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THE EIGHTH REPORT OF THE ROYAL COMMISSION ON SEWAGE DISPOSAL.
1530 of transport for bringing the wounded from the field of being looked after by only one surgeon and that the greater battle, and that probably accounted for this state of number of the patients were dying from gangrene and
affairs. neglect. The soldiers did not object to taking chloroform, and many On leaving Constantinople it was sad to see the cursory prea brave soldier walked in to the operating theatre to undergo cautions that were taken by the sanitary authorities at the east some serious operation. But amputations were strongly end of the Bosphorus on board the Constanza boat. A female obj ected to on religious grounds against mutilation, and several and male came on boat; the former asked if one had any died’ who might otherwise have been saved but for this pre- dirty linen, and the latter looked at me, breathed rather judice. One of the most interesting cases was under the care hard on me, which may be taken was the disinfecting of Dr. llaclean at the British Seamen’s Hospital, and of this process, and finally each person was presented with a card on it is to be hoped he will later give full particulars. It was which the worddezinfectat’ was written, and this ended of symmetrical gangrene of both hands and both feet. the so-called disinfecting’ process, and one was allowed to Whether this was due to shock or the taking of ergot of rye proceed. A word of thanks must not be forgotten to one in bread it is difficult to say, but it is hoped we shall learn of your local correspondents, Dr. Sandler, who did everything more of this very interesting case later on. There was no he could to make things run smoothly." sign of the man having received any injury at all. This 81lggesterl Rest Hospital, S°. hospital, under the management of Dr. Maclean, is perfect in every detail, possessing every requirement for present-day Mr. Osborn’s suggestion of having a rest hospital close to the railway station and a base hospital farther off was not surgery. Ontbreak of Cholera. adopted. The rest hospital could have been easily fed The first case of cholera which had been daily expected, through the kindness of Sir R. Crawfurd, of the Customs House, and the transport of the wounded from the train to as so many reservists came from Asia Minor, was met with this hospital would have been carried out by his Customs on Nov. 7th, and this man died in Mr. Osborn’s arms before brandy could be obtained to give him. The authorities were porters, the Kurds. This scheme was not carried out. The base very loath to admit it was a case of Asiatic cholera, but the hospital allocated to the British by the Turkish Red Crescent sunken eyes, livid face, open mouth with drawn lips, with Society is the museum. It contains very splendid rooms, but the teeth showing, and the rigid contraction of the limbs, more suitable in the eyes of the medical men to bas reliefs pointed to the diagnosis. Next day the authorities and stone figures, which do not require feeding, lights to read had to allow it was the first case and disinfectants by at night, water to drink, and other sanitary conIt would have Men carried carbolic sprinklers, and veniences, than for wounded soldiers. were freely used. chloride of lime was strewn about and between the been far better, says medical opinion, to have taken the several goods sheds where the wounded and sick were Girls’ School in Stamboul or the Hotel Kroceker in Pera. That the British Red Cross detachment have no beds detrained. The next day (the 8th) the cases of cholera arrived in shoals, and that their wounded are lying on mattresses placed and stretcher after stretcher passed to the large goods shed, on the stone floor of the Museum is due to the fact that they where dying and dead were put in together. A more did not bring their stores with them, and came out terrible and ghastly sight it seemed impossible to witness, more as a field hospital for the front (the front has now but things went on from bad to worse. When going come to them) than as a stationary or base hospital, for ;;wounded, those dead from cholera were in the train but everything is being done by Major Wyllie and a capable mixed together, the occupants being too weak to throw the coadjutor, his wife, and these apparently insurmountable cholera cases out of the windows, as had been done in the difficulties are being rapidly overcome by indomitable journey from the