809 activity has been displayed by M. Millerand in endeavouring to improve the medical services in view of benefiting both the medical men and their patients. It is to be hoped that so good an example will not be lost on this country. SOME MEDICAL ASPECTS OF THE PAN- AMERICAN EXPOSITION AT BUFFALO. (FROM OUR SPECIAL CORRESPONDENT.) Ix my letter last week 1 the Munson tent, which has been adopted for use in the United States army and which is exhibited in the model brigade field hospital at the Exposition, was described, and one or two other features of the display were touched upon. The tent contains all the instruments and materials necessary for the adequate performance of operations in the field. These are carried in the field in surgical and sterilised chests and, as in the case of the medical chests, are packed so as to take the mi.nimum amount of room. Ligatures and sterilised dressings, inclosed in hermetically sealed packets, to be used when needed, are carried in large quantities. The light for field opera- tions is provided by a small acetylene generator which will furnish a sufficient illumination for eight hours without being recharged. As to food the model brigade field hospital is well pro- vided, the same exactitude in packing being observed as is displayed throughout every branch of the system. A mess outfit for 100 men, with cooking utensils and tent, are contained in a moderate-sized chest somewhat larger and of about twice the weight of that used during the Spanish-American war for the mess outfit of six men. Thus, it will be seen that in this instance a veritable triumph of concentration has been reached, one chest taking the place of 16 of those formerly used, making a reduction in weight of at least a ton in the transportation of mess materials alone. The food tent, which adjoins the kitchen tent, contains field rations for 200 men, and in addition two food chests are filled with light, nutritive articles of diet in concentrated form suitable for sick persons. The kitchen tent, which is situated next to the mess tent, is furnished with all that is needful to prepare food for 100 men at one time. The portable cooking range, which is a marvel of lightness and compactness, contains within itself the requisite utensils for the preparation of food for this number of patients. The most essential part of the equipment of a field hospital-indeed, of the army itself-is perhaps the means of obtaining a supply of uncontaminated water. The chief method in vogue in the field hospitals of the United States army to attain this object is the Waterhouse- Forbes steriliser. This steriliser, adopted on the recommenda- tion of the Army Board after a number of exhaustive experiments, as the best of many water-sterilisers submitted for trial, is deserving of a few remarks. Its principle, action, and construction are thus described by its inventors. Firstly, a source of water-supply, having a maintenance level below that required for causing the water to pass entirely through the apparatus. Secondly, the application of heat to a part of the water in the apparatus at the point reached by gravity until ebullition is produced, thereby causing the water to rise and pass on through the remainder of the apparatus. Thirclly, the transference of the heat from the hot water passing from, to the cold water passing to, the point where the heat is applied. An improved apparatus of this design-one of which is exhibited in the kitchen tent of the field brigade hospital at the exposition-has recently been devised by the Waterhouse-Forbes Company, the weight of which, when boxed, is 80 pounds, with a capacity in an ordinary way of about 30 gallons hourly. Heat for this steriliser is generated by the combustion of mineral oil, one quart of the latter being sufficient for five hours’ con- tinuous use. It is claimed for the Waterhouse-Forbes steri- liser that it economises fuel, that it cools water as rapidly as it boils, and that it boils without loss of the dissolved gases ; and last, but not least, that it possesses conspicuous merits distinguishing it above other field sterilisers in that it is light and portable. The experience of the United States army with regard to filters tallies in the main with that of 1 THE LANCET, Sept. 14th, 1901, p. 749. the British army in South Africa and of European armies generally-namely, that an ideal, or even really serviceable, field filter has not as yet been forthcoming. Six four-horse wagons are allowed for the transportation of a United States army brigade field hospital of 100 beds, with equipment of every description for the care of that number of men-a result which speaks well for the success of the eitorts of the Board to solve the difficult problem set them. A.New Building for the New York Laboratory of Research at Buffalo. I have taken the opportunity, while in Buffalo at the Exposition, to visit Buffalo University, and especially the New York State Laboratory, which has up to the present done its work within the walls of the Buffalo University. The interesting experiments conducted under the direction of Dr. Gaylord with the view to discover the cause of cancer, and his publication of the results, drew the attention of scientists throughout the world to the laboratory at Buffalo; and although the outcome of these investigations has not equalled the expectations aroused by the announce- ment-widely and prematurely heralded by the lay journals-that the origin