsolution. As Professor Blair Bell gives andadvocates a dose of 20 c.c. of this, you willagree we should be sailing near to dangerby giving to patients in one week half thefatal dose; weekly doses are given forcancer. The effect of lead is measured bythe blood-tests; the hzemoglobin is esti-mated, and films of the blood are made, andwhen the punctate basophilia appears, thebio-chemist holds his hand until the bloodis clear of its stippled cells before givinganother dose.When lead is given intravenously there

may be gastro-intestinal symptoms, withcolic, just as when lead is swallowed by themouth: there are very marked blood

changes, and there may be an action on thenervous system. It may cause encephalo-pathy. It may act on the eye, causingamaurosis, that is to say, temporary blind-ness. Or it may cause optic atrophy,though this latter is a very uncommonoccurrence. Lead may cause nephritis, thatis to say, there is albumin in the urine,casts, possibly blood. It may also act onthe liver, if given intravenously, and causetoxic jaundice. I have seen all these sym-ptoms occur from the use of lead intraven-ously in the treatment of cases of cancer.You will, therefore, agree, that lead must beused with great caution.There is another compound of lead

which is of great interest to everyone, andthat is lead tetra-ethyl; it was discoveredabout sixty years ago. It is Pb (C.H5)4. Itwas discovered in the chemical laboratoryof Oxford University, and some originalwork was done on it there. It is a colour-less liquid of a specific gravity of I'62; it islipoid-soluble, and boils at 200° C. Whenpeople were first working on this lead tetra-ethyl, the assistants who were doing the" spade-work," it was noticed, were affectedmentally; they had attacks of mania, andtwo of them died. It was thought to benothing more than a coincidence. Butwhen a third developed similar symptoms itwas thought that this tetra-ethyl might beresponsible for the condition, and that wasfound to be so. It is one of the most

dangerous cerebral poisons there is. It islipoid soluble, it may be inhaled andabsorbed and it can be absorbed bythe skin. It attacks the brain, and you getprofound mental symptoms; it causesinsomnia, delusions, mania, restlessness,tremrors, and may cause coma, convulsionsand death in a few days.You may ask, "What has this to do with

the M.R.C.P. or with present-day affairs ?"It has much to do with them, because themotor is the chief means of transport to-

day; nearly everyone has a motor-car orrides in one. It has been found that if you

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add to ordinary petrol certain substancesyou can make the explosion more even, youcan prevent what is known as " knocking"in a mlotor car by these additions to thepetrol. Many substances have beentried, and it was found that lead tetra-ethyladded to ordinary petrol, or even to inferiorpetrol, made it better for use, becauseof the greater evenness of the explosion.An ethyl-petrol-petrol to which i part in1,3oo has been added of lead tetra-ethyl,has been introduced into America and isbeing largely used there. It has also beenintroduced into England. Perhaps theAmerican cars are more in need of some-thing to smooth their explosion than theEnglish cars, so I doubt if this substancewill come into general use in England; oneobjection is that it is' 2d. a gallon more.Another reason why it has not come intouse, perhaps, is that one of the leadingIewspapers made a great attack on ethyl-petrol and alarmed people. As a result, aGovernment Committee was appointed-ofwhich I was a member, and our Report wasissued a few weeks ago. We collected allthe evidence we could. Though lead tetra-ethyl is such a deadly poison, yet when it isdiluted down 1,300 times with petrol, theredoes not seem to be any danger if care isexercised. In fact we were unable to find a

single case of lead tetra-ethyl poisoningfrom the use of ethyl-petrol. But the sideissues from these scares, or fromthe use of these uncommon substances, areoften of great importance, and they were ofgreat importance here, because a remarkablediscovery was made. When ethyl-petrolwas introduced a great many investigationswere made to see if it was dangerous, andcontrol tests were made; that is to say,persons exposed to the use of this had theirurine and faeces examined, and control testswere done on people who were not soexposed; and the remarkable discovery wasmade that lead occurs in the urine of every-body at the present day. It used to bethought that it it was present it meant the

