THE PERSISTENCE OF THE SLUM.

1351 In the

same

issue

of

Garden

Cities and

Town

Planning, the Editor, Mr. W. L. HARE, puts together figures drawn from official sources during the five-year period 1920-24, giving a more exact picture than can be found elsewhere of the present state of insanitary housing. During this period 72million houses were LONDON, SATURDAY, JUNE 25, 1927. inspected by local authorities under various Acts and regulations, when 1 million of them were found to be either unfit or not reasonably fit for human habitation. The number is ominously large, although the THE PERSISTENCE OF THE SLUM. A NOTE of complacency has recently crept intostandard set by sanitary inspectors is believed not to official statements regarding the housing programme, be unduly exacting. Something like 1 million houses

THE

LANCET.

contrast with the situation revealed in the were rendered fit in obedience to the authorities. whose condition was more serious. Of reports of medical officers of health which we leaving 174,426 were ordered to be closed, but 3023 were these, 12,690 A time week short summarise from to week. on being rendered fit, the" fitness " being reopened the Sir KINGSLEY said that since WOOD ago armistice 866,000 new houses had been completed, presumably a temporary quality. Of the condemned houses only 3111 in the five years under review were no fewer than 217,000 of these within the twelvemonth ended on March 31st last ; and in an admirably lucid actually closed, and on the positive side 3898 dwellings supplied in place of demolished slums, chapter of his recent book1 dealing with the shortage in all were a miserable credit balance of only 787 houses. making of houses due to the cessation of building during the of progress elimination of the unhealthy this rate At F. E. the Lieut.-Colonel war, FREMANTLE—putting annual need of houses at 120,000 and the present annual area will not be a question of years but of generations. output at 190,000-calculates it should only take till Nor is the abolition of the slum easily amenable to mid-1930 to reach conditions better than those the solution of providing alternative dwellings. The slum-dweller is ever to be rehoused in existing in the pre-war census year of 1911. But all cry of the on the same site, for by removing a man from cottages this building has only touched in the smallest degree, if at all, the conditions under which the really poor his work hours are wasted each day in travelling. are housed. The Minister’s total of 866,000 houses Cottages, however, cannot be built in cities and these includes 112,742 that are rated above 1:26 per people have an instinctive dislike to the block buildings Even when the grosser forms of post-war which would make it possible to provide them with annum. homes near their work, preferring to have overcrowding have ceased to exist there will still adequate a of bit yard and space to keep poultry or rabbits. remain, as -Lllr. NEVILLE CHAMBERLAIN writes in a prefatory note to Colonel FREMANTLE’s book, Scottish experience, furthermore, shows that in the problem of the slums. It is hardly possible, tenement dwellings children are kept indoors at the expense of their health and spirits, and it is certainly nor is it strictly necessary, to define exactly what is meant by a slum. The fact that it is cognate both with a sound principle that in all rehousing schemes the the word slump and the German word for mud main object should be ease of access to the open air the interests of the children rather than proximity sufficiently indicates the dual aspect of the problem in to A work in the interests of the breadwinner. which it creates. For while, as Mr. G. H. DUCKWORTH writes in a Special Slum Number of Garden Cities and practical difficulty, however, lies in the fact that in Toww Planning,2 the slum inhabitants are not I London and the big cities the passenger traffic at rush hours is already approaching its limits, necessarily very poor or necessarily bad, they are the no doubt the final solution will be found in the and in their usually thriftless, irregularly employed, rough of the Garden Cities Association, manners, and unclean, thus constituting a social "grand policy " which in the removal of a certain body of consists world of their own. On the physical side disease flourishes in sinm surroundings. Sir .TOHN ROBERTSON industries, along with the population serving them, to satellite towns on rural sites. compares two artisan areas in Birmingham of approxiThe problem is not as hopeless as is supposed by mately the same size, in one of which the houses are those who hold that the slum-dweller carries the slum former and in the The has a other bad, fairly good. birth-rate of 33 and a death-rate of 21, compared with to whatever surroundings he is moved. Experience 24 and 12 in the latter. The infant mortality among in Glasgow has convinced Dr. A. S. M. MACGREGOR the badly housed population is almost double, the that rehousing does eliminate the greater part of their Out of 835 removals the results death-rate from measles more than treble, from "slum qualities." were as reported very good in 510, and only 44 were diarrhoea quadruple, that of the better-housed district. after the Unhappily, even in their " dirty " Taking typical slum areas in three county boroughs Dr. FREMANTLE finds the death-rate from tubercle present state, the slums are often lucrative property, in each case to be more than twice that of the rate in and to buy them up at market value would be almost the whole city. But the slums are not saddled with prohibitive in cost, though it is to be noted that under Act the basis of compensation, where physical disease only, for, as he says, it is in them that the 1925 are closed on account of their insanitary the dregs of mankind converge in the most decadent i buildings the is value of the land regarded as a condition, houses and the least delectable districts, men and houses together constituting the slum ; the casualties cleared site. Moreover, it is untrue to say, as many of modern life are sucked down into it by the thousand people do, that nothing can be done to improve and fasten on it a reputation from which both men conditions until money is found for the reconstruction and houses suffer until recovery becomes beyond and removal of dwellings. The problem is not one of building alone. Even assuming, as Mr. CHAMBERrepair. That, at all events, is not too lurid a picture LAIN does, that a very large proportion of workers of the situation in London. must continue to live near their work in present1 Housing of the Nation. By Lieut.-Colonel F. E. Fremantle, industrial centres, there is much to be hoped M.P., F.R.C.P., F.R.C.S., D.P.H., Consulting Medical Officer of day Health for Hertfordshire. London: Philip Allan and Co. from enlightened management of house property. 1927. Pp. 193. 8s. 6d. Mr. CHAMBERLAIN has given his deliberate opinion 2 April-May, 1927. Price 1s. From the Garden Cities and that the faulty management of the past has been Town-Planning Association, 3, Gray’s Inn-place, London, W.C.