of cancer had at length been finally decided, yet, at the same time, his researches have been productive of good. It is Dr. Gaylord’s intention to proceed steadily along the lines which he has mapped out, and when he recommences work in October he will be able to do so under more favourable conditions than heretofore have existed. The rooms set apart at the Buffalo University for laboratory investigations have been long recognised as. inadequate to the purpose. There is, however, now in course of construction in the vicinity of the Buffalo University a building which will be adapted in every respect to the object of scientilic research. This edifice, which will be ready for use in October, has been erected by a family named Gratwick as a memorial of a near relative and it will, when furnished, cost$30,000 (£6000). It is a three-storey building of ample size and having been planned and designed under the direction of the State Laboratory staff it should not fail to satisfy the requirements of its projectors. Public Health and Poor Law. LOCAL GOVERNMENT BOARD. REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT OF THE LOCAL GOVERNMENT BOARD.’ i On the Sanitary Cireumstances and Administration of the Holsworthy Urban District, buy Dr. THEODORE THOMSON. On the General Sanitary Circumstances and Administration of the Alcester Rural District, by Dr. S. MONCKTON CoPESTw. On the Sanitary Circuntstances and Administration of the Urban District of St. Helens, Isle of Wight, by Dr. H. TIMBRELL BULSTRODE. THESE three reports relate to comparatively small popu- lations and their interest is in the main local and adminis- trative. As regards the little market town of Holsworthy, in North Devon, Dr. Thomson indicates that its sanitary advancement has in the past been greatly hindered by its inclusion in a large agricultural area under the control of a rural district council. Such conditions occur frequently, and it is open to argument whether in a case of this sort remedy should be found in the separation of such a district as Holsworthy-the population of which is only some 1300-from the rest of the rural district, or by the exercise of central authority to compel the rural district council to do its duty. At Hols- worthy the first alternative, which is certainly the easier, has been adopted. Last year a separate urban district was created and the new district council is now faced with a number of somewhat troublesome sanitary questions. Here they should be helped by Dr. Thomson’s report, which not only points to the directions in which improvement is needed, but also distinguishes the practical improvements which are most urgently called for. The matter of water-supply clearly claims the first place. Year 1 London: Eyre and Spottiswoode; Edinburgh : Oliver and Boyd ; Dublin : E. Ponsonby. Price 2d., 4d., and 2d.
Transcript
809
activity has been displayed by M. Millerand in endeavouringto improve the medical services in view of benefiting boththe medical men and their patients. It is to be hoped thatso good an example will not be lost on this country.
SOME MEDICAL ASPECTS OF THE PAN-AMERICAN EXPOSITION AT BUFFALO.
(FROM OUR SPECIAL CORRESPONDENT.)
Ix my letter last week 1 the Munson tent, which has
been adopted for use in the United States army and
which is exhibited in the model brigade field hospital at theExposition, was described, and one or two other features
of the display were touched upon. The tent contains
all the instruments and materials necessary for the adequateperformance of operations in the field. These are carried inthe field in surgical and sterilised chests and, as in the caseof the medical chests, are packed so as to take the mi.nimumamount of room. Ligatures and sterilised dressings, inclosedin hermetically sealed packets, to be used when needed,are carried in large quantities. The light for field opera-tions is provided by a small acetylene generator which willfurnish a sufficient illumination for eight hours without beingrecharged.As to food the model brigade field hospital is well pro-
vided, the same exactitude in packing being observedas is displayed throughout every branch of the system.A mess outfit for 100 men, with cooking utensils and tent,are contained in a moderate-sized chest somewhat largerand of about twice the weight of that used during theSpanish-American war for the mess outfit of six men. Thus,it will be seen that in this instance a veritable triumph ofconcentration has been reached, one chest taking the placeof 16 of those formerly used, making a reduction in
weight of at least a ton in the transportation of mess
materials alone. The food tent, which adjoins the kitchentent, contains field rations for 200 men, and in additiontwo food chests are filled with light, nutritive articles of dietin concentrated form suitable for sick persons. The kitchentent, which is situated next to the mess tent, is furnishedwith all that is needful to prepare food for 100 men atone time. The portable cooking range, which is a marvelof lightness and compactness, contains within itself the
requisite utensils for the preparation of food for this numberof patients.The most essential part of the equipment of a field