person was being poisoned by lead. InLondon the normal amount of lead in theurine is about o005 parts per million; andin the case of people living in the country,0o025, or lhalf that in town dwellers. Ifpeople are exposed to the action of lead, theamount of lead in the urine is very muchgreater, tetn or more times greater.A new method has been discovered for

detecting these minute quantities of lead, orseveral methods. I think the best is that

published by Sir Robert Robertson, theSenior Government Chemist, who was a

member of this Ethyl-petrol Committee.So those are very interesting points with

regard to lead, its use in cancer, the occur-rence of lead normally in the urine of peopleto-day--probably it occurred in former days,but to-day we have got lead all round us,paint, lead pipes and lead everywhere, leadin soldered food tins, so it is not surprisingthat there are small amounts of lead in theurine.Now I come to some new points relating

to arsenic. You know the various types ofarsenical poisoning. There is the acutearsenical poisoning which occurs when whitearsenic or some such compound of it is takenby the mouth. It causes an acute typicalgastro-enteritis. A fatal dose is 2 gr. ofarsenic. As I have said, if you take a bigdose of any poison you get acute symptoms,and there may be some of the poison leftin the body, leaving chronic symptoms;that is to say, one big dose of arsenic maynearly kill the person from acute gastro-enteritis, and he may recover, and have aftera few days peripheral neuritis from the onedose. I have seen that. The books talk ofarsenic being an irritant poison. It is morethan that, it is a deadly poison. It acts onthe kidney and heart muscle and on theliver, and it does not really cause death byproducing vomiting and diarrhoea-peopledo not vomit to death, they are not purged todeath-when arsenic kills it kills because itpoisons the heart, kidneys and liver; it is atissue poison.

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Chronic arsenical poisoning you arefamiliar with, when small doses are taken.It particularly acts on the nervous system,and there occur peripheral neuritis, foot-drop, wrist-drop, &c. I shall not go intothat.

Arsenuretted hydrogen is another type,and that is different from the other two. Itis a most deadly poison, and acts on theblood, destroying the blood cells, causingextreme anaemia. It is a liver poison, sothat you get toxic jaundice, haemorrhages,hzematuria and purpura. It is a very rapidly-acting deadly poison.Another type of arsenical poisoning is pro-

vided by the arsenical compounds used inthe treatment of syphilis, &c., arsenobenzol.I wonder there are not more cases of poison-ing from them, from the way they are used.I have seen many fatal cases from their use,and the danger must always be borne inmind. This preparation is generally givenintravenously, and some people have anidiosyncrasy; some can tolerate it, but inothers even a small dose may be fatal ordeadly. A careful man will first find if thepatient is sensitive to it before using the re-gulation dose. A few months ago I had thecase of a person who had syphilitic infectionand was given 0o3 of a grm. of N.A:B., andhe got jaundice after it. He was givenanother dose, o-I grm., and he had severetoxic jaundice after it. If we had continuedwith the drug it would have killed him; hewas sensitive to arsenobenzol. It used tobe thought that the poison attacked the brain,as they had symptoms like uraemia, mentalirritability, vomiting, drowsiness, then be-came delirious and comatose. That was

thought to be due to the action on the brain.I think I was the first to show that such wasnot the case; that was in I910, just afterarsenobenzol was introduced. I saw severalfatal cases, and I analysed the brains ofseveral of them, and found no arsenic illthe brain. Arsenobenzol causes death byits action on the liver, causing acute de-generation of the liver cells, and there is an

auto-intoxication due to defective liver func-tion. In other words, the death from thiscause is like that from acute yellow atrophy.There may be jaundice, but in arsenobenzolpoisoning the persons are, often, dead beforejaundice has had time to show itself. SirBernard Spilsbury and I have investigatedmany cases, and we found very marked fattydegeneration of the liver cells in all thesecases. Therefore arsenobenzol must beused with care, because it is a liver poisonand may cause death by auto-intoxicationand paralysis of the liver function.How can you prevent these tragic deaths ?

