flooring at short intervals, so as more readily to admit the heat. The pit for the stove was covered over by a pent roof, a few steps leading down to the fireplace. A movable valve in the flue provided a ready means of regulating the temperature, and even of diverting the heat from one tent to the one adjoining, for which purpose branch flues were arranged from some of them. "Among the many advantages of this mode of heating was the circumstance that after a time the soil under the tent became heated as well as the interior itself; a steady and constant movement of air in the interior was, moreover, kept up; and even in the depth of winter, with an external temperature of 25° F., that of the interior could be retained easily at 55° F. if necessary."-(Lessons on Hygiène and Surgery from the Franco-Prussian War, by C. A. GORDON.) In the American war some of the hospitals contained from 2000 to 2800 beds-in fact, they were much too large. The numbers under the same roof should be as small as possible. Hammond states that in his experience the best size for a ward or tent was that which would accommodate fifty men: length of ward, 175 feet; width, 25 feet; height, 14 feet; superficial area per man, 87 feet; cubic space per man, 1200 feet; ridge ventilation by an opening 10 inches wide running the whole length of the roof. In the Austrian campaign of 1859, the method of distribution over a large tract of country, and in many small hospitals frequently entirely removed from military control, notwithstanding the disadvantage of badly arranged transport and want of care en route, was attended by most satisfactory results, not only as regards the health of the sick but the behaviour of the soldiers. The distribution spread no epidemic among the civil population, but, on the contrary, epidemics among the soldiers were arrested by it. Hospital Ships.-Ships have the one great advantage of isolation, but they are difficult to ventilate, the space is cramped, and there are other disadvantages. They are, however, extremely useful in certain cases, especially in warfare. One of the best hospital ships ever constructed was the Victor Emmanuel, sent out to the Ashantee war. A short account of this vessel will give an actual example of what a hospital ship ought to be. "H.M.S. Victor Emmanuel is a wooden screw steamship of the old class, of 5157 tons, and carried originally seventy-nine guns. She was launched at Pembroke dockyard in September 1855, under the name of the Repulse; but having been, shortly after the close of the Crimean war, visited and admired by the Emperor Victor Emmanuel, she was ordered henceforth to bear the name of that monarch." She was converted into a hospital ship in 1873. As now constituted, she is a flushed-deck ship with poop added, and has below what may be called a service deck, a main, gun (or lower), and orlop deck. The water-supply is stored in large tanks amidship. Three of these reservoirs contain salt water for flushing closets; three fresh water, for washing and bathing purposes; and two are fitted with Crease's filters, for drinking and cooking purposes only. From these tanks, by an elaborate system of pipes, all parts of the ship are supplied, so that anywhere, at any moment, salt, fresh, or filtered water may be obtained. The hospital deck is 230 feet long; width, 52 feet; height from deck to beam 6 feet 2 inches, and from deck to deck nearly 7 feet. Ventilation and light are ensured by sixty-six ports, fitted with sashes and jalousies. The hatchways and two large stern ports also assist ventilation; while six cowled tubes, projecting higher than the bulwarks, and trimmed head to wind, act as downcasts. The upcast ventilation is provided for by long slits in the deck, covered with wooden hoods (resembling in some respects the ridge ventilation in hospital tents). These hoods are arranged so that they may be raised or depressed to any extent. There are numerous orifices leading into goose-neck pipes along the top-sides of the deck above, which also assist. The engine room hatchway is completely separated by glazed bulkheads, so that no heat or smell can find its way from that source into the hospital deck. There are cabins on each side of the stern for the use of sick officers. The latrines are on the upper deck, opening towards the bows just abreast of the smoke-funnel. There are also closets fitted with patent disinfecting apparatuses in different parts of the ship. They are arranged in three sets-viz., two sets aft, two at the bows, and two opposite the engine hatchway. The hospital accommodates 140 patients, occupying cots arranged in three rows fore and aft, and made so as to "rock and "lock." The cots are also provided with mosquitocurtains rendered uninflammable by tungstate of soda, and light canvas screens are provided. There is a large outside platform, protected by wire fencing, on each side of the hospital deck, on which the patients can have the benefit of fresh air either in beds or chairs. There are excellent arrangements in the lavatories, numerous baths, and a laundry fitted with Bradford's washing apparatus, an arrangement by which the foul linen can be hoisted up from below. The ship has a spacious cooking-galley, ice-making machines, dispensary, lifts, pumps, &c., and the whole painted white, in order to show any dirt. The arrangements were so admirable that it was expected to be a great success, and it fully realised all anticipations, except a few minor defects easily remedied. Here, then, we have a model of a hospital ship-effectual arrangements for plenty of water, for cooking food, the disinfection of excreta, the ventilation of the ship throughout, the comfort and amusement of the sick, and as much cubic space as can well be obtained in a vessel.