1446

knowledge of the anatomy of the movements he cultivatesand that he should have some acquaintance with the phy-siology of motion, of muscular development, and of fatigue.The literature of the subject is meagre and not wholly satis-factory. Dr. Dupuy in the present volume attempts tosatisfy this need. The book is intended for non-medical

readers, for "professors" of physical education, heads ofschools and others who are practically concerned in the well-being of children. It begins with a simple account of

the skeleton illustrated with some very excellent wood-cuts and then deals in a somewhat sketchy manner

with the proportions of the body and its weight and growth.The anatomy of the joints and muscles is considered in

some detail and the sections are very fully illustrated. The

physiology of movement is dealt with in but a fragmentarymanner. The anatomical part of the work calls for highpraise. The part which is the most disappointing is that inwhich the various gymnastic movements are considered.These sections, which should form the most important partof the book, are somewhat superficial and incomplete. Theauthor has introduced a great deal of unnecessary matterwhich in a future edition may well be eliminated. In sucha work as the present there is little object in discussingthe various diseases of bones and muscles, the forms andtreatment of fractures, the methods of reducing dislocationsand the more obvious details of physiognomy.

Chemistry for All, or Alternative -Elementary Chemistry. ByW. JEROME HARRISON, F.G.S., and ROBERT J. BAILEY.London : Blackie and Son. 1893.

THIS is one of those little works which invokes severe

criticism from a great many reviewers because it is written"upon the lines of that syllabus." The syllabus referred toin this particular instance relates to the Alternative (sie)Elementary Chemistry of the Science and Art Department, thesubject of examination of the annual "May Exams." In spiteof the limitation of the subject-matter, which is necessarilyinvolved when mere preparation for examination is the objectand purpose of the writer, we venture to think that thelittle book before us might with profit be placed in thehands of all those desirous of a sound acquaintance withthe rudiments of chemical science. It is clearly and simplywritten, the introduction of perplexing symbols and formulaehas been avoided, and many of the experiments, as will beobvious to the intelligent reader, may be performed with thesimplest of materials The performance of one experiment,however, will probably puzzle and would certainly incon-venience most students; it is to dip (p. 17) a bucket into theriver at London Bridge and measure out a gallon of the waterfor the purpose of studying the composition and nature of riverwater, the Thames being taken as a type. But altogetherthis contribution is a model of what elementary text-booksof this class should be.

LIBRARY TABLE.

Guide to Lucerne, the Lake and its Environs. Published

by the Official Commission of Traffic. Text worked out byJ. C. HEER. With Illustrations, Plan of the Town, Mapof the Lakes of Lucerne and Zug, Road Maps &c. Lucerne :H. Keller. 1892. - " The metropolis of the travelling world,’’as the chief town of the four forest cantons has been called,has had many descriptive guide-books devoted to it, but wehave met with none so complete in every respect as this.And yet the book is by no means a bulky one and may beslipped into the coat-pocket or the travelling-bag with butsmall encroachment on their other contents. It has suc-

ceeded in combining fulness of detail with convenience ofsize by the judicious admixture of illustration and letterpress,the former minimising the latter at every point where

pictorial or graphic indication can take the place of

literary exposition. Its editor, Mr. Heer, has evidentlypursued the method practised by the late John Murrayand Karl Baedeker-he has seen everything for him-

self, accepting no statement unverified and recommending:no excursion in which he himself has not taken part.The result is the eminently practical character of the bookand the sense of confidence it inspires in the reader. Oneword as to the best mode of seeing Lucerne and its environs.may not be out of place here. Crowded as the town itselfis in the late summer or early autumn, the plan to adoptis that of making the excursions first and enjoying thescenery and the residence at the various points of interestwhilst yet there is freedom from the pressure of the tourist.world. The visitor will thus have enjoyed the attractions.of the outlying resorts before his return to Lucerne, which inSeptember or October, or even later, is a delightful place ofabode, the hotels being then least frequented, whilst retainingall the service required and presenting none of the endless.distractions of the constant coming and going of guests. Wecan speak from experience as to the delights of October,and part at least of November, in Lucerne-not the least ofwhich are the tranquil enjoyment of the delicious autumnaltair and scenery out of doors and the freedom from the noise’and bustle of the mighty table d’hôte and overcrowded read-

ing-room within. The railway map appended to the volume.gives a clear indication of the routes from Italy to England-from Naples in the south to London in the north. By it the:British members of the International Medical Congress canselect their journey out or homewards, taking Switzerland’both ways, but each time passing through a different part.of it. °

