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with dilute domestic sewage there is no reason for sup-

posing that its emanations are prejudicial to health. The

case is probably very different, however, when drains andpipes are foul or contain dried material, for then it is easilypossible that the air escaping through such channels maycontain impurities with marked pathogenic properties. The

same may be said when the sewage is allowed to stagnateor decompose, in which case an unnecessary amount of

noxious gases which are not normally present under otherconditions is discharged, a contingency which if the seweris in proper working order could not occur. The report,although not as complete as Professor Delepine would havewished it, teaches, at all events, the valuable lesson thatno fears need be entertained about injurious or pathogenicqualities of sewer air so long as the sewer is properly con-structed, acts well, and is not unfairly or improperly taxed.

THE SICULO-CALABRIAN CATACLYSM: REMISS-NESS IN RELIEF WORK.

"THE English-speaking world," writes an Italian contri-

butor, " by far the promptest and most free-handed in re-lieving the sufferers from the earthquake of Dec. 28th, 1908,is entitled to know how its largess has been employed andits active sympathy responded to. Sicilians and Calabriansthemselves-interested as survivors of the visitation-havebut one answer to give to that question, an answer summedup by one of the most authoritative of their numbeI

in the sentence : Little has been done, and that little

badly.’ These words of the eminent surgeon and senatoiFrancesco Durante well-nigh a month after they wereuttered in the Upper Chamber of Parliament are still

without practical effect on the status q1lO! ! Nay, theyare as true in the week now passing as when theywound up a debate on the situation in April last. On

May 6th Signor Paniano, a prominent member of the LoweIHouse, received the following telegram from Messina: Foitwo days we have had rain and snow. The population’ ° accommodated " in the huts-huts without doors, withoutwindows, without tiles-are benumbed and dying of cold.We want to know to what Government we ought to turn foithe provisions required. Signed : Martini, Vice-Syndic.Commenting on thisappeal, one of the leading Roman journalswrites: The whole country, which had a primary outburst ofsympathetic solidarity in behalf of Sicily and Calabria, shouldfollow that up with a second, not indeed to collect funds,but to insist on the proper application of those alreadycollected.’ As if to add a personal, not to say self-interested,motive to that which common humanity ought to inspire inaccelerating and intensifying the relief work, a Catanianjournal of about the same date as the above-cited telegram,under the title of Un Nuovo Flagello’ (a new scourge),says : A strange, fierce crowd infests the’dead city of Messina-a crowd of vermin and microbes, which take by assaultthe corpses disinterred by the eager avarice of those who,night and day, are grubbing for loot among the ruins,’ andafter a gruesome description of the maggots and insects

subsisting on the putrescent dead, the journal adds :’Meanwhile a foetor, heavy as a cloud, destructive as a

pestilence, ascends from the vast cemetery.’ There may be

exaggeration in this, as the official organs are fainto plead, but if only half of it be true it constitutesa severe indictment of the efforts, central as well as

local, to retrieve a situation appealing, now these fourmonths, to the sympathies of all Italians, not to say of theoutlying world. The official organs referred to make muchof isolated relief work at this or that centre of population towhich the survivors have been deported. At Palermo, forinstance, something has been achieved in the Clinica

Pediatrica attached to the University Hospital and also inthe Ospedale dei Bambini’ (Children’s Hospital). But while’ hand-to-mouth ’ relief has undoubtedly been practice hereand there, and while cases can be quoted of effective assist-ance rendered to this or that sufferer, the net result is

deplorably inadequate to the means and the resources,

monetary and other, placed at Italy’s disposal by a

sympathising and generous world. Unfortunately her recordin visitations of a similar kind is by no mea.ns unimpeach-able-witness the malversation of funds subscribed in GreatBritain alone in 1883 for the victims to Venetian floods andIschian earthquakes I Even as late as 1903, when Calabriasuccumbed to a telluric storm’ only less disastrous thanthat of Dec. 28th, 1908, next to nothing was effected for thesufferers until a surprise visit’ of the King brought thelocal authorities to a sense of their duties. It is unpleasantto have to write in this strain, but Italy, if she wants to

keep, as she certainly has deserved, the sympathy of theoutside world, must henceforth see to it that the help soamply, so promptly vouchsafed has been properly distributedand not, by carelessness, or remissness, or worse, been

frittered away in the distribution."