hospital-indeed, of the army itself-is perhaps the meansof obtaining a supply of uncontaminated water. Thechief method in vogue in the field hospitals of the UnitedStates army to attain this object is the Waterhouse-Forbes steriliser. This steriliser, adopted on the recommenda-tion of the Army Board after a number of exhaustiveexperiments, as the best of many water-sterilisers submittedfor trial, is deserving of a few remarks. Its principle,action, and construction are thus described by its inventors.Firstly, a source of water-supply, having a maintenance levelbelow that required for causing the water to pass entirelythrough the apparatus. Secondly, the application of heat to apart of the water in the apparatus at the point reached bygravity until ebullition is produced, thereby causing thewater to rise and pass on through the remainder of the
apparatus. Thirclly, the transference of the heat from the hotwater passing from, to the cold water passing to, the pointwhere the heat is applied. An improved apparatus of thisdesign-one of which is exhibited in the kitchen tent of thefield brigade hospital at the exposition-has recently beendevised by the Waterhouse-Forbes Company, the weightof which, when boxed, is 80 pounds, with a capacity in anordinary way of about 30 gallons hourly. Heat for thissteriliser is generated by the combustion of mineral oil,one quart of the latter being sufficient for five hours’ con-tinuous use. It is claimed for the Waterhouse-Forbes steri-liser that it economises fuel, that it cools water as rapidlyas it boils, and that it boils without loss of the dissolvedgases ; and last, but not least, that it possesses conspicuousmerits distinguishing it above other field sterilisers in thatit is light and portable. The experience of the United Statesarmy with regard to filters tallies in the main with that of
1 THE LANCET, Sept. 14th, 1901, p. 749.
the British army in South Africa and of European armiesgenerally-namely, that an ideal, or even really serviceable,field filter has not as yet been forthcoming.
Six four-horse wagons are allowed for the transportationof a United States army brigade field hospital of 100 beds,with equipment of every description for the care of thatnumber of men-a result which speaks well for the success ofthe eitorts of the Board to solve the difficult problem setthem.
A.New Building for the New York Laboratory of Researchat Buffalo.
I have taken the opportunity, while in Buffalo at the
Exposition, to visit Buffalo University, and especially theNew York State Laboratory, which has up to the presentdone its work within the walls of the Buffalo University.The interesting experiments conducted under the directionof Dr. Gaylord with the view to discover the cause of cancer,and his publication of the results, drew the attention ofscientists throughout the world to the laboratory at Buffalo;and although the outcome of these investigations hasnot equalled the expectations aroused by the announce-
ment-widely and prematurely heralded by the layjournals-that the origin of cancer had at length beenfinally decided, yet, at the same time, his researches havebeen productive of good. It is Dr. Gaylord’s intention toproceed steadily along the lines which he has mapped out,and when he recommences work in October he will be ableto do so under more favourable conditions than heretoforehave existed. The rooms set apart at the Buffalo Universityfor laboratory investigations have been long recognised as.inadequate to the purpose. There is, however, now in courseof construction in the vicinity of the Buffalo University abuilding which will be adapted in every respect to the objectof scientilic research. This edifice, which will be ready foruse in October, has been erected by a family named Gratwickas a memorial of a near relative and it will, when furnished,cost$30,000 (£6000). It is a three-storey building of amplesize and having been planned and designed under thedirection of the State Laboratory staff it should not failto satisfy the requirements of its projectors.
Public Health and Poor Law.LOCAL GOVERNMENT BOARD.
REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT OF
THE LOCAL GOVERNMENT BOARD.’ i
On the Sanitary Cireumstances and Administration of theHolsworthy Urban District, buy Dr. THEODORE THOMSON.On the General Sanitary Circumstances and Administration
of the Alcester Rural District, by Dr. S. MONCKTON CoPESTw.On the Sanitary Circuntstances and Administration of the
Urban District of St. Helens, Isle of Wight, by Dr.H. TIMBRELL BULSTRODE.THESE three reports relate to comparatively small popu-
lations and their interest is in the main local and adminis-trative. As regards the little market town of Holsworthy,in North Devon, Dr. Thomson indicates that its sanitaryadvancement has in the past been greatly hinderedby its inclusion in a large agricultural area under thecontrol of a rural district council. Such conditions occur
frequently, and it is open to argument whether in a case ofthis sort remedy should be found in the separation ofsuch a district as Holsworthy-the population of whichis only some 1300-from the rest of the rural district,or by the exercise of central authority to compelthe rural district council to do its duty. At Hols-
worthy the first alternative, which is certainly theeasier, has been adopted. Last year a separate urbandistrict was created and the new district council is nowfaced with a number of somewhat troublesome sanitaryquestions. Here they should be helped by Dr. Thomson’sreport, which not only points to the directions in which
improvement is needed, but also distinguishes the practicalimprovements which are most urgently called for. Thematter of water-supply clearly claims the first place. Year
