260 A NEW HOPE IN DOMESTIC HEATING

approaching 4000 remain under-doctored. The finan-cial sacrifices now being asked of many who are not in aposition to secure big lists would be reduced. But whatmatters most of all is that, as soon as may be feasible,practitioners everywhere should be in a position to dotheir work properly, without perpetual hurry, andthat the nation should have the benefit, in fact as intheory, of a genuine family-doctor service.

International Health or World Health?A MONTH’S work by the first World Health Assembly

is briefly recorded by Dr. N. M. GooDMAN on anotherpage. Much of this work was useful and promising,but the outstanding achievement of the meetingwas its proof that, even in the present state of tension,international political groupings do not retain theirstructure when health is under consideration. Politicaldetachment may well be expected among cliniciansor scientists, but to find it in a body of official govern-ment representatives discussing administrative

problems is a hopeful sign for the future of theWorld Health Organisation. Anyone reading throughthe unidentified remarks of delegates, at least in theassembly’s committees, would be hard put to discovertheir countries of origin, and he would have evengreater difficulty in defining any general " grouppolicies.

This held broadly true even on the major issuesof programme and budget. As we remarked at its

opening,’ the assembly had a choice between whatmay be called international health and world health-it could rest content with doing small things whichcan only be done internationally, or it could attemptto achieve a measurable improvement in the healthof the world-and this choice had to be faced in thedebates on the budget. The Interim Commissionhad proposed to the assembly a budget of 6,324,700U.S. dollars, which already represented a compromisebetween the older school and the " up-and-at ’ems."The British delegation-understandably perhaps, inview of our economic situation and our conservative

traditions-proposed a 4 million dollar budget.In this it received general support from the UnitedStates, for internal political reasons, in spite of theUnited States having been the original proponentsin the Interim Commission of the " W.H.O. abolishesmalaria " theory; and also from the Russians,for reasons not entirely clear, but apparently from ageneral dislike of " swollen bureaucracies." Onlythe smaller nations-and by no means those withmost to gain-headed by Dr. KARL EvANG, of Norway,wished to keep to the original figure of the InterimCommission. There were many protests when thefavourite’subjects of the delegates or their govern-ments had to be cut out of the programme or

drastically reduced, and nearly all delegates supported,from various motives, immediate regionalisation,which still further reduced the funds that can bedevoted to field work. The result was a budgetof 5 million dollars-more than ample for an inter-national health programme in the pre-war sense, yetobviously inadequate for an attack on the majordiseases of the world. Indeed, on a crude populationbasis, the sum available for such an attack worksout at less than one dollar per 1000 inhabitants of the

1. Lancet, July 3, p. 17,

globe. Nevertheless, this may prove to be the best-solution, at least for the first year of the organisation’slife, since experiments on aid to governments on alimited scale may not only provide experience for thefuture but may achieve some useful results on catalyticlines.

There remains the problem of allocating even

these comparatively small sums between the variousclaimants. It proved hard enough for the InterimCommission to decide between the 14 UNRRA-aidedcountries with a fairly well-defined programme. The

assembly passed this responsibility on to the executiveboard, without laying down any guiding principles.How will it be possible in the future to decide betweena war-damaged library in the Ukraine, three fellow-ships requested by the Philippines, or a B.C.G. teamfor, say, Liberia ? This is probably the most awkwardproblem before the new organisation, but a solutionshould not be beyond the capacity of the executiveboard and the new director-general, Dr. BRoCKCHISHOLM, to whom we extend our congratulationsand good wishes in his difficult task.

A New Hope in Domestic Heating"To have the air inside a dwelling as fresh as the air

outside, it is not necessary to have it as cold. ""-FLORENCENIGHTINGALE.

THE urgent need for fuel economy has given a newimpetus to the campaign for smoke abatement anda new encouragement to thosewho demand efficientdomestic heating. The Department of Scientific andIndustrial Research has now established at Greenwichan active station for fuel research, which has as itsprincipal aim the economical use of fuel in the home.Before the late war, coal in Great Britain was relativelycheap and easily obtainable. In twelve or thirteenmillion homes it was used for heating, washing, andcooking to the extent of 60 million tons a year--or athird of the total consumption for all purposes. Ofthe vast amount of heat liberated, only a fifth wasusefully employed and the remaining four-fifths waswasted. Because of this our houses in general havebeen badly heated. In the winter it is usual to find

only a small area round the fire in one room kept ata comfortable temperature, the rest of the house

being bitterly cold. Even the heated room does not

give a full measure of comfort, owing to the draughtfrom the excessive quantities of cold air drawn infrom outside to pass up the chimney. Furthermore,our domestic chimneys have been responsible forabout half of the pollution of the atmosphere by smoke.It has been estimated that smoke emitted from coalburnt in open grates before the war carried more thana million tons of tar and soot into the air every year.During recent years industry has developed domesticheating appliances which are at least twice as efficientas the older ones and can now be obtained in increasingnumbers. This means that we can have more comfort-able and healthier homes and can save fuel at thesame time-and a saving of 5% in the fuel used fordomestic consumption means an extra 21/2-3 milliontons of coal a year for the export drive. It meansalso a saving for the consumer’s pocket, for in thepast the amount spent on fuel by the average house-holder over a period of 40 years was often equal tothe capital cost of the house. -