in

change.

1352 for the carelessness and destructiveness of the slum tenant. It was, as everyone knows, the late Miss OCTAVIA HILL who showed how the business of rent collecting undertaken by women of tact and sympathy without a hint of meddling or intrusion, might become a great humanising force. Even now many local authorities are able to secure all necessary repairs by friendly conference with owners and without recourse to statutory notice. An Association of Women’s House Property Managers3 is carrying on the work begun by Miss HILL, and public utility societies are beginning to acquire and renovate house property in congested districts. There is here a great opening for the service of trained women.

largely responsible

BASAL BRAIN TUMOURS. THE few

surgeons

who llave as

yet specialised

in

surgery of the base of the brain have not been discouraged by the extreme difficulties associated with the removal of basal tumours from their inaccessible situations ; knowledge has gradually been accumulated by them, with the result that the removal of part of the pituitary body or a tumour of the acoustic nerve are recognised procedures. Clinically, basal brain tumours often grow in the neighbourhood of large and important nerves, so that they can be accurately localised, although they are quite diflicult to reach. Thus acoustic tumours give very distinctive signs, and there appears to be another group of tumours which grow from the front part of the cranial cavity in the olfactory grooves, exerting pressure upon the olfactory nerves and the frontal lobes, and ultimately giving rise to symptoms suggesting pituitary new growth. Successful excision even of a tumour lying in the olfactory groove can now be contemplated. Our present issue contains good evidence of the interest shown in this dinicult branch of surgery by leaders of surgical thought outside this country. Prof. HARVEY CUSHING, of Harvard, has taken the meningiomas which arise from the olfactory groove as the subject of his Macewen Memorial Lecture. Dr. OSKAR HIRSCH, of Vienna, calls attention to certain clinical phenomena of pituitary tumours, describing especially the ocular symptoms associated with them. Speaking with the authority of one who has performed 100 operations upon hypophyseal tumours, he divides tumours of the hypophysis into two great groups : a benign group in which simple adenoma is present, and a malignant group comprising tumours which, whatever their minute structure may be, take on a malignant character. The fundamental difference between the groups lies in their mode of growth : in the former the tumour does not tend to emerge from the pituitary fossa upwards into the general cavity of the skull ; extension upwards is characteristic of the second group. The optic chiasma does not lie directly in the optic groove, but somewhat aboveand behind it, and it is only pressed upon by a pituitary tumour which emerges from its fossa. The ocular signs are primarily an optic atrophy with bitemporal hemianopia ; papilloedema and active neuritis are uncommon phenomena. If they exist, the diagnostician should be sceptical of the existence of a pituitary tumour unless other symptoms render it a certainty. Prof. CUSHING describes the clinical features of tumours which originate in the neighbourhood of the olfactory groove. They are not very common, but when they occur they give rise to a clinical picture which can be recognised provided that a careful history has been

