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SCHOOL BOARDS AND THEIR MEDICAL OFFICERS.
SOME POINTS IN THE LONDON WATER-SUPPLY.
886
magistrates
will follow Mr. MEAD’S clear-headed
example.
It is, of course, much too early to attempt to form any - definite opinion as to the effects of the new law or the extent to which recourse will be had to the conscience clause. The .action of those boards of guardians which, owing to the want of a conscience clause, have of late refused to administer the Act will be watched with special interest, but some time must elapse before the boards all over the country - can
be
expected to elaborate new system.
the details of their
procedure
under the
Annotations. "Ne quid nimis."
SOME POINTS IN THE LONDON WATERSUPPLY. IT is possible that the present distress occasioned in the .North-east areas of the metropolis by the unprecedented drought will do more towards hastening a better state of things in regard to London’s future water-supply, its quality, quantity, and administration, than any other event could possibly have done. This is not the first time that the portion of the population of London which is now suffering from a scanty water-supply has been placed in the trying situation in which it finds itself. The Lee as a source of supply has failed under conditions which it must be admitted are exceptional, but it has failed before under less trying circumstances and no margin can be allowed on the question of providing life’s first necessity. It remains to be considered whether, taking the sources of supply as a whole, the London watershed can be regarded under all conditions as adequate to the needs of a rapidly growing population. It is said that the other large water companies are not feeling so far any serious effects as a result of the drought, for some of them have enough water to spare, it appears, to relieve the shortage of the East London Waterworks Company. It seems clear, however, that up to the time of the present distress there was practically no provision made by which the mains of one company could be connected with those of another. As will be seen by reference to our Special Commissioner’s -articles, the East London Waterworks Company has two connexions with the mains of the Grand Junction Company, ’which company has also a connexion with the Southwark and Vauxhall Company. Recently a main was completed which joined the Kent system with the East London system and -further, a junction has been made with the Southwark and Vauxhall Company through the Tower Bridge subway, which together will yield an auxiliary supply of 6,250,000 gallons per day. Other direct means of adding to the supply do not appear feasible, but the West Middlesex Company ’may join their mains with those of the Grand Junction - Company, which will maintain the supply thus indirectly to the East London Company. This, according to Mr. Chaplin, will give an additional million gallons of water, but the connexion cannot be effected for some weeks yet to come. Thus it is estimated that a deficiency of 15 millions of gallons will be partly met by some 12 millions of gallons from these supplementary sources. Mr. Chaplin’s - comprehensive reply to a deputation representing the districts supplied by the East London Company on Sept. 24th may be taken almost as a declaration of policy, affording, wethink, a glimpse at any rate of the attitude which the Government may be expected to adopt in relation to the entire question. He seemed to foreshadow the creation of a central administrative body.
He was not content to restrict himself to the water famine in the East-end, for he touched also with no uncertain sound upon the greater questions of new administration, of municipal purchase, and of the scope of the Royal Commission presided over by Lord Llandaff and the probability of the Government dealing promptly and decisively with the matter. It will be admitted that Mr. Chaplin’s review of the situation in the East-end of London was perfectly correct. The East London water-supply, he said, had failed on account of an abnormally low rainfall. In other words, the Lee is not equal to the demands of the two great water companies, and the New River Company drawing on the upper reaches of the river has so depleted it as to leave little to flow to the intakes of the East London Company in the lower reaches. The New River Company also derives a large supply of water from wells, upon which, however, the drought is having a very serious effect, so that it may not be convenient to them to sell water to another company for an indefinite period. The minor wells in the neighbourhood have practically disappeared as a source of local supply. This fact introduces a very important element into the question of London water-supply. Those living in the area immediately outside London not unreasonably contend that they should have a voice in the matter relative to the management of the supply, which could not be the case if the new administrative body were composed exclusively of representatives of the London County Council. The deputation urged upon Mr. Chaplin to convene an autumn session of Parliament in order to give the subject full discussion while the present situation was fresh in everybody’s mind, but Mr. Chaplin expressed the opinion that an autumn session would be futile, while it should be remembered that the Government was waiting for the results of a practical Commission of Inquiry, that being now held by Lord Llandaff. Putting aside the great questions of policy in the matter of purchase and control it is obvious, we think, that the first step which legislation must take will be the establishment of a system by which the mains of all the different water companies in London could be instantly connected in the event of emergency at any one point. This cannot be a matter involving any large scheme of engineering, and if what has already been done had been done sooner, it would have saved the East-end of London from much hardship and distress. Upon this very important point, to which Mr. Chaplin so emphatically referred, the recent inquiry undertaken by ourselves as to the machinery, plant, and distributing services of the London water companies1 should afford information of a very pertinent character.
