1
986 ,distribution so that the residual material left after fumigation can all be removed from the ship’s hold or other compartment. Spreading in thin layers on paper is recommended. It was found that rats, which were all of one breed, varied considerably in their resistance to the poison, and no opinion could be offered as to the relative susceptibility of these rats and wild rats. They were usually placed in cages at both floor and ceiling level in the test-rooms in which a standard dosage of 2 oz. of HCN per 1000 cubic feet was used as a rule. Diffusion of the gas was found to be slow, which, having regard to the small difference between its density and that of air, is not surprising. Also, as the gas is slightly lighter than air, the rats at ceiling level succumbed sooner than those on the floor. The authors say : " It is a well-known fact that rats escape cyanide fumigation as fumigation is usually done, and the reason for this becomes clear when it is seen that a lethal quantity of the gas will not flow through small openings into tightly closed sections not primarily exposed to the gas. The practical proof of this was witnessed on shipboard when test animals, concealed in the covered bilges, closed drawers, and similarly tight compartments, were unaffected by standard amounts of cyanide .during the course of a two-hour fumigation." The importance of careful preparation of a ship before fumigation is therefore obvious. Experiments showed that the residues of the solid preparations, more especially from calcium cyanide, should be removed with great care to avoid danger. A concentration of one-tenth of an ounce of hydro- cyanic acid in 1000 cubic feet of air, in the opinion of the authors, " must be considered as dangerous to human beings exposed over a long period of time, and they also suggest that rats which are well enough protected in living quarters to escape a dose of 1 oz. of HCN per 1000 cubic feet will also survive a two-hour exposure to the standard dose." The lethal efficiency of liquid acid is much greater than that of gas generated from cyanide in situ and still more so than that of calcium cyanide. Zyklon-B is very effective - obviously it is in effect liquid acid. The conclusion was forced on the authors that less than the theoretical amount of gas was evolved into the air from sodium cyanide by the agency of mineral acids. A wise note ,of warning is struck in respect of the absorption of hydrocyanic acid by bedding, mats, rugs, &c., which are not dry and which are best removed before operations commence. Conversely the protective effect of layers of damp sacking or similar materials on rats hiding under them should be considered, as it is very great. " If managed with due care and proper respect," the investigation concludes, " hydrocyanic acid is the best of all fumigants for rodents. Careless use of it will be attended with human fatalities, but it I will kill rats under conditions that the use of sulphur I cannot meet; and it is obvious that if fumigation does not kill rats,. time and money are wasted." Incidentally, it kills those minor horrors of life at sea- cockroaches, bugs, and the like. At well-equipped fumigating stations with a highly-trained personnel liquid acid will be found the best agent to use. For smaller ones Zyklon-B has advantage. The liquid acid is not a very safe substance to convey on account of some tendency to undergo violent decomposition, and should not be sent by common carrier. The lessons learned in the course of the experimental work .covered in this report point insistently to one con- clusion : .Fzcmigate fewer ships better. DAWSON WILLIAMS MEMORIAL PRIZE. AT the general meeting of subscribers to the Dawson Williams Memorial Fund, held on July 10th last under the chairmanship of Sir Humphry Rolleston, it was resolved that the sum subscribed to this memorial should be devoted to a prize in paediatrics, to be awarded every two years or at longer intervals, .and that the scope of the prize and the details of its adjudication should be left to the discretion of the trustees, with the assistance of such other persons as they might wish to consult. The following have agreed to act ex officio as trustees: the Presidents (for the time being) of the Royal College of Physicians of London, the Royal College of Surgeons of England, the British Medical Association, the Royal Society of Medicine, the Section for the Study of Disease in Children (R,.S.M. ), and the Editor of the British Medical Journal. The Medical Secretary of the British Medical Association acts as convener and secretary of the trusteeship, and the first meeting of the trustees was held at the House of the Association on Oct. 19th, with Sir John Rose Bradford, P.R.C.P., in the chair. It was decided to ask the Charity Commissioners to accept for investment the sum of t849 now in hand, to receive all interest accruing therefrom, and to pay this over to the trust account at the bank for the purposes of the Fund. In pursuance of the resolutions of the meeting on July 10th it was resolved that the Dawson Williams Memorial Prize should take the form of an award for the best work done in paediatrics during the five years immediately preceding the date of the award ; that any registered medical practitioner in the British Empire should be eligible for the award ; and that the first award, to be made by the trustees in July, 1930, should consist of a cheque for 50 guineas. PAY BEDS IN LONDON HOSPITALS. FivE years ago 1 we published a list of 13 general hospitals in London which provided accommodation for patients of moderate means. It contained the names of three hospitals with medical schools attached, providing between them 108 pay beds, and ten other hospitals, mostly general, with resident medical officers, providing between them 213 pay beds. In the report of the special committee on pay beds of King Edward’s Hospital Fund for London, published in July, 1928, the first of these two groups contained the names of six hospitals, providing 164 beds, and the second the names of 22 hospitals, providing 358 beds. It is true that the area surveyed by the special committee was much wider than that covered by our own inquiries, which made no claim to be exhaustive, but even so the increase that has taken place in hospital accommodation for paying patients during the last five years is significant. It has a bearing on a doubt, expressed by the special committee referred to above, as to whether the nature and extent of the existing pay-bed accommo- dation at voluntary hospitals is generally known by members of the middle and professional classes. The committee suggested that King Edward’s Hospital Fund might well consider the wisdom of preparing and publishing year by year, for the information of the public, a list of the pay beds at the London voluntary hospitals, with rates of charge and other particulars. We are informed that the management committee of the Fund are at present considering this recommendation and would be glad to know whether a list such as is included in the appendix of the report of the special committee, if prepared and issued annually, would be likely to be of use to the public and the medical profession throughout the country. It seems to us clear that it is of the utmost importance for practitioners to be kept up to date with developments of this kind, and we would urge the Fund to proceed with arrangements for the annual issue of such a list. The appendix to the report includes also particulars of 22 general, cottage, and other hospitals without resident medical officers who admit paying patients, 8 hospitals for women, and 24 other special hospitals. As further evidence of the importance of an annual supplement to the information here provided is the information that of the teaching hospitals not hitherto providing pay beds the Middlesex, St. Bartholomew’s and St. Mary’s have schemes for establishing such beds, while St. Thomas’s, the Royal Free, King’s College, and Westminster Hospitals propose to add consider- ably to the number of private wards at present available. Many other extensions of this sort to general and special hospitals are contemplated, and 1 THE LANCET, 1923, ii. 1000.

