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of carriers was not wanting. Dr. GRAHAM FORBES,in a recent communication to the Medical Officers ofSchools Association, stated that he had found reasonto associate this epidemic in London schools withthe type III. bacillus. The curious observation thatcarriers of virulent B. diphtherice may, during non-epidemic times, attend school without either the spreadof the bacillus to others or the occurrence of cases,is probably explained by the presence of a highproportion of immune scholars or by the relativelyscanty distribution of bacilli which some carrierseffect. The difference in the relative efficiency withwhich different carriers disperse the infection whichthey carry to their neighbours has often been noticedin the case of the enteric as well as in that of thediphtheria carrier. It is to be hoped that increasedapplication of the Schick test in this country willthrow light on the varying immunity of the population,and enable active immunisation to be carried outwhere required. The results of tests so far publishedby COPEMAN, O’BRIFN, EAGLETON, and GLENNY havegiven results comparable with those obtained in theU.S.A. and elsewhere. Correlation of the results withthose of carrier examination has led and will furtherlead to important advances in theory and practice.There has never hitherto been sufficient accurate

laboratory work available to meet the demands of theprogressive health officer.

Annotations." Ne quid nimis."

ECLAMPSIA.

INNUMERABLE medical and operative proceduresfor eclampsia have been adopted and abandoned.Bozzi’s dilator was practically invented for thetreatment of eclampsia and is now generally found inthe hospital museum; Caesarean section, after anextensive trial, is generally condemned. Numerousdrugs have also been tried, but the mortality hasremained unaltered, between 20 and 25 per cent.,irrespective of the variety or combiriation of treatmentadopted, with the exception of two lines of treatmentwhich have been followed during the past 20 years,more or less unchanged, and give a mortality result ofabout 10 per cent. These two treatments were

instituted by Stroganoff and Hastings Tweedyrespectively ; the former has been carried out exten-sively on the continent and in America, while thelatter has chiefly been adopted in Ireland. Both havesuffered from incomplete acceptance and prosecution.On p. 666 of our present issue Dr. Gibbon FitzGibbonsets forth in some detail the Hastings Tweedy treat-ment as it is carried out in the Rotunda Hospital,Dublin. In commending his article to the attentionof practitioners we would recall the conference oneclampsia! held at Liverpool in June, 1922, where theRotunda method of preventing and treating thisdisease was acknowledged by several authorities togive good results compared with other methods, eventhough the theory on which it is based was notuniversally accepted. At the last annual meeting ofthe British Medical Association the matter was againdiscussed in the Section of Obstetrics and Gynaecology2and the case for the expectant and eliminativetreatment still further established.

MENTAL HOSPITALS IN NEW SOUTH WALES.

THE Inspector-General of Mental Hospitals forNew South Wales in his report for 1922 complains,apparently not for the first time, that the ten existinginstitutions are overcrowded. The lack of accommo-dation is particularly acute in the case of criminallunatics, some of whom have at present to remain in I

1 See THE LANCET. 1922, ii., 89 and 144.2 Ibid., 1922, ii., 713.

the gaols. Otherwise the working of the mentalhospitals is regarded as satisfactory, and the recoveryrate of 43 per cent. is a high one. It is interesting tonote that a Bill has been introduced to amend theLunacy Act, by classifying patients into three groups,according to the degree of restraint they require. Inthe first group are those amenable to voluntarytreatment in special wards of a general hospital ;in the second " those who will be subject to detentionwhere the exercise of same is in the patient’s interest,"these patients to be treated in special hospitals-thepatient being admitted as a voluntary boarder andcertified only if necessary subsequently ; in the thirdgroup are those " who require compulsory detentioneither for their own protection or that of the public."There exists already a psychiatric clinic under thedirection of Sir John MacPherson, where out- andin patient treatment is available on a voluntarybasis ; there is also a voluntary home for inebriates.but no provision for the care of any but the certifiedis made as yet by the law of the State.