SMOKE ABATEMENT.

THE report recently presented to the London CountyCouncil on the smoke abatement question furnishesfurther evidence as to the source of the evil, and in

many particulars this evidence will be found analogous withthat which we have brought to the notice of our readers in apractical form from time to time. It is pointed out thatapart from the smoke emitted from trade premises serioussmoke nuisance also arises from private houses. It isestimated that one-half of the smoke in London comes fromthis source, for which there is no legislative remedy.The emission from each individual chimney may be

slight, but in winter probably one million domestic chim-neys pour forth smoke daily into the atmosphere, andit is therefore evident that the total volume of smoke

must be very great. It has been noticed that some

of the densest London fogs have arisen on days when thegreat bulk of business premises have been closed. A bank of

smoke has been seen to rise to a height of 3000 or 4000 feetand to be carried by the wind in a sunlight obscuring trail toa distance of 50 miles. Dr. W. N. Shaw of the Meteoro-

logical Office says the records show that owing to its smokeLondon loses half its sunshine in winter and one-sixth insummer. Many people advocate the abolition of the openfire in favour of the closed stove system in use on the

continent, but the Public Control Committee in its report re-marks that, while undoubtedly the general adoption of such asystem of heating would result in a purer external atmosphere,this would be secured at the sacrifice cf much of the fresh

air indoors, for which open fires, by providing a gooddeal of ventilation, are largely responsible. The com-

mittee looks for a reduction of domestic smoke from the use

of open fire grates which secure better combustion of coal,and from the growing use of gas and electricity for heatingand cooking. There are nearly half a million gas cooking-stoves employed in London houses at the present time. To

diminish domestic smoke materially public opinion needs tobe educated, and a step in this direction is the instructionwhich is given to children in the day-schools in the prin-ciples of combustion, so,as to make them grasp the fact thatsmoke is not inevitable but often results from the wastefuluse of fuel. The committee does not suggest any action todeal with nuisance from the domestic chimney, but it

points out that it may be necessary, unless public opinionbrings about some radical improvement, to give serious

1404

attention to this grave problem. With a view to col-

lecting and disseminating information the committee recom-mends that the Council should obtain powers to spend notmore than .E500 a year in the advancement of measures forthe abatement of smoke nuisance. The committee also

suggests definite amendments of the Public Health (London)Act, 1891, which experience of the working of the measurehas shown to be necessary. The most important of theseis a proposal to delete the qualifying word black" asapplied to smoke. It is also desired to bring the premises ofthe Crown, of local authorities, and of statutory companiesunder the operation of the statute, and to obtain powers todeal with the nuisance arising from smoke drifting into

London from premises situated outside the county boundary.This clause would be enforced by the London County Council,but the Act, as a whole, is administered by the boroughcouncils. The Finance Committee, reporting on the pro-

posals from a financial point of view, raises no objectionso far as strengthening the powers of the borough councilsis concerned, but it "views with apprehension " any pro-posal which might involve the County Council in increasedexpenditure of an unascertained amount. As we have said,the substance of these recommendations will be found in the

pages of THE LANCET for the past decade or so as the

outcome of several practical inquiries made by us upon thesubject.

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THE MORTALITY AMONG WORKHOUSE BABIES.

IT may be recollected that the early part of the thirdchapter of the Minority Report of the Poor-law Commissioncontained severe criticism of the maternity wards and

nurseries of workhouses which had come under the observa-tion of certain of the Commissioners, based partly uponconditions described as existing in them, and partly uponstatistics of infantile mortality in workhouses and upon thecomparison of these with figures relating to infantile

