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THE WINTER EXHIBITION AT BURLINGTON HOUSE.
117
Passing on to the experiences of states Dr. that the population of the! Nash Southend, numbers about 30,000, of whom about 10,000 borough roughly be reckoned to be children under 15 years of age, may Revaccination and of these about 9000 are vaccinated. has been so freely resorted to during the last twelve months that 15,000 persons-i.e., one-half of the population-may be assumed to have been vaccinated within the last 15 years. The remaining 15,000 inhabitants may be divided into two groups-one of 13,000 who have not been vaccinated for over 15 years and one of 2000 unvaccinated. During the six months under review no case of small-pox occurred in the group of 15,000 vaccinated within 15 years, 15 cases of small-pox with one death occurred in the group of 13,000 not vaccinated for over 15 years, and 10 cases of small-pox with four deaths occurred in the group of 2000 unvaccinated. Both the attack-rate and the mortality-rate were therefore very much higher among the unvaccinated ,than among the vaccinated. the
the following osseous malformations or peculiarities of development are present in rickets : beaded ribs in 24 cases, natiform skull in six cases, "Olympian forehead"in 10 cases, prognathism of the superior maxilla in three cases, scoliosis of the spine in five cases, incurved shape of the tibias in six cases, incurved shape of the femora in eight Of the 430 patients cases, and genu valgum in two cases. examined 35 exhibited signs and symptoms of rickets, a proportion of nearly 12 per cent. The mental condition of these rachitic patients, says Dr. Renoult, was not one of marked or low-grade idiocy. They were mostly imbecile feeble-minded. or Moreover, they did not present many or marked anatomical stigmata of degeneracy that
previous operation.
THE RELATION OF RICKETS TO MENTAL ENFEEBLEMENT. THE relationship of rickets to certain forms of mental defect and weak-mindedness has only been recently established. Trousseau in his famous lectures delivered at the Hotel Dieu, Paris (1868), said that "rachitics were of superior intelligence to other children of the same age," a statement now known to be only partially correct. The mental ,condition of rachitic children has been closely studied by Eichhorst, Bourneville, and others who have shown that in combination with liveliness of spirits and some precocity the rachitic child undoubtedly exhibits mental deficiency. Dr. Paul Renoult of Paris in a recent These de Pa,7-is (1902) gives a careful study of the mental and cerebral conditions in rachitic children. Anatomically the rachitic skull is, he says, characterised by persistence of the fontanelles and late closure of the sutures, while both swelling and softening of The .the bones of the cranial vault are also present. result is a protuberance of the frontal region of the head, giving rise to the so-called " Olympian forehead." The parietal eminences or bosses are prominently developed while the intermediate sagittal suture is depressed and gutter-like in appearance. The rachitic skull tends to be large and brachycephalic in form, while the marked development of the parietal and frontal eminences .often gives it a quadrate appearance. Certain interesting anatomical differences are pointed out between the skull of the "degenerate"and of the rachitic. The skull of the degenerate tends to be plagiocephalic-i.e.,. of asymmetrically oblique formation. Such a condition is never seen, adds Dr. Renoult, in the rachitic skull. Scaphocephaly, or a keel-like elevation of the sagittal line of the skull, is fre- quent in degenerates but is rare in rachitic subjects. Finally, hydrocephaly and microcephaly are characteristic of idiocy and the grosser forms of degeneracy but are not met with in rickets. As regards development of the face and jaws it is pointed out that whereas an asymmetrical face and a narrow and high-arched palate are very characteristic of idiocy the former is not present in rickets, though the A slight or latter is occasionally found. moderate of the is often associated with upper jaw prognathism rickets. Abnormalities and malformations of the eyes, eyelids, ears, and genital organs are not infrequently found in idiots and imbeciles but seldom in cases of rickets. On other hand, characteristic osseous the deformities of the spine (scoliosis and kyphosis), pelvis (flattening and obliquity), and lower limbs (curved tibias) are frequent in rickets and rare in idiocy. From careful studies and measurements made on 430 idiots and imbeciles at the Bicetre, Paris, Dr. Renoult has ascertained
I
The defect of intelligence in theselike the idiots. rachitic patients is not regarded by Dr. Renoult as congenital but as acquired in infancy as the result of gastro-intestinalor pulmonary infection. Infants, he adds, are prone to catarrhal affections of the alimentary and respiratory tracts, subacute and persistent in character, attended by moderate febrile disturbance, and followed by marked symptoms of toxæmia. As a result of such toxasmia two sets of changes may be produced—-viz., a rachitic alteration of the osseous structures and a degeneration of the cerebral nerve cells with partial arrest of their development. The latter is the underlying cause of the mental deficiency-backwardness in speech and general intelligence-exhibited by the rachitic child. Detailed accounts of necropsies of five cases are given which support the above views. In conclusion, says Dr. Renoult, we are not entitled to say that rickets is the cause of weak-mindedness but that both rickets and weakmindedness are sometimes due to the same infective processes and toxasmias of infancy. _
THE WINTER EXHIBITION AT BURLINGTON HOUSE.