HOUSING IN SCOTLAND.THE instalments of the Scottish Census have appeared

in steady succession, and we have before us thetwenty-eighth part of Vol. I., giving the statisticscompiled from Census returns for the county of Perth.Vol. 1. will be completed when the thirty-seventh partis issued. Each of these parts includes full particularsrespecting the different parishes, burghs, and otheradministrative areas in each county, and a detailedstatement as to age-distribution, orphanhood, andconjugal condition, and as to occupations, industries,birth-places, housing, and institutions within thecounty. From a comparative examination of thehousing statistics of eight important counties inScotland, it is now possible to derive a generalimpression of housing conditions in the northerncountry in the Census year. The general results areshown in Table I.

TABLE I.

CottMtes.—(1) Lanark. (2) Ayr. (3) Dumbarton. (4) Mid-lothian. (5) Fife. (6) Inverness. (7) Perth. (8) Kincardine.

The proportion of dwellings comprising only oneroom varied from 4-1 per cent. in Kincardine to 19.0per. cent. in Lanark (including Glasgow). The countiesof Ayr, Dumbarton, and Midlothian (includingEdinburgh) came nearest to Glasgow and greaterGlasgow in respect of the high proportion -of one-roomed dwellings, while in Fife, Inverness, and Perthhousing conditions were less unfavourable. Of course,some dwellings are occupied by single persons and someby married couples without children ; but a dwellingcomprising less than three " windowed rooms " cannotbe regarded as satisfactory ; and it is significant thathousing in Lanark, Ayr, and Dumbarton stands con-demned in this respect for more than half the totaldwellings in these counties. The classification ofhouses by number of rooms can be checked by thestatement in the latter half of the preceding table,which shows the proportion of the total populationwhich at the time of the Census was living in houses ofdifferent sizes. In Lanark 14-2 per cent. of the totalpopulation dwelt in single rooms, and 64 per cent. inone or in two rooms. In Ayr 50-8 per cent. of the totalpopulation lived in one or in two rooms, the proportionin other counties thus unsatisfactorily housed being

663

as shown in the table. The conditions thus indicatedare deplorable. It may be urged, however, that it issmall families especially which live in these one- andtwo-roomed dwellings. The second half of Table I.goes far to disprove this explanation ; and the realfacts are shown, in part, in Table II., which has beenextracted from other parts of these Scottish reports.

TABLE n.-Percentage of the Population per Room.

All rooms having windows are reckoned as dwellingrooms, and not only living and bedrooms, but alsokitchens and sculleries are included in the accommo-dation as shown in the above table. Including suchrooms, nearly 81 per cent. of the dwellings in Perth didnot average more than two persons to a room, inLanark the corresponding proportion was 42-4. InLanark 15-2 per cent. of the total dwellings had livingin them more than four persons to a room (defined asabove) ; in Ayr 12-1 per cent., and in Dumbarton10-6 per cent. were thus overcrowded.The figures speak for themselves. The desire for good

housing in a large part of Scotland is lamentably low,or there is lamentably deficient housing accommoda-tion, or both these causes of insanitary overcrowdingare operating to an extent which is nationally dis-creditable. Nor can there be doubt as to the mischiefarising from family life in one, in two, or even in threerooms. The startling figures published by the lateDr. Burn Russell as to one-roomed dwellings in Glasgoware well known. They have been supplemented bymore recent and carefully corrected statistics pre-pared by Dr. A. K. Chalmers, which show theexcess of acute infectious diseases, of tuberculosis,and of nutritional diseases, and of infant mortality inthe smaller dwellings ; and Sir Leslie Mackenzie con-tributed to the Scottish Housing Commission’s reportan eloquent indictment of the results of bad housing inScotland. To argue that bad housing is chiefly anindex of the low standard of physique of intelligenceand morality of those thus housed is a petitio principii; ;and no social well-wisher can be satisfied until thepublic conscience has been aroused to supply thedeficiencies of housing accommodation and to educateall wage-earners to a standard of life which will not becontented to accept less than is necessary for health andmorality. --

HÆMATEMESIS IN NEPHRITIS.