For when a person in normal health diesin two or three days it is tragic. You mustfirst give only a small dose, and if jaundiceresults, do not use the drug. Another wayis this: it is always a good plan, before a

person is exposed to a toxic substance, to

protect the liver by giving glucose. If yougive an ounce of glucose two or three hoursbefore giving arsenobenzol, the drug istolerated much better. It is good alsobefore an anaesthetic. Chloroform is a liverpoison, and if you give an ounce of glucosea few hours before, it is tolerated very well.When I was trying this lead for cancer I

always gave glucose three or four hoursbefore giving the lead injection.When arsenic has been taken, either for

criminal purposes or in any way, you can

find it in the urine for three or four weeksafterwards. It is absorbed by the hair andthe nails, where you may be able to find itmonths or years afterwards. It is excretedin the faeces, too, for three or four ,weeks.Arsenic poisoning may be thought to befood poisoning, because of the gastro-enteritis,as in the Armstrong case. When MajorArmstrong tried to poison a rival solicitor,the doctor thought there was food poisoning,but he sent some urine up for examinationa few days afterwards, and it was loadedwith arsenic. I remember seeing the caseof a person who had been in India and whowas suffering from neuritis. This patienttold me it was really no good his seeing me,

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as he had seen many doctors in India, andnone of them could find out what was thematter with him; soine said he had beri-beri. I said to him, " Will you let me cutyour hair ?" He probably thought I hadgone mad. I cut some of his hair off andhad the Marsh test applied, and it was foundto be loaded with arsenic. I said to him," You have arsenic poisoning. What hap-pened before you were ill ?" He said,"That was the day I had a row with mycook." The cook had given him a dose ofarsenic a few months before I saw him andhe was suffering from the late effects ofarsenic poisoning. So you can detectarsenic months, even years, after the takingof the arsenic, in the nails and hair.Some interesting work on arsenic has been

done recently. About forty years ago someAmerican discovered arsenic normally inthe urine in a certain district. The state-ment was looked upon with suspicion andno notice taken of it. A short time ago aCommission was appointed in Sweden toinquire into arsenical poisoning, and theymade the startling discovery that arsenicwas present in the urine of normal personsin Sweden. Naturally, then, other countriesbegan to investigate this.question, and in1925 a paper was published in England byDr. Cox, who analysed the urine of a numberof persons who were not having arsenic inany form, and he found arsenic in the urineof nearly all of them in quantity up to o'i

per million.Quite recently it has been found that

arsenic is a normal constituent in certainfish and crustaceae: plaice, sole, slirimps,cod, turbot, and many of the common fishwe eat, have small quantities of arsenic inthem; while oysters, mussels, lobsters andcrabs have quite large amounts. Plaice, codand sole may have o'- to o-8 parts of arsenicper million; lobsters,and shrimps may haveas much as 20 to 40 parts per million;mussels Ioo parts per million; oysters ioparts per million. These animals are dis-obeying the Royal Commission, because

that Commission which sat on the subjectof arsenic, in 900o, enacted that the limitfor arsenic in solids should be I14 permillion, and in liquid o0I4 per million. Solobsters have about thirty times as mucharsenic in them as the Royal Commissionpermit. You may say, again, "What hasthis to do with medicine ?" It has this todo with it: that if persons die from thesesymptoms and arsenic is found in theirbodies, you have to ask, "Is it possible thisarsenic may have got in through the naturaldiet? Or has it been criminally adminis-tered ?" That problem presented itself to melast year. A lady in Wales had rheumatoidarthritis and chronic kidney disease, ascites,a dilated heart, and so on, and it was notto be wondered at that before she died shehad vomiting and diarrhoea. Some urineand a stool were sent to the analyst and asmall amount of arsenic was found in thetm.An inquest was held, and it was alleged thatthis lady had been poisoned by arsenic.When the matter was gone into carefully, itwas found that the amounts of arsenic foundin the organs were very minute, and thoughthis lady was in such a terrible condition ofhealth, she had retained a very good appetiteto the end; she had been in the habit ofsendiing out for fried fish for lunch, and ofthis she ate heartily, and so it was clear,taking all the evidence into account, that thearsenic had got into her body in a naturalway, that it was not a case of criminalarsenical poisoning.

