September 17, 1891] 



NATURE 



487 



district. The position of these hospitals is shown on the map. 

 The average length of the journey a patient has to be carried to 

 reach the hospital nearest to his home is three and a half miles. 

 During 1886-S7 the number of beds in the eastern and western 

 districts was found to be insufficient, and steps are now being 

 taken to establish an additional hospital in the North-East of 

 London, and to increase the number of beds in the Western 

 Hospital to 400. These additions will give a total number of 

 beds for fever and diphtheria of 2959, or one bed for every 

 1423 inhabitants. The total number of cases of fever and diph- 

 theria admitted into the managers' hospitals from 1870 to the end 

 of 1890 was 55,204. The accommodation for small pox is the 

 Floating Hospital at Long Reach, fifteen miles below London 

 Bridge. It contains 350 beds for acute and severe cases on board 

 the Atlas and the Castalia, the Endymion being used for ad- 

 ministrative purposes, and 800 in the convalescent hospital at 

 Gore Farm, four miles distant from the ships, giving a total of 

 1 150 beds. The number of small-pox cases admitted into 

 hospital since 1870 to 1890 is 56,979. To this number must be 

 added 1028 cases other than small-pox, making a total of 58,007 

 admissions. The river service is exclusively used for small-pox 

 cases, and consists of three wharves on the Thames in London 

 for the embarkation of patients. The wharves, as shown on the 

 map, are the " West " at Fulham, the " North " at Poplar, and 

 the "South" at Rotherhithe. In each there is a floating pier 

 in deep water, approached by a bridge, and a shed into which 

 the ambulance carriage drives, with an examination room. As 

 an example of the work, it may be stated that during the small- 

 pox epidemic of 1884-85, 11,060 cases were removed from their 

 homes to the Floating Hospital, 175 doubtful cases were sent 

 from the wharves to the land hospitals, 38 cases were detained 

 in London on account of fog, and 35 persons, not having small- 

 pox at all, were vaccinated and taken home. The greatest 

 number of patients taken down to the Floating Hospital in one 

 day was 104, by the Red Cross, in three trips. At the close of 

 the epidemic the Ambulance Committee were able to report 

 the satisfaction they felt that so large a number of persons of 

 both sexes and all ages, most of them in physical suffering, and 

 many helpless from disease, had been carried in all weathers, 

 throughout all seasons of the year, and to a great extent 

 during the hours of darkness, without discomfort or detri- 

 ment to the patients, and without mishap to any person 

 whatever. 



Sir Vincent Barrington, after urging the importance of 

 preserving statistics of work done from an economical, as well as 

 a sanitary point of view, presented statistical papers of fever 

 and small-pox cases treated in Board hospitals. He com- 

 mented upon the supposed prevalence of disease in 1887, 

 and urged every publicity to be given to Board work, to get 

 over the old prejudices of the working classes against send- 

 ing patients to the isolated hospitals. He showed a chart 

 demonstrating that the increased use by the public of the Board 

 hospitals and the transport from 1879 to 1890, had been followed 

 by steadily decreasing fever mortality in London. Now over 

 half the cases of scarlet fever in all London are probably treated 

 in Board hospitals. He referred to the improved sanitation of 

 dwellings and the decreasing severity of the type of the 

 disease as factors in the decreased mortality observed. He 

 presented small-pox pedigrees in non-epidemic times, show- 

 wing in one case that 19 persons, in another 10 persons, 

 were infected from a single case. Also that 20 cases of the 53 

 treated this year had been barren of infecting others as they 

 were so rapidly removed to floaiing isolated hospitals. The 

 deduction drawn was that the rapid system of removal of recent 

 years by the combined land and river service of the Board 

 had a sensible effect in checking a possible epidemic. He 

 presented the forms for recording the evidence of the ex- 

 istence of vaccination cicatrices on the improved system 

 adopted after conferences with Board medical officers and the 

 Local Government Board, and advocated other sanitary bodies 

 adopting the same system, thus facilitating the compilation of 

 statistics, invaluable for the advance of science, and therefore 

 for the treatment and check of small-pox, and the consideration 

 of protection by vaccination. 



Dr.' Seaton, of London, Dr. Armstrong, of Newcastle, Dr. 

 Dudfield, of London, Prof. Stokvis, of Amsterdam, and Dr. 

 Hauser, of Madrid, also spoke on this subject. 



Surgeon- General Beatson, M.D., of Eastbourne, read a 

 paper on " Prevention of Disease in Growing Towns." 



NO. 



II 42, VOL. 44] 



Prof. Stokvis and Dr. Dickson spoke on the subject. 



