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COFFEE AND SEWAGE.To the Editors of THE LANCET.

SIRS,-In THE LANCET of Feb. 18th, p. 460, Mr.R. J. Friswell complains of your comment of Feb. 4thon the above as being unfair. In this connexion I’should like to point out that, according to Dr. J. W. H.Eyre’s examination, each berry acted as a nutritivemedium for bacillus coli communis, bacillus enteritidissporogenes, and sewage streptococci. If the presence ofthese does not show sewage contamination I should like toknow what does. Why is sewage itself dangerous ? Becauseit contains these very organisms and may contain manyothers more generally recognised as pathogenic. Evenwere the quantity of sewage small it might be verydeleterious because the berries from the way in which theywere packed-viz., in bags-acted as a kind of filter bed,freeing the water which passed through them of a largeamount both of organic and inorganic filth which becamedeposited on the surface of the berries. The evidence of thesanitary officials was given on the assumption (uncontra-dicted) that the coffee during roasting attained a temperatureof from 3000 to 4000 Centigrade, but Mr. Friswell in hisletter now states this ought to have been Fahrenheit. Hadwe understood that 180° C. was the highest temperature weshould not have admitted that all organisms were destroyedby roasting, since it is quite conceivable that certain sporesmay have escaped, not to mention the various cellular toxins.In view of the fact that caffein itself is not destroyed atthis temperature I consider it quite an open questionwhether the products of the various bacteria which infestedthe berries were rendered harmless.

I am, Sirs, yours faithfully,R. K. BROWN, M.D.R.U.I.

The Town Hall, Spa-road, S.E., Feb. 20th, 1905.

HIGH BAROMETRIC PRESSURE ANDCEREBRAL HÆMORRHAGE.

To the Editors of THE LANCET.

SIRS,-I have only just seen the issue of THE LANCET ofJan. 28th in which Dr. James W. Russell of Birmingham hasan article on the Relation between Various AtmosphericConditions and the Occurrence of Cerebral Haemorrhage.In this he refers to Dr. R Hensleigh Walter as having sug-gested that there is a relation between a high barometricpressure and an attack of cerebral haemorrhage. Now, sofar as I know, I was the first to suggest the influence of ahigh barometric pressure upon haemorrhages generally, in-

eluding, of course, cerebral. This I did in an article whichappeared in 1896,’ entitled Haemorrhages: their Relationto Barometric Pressure." I have drawn your attention tothe above article as in recent literature the fact that therelation between high barometric pressures and hmmorrhageshad been observed and commented on nearly ten years agohas been entirely ignored.

I am. Sirs, yours faithfully,Edinburgh, Feb. 18th, 1905. THOS. WHITELAW, M.D. Edin.

SANTA CRUZ, TENERIFFE, AS A HEALTHRESORT.

To the Editors of THE LANCET. i

SIRS,-I wish to draw attention to the claims of SantaCruz, Teneriffe, as a health resort. I refer more particularlyto the new suburbs above the English church (from 200 to300 feet above sea level), where there are now a number ofgood hotels and pleasant gardens amidst salubrious and

picturesque surroundings. The average mean temperatuieof the winter and spring months is about 65 F., relative

humidity 65, and rainfall 11’ 50 inches per annum. There isan abundance of bright sunshine, the nights are warm, andthere is a very slight dewfall. There is generally a pleasantbreeze from the sea and altogether it may be considered one ofthe best climates in the world for invalids or people wishingto spend their winters abroad. The electric tramway fromSanta Cruz to La Laguna and on to Tacoronte (a rise ofnearly 2000 feet) is a great boon to visitors and during thesummer Santa Cruz, which is the capital of the Canary

1 Brit. Med. Jour., May 30th, 1896.

Islands, is a most interesting old city and the most lively inthe archipelago. If desired I shall be glad to give anyfurther information.-I am, Sirs, yours faithfully,

A. W. W. DOWDING, M.D. Durh.Santa Cruz, ’reneriffe, Fob. lOtb, 1905.

HUNTERIAN ORATORS.To the Editors of THE LANCET.

SIRS, -It is generally agreed that Mr. J. Tweedy’s Hun-terian Oration marks a new departure in point of originalityand your favourable notice of it will be endorsed by all whoheard it. Not only did he offer his audience an unhackneyedappreciation of the work and methods of John Hunter but hehad the courage to analyse one of the tiresome rhetoricalcommonplaces copied from one another by indolent oratorshalf a century ago, according to which Hunter is likened toBacon. The orator showed that Francis Bacon, great as hewas, was the last of the mediaeval philosophers, while JohnHunter was a pioneer entirely on a higher plane, becausemore careful of the truth than the Lord Chancellor who issupposed to have written the plays of Shakespeare. Oratorshave in the past been cruelly hampered by the necessityof always speaking about the same man. In their de-ireto say something new about John Hunter they have toooften unconsciously repeated the veriest platitudes. Some-times the task has been too much for them. In 1841,for instance, Thomas Callaway failed conspicuously in hisoration. He could not decipher his own writing and

though more wax candles were brought by Clift, his speechwas described as a " most miserable failure." John FlintSouth in 1844 was original at John Hunter’s expense. Heomitted to mention him in his oration. Lawrence lost histemper and made a famous attack on the general practi-tioners who had crowded to hear him (1846). Asked to

apologise, he indulged in ferocious repartee and called hisaudience geese. Luke’s oration in 1852 was very poor andBransby Cooper’s "a a great failure." The oration ofHonoratus Leigh Thomas is described as "a most modestproduction" in 1827, while Sir Anthony Carlisle simplydelivered a lecture on oysters. Hence, his nickname in thepages of THE LANCET of the time, "Sir Anthony Oyster."Similar in kind though far different in degree was