mortality outside the domain of Poor-law relief. So startlingwere the figures that Mr. F. E. Smith, K.C., called attentionto them in the House of Commons immediately by a questionaddressed to the President of the Local Government Board,and an amplifi.cation of the reply then given by Mr. Burnshas since been issued by the Board as a Parliamentary paper.The paper criticises the figures of the Minority Report andin turn has been criticised by Mrs. Sydney Webb, one of thefour members of the Commission responsible for that report.Mrs. Webb’s able letter has appeared in several papersand the statement of the Local Government Board isobtainable through the usual channels at the price of ld.It was pointed out in our first criticism of the MinorityReport 1 that discussion as to the accuracy and justice of thefigures and the arguments relating to this particular topicwas inevitable, and the subject is one well worthy of atten-tion. In the workhouse lying-in wards and nurseries a highpercentage of mortality exists, to which and to possiblemeans for preventing it the four Commissioners rightly drewattention ; but in dealing with it statistically they relied inpart upon figures which were unimpeachable, but which insome degree are open to the criticism of not being upon asufficiently large scale to make it safe to generalise fromthem, and in part upon others of a more speculative nature,drawing conclusions from the combination of the two classes.Those conclusions and the data upon which they are basedform the subject of the Local Government Board’s statement,which Mrs. Webb characterises as a I white-washing report,"and as to which it is true that so far as it goes it defends theworkhouses, dissenting from the conclusions of the MinorityReport. It confines its attention, however, to the subjectof Mr. Smith’s question-namely, the figures-and does not

1 THE LANCET, March 6th, 1909, p. 707

touch upon the conditions which were described in the

Minority Report as existing more particularly in the nurseriesand as contributing to, or as responsible for, the mortality towhich the figures related. In fact, it seeks to repel only oneportion of the attack aimed at the workhouses, for which theBoard must accept a measure of responsibility. It points out theimportance of considering pre-natal conditions in determiningthe causes of death among the infants in the lying-in wardof a workhouse infirmary, showing by a table that of 112infants dying in the first week of life out of 2653 born inLondon Poor-law institutions 57 were prematurely born, 46were doomed to early decease by congenital defects, atrophy,debility, marasmus, and inanition, the remaining nine

succumbing to other stated causes. As an instance of

statistical weakness the Board points out that in deal-

ing with the later life of infants born in workhouses,who either remain in the institution or are taken fromit in their first year, the Minority Report assumes that

those who left the workhouse within the year had a

death-rate equal to those who remained in the institution.Figures thus arrived at are clearly not to be relied upon incontroversy, nor are any which are open to the criticismthat they are based upon the observation of an insufficientnumber of cases or upon cases not properly related to thosewith which they are to be compared. Figures, in short, haveto be handled with exactitude, in a spirit as little as possiblethat of the partisan, and with full knowledge of the circum-stances to which they may be traceable. As an instance ofwhat we mean, we take at random some percentages given ina footnote at page 782 of the report, where we read that theproportion of infantile deaths to the births during 1907 wasin the City of London Lying-in Hospital, 26.1 1 per 1000;in the East-end Mothers’ Home, 21-07 per 1000 ; in QueenCharlotte’s Lying-in Hospital, 26 - per 1000 ; and in theGeneral Lying-in Hospital, 59-3 per 1000." This mightcondemn at first sight one of the institutions named as

deserving greater censure than the workhouse lying.inwards. As it is, it does nothing of the kind, for we

neither draw nor suggest any conclusion from it. We alsoat present do not draw conclusions from all the figuresupon which Mrs. Webb lays stress. We are, however,in accord with her when she calls attention to some

which on their face are comparable, and we agree that

inquiry is desirable as to the cause of serious differences in

the rate of mortality where such exist between adjoiningunions in the same towns " or between unions whose circum-stances are provably similar. We also observe that the

Local Government Board’s statement does not cover such

allegations of fact as are contained in the first of Mrs.

Webb’s numbered conclusions, and that it does not dealwith corresponding statements on the subject of workhousenurseries made in the Minority Report, which its signatoriesare no doubt ready to justify. These questions of fact arecapable of independent authoritative inquiry and are fit

subjects for it. Moreover, the conditions complained of, iffound to exist, are capable of amendment without recourseto legislation and without waiting for boards of guardiansto be superseded by other bodies administering the samefunctions.

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DIPHTHERIA AND ANTITOXIN TREATMENT.

OUR Swiss correspondent writes from Zurich that atthe request of Professor Kroenlein, professor of surgery atthe University of Ziirich, Dr’. Ph. Schoenholzer, his seniorhouse surgeon, has published an extensive report on 3322cases of diphtheria treated at the clinique during a periodof 28 years. As in 14 of these years the old methodsof treatment were employed and in 14 the modem antitoxintreatment, a comparison of therapeutic wresults is’ readilyavailable. The antitoxin used for these patients was prepared