Ditermination Pratique de la Réfraction Uezekzire pccr la

Kératoscopie ou Skiascopi6. Par le Dr. BILLOT. Paris : Société,d’Editions Scientifiques, Place de l’École de Medecine. 1893.

pp. 100. -This brochure gives the usual proceedings for deter-mining the refraction of the eye by what in this country ie.usually termed "retinoscopy,

" which the author considers to

be well adapted for the examination of the eyes of conscripts.The point on which Dr. Billot lays stress is contained in the.following quotation : "When without the use of a correctingglass the shadow moves in any meridian in the opposite-direction to the mirror this meridian is emmetropic or

hypermetropic. In order to distinguish these two states

experiment has taught and theory confirms that it is sufficient,to place before the eye examined a + 1 D glass and to notethe effect....... Three cases may present themselves. The

shadow previously inverse in both vertical and horizontalmeridians moves in the same direction with the mirror in both

directions. It may then be taken for granted that bothI meridians are emmetropic ; or, secondly, the shadow remains.inverse in both meridians, in which case both are certainlyhypermetropic ; finally, the shadow previously inverse in bothdirections with the + 1 D moves in the same direction)with the mirror in one meridian (say, the horizontal)and remains inverse in the other or vertical. It may thenbe taken that the horizontal meridian is emmetropic andthe vertical meridian is hypermetropic, or that there is.

simple hypermetropic astigmatism in the vertical meri-

dian." He says nothing of the employment of atropine,.perhaps because it is not applicable to conscripts. Hence

only rough approximations to the proper correcting glasses.can be obtained.

ST. JOHN AMBULANCE ASSOCIATION.-The suc-cessful members of the King’s-cross Branch of the Associa-tion were recently presented with certificates and medallionswon by them in competition. The branch is of recentformation and Sir Henry Oakley complimented both the com-petitors and Dr. J. Brunton, who instructed them, on the

skill displayed on the occasion.

1447PARLIAMENT & THE PROBLEM OF HOSPITALS FOR INFECTIOUS DISEASES.

THE LANCET.

LONDON: SATURDAY, JUNE 17, 1893.

TEE public are very much indebted to Mr. COHEN and toMr. GOSCHEN for bringing into the light of Parliament the

problems connected with the working, under present con-editions, of the Metropolitan Asylum Hospitals for infectious- diseases. If the problems have not been created by Parliament

>they have been rendered very much more difficult of solution

by legislation. It is so easy to legislate. The draftsman is

always at hand and can construct in a few lines a clause ina Bill which will alter the theory of pauperism and involve theState or the ratepayers in additional taxation to the tune ofhundreds of thousands of pounds. The pocket of the metro-

politan ratepayer is supposed to be deep and he himselfhas been hitherto a much enduring man. So it has come

to pass that, although scarcely aware of it, he has become

theoretically chargeable with the cost of providing accom-modation for the whole infectious disease of London, andin practice is already bearing the weight of over 50 per- cent. of it. No less than 54’6 per cent, of all the noti-

fied cases of infectious sickness are now admitted into

the hospitals of the Metropolitan Asylums Board; and

-there is no sign of any abatement in this demand. The

statements of the Managers at their last meeting were:somewhat startling. They said that it had been necessary torefuse admission to cases of both scarlet fever and diphtheria,.and that "about 50 per cent. only of the persons requiring.admission can be dealt with. " It would be interesting toknow whether this means 50 per cent. of cases so badly.situated for purposes of attention and isolation as impera-tively to need admission, or only 50 per cent. of all

wishing for admission though having the means of

isolation in their own homes. Mr. CoHEN’S question,which was put on June 8th, was obviously intended

o elicit the truth on this point. But the answer of

Mr. FOWLER was unsatisfactorily vague. "Hehadinquiredof the Managers of the Metropolitan Asylums Board, and he

thought there was no reason to suppose that any appreciablepercentage of the patients in the hospitals were persons who- could properly be isolated in their own homes. A large pro-portion of cases were admitted on the recommendation of the