Joseph Henry Green’s famous oration on " Mental

Dynamics," while in recent years Mr. Macnamara lecturedvery ably on anthropology and but little on John Hunter.Mr. Tweedy’s oration is in some sort a return to the typicalexercises in which John Hunter has been kept in view as atext, new and appropriate lessons being drawn from hiswork and his character. As such it will rank among theclassics of the College. I am, Sirs, yours faithfully,Feb. 20th, 1905.

__________________

P. V.

ADVANCED PLUMBING.(FROM A CORRESPONDENT.)

Aa examination of the sanitary fittings and plumbc:s’work now nearing completion at the new wing of St. Mark’sHospital, Paddington, is encouraging, indicating as it doesthat the hitherto slow march of the plumber is being broughtinto time with the quick-step of modern surgery. At St.

Mary’s Hospital the greatest attention has been given to everydetail and the result reveals a unity of purpose in conceptionand construction which reflects the greatest credit on allconcerned. A special feature throughout all the internalfittings is simplicity in form, there being a complete absenceof any attempt at ornamentation. Sharp angles are

avoided, all necessary mouldings or projections beingrounded or hollowed, thus avoiding corners in which dirtand germs could accumulate. Each part of the severalfittings is accessible for cleansing, while all unavoidablejointings are flush. There are several deviations from existingwork of the kind that are well worth special attention.

Closets.-The closets are of white enamelled fire clay, onthe cantilever principle, carefully formed with roomyshallow pans to avoid 1’oul?ng, and are fitted with a speciallyconstructed flushing rim that insures thorough cleansing.

1 See THE LANCET, Feb. 18th, 1826: "Hunterian Oration read !by Sir Anthony Oyster ..... His speech was a fine sample, on thewhole, of rhetoric, which the learn’d call r’ gmarole."

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These closets are built into the wall clear of the ground andthe seat is at a lower level than usual. The low level isconsidered to have certain physiological advantages and itcertainly offers a more natural position than the ordinary17-inch high seat. The safe beneath, in place of lead orthe usual more or less absorbent tile, is a heavy cast-irontray, coated with porcelain enamel and provided with agrating and waste pipe. The lead service and the anti-

syphonage pipes to the closet are connected with adjustablegun-metal fittings. The flushing supply cisterns are of cast-iron, somewhat tapered at the bottom, which form, togetherwith the use of a special valve, renders them as nearly aspossible silent in action. The cisterns are also coated withwhite porcelain enamel, while the lever chains are of a non-corrosive metal with celluloid handles.Commode cupboards.-One very important provision is that

of the white porcelain cupboards for the storage of bedpansand urine bottles containing samples awaiting inspection.These are supplied with a novel system of ventilation, bothinlet and exhaust. The fresh-air inlet, which is carriedthrough the external wall, is fitted with a fine wire gauzemoveable panel or fly trap. Thorough ventilation takes placeeach time the adjacent bedpan sink is used, some 200 or 300cubic feet of air being drawn through the cupboards auto-matically. This is accomplished thus : the water-supply tothe flushing cistern of the sink is utilised to operate a

ventilating fan in its passage to charge the cistern. By thismeans any extra waste of water is avoided. Where thesecupboards are not in the immediate vicinity of the bedpansinks, shafts have been carried up ’from them fitted withcopper exhaust ventilators which are kept ill constant actionby means of a small Bunsen burner fixed in the shaft.

Scalding sinks.-The bedpan sinks are of one piece ofenamelled porcelain with ascending jets for scalding the

pans and a special arrangement for urine bottles. The jetsare controlled by self-closing non-concussive gun-metalvalves. The basins or hoppers of these sinks are flushed bythree-gallon cisterns similar to those used for the waterclosets. Porcelain corrugated slabs are supplied in connexionwith these sinks, provided with hose and hand sprays, forscouring mackintosh sheets.