Hon. Sec., Miss A. Churton

3

Redford-square,

London, WC1.

taken. Having established the presence of such tumours it became necessary to devise a technique for their removal, radical extirpation in the case of a meningioma giving the patient a good prospect of

permanent cure. The growth is reached by an osteoplastic approach from the front, just as an acoustic tumour is reached by exposing the cerebellum. There is another parallel between the two tumours in that their removal is accompanied by the danger of One patient upon whom Prof. severe haemorrhage. CUSHING operated survived, but only after passing through a serious illness and submitting to three operations in each of which the danger of hæmorrhage was encountered. It was then that Prof. CUSHING turned his attention to methods of removal othf’r than simple curettage. The first patient upon whom he used modern electro-surgical methods, to which we recently called attention 1, passed through the ordeal without running any serious risk and with relief from his tumour at one sitting. The performance was repeated on another patient with a similarly happy result. The operation demands the most exacting attention to detail and the avoidance of all haemorrhage ; the first tumour took seven hours and the second one nine hours to remove. The apparatus used by Prof. CUSHING is one devised by Prof. W. T. BOVIE; it resembles WYETH’s endotherm knife in that both coagulating and cutting currents are combined in one machine, but in BoviE’s instrument the current is so powerful that for both purposes a loop may be employed in place of the straight needle. Such operations imply the utmost endurance on the part of surgeon and the theatre staff ; but now that the way has been pointed out, development of technique should shorten the time required. The restoration to health, by the removal of tumours from the base of the skull, of two patients who had become mentally deficient is a new land-mark in surgery.

ANÆSTHETICS AND INQUESTS. FROM time to time public apprehension about the danger of anaesthetics appears to be quickened to an almost unreasonable pitch. The cause of this state of fear, which seems to be entirely unjustified, is no doubt mainly the publicity given to fatalities occurring during anaesthesia. This publicity is often so scanty and indiscriminating, and therefore so startling, that the ordinary newspaper reader is naturally alarmed. He has not knowledge enough, nor is he sufficiently supplied with facts to realise that in many cases the death which alarms him not due primarily or even mainly to an was anaesthetic. It is the fashion to-day to believein the universal benefaction of publicity ; " bring the truth to light," " expose all the facts "-these and similar slogans are the general recipe for avoiding trouble in public and private affairs. A departure, however, has recently been made in the law which prevents full reports of divorce proceedings, and it may be argued that there are other topics on which a discretionary silence serves the public better than does full publicity. It is certainly open to question whether this doctrine does not apply to reports of fatalities during anaesthesia. The advocates of publicity maintain that it is by public inquiry alone that the minds of relatives and friends can be adequately set at rest and that they can be assured that there has been no question of negligence or lack of care. Surely a private inquiry conducted with the same consideration and thoroughness that the coroner now devotes to his task, but not open to public description, would be equally convincing to all concerned ? The present publicity of these inquiries may, indeed, have the advantage of deterring the inexperienced from running the risk of having to appear before the coronerand