Dr. Pistor, of Berlin, read a paper entitled " Ueber die Des- 

 infection," of which the following is an abstract. Dr. Pistor 

 dealt with the general rules and methods to be observed in the 

 disinfection of infectious diseases. Such rules should be short, 

 clear, and capable of being understood by everyone. Incinera- 

 tion and boiling for half an hour are, of course, very effectual 

 disinfectants, but they are not always applicable. A i to 2 per 

 cent, solution of caustic soda is a very useful disinfectant. Other 

 methods are steaming, mechanical cleansing (such as rubbing, 

 brushing, &c. ), carbolic acid solution (2 to 5 percent.), lime- 

 water containing about 20 per cent, of caustic lime, and a I to 2 

 per cent, solution of calcined carbonate of soda. These methods 

 and solutions are effective against all the poisons of infectious 

 diseases. The head of the house or institution ought to be 

 responsible for the disinfection under the direction of the doctor, 

 and a record ought to be preserved of the mode of disinfection 

 used. 



Sir William Moore, K.C. I.E., Q. H. P. , read a paper on "The 

 Prevention of Fevers in India." 



A discussion followed, in which Surgeon-General Cook of 

 Bombay, the President, Surgeon-General Beatson, Dr. Leduc 

 of Nantes, Dr, Payne of London, Surgeon-Major Poole of 

 London, and Dr. W. Dickson, R.N., took part. 



Dr. Prospero Sonsino, of Pisa, read a paper on " The Princi- 

 pal and most Efficacious Means of preventing the Spread of 

 Entozoal Affections in Man." 



Dr. Sandwith, of Cairo, and the President, made a few 

 remarks. 



Dr. F. M. Sandwith, of Cairo, read a paper on "Cholera 

 in Egypt." 



Dr. Stekoulis, of Constantinople, and Dr. Simpson, of Cal- 

 cutta, took part in the discussion. 



Dr. Curgenven, of Teddington, read a paper on "The Dis- 

 infection of Scarlet Fever and other Infective Disorders by 

 Antiseptic Inunction." 



Dr. W. Gemmell, of Glasgow, spoke. 



Dr. Phineas S. Abraham, of London, read a paper entitled 

 " On the Alleged Connection of Vaccination with Leprosy." 



Mr. Milnes, of London, Dr. Cassidy, of Toronto, and 

 Surgeon-Major Pringle spoke on this subject. 



Dr. J. P. Williams Freeman, of Andover, read a paper en- 

 titled " Importance of more actively enforcing Ventilation : 

 suggesting a Standard of Air Impurity as a Basis of Prosecu- 

 tions." Dr. Freeman said that ventilation is of well-recognized 

 importance ; the causation of phthisis is a good example of it. 

 Foul air is a cause of tuberculosis in three ways : directly, by 

 supplying the bacillus to the lungs, and through the saliva to the 

 intestinal canal ; indirectly, by causing tuberculosis in cattle, 

 and by so reducing the human body's vitality as to render it a 

 suitable nidus. The bacteriologist leads us to expect that fresh 

 air will be hostile to the virus ; the demographist shows that 

 the death-rate from phthisis increases from islands, coast dis- 

 tricts, agricultural districts, small towns, to large towns ; also 

 in occupations, according to their exposure to the open air, 

 from farmers and fishermen up to drapers and printers (see Dr. 

 Ogle's table). The loss of health from want of ventilation is so 

 familiar as to be little thought of, but the deaths from phthisis 

 alone, fully preventable, must be enormous. The Public 

 Health and Factories Acts provide for proper ventilation of 

 buildings. Any standard that public opinion, lay and medical, 

 may demand might be enforced. Beyond seeing to the cubic 

 space in common lodging-houses, practically nothing is done, and 

 the air of buildings is often "dangerous and injurious to health." 

 An inspector should frequently "sample" the air of buildings, 

 and if it exceed a certain limit of impurity the owner should be 

 prosecuted, cubic space and means of ventilation being left for 

 the architect ; the limit to be when the air inside a build- 

 ing contains twice as much carbonic acid gas as the air 

 outside at the same time. This would usually correspond 

 to De Chaumont's "Rather close, organic matter becoming 

 perceptible." Students of preventive medicine should demand 

 this reform from the administrators of the law. Polluted air is 

 as recognizable, preventable, and harmful as unsound food or bad 

 water, and should be treated on the same lines. 



Two other papers were taken as read, one by Dr. S. Lodge, 

 Jun., of Bradford, entitled " On the Occurrence of the Broncho- 

 pulmonary form of Anthrax amongst Rag-pickers in England, 

 and Suggestions for its Prevention," and one by Dr. H. Rident, 