Snrgical sinks.-The surgical sinks have naturally receivedmost careful attention. The adoption of a toe action com-bined hot and cold valve would seem to be a considerable

improvement on the pedal valves previously in use, as

the slightest tap of the toe instantly controls both the

quantity and the temperature of the flow, while thereis no necessity for maintaining a regular pressure as

with the pedal; necessarily, by doing away with the

pedal, the fitting is rendered less complicated. Thesinks themselves are of white porcelain with rolled edgesand fitted with recessed accessible wastes, which lastare removeable for sterilising. The sinks are in pairs andbetween each is fixed a polished gun-metal wringer for usewhen cleansing sponges, &c. The hot and cold supply isdelivered through overhead swing brackets having a sprayand douche attached. In connexion with these sinks are

porcelain draining trays for cleaning instruments. Glassshelves for the disinfectant bottles are also provided whichlast have vulcanite valve stoppers.Lavatories. -Adjoining the operating room is the surgeons’

room in which are three large plain porcelain lavatories, eachone being fitted in all respects like the surgical sinks, onlythe wastes are governed by a slide arrangement and can beopened or closed by a touch of the elbow, the wringers ofcourse excepted. The whole of the metal used is non-

corrosive. The baths, sinks, and other plumbers’ workthroughout the building are all of a proportionately highstandard. The nurses’ sinks are fitted with speciallyporcelain-enamelled Berkefeld filters. Water storage isprovided for two days’ supply and a small auxiliary electricmotor has been fixed in order to insure their being chargedin the event of the pressure failing in the water company’smain.Great credit is due to the architect, Sir William Emerson,

and the hospital staff for the foresight and care shown inthe details, as also to Messrs. Davis and Bennett, thecontractors who have carried out the work. It may be addedthat only registered plumbers have been employed.

TORBAY HOSPITAL, TORQUAY.-£1800 have beenreceived by the governors of the Torbay Hospital, Torquay,in response to their appeal for E2000 for the purpose ofproviding a children’s ward and a new operating theatre.

SMALL-POX AND SLUMS AT PITTSBURGAND ALLEGHENY.

(FROM OUR SPECIAL SANITARY COMMISSIONER.)

IN visiting what I was informed were considered to be theslums of Boston I only found one small group of houseswhich were inhabited by organ-grinders and which might bequalified as really bad. At Pittsburg and Allegheny there wasno difficulty in discovering slums well worthy of comparisonwith the lowest quarters of large English industrial centres.The towns which have developed very rapidly in con-

sequence of some newly created industry do not seem to beadministered so well as the more ancient and historic townsand cities where the growth in size and trade has beenmore slow and more deliberate. Then there is one markeddifference. In the older towns or cities the great diffi-culty is to find land to build upon ; in the newer townsthe difficulty is to find land that has been built upon.At Pittsburg there are vast stretches of elevated landoutside the city where a large district of villadom is fastspringing into existence. The result is that whole streetsof more closely packed houses built near the centre of thecity, which served as residences for the well-to-do beforeelectric trams came into existence, are now handedover to the poorer sections of the community. Thesein some instances have degenerated into slums. Of course,the land in the business centre of the city has becomeextremely valuable and there the houses consist of officeswith but very few inhabitants. Indeed, to make stillmore use of the land skyscrapers have been built, oneof these being no less than 28 storeys high. It is to be

hoped that measures will be taken here as at Boston tolimit this style of building, for though a "skyscraper" ortwo may not do much harm, except it be by reason of itsugliness, a large number would so shut out the air and lightfrom the streets as to constitute a considerable danger to thepublic health. What the town may become may be inferredby the bargain made by one of the churches. The length ofthis church ran parallel with the street and thus it occupieda good deal of frontage. The church thereupon sold halfthis frontage to a skyscraper building company. Besides

paying a considerable sum of money, this company pulleddown the church at its own expense and then rebuilt it theother way round-namely, at right angles with the streetinstead of parallel. Thus, only the narrow end of the churchfaces the street, and on the frontage space vacated a huge" skyscraper," containing many hundred offices and businesspremises, towers above the church and its steeple. Insteadof driving the money-changers out of the temple the landon which the temple stood has been sold to the money-changers.

It has already been explained that in spite of the immensewealth accumulated at Pittsburg there is no properwater-supply and typhoid fever prevails in an endemic con-dition which occasionally bursts out into an epidemic.’ Anadministration which is content to serve out sewage-contami-nated water to the entire city is not likely to bestow par-ticular care on the housing of the poor or the disposal of its

sewage. There is no sewage-disposal scheme before the

municipal authorities that is in the least likely to save thecity. A plan for filtering the sewage-contaminated water nowdrunk is before the authorities. The cost of the filters is to bemet by introducing meters and making a charge in proportionto the quantity consumed; a method which will not encouragepoor people to take baths. But there are legal difficulties inthe way of this scheme that could well supply pretexts forindefiuite postponement. Yet there have been many warn-

ings as to the general insanitary condition of Pittsburg.As soon as the temperature rises to about 80° F. there is anabnormal prevalence of infantile diarrhoea. The sanitarydepartment does a good deal of work in endeavouring tocope with existing evils. On the receipt of a message fioma medical practitioner municipal inspectors examine the

plumbing, the drains, and the water-supply of any housewhich is considered to be in an insalubrious condition. Itoften happens that the inhabitants are found to be drinkingcontaminated water from a private well and they are thengiven the contaminated public water-supply by way of

1 See Typhoid Fever and the Water-supply at Washington Pittsburg,and Allegheny, THE LANCET, Nov. 19th, 1904, p. 1451.