front. The route from the battlefield to energy. the railway station in Constantinople was lined with these poor wretches, some even lying on the foot-board of the railway carriages. But few had been buried, some collected THE EIGHTH REPORT OF THE ROYAL into a heap were burned, others lay by the roadside where COMMISSION ON SEWAGE DISPOSAL. they had fallen, to be driven over by carts and wagons in their flight from the front. It is to be feared that the Turkish authorities troubled IN the eighth report of the Royal Commission on Sewage too little over cases in which cholera had developed, giving them up at once as hopeless. The first case which occurred Disposal which was issued last week (Cd. 6464) the comat the English Hospital at Shishli was so handed over to the missioners deal with the question of the standards to be sanitary authorities, and this was found to mean signing applied to sewage and sewage effluents discharging into his death warrant. So it was decided that for the future rivers and streams, and the tests which, in their opinion, In the next this should not be done, and that all cases should be isolated should be used in determining those standards. and not given up as hopeless, and the action proved successful and final report the commissioners propose to deal with by their cure. This was accomplished by giving internally methods of disposal not involving water carriage and with diluted solutions of Condy’s fluid, subcutaneous injections of standards in regard to trade effluents. Since the issue of the strychnine, with milk and brandy every hour as diet, and last report, in which particular reference was made to the subsequentlyyuork,"the Turks’ favourite food, a species of question of local circumstances being taken into account fermented milk. Mr. Osborn is quite of opinion that the with the view of affecting economies, much of the time British Red Cross Association is doing the right thing of the Commission has been devoted to the object in sending out a properly equipped cholera hospital and of ascertaining the extent to which it may be practicable to take such circumstances into account and the machinery physicians. The streets especially round and about the railway station, by which this may be done. Accordingly they have were from almost the first blocked with refugees who had fled kept under observation, through their officers, a confrom their homes-men, women, and children living in their siderable number of rivers and streams of different types covered country carts, bringing their flocks of goats, sheep, with a view of tracing the effects of discharging various cattle (some of which could be seen dead on the pavement), sewage liquids of known composition and volume into with straw, and manure all about, like one gigantic farm- streams of known quality, volume, and velocity. As a result " yard. "What this will generate later on heaven only knows," of these observations the commissioners reiterate their recomsaid Mr. Osborn. ’’ There have been some cases of small-pox, mendation that the law should be altered so that local but as yet nothing to an alarming extent. authorities should not be required to purify their sewage more highly than is necessary to obviate the risk of actual Unfonnded Runaotcrs. Ctcrsory Sanita1’Y Preea2ctioas. nuisance arising from its discharge. This recommendation I visited several other hospitals by request of Lady Lowther, obviously necessitated the collection of new materials which as there were many disquieting rumours, happily false, afloat should form a wide basis for estimating the comparaconcerning them. The Asile des Pauvres out by the Sweet tive value of different chemical tests in measuring the conWaters and the Artillery Barracks Hospital on the Golden dition favourable to producing a nuisance possessed by a Horn, near Haskway, both run by Turkey surgeons, were sewage liquid which yields certain data on chemical analysis. admirably administered and there was no sign of neglect, Ultimately attention was given exclusively to three tests: although it was said that the 600 wounded in the latter were (1) the amount of ammoniacal nitrogen present; (2) the
1531 amount of oxygen absorbed from permanganate in four hours; and (3) the amount of dissolved oxygen taken up in i five days. The relative value of these tests as bearing upon the questions of pollution and purification, together with the best methods of applying them, are fully discussed in the
THE PROVISION OF STREET AMBULANCES FOR LONDON.