-(For further details, see Report on H.M.S. Victor Emmanuel, Lancet, 1873, and Lancet, April 18, 1874.) Dr. Parkes considers it would be a good plan in large expeditions to have a small ship converted entirely into a laundry, a proposal that deserves consideration; and he insists on the facilities for bathing and sea drenching, with regular fumigation and disinfection. Cottage Hospitals.-The same principle that has already been laid down as applied to separate tents in military field hospitals, to separate pavilions in large hospitals, is seen in cottage hospitals. These have now been established in nearly every county in England, and the results of treatment are so good that they are on the increase. The cottage-hospital system was originated by Mr. Napper of Cranleigh; it is especially applicable to rural districts. Its advantages are 1. Skilled nursing. 2. Special appliances-such as water beds, fracture apparatus, &c. (in fact, all the mechanical appliances necessary). 3. Isolation. 4. Home comforts. 5. Any medical man practising in the dis 12 X 17 LOBBY COVERED WAY KITCREN 13 X 20 ADDIT ROOMS Fig. 47. trict may have the use of them for å deserving | tal, it should be at the rate of one bed for patient. The patients themselves pay a certain sum weekly, according to their means, so that the cottage hospital is to some extent self-supporting, although voluntary contributions are also necessary. Each subscriber, no matter what the amount of his subscription, should have equal privileges in recommending cases. Those of emergency and accident are at once admitted, in other cases a recommendation from a subscriber is necessary. All infectious cases as well as incurable diseases are excluded. There will be little difficulty either in construction or in selecting a proper site. "In most instances a couple of huts or cottages for each sex, with two or three rooms each for subdivision, nurses' rooms alongside the wards, and detached kitchens, all connected by open verandahs, will answer every purpose."-(GALTON and SUTHERLAND's Hospital Construction.) With regard to the size of a cottage hospi every 1000 of population. Three cottage hospitals, of six beds each, will serve effectually a rural population of 18,000. The cost is about £90 per bed. Hospitals for Infectious Diseases.-It is im portant that every sanitary authority should act upon the 131st section of the Public Health Act, and provide a proper place for the treatment of infectious diseases. Every board of guardians should also have a detached contagious ward. "Every village ought to have the means of accommodating instantly, or at a few hours' notice, say, four cases of infectious disease, in, at least, two separate rooms, without requir ing their removal to a distance. A decent four-room or six-room cottage at the disposal of the authority would answer the purpose. Or permanent arrangement might be made beforehand with trustworthy cottage-holders, not having children, to receive and nurse, in case of need, patients requiring such accom A. administrative buildings (kitchen, stoves, offices, nurses' bedrooms, &c.); B, laundry, &c.; C, dis'nfection, dead-house, &c.; D, huts for ten patients each, with scullery and bathroom at end, and closet and sink at other end of each; E, open corridors. The dotted lines show direction for farther extension. The London vestries have generally erected Where any suitable hospital or place for the temporary hospitals of corrugated iron lined reception of the sick is provided within the with match-wood. In the Hampstead Small-district of a local authority, or within a conpox Hospital there was an interval between the wood and iron which was filled with felt. Any local authority may provide for the use the inhabitants of their district hospitals, or temporary places for the reception of the sick, and for that purpose may Themselves build such hospitals or places of reception; or Contract for the use of any such hospital or part of a hospital or place of reception; or Enter into any agreement with any person having the management of any hospital, for the reception of the sick inhabitants of their district, on payment of such annual or other sum as may be agreed on. Two or more local authorities, having respectively power to provide separate hospitals, may combine in providing a common hospital. -- (P. H., s. 131.) Any costs incurred by a local authority in maintaining in a hospital, or in a temporary place for the reception of the sick (whether or not belonging to such authority), a patient who is not a pauper, shall be deemed to be a debt due from such patient to the local authority, and may be recovered from him at any time within six months after his discharge from such hospital or place of reception, or from his estate in the event of his dying in such hospital or place.