1903 exhibition of works by the "Old Masters"" certainly deserves its name, for the works shown go back to the time of Daedalus, say to 2000 B. c. Though none of the actual works of that versatile artist, who was somewhat comparable to Giotto, Leonardo da Vinci, M. Santos Dumont, and Sir Joseph Whitworth rolled into one, are THE
exhibited, yet there are photographs and coloured drawings of works by him or by his pupils. These exhibits are of and the result researches excavations undertaken mostly by Mr. Arthur Evans between 1894 and 1902 inclusive. But a few articles are shown by Mr. D. G. Hogarth who has also been excavating in Crete. All the exhibits are of extraordinary interest and show the marvellous height to which the arts had risen in the time of Daedalus. To the of at of Minos which Knossos, begin with, palace Daedalus was the architect, had a complete system of baths with a drainage system with ventilating shafts and other sanitary arrangements on an almost modern plan. Photographs are shown of a set of ivory statuettes representing youths leaping, in which the anatomical modelling and the muscular action are represented with extraordinary power and accuracy. In a water-colour drawing from a fresco we see a bull-fight. There are no horses in the ring, but there is the bull, a magnificent animal, together with three bull-fighters. Two of these are ladies. They are scantily dressed, but what struck us most was the size of their waists. Presuming that the Knossian lady was of about the same size as a modern Englishwoman her waist would have been about 12 inches in circumference. As the clothing of the lady in question consists simply of a corset made apparently of some golden fabric and a small scarf depending in front and behind from it, it would seem that the fulminations which the medical profession has for ages been hurling at tight stays can no longer be sustained on
supplied
I
118
T
then it was found that the right arm and the right cheek At the age of five months he weighed 28 were the larger. pounds. At the age of seven months he came under the observation of Dr. Reissmann. The left side of the cranium The anterior fontanelle was much larger than the right. was widely patent and the posterior fontanelle was just patent. There was slight proptosis of the left eye. The ears were of equal length. The right cheek, jaw, and gums MEDICAL OFFICERS IN THE MERCHANT The right side of the were distinctly larger than the left. SERVICE. tongue was greatly enlarged, which enlargement when the WITH reference to the case of Dr. T. W. S. Paterson, the organ was protruded caused deviation to the left. The particulars of which were reported in THE LANCET of right shoulder, arm, forearm, wrist, hand, fingers, and Dec. 13th, 1902, p. 1642, we learn by cable that the appeal nails were much larger than the left. From the deltoid of the Peninsular and Oriental Steamship Company against tubercle of the acromion to the styloid process of the ulna the decision of the magistrate was heard before the Appeal measured 20 centimetres on the right side and 17½ on the The enlargement appeared to involve skin, subCourt at Shanghai in December, 1902. The court reserved left. its decision, and on Jan. 5th judgment was pronounced in cutaneous tissue, and muscle, and certainly involved bone. favour of Dr. Paterson. The Peninsular and Oriental Com- Little difference was noted in size between the two sides of chest. The right side of the abdomen was slightly pany has given notice of appeal to the Privy Council. We are than the left, particularly the skin and subcutaneous larger told that Dr. Paterson has begun an action in the High Court of Justice in England against the Peninsular and Oriental tissue which formed on the right side a loose fold above Poupart’s ligament. There was an umbilical hernia. Company, claiming damages for malicious prosecution. The right buttock, leg, foot, toes, and toe-nails were The right leg was longer much larger than the left. THE THE PROSTITUTION OF POST OFFICE. The enlargement than the left by five centimetres. IN THE LANCET of Dec. 20th, 1902, p. 1712, we referred to to involve all