THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA PRESENTED BY PROF. CHARLES A. KOFOID AND MRS. PRUDENCE W. KOFOID LECTURES ON PUBLIC HEALTH, DELIVERED AT THE ROYAL COLLEGE OF SURGEONS, BY E. D.'MAPOTHER, M.D., PEOFESSOK. OF HYGIENE, HONORARY MEMBER METROPOLITAN ASSOCIATION OF MEDICAL OFFICERS OF HEALTH ; MEJIBEK OF COUNCIL OF SURGICAL AND OF STATISTICAL SOCIETIES; MEDICAL OFFICER OF HEALTH, CITY OF DUBLIN; SUKGEON TO ST. VINCENT'S HOSPITAL. SECOND EDITION. numerous DUBLIN: FANNIN & CO., 41 GRAFTON-STREET. LONDON : LONGMAN AND CO. EDINBURGH : MACLACHLAN AND STEWART. 1867. PRINTED AT MU;,LANY'S STEAM PRINTING WOUKS, 47 FLEET-STREET, DITELIN. THE fopl College 0f Surgeons ire |relanir, IN 1844, PROCLAIMED THE IMPORTANCE OF SANITARY INSTRUCTION BY FOUNDING A CHAIR OF HYGIENE. TO THE FELLOWS OF THAT BODY, THEREFORE, WHOSE ABILITY, DISINTERESTEDNESS, AND SOCIAL STANDING, HAVE MUCH INFLUENCED LEGISLATIVE MEASURES FOR THE PRESERVATION OF PUBLIC HEALTH, %\m lectures are BY THEIR GRATEFUL SERVANT, THE AUTHOR. M375187 PREFACE. IN publishing the first course of these Lectures, I was obliged to excuse many shortcomings by ac- knowledging that they had been hurriedly prepared. I must now put in a similar plea, for just as I had begun to prepare for press last November, I was called on to take temporary charge of the Chair of Physiology ; and although chemistry and the micro- scope afforded the principal sources of instruction for this subject as well as Hygiene, additional time was needed for the arrangement of appliances. However, as some interest would attach to an account of the Cholera Outbreak, and to Sanitary Statistics in view of improved legislation during the approaching Session, I was unwilling to postpone publication to a time of greater leisure. The first Lecture, having been scarcely altered, exhibits the status of disease in Dublin in 1864 ; the PREFACE. others included in the first edition have been en- larged, and twelve new ones have been added. Throughout all of them my aim has been to awaken an interest in the study of the healthy functions of the human body, as I believe that it is only by the spread of such knowledge that quackery will wane, and that sanitary reforms will rest on a safe, because reasonable, foundation. E. D. M. IA>/ February, 1867. CONTENTS. LKCTCKE. PAGE I. Introduction. Epidemics of the Middle Ages. Recent Epidemics. Sanitary State of Dublin in 1864 .. .. .. .. 7 II. Air its Impurities, and Pollution from Factories 34 III. Air continued Ventilation Warming Diseases due to Impure Air . . . . . . 62 IV. Water its Impurities, and Diseases produced by them Methods for their removal The Dublin Waterworks .. .. .. .. 89 V. Influences of Soil and Climate on Disease Clima- tology of Ireland .. .. ., 122 VI. Food Physiological Purposes Tissue-making Food Methods of Preparing and Preserving . . 145 VII. Food continued Heat-producing Foods. Dietics 170 VIII. Food continued Vegetarianism Alcohol Adul- teration Diseases due to scanty or improper Food .. .. .. .. ..194 IX. Healthy Skin Baths Clothing .. .. 227 X. Mental and Physical Exercises their Disuse, Use, and Abuse . . . . . . . . 250 XI. Sanitary Architecture Hospitals .. .. 274 XII. Dwellings of the Labouring Classes Lodging Houses Tenements Building Acts . . 297 XIII. Sewerage The Liffey Utilization of Sewage . . 327 XIV. The Burial of the Dead Intramural Interment Regulations in England Condition of Grave- yards in Ireland Burial and Provident Societies 350 XV. Town Improvement Irish Towns . . . . 367 6 CONTESTS. LBCTUKK. XVI. Occupations Injurious to Health Prevention of Accidental Poisoning and Drowning XVII. The Prevention of Zymotic and Constitutional Dis- eases, Fevers, Eruptive Diseases, Diarrhoea, Con- sumption, &c. XVIII. The Cholera Outbreak, 1866 The Circumstances which Conduce to the Development of the Disease XIX. The Cattle Plague in England and Ireland XX. Disinfection XXI. Vital Statistics of Ireland Systems of Registra- tion The Mortality of Dublin XXII. The Poor of Ireland Medical Charities XXIII. Sanitary Organization XXIV. Sanitary Laws Proposals for Codification APPENDIX Sanitary Act, 1866 Nuisances Act, 1855 Disease Prevention Act, 1855 Sewage Utilization Act, 1865 Public Health Act, 1848 ERRATA. Insert Hardwicke in line 1C, page 489. ot 15, 588. For Barkers read Baker, line 1 , 594. LECTURES ON PUBLIC HEALTH. INTRODUCTORY. EPIDEMICS OF THE MIDDLE AGES. RECENT EPIDEMICS. SANITARY STATE OF DUBLIN IN 1864. MR. PRESIDENT, MY LORD, AND GENTLEMEN The natural pride which I derive from the honorable, but, I fear, too difficult post which you have elected me to, is iringled with a feeling of admiration for the far-seeing wisdom of the governing body of this College, who, in 1844, founded this Chair, and thus anticipated the insti- tution of any similar means for diffusing amongst the community at large a knowledge of those laws by which health may be preserved and disease diminished. Since that period, in many Continental and a few British schools, professorships of this subject have been founded under the various titles of " Preventive Medicine," " Public Health," " Hygiene," and similar designations ; and the directors of army medical education, both at home and abroad, have signalized themselves by the importance they have attached to it. In the great school recently created at Netley Hospital there are combined, under the able direction of Prof. Parkes, the most perfect appliances for teaching hygiene hitherto realized. This science, as I understand it, is an application of the laws of physiology and general pathology to the maintenance of the health and life of communities, by