-(P. H., s. 132.) venient distance of such district, any person who is suffering from any dangerous infectious disorder, and is without proper lodging or accommodation, or lodged in a room occupied by more than one family, or is on board any ship or vessel, may, on a certificate signed by a legally-qualified medical practitioner, and with the consent of the superintending body of such hospital or place, be removed, by order of any justice, to such hospital or place at the cost of the local authority; and any person so suffering, who is lodged in any common lodging-house, may, with the like consent and on a like certificate, be so removed by order of the local authority. An order under this section shall be addressed to such constable or officer of the local authority as the justice or local authority making the same may think expedient; and any person who wilfully disobeys or obstructs the execution of such order shall be liable to a penalty not exceeding ten pounds.-(P. H., s. 124.) Any local authority may make regulations (to be approved of by the Local Government Board) for removing to any hospital to which such authority are entitled to remove patients, and for keeping in such hospital so long as may be necessary, any persons brought within their district by any ship or boat who are in T fected with a dangerous infectious disorder, and such regulations may impose on offenders against the same reasonable penalties, not exceeding 40s. for each offence.-(P. H., s. 125.) | The Admiralty, with the consent of the Treasury, lend old ships to port sanitary authorities for the purpose of conversion into floating hospitals. See VENTILATION; HYGIENE, NAVAL, &c. Houses-See HABITATIONS. House-to-House Inspection Medical officers of health, where they possibly can do so, should have a minute inspection of all the houses in their district made once, at least, in every five years. The agents or inspectors who are selected for this office should inquire into all the sanitary arrangements and surroundings of the building, health of the inmates, number, sex, age, &c. Such an inspection, if uniformly carried out by every district once, at least, every two years, would be a complete census, and afford valuable statistical aid to the politician and to the hygienist. Such inquiries for health purposes have been made in several districts, but as the permission and the carrying out of such a scheme rest with sanitary authorities, unfortunately it has not been in any degree uniform; and though the officer of health may recommend, he cannot enforce it, being in this respect at the mercy of the authorities. "Such an inquiry was made in Merthyr in the autumn of 1866. Nearly 10,000 houses were examined and reported on by four intelligent persons. Five weeks were occupied in the examination and report, the cost to the local board being £25. This inquiry embraced the following: The name of the street, number of each house, names of occupier and owner, number of family and lodgers; the ventilation, how it was secured, whether by back-doors or by windows the upper sashes of which could be fully let down; the number of privies or of waterclosets, and the condition of these; the watersupply, whence derived; and the state of any back premises, noticing particularly whether any animals or poultry were kept. When these returns were completed, they were tabulated by the medical officer for each street in each district, and the results summed up. The usefulness of these returns has been continuous. They now afford standpoints of reference whence to mark the improvements made, and to note the dark spots that call for amendment by referring to this Dictionary of Habitations.' The state of each house is at once apparent, and upon the occurrence therein of any case of disease-such as, c.g., enteric fever or phthisis-the exciting cause, whether excrementitious exhalations or damp- | ness of foundations, may be found."-(British Medical Journal, November 16, 1872.) This course has also been adopted amongst the rural sanitary authorities in the county of Gloucester. Dr. Bond in his annual report says: "I therefore felt it my duty to advise each authority that the first object to which it was advisable that its attention should be directed was to obtain a complete and detailed sanitary survey of the district under its jurisdiction, and that its subsequent action should be founded upon the facts which the survey might disclose. This course has been adopted by all the authorities with whom I am connected, with two exceptions, in one of which nothing has been done in consequence of delay in the appointment of an inspector. The inspectors in various parts of the district have, up to the 31st of December, in vestigated the condition of the whole or part of 72 parishes, embracing a total of 8546 separate premises."