the of the limb-skin, conappeared parts an abominable advertisement emanating from the United nective tissue, muscle, and bone. The muscular tone was States in the form of an envelope inclosing an account of good and equal on both sides, but the movements of the some coal-tar derivative. The envelope was adorned with a right side were more clumsy than those of the left ; the large scarlet heart held by a skeleton hand. We forwarded attempt to grasp an object with the right arm was less a selection of these envelopes to His Majesty’s Postmasterdecided then with the left. The knee-jerks were not so General and have been favoured with the following reply :— readily obtained on the right side as on the left. Thus there GENTLEMEN,-With reference to your letter of the 15th instant I am was enlargement of almost the whole of the right side of directed to inform you that the designs on the covers which you enclosed are not offensive within the meaning of the Act restraining the body and of the left side of the cranium, and therefore the transmission of objectionable articles by post ; and, in these also of the left side of the brain. Dr. Reissmann infers that circumstances, the Postmaster-General is not able to take any steps there was also enlargement of the right side of the spinal such as you suggest to prevent their circulation. I am. Gentlemen, your obedient Servant, cord, as it was improbable that the enlargement of the brain To the Editors of THE LANCET. H. BUXTON FORMAN. He thinks that was due to mere overgrowth of neuroglia. All we can say is that the sooner the law enables the Post- the nerve cells and their axis cylinders, the upper neurons, master-General to take steps for the stopping of the trans- were enlarged. If the upper neurons were enlarged the mission by post of circulars of this nature the better it lower ones were probably enlarged also. But he seems to will be. overlook the fact that a numerical increase of the neurons without enlargement is equally probable and would equally BODY WITH HEMI-HYPERTROPHY OF THE account for the facts. This enlargement of one side of the ENLARGEMENT OF THE OPPOSITE SIDE brain and of the opposite side of the body is as curious as OF THE BRAIN. it is rare. No doubt it is rational to explain the latter by an WE have recently called attention to a case of hemi- abnormal trophic influence of the affected side of the brain. hypertrophy of the head and face associated with neuro- But this only goes one step backwards. The question arises, fibromata of the cranial nerves on that side, in which the how is the cerebral overgrowth to be explained
that these articles are a modern innovation ; nor it be said that they impede muscular action. Possibly, however, the lady in question only girded herself in the fashion shown when she was in the ring and so escaped gastroptosis, digestive troubles, a red nose, and fits of "the vapours "-all of which have been ascribed to tight stays of modern type.
the
ground
can
-
I
the
’
____
-
-
be due to an abnormal trophic In the Australasian influence of the affected nerves.].1 Medical Gazette for September another curious case of hemihypertrophy is recorded by Dr. C. Reissmann, and though widely different is analogous in that an abnormal trophic influence of nervous origin is again suggested. In this case the whole half of the body was affected and the associated nervous affection was enlargement The patient was of the opposite side of the brain. The mother a boy, the youngest of a family of three. was healthy and attributed the deformity to a shock which she received when two months pregnant on seeing a The pregnancy confriend who was accidentally killed. tinued to term, but the abdomen was larger than in the previous pregnancies and at the fifth and seventh months there were false labour pains. There was some difficulty in the labour in consequence of the size of the head and the child was delivered with forceps. He On the fifth day after birth weighed 14 pounds. the right leg was noticed to be larger than the left ;
hypertrophy was supposed to
1 THE
LANCET, Dec. 20th, 1902, p. 1711.
PRACTICAL ARMY HYGIENE
IN
THE
FIELD.
