the training of railway signalmen
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39THE DIFFUSION OF SMALL-POX.
his valuable services as Almoner, and to Sir Henry Pitmanfor kindly undertaking the duties of Hon. Auditor. Uponthe retirement of Mr. Bryant, from the Presidency of theRoyal College of Surgeons, his successor, Mr. John WhitakerHulke, F.R.S., as President of the College, became an
Almoner; and on the death of Sir Andrew Clark, Dr. J.Russell Reynolds, F.R.S., the recently elected President ofthe Royal College of Physicians, likewise consented to
serve in that capacity. Owing to the press of matter inthe current issue we are compelled to postpone the publica-tion of the Forms of Application until next week. Such
forms, however, can always be obtained by writing ;toMr. Edward Davies, the Secretary of the Fund, THE LANCETOaices, Strand, W.C.
THE DIFFUSION OF SMALL-POX.
IN several large towns there is some diminution in the dis-tribution of small-pox during the week endiiiln Dec. 30th, 1893,as compared with the preceding week. Thus, in Birminghamthe fresh cases fell from 66 in the former week to 38 last
week ; in Walsall they fell from 33 to 26 ; in Oldham from15 to 6; in Chadderton from 19 to 2 ; in Wakefield from
14 to 2; in Bradford from 14 to 12 ; and in Bristol from16 to 13. On the other hand, there was an increase in WestHam, where the new attacks were 11, and amongst otherattacks there were as follow : Aston Manor, 5 ; Leicester, 2 ;Rowley Regis, 2 ; Dewsbury, 2 ; and several instances of
isolated attacks. In Birmingham over 200 patients were stillin the Small-pox Hospital at the end of 1893, and in Stroud,where there were 19 attacks, the local board of health decidedto fit up some slaughter-houses as the best makeshift
hospital that could be quickly provided. In the hospitalsof the Metropolitan Asylums Board 85 small-pox patientswere under isolation on the lst inst.
MB. LAWRENCE-HAMILTON has written to us urging thatall condemned meat, fish, &c., which is seized by the sanitaryauthorities should be consigned to a properly constructedfurnace for destruction. His letter has been evoked by anadvertisement of the City of London Corporation invitingtenders from persons who are desirous of utilising such con-demned material for manurial or allied purposes. Mr.Lawrence-Hamilton not only sees danger in the transportationof such matter through a crowded city, but he hints at thepossibility of crops being rendered unwholesome when manuredwith such stuff. He further hints that this condemned food
may be surreptitiously worked up into comestibles of a moreor less tempting nature. To deal with the last contention wemast remind our correspondent that the Justice who con-demns the food is obliged to order its disposal in such
a way as "to prevent its being exposed for sale or used forthe food of man." It surely cannot be a difficult matterto be tolerably certain of the bona .tides of the purchaser andto insure that hi" dealings with tile material are not of anature to prejudice the public health Even supposing thatsuch matter is destroyed in a furnace it must be rememberedthat it has to be taken to the furnace, and that the necessityof conveying it through the public streets would not beavoided. It is hardly desirable that such furnaces should bein the centres of crowded places. The condemned stuff mustbe carted to the outskirts, and, that being so, properly con-structed closed vehicles are necessary, and we fail to see
why, when once it is enclosed in a properly covered receptacle,it should not be taken any reasonable distance. It is not
altogether advisable to neglect the economic aspects of the
question. If the condemned material is removed by a
contractor to be "dealt with" this is probably the cheapestfor the ratepayer ; while if it is to be burnt not only hasthe furnace to be built but there is a constant drain for
fuel, wages, and repairs. The products of combustion wouldcertainly foul the air, and if the combustion were imperfectthere would be nauseous odours as a result. Clearly a verysure case ought to be made out as to the definite evils whichhave resulted from the prevailing methods of dealing withcondemned offal before the more expensive measures (whichare by no means free from sanitary drawbacks) are forced uponthe ratepayers. If glue, tallow, and manure can be obtainedfrom such matter without serious risk to the public health,sanitarians ought carefully to abstain from interfering withoutadequate grounds for so doing. To do so is to destroy indus-tries, to throw labourers out of employment and to impoverishthe soil. Agriculture in this country has sunk to a dangerouslylow level, and this is having the effect of driving the popula-tion from the healthy country into the comparativelyunhealthy towns. Farm labourers are about the healthiest
class of the population. Taking the average mortality of theentire population as 1000, the farm labourer has, accordingto Dr. Ogle, a mortality of 701, while that of the Londonlabourer is 2020. If we starve the soil we shall inevitablyraise the mortality of the whole country, be driven to importmore food, and be still further dependent than we are atpresent on huge and expensive armaments for the purpose ofmaintaining our existence. The handling of condemned offalmay be a dangerous trade, but, in the f, ce of the low mor-tality of farm labourers and gardeners, the manipulation ofdung and manures, which must often contain pathogenicorganisms, cannot reasonably be regarded as dangerousemployments. Decayed fish has long been regarded as avaluable manure ; and although when freshly applied it is
far from savoury, we are not aware of any well-establishedfacts which point to its being a danger to the public health.Possibly some of our readers may be able to give us thedetails of the manipulations to which condemned food andoffal are subjected by their purchasers.