=sanitary authorities and medical officers of health." In

-answer to a suggestion that inquiry should be made as to the

efficacy of the system in staying the disease in houses fromwhich the patients are removed, the President of the Local’Government Board said such an inquiry would involve muchtime and was not necessary.

Mr. GosoriErr’s questions were based on the view that thedemand for these hospitals is likely to increase more andmore and that the Government should undertake to assist theBoard in getting further sites for fever and small-pox hos-pitals. It is found that the representatives of the districtsin which it is proposed to place these hospitals withone consent make excuse, and that nothing short of

compulsory powers of purchase will enable them to keep pacewith the demand for admissions. Mr. FOWLER, in reply

intimated that the metropolis could no longer supply the

space needed for this purpose. He would be happy to pro-cure further legislation, if necessary, "as it was, in his view,quite impossible to confine the provision for these patientswithin the present metropolitan area. "These questions and answers emphasise the point on

which we have long insisted: viz., that the law has

placed on the Metropolitan Asylums Board a duty far largerthan was ever contemplated by the original promoters of theBoard and its hospitals. These hospitals were intended forthe poor-for those dependent on the rates ; in other words,for paupers. The change-the abolition of this particularform of pauperism-was not effected quite abruptly, as faras we understand. By the Poor Law Act of 1889 it was

enacted that where persons were admitted into these hospitalswho were not paupers, the expenses for their maintenance were

to be paid by the guardians of the Union from which they werereceived, and that those guardians might recover the amountof the expenses. But by the Public Health Act of London,1891, all this power of recovery from the person was abolishedand the charge was thrown primarily on the guardiansof the poor, who in their turn were to be repaid out of the

Metropolitan Common Poor Fund. By Clause 4 of Section 80it was enacted that the admission of a person into one of

these hospitals suffering from an infectious disease or hismaintenance should not be considered parochial relief, alms,or allowance "; and that no person by reason thereof shouldbe subjected to any disability or disqualification." By admis-sion for any other disease than an infectious one he would have

to pay or incur the odium of receiving relief or alms ; but notso where the disease is infectious, the theory being that hesubmits to isolation for the public good. The consequenceof this theory is a wholesale rush to the metropolitan hospitalsso that only half that "require admission " can be admitted,and London itself cannot supply sites for the necessarynumber of hospitals. The officials of these hospitalsand the Managers-who deserve all praise for their labours-are much too busy in providing beds to make any inquiryinto the circumstances of patients; and the sanitary autho-rities are naturally apt in a mechanical sort of way to

send all infectious cases into these hospitals. This maybe the right method, and it may be necessary to largelyincrease the accommodation; but is it certain that

this is desirable ? Have the clauses of the Act of 1891

not gone too far in altering the law of pauperism as respectsmaintenance in these hospitals 2 Are not the comparativelywell-to-do availing themselves of the benefit of the hospitalsto the prejudice of the really poor ? We are not aware

that in the provinces there is any such accommodation

of the law of pauperism. It is only eleven years since a

Royal Commission said that 3000 beds would suffice for

the accommodation of the really poor. Now we have 4600

beds, and more than 50 per cent. of the patients who requireadmission have to be refused. We trust that Mr. COHEN

and Mr. GOSCHEN will continue their questions to the LocalGovernment Board till more light as to our real situation isobtained. The Board is responsible at least for the regu-lations and restrictions " under which patients are admittedinto the hospitals. It can surely find time to make suchregulations and restrictions as will for the future secure an

inquiry into the social circumstances of the applicants and