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986

,distribution so that the residual material left afterfumigation can all be removed from the ship’s holdor other compartment. Spreading in thin layers onpaper is recommended. It was found that rats,which were all of one breed, varied considerably intheir resistance to the poison, and no opinion could beoffered as to the relative susceptibility of these ratsand wild rats. They were usually placed in cages atboth floor and ceiling level in the test-rooms in whicha standard dosage of 2 oz. of HCN per 1000 cubic feetwas used as a rule. Diffusion of the gas was found tobe slow, which, having regard to the small differencebetween its density and that of air, is not surprising.Also, as the gas is slightly lighter than air, the ratsat ceiling level succumbed sooner than those on thefloor. The authors say : " It is a well-known factthat rats escape cyanide fumigation as fumigation isusually done, and the reason for this becomes clearwhen it is seen that a lethal quantity of the gas willnot flow through small openings into tightly closedsections not primarily exposed to the gas. Thepractical proof of this was witnessed on shipboardwhen test animals, concealed in the covered bilges,closed drawers, and similarly tight compartments,were unaffected by standard amounts of cyanide.during the course of a two-hour fumigation." Theimportance of careful preparation of a ship beforefumigation is therefore obvious.

Experiments showed that the residues of the solidpreparations, more especially from calcium cyanide,should be removed with great care to avoid danger.A concentration of one-tenth of an ounce of hydro-cyanic acid in 1000 cubic feet of air, in the opinion ofthe authors, " must be considered as dangerous tohuman beings exposed over a long period of time,and they also suggest that rats which are well enoughprotected in living quarters to escape a dose of 1 oz.of HCN per 1000 cubic feet will also survive a two-hourexposure to the standard dose." The lethal efficiencyof liquid acid is much greater than that of gasgenerated from cyanide in situ and still more so thanthat of calcium cyanide. Zyklon-B is very effective- obviously it is in effect liquid acid. The conclusionwas forced on the authors that less than the theoreticalamount of gas was evolved into the air from sodiumcyanide by the agency of mineral acids. A wise note,of warning is struck in respect of the absorption ofhydrocyanic acid by bedding, mats, rugs, &c., whichare not dry and which are best removed beforeoperations commence. Conversely the protectiveeffect of layers of damp sacking or similar materialson rats hiding under them should be considered, as itis very great. " If managed with due care and properrespect," the investigation concludes, " hydrocyanicacid is the best of all fumigants for rodents. Carelessuse of it will be attended with human fatalities, but it

Iwill kill rats under conditions that the use of sulphur Icannot meet; and it is obvious that if fumigationdoes not kill rats,. time and money are wasted."Incidentally, it kills those minor horrors of life at sea-cockroaches, bugs, and the like. At well-equippedfumigating stations with a highly-trained personnelliquid acid will be found the best agent to use. Forsmaller ones Zyklon-B has advantage. The liquidacid is not a very safe substance to convey on accountof some tendency to undergo violent decomposition,and should not be sent by common carrier. Thelessons learned in the course of the experimental work.covered in this report point insistently to one con-clusion : .Fzcmigate fewer ships better.