THE TRAINING OF RAILWAY SIGNALMEN.
A REPORT recently furnished by Major H. A. Yorke to theBoard of Trade on the collision which occurred at EveringhamStation on Nov. 6th, 1893, has once more directed attentionto a standing defect in our system of labour-namely, thelack of technical instruction. We may notice this in almost
any department of industry, and never without perceiving itsinevitable consequences in error and incapacity. Some kindsof work, no doubt, require less intelligence for their accom-plishment and suffer less at the hands of a tyro ; but it is,and it must be, true, nevertheless, that in every case the wayto success is by learning. We may close our eyes to the factif we choose when personal interests alone are involved, butit is obvious that we dare not, and must not, wheneverthe workman’s position is one of trust and responsibility.Such it is, beyond all question, where the duty involved is ofso critical a nature as that of the railway signalman. In thecase already referred to the signalman’s cabin was for the timebeing in charge of an imperfectly qualified porter. The
result we know. Furthermore it appears that discipline atthe station itself was lax. Rules were neglected and mattersgenerally seem to have been administered in a haphazardfashion. Clearly a change of method is needed, and we failto see that railway companies can in such a case absolvethemselves of blame by transferring this to the shoulderseven of immediately guilty persons in their employ. It isnot the men alone but the system which is in fault,and what is urgently called for in the interest of mere
public safety is primarily the due recognition by the
official authorities of their own duty in the matter.
After what has been taught by experience not only in thisbut in many other instances it should be insisted on that
none but thoroughly capable persons should be at any time incharge of the signals. If in any case a learner is entrusted
40 THE ROYAL COLLEGE OF PHYSICIANS OF LONDON.
with them he should act only under trained supervision.To provide this, technical instruction must of course be
adequately extended. It should imply theoretical as well aspractical teaching, and it should take note of personalqualities of character and physical adaptation. Above all, itmust succeed in impressing the trained official with a fullsense of his personal responsibility. We would add a reminderthat the familiar evil of overwork, if permitted to continue,must result in failure and possibly in disaster in spite of themost efficient course of education.
THE NUMBERS OF THE PROFESSION,
THE Medical Directory for 1894, now published, gives thefollowing as the numbers of the medical profession for theyear 1894. In London, 5590 ; in the provinces, includingWales, 14,897 ; in Scotland, 3107 ; in Ireland, 2485 ; regis-tered practitioners resident abroad, 3209 ; naval, military,and Indian Medical Services (excluding those which appearalso in other lists), 2426 ; " too late " list-additional
names, 58. The total number of practitioners in the Direc-tory for 1894 is 31,772, as against 30,759 in the previousyear. This shows an increase in the twelve months of
1013. The obituary list, which seems to be wonderfully com-plete, gives the deaths as 639. The above figures give onemedical practitioner in London for every 750 of the popula-tion ; in the Provinces, one in 1650 ; in Scotland, one in
1300 ; in Ireland, one in 1900; and in the United Kingdomgenerally, one in 1450.
THE PERILS OF FOOTBALL.
