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using this fire is considerably less than the averagecoal fire with its attendant dust and trouble. Thereis no need at any time to lift out the remainder of theprevious day’s fuel. Fresh fuel can be added on topof the cinders at the bottom of the grate, andignition is rendered simple and quick by the provisionof a gas-lighter.

Ventilation and Heating.The papers and discussions at the Conference, like

the stands at the exhibition, mainly retold what wasalready known-not indeed to the bulk of fuel-users,but to the scientists and experts. Sir John Robertsonand Dr. Leonard Hill dealt effectively with the valueof sunlight and with ventilation and heating, and bothargued strongly that there is no justification for thecontinued use of raw coal on its present enormousscale. In Dr. Hill’s words it is bad policy to " putoff the demand for abolition of smoke pollution on theplea of waiting for the economic production of asmokeless fuel better than coke and gas. Themodern gas fire has been perfected so as to give amaximum of radiant energy including visible red rayswhich penetrate the skin and the tissues to somedepth." It was also. he said, a fairly efficient ventilator,especially where a second opening into the flue wasprovided, as in the best designs, so as to raise thetotal ventilation of a small shut-up room to some 3000cubic feet an hour. But the radiant energy of a gasfire, he added, is so great that a window can and shouldalways be kept open. He laid considerable stress onthe error both of overheating, a common mistake inusing gas fires, and of monotonous heating ; there wasa definite advantage in the variations in the heatemitted by coal fires, and though this could be easilyobtained with gas, people tended to make too littleuse of the control which the gas taps afforded.

Dr. J. S. Owens underlined the emphasis laid onventilation.. In estimating the efficiency" of heatingappliances, the function of the appliance must beclearly understood ; you cannot, he said, relate inputto output unless you know what sort of output youwant. It so happens that ventilation is a functiongenerally left to heating appliances ; and it ismisleading to talk of an appliance being highlyefficient when it fulfils the heating function only.There was also good sense in Dr. Owens’s point thatit is not necessarily sound to be always seeking torender new fuels suitable for use in appliancesdesigned for some other fuel ; it may be better policyto adapt appliances to fuels than fuels to appliances.

The Domestic Chimney.Much light on the practicability of domestic smoke

abatement was supplied in a paper on MunicipalHousing Schemes by Mr. E. D. Simon and Miss M.FitzGerald. The Smoke Abatement League circulatedto local authorities a questionnaire designed to elicitwhat steps, if any, they had taken to reduce or

abolish smoke from their own houses, and what werethe results in the opinion of both authority andtenants. The answers, summarised in the paper,clearly showed that domestic smoke abatement waspractically a new idea to some authorities. In a veryfair number of housing schemes, however, provisionhad been made for smokeless heating and cooking withthe exception of one coal fire, and in some cases

all-gas and all-electric houses had been tried. Aftermaking allowance for the natural dislike of change,even for the better, the evidence justified theconclusion that a far wider use of smokeless methodswould be acceptable and economic even in housesoccupied by people of limited means. The Conferenceendorsed the view that the Government in its SmokeAbatement Bill was quite needlessly overcautious inrefusing to deal with the domestic chimney. A

purely permissive clause was required, enabling localauthorities to make regulations with regard to cookingand heating arrangements in Pezv dwelling-houses,with a view to reducing smoke.

Mr. Raymond Unwin and Mr. Pointon Taylor,Chief Architect and Chief Assistant Architect respec-

tively to the Ministry of Health, while defending theGovernment’s caution, set forth in their paper on" Clean Air and Clean, Houses " the possibilities ofsmoke abatement in an encouraging way which seemedhardly consistent.

Further Steps.Papers were also contributed on the subject of

industrial smoke, and a preliminary step was takento bring about the formation of voluntary associationsof manufacturers to study in cooperation and applyindividually means of eliminating the inefficiency andwaste which their present smoke production represents.A more comprehensive suggestion was also thrownout that the delay between the admitted establishmentof economic remedies for smoke and their adoption bydomestic and industrial fuel-users might be reduced ifa national smoke abatement movement were broughtinto being, embracing all the smoke abatement effortsnow carried on too much in isolation. At any rate theConference made clear the slowness with which peopleput into practice even smokeless methods that areknown to pay, apart from their value as such.Attendance at the exhibition has been disappoint-

ingly small. But at present it is not apparent whencethe funds are to be drawn for a campaign on a scalewhich would attract adequate notice.