much the want of sanitary knowledge as the difficulty or impracticability of applying it in the circumstances of war that has to be overcome in a campaign. Apart from forced marches, night attacks, and hurried movements often in entire ignorance of the position that a force will occupy until it actually finds itself there, all of which are more or less incidental to modern warfare, there has to be considered what is the best sanitary organisation to be adopted. The Army Hospital Services Inquiry Committee following the Egyptian campaign of 1882 recommended that a conservancy body should be organised in connexion with the Quartermaster-General’s department. Not only does the provision of a special sanitary corps presuppose the presence of a directing staff of well-trained and competent officials to point out and to advise what has to be done, but it requires a properly organised executive of sanitary engineers and workmen with all the necessary appliances to do it. If the latter are to consist largely of the civil element-navvies and artisans, for example, with carts, picks, and shovels-they IT is not
so
Passing on to the experiences of states Dr. that the population of the! Nash Southend, numbers about 30,000, of whom about 10,000 borough roughly be reckoned to be children under 15 years of age, may Revaccination and of these about 9000 are vaccinated. has been so freely resorted to during the last twelve months that 15,000 persons-i.e., one-half of the population-may be assumed to have been vaccinated within the last 15 years. The remaining 15,000 inhabitants may be divided into two groups-one of 13,000 who have not been vaccinated for over 15 years and one of 2000 unvaccinated. During the six months under review no case of small-pox occurred in the group of 15,000 vaccinated within 15 years, 15 cases of small-pox with one death occurred in the group of 13,000 not vaccinated for over 15 years, and 10 cases of small-pox with four deaths occurred in the group of 2000 unvaccinated. Both the attack-rate and the mortality-rate were therefore very much higher among the unvaccinated ,than among the vaccinated. the
the following osseous malformations or peculiarities of development are present in rickets : beaded ribs in 24 cases, natiform skull in six cases, "Olympian forehead"in 10 cases, prognathism of the superior maxilla in three cases, scoliosis of the spine in five cases, incurved shape of the tibias in six cases, incurved shape of the femora in eight Of the 430 patients cases, and genu valgum in two cases. examined 35 exhibited signs and symptoms of rickets, a proportion of nearly 12 per cent. The mental condition of these rachitic patients, says Dr. Renoult, was not one of marked or low-grade idiocy. They were mostly imbecile feeble-minded. or Moreover, they did not present many or marked anatomical stigmata of degeneracy that
previous operation.
THE RELATION OF RICKETS TO MENTAL ENFEEBLEMENT. THE relationship of rickets to certain forms of mental defect and weak-mindedness has only been recently established. Trousseau in his famous lectures delivered at the Hotel Dieu, Paris (1868), said that "rachitics were of superior intelligence to other children of the same age," a statement now known to be only partially correct. The mental ,condition of rachitic children has been closely studied by Eichhorst, Bourneville, and others who have shown that in combination with liveliness of spirits and some precocity the rachitic child undoubtedly exhibits mental deficiency. Dr. Paul Renoult of Paris in a recent These de Pa,7-is (1902) gives a careful study of the mental and cerebral conditions in rachitic children. Anatomically the rachitic skull is, he says, characterised by persistence of the fontanelles and late closure of the sutures, while both swelling and softening of The .the bones of the cranial vault are also present. result is a protuberance of the frontal region of the head, giving rise to the so-called " Olympian forehead." The parietal eminences or bosses are prominently developed while the intermediate sagittal suture is depressed and gutter-like in appearance. The rachitic skull tends to be large and brachycephalic in form, while the marked development of the parietal and frontal eminences .often gives it a quadrate appearance. Certain interesting anatomical differences are pointed out between the skull of the "degenerate"and of the rachitic. The skull of the degenerate tends to be plagiocephalic-i.e.,. of asymmetrically oblique formation. Such a condition is never seen, adds Dr. Renoult, in the rachitic skull. Scaphocephaly, or a keel-like elevation of the sagittal line of the skull, is fre- quent in degenerates but is rare in rachitic subjects. Finally, hydrocephaly and microcephaly are characteristic of idiocy and the grosser forms of degeneracy but are not met with in rickets. As regards development of the face and jaws it is pointed out that whereas an asymmetrical face and a narrow and high-arched palate are very characteristic of idiocy the former is not present in rickets, though the A slight or latter is occasionally found. moderate of the is often associated with upper jaw prognathism rickets. Abnormalities and malformations of the eyes, eyelids, ears, and genital organs are not infrequently found in idiots and imbeciles but seldom in cases of rickets. On other hand, characteristic osseous the deformities of the spine (scoliosis and kyphosis), pelvis (flattening and obliquity), and lower limbs (curved tibias) are frequent in rickets and rare in idiocy. From careful studies and measurements made on 430 idiots and imbeciles at the Bicetre, Paris, Dr. Renoult has ascertained
I
The defect of intelligence in theselike the idiots. rachitic patients is not regarded by Dr. Renoult as congenital but as acquired in infancy as the result of gastro-intestinalor pulmonary infection. Infants, he adds, are prone to catarrhal affections of the alimentary and respiratory tracts, subacute and persistent in character, attended by moderate febrile disturbance, and followed by marked symptoms of toxæmia. As a result of such toxasmia two sets of changes may be produced—-viz., a rachitic alteration of the osseous structures and a degeneration of the cerebral nerve cells with partial arrest of their development. The latter is the underlying cause of the mental deficiency-backwardness in speech and general intelligence-exhibited by the rachitic child. Detailed accounts of necropsies of five cases are given which support the above views. In conclusion, says Dr. Renoult, we are not entitled to say that rickets is the cause of weak-mindedness but that both rickets and weakmindedness are sometimes due to the same infective processes and toxasmias of infancy. _
THE WINTER EXHIBITION AT BURLINGTON HOUSE.
