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defence, and held that the resolution passed was not, in anyevent, such an illegal act as to justify an action beingbrought in connexion with it. It was, he held, a matter

to be decided by arbitration under the rules of the society,as contemplated by Section 67 of the Act, with rightof appeal to the Insurance Commissioners. Mr. Justice

BAILHACHE therefore dismissed the action before him

with costs, and any appeal that may be made againsthis decision will be awaited with interest, as will also be

the result of appeal to the Commissioners if the determina-tion of the question should be found to rest ultimately withthem.

The Organisation in London ofthe Treatment of Tuberculosis.

initiated in July of last year, but during the months thatinitiated in July of last year, but during the months thathave passed since then, although a certain number of

patients have been admitted into hospitals or sent to sana-toriums, much confusion has existed in relation to all

organised effort to deal with the problem. The London

- County Council, in its position of central public health

authority, is well fitted to systematise the arrangementsin London, and we are glad to see that the Public

Health Committee of that Council have been requestedto prepare forthwith and submit to the Council a

scheme for dealing with tuberculosis throughout the Ad-ministrative County of London. We have publishedan account of a report from that committee which fore-

shadows the course to be recommended. The existingprovision for dealing with tuberculosis is in the hands

of several authorities and institutions, so that some con-

fusion is perhaps inevitable. These may be classified as

follows: (1) official agencies-the County Council, both

as a health and an education authority, the local

sanitary authorities, the Poor-law authorities (including the

Metropolitan Asylums Board), and the Insurance Committee :and (2) voluntary agencies, as the general and specialhospitals, the tuberculosis dispensaries, the various nursing,charitable, and philanthropic associations, and religiousbodies. It is obvious that if the best results are to be

obtained these authorities and institutions must be coördi-

nated. Particularly in relation to the London CountyCouncil and the Local Government Board might it be

suggested :—

When two authorities are up, °

Neither supreme, how soon confusionMay enter ’twixt the gap of both, and takeThe one by the other.

We especially approve of the proposition that advantageshould be taken as far as possible of the large general and

special hospitals. The advantages they can offer in the wayof an experienced staff, beds for observation cases, specialdepartments, and clinical laboratories are far in excess.

of any provisions that could be made by the local

authorities in the shape of new dispensaries, with a

limited staff. Important assistance as regards research

might also be obtained by investigations made at hospitalsdevoted to diseases of children, where opportunities arise of

studying tuberculosis in the early years of life. This is well

illustrated by an interesting paper which we publish this

week in another column on the pathology of tuberculosis in

infancy and childhood, by Dr. C. PAGET LAPAGE and Dr.

WILLIAM MAIR. Further, facilities for research would be

much greater and more valuable at one of the existinghospitals than at a newly formed dispensary. In order to

facilitate the part to be played by the large hospitalsin the general scheme for the treatment of tuberculosis,the staffs of the London special hospitals met on

Dec. 10th, 1912, and passed certain resolutions. Amongthese resolutions one was to the effect that each specialhospital for diseases of the chest should be the central

tuberculosis authority in its own area ; that area would

consequently have the advantage of the services of the

members of the staff of the hospital and the many

opportunities offered by such an institution which we havementioned, while in an area where no special hospital existedone of the general hospitals could act as the central

tuberculosis authority. We heartily commend this pro-

position and the others passed at the meeting to the favour-able consideration of the Public Health Committee of the

London County Council.

There is another matter in reference to the workingof the sanatorium benefit to which we think attention

should be drawn. Tuberculosis officers have been, or are

about to be, appointed throughout the country. It is of the

utmost importance that care should be taken, first, that

they have had an amount of practical experience withtuberculosis sufficient to render them actual experts;secondly, if these oflicers are appointed by the various

local authorities a strict veto should be exercised

by the chief administrative body, so as to preventlocal influence from being exerted to bring about the

election of unsuitable candidates. In order to givethose medical men who wish to devote themselves to the

duties of a tuberculosis officer opportunities of special studycourses of instruction are being instituted at the hospitalsfor diseases of the chest in London. A complete curriculumshould consist of studies in the wards, out-patient roomsand laboratories, instruction in a sanatorium, and in additionattendance on special lectures in the diagnosis and treatmentof tuberculosis and in administrative duties. At present theamount of experience required in candidates for these

appointments borders on the farcical. Attendance on two

afternoons a week at a tuberculosis dispensary over a shortperiod is all that is necessary. We trust that when a central

tuberculosis authority is established, at least six months’

study in a special hospital will be insisted on. Indeed, wewould go further and say that as the duties involved will

practically form a special municipal or State service, similarcourses of study should be required as in the case of medicalofficers of health, and certificates stating that the candidateshave shown efficiency in this particular branch of medicineshould be demanded. We believe that if this plan were

instituted, combined with the endowment of laboratories for

research, an encouraging commencement would be made for

combating- the disease. Another advantage resulting fromsuch special training would be that the officers would be ina position to recognise and report upon the rarer forms of

1 THE LANCET, Dec. 14th, 1912, p. 1672.

973

pulmonary tuberculosis, and thus add to the general know-

ledge of that disease. Dr. J. NICOL GALBRAITH records

this week an interesting case of acute tuberculous pneumoniawith recovery. This condition is generally supposed to be

fatal, but tuberculosis officers will have exceptionalopportunities of meeting with similar cases. Especialexperience is needed in order to recognise them, but when

recognised they may be successfully treated.

