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extension on a new site, and provision of paying wards for persons of moderate means, was placed before the managing board in 1920 by certain members of the

Hospital, and there is a specially trained nursing staff.In accordance with the requirements of the Board ofEducation, children while undei-going treatment in

FIG. 1.

P,oyal United Hospital, Bath. General View of the Private Wards.[Photos by permission of "Bath Herald."

staff of the hospital, the suggested site being the landat Combe Park on which the Bath War Hospitalwas built in 1915. This scheme was subsequentlyadopted at a public meeting in the Guildhall, Bath.The site at Combe Park, consisting of about 20 acres,was purchased, a portion being retained and theremainder leased to the Pensions Ministry, whichhad taken over the war hospital. On the portionretained, the private hospital and an orthopædichospital for the treatment of surgical tuberculosis inchildren have been erected. The private hospital isa one-storey building with a total accommodation

FIG. 2.

Interior of a Ward (1’2 Bcdb).

of 72 beds. In the admission of patients preferencewill be given to those from Bath and the area coveredbv the Royal United Hospital, but others will beadmitted provided there are beds available. Allpatients can be attended by their own doctors.

-About 100 yards to the north of the private hospitalis the orthopædic ward, consisting of one large open-air room about 80 feet long and 30 feet wide. givingaccommodation for the reception of 37 patients.The ward faces due south and is open in its entirelength, but has a sun balcony in front of it partiallycovered by a lean-to glass roof. The surgical staffconsists of members of the staff of the Royal United

hospital will be educated by a fully qualified school-mistress.

: It is proposed that this shall be the central unitof an organisation covering the area served by theRoyal United Hospital in parts of Somerset, Wiltshire,and Gloucestershire, on the lines of the Wingfieldand Shropshire Orthopaedic Hospitals, and localclinics will be established at suitable centres through-out the area at which will be carried out out-patient treatment, periodical inspection of alloutside cases, the examination and diagnosis of newcases. A specially trained orthopædic after-caresister from the central hospital will visit themregularly, and members of the surgical staff of thehospital will attend at stated intervals. Theseclinics will be controlled by local committees in

cooperation with the medical men practising in theirI neighbourhood.

On Wednesday, May 28th, a meeting will be held atthe hospital by the Bath Division of the BritishMedical Association, which will be in the nature of anofficial medical opening of the new wards. These willbe open for inspection, and Lord Dawson of Penn willdeliver an address.

UNITED STATES OF AMERICA.

(FROM AN OCCASIONAL CORRESPONDENT.)

Cyanogen Chloride for Fumigation.SINCE the introduction of cyanogen as a fumigating

agent on board ships several fatal accidents havebeen reported from various parts of the world, sothat it became evident that either a very valuabledisinfectant-fatal in comparatively low concentrationboth to insects and vermin yet comparatively non-injurious to cargo—must either be abandoned or

else improved precautionary measures must beintroduced. The United States Public Health Servicehas been experimenting with the latter object in viewand during the last year has elaborated a chemicalsafeguard which has so far given most satisfactoryresults. It consists in combining the cyanogen withchlorine so that the poisonous fumes may give urgentwarning of their presence. Cyanogen chloride issaid to be produced by a chemical reaction which isexpressed as follows :-3 NaCN + NaClO3 + 6 HCl = 4 -NaCl + 3 H2O + 3 CNCl.

1080

The following prescription furnishes sufficient gas

During the last nine months this gas has been usedas a routine at the port of Baltimore quarantinestation. On two occasions stowaways have escapedthe vigilance and warning cries of those sent downto clear the hold-on one occasion the man said thathe was asleep in his hiding place, and on the otherhe escaped without being noticed to the deck, wherehe hid in a coil of rope. Both men were driven offthe ship by the " tear-gas " action of the new com-pound before the cyanide action had time to causeany serious injury. It is found, too, that by the timethe former action is lost through dilution, the latter has also disappeared.

I understand that the only reason which hasprevented the Public Health Service from publishingthis discovery is its natural anxiety to give themethod a thorough trial and to perfect the technique. It was found at Baltimore, for example, that thereis danger of causing fire through the excessive heatdeveloped in the chemical reaction, and that thisdanger could be obviated by first dissolving thesodium chlorate in water, so that those making themixture are obliged to dilute the final solution to acertain degree. I had the privilege of witnessing ademonstration, and noticed the bright yellow fumesof cyanogen chloride and the very marked irritanteffect on the mucous membranes of those who wereimprudent enough to sample even a small and well-diluted dose.

Automobile Accidents in 1923.Estimates issued by the National Bureau of

Casualty and Surety Underwriters indicate that the1922 record number of fatal automobile accidents hasbeen exceeded by some 2000 deaths in 1923. Accidentsoccurring at level crossings are still a common sourceof fatalities, despite the terrifying pictures exhibitedat all railway stations showing with vivid realismthe immediate preliminaries to such a disaster.These accidents included, the total amounts tomore than 17,000 deaths. Roughly, one-third of theslain were children under 15 years of age.

