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496 SCIENTIFIC SOCIETIES AND RATES " substitution " method of serum therapy, by which serum containing phenolphthalein as an indicator is introduced into the ventricle at the same time as cerebro-spinal fluid is being drained by lumbar puncture, the process being stopped when serum appears at the lumbar site. Tripoli places the patient on his side, the head of the table being raised 9 inches. He then introduces a needle into the basal cistern and a second needle into the lumbar cistern, and allows spinal fluid to escape from both needles. The flow from the basal cistern usually ceases first, and as soon as this happens, the lumbar flow continuing, warm serum containing a phthalein indicator is introduced cisternally. The table is then lowered immediately, so that the foot is 6 inches higher than the head, and the serum is allowed to flow into the cistern until it fills the ventricles and appears at the lumbar tap. At the same time, up to 80 c.cm. of serum is given intravenously and up to 100 c.cm. intramuscularly. Of 19 successive cases treated by this method 8 were fatal (case-mortality 42 per cent.), a result which Tripoli, while drawing no definite conclusions, points out is more favourable than those of other methods. He mentions the satisfactory reports upon Ferry’s meningococcal antitoxin, but, pending the completion of his own comparative study, expresses no opinion on it. The methods employed for the treatment of the 247 cases of meningitis other than meningococcal were many and various. Simple lumbar drainage used in 181 cases resulted in 1 recovery, the organism in this case being Haemophilu8 influenzce (Pfeiffer’s bacillus). Intraspinal administration of chemical agents such as mercurochrome proved to be use- less in 7 cases; indeed death occurred so quickly in 4 of them that the chemical employed was suspect. For pneumococcal meningitis, specific and non-specific sera and vaccines were without avail; severe reactions " sometimes causing death" are stated to have attended the use of antipneumococcus serum. Per- manent and forced drainage of the basal and lumbar cisterns (L. S. Kubie), or surgical drainage of the focus and replacement of the spinal fluid by non- specific serum with and without intracarotid injec- tion of chemical agents were among the heroic methods employed in other cases in Tripoli’s series. It is true that in 4 cases of non-meningococcal menin- gitis treatment by spinal lavage with non-specific serum and the eradication of primary foci of infec- tion was successful; but, on the whole, the results of therapy in forms of meningitis other than cerebro- spinal fever were almost uniformly bad. SCIENTIFIC SOCIETIES AND RATES WHILE the de-rating of hospitals is still awaiting the serious attention of Parliament, a recent case at Liverpool is a reminder that scientific societies can sometimes escape assessment. An Act of 1843 exempted non-profit-making societies instituted for the exclusive purpose of science, literature, or the fine arts, and supported wholly or in part by annual voluntary subscriptions. The Liverpool Amateur Photographic Society, founded in 1853, claimed to come within the statutory exemption. It seemed to be wholly or partly supported by voluntary contri- butions, and it was precluded from making any dividend, gift, or bonus to its members. The society had a distinguished history, and one of its members had invented the dry-plate process. Counsel for the assessment committee replied that the yearly pay- ments of the members could not be regarded as voluntary contributions within the words of the Act. Photography, he said, might be a science ; to some it was a business, to others a hobby; all that the members of the society appeared to do was to congregate for intercourse relating to their corn- mon hobby. The Recorder of Liverpool decided against the society. He held it was not instituted exclusively for the purposes of science or the fine arts, nor did the annual subscriptions and occasional gifts of its members amount to " annual voluntary contributions." According to a dictum of Lord Herschell in the case of the Art Union of London in 1896, members’ yearly subscriptions, which purchase them an advantage and are not made as a gratuitous offering for the benefit of others, do not comply with the statutory condition that the society should be supported by " annual voluntary contributions." The Act of 1843, be it noticed, speaks of " science or fine arts." The Royal College of Music obtained exemption from rates in 1898, music being one of the fine arts. The Institution of Civil Engineers had earlier been refused exemption. A professional art, it seems, is not a fine art. A PLEA FOR COÖRDINATED TOWN PLANNING THE National Housing Committee, a voluntary band of nine public-spirited men who are working under the chairmanship of Lord Amulree, had already published two important constructive reports 1 before ’the Housing Act of 1935 came into force. In a further interim report, they point out that this Act marks a definite stage in the evolution of national housing policy, and that if the Government’s antici- pations are fully realised, one side of the housing problem-the provision of a very large number of dwellings for overcrowded populations-should be solved in measurable time. It is not enough, however, to provide dwellings ; it is at least equally important that these dwellings should be built in the right places and in the right relationship to transport facilities, to places of employment and recreation, and to all the other elements which compose the physical pattern of the country’s development. Without an efficient system of town and country planning, the national housing campaign may create as many problems as it solves. The committee give examples of fundamental errors both of distribution and of interrelation in the development of housing (municipal as well as private enterprise), of industries, of road and rail transport, and of public services, in various parts of the country. All will agree that the safety and efficiency of the Great West-road as a long-distance fast-traffic artery has been permanently damaged and its amenities ruined by the failure to restrict and plan its frontage development, and those who have recently driven along the Barnet by-pass road on the London side of Hatfield, near the road to Lemsford, will have been horrified by a mushroom development of similar unplanned type. Local authorities have been invested with considerable powers of control, but the powers are permissive, and there is no national and often no regional master. scheme to guide the planning work of individual authorities. The committee’s plea is for machinery through which a policy and a broad master-plan for the physical pattern of national development can be worked out at the centre, and imposed as a con- trolling background and purpose on local schemes and projects. The machinery must operate con- tinuously, for its plans and policies must be readily adjustable to suit changing circumstances. It must 1 See THE LANCET, 1934, i., 1123, and ii., 148.