Superfluous Oxygen as the Perilof the Mine.

IT used to be taught in the early days of chemical

lessons that when a candle went out it was safe to assume

that the air was no longer fit for human respiration.The belief still prevails even amongst miners, for theyreckon that they have had a narrow escape if theyeventually reach the surface safely after passing alonga mile or so of mine roadway in which the air

would not support the combustion of an oil lamp.According to recent researches this is a fallacy, and the,observation is of the utmost importance connected Nvith the protection of life in mines. The fact would appear tobe that normal air at sea level contains oxygen in excess of

the requirements of healthy respiration; and when we reflectthat at great altitudes colonies of human beings are knownto exist and enjoy a hardy and vigorous life in spite of

the fact that the partial pressure of oxygen is only12 per cent., the point may well arrest our attention.

The physique of the Indians dwelling on the upper slopes ofthe Andes is notoriously splendid, and the inhabitants of

the high plateaus of Thibet combine physical vigour with

activity. "It is well known,’’ writes Dr. LEONARD HILL,"that men can work hard and live vigorous, healthy lives inthe mountainous regions of the earth where the partialpressure of oxygen is only 17 per cent. of an atmosphere orless. In the Alps there are noted health resorts at very

high altitudes, and the Alpine guides and soldiers are thehealthiest of men. Mexico City and Johannesburg werebuilt at an altitude of about 6000 feet. In the Andes

railways have been built and mines worked at an altitude of

12,000 to 15,000 feet, and several towns with populationsexist at 10,000. The human organism easily com-

pensates itself for the diminution in the partial pressure of

oxygen. The ventilation of the lungs and the percentageand total amount of haemoglobin increase, while the powerof the hasmoglobin to hold oxygen in combination also

changes, with the result that the tissues obtain an adequateamount of oxygen."

If it can be substantiated that, while chemical combus-tion requires the presence of something over 17 per cent. of

oxygen in the air human respiration can be satisfied

with less without any harm accruing to the organism, it

follows that a scheme presents itself, the application of

which should diminish very considerably the loss of humanlife in the coal mine. The suggestion of adopting a pro-tective measure based upon these considerations has reached

us in a little book written by a practical, chemical and

mining engineer.1 He shows that the needs of combustion

1 Coal, and the Prevention of Explosions and Fires in Mines, byJohn Harger, M.Sc. (Victoria), Ph.D. (Heidelberg), M.Inst.M.E.London: Longmans, Green, and Co. 1913. Pp. 183. Price 3s. 6d. net.

and respiration are different equations. Thus in the case

of combustion it is the percentage amount of oxygen thatmatters, but in respiration it is (within limits) the actual

quantity-i.e., the weight in a given volume-that counts. Acubic foot of air, for example, with an oxygen percentage of17-5, contains, at sea level, almost exactly the same weightof oxygen as an equal volume of air with 21 per cent. of

oxygen at an altitude of 5000 feet. A lamp will not burn inthe former, but will, of course, burn quite readily in thelatter. For the purposes of respiration, however, they are

exactly alike., It seems possible, therefore, to provide theilliller with a supply Ul all’ peiiHCbly nu.H.pmu. mr respiration,

but which fails to support combustion. In such an atmospherehe should be able to live a healthy respiratory life, whilehe should be free from the terrible risks of a fierce chemical

union of gases or dust with oxygen which gives rise to the

appalling colliery explosion. While the air is good enough forhim to breathe it would fall short of the requirements ofchemical combustion. Dr. HARGER points out that, curiouslyenough, one gas-methane-which is of such vital import-ance, because it is the chief explosive constituent, in mines,lS fortunately extremely sensitive to lack of oxygen, for themethane flame goes out when the oxygen has been reduced

to about 17 - 5 per cent. Hydrogen and acetylene, however,will continue to burn until the oxygen is reduced to 7.5 percent. and 9.5 per cent. respectively, but they are rarelyif ever constituents of mine air. These observations are

again of importance, since it means that the acetylenelamp could be used without risk for illuminating the minein an atmosphere containing a reduced amount of oxygen,but yet which is sufficient for respiratory purposes.

Paradoxical as it may appear, it is quite conceivable that

many of the great mine explosions have been caused by theenforcement of a high degree of chemical purity of theair. When ventilation was bad there were, at all events,no great dust explosions, and yet the Coal Mines RegulationsActs insist that a place shall not be in a fit state for workingor passing therein if the air contains less than 19 per cent.of oxygen or more than 1’ 25 per cent. of carbon dioxide.

On the other hand, Dr. LEONARD HILL has declared

that if the mine were ventilated with air containing17 per cent. of oxygen in sufficient volume to keepthe miners cool and fresh, not only would explosionsbe guarded against, but the mines could be safelyworked and illuminated with electricity, and miners’

nystagmus prevented. If these conclusions have a goodfoundation-and they appear to rest on sound reasoning,practical considerations, and experiment-it may well beasked why in the name of humanity the principles laid

down are not put immediately into practice? Dr. HARGER

says the reduction of the percentage of oxygen in the

ventilating current is undoubtedly the surest method of

rendering mines safe from both gas explosions and dust

explosions, as well as from the more frequent though lessdisastrous fires in the roadways, and he adds that this-

method, founded on his work and only recently discovered,is not yet in practice, though it has been proved that it canbe worked on a large scale with every satisfaction. Is

there any reason for delaying the application of a methodwhich suggests the prevention of an appalling sacrifice of

human life and of much human misery and pain ?