report. considered cover the methods of applying a standard, the quality of water as a factor in a graduated scale of standards, dilution as a factor in determining the selection of a standard, a normal standard for effluents, specially stringent standards, the relaxation of normal standards under circumstances which appear to justify it, the conditions under which it may be permissible to discharge partially purified or unpurified sewage into a stream, and the broad question of the administration As an outcome of the investigaof standards in general. tions, which are based upon many practical experiments and laboratory researches, it is suggested that the law should be altered (the Itivers Pollution Prevention Act, 1876), so that a person discharging sewage matter into a stream shall not be deemed to have committed an offence under the Act if the sewage matter is discharged in a form which satisfies the requirements of the prescribed standard. This standard would be either the general standard or a special standard which will be higher or lower than the general standard as local circumstances require or permit. It is recommended that an effluent, in order to comply with the general standard, should not be permitted as discharged to contain more than 3 parts per 100,000 of suspended matter, and with the suspended matters included the efHuent should not take up at 650 F. more than 20 parts per 100,000 of dissolved oxygen in five days. It is proposed that this general standard should be prescribed either by statute or by order of the central authority, and should be subject to modifications by such authority after an interval of not less than ten years. Of course, the dilution afforded by the stream is the chief factor to be considered in fixing any special standard. Thus, if the dilution is low it may be necessary, as the commissioners point out, for the central authority, either on their own initiative or on application by the rivers board, to prescribe a specially stringent standard which should remain in force for a period of not less than ten Further, if the dilution prove to be very years. great, the standard may, with the approval of the central authority, be relaxed or suspended altogether. In the experience of the commissioners if the dilution, while not falling below 150 volumes, does not exceed 300, the dissolved oxygen absorption test may be omitted and the standard for suspended solids fixed at 6 parts per 100,000. In order to comply with this test no treatment beyond chemical precipitation would appear ordinarily to be needed. When the dilution, while not falling below 300 volumes, does not exceed 500, the standard for suspended solids may, in the commissioners’ opinion, be further relaxed to 15 parts per 100,000. Then tank treatment without chemicals would, they think, suffice if the tanks were properly worked and regularly cleansed. It is obvious that these relaxed standards should be subject to revision, and it is suggested that this should be done at periods to be fixed by the central authority, these periods to be shorter than those prescribed for the general or for the more stringent standards. Lastly, with a dilution of over 500 volumes the commissioners conclude that all tests might be dispensed with and crude sewage discharged, subject to such conditions as to the provision of screens or detritus tanks as might appear The
DURING the meeting of the London County Council on Nov. 12th an urgency report was presented by the General Purposes Committee dealing with the question of street ambulance provision in London. The County Council is empowered by the Metropolitan Ambulances Act, 1909, to establish an ambulance service.
points
Report of
General
Picrposes Committee.
The General Purposes Committee in its report observed that the powers conferred upon the Council by this Act were permissive only. The Council in approving in 1905 an experimental scheme for the establishment of an ambulance service was presumably satisfied at that time that such a service was necessary. It had now to be considered, however, whether such material improvement had taken place in the provision of ambulances in the last six years as to render it unnecessary for a municipal service to be established and maintained, and whether the needs of the county could be met by subsidising existing organisations or by an organisation which might be instituted by private enterprise. The committee had therefore obtained information as to existing ambulances from the metropolitan police, the Port of London Authority, the Metropolitan Asylums Board, the Metropolitan Water Board, the borough councils, of guardians, and the principal hospitals. boards The most important provision was made by the metropolitan police, which maintained 199 ambulances at police stations and 137 placed in streets. The Port of London Authority was effecting great improvements in its ambulance facilities, and when these were complete the service would consist of 4 motor ambulances, 41 litters and litter under-carriages, 43 stretchers, and 38 awnings. The equipment was designed for the service of the dock premises, and would not prove more than adequate for that purpose. The