MEDICINE AND THE LAW.

Hospital Collection Frauds.MENTION was made in this column a few weeks

ago of sentences passed upon a group of defendantswho had been conspiring to obtain charitable con-

tributions by fraud. Their method was to representthemselves as an organisation engaged in collectingmoney in aid of hospitals, and they obtained consider-able sums from audiences at cinematograph theatres,being sometimes allowed to address the audiencesfrom the stage. An associate of these defendantspleaded

"

Guilty " on Sept. 8th at the Central Criminal

Court to a charge of conspiring to obtain charitablecontributions by fraud, and was sentenced to ninemonths imprisonment in the second division. Hewould have been tried and sentenced with thedefendants in the previous proceedings had he notdisappeared while on bail awaiting trial. In a countrywhere the hospitals rely so largely upon voluntarysubscriptions this particularly mean fraud seems torequire specially vigorous measures. It is perhapshopeless to expect the charitable public, though oftenimposed upon, to examine the credentials of everyperson who invites contributions for charitableobjects. But a great deal can be done by local, ifnot general, restrictions upon the abuse of flag-days,and upon unauthorised collection in places of publicresort. By-laws should be elaborated, if necessary,and every locality should see that its inhabitantsare protected. The bench will no doubt bear in mind,too, the desirability of passing exemplary sentences.

Poisoning Cases : Immediate Treatment at Hospitals.There are few practitioners who have not had

experience of the manifestations of disappointmentof persons who wish for the immediate treatment ofa patient at a juncture when every moment ofprofessional time is already occupied with the treat-ment of others. The same disappointment mustoften occur where a hospital is asked to give facilitiesor accommodation when neither are available. Atan inquest on Sept. 10th the Hackney coroner (Dr.Edwin Smith) commented adversely upon the actionof a doctor at the German Hospital at Dalston,who had omitted to treat a woman suffering fromlysol poisoning. The woman was found lying uncon-scious upon the floor of her kitchen, having apparentlyswallowed poison. She was taken to the GermanHospital, but, as no bed was available, she wasremoved to the Metropolitan Hospital, where shedied an hour later. The coroner’s point was that

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first-aid should have been rendered, and that for thispurpose it was unnecessary to wait till the patientcould be put to bed. The resident at the GermanHospital was asked if he did not think it would have ebeen better to have gone down and looked at thepatient before sending her away to another hospital.He did not agree ; he said it would have takensome time to administer treatment and he was notin a position to admit her to his hospital. It appearedfrom his further evidence that the German Hospitalwas not equipped with a poison cupboard withstomach-pumps, antidotes, and emetics in readinessfor prompt use, and that it would have taken time tocollect apparatus and drugs. The coroner in recordinga verdict of " Suicide while of unsound mind " tookthe view that while treatment would not have savedlife in this instance, the hospital should have beenprepared to meet such an emergency. We note thatin the Medical Directory this hospital is discribed as" for........all cases of emergency."

Pcatient Declining to Remain in Hospital.An incident of a converse character, occurring

on the same day, illustrates the reluctance of somepatients to be admitted to hospital. A woman wasknocked down by a motor-car and was taken in anambulance to St. George’s Hospital. There she wasexamined by a doctor who advised her to remain.She declined to remain and signed a documentto the effect that she had left of her own accord andcontrary to the doctor’s advice. Five days later shewas found dead at her flat. The post-mortem examina-tion showed that the deceased, a woman of 60, hada fissured fracture at the base of the skull, a fractureof such a nature that it could hardly be diagnosedduring life. She had also four ribs fractured. Thedivisional police surgeon, Dr. Percy J. Edmunds,giving evidence in the Westminster coroner’s court, expressed the opinion that the deceased had lainin bed for some time, but that, owing to the gradualoozing of blood in the brain, she had begun to feelfaint and probably got up to summon assistance whenshe fell and died. The coroner’s jury returned averdict of " Accidental death."

BERLIN.

(FROM OUR OWN CORRESPONDENT.)