Tuberculosis Research at Johns Hopkins Hospital.A great deal of work on the nature of infection

.and the development of immunity in tuberculosishas been carried out in recent years at Johns Hopkins.The results have not been spectacular, but on theother hand a foundation is being laid, a foundationof fundamental knowledge derived from carefullycontrolled animal experimentation which is certainto prove of great value to tuberculosis researcheverywhere. Much of this work has been publishedin your columns. In giving their report this weekof the " work in progress in the Kenneth DowsTuberculosis Laboratory " Dr. A. K. Krause andDr. H. S. Willis reminded the Medical Society ofJohns Hopkins Hospital of the important distinctionto be drawn between tuberculosis in the guinea-pigand in the rabbit. The former shows pathologicalchanges associated with the absence of lymphatictissue in the parenchyma of the lung and its abundanceat the hilum, the latter a pulmonary type of tuber-culosis associated with lymphatic deposits at everybifurcation of the bronchial tree with atrophiedglands at the hilum. The experimental guinea-pigthus corresponds very closely with the infected humanchild, the experimental rabbit anatomically andclinically reproduces the human adult.The recent work hitherto unpublished includes

experiments to determine the rate of migration ofinfecting bacilli in normal and in allergic pigs. Anintradermal dose of living bacilli was given to youngguinea-pigs and their migration controlled (1) byremoval of an area of skin for 15-18 mm. around thepoint of inoculation at varying intervals after the injec-tion ; (2) by removal of the neighbouring lymphaticnodes at varying intervals and examination of samefor bacilli. The experimenters were surprised at the

rapidity with which the bacilli found their way innormal animals to a distance from the point of

, injection into the skin. Within four hours (in one. case within a single hour) they had traversed the

area of skin excised. It took from 10 to 24 hours, to reach the nearest lymphatic gland. In allergic

animals, on the other hand, the time was very greatlyincreased. Three to four days were needed to

, traverse the area of excised skin and as much as, two to three weeks to reach the nearest lymph-nodes.Another set of experiments was designed to determinewhether continuous reinfection with sub-lethal dosescould bring about a progressive and fatal tuberculosis.The Rl strain—an avirulent bacillus originally isolatedby Dr. Trudeau at Saranac Lake-was selected forthis experiment. It was found that 86 daily intra-dermal injections did not have this effect, only aslight depression of allergy resulted. A second batchof animals given daily inoculations were killed onthe sixty-ninth day. Although there were multiplesubcutaneous abscesses no visceral tuberculosis wasobserved. However, the interesting observation wasmade that all the serous membranes were coveredwith adhesive exudate. This phenomenon Dr.Krause does not explain-he proposes to investigateit further. Again, a third batch of animals weregiven daily inoculations for from 30 to 50 days andthen inoculated with a virulent germ. Comparisonwith controls (normal animals and animals inoculatedwith a single dose of R 1) indicated that the immunityhad been lowered to some extent by the series ofinoculations.

I understand that the whole series of experimentsare to be reported in detail in a forthcoming numberof the American Review of Tuberculosis.

INFECTIOUS DISEASES IX ENGLAND AND WALESDURING THE WEEK ENDED MAY 10TH, 1924.

Notifications.—The following cases of infectious diseasewere notified during the week-namely : Small-pox, 82 ;scarlet fever, 1420 ; diphtheria., 627 ; enteric fever, 65 ;pneumonia. 1011 ; puerperal fever, 29 ; cerebro-spinalfever, 9 ; acute poliomyelitis, 6 ; acute polioencephalitis, 2 ;encephalitis lethargica, 290 ; dysentery, 2 ; ophthalmia.neonatorum, 119. No cases of cholera, plague, or typhusfever were notified. The cases of encephalitis lethargicashowed an increase on the i1gul’e 278 of the previous week.

Deaths.-In the aggregate of great towns the deaths frominfluenza fell further from 167 to 95. In London the deathsfrom diphtheria fell to 7, those from measles to 22, whilethe deaths from influenza numbered only 11.

The Services.ROYAL NAVAL MEDICAL SERVICE.

Act. Surgeon Lts. (D) to be Surgeon Lts. (D) : E. R-Longhurst, M. V. Barnes, C. J. Barrable, D. L. Simpson,and D. H. Le Marchant. -

ROYAL ARMY MEDICAL CORPS.

Capt. G. Fleming retires receiving a gratuity.ROYAL ARMY MEDICAL COLLEGE.

Maj. G. De la Cour, R.A.M.C., to be Professor, vice Lt.-Col.and Bt. Col. J. W. West, K.H.S., R.A.M.C.

TERRITORIAL ARMY.

E. L. Elliott (late Royal Navy) to be Capt.J. C. Adarn and C. Stewart to be Lts.

ROYAL AIR FORCE.

Flight Lt. W. D. Miller is transferred to the Reserve,Class D.2. --

DEATHS IN THE SERVICES.

Deputy Inspector-General Archibald AlcKinlay, R.N.,retired, who died on May 17th at, Southsea, qualified asL.R.C.S.I. in 1872 and as L.R.C.P.I. in the following year,entered the Royal Navy as a surgeon in 1874, and wassubsequently appointed to the Nymphe in Australia. In1880 he joined the gunboat Vlosqzcito in China, and sawactive service in this vessel during the Egyptian War of1882 (Egyptian medal and Khedive’s bronze star). Hewas promoted to staff surgeon in 1886, and fleet surgeonin 1891. He retired in 1905.