ACCO]ETDING to Dr. ]LiowarcL Jb. s.5’hattOCk of the

Postgraduate Hospita,l, new York, who records anillustrative case, haematemesis is an unusual com-plication of chronic nephritis, and when it does occuris rarely profuse. Richard Bright himself, in 1829,spoke of gastric and intestinal haemorrhage in somecases of nephritis, but he regarded the occurrencemerely as a coincidence without any aetiologicalrelationship between the two conditions. Even beforeBright, Latour, in 1815, described epistaxis and otherforms of bleeding in dropsy, and earlier still Morgagnireported the case of a woman with the odour of urinein her breath, who vomited blood, and had epistaxiswith favourable results. Later the association ofvarious forms of haemorrhage, including gastro-intestinal haemorrhages in nephritis and uraemia, werenoted by a number of observers, including GeorgeJohnson and Moxon in this country, and Fournier,Lancereaux, Mathieu and Roux in France, most ofwhom described the intestinal haemorrhages whichwere more frequent than the gastric. R,iesman

1 American Journal of the Medical Sciences, February, 1923.

regards renal disease as the cause of the haemorrhagicdiathesis, the factors being hypertension, arterialdisease, and toxemia. No uniform pathological find-ings have been reported in these cases, so that noconclusions can be drawn as to the causes or pathologyof haematemesis in nephritis. In Dr. Shattock’s case,which occurred in a woman aged 31, haematemesisof a " cupful " of blood was not preceded by anyabdominal pain or other symptoms referable to thegastro-intestinal tract except anorexia, nausea, andvomiting during the last three months. Slight haemat-emesis recurred on three occasions during the first24 hours after the first but not subsequently. Theurine had a specific gravity of 1010-1016, a persistentfaint trace of albumin and a few casts. The blood-

urea was low ; 11-4 mg. per 100 c.cm. of blood and theuric acid was increased ; 3-5 mg. in 100 c.cm. of blood.The blood pressure was 194 systolic, 124 diastolic.Temporary improvement took place under treatment,but death from uraemia occurred seven months afterthe haematemesis. Autopsy was refused.

GOVERNMENT GRANTS TO VOLUNTARY

HOSPITALS.

THE Voluntary Hospitals Commission have nowdealt with all the applications for grants in respectof 1921, except for a limited number of areas in Scot-land in which Local Voluntary Hospital Committees &deg;were late in being established. The total deficitsreported to the Commission amounted to z295,170for London, 2425,727 for the rest of England andWales, and .815,340 for Scotland. The total deficitsreported for the whole of Great Britain amounted tojB736,237, as compared with the estimate of 21,000,000by Lord Cave’s Committee on which the Governmentgrant of 2500,000 was based. Grants totallingz6424,983 have now been made on the basis of poundfor pound of new money raised or in sight, except ina limited number of cases in which emergency grantshave been made to hospitals, which had exhaustedtheir realisable assets and without assistance fromthe Commission would have been compelled to closebeds. The grants are as follows : London, z225,000 :England and Wales1 (excluding London), jB194,242 ;Scotland, .65741. The London hospitals havereceived their full share of the grant, but a balanceof <675,017 still remains for distribution in the restof England, Wales, and Scotland. This balance hasbeen apportioned on the basis of Lord Cave’s estimateas follows : England and Wales, .645,758 ; Scotland,229,259. The Local Voluntary Hospital Committees inEngland and Wales and the Consultative Committeein Scotland are being asked to formulate proposals,subject to the Treasury conditions, for the distribu-tion of these balances towards the liquidation of the’deficits which accumulated prior to 1921.

CONJUGAL INFECTION IN TUBERCULOSIS.

Dr. Paul Roussel, assistant physician to theSanatorium des Pins and the Villemin Dispensaryat Nancy has made a valuable contribution2 to ourknowledge of a much debated subject. At thedispensary he found that husband and wife wereboth tuberculous in 11-6 per cent. of 423 familiesinvestigated, and with 25 per cent. of tubercle amongthe children. The figures led him to conclude onfurther scrutiny that in 11-6 per cent. of open pul-monary tuberculosis conjugal infection had occurred,and 37-5 per cent. of the children were infected ;if all cases were included the cases of conjugal infectiondropped to 5-2 per cent. and the infection-rate of thechildren to 25 per cent. It is noted that conjugalinfection is in general milder than other infections,especially those of children, the difference beingexplained by a

" surinfection " in one case and a‘‘primoinection" in the other; that is by the

1 Includes a grant of &pound;3950, which has not yet been paid.2 La Tuberculose Conjugale: Contagion et Mariage. Paris:

A. Maloine et Fils. 1922. Pp. 140.