Epidemic of Gastro-intestinal Catarrh.IN certain districts of the city of Hanover an

epidemic of gastro-intestinal catarrh has occurred,fortunately without fatal issue up to the time ofwriting. It has been ascertained by the HygienicInstitute of Hanover that the cause of the disease wasa contamination of the drinking water. Althoughthe organisms of enteric fever, dysentery or cholerawere not present, the percentage of germs in the waterfrom one of the waterworks was found to have con-siderably increased. The epidemic, which had affecteda large number of the people in the district which issupplied from this source, nas now been stamped out,and officials of the Health Office state that the wateris now safe for drinking purposes without beingboiled. They are of opinion that the inundationsof this summer had caused germs from the surfaceof the soil to penetrate into the deeper strata whencethe water is derived ; moreover, a deficiency in thedrains due to the floods had allowed the waste waterfrom a tar factory to find its way to the water-works.

Birth-rate in Germany and in France.At a recent meeting of the Berlin Society for

Public Health the birth-rate in Germany was discussedby Prof. Grotjahn. He stated that formerly thebirth-rate had exceeded the number of deaths, so

that the population showed a constant increase and

1 Fatal cases have since been reported in the press, in whichthe outbreak has generally been described as one of typhoidfever.—ED. L.

Germany became overcrowded. This state of thingshas changed during the last 20 years. At present thenumber of deaths is certainly smaller than that ofthe births ; this is, however, attributed to the factthat during the war so many people were killed, andimmediately afterwards, during the inflation, under-feeding caused the premature death of others. Nowthat normal conditions have been restored, the death-rate is expected to show an increase, whilst thebirth-rate will diminish. The decrease of the birth-rateis believed to be due to the indiscriminate use ofcontraceptive drugs and appliances, a factor commonto all nations of the West ; in Slavonic countries anenormous number of births still take place. Bystatistical researches it has been ascertained that tomaintain the number of the population-not toincrease it-there must be three children for everymarriage, and as every marriage cannot producethat number there must naturally be families withmore "children. In France there is a law according towhich families of small financial means receive

support from the municipality on behalf of everychild born after the second. They moreover enjoyother privileges. Germany has done nothing in thisdirection. Prof. Grotjahn pointed out that it iserroneous to believe that the decrease of the birth-rateis a remedy for unemployment. The example of Franceshows, on the contrary, that the decrease of thebirth-rate in a country induces foreign workmen tocome to seek work there. The state of things inGermany is the more undesirable, as in France thedecrease of births has been nearly stopped for severalyears, whilst in Germany it is still growing steadily.In Germany, in 1900, 35 births were registered foreach 1000 inhabitants ; in 1924, only 20-4. In Francethe birth-rate was only 21-3 in 1900 ; but scarcelyless-19-3-in 1924. The speaker (Prof. Grotjahn)advised the Government to adopt and to improveupon the French system of support of families havingmany children.

Articles in the Medical Press.

Seventy-eight editors of German medical periodicals,including the leading medical journals, have collec-tively approached the heads of university clinics andother scientific institutions, asking them to insiston the reduction to a reasonable size of articles sub-mitted for publication by their assistants. They statethat they can no longer afford to give as much spaceas before the war to lengthy communications, andpoint out that when the MSS. for publication areshortened in the editorial office undesirable con-

troversy may ensue. Heads of clinics and scientificinstitutes are therefore asked to use their authorityin supervising articles issued by their juniors, and toinduce them to submit MSS. in a more concentratedform. Articles of minor importance, when too long,must inevitably be refused. The editors point out thatthis step has been taken only in the interest of main-taining the high standard of their journals.

Statistics of Hospitals in Prussia.In 1924 the number of hospitals, clinics, and

infirmaries in Prussia was 2195, of which 1816 werepublic institutions. The number of institutions hasdecreased by 134 since 1913, but the number of bedshas increased, being 205,516, against 177,184 in 1913.For each 10,000 inhabitants 54-9 beds are now avail-able, against 42-5 before the war. The number ofhospital patients in 1924 was 1,606,178, against1,534,209 in 1913. Of these 88,836 died, giving adeath-rate of 5-5 per cent., against a death-rate of6-1 in 1923 and 5-6 in 1913. The relation of thedeaths in hospital to the general death-rate was,in 1924, 193-5 to 10,000; in 1921, 177-8, and in 1913,only 136-7. This relative increase of the deaths inhospital is ascribed to the fact that membership to asick club which has to cover the expenses of a hospitalstay having become compulsory for a much greaterpercentage of the population, in consequence manymore patients than formerly are conveyed to hospitalwhen ill.