1 London: Eyre and Spottiswoode; Edinburgh : Oliver and Boyd ;Dublin : E. Ponsonby. Price 2d., 4d., and 2d.
810
.after year Holsworthy suffers from "water-famine" owingto the local shallow wells running dry. At these times thednhabitants are entirely dependent on water, brought once ortwice in the day in barrels from a spring a mile from thetown. Prevention of overcrowding of dwellings upon a
certain area of land is another matter which in Dr.Thomson’s view needs special attention, although, as heremarks, it is singular that such crowding should havearisen, and particularly that it should have been occasionedby recent building, in a town such as Holsworthy.Somewhat similar problems arise in the rural district of
Alcester, in the south of Warwickhire. This district has a
population of 11,500, of which some 7000 consist ofpersons living under urban or quasi-urban conditions in thetowns of Alcester, Studley, and Bidford. These places aresewered and in Alcester water-closets are general. But asthe water-supply furnished by the Alcester Waterworks
Company is very inadequate, provision for flushing theseclosets has seldom been made and the usual objectionable.results have followed. At Bidforcl, where privy pails are inuse, there is a local contract for periodical removal of theircontents by a contractor, but many inhabitants who possess.allotments will not avail themselves of the contractor’sservices and store up cxcremental matter near their dwellingsfto use when they think desirable on their allotment patches.By the exercise of a little common sense it should be possible’to avoid difficulty of this sort. If allotments are outside theown it should be easy to have available there a supply.of town manure for those villagers who demand it.Dr. Copeman points to the serious overcrowding whichoccurs in Bidford cottages every summer through the large.numbers of working-class people from Birmingham who come.tor a brief holiday. Overcrowding is also met with inAlcester, sometimes in very insanitary dwellings. The isola-tion hospital is too small and has insufficient staff for theneeds of Alcester, to say nothing of the adjoining district- of Feckenham, from which cases are also received. It is
’lxopeful to note that since his appointment two years agothe medical officer of health, Mr B. S. Browne, has donemuch good work in bringing to notice various unsatisfactoryconditions in his district and in suggesting practicalremedies. It is quite obvious, as Dr. Copeman points out,that the remuneration of his office is far from adequate.
The urban district of St. Helens, Isle of Wight, has apopulation of some 4500. St. Helens proper obtains waterfrom a series of shallow wells which are described- ft’3 both unsatisfactory and unsafe. But it is intendedshortly to extend to this locality the public supply ofthe Ryde Corporation Waterworks which at present serves
.11, considerable part of the St. Helens district. Dr. Bulstrode
points to considerable slackness in this district in securingthe proper cleanliness of cowsheds. Clamour for isolationhospital accommodation has recently arisen owing to a
considerable outbreak of scarlet fever which took placelast year. It is said that none of the large land-owners ofthe locality are willing to sell land to the district council for,hospital purposes. This ditliculty has often been met with- and surmounted elsewhere.
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN 33 of the largest English towns 6261 births and 4018deaths were registered during the week ending Sept. 14th.’The annual rate of mortality in these towns, which had’been 21-6, 21-0, and 19-4 per 1000 in the three precedingweeks, further declined to 18 -3 per 1000 last week. In London’ the death-rate was equal to 16 -0 per 1000, while it averaged 19 ’7,per 1000 in the 32 large provincial towns. The lowestdeath-rates in these towns were 11’6 in Plymouth, 13’8 in
Derby, 14’5 in Cardiff, and 14-8 in Huddersfield ; the highest1 mtes were 24-5 in Sunderland, 26-4 in Salford, 27-8 in
ivTewcastle, and 28-8 in Gateshead. The 4018 deathsdn these towns last week included 971 which were
’referred to the principal zymotic diseases, against,1506 and 1256 in the two preceding weeks ; of’these, 704 resulted from diarrhceal diseases, 77 from
’diphtheria, 61 from "fever" (principally enteric), 45 fromwhooping-cough, 38 from measles, 37 from scarlet fever,and nine from small-pox. The lowest death-rates fromthese diseases last week were recorded in Brighton, Bristol.Swansea, and Derby; and the highest rates in Wolver-hampton, Manchester, Salford, Sheffielfl, and Gateshead.