SCHOOL BOARDS AND THEIR MEDICAL OFFICERS. THE Halifax School Board had a meeting on Sept. 19th when the following report of the committee regarding the duties and remuneration of the medical officer was
presented :"Reporting appointed by
to the duties of the medical officer to be the board the board in committee recommended that they should be as follows :-’ (1) To examine when required by the board or the school attendance committee children who are said to be physically unfit to attend school and all children whom it is proposed to send to the " special" classes, and to make out certificates ; (2) to examine probationers and candidates for pupil teachership, also pupil teachers at the end of the second year of their apprenticeship, and to make out the certificates required by the Education Department ; (3) to visit and report in writing when required by the board or any of its standing committees on any employe who is absent from
1
THE
supply :
as
LANCET, Special Commission on the Metropolitan WaterLANCET, vol. i., 1897, passim.
THE
887
duty on account of illness ; (4) to examine candidates for than half the size of the right half. The whole employment under the board or employes when required bone appears to be rotated about both a vertical and by the board or any of its standing committees, and to an antero-posterior axis, so that the anterior surface make out certificates; (5) to examine and report upon looks to the left while the upper surface of thecases of blind and deaf children when required and to each not atrophied left wing is some millimetres higher than the to visit out make certificates ; (6) department less than once every three months, or oftener if required, upper surface of the right wing. The result of the abnormal and report in writing on any sanitary defect of the pre- curvature of the two ilio-pectineal lines and the flattening mises to which his attention may be called and on the of their anterior extremities, together with the deviation of general health of the scholars ; (7) at such periodical visits the anterior surface of the sacrum, is to give the inlet of the to examine and test the eyesight, hearing, or other physical condition of any scholar to whom attention may be called pelvis an obliquely triangular form. The left pelvic wall is by the head teacher.’ It was further agreed,That the pushed in towards the middle line, so that the left ischial remuneration for the foregoing duties be 75 guineas per spine and the left ischial tuberosity project inward to a annum, the engagement with the board to be for a period greater extent than normal. The same condition, though less of one year.’ marked, is present upon the right side, so that the transverse The Rev. Father Quinlan moved, and Mr. Robertshaw diameters of both the cavity and the outlet of the pelvis are. seconded, the adoption of these proposals. Mr. Bates diminished. The subpubic arch forms an angle of 52°. moved as an amendment that the salary should only be The sacrum is not only rotated upon a vertical and anteroThe Rev. 50 guineas, and Mr. Braithwaite seconded. but also upon a transverse axis, so that the posterior axis, Father Quinlan said that he did not consider the appointdiameter of the outlet is increased by the antero-posterior ment of medical officer necessary. If, however, they were deviation backwards of the lower end of the sacrum and, going to have one he personally would give him a much coccyx. The pelvis resembles a Naegele oblique pelvis in the bigger salary than 75 guineas. Eventually 5 members voted ankylosis of the left sacro-iliac joint, the atrophy of the for the motion and 5 for the amendment and the chairman left wing of the sacrum, the deviation of the sacrum Another to the affected side and of the gave his casting vote for the amendment. symphysis pubis to the amendment was then moved to refer the matter back sound the of the left pelvic wall and side, flattening to the next meeting of the board and this was the inward of the left ischial projection spine and the carried. Considering the amount of duties the medical left ischial tuberosity. The same conditions, however, officer may be required to do 75 guineas is none though to a less extent, exist upon the opposite side:o The thus there are some want of too much; in fact, we consider it quite inadequate. development in the sacrum, is somewhat less than the remunera- some sum proposed of the pelvic wall and some undue flattening tion