SCIENTIFIC SOCIETIES AND RATES

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496 SCIENTIFIC SOCIETIES AND RATES

" substitution " method of serum therapy, by whichserum containing phenolphthalein as an indicatoris introduced into the ventricle at the same time ascerebro-spinal fluid is being drained by lumbar

puncture, the process being stopped when serumappears at the lumbar site. Tripoli places the patienton his side, the head of the table being raised 9 inches.He then introduces a needle into the basal cisternand a second needle into the lumbar cistern, andallows spinal fluid to escape from both needles. Theflow from the basal cistern usually ceases first, andas soon as this happens, the lumbar flow continuing,warm serum containing a phthalein indicator isintroduced cisternally. The table is then lowered

immediately, so that the foot is 6 inches higher thanthe head, and the serum is allowed to flow into thecistern until it fills the ventricles and appears at thelumbar tap. At the same time, up to 80 c.cm. ofserum is given intravenously and up to 100 c.cm.

intramuscularly. Of 19 successive cases treated bythis method 8 were fatal (case-mortality 42 per cent.),a result which Tripoli, while drawing no definiteconclusions, points out is more favourable thanthose of other methods. He mentions the satisfactoryreports upon Ferry’s meningococcal antitoxin, but,pending the completion of his own comparative study,expresses no opinion on it.The methods employed for the treatment of the

247 cases of meningitis other than meningococcalwere many and various. Simple lumbar drainageused in 181 cases resulted in 1 recovery, the organismin this case being Haemophilu8 influenzce (Pfeiffer’sbacillus). Intraspinal administration of chemical

agents such as mercurochrome proved to be use-

less in 7 cases; indeed death occurred so quicklyin 4 of them that the chemical employed was suspect.For pneumococcal meningitis, specific and non-specificsera and vaccines were without avail; severe reactions" sometimes causing death" are stated to haveattended the use of antipneumococcus serum. Per-manent and forced drainage of the basal and lumbarcisterns (L. S. Kubie), or surgical drainage of thefocus and replacement of the spinal fluid by non-specific serum with and without intracarotid injec-tion of chemical agents were among the heroicmethods employed in other cases in Tripoli’s series.It is true that in 4 cases of non-meningococcal menin-gitis treatment by spinal lavage with non-specificserum and the eradication of primary foci of infec-tion was successful; but, on the whole, the resultsof therapy in forms of meningitis other than cerebro-spinal fever were almost uniformly bad.