THE football season of 1893-1894 is just at its height-indeed, when we recollect the late period of spring intowhich the winter pastime is now prolonged it is doubtful ifthe chase of the leather has yet reached its zenith-but
already we have had to chronicle five deaths which have
occurred immediately upon injuries received during the game,and numerous serious accidents, any proportion of which
may since have resulted in permanent loss of health,crippling, or disfigurement. Further, it must be remembered
that we make no special effort to obtain a complete roll ofthese casualties, but that we simply record them as we
chance to come across them in the columns of our contem-
poraries, so that, as we have previously pointed out whendealing with this subject,1 we do not pretend that our notesfrom week to week represent even a small fraction of themischief. There can be no denying that a pastime whichhas accounted in four months, even by our confessedly im-perfect records, for five sudden deaths, two concussions ofthe spine (in one of which it was stated that three ribswere torn from the spinal column "), one concussion of thebrain, one fracture of the thigh, sixteen fractures of the leg(some of these were simple and some compound, some of eachand some of both bones, but further classification is unneces-sary), nine fractures of the clavicle, and two of the arm " is adangerous one. But in saying this w e do not condemn out-of-hand a fine and manly sport, or shut our eyes to the many fac-tors which combine to make the danger really much smallerthan the gruesome details above would tend to show. The
value of a form of exercise which appeals by its splendidathletic possibilities as much as by the moderation of its
demands on their time and purse to the whole of a peoplesimply cannot be over-estimated from a health-giving point ofview, while the roll of disaster becomes comparatively insig-nificant as the number of players becomes larger. These thingsare obvious, but unfortunately the impression remains in theminds of many that the element of danger in football is
unnecessarily great. Is it ? This and a second question-ifso can practical steps be taken to lessen the danger without
1 THE LANCET, May 30th, 1891,
spoiling the game?-are not to be answered without thought,or on the spur of the moment. They have to be fairly con-sidered from many points of view, and we propose to returnto the subject.
THE ROYAL COLLEGE OF PHYSICIANS OFLONDON.
WE understand that the desirability of instituting somememorial of their late President, Sir Andrew Clark, and, if
the proposal be approved, the question of the form whichsuch a memorial should take will be submitted to the con-
sideration of the Fellows of the Royal College of Physiciansof London by the President, Dr. Russell Reynolds, at thenext general meeting of the College on Jan. 25th.
SMALL-POX AND VACCINATION IN THEBIRMINGHAM WORKHOUSE.
ALL but the anti-vaccination party will be grateful toMr. Hopwood for the question which he put the other dayto Sir Walter Foster in the House of Commons as to thenumber of times that an assistant nurse in the BirminghamWorkhouse had undergone revaccination before she con-
tracted small-pox in a fatal form. The answer which Mr.
Hopwood elicited was doubly valuable. It showed, firstly,that the poor woman had been ’ignorant enough to refuseto be revaccinated, and, as has so often happened before atLeicester and elsewhere, she was singled out by small-pox asthe result ; and, in the second place, it has exposed a seiiousdefect in the administration of the workhouse. People havea right, if they choose, to refuse revaccination, but it is
singularly unfortunate that when small-pox is prevalent andwhen it is known to be spreading to people inside the work-house that the guardians should retain any officer in theirservice who refnses to accept vaccination. Such an officer is
obviously a danger to young infants or to people who, onaccount of illness or otherwise, may not at the moment beable to be properly subjected to the process of vaccinationor revaccination.
ESTIMATION OF THE TOTAL NITROGEN INURINE.
THE total nitrogen in urine may be very conveniently esti-mated by means of the process now universally employed bychemists in estimating the nitrogenous value of foods andfertilisers. A definite quantity of the urine (from 5 cc. to
10 cc.) is treated gradually with 20 cc. of strong sulphuricacid in a flask into which a few pellets of mercuryhave been dropped, and gently boiled until the liquidis colourless, or nearly so. At this point the wholeof the nitrogen will have been converted into ammonia,combined, of course, with sulphuric acid. The acid
liquid after cooling is then transferred to a flask of largecapacity and neutralised and made alkaline with a 20 per cent.solution of caustic soda after the addition, also, of about20c.c. of a 4 per cent. solution of sodium sulphide to
decompose mercury-ammonium compounds. The solution is
then boiled, the steam condensed in a Liebig condenserand the distillate passed into a solution of acid ofknown strength. From the reduction effected in the
strength of the acid, which is ascertained by titrationwith standard alkali, the amount of ammonia or nitrogenmay be readily calculated. A serious difficulty in the processis the bumping of the strong saline solution in the flask
during boiling, and the consequent carrying over of thealkali into the standard acid, besides which, also, the glassflask is very liable to fracture. All this is obviated by arecent modification suggested by Mr. Vincent Edwards, whichconsists in substituting for the glass distilling flask a vesselmade of copper. This not only steadies the boiling consider-ably, but amongst other impoitant advantages it offers are