916

wards is variously given, but it will be within the mark ifthe number is taken as 328, which multiplied by .675, thecost per bed, equals .624,600. The Colney Hatch Asylumauthorities were, however, entitled to have more beds accord-ing to the rules laid down by the Commissioners in Lunacy-viz., 290 in the dormitories and 115 in the sick wards,making 405 in all. This would, by increasing the number ofbeds, reduce the cost to f-60 14s. 9d. per head. The deduction,say, of &pound; 10 per head for furniture (an ample allowance),which it is presumed is included in the .675 figure but not inour example, gives a comparative cost for the Colney Hatchbuilding of f-50 14s. 9d. per bed. Upon the same basis,taking one-third of the 167 patients in our example to belongto the infirmary class, we get a reduced number, giving anaverage of 150 beds, costing f-41 7s. Taking the lowestform of building at f-2.0 per bed and adding &pound; 10 forfurniture and a probable <66 per bed for heating, lighting,and lavatories, we arrive at a figure of f-36 per bed for thelowest estimate at all approaching the accommodation hereproposed.The result of our inquiries has, to tell the truth, somewhat

startled us. We were prepared to find that the cost of

building a temporary hospital with any pretensions to

being fire-resisting was almost prohibitive. In view, how-ever, of the money expended in some instances uponbuildings of the inflammable type, exceeding the amountnow found necessary for one of a fire-resisting nature, thereason for their continued use must be sought elsewhere.The error has been in a defective principle of construction.While our county councils have been very properly framingrules for the removal of constructive motes in the eyes ofothers they have failed to observe the inflammable beams intheir own buildings. Tbe name " temporary" has indeedbecome so identified with this particular class of building thatthe idea of any new departure has with very few exceptionsnever occurred to the able men who preside over the publicwelfare in those matters, notwithstanding the manyimprovements now in daily use. Will it be too much to

hope that recent events will do more than cause some

temporary excitement and that no other buildings of a likenature will be put up or be permitted to remain in their

present condition in this land where all things are forgott n ?REPRINT FROM THE REPORT OF THE LANCET SPECIAL

COMMISSION ON WATER-SUPPLY AND DISPOSALOF SEWAGE IN COUNTRY HOUSES.

Fire 7ydrccrts.-It frequently happens that a house is

dependent more or less for a supply of water in the event ofa fire upon a lake or stream situated at a lower level ; in thiscase the suction pipes should be laid to the most convenientpoints at which an engine could work so as to save the delayand confusion likely to arise in laying a hose from a dis-tance. In reference to these pipes the question of frictionmust not be overlooked. In all cases where the waterreaches the hydrants by gravity it is of paramount import-ance that the valves should be of the simplest constructionand unlikely to become set fast through neglect. The meansof connecting the hose should also be of such a character thata novice, however agitated, cannot become involved in anydifficulty. In the event of a fire everything depends on thepromptitude with which the first supply of water is broughtto bear upon the outbreak. Every minute is of the greatestvalue. Wheel valves are liable to become set when not in

frequent use, and when this is so some confusion may occur,the operator being uncertain as to which way the wheelshould be turned. Time is also lost in turning the wheelbefore the valve can be completely opened. With a full-

way lever cock with a long handle this is obviated. Thehose connexion is also much better adapted for private usethan the regulation screw pattern. Being a spring connexionit only requires to be pushed into the socket provided in thevalve with one hand whilst with the other the lever of thevalve is pulled down. The valves and connexions should befitted in addition with screw threads of a pattern to fit thehose in use in the local fire brigade. Besides the hose con-nexion shown, which is largely used, there is another patentof very similar construction, but it has a slight disadvantageas the coupling cannot be so readily undone by one man andthe latch joint is not quite so complete In addition to theconstant supply to the hydrants which should be fixed bothinside and outside the house a supplemental one is sometimesobtained by pumping directly into the hydrant mains, inwhich case some provision may be necessary to prevent thewater from being forced back into the supply tank or by theuse of a pressure augmenter.

Hydrant reservoir.-Where a reservoir is essential for adomestic supply it is, of course, a great saving of expense touse the same for the fire hydrants. The objection to thisarrangement, however, is that the pressure requisite for thehydrants is very undebirable for the fittings for the domesticsupply, necessitating additional strength in the pipes andbrass work and frequently causing much noise and vibrationwhen taps are turned off As to the quantity necessaryto be retained for this last purpose it must depend notonly upon the size of the house or farm buildings but alsoupon the facilities that exist for replenishing the reservoirin the event of an outbreak. Where a reservoir is usedfor the dual purpose the domestic supply should be takenin a separate pipe connected with the reservoir some

distance from the bottom ; by this means a reserve will

always remain in case of fire. The probable quantity requiredin case of fire is generally taken at 300 gallons per minute fortwo hours, which would require 36,000 gallons, but this mustdepend upon the extent of the premises. The height atwhich the reservoir is fixed and its distance from the housewill greatly influence the size of the hydrant mains, thefriction in mains of varying diameters and lengths greatlyaffecting jets of water from the same head. This veryobvious fact is one frequently lost sight of and is the causeof much disappointment and ui-eless expense. If dependentupon rainfall the reservoir should be able to hold about one-third of the annual supply. It should not be forgotten thata slight loss of head is caused by every bend in proportionas it is more or less acute. In deciding the size andthickness of iron mains the following points have to betaken into consideration.