of a butler, but, of course, the care of other people’s the ischial of prominence spine and ischial tuberosity, and children is a less onerous and responsible office than the care these facts show that the diminution in the diameters is not of another person’s plate and wine. The population of due to a change affecting one side of the pelvis alone but Halifax is in round numbers 90,000, so we suppose there are to changes affecting both sides. While ii many of its about some 9000 children in its Board schools, judging from characters the pelvis undoubtedly resembles that of Naegele. the case of London, which has 500,000 children out of a it differs from it in the projecting keel-like form of population of 5,000,000. Besides looking after the children the symphysis pubis, in the slight separation of the two the medical officer will also have to inspect sundry pupil ischial tuberosities and the consequent shortening of the. teachers. If the Halifax board is going to pay at all let it transverse diameters, and in the smallness of the subpubic. give a decent salary ; otherwise let it frankly ask candidates angle. In these it approaches the type of the transversely to come forward for the honour and glory of the post. contracted pelvis of Robert. Dr. Juan Duque de Estradathinks that the latter characters are sufficiently marked to show that it is not merely a Naegel6 oblique pelvis. THE MEXICAN PELVIS. modified by the ankylosis of the symphysis pubis, but that IN the June number of the Chronica Jfediea ]}Ieaeicana it represents a type of pelvis midway between that of Dr. Juan Duque de Estrada describes what he believes to be and that of Robert, for which he proposes the Naegele The a previously unrecorded variety of contracted pelvis. name of the " Mexican pelvis." The occurrence of bony patient, a Mexican girl, sixteen years old, was delivered with ankylosis between the two halves of the pubes is an great difficulty by perforation of the aftercoming head, the exceedingly rare event, and even in those cases where. child having presented by the breech and the head being from the difficulty experienced in dividing the joint in thecompletely arrested above the brim of the pelvis. On operation of symphysiotomy it has been diagnosed as present examination the pelvis presents two striking peculiaritiesit is a little doubtful whether the difficulty was not due complete ankylosis of the left sacro-iliac articulation and of rather to deviation of the line of the joint than to bony the symphysis pubis. The bones of the pelvis as a whole ankylosis. are mal-developed and all the diameters except the anteroposterior of the outlet are markedly diminished. The left LUMINOUS SUGAR. iliac fossa is smaller than the right and the left ilium is THERE are phenomena attending the formation of crystals; completely ankylosed to the atrophied left wing of the sacrum. The left ilio-pectineal line is too curved posteriorly, which are apparently quite distinct from chemical action. while anteriorly it is too straight and with the whole of the When, for example, a hot saturated solution of arsenious acid left wall of the pelvis appears to be pushed over to the right is allowed to cool the act of crystallisation is accompanied. by the pressure of the left femur. The two halves of the by a flash of light. As each crystal forms there is a short pubes are completely ankylosed, only a slight trace of the sharp glow indicating the release of a certain amount of latent line of the joint being visible upon the anterior surface. energy in the form of light radiation. A related phenomenon The symphysis pubis is directed forward in a keel-like would seem to be the case when two pieces of cane manner and deviates to the right of the middle line. The sugar are quickly rubbed together. The flash is perfectly and iliac sacro-iliac articulation the fossa are distinct and bluish-white in colour, the light extending into right right normal. The right ilio-pectineal line posteriorly is less the substance itself far below the surface. Some interesting, curved than normal and anteriorly resembles the left in experiments on this manifestation have recently been made. being almost straight. The asymmetry of the sacrum is by Mr. John Burke. M.A., the results of which were comvery striking, the left half, markedly atrophied, is less municated to the recent meeting of the British Association. "
-
886
magistrates
will follow Mr. MEAD’S clear-headed
example.