Apples may contain arsenic in their skins,that is those apples which have been sprayedwith sprays made for killing insects, manyof them containing arsenate of lead. Englishapples have not been found to containarsenic.

I advise you to read up about drugs ofaddiction; time will not permit me to talkabout them : morphine, cocaine, heroin, &c.You should know the important enactmentsof the Dangerous Drugs Acts and Regula-tions. Remember that morphine, if inamounts of over 0'2 per cent., morphia and

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all its preparations, come under the Dan-gerous Drugs Acts; also cocaine and itspreparations in amounts over o'I per cent.;and recently heroin, in all amounts, hasbeen added. Any preparation of heroin,however minute its quantity, must be pre-scribed in a manner which fulfils all therequirements of the Dangerous Drugs Acts.

I want now to say a word or two aboutalcohol. When you talk about alcohol youmean, of course, ethyl alcohol. There hasbeen a good deal of medico-legal troublerecently on the question of drunkenness,especially'drunkenness when in charge of amotor car. The legal definition of drunken-ness is "the condition in which a man isdrunk," and you will agree that does nottake us "much forrader." Lawyers refuseto define the term "drunk." We makeelaborate definitions, but I will not go intothat. Suffice it to say that, though Com-mittees have sat and pondered over the testsfor drunkenness (I was a member of theBritish Medical Association Coimmittee), yetwe are not carried much further. Becausethere is no legal definition of " drunk," therehas been an attempt to put the matter on ascientific basis. There has been a good dealof work done recently, and iDr. Southgateis one who has published several papers inthis country during the last few years on theexcretion of alcohol. When ethyl alcoholis taken by the mouth, it is quickly absorbed,and it is slowly and steadily excreted. So ifa large quantity of alcohol is taken, withinan hour it finds its way into the blood to itsmaximum amount, and then steadily falls.If a big dose of alcohol is taken probably itwill take twelve hours for it to be excreted;if a very big dose, it might take twenty-fourhours. But it is quickly absorbed. That,in the normal person, differs entirely fromsugar. There will be 0'2 per cent. alcoholin the blood in an hour's time, and then itwill gradually come down, and the bloodwill be normal again in twelve to eighteenhours. If a smaller quantity is taken it willprobably all be excreted in about twelve

hours. If glucose is taken by the mouth, itis alsorbed very quickly, and within twohours it will all have disappeared from theblood. It will not have been excreted inthat time, but will be stored in the liver.Southgate has shown that when alcohol istaken by the mouth it is quickly absorbed,and quickly appears in the blood, and that ittakes twelve to twenty-four hours for it tobe eliminated from the blood, and that inthe urine you can find alcohol in very similaramounts to that in the blood. So on testingthe urine of a person, if he has had alcoholwithin six hours you will find it being ex-creted in the urine. So this would be avaluable test for drunkenness. No one hasyet dared to give specific amounts, but youmay take it from me that if there is over 0'2per cent. alcohol in the blood or urine, thatthat person, though he may not be " drunk,"is not fit to drive a motor car; if he is notdrunk it takes him all his time to hide thesymptoms of drunkenness. He is under theeffects of alcohol, and with over 0'2 per cent.of alcohol there might be more or less deepintoxication. But you cannot ask a personto give evidence which may be against him-self; you cannot ask a wife to give evidenceagainst her husband, nor a husband againsthis wife; so, according to English law, it isnot quite fair, if a person is suspected ofbeing drunk, to say that you want a little ofhis blood, or to ask him to pass water foranalysis, so that you may say whether he isdrunk. That test has not come into generaluse here; but it would be of great value, ifa person under suspicion had locomotorataxy and were arrested, and the test showedabsence of alcohol in blood or urine, to beable to say such person could not have beendrunk. If a person takes a dose of 75 c.c.of ethyl alcohol it would be a pretty stiffdose, equalling 5 or 6 oz. of whisky. Agood deal of it is got rid of in six hours, butit takes twelve hours for the majority of itto be eliminated; it might even take a littlelonger. And that corresponds to the clinicaleffects in a person who gets drunk; some