1. The quantity of water required per minute. 2. Theheight of head. 3. The length of main for friction. 4. Theheight to which a jet of water is required to be thrown forfire hydrants. This last is greatly influenced by the size andshape of the nozzle used, the same head of water giving ajet greatly varying in height with different sized nozzles.It is impossible to offer in a few lines any general rule forguidance, as the several factors vary in almost every in-stance. With a little care by the help of a few goodhydraulic tables the difficulty can be surmounted. Theenormous loss of pressure by friction in long lengths of smallpipes is a point too often lost sight of.

Looking Back.FROM

THE LANCET, SATURDAY, MARCH 26, 1825.

FOREIGN DEPARTMENT.

ANALYSIS OF FOREIGN MEDICAL JOURNALS.

REVUE MEDICALE-JAN.

Observatons on the Hypertrophy of thetrain, by Pr.ofes.wr HUFELAND.

On examination of the bodies of those persons who had

presented the symptoms of acute hydrocephalus, when littleserosity was found in the ventricles, the author observed thatthe brain had acquired a great increase in volume ; that itappeared to fill completely the cavity of the cranium, and thatit suffered considerable pressure. Dr. Hufeland inferred fromthis appearance, that the brain, particularly in children, mightbe the seat of a too active nutrition, as well as other organs,and therefore acquire a greater developement than ordinary.If in this state &sect;the cranium be not prepared for it, in con-sequence of ossification having advanced too far, thisdevelopement of size must necessarily be attended with con-siderable pressure, and give rise to all the symptoms usuallyattending acute hydrocephalus. He goes farther than this,and imagines that the serous effusion in the brain is theresult of this compression of the organ, and consequently,that the increase of the brain itself is often the cause of thehydrocephalus. He considers these observations worthy theattention of medical men, and that they show the import-ance of attending to the physical as well as the moraleducation of children, in avoiding everything that mighttend to the too prompt developement of the cerebral mass, as

917

the premature exercise of the intellectual functions, the useof spirituous drinks, of high seasoned food, &c. ; and, on theother hand, that the increase of the muscular action shouldbe encouraged ; that cold lotions should be frequently laidupon the head, and that, according to ancient usage, mildaperients should occasionally be given.-Journal der Prac-tischen Heilkunde.Perhaps the Doctor’s advice may be useful in Germany,

but we believe it would be a difficult thing to find out acase of hydrocephalus occasioned by precocity of intellect onthis side of the channel. The stomachs of the dear little onesare more frequently crammed than their brains.

Public Health and Poor Law.LOCAL GOVERNMENT BOARD.

REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT OF

THE LOCAL GOVERNMENT BOARD.

On the Prevalence of Diphtheria in the RisboroughRegistration Sub-distract, forming part of the WyconebeRural 1Jistrict, by Dr. E. P. MANBy.l-This report dealsmainly with the prevalence of diphtheria during two years,1900-02, in the villages of Princes Risborough and MonksRisborough in Buckinghamshire. During this period therewere only two months in which no cases of diphtheria werenotified trom the Risborough registration sub-district; in all,69 cases of the disease occurred among a population of some6000. Dr. Manby pays special attention to the influence ofschool attendance in fostering diphtheria. This was particu-larly evident in connexion with the Monks Risboroughschool, and it is noteworthy that in June, 1902, when theprevalence of diphtheria had practically came to an end, thechildren at this school showed an unusually high proportionof "unhealthy throats " when compared with those at otherschools in the neighbourhood. Dr. Manby gives the

following table showing the conditions of the throat observedby him :&mdash;

All these schools, and Monks Risborough school in particular,were much in need of improvement as regards ventilation.Samples of dust taken from the bare brick walls wereexamined, but no evidence of the presence of the diphtheriabacillus was found. Disinfection of the school buildingsappears to have been very inadequately performed and inthis and numerous other matters Dr. Manby found thesanitary administration by the Wycombe rural districtcouncil extremely unsatisfactory. The inspector ofnuisances ’’ had no book on sanitation or sanitary law toshow me of more recent date than 1873-two years beforethe present Public Health Act was passed." The districtcouncil appears to pay little heed to the advice given to it Iby its medical officer of health, Dr. J. D. Dickson, who formany years has done his best, in face of persistent dis-

couragement and of a salary which seems quite inadequate,to obtain improvement in the many insanitary conditions ofthe district. It is to be hoped that the publication ofthis report will effect a much-needed change for the better.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8501 births and 4905deaths were registered during the week ending March 21t.The annual rate of mortality in these towns, which had