261EXTROPHY OF THE BLADDER

Since its inception, the Fuel Research Station hasbeen busily testing the new appliances before theirrelease for installation in the post-war housing pro-gramme. To link up with these " laboratory " tests,the parent Department of Scientific and IndustrialResearch arranged a series of practical " living "experiments whereby many different types of heatingappliances were installed in houses newly erected foroccupation. The tenants themselves (sometimes, butnot always, specially selected for the purpose), withthe assistance of scientific observers, have been

collecting observations on these " designs for living,"on the physiological reactions of householders to thevarious appliances, and on the fuel consumption ofeach. The third stage in this enterprising researchprogramme was the construction at the Fuel ResearchStation of a calorimeter building, lately declared openby Sir EDWARD APPLETON, F.R.S., secretary of thedepartment. This building is not a research laboratoryin the ordinary sense. It is really a scientific instru-ment for the measurement of heat. No-one has yetaccounted completely for all the heat in the fuelburned in a domestic grate. The heat is very difficultto trace. It may be transmitted by radiation, byconduction, or by convection ; it may reach therooms in the house, but much undoubtedly is lost.The calorimeter building is designed to measure

precisely all the useful heat and all the losses. Thewhole building is a piece of experimental apparatusof such a size that every experiment can be carriedout with a full-size heating appliance. The broad

principle underlying its use is that adopted by thephysicist in his laboratory when he measures theheat from half a thimbleful of coal with a calorimeter.In the new building each room is a calorimeter, andthere are four of them, each 12 feet square and 9 feethigh-about the size of an ordinary living-room in asmall house. The rooms are of air-tight’constructionwith specially balanced draught arrangements toeliminate leakage and enable the amount of incomingair to be recorded. The total useful heat from the

appliance can thereby be determined by directmeasurement. It is also possible to measure separatelyradiant heat, warmed air from convection jackets,and heat to the boiler water. In this way an appliancemay be tested without its performance being affectedby the measuring instruments. The tests will give acomplete picture of the behaviour of the applianceunder different operating conditions, and withdifferent fuels. The building also includes rooms

for measuring ’ by photo-electric methods theamount of smoke produced by each applianceunder test.

" Mental anxiety may perhaps be considered themost powerful enemy to the duration of human life,and next to it defective nutriment, whether in

quantity or quality, but after these no other causeat least in modern times, appears to have inflicted sogreat an amount of evil upon the human race asdefective ventilation." The epidemics of catarrhalinfections which plague us every winter are evidencethat these words, written by Dr. D. B. REID in 1844,are still true. The Department of Scientific andIndustrial Research is making a determined attemptto overcome the outstanding difficulties as they applyto the home.

Annotations

OCCLUSIVE DRESSINGS

THE search for a protective dressing that will effec-tively exclude liquids and micro-organisms, and will notat the same time damage the healing tissues, has recentlymet with some success. If maceration of the underlyingtissues is to be prevented there should be evaporationthrough the dressing. Epithelium is particularly liableto maceration, as anyone knows who has wrapped his

finger in a waterproof dressing to exclude air and waterfrom a small cut or abrasion : the disappointing conse-quence-a white, sodden area extending round an

imperfectly healed lesion-is one of common experience.Burnt surfaces tend to become macerated under all theusual dressings, and often this results in the destructionof the growing edges of epithelium, and of the islets ofregenerating epithelium on which rapid healing depends.When the horny layer at the edges of a wound issodden by insensible perspiration and sweat-glandsecretions the danger of infection is enhanced.A new technique in the treatment of burns has latelybeen described, at a meeting of the American Associationfor the Surgery of Trauma, by W. A. Brown, A. W.Farmer, and W. R. Franke, who have developed itat the Hospital for Sick Children, Toronto, and at theRoyal Canadian Air Force institute of aviation medicine.The dressing they advocate is aluminium foil, which,they point out, is non-toxic and easily sterilised. Theyuse this foil in sheets 0-001 in. thick, and apply it directlyto the burnt surface, with a superimposed pressuredressing. The pressure is essential, since without itthe wound may still become soggy. The foil is not

impervious : the thin sheets have minute pores whichallow of " perspiration

" of the wound. With adequatepressure " weeping " of the wounds ceases very quickly.Second-degree burns examined ten days after applicationof the foil were found to be pink, dry, and healing byepithelisation without maceration. The dressings wereodourless, and the foil had retained its sheen on bothsurfaces. In a series of 50 cases treated with aluminium-foil dressings there was one in which 35% of the bodysurface was burnt to the third degree ; on removal ofthe foil the burns were found to be covered by a greyslough. Severe systemic reactions were encounteredin only 12 of the 50 cases, and urinary output wasgenerally unimpaired. Intramuscular penicillin was

given sometimes, but not as a routine.During the war, in the search for a method of water-

proofing clothing for the tropics, it was noted thatmaterial which is highly resistant to liquid water mayyet be permeable to water vapour ; and last week wepublished an account 1 of experiments with nylonderivative in the form of a film which has these virtuestogether with the toughness and pliability that make itsuitable for a wound dressing. Clinical trial has shownthat the dressing is practical and that wounds treatedwith it heal well. -

EXTROPHY OF THE BLADDER

CONGENITAL malformations are a rousing challengeto surgeons because of the lifelong burden they imposeand because of the child’s lively powers of recovery andadaptation after operation. Few congenital defectscause more grievous mental and physical sufferingthan extroversion, or extrophy, of the bladder, and nosurgeon can remain satisfied with the results of treat-ment so far attained. In a paper read before the BritishAssociation of Urological Surgeons on,. June 26, Dr. LouisMichon, of Paris, described his attempts to restore

urinary continence in these patients. The usual treat-ment-diversion of the urine-is not a cure and is a

1. Bull, J. P., Squire, J. R., Topley, E. Lancet, Aug. 7, p. 213.