1903 exhibition of works by the "Old Masters"" certainly deserves its name, for the works shown go back to the time of Daedalus, say to 2000 B. c. Though none of the actual works of that versatile artist, who was somewhat comparable to Giotto, Leonardo da Vinci, M. Santos Dumont, and Sir Joseph Whitworth rolled into one, are THE
exhibited, yet there are photographs and coloured drawings of works by him or by his pupils. These exhibits are of and the result researches excavations undertaken mostly by Mr. Arthur Evans between 1894 and 1902 inclusive. But a few articles are shown by Mr. D. G. Hogarth who has also been excavating in Crete. All the exhibits are of extraordinary interest and show the marvellous height to which the arts had risen in the time of Daedalus. To the of at of Minos which Knossos, begin with, palace Daedalus was the architect, had a complete system of baths with a drainage system with ventilating shafts and other sanitary arrangements on an almost modern plan. Photographs are shown of a set of ivory statuettes representing youths leaping, in which the anatomical modelling and the muscular action are represented with extraordinary power and accuracy. In a water-colour drawing from a fresco we see a bull-fight. There are no horses in the ring, but there is the bull, a magnificent animal, together with three bull-fighters. Two of these are ladies. They are scantily dressed, but what struck us most was the size of their waists. Presuming that the Knossian lady was of about the same size as a modern Englishwoman her waist would have been about 12 inches in circumference. As the clothing of the lady in question consists simply of a corset made apparently of some golden fabric and a small scarf depending in front and behind from it, it would seem that the fulminations which the medical profession has for ages been hurling at tight stays can no longer be sustained on
supplied
I
118
T
then it was found that the right arm and the right cheek At the age of five months he weighed 28 were the larger. pounds. At the age of seven months he came under the observation of Dr. Reissmann. The left side of the cranium The anterior fontanelle was much larger than the right. was widely patent and the posterior fontanelle was just patent. There was slight proptosis of the left eye. The ears were of equal length. The right cheek, jaw, and gums MEDICAL OFFICERS IN THE MERCHANT The right side of the were distinctly larger than the left. SERVICE. tongue was greatly enlarged, which enlargement when the WITH reference to the case of Dr. T. W. S. Paterson, the organ was protruded caused deviation to the left. The particulars of which were reported in THE LANCET of right shoulder, arm, forearm, wrist, hand, fingers, and Dec. 13th, 1902, p. 1642, we learn by cable that the appeal nails were much larger than the left. From the deltoid of the Peninsular and Oriental Steamship Company against tubercle of the acromion to the styloid process of the ulna the decision of the magistrate was heard before the Appeal measured 20 centimetres on the right side and 17½ on the The enlargement appeared to involve skin, subCourt at Shanghai in December, 1902. The court reserved left. its decision, and on Jan. 5th judgment was pronounced in cutaneous tissue, and muscle, and certainly involved bone. favour of Dr. Paterson. The Peninsular and Oriental Com- Little difference was noted in size between the two sides of chest. The right side of the abdomen was slightly pany has given notice of appeal to the Privy Council. We are than the left, particularly the skin and subcutaneous larger told that Dr. Paterson has begun an action in the High Court of Justice in England against the Peninsular and Oriental tissue which formed on the right side a loose fold above Poupart’s ligament. There was an umbilical hernia. Company, claiming damages for malicious prosecution. The right buttock, leg, foot, toes, and toe-nails were The right leg was longer much larger than the left. THE THE PROSTITUTION OF POST OFFICE. The enlargement than the left by five centimetres. IN THE LANCET of Dec. 20th, 1902, p. 1712, we referred to to involve all the of the limb-skin, conappeared parts an abominable advertisement emanating from the United nective tissue, muscle, and bone. The muscular tone was States in the form of an envelope inclosing an account of good and equal on both sides, but the movements of the some coal-tar derivative. The envelope was adorned with a right side were more clumsy than those of the left ; the large scarlet heart held by a skeleton hand. We forwarded attempt to grasp an object with the right arm was less a selection of these envelopes to His Majesty’s Postmasterdecided then