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may get a little better of their symptoms ina few hours, but it takes twelve hours to getrid of their symptoms. I shall not go intothe clinical effects of alcohol, because youwill find them described in the books.Now a word or two about other alcohols.

In appearance and smell and taste, methylalcohol is exactly like ethyl alcohol; butmethyl alcohol is a much more deadlypoison; IO c.c. of it has caused death. Andit is a poison which does not produce thepleasurable effects of alcohol. The onsetof the symptoms of methyl alcohol may bedelayed, but its action is very prolonged; aperson may be in coma from it for three orfour days.

Methyl alcohol has a selective affinity forthe optic nerve, and many persons who havebeen poisoned by methyl alcohol havedeveloped blindness and optic atrophy in alarge number of cases. You may say, again,What has that to do with us ? It has this.Sometimes the makers of spirits-fortunatelynot in England but in other countries-andof brandies and liqueurs and scents andessences have used methyl alcohol insteadof ethyl alcohol. In Germany there havebeen several very bad epidemics of blindnessfrom the use of adulterated brandy; and, inAmerica, from adulterated whisky and'essences. I have seen some cases. Fortu-nately, however, they are very rare in thiscountry.Remember what methylated spirit is.

Before the War it was an ordinary crudealcohol, but since the War, in order to pre-vent people from drinking methylated spirit,it has had additions. Before the War itcontained io per cent of wood naphtha, avery impure methyl alcohol. Since the Warit has been made nauseous stuff; it is colouredblue with aniline dye, and it has in it pyri-dine and paraffin, as well as wood naphtha,and anybne who drank this would haveviolent vomiting. It contains i per cent. ofpyridine, and 0'375 per cent. of paraffin.But for industrial purposes methylated spiritcan be bought which is purer than that sold

before the war. It is methyl alcohol with5 per cent. commercial wood naphtha. Itis difficult to buy industrial methylatedspirit; all sorts of forms have to be filledup, because of the danger of people drinkingit. " Surgical spirit" is industrial spirit towhich some castor oil has been added; whythat should be added I do not know;whether it is to prevent surgeons drinking itI cannot say! They do, however, put in3 per cent. of castor oil.There is another alcohol, isopropyl alco-

hol. It is an alcohol which is very similarto ethyl alcohol in appearance, and it hasmany of the facilities and properties of thatwhich render it useful for the arts: it is asolvent for varnishes and can be used forperfumes, and it may replace ethyl alcohol.It is twice as poisonous as ethyl alcohol,though it is not likely to replace it as a drugof addiction, as it does not produce pleasur-able effects; it only makes the person drowsyand sleepy. If people know about it, thereis a danger of it being used in this countryas a beverage.

Lastly, I remind you that amyl alcohol isa toxic, nasty, irritant liquid, has a pear-likeodour, is five times as poisonous as ethylalcohol, causes headache, stupor and coma,and persons taking it suffer from glycosuria.It is one of the chief constituents of fuseloil, that is to say the spirit which is producedin ethylic fermentation. And it is one ofthe impurities occurring in bad whisky.Those points which I have mentioned

will, I hope, be useful to you in supplement-ing your reading on toxicological subjects.

POST-GRADUATE NEWS.

FROM September onwards the Fellowshipof Medicine has arranged a varied choice ofSpecial Courses. Particularsof these can beobtained from the Secretary of the Fellow-ship, i, Wimpole Street, London, W. I, whowill be pleased to supply copies of syllabuses

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