Metropolitan Asylums Board possessed 8 ambulance stations, which combined had accommodation for 184 men and 60 nurses. There were immediately available 62 horsedrawn ambulances, 17 petrol-driven ambulances, and 11 petrol-driven omnibuses ; 11 more motor ambulances were to be acquired. The Board’s ambulance service was instituted for the conveyance of infectious cases, but during the last ten years it had been necessary to provide for the conveyance of non-infectious patients to the imbecile asylums and children’s institutions. In the last three years no fewer than 5000 non-infectious cases were conveyed in the Board’s ambulances. The Metropolitan Water Board had no ambulance facilities; in 25 boroughs no ambulances were under the direction of the borough council. There was small provision in Battersea, Fulham, and Poplar. As to the boards of guardians, the ambulances were principally used for conveying patients between the workhouses and the infirmaries. In regard to the provision at the hospitals, the following had no ambulances : Bolingbroke, Guy’s, Kensington and Fulham, King’s College, London Homoeopathic, Middlesex, St. George’s, St. John and St. Elizabeth, and West London. The following had one hand ambulance each: Charing Cross, London Temperance, Metropolitan, Miller General, Poplar, St. Bartholomew’s, St. Mary’s, St. Thomas’s, Royal Free, Westminster, and Great Northern Central (used occasionally for cases of accident occurring The London Hospital and University near th6 hospital). had one horse ambulance and a hand College Hospital necessary to the central authority. The St. John Ambulance Association This document is a valuable one, and presents issues of ambulance each. the utmost importance to the community. It may, however, appeared to have no general organisation for dealing with ordinary street accidents. be well assumed that the recommendations are
i
suggested
founded on very careful observations, and that the commissioners are justified in submitting that the relaxation of a standard of purification in regard to the discharge of sewage into streams may in some circumstances be permitted. It seems, however, desirable, in the event of these recommendations being adopted, that the central authority to whom such questions are to be referred shall be a very efficient and vigilant body, for the question of the pollution of our rivers has intimate relations with the maintenance of the public health, and no considerations of economy should be allowed to interfere with hygienic
requirement--..
Proposal of Committee
to Coordinate present Ambulance
Services. the London boards of guardians held of A conference in 19071 to consider the ambulance question passed the following resolution :That this conference is of opinion that an effective ambulance service for London can be established and maintained without expense to the public rates, by coordinating and developing the existing services, and by empowering the Poor-law authorities of the metropolis—viz., the Metropolitan Asylums Board and the boards of guardians-to place the ambulances they possess at the disposal of the public. 1
THE
LANCET Feb. 16th, 1907, p. 449.
affairs. neglect. The soldiers did not object to taking chloroform, and many On leaving Constantinople it was sad to see the cursory prea brave soldier walked in to the operating theatre to undergo cautions that were taken by the sanitary authorities at the east some serious operation. But amputations were strongly end of the Bosphorus on board the Constanza boat. A female obj ected to on religious grounds against mutilation, and several and male came on boat; the former asked if one had any died’ who might otherwise have been saved but for this pre- dirty linen, and the latter looked at me, breathed rather judice. One of the most interesting cases was under the care hard on me, which may be taken was the disinfecting of Dr. llaclean at the British Seamen’s Hospital, and of this process, and finally each person was presented with a card on it is to be hoped he will later give full particulars. It was which the worddezinfectat’ was written, and this ended of symmetrical gangrene of both hands and both feet. the so-called disinfecting’ process, and one was allowed to Whether this was due to shock or the taking of ergot of rye proceed. A word of thanks must not be forgotten to one in bread it is difficult to say, but it is hoped we shall learn of your local correspondents, Dr. Sandler, who did everything more of this very interesting case later on. There was no he could to make things run smoothly." sign of the man having received any injury at all. This 81lggesterl Rest Hospital, S°. hospital, under the management of Dr. Maclean, is perfect in every detail, possessing every requirement for present-day Mr. Osborn’s suggestion of having a rest hospital close to the railway station and a base hospital farther off was not surgery. Ontbreak of Cholera. adopted. The rest hospital could have been easily fed The first case of cholera which had been daily expected, through the kindness of Sir R. Crawfurd, of the Customs House, and the transport of the wounded from the train to as so many reservists came from