It is, of course, much too early to attempt to form any - definite opinion as to the effects of the new law or the extent to which recourse will be had to the conscience clause. The .action of those boards of guardians which, owing to the want of a conscience clause, have of late refused to administer the Act will be watched with special interest, but some time must elapse before the boards all over the country - can
be
expected to elaborate new system.
the details of their
procedure
under the
Annotations. "Ne quid nimis."
SOME POINTS IN THE LONDON WATERSUPPLY. IT is possible that the present distress occasioned in the .North-east areas of the metropolis by the unprecedented drought will do more towards hastening a better state of things in regard to London’s future water-supply, its quality, quantity, and administration, than any other event could possibly have done. This is not the first time that the portion of the population of London which is now suffering from a scanty water-supply has been placed in the trying situation in which it finds itself. The Lee as a source of supply has failed under conditions which it must be admitted are exceptional, but it has failed before under less trying circumstances and no margin can be allowed on the question of providing life’s first necessity. It remains to be considered whether, taking the sources of supply as a whole, the London watershed can be regarded under all conditions as adequate to the needs of a rapidly growing population. It is said that the other large water companies are not feeling so far any serious effects as a result of the drought, for some of them have enough water to spare, it appears, to relieve the shortage of the East London Waterworks Company. It seems clear, however, that up to the time of the present distress there was practically no provision made by which the mains of one company could be connected with those of another. As will be seen by reference to our Special Commissioner’s -articles, the East London Waterworks Company has two connexions with the mains of the Grand Junction Company, ’which company has also a connexion with the Southwark and Vauxhall Company. Recently a main was completed which joined the Kent system with the East London system and -further, a junction has been made with the Southwark and Vauxhall Company through the Tower Bridge subway, which together will yield an auxiliary supply of 6,250,000 gallons per day. Other direct means of adding to the supply do not appear feasible, but the West Middlesex Company ’may join their mains with those of the Grand Junction - Company, which will maintain the supply thus indirectly to the East London Company. This, according to Mr. Chaplin, will give an additional million gallons of water, but the connexion cannot be effected for some weeks yet to come. Thus it is estimated that a deficiency of 15 millions of gallons will be partly met by some 12 millions of gallons from these supplementary sources. Mr. Chaplin’s - comprehensive reply to a deputation representing the districts supplied by the East London Company on Sept. 24th may be taken almost as a declaration of policy, affording, wethink, a glimpse at any rate of the attitude which the Government may be expected to adopt in relation to the entire question. He seemed to foreshadow the creation of a central administrative body.
He was not content to restrict himself to the water famine in the East-end, for he touched also with no uncertain sound upon the greater questions of new administration, of municipal purchase, and of the scope of the Royal Commission presided over by Lord Llandaff and the probability of the Government dealing promptly and decisively with the matter. It will be admitted that Mr. Chaplin’s review of the situation in the East-end of London was perfectly correct. The East London water-supply, he said, had failed on account of an abnormally low rainfall. In other words, the Lee is not equal to the demands of the two great water companies, and the New River Company drawing on the upper reaches of the river has so depleted it as to leave little to flow to the intakes of the East London Company in the lower reaches. The New River Company also derives a large supply of water from wells, upon which, however, the drought is having a very serious effect, so that it may not be convenient to them to sell water to another company for an indefinite period. The minor wells in the neighbourhood have practically disappeared as a source of local supply. This fact introduces a very important element into the question of London water-supply. Those living in the area immediately outside London not unreasonably contend that they should have a voice in the matter relative to the management of the supply, which could not be the case if the new administrative body were composed exclusively of representatives of the London County Council. The deputation urged upon Mr. Chaplin to convene an autumn session of Parliament in order to give the subject full discussion while the present situation was fresh in everybody’s mind, but Mr. Chaplin expressed the opinion that an autumn session would be futile, while it should be remembered that the Government was waiting for the results of a practical Commission of Inquiry, that being now held by Lord Llandaff. Putting aside the great questions of policy in the matter of purchase and control it is obvious, we think, that the first step which legislation must take will be the establishment of a system by which the mains of all the different water companies in London could be instantly connected in the event of emergency at any one point. This cannot be a matter involving any large scheme of engineering, and if what has already been done had been done sooner, it would have saved the East-end of London from much hardship and distress. Upon this very important point, to which Mr. Chaplin so emphatically referred, the recent inquiry undertaken by ourselves as to the machinery, plant, and distributing services of the London water companies1 should afford information of a very pertinent character.