DAWSON WILLIAMS MEMORIAL PRIZE.AT the general meeting of subscribers to the

Dawson Williams Memorial Fund, held on July 10thlast under the chairmanship of Sir Humphry Rolleston,it was resolved that the sum subscribed to thismemorial should be devoted to a prize in paediatrics,to be awarded every two years or at longer intervals,.and that the scope of the prize and the details of itsadjudication should be left to the discretion of thetrustees, with the assistance of such other persons asthey might wish to consult. The following have

agreed to act ex officio as trustees: the Presidents(for the time being) of the Royal College of Physiciansof London, the Royal College of Surgeons of England,the British Medical Association, the Royal Society ofMedicine, the Section for the Study of Disease inChildren (R,.S.M. ), and the Editor of the British MedicalJournal. The Medical Secretary of the British MedicalAssociation acts as convener and secretary of thetrusteeship, and the first meeting of the trustees washeld at the House of the Association on Oct. 19th,with Sir John Rose Bradford, P.R.C.P., in the chair.It was decided to ask the Charity Commissioners toaccept for investment the sum of t849 now in hand,to receive all interest accruing therefrom, and to paythis over to the trust account at the bank for thepurposes of the Fund. In pursuance of the resolutionsof the meeting on July 10th it was resolved that theDawson Williams Memorial Prize should take theform of an award for the best work done in paediatricsduring the five years immediately preceding the dateof the award ; that any registered medical practitionerin the British Empire should be eligible for the award ;and that the first award, to be made by the trustees inJuly, 1930, should consist of a cheque for 50 guineas.

PAY BEDS IN LONDON HOSPITALS.FivE years ago 1 we published a list of 13 general

hospitals in London which provided accommodationfor patients of moderate means. It contained thenames of three hospitals with medical schools attached,providing between them 108 pay beds, and ten otherhospitals, mostly general, with resident medicalofficers, providing between them 213 pay beds. Inthe report of the special committee on pay beds ofKing Edward’s Hospital Fund for London, publishedin July, 1928, the first of these two groups containedthe names of six hospitals, providing 164 beds, andthe second the names of 22 hospitals, providing358 beds. It is true that the area surveyed by thespecial committee was much wider than that coveredby our own inquiries, which made no claim tobe exhaustive, but even so the increase that hastaken place in hospital accommodation for payingpatients during the last five years is significant. Ithas a bearing on a doubt, expressed by the specialcommittee referred to above, as to whether thenature and extent of the existing pay-bed accommo-dation at voluntary hospitals is generally known bymembers of the middle and professional classes.The committee suggested that King Edward’s HospitalFund might well consider the wisdom of preparingand publishing year by year, for the information ofthe public, a list of the pay beds at the Londonvoluntary hospitals, with rates of charge and otherparticulars. We are informed that the managementcommittee of the Fund are at present considering thisrecommendation and would be glad to know whethera list such as is included in the appendix of thereport of the special committee, if prepared and issuedannually, would be likely to be of use to the publicand the medical profession throughout the country.It seems to us clear that it is of the utmostimportance for practitioners to be kept up to datewith developments of this kind, and we would urgethe Fund to proceed with arrangements for theannual issue of such a list. The appendix tothe report includes also particulars of 22 general,cottage, and other hospitals without resident medicalofficers who admit paying patients, 8 hospitals forwomen, and 24 other special hospitals. As furtherevidence of the importance of an annual supplementto the information here provided is the informationthat of the teaching hospitals not hitherto providingpay beds the Middlesex, St. Bartholomew’s and St.Mary’s have schemes for establishing such beds,while St. Thomas’s, the Royal Free, King’s College,and Westminster Hospitals propose to add consider-ably to the number of private wards at presentavailable. Many other extensions of this sort togeneral and special hospitals are contemplated, and

1 THE LANCET, 1923, ii. 1000.