Asia Minor, was met with this hospital would have been carried out by his Customs on Nov. 7th, and this man died in Mr. Osborn’s arms before brandy could be obtained to give him. The authorities were porters, the Kurds. This scheme was not carried out. The base very loath to admit it was a case of Asiatic cholera, but the hospital allocated to the British by the Turkish Red Crescent sunken eyes, livid face, open mouth with drawn lips, with Society is the museum. It contains very splendid rooms, but the teeth showing, and the rigid contraction of the limbs, more suitable in the eyes of the medical men to bas reliefs pointed to the diagnosis. Next day the authorities and stone figures, which do not require feeding, lights to read had to allow it was the first case and disinfectants by at night, water to drink, and other sanitary conIt would have Men carried carbolic sprinklers, and veniences, than for wounded soldiers. were freely used. chloride of lime was strewn about and between the been far better, says medical opinion, to have taken the several goods sheds where the wounded and sick were Girls’ School in Stamboul or the Hotel Kroceker in Pera. That the British Red Cross detachment have no beds detrained. The next day (the 8th) the cases of cholera arrived in shoals, and that their wounded are lying on mattresses placed and stretcher after stretcher passed to the large goods shed, on the stone floor of the Museum is due to the fact that they where dying and dead were put in together. A more did not bring their stores with them, and came out terrible and ghastly sight it seemed impossible to witness, more as a field hospital for the front (the front has now but things went on from bad to worse. When going come to them) than as a stationary or base hospital, for ;;wounded, those dead from cholera were in the train but everything is being done by Major Wyllie and a capable mixed together, the occupants being too weak to throw the coadjutor, his wife, and these apparently insurmountable cholera cases out of the windows, as had been done in the difficulties are being rapidly overcome by indomitable journey from the front. The route from the battlefield to energy. the railway station in Constantinople was lined with these poor wretches, some even lying on the foot-board of the railway carriages. But few had been buried, some collected THE EIGHTH REPORT OF THE ROYAL into a heap were burned, others lay by the roadside where COMMISSION ON SEWAGE DISPOSAL. they had fallen, to be driven over by carts and wagons in their flight from the front. It is to be feared that the Turkish authorities troubled IN the eighth report of the Royal Commission on Sewage too little over cases in which cholera had developed, giving them up at once as hopeless. The first case which occurred Disposal which was issued last week (Cd. 6464) the comat the English Hospital at Shishli was so handed over to the missioners deal with the question of the standards to be sanitary authorities, and this was found to mean signing applied to sewage and sewage effluents discharging into his death warrant. So it was decided that for the future rivers and streams, and the tests which, in their opinion, In the next this should not be done, and that all cases should be isolated should be used in determining those standards. and not given up as hopeless, and the action proved successful and final report the commissioners propose to deal with by their cure. This was accomplished by giving internally methods of disposal not involving water carriage and with diluted solutions of Condy’s fluid, subcutaneous injections of standards in regard to trade effluents. Since the issue of the strychnine, with milk and brandy every hour as diet, and last report, in which particular reference was made to the subsequentlyyuork,"the Turks’ favourite food, a species of question of local circumstances being taken into account fermented milk. Mr. Osborn is quite of opinion that the with the view of affecting economies, much of the time British Red Cross Association is doing the right thing of the Commission has been devoted to the object in sending out a properly equipped cholera hospital and of ascertaining the extent to which it may be practicable to take such circumstances into account and the machinery physicians. The streets especially round and about the railway station, by which this may be done. Accordingly they have were from almost the first blocked with refugees who had fled kept under observation, through their officers, a confrom their homes-men, women, and children living in their siderable number of rivers and streams of different types covered country carts, bringing their flocks of goats, sheep, with a view of tracing the effects of discharging various cattle (some of which could be seen dead on the pavement), sewage liquids of known composition and volume into with straw, and manure all about, like one gigantic farm- streams of known quality, volume, and velocity. As a result " yard. "What this will generate later on heaven only knows," of these observations the commissioners reiterate their recomsaid Mr. Osborn. ’’ There have been some cases of small-pox, mendation that the