means of those agencies which are in common and con- 2 8 THE OBJECTS OF HYGIENE. stant use. It is, therefore, a department which the medical profession can share advantageously with the public, who, indeed, through the medium of Social Science Associations, Parliamentary Commissions, and similar organs of inquiry, are advancing rapidly in sani- tary knowledge. Opportunities for enforcing its teach- ings lie within the power of every individual, and espe- cially of local municipal authorities, who undertake the onerous duty of caring for the domestic, and public wants of their fellow-citizens. Although, in all times, attention was paid by physicians to the prevention of disease, it is only within a very recent period that public attention has been attracted to sanitary inquiries. In civil life an interest was especially awakened by the reports on the health of towns by Edwin Chadwick, in 1846 ; and in military life the subject forced itself on the autho- rities in a still more painful manner by the lamentable loss of life among our brave soldiers during the Crimean campaign, which was afterwards proved to have been avoidable in a great degree. It was proved that nothing is more costly than disease, and that the outlay which increases health and strength amply repays. The em- ployer often finds that by due sanitary care of his work- men, he at once gains by better work and greater assi- duity, as well as by fewer interruptions from sickness. Prof. Parkes likewise shows that this is an obligation in the case of the army, for the state removes from the sol- dier the self-control with regard to hygienic rules which other men possess ; and it is therefore bound, by every principle of fair contract, to take care that he shall not be injured in any way by its system. " It was the moral argument, as well as the financial one, which led Lord Herbert to devote his life to the task of doing justice to the soldier of increasing the amount of his health, and moral and mental training, and in so doing of augmenting not only his happiness, but the value of his services to the country. And by tho side of Lof'd THE PUBLIC HEALTH IN ANCIENT TIMES. 9 Herbert in this work was one whose name will ever be dear to the country, and whose life, ever since that memorable winter at Scutari, in 1855, has been given up entirely to the attempt to improve the condition of the soldier" the glorious Florence Nightingale. The audience which I will have the honour to address in this and succeeding lectures being composed of both lay and professional persons, I feel the peculiar difficul- ties which arise from such a circumstance, for I fear that in endeavouring to elucidate many facts unfamiliar to the former, I shall be reciting what my medical brethren must regard as obvious corollaries from data already in their possession. It seems to me that I shall most readily secure your attention upon the present occasion, and convince the sceptical, if such there be, of the importance of sanitary instruction and organization among the general public, by sketching, though very briefly, the evils which, both in ancient and modern times, have ensued from neglect of all wholesome pre- cautions, and the benefits which a diffusion of sanitary knowledge has conferred on mankind. Those of the Mosaic laws which regard bodily health are of the fullest and most positive character, and to people living under similar climatic conditions none more appropriate could be devised at the present day. In this divinely-instituted system, hygienic observances are incorporated with the religious code. Many of the teachings of the Koran also, respecting ablutions and other means of personal cleanliness, are worthy of our best attention ; while the sanitary knowledge of heathen Rome is attested by the stupendous aqueducts and sewers, whose very ruins at present excite our admiration. A lamentable falling off in the regard paid to public health is observable in the towns and cities of medieval Europe. Crowded within a narrow compass, hemmed in by high walls, all sanitary laws neglected in the un- settled and disorganized condition of society then ex- 10 THE PUBLIC HEALTH IN ANCIENT TIMES. isting, the masses were decimated by constantly recur- ring plagues, fevers, and famines. Prof. Parkes says : " Whoever considers carefully the record of the mediaeval epidemics, and seeks to interpret them by our present knowledge of the causes of disease, will, I believe, be- come convinced that one great reason why those epi- demics were so frequent and so fatal, was the compres- sion of the population in faulty habitations. Ill-contrived and closely-packed houses, with narrow streets, often made winding for the purpose of defence ; a very poor supply of water, and therefore an universal uncleanliness ; a want of all appliances for the removal of excreta ; a population of rude, careless, and gross habits, living often on innutritious food, and frequently exposed to famine from their imperfect system of tillage such were the conditions which almost throughout the whole of Europe enabled diseases to attain a range, and to dis- play a virulence, of which we have now scarcely a con- ception. The more these matters are examined, the more, I believe, shall we be convinced that we must look, not to grand cosmical conditions, not to earth- quakes, comets, or mysterious waves of an unseen and poisonous air not to recondite epidemic constitutions, but to simple, familiar, and household conditions to ex- plain the spread and fatality of the medieval plagues." The plague popularly known as the " Black Death," which travelled over the Old World, from China even to Greenland, during the five years from 1345 to 1350, and carried off at least one-fourth of its population, is now well known to have been due to over-crowding and want of cleanliness, and was preventible by their removal and by quarantine. This pest had always had its starting point and permanent habitat in Egypt, where the Arab, his wives, children, servants, and domestic animals exist huddled together in a state which the distinguished observer Clot Bey describes in the words, " unheard-of filth reigns in their infected haunts." Their strength is ANCIENT AND MODERN EPIDEMICS. 