SCIENTIFIC SOCIETIES AND RATES

WHILE the de-rating of hospitals is still awaitingthe serious attention of Parliament, a recent case atLiverpool is a reminder that scientific societies cansometimes escape assessment. An Act of 1843

exempted non-profit-making societies instituted forthe exclusive purpose of science, literature, or thefine arts, and supported wholly or in part by annualvoluntary subscriptions. The Liverpool AmateurPhotographic Society, founded in 1853, claimed tocome within the statutory exemption. It seemed tobe wholly or partly supported by voluntary contri-butions, and it was precluded from making anydividend, gift, or bonus to its members. The societyhad a distinguished history, and one of its membershad invented the dry-plate process. Counsel for theassessment committee replied that the yearly pay-ments of the members could not be regarded as

voluntary contributions within the words of the

Act. Photography, he said, might be a science ; tosome it was a business, to others a hobby; allthat the members of the society appeared to do wasto congregate for intercourse relating to their corn-mon hobby. The Recorder of Liverpool decided

against the society. He held it was not instituted

exclusively for the purposes of science or the fine

arts, nor did the annual subscriptions and occasionalgifts of its members amount to " annual voluntarycontributions." According to a dictum of LordHerschell in the case of the Art Union of London in1896, members’ yearly subscriptions, which purchasethem an advantage and are not made as a gratuitousoffering for the benefit of others, do not complywith the statutory condition that the society shouldbe supported by " annual voluntary contributions."The Act of 1843, be it noticed, speaks of " scienceor fine arts." The Royal College of Music obtainedexemption from rates in 1898, music being one ofthe fine arts. The Institution of Civil Engineershad earlier been refused exemption. A professionalart, it seems, is not a fine art.

A PLEA FOR COÖRDINATED TOWN PLANNINGTHE National Housing Committee, a voluntary

band of nine public-spirited men who are workingunder the chairmanship of Lord Amulree, had

already published two important constructive reports 1before ’the Housing Act of 1935 came into force.In a further interim report, they point out that thisAct marks a definite stage in the evolution of nationalhousing policy, and that if the Government’s antici-pations are fully realised, one side of the housingproblem-the provision of a very large number ofdwellings for overcrowded populations-should besolved in measurable time. It is not enough, however,to provide dwellings ; it is at least equally importantthat these dwellings should be built in the rightplaces and in the right relationship to transportfacilities, to places of employment and recreation,and to all the other elements which compose the

physical pattern of the country’s development.Without an efficient system of town and countryplanning, the national housing campaign may createas many problems as it solves. The committee giveexamples of fundamental errors both of distributionand of interrelation in the development of housing(municipal as well as private enterprise), of industries,of road and rail transport, and of public services, invarious parts of the country. All will agree that the

safety and efficiency of the Great West-road as along-distance fast-traffic artery has been permanentlydamaged and its amenities ruined by the failure torestrict and plan its frontage development, and thosewho have recently driven along the Barnet by-passroad on the London side of Hatfield, near the roadto Lemsford, will have been horrified by a mushroomdevelopment of similar unplanned type. Localauthorities have been invested with considerablepowers of control, but the powers are permissive, andthere is no national and often no regional master.scheme to guide the planning work of individualauthorities. The committee’s plea is for machinerythrough which a policy and a broad master-plan forthe physical pattern of national development can beworked out at the centre, and imposed as a con-

trolling background and purpose on local schemesand projects. The machinery must operate con-

tinuously, for its plans and policies must be readilyadjustable to suit changing circumstances. It must

1 See THE LANCET, 1934, i., 1123, and ii., 148.