SCHOOL BOARDS AND THEIR MEDICAL OFFICERS. THE Halifax School Board had a meeting on Sept. 19th when the following report of the committee regarding the duties and remuneration of the medical officer was
presented :"Reporting appointed by
to the duties of the medical officer to be the board the board in committee recommended that they should be as follows :-’ (1) To examine when required by the board or the school attendance committee children who are said to be physically unfit to attend school and all children whom it is proposed to send to the " special" classes, and to make out certificates ; (2) to examine probationers and candidates for pupil teachership, also pupil teachers at the end of the second year of their apprenticeship, and to make out the certificates required by the Education Department ; (3) to visit and report in writing when required by the board or any of its standing committees on any employe who is absent from
1
THE
supply :
as
LANCET, Special Commission on the Metropolitan WaterLANCET, vol. i., 1897, passim.
THE
887
duty on account of illness ; (4) to examine candidates for than half the size of the right half. The whole employment under the board or employes when required bone appears to be rotated about both a vertical and by the board or any of its standing committees, and to an antero-posterior axis, so that the anterior surface make out certificates; (5) to examine and report upon looks to the left while the upper surface of thecases of blind and deaf children when required and to each not atrophied left wing is some millimetres higher than the to visit out make certificates ; (6) department less than once every three months, or oftener if required, upper surface of the right wing. The result of the abnormal and report in writing on any sanitary defect of the pre- curvature of the two ilio-pectineal lines and the flattening mises to which his attention may be called and on the of their anterior extremities, together with the deviation of general health of the scholars ; (7) at such periodical visits the anterior surface of the sacrum, is to give the inlet of the to examine and test the eyesight, hearing, or other physical condition of any scholar to whom attention may be called pelvis an obliquely triangular form. The left pelvic wall is by the head teacher.’ It was further agreed,That the pushed in towards the middle line, so that the left ischial remuneration for the foregoing duties be 75 guineas per spine and the left ischial tuberosity project inward to a annum, the engagement with the board to be for a period greater extent than normal. The same condition, though less of one year.’ marked, is present upon the right side, so that the transverse The Rev. Father Quinlan moved, and Mr. Robertshaw diameters of both the cavity and the outlet of the pelvis are. seconded, the adoption of these proposals. Mr. Bates diminished. The subpubic arch forms an angle of 52°. moved as an amendment that the salary should only be The sacrum is not only rotated upon a vertical and anteroThe Rev. 50 guineas, and Mr. Braithwaite seconded. but also upon a transverse axis, so that the posterior axis, Father Quinlan said that he did not consider the appointdiameter of the outlet is increased by the antero-posterior ment of medical officer necessary. If, however, they were deviation backwards of the lower end of the sacrum and, going to have one he personally would give him a much coccyx. The pelvis resembles a Naegele oblique pelvis in the bigger salary than 75 guineas. Eventually 5 members voted ankylosis of the left sacro-iliac joint, the atrophy of the for the motion and 5 for the amendment and the chairman left wing of the sacrum, the deviation of the sacrum Another to the affected side and of the gave his casting vote for the amendment. symphysis pubis to the amendment was then moved to refer the matter back sound the of the left pelvic wall and side, flattening to the next meeting of the board and this was the inward of the left ischial projection spine and the carried. Considering the amount of duties the medical left ischial tuberosity. The same conditions, however, officer may be required to do 75 guineas is none though to a less extent, exist upon the opposite side:o The thus there are some want of too much; in fact, we consider it quite inadequate. development in the sacrum, is somewhat less than the remunera- some sum proposed of the pelvic wall