with the left. The knee-jerks were not so General and have been favoured with the following reply :— readily obtained on the right side as on the left. Thus there GENTLEMEN,-With reference to your letter of the 15th instant I am was enlargement of almost the whole of the right side of directed to inform you that the designs on the covers which you enclosed are not offensive within the meaning of the Act restraining the body and of the left side of the cranium, and therefore the transmission of objectionable articles by post ; and, in these also of the left side of the brain. Dr. Reissmann infers that circumstances, the Postmaster-General is not able to take any steps there was also enlargement of the right side of the spinal such as you suggest to prevent their circulation. I am. Gentlemen, your obedient Servant, cord, as it was improbable that the enlargement of the brain To the Editors of THE LANCET. H. BUXTON FORMAN. He thinks that was due to mere overgrowth of neuroglia. All we can say is that the sooner the law enables the Post- the nerve cells and their axis cylinders, the upper neurons, master-General to take steps for the stopping of the trans- were enlarged. If the upper neurons were enlarged the mission by post of circulars of this nature the better it lower ones were probably enlarged also. But he seems to will be. overlook the fact that a numerical increase of the neurons without enlargement is equally probable and would equally BODY WITH HEMI-HYPERTROPHY OF THE account for the facts. This enlargement of one side of the ENLARGEMENT OF THE OPPOSITE SIDE brain and of the opposite side of the body is as curious as OF THE BRAIN. it is rare. No doubt it is rational to explain the latter by an WE have recently called attention to a case of hemi- abnormal trophic influence of the affected side of the brain. hypertrophy of the head and face associated with neuro- But this only goes one step backwards. The question arises, fibromata of the cranial nerves on that side, in which the how is the cerebral overgrowth to be explained
that these articles are a modern innovation ; nor it be said that they impede muscular action. Possibly, however, the lady in question only girded herself in the fashion shown when she was in the ring and so escaped gastroptosis, digestive troubles, a red nose, and fits of "the vapours "-all of which have been ascribed to tight stays of modern type.
the
ground
can
-
I
the
’
____
-
-
be due to an abnormal trophic In the Australasian influence of the affected nerves.].1 Medical Gazette for September another curious case of hemihypertrophy is recorded by Dr. C. Reissmann, and though widely different is analogous in that an abnormal trophic influence of nervous origin is again suggested. In this case the whole half of the body was affected and the associated nervous affection was enlargement The patient was of the opposite side of the brain. The mother a boy, the youngest of a family of three. was healthy and attributed the deformity to a shock which she received when two months pregnant on seeing a The pregnancy confriend who was accidentally killed. tinued to term, but the abdomen was larger than in the previous pregnancies and at the fifth and seventh months there were false labour pains. There was some difficulty in the labour in consequence of the size of the head and the child was delivered with forceps. He On the fifth day after birth weighed 14 pounds. the right leg was noticed to be larger than the left ;
hypertrophy was supposed to
1 THE
LANCET, Dec. 20th, 1902, p. 1711.
PRACTICAL ARMY HYGIENE
IN
THE
FIELD.
much the want of sanitary knowledge as the difficulty or impracticability of applying it in the circumstances of war that has to be overcome in a campaign. Apart from forced marches, night attacks, and hurried movements often in entire ignorance of the position that a force will occupy until it actually finds itself there, all of which are more or less incidental to modern warfare, there has to be considered what is the best sanitary organisation to be adopted. The Army Hospital Services Inquiry Committee following the Egyptian campaign of 1882 recommended that a conservancy body should be organised in connexion with the Quartermaster-General’s department. Not only does the provision of a special sanitary corps presuppose the presence of a directing staff of well-trained and competent officials to point out and to advise what has to be done, but it requires a properly organised executive of sanitary engineers and workmen with all the necessary appliances to do it. If the latter are to consist largely of the civil element-navvies and artisans, for example, with carts, picks, and shovels-they IT is not
so