1 London : Eyre and Spottiswoode, East Harding-street; Edinburgh :Oliver and Boyd ; Dublin E. Ponsonby. Price 3d.

been 16 6, 16 6, and 17’ 2 per 1000 in the three precedingweeks, declined again last week to 17’0 0 per 1000. InLondon the death-rate was 17’ 2 per 1000, while it averaged16’ 9 per 1000 in the 75 other large towns. The lowestdeath-rates in these towns were 9’ 0 in Kings Norton, 9’ 3in Hornsey, 10 - 7 in Wallasey, 11’0 in Stockton-on-Tees, 11’ 3in Devonport, 11 - 4 in Tottenham, and 11-8 8 in Walthamstow,Warrington, and Rotherham ; the highest rates were 21 ’0 inWolverhampton and in Preston, 21’4 in Salford, 21’5in Bootle, 22-2 in Smethwick, 23-1 in Burnley, 24-7in Merthyr Tydfil, 25-7 in St. Helens, and 28-5 inWigan. The 4905 deaths in these towns last weekincluded 492 which were referred to the principal infec-tious diseases, against 453, 501, and 483 in the three pre-ceding weeks ; of these 492 deaths 163 resulted from measles,111 from whooping-cough, 72 from diphtheria, 66 fromdiarrhoea, 42 from scarlet fever, 26 from " fever " (principallyenteric), and 12 from small-pox. No death from any ofthese diseases was registered last week in Hastings, Bourne-mouth, Devonport, Burton-on-Trent, King’s Norton, Barrow-in-Furness, Halifax, York, or Newport (Mon.) ; while thehighest death-rates from the principal infectious diseaseswere recorded in Willesden, Tottenham, East Ham, WestBromwich, Grimsby, Wigan, Rhondda, and Swansea. The

greatest proportional mortality from measles occurred inCroydon, Tottenham, East Ham, Leyton, Walthamstow,Wolverhampton, Wigan, Manchester, Salford, and Swan-sea ; from scarlet fever in Great Yarmouth and Roch-dale ; from diphtheria in Hornsey, West Bromwich, andMiddlesbrough ; from whooping-cough in Croydon,Willesden, West Ham, Leyton, Southampton, Grimsby,Stockport, and St. Helens ; from "fever" in Hudders-field ; and from diarrhoea in West Bromwich and Grimsby.Six fatal cases of small-pox were registered in Liver-

pool, three in Birmingham, and one each in Aston Manor,Wallasey, and Hull, but not one in any other of the 76 largetowns. The number of small-pox cases under treatment inthe Metropolitan Asylums hospitals, which had been five,six, and seven in the three preceding Saturdays, was

again seven on Saturday, the 21st inst. ; two new caseswere admitted during the week, against two in each ofthe two preceding weeks. The numbeJ of scarlet fevercases in these hospitals and in the London Fever Hos-

pital at the end of last week was 1789, against 1851,1790, and 1798 at the end of the three preceding wseks ;133 new cases were admitted during the week, against197, 193, and 231 in the three preceding weeks. Thedeaths referred to diseases of the respiratory organs inLondon, which had been 271, 251, and 258 in the three

preceding weeks, further rose last week to 282, but were 236below the corrected average number. The causes of 45, or0 9 per cent., of the deaths in the 76 large towns last weekwere not certified either by a registered medical practitioneror by a coroner. All the causes of death were duly certifiedin Bristol, Nottingham, Manchester, Salford, Leeds, New-castle-on-Tyne, and in 49 other smaller towns ; the largestproportions of uncertified deaths were registered in Ports-mouth, Birmingham, Liverpool, St. Helens, Preston, andSunderland.

____

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been 17-7, 18 5, and 19-7 per 1000in the three preceding weeks, further rose to 20’ 1 per1000 during the week ending March 21st, and showed anexcess of 3 1 per 1000 over the mean rate during the sameperiod in the 76 large English towns. The rates in theeight Scotch towns ranged from 14 9 in Aberdeen and 18 3in Paisley, to 21 6 in Leith and 21 &deg; in Perth. The 657deaths in these towns included 32 which were referred to

whooping-cough, 14 to diarrhoea, eight to measles, six toscarlet fever, five to "fever," and three to diphtheria. Inall 68 deaths resulted from these principal infectiousdiseases last week, against 59, 75, and 67 in the three pre-ceding weeks. These 68 deaths were equal to an annualrate of 2 - per 1000, which was 0’4 per 1000 above themean rate last week from the same diseases in the 76 largeEnglish towns. The fatal cases of whooping-cough, whichhad been 32 and 28 in the two preceding weeks, roseagain last week to 32, of which 19 occurred in Glasgow,seven in Edinburgh, and two in Leith. The deaths fromdiarrhoea, which had been 21 and 12 in the two precedingweeks, rose again to 14 last week, and included seven inGlasgow, three in Edinburgh, and two in Paisley. The fatal