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Annotations

TOWN PLANNING

THE success of town planning may be measured by thenumber of people saved from hospital. This view was putforward on Nov. 5 by Mr. Arthur Ling, senior planningofficer in the L.C.C.’s architects department, in a lectureat the Royal Institute of Public Health and Hygiene.The purposes of town planning, he suggested, are toeradicate the environmental causes of sickness, and tocreate a harmonious and healthy background for an

enjoyable life. Over four-fifths of the population live inurban areas, where, owing to the high value of land,sites have been intensively exploited. In 1936 10% offamilies in England and Wales were found to be over-crowded, while in some parts of Scotland the proportionwas even higher : the figure for Clydebank was 44%and for Motherwell 40%. It is not sufficiently known thatjust before the late war no less than 60% of familiesin the County of London were sharing houses in

non-structurally separated buildings ; the sharing ofaccommodation, and notably of a kitchen, is the sourceof constant friction.

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Hitherto the better properties have usually been sitedon high ground, while overcrowding has been greateston low ground. Owing to the larger cost of land on highground local authorities have often been compelled toacquire for housing estates low-lying sites close to

railways or industries. More open space is needed intowns ; statistics prove that death-rates are highestwhere there is least open space. In the last fifty yearscities have sprawled out into the countryside: thetown has been taken to the country. Now the trendmust be reversed and the country brought to the town.The key to redevelopment is a national policy for theredistribution of industry and population. Workersnow commonly live far out from the centre of cities,but the industries which employ them remain at thecentre. Workers thus have an excessive amountof travelling, with consequent expense, loss of time,tiredness, liability to infection, and tendency to a

time-killing attitude of mind. Two-thirds of LondonTransport’s traffic is accounted for by the movementof workers. During the late war 14h..Ernest Bevin, asMinister of Labour, estimated that if this travelling timecould be halved production would rise by 10%. Staggeringof hours, transfer of workers in multiple firms to branchesnear their homes, and improvements in the transportservices would relieve the congestion. But the onlyreal solution lies in planned decentralisation of industryto new towns, and in local decentralisation to the suburbs,whereby as many employees as possible would live neartheir place of work, and the flow of one-way traffic toand from towns at the start and end of the day wouldbe superseded by a two-way flow. A more obviousdefect in the present design of our towns is reflectedin the figures for road accidents. Of 6000 fatal accidentsin 1936-37, two-thirds happened in urban areas. Townroads were designed for horse traffic, and the value ofnew arterial roads has been nullified by ribbon develop-ment. Pedestrians should be segregated by the construc-tion of by-passes, the reservation of certain roads forfast traffic, and eventually perhaps by the buildingof traffic lanes on different levels. Improvements inthe main roads will make possible the formation of

neighbourhoods or precincts ; happy examples of

precincts are to be found in the Temple, Lincoln’s InnFields, and the colleges at Oxford and Cambridge.The concept of the neighbourhood has now been

generally accepted. These should be as far as possibleself-contained, and they should include communitybuildings. In planning health centres the usual proposalis that one contre, with 6-8 doctors, shall serve about

20,000 population. This does not fit in, however, withthe structure of the neighbourhood, with its 6000-10,000population ; and Mr. Ling thought that centres servingso large a group might be too remote from the everydayactivities of its users.The town-dweller is constantly exposed to the din of

traffic, with its subtle but serious effects on health.

Every transport vehicle should be tested for noiseemission ; and where noise cannot be eliminated apolicy of segregation should be pursued. Throughatmospheric pollution central London gets only half asmuch sunshine as Kew. Two-thirds of the pollutionis due to the domestic chimney. The nuisance could becontrolled if households gave up their open fires or

used smokeless fuel. Perhaps district heating mightbe developed ; a great deal of heat now lost from thepower stations could be distributed on this basis. Lastwinter’s fuel crisis, with the resulting ban on the useof electricity, showed to what a large extent offices relyon artificial lighting. Daylight standards should beimproved; and a new code has been prepared bythe Ministry of Town and Country Planning. In this,as in other aspects of town planning, Mr. Ling concluded,the planners should work in close partnership with thoseresponsible for the health services.

REGIONAL ILEITIS

REGIONAL ileitis is a rare disorder, but, as ProfessorMerke shows in his latest report,l it is not so rare that wecan afford to forget it. Of the 9 cases he describes, 3had been submitted to operation on the mistaken diag-nosis of acute or chronic appendicitis. Merke holds thatthis error, and the usually long delay in diagnosis, wouldnot be encountered if the condition were more generallyborne in mind. The duration of symptoms in his casesvaried from four weeks up to at least eleven years ; andthe symptoms were strikingly uniform, consisting in

colicky pain and diarrhoea. Among the other diagnosticpoints are a consistently positive benzidine test in thefaeces and, often, a positive indican test in the urine ;the blood-sedimentation rate is increased. But diagnosishangs on the radiological findings : barium is delayed inthe lower ileum, and advanced stenosis of the ileumclose to the ileoesecal valve may be observed ; ;.sometimes an " ulcer crater " can be defined. Patho-

logically, the naked-eye appearance resembles that oftuberculosis ; and Merke is indeed inclined to regardthis obscure lesion as tuberculous. In 5 of his 9 casesthere were manifestations of tuberculosis elsewhere illthe body ; and in 2 further cases there was a history oftuberculosis in the patients’ households.

SNORING

SNORING, though a widespread habit, has had littleattention from the medical profession ; yet it is oftena nuisance to the snorer himself, and it is certainly anuisance to his associates, as many found during thewar in the community life of the Services. To someextent it is a disorder of civilisation ; apparently wolvesnever snore, whereas the domestic dog does. It is alsoa disorder of certain times of life : the child is often asnorer, the adolescent rarely ; the practice is commonestin late middle life and old age.The noise is produced by vibration of the soft palate

and posterior faucial pillars, usually during inspirationthrough the mouth. A reservoir of air is formed in thenasopharynx, and vibration occurs when a certain relativeposition of the palate and tongue is reached. The dampingeffect is produced by the texture of the palatopharyngealmusculature together with the thickness of the tissuesinvolved, of which the mucosa is the most important.The normal resting position of the tongue and soft

palate varies with age. In the babe the two structures are

1. Merke, F. Schweis. med. Wschr. 1947, p. 751.