law should be altered so that local but as yet nothing to an alarming extent. authorities should not be required to purify their sewage more highly than is necessary to obviate the risk of actual Unfonnded Runaotcrs. Ctcrsory Sanita1’Y Preea2ctioas. nuisance arising from its discharge. This recommendation I visited several other hospitals by request of Lady Lowther, obviously necessitated the collection of new materials which as there were many disquieting rumours, happily false, afloat should form a wide basis for estimating the comparaconcerning them. The Asile des Pauvres out by the Sweet tive value of different chemical tests in measuring the conWaters and the Artillery Barracks Hospital on the Golden dition favourable to producing a nuisance possessed by a Horn, near Haskway, both run by Turkey surgeons, were sewage liquid which yields certain data on chemical analysis. admirably administered and there was no sign of neglect, Ultimately attention was given exclusively to three tests: although it was said that the 600 wounded in the latter were (1) the amount of ammoniacal nitrogen present; (2) the
1531 amount of oxygen absorbed from permanganate in four hours; and (3) the amount of dissolved oxygen taken up in i five days. The relative value of these tests as bearing upon the questions of pollution and purification, together with the best methods of applying them, are fully discussed in the
THE PROVISION OF STREET AMBULANCES FOR LONDON.
report. considered cover the methods of applying a standard, the quality of water as a factor in a graduated scale of standards, dilution as a factor in determining the selection of a standard, a normal standard for effluents, specially stringent standards, the relaxation of normal standards under circumstances which appear to justify it, the conditions under which it may be permissible to discharge partially purified or unpurified sewage into a stream, and the broad question of the administration As an outcome of the investigaof standards in general. tions, which are based upon many practical experiments and laboratory researches, it is suggested that the law should be altered (the Itivers Pollution Prevention Act, 1876), so that a person discharging sewage matter into a stream shall not be deemed to have committed an offence under the Act if the sewage matter is discharged in a form which satisfies the requirements of the prescribed standard. This standard would be either the general standard or a special standard which will be higher or lower than the general standard as local circumstances require or permit. It is recommended that an effluent, in order to comply with the general standard, should not be permitted as discharged to contain more than 3 parts per 100,000 of suspended matter, and with the suspended matters included the efHuent should not take up at 650 F. more than 20 parts per 100,000 of dissolved oxygen in five days. It is proposed that this general standard should be prescribed either by statute or by order of the central authority, and should be subject to modifications by such authority after an interval of not less than ten years. Of course, the dilution afforded by the stream is the chief factor to be considered in fixing any special standard. Thus, if the dilution is low it may be necessary, as the commissioners point out, for the central authority, either on their own initiative or on application by the rivers board, to prescribe a specially stringent standard which should remain in force for a period of not less than ten Further, if the dilution prove to be very years. great, the standard may, with the approval of the central authority, be relaxed or suspended altogether. In the experience of the commissioners if the dilution, while not falling below 150 volumes, does not exceed 300, the dissolved oxygen absorption test may be omitted and the standard for suspended solids fixed at 6 parts per 100,000. In order to comply with this test no treatment beyond chemical precipitation would appear ordinarily to be needed. When the dilution, while not falling below 300 volumes, does not exceed 500, the standard for suspended solids may, in the commissioners’ opinion, be further relaxed to 15 parts per 100,000. Then tank treatment without chemicals would, they think, suffice if the tanks were properly worked and regularly cleansed. It is obvious that these relaxed standards should be subject to revision, and it is suggested that this should be done at periods to be fixed by the central authority, these periods to be shorter than those prescribed for the general or for the more stringent standards. Lastly, with a dilution of over 500 volumes the commissioners conclude that all tests might be dispensed with and crude sewage discharged, subject to such conditions as to the provision of screens or detritus tanks as might appear The
DURING the meeting of the London County Council on Nov. 12th an urgency report was presented by the General Purposes Committee dealing with the question of street ambulance provision in London. The County Council is empowered by the Metropolitan Ambulances Act, 1909, to establish an ambulance service.
points
Report of
General
Picrposes Committee.