y The greatest mortality from scarlet fever occurred in
Bolton ; from whooping-cough in Leicester and Gateshead ;r from "fever" in Swansea, Nottingham, Birkenhead, Hud.) dcrsiield, and Sheffield ; and from diarrheeal diseases in1 Wolverhampton, Manchester, Salford, Preston, Sheffield, and. Gateshead. The mortality from measles showed no marked
excess in any of the 33 towns. The 77 deaths from diphtheria3 included 28 in London, nine in Sheffield, six in West Ham,I four in Bristol, four in Manchester, three in Leicester, and
three in Gateshcad. Nine fatal cases of small-pox were regis-tered last week in London, but not one in any other of the 33
t large towns. There were 135 cases of small-pox remainingf under treatment in the Metropolitan Asylums hospitals on, Saturday, Sept. 14th, against 13, 41, 74, and 92 at the end of, the four preceding weeks ; 60 new cases were admitted
during the week, against 30, 52, and 31 in the three preced.ing weeks. The number of scarlet fever patients in these
, hospitals and in the London Fever Hospital on Saturday, last was 3065, against 3040, 3008, and 2994 on the threei preceding Saturdays : 457 new cases were admitted during
the week, against 273, 303, and 346 in the three precedingweeks. The deaths referred to diseases of the respiratoryorgans in London, which had been 126, 114, and 124 in the
; three preceding weeks, declined again last week to 116.and were 26 below the corrected average. The causes of
, 34, or 0-8 per cent., of the deaths in the 33 towns were: not certified, either by a registered medical practitioner or
by a coroner. The causes of all the deaths were dulycertitied in West Ham, Bradford, Leeds, Newcastle, and in
. 13 other smaller towns ; the largest proportions of uncerti-’ fied deaths were registered in Liverpool, Blackburn,’ Sheffield, and Sunderland.
-
HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in the eight Scotch towns,; which had been 17-4 and 17-8 per 1000 in the two’ preceding weeks, declined again to 17’5 during the week end., ing Sept. 14th, and was 0’8 per 1000 below the mean-rate
during the same period in the 33 large English towns. Therates in the eight Scotch towns ranged from 14’2 in Perthand 15’0 in Paisley to 19-1 in Greenock and24’8 in Leith,The 556 deaths in these towns included 38 which were
referred to diarrhoea. 12 to "fever," 10 to whooping-cough, eight to measles, three to scarlet fever, and three
,
to diphtheria. In all. 74 deaths resulted from these
principal zymotic diseases last week, against numbers
decreasing from 174 to 111 in the six preceding weeks.These 74 deaths were equal to an annual rate of 2-3 per1000, which was 2 ’1 per 1000 below the mean rate .from thesame diseases last week in the 33 large English towns.The fatal cases of diarrhoea, which had declined from129 to 77 in the five preceding weeks, further decreasedlast week to 38, of which 15 occurred in Glasgow, eight inDundee, six in Edinburgh, four in Leith, and three inAberdeen. The deaths referred to different forms of "fever."which had been 11 and six in the two preceding weeks,rose again to 12 last week, and included eight in
Glasgow and two in Dundee. The fatal cases of
whooping-cough, which had been eight, 12, and 13 in thethree preceding weeks, declined again last week to 10,of which three were registered in Edinburgh, three in
Dundee, and two in Leith. The deaths from measles, whichhad been 12, 12, and eight in the three preceding weeks,were again eight last week, and included six in Glasgow.The fatal cases of scarlet fever showed a decline of two fromthe number in the preceding week, and included two in
Glasgow, where the three deaths from diphtheria werealso registered. The deaths referred to diseases ofthe respiratory organs in these towns, which hadbeen 62 and 60 in the two preceding weeks, rose
again last week to 79, and were 9 in excess of the numberin the corresponding period of last year. The causes of 17,or more than 3 per cent. of the deaths in these eight townslast week were not certified.
HEALTH OF DUBLIN.
The death-rate in Dublin, which had been 245, 23’5,and 20-6 per 1000 in the three preceding weeks, rose
again to 22’2 per 1000 during the week ending Sept. 14th.During the past four weeks the death-rate has averaged22-7 per 1000, the rates during the same period being17-7 in London and 17-3 in Edinburgh. The 160deaths of persons belonging to Dublin registered during the