-(Annual Report of Medical Officer of Health to Gloucester Combined Sanitary Authorities, 1874.) Hydatids-See ECHINOCOCCUS. Hydrometer-An instrument used for the purpose of ascertaining the density of water. It is a glass vessel loaded with mercury or shot, and furnished with a scale. The zero point is found by floating it in distilled water at a temperature of 60°, and marking the point on the scale just where it meets the surface of the water. Hydrophobia, Rabies, Canine Mad ness (LA RAGE)-Hydrophobia or rabies is a disease resulting in man from the transmission of the rabies of animals, especially of the genus Canis, characterised by general illness and a profound affection of the nervous functions, great exaltation of sensibility, severe constrictions of the throat, spas modic action of the diaphragm, and often tetanic spasms-all aggravated by attempts to drink fluid, by the sound of running water. the least breath of air, the contact of cold things, and other external impressions. It is uniformly fatal. The deaths from hydrophobia in this country are on the increase. In the four years from 1868-71 they were as follows: 7, 18, 52, and 56. In Prussia it is still more fatal than in our country, for in ten years 1666 deaths wer attributed to it. In France about twenty-three deaths occur annually from hydrophobia. The animals in whom hydrophobia is supposed to originate are the dog, the wolf, the fox, and perhaps the cat. The causes predis posing are somewhat vaguely enumerated as extreme heat, alternations of temperature, bad food, deficient water, forced continence, &c. It is highly probable that it never arises de noro, but is always propagated by contagion. In this way it may be produced in almost any animal, and even in birds; they in their turn can communicate it to others, and so on. With respect to the species of animal whence the disease was communicated to man in 228 cases in France, the following figures are interesting: The Number of Cases of Hydrophobia in France from 1850 to 1859, with their Origin. 188 from the bite of the dog. Thus the important fact is established, that the effects of rabies are usually seen in from a few weeks to three months after the contagion, and that longer periods are more rare. There are, however, a few instances on record in which the incubative period would appear excessive-e.g., a case recorded by Mr Hall Thompson, in the "Lancet," of a lad aged eighteen, who had been twenty-five months in prison, during which period he had certainly not been bitten by any animal; but it was found that seven years previously he had been severely bitten by a dog on the hip, the scar still remained, and death occurred after a three days' illness. The symptoms in the dog, and, generally speaking, in other animals, are as follows: He first appears depressed and restless, and refuses food and drink. To this succeeds a state of agitation, the animal is deaf to the voice of its master, wanders without any apparent object, the eyes inflamed and threatening, the ears and tail down, with the mouth foaming and the voice hoarse or almost extinct. Sometimes he howls dismally. In his course at times rapid, at others slow and uncertain-he attacks, either spontaneously or because irritated, animals and men whom he may meet. Many dogs avoid water, but some show no dread whatever of that fluid, and will lap it during the disease. These acute symptoms do not last long. After four, five, or six days the strength becomes exhausted, and paralysis of the hind-legs supervenes, or frequently-recurring convulsions end in death. But the symptoms are not always the same. Certain mad dogs are to the last attached to their master, and do not refuse drink from his hand. The desire to bite is confined to those animals which use the teeth as a weapon of defence. This tendency is in some cases neutralised by paralysis of the lower jaw, which hangs uselessly (rage mue). There is no characteristic morbid change if the affection has been of short duration, but in cases of any length, the principal lesions are found in those parts supplied by the eighth pair of nerves-i.e., the tongue, fauces, salivary glands, &c.-which are swollen and inflamed. Vesicles underneath the tongue were said to exist, but this is erroneous; they may be present in a few cases, but have no connection with the disease. Symptoms in Man.-The invasion of the disease is marked by a feeling of general lassitude, accompanied with headache, agitation, sleeplessness, an unaccustomed exaltation of the intellectual faculties, or, on the contrary, an unwonted sadness, a seeking for solitude, gloomy presentiments, and sometimes spasmodic movements, rigors, nausea, and vomiting. In a few cases there are dull or lancinating pains in the wound. The cicatrix which has formed as usual over the seat of, injury may become the seat of a more or less considerable swelling, which, taking a livid tint, may even burst, and give exit to a reddish serosity. This period of invasion may last from two to three, or four to six days. It is soon followed by more serious events; the agitation is increased, and is accompanied with a pitiable feeling of distress. The senses are greatly exaggerated, the least noise or light is insupportable, and the sight of bright objects, especially water, determines violent convulsions. This hydrophobia is carried in the greatest number of cases to such a degree that the patients repel all kinds of drink, falling into convulsions if they feel the contact of a drop of liquid, or if an attempt is made to |