The General Purposes Committee in its report observed that the powers conferred upon the Council by this Act were permissive only. The Council in approving in 1905 an experimental scheme for the establishment of an ambulance service was presumably satisfied at that time that such a service was necessary. It had now to be considered, however, whether such material improvement had taken place in the provision of ambulances in the last six years as to render it unnecessary for a municipal service to be established and maintained, and whether the needs of the county could be met by subsidising existing organisations or by an organisation which might be instituted by private enterprise. The committee had therefore obtained information as to existing ambulances from the metropolitan police, the Port of London Authority, the Metropolitan Asylums Board, the Metropolitan Water Board, the borough councils, of guardians, and the principal hospitals. boards The most important provision was made by the metropolitan police, which maintained 199 ambulances at police stations and 137 placed in streets. The Port of London Authority was effecting great improvements in its ambulance facilities, and when these were complete the service would consist of 4 motor ambulances, 41 litters and litter under-carriages, 43 stretchers, and 38 awnings. The equipment was designed for the service of the dock premises, and would not prove more than adequate for that purpose. The Metropolitan Asylums Board possessed 8 ambulance stations, which combined had accommodation for 184 men and 60 nurses. There were immediately available 62 horsedrawn ambulances, 17 petrol-driven ambulances, and 11 petrol-driven omnibuses ; 11 more motor ambulances were to be acquired. The Board’s ambulance service was instituted for the conveyance of infectious cases, but during the last ten years it had been necessary to provide for the conveyance of non-infectious patients to the imbecile asylums and children’s institutions. In the last three years no fewer than 5000 non-infectious cases were conveyed in the Board’s ambulances. The Metropolitan Water Board had no ambulance facilities; in 25 boroughs no ambulances were under the direction of the borough council. There was small provision in Battersea, Fulham, and Poplar. As to the boards of guardians, the ambulances were principally used for conveying patients between the workhouses and the infirmaries. In regard to the provision at the hospitals, the following had no ambulances : Bolingbroke, Guy’s, Kensington and Fulham, King’s College, London Homoeopathic, Middlesex, St. George’s, St. John and St. Elizabeth, and West London. The following had one hand ambulance each: Charing Cross, London Temperance, Metropolitan, Miller General, Poplar, St. Bartholomew’s, St. Mary’s, St. Thomas’s, Royal Free, Westminster, and Great Northern Central (used occasionally for cases of accident occurring The London Hospital and University near th6 hospital). had one horse ambulance and a hand College Hospital necessary to the central authority. The St. John Ambulance Association This document is a valuable one, and presents issues of ambulance each. the utmost importance to the community. It may, however, appeared to have no general organisation for dealing with ordinary street accidents. be well assumed that the recommendations are
i
suggested
founded on very careful observations, and that the commissioners are justified in submitting that the relaxation of a standard of purification in regard to the discharge of sewage into streams may in some circumstances be permitted. It seems, however, desirable, in the event of these recommendations being adopted, that the central authority to whom such questions are to be referred shall be a very efficient and vigilant body, for the question of the pollution of our rivers has intimate relations with the maintenance of the public health, and no considerations of economy should be allowed to interfere with hygienic
requirement--..
Proposal of Committee
to Coordinate present Ambulance
Services. the London boards of guardians held of A conference in 19071 to consider the ambulance question passed the following resolution :That this conference is of opinion that an effective ambulance service for London can be established and maintained without expense to the public rates, by coordinating and developing the existing services, and by empowering the Poor-law authorities of the metropolis—viz., the Metropolitan Asylums Board and the boards of guardians-to place the ambulances they possess at the disposal of the public. 1
THE
LANCET Feb. 16th, 1907, p. 449.