and some undue flattening tion of a butler, but, of course, the care of other people’s the ischial of prominence spine and ischial tuberosity, and children is a less onerous and responsible office than the care these facts show that the diminution in the diameters is not of another person’s plate and wine. The population of due to a change affecting one side of the pelvis alone but Halifax is in round numbers 90,000, so we suppose there are to changes affecting both sides. While ii many of its about some 9000 children in its Board schools, judging from characters the pelvis undoubtedly resembles that of Naegele. the case of London, which has 500,000 children out of a it differs from it in the projecting keel-like form of population of 5,000,000. Besides looking after the children the symphysis pubis, in the slight separation of the two the medical officer will also have to inspect sundry pupil ischial tuberosities and the consequent shortening of the. teachers. If the Halifax board is going to pay at all let it transverse diameters, and in the smallness of the subpubic. give a decent salary ; otherwise let it frankly ask candidates angle. In these it approaches the type of the transversely to come forward for the honour and glory of the post. contracted pelvis of Robert. Dr. Juan Duque de Estradathinks that the latter characters are sufficiently marked to show that it is not merely a Naegel6 oblique pelvis. THE MEXICAN PELVIS. modified by the ankylosis of the symphysis pubis, but that IN the June number of the Chronica Jfediea ]}Ieaeicana it represents a type of pelvis midway between that of Dr. Juan Duque de Estrada describes what he believes to be and that of Robert, for which he proposes the Naegele The a previously unrecorded variety of contracted pelvis. name of the " Mexican pelvis." The occurrence of bony patient, a Mexican girl, sixteen years old, was delivered with ankylosis between the two halves of the pubes is an great difficulty by perforation of the aftercoming head, the exceedingly rare event, and even in those cases where. child having presented by the breech and the head being from the difficulty experienced in dividing the joint in thecompletely arrested above the brim of the pelvis. On operation of symphysiotomy it has been diagnosed as present examination the pelvis presents two striking peculiaritiesit is a little doubtful whether the difficulty was not due complete ankylosis of the left sacro-iliac articulation and of rather to deviation of the line of the joint than to bony the symphysis pubis. The bones of the pelvis as a whole ankylosis. are mal-developed and all the diameters except the anteroposterior of the outlet are markedly diminished. The left LUMINOUS SUGAR. iliac fossa is smaller than the right and the left ilium is THERE are phenomena attending the formation of crystals; completely ankylosed to the atrophied left wing of the sacrum. The left ilio-pectineal line is too curved posteriorly, which are apparently quite distinct from chemical action. while anteriorly it is too straight and with the whole of the When, for example, a hot saturated solution of arsenious acid left wall of the pelvis appears to be pushed over to the right is allowed to cool the act of crystallisation is accompanied. by the pressure of the left femur. The two halves of the by a flash of light. As each crystal forms there is a short pubes are completely ankylosed, only a slight trace of the sharp glow indicating the release of a certain amount of latent line of the joint being visible upon the anterior surface. energy in the form of light radiation. A related phenomenon The symphysis pubis is directed forward in a keel-like would seem to be the case when two pieces of cane manner and deviates to the right of the middle line. The sugar are quickly rubbed together. The flash is perfectly and iliac sacro-iliac articulation the fossa are distinct and bluish-white in colour, the light extending into right right normal. The right ilio-pectineal line posteriorly is less the substance itself far below the surface. Some interesting, curved than normal and anteriorly resembles the left in experiments on this manifestation have recently been made. being almost straight. The asymmetry of the sacrum is by Mr. John Burke. M.A., the results of which were comvery striking, the left half, markedly atrophied, is less municated to the recent meeting of the British Association. "
-