11 destroyed by their precarious supply of food, which they cook over fires made with dried manure. In China 13,000,000 perished, and thousands fell victims to this scourge of the fourteenth century in every town in Europe. In Venice 100,000 died, and in Paris the number of deaths was at least 50,000 ; and it is also recorded that "in many places in France not more than two out of twenty of the inhabitants were left alive, and the capital felt the fury of the plague alike in the palace and the cot. Two queens, one bishop, and great num- bers of other distinguished persons fell a sacrifice to it, and more than 500 a-day died in the Hotel Dieu under the faithful care of the Sisters of Charity, whose dis- interested courage in this age of horror displayed the most beautiful traits of human virtue. For although they lost their lives evidently from contagion, and their numbers were several times renewed, there was still no want of fresh candidates, who, strangers to the un- Christian fear of death, piously devoted themselves to their holy calling." The College of Physicians of Paris issued a remarkable manifesto, in which they endeavoured to prove an astral origin for the plague ; but their advice with regard to water and food is not to be despised. It is a remarkable circumstance, which is recorded by all writers on the subject, that the fecundity of females was much increased after this dire destruction of human life. That fearful affliction of the middle of the 16th century, the sweating sickness, appeared to partake of the characters of ague and of rheumatic fever. It began in England, and never extended to this country, although multitudes of the affrighted people flocked hither. It frequently caused death in twenty-four hours ; and although it remained but a few days in each town, one-fourth of the inhabi- tants often perished. Recoveries were numerous when the patient was let alone, or treated by a cooling regi- men in an airy room. In Germany, the death of those 12 ANCIENT AND MODEEN EPIDEMICS. attacked at first was certain, although not surprising when we reflect upon the following mode of treatment : " They put the patients, whether they had the sweating sickness or not (for who had calmness enough to distin- guish it ?), instantly to bed, covered them with feather- beds and furs, and whilst the stove was heated to the utmost, closed the doors and windows with the greatest care to prevent all access of cool air. In order, more- over, to prevent the sufferer, should he be somewhat impatient, from throwing off his hot load, some persons in health likewise lay upon him, and thus oppressed him to such a degree, that he could neither stir hand nor foot ; and finally, in this rehearsal of hell, being bathed in an agonizing sweat, he sank exhausted." The plague which produced over 100,000 deaths in London in 1665, and of which we cannot read in the graphic pages of De Foe after such a lapse of time without the strongest feelings of awe and pity, was the last epidemic of its kind which visited western Europe. Many outbreaks of it, however, have occurred since then in the East, and during the late war a malignant fever arose at Odessa, which, but for the prudence of the Russian government, desirous to check alarm, should have received its true name "the plague." As an example of a severe epidemic resulting from neglect of sanitary precaution, I shall allude to the Russian epi- demic of 1864, as it is of such recent occurrence and excited such interest. As you are aware, it was at first named " the plague," and believed to be similar to that pest which has a constant habitat in Egypt, and which occasionally breaks out in the eastern lands ; but it was afterwards shown, by the investigations of St. Petersburgh physicians, and of a Commission sent by the English Privy Council, to be but a very prevalent and fatal epidemic of typhus fever and of relapsing fever. The former was evidently due to the filthy and over-crowded' state of the dwellings of the labouring class, which, be- ANCIENT AND MODERN EPIDEMICS. 13 cause of the coldness of the weather, are kept horribly close ; and the latter to a scarcity of food which at the same time afflicted them. This famine-fever having been previously unknown in Russia, created the greatest and most universal alarm. In this country the disease is but too well known. Another epidemic of an entirely different kind pre- vailed in northern Germany, along the Vistula, in the winter of 1864 and following spring ; and, strange enough, we have had experience of it also in Ireland. During the famine years, especially 1847, the younger inmates of the Bray and South Dublin Union were at- tacked in considerable numbers by a peculiar and fatal nervous disease, which was fully described by Dr. Darby and by the late lamented Dr. Mayne: It was charac- terised by the most extreme stiffness of all the muscles, similar to what occurs in lockjaw, and by such increased sensitiveness of the skin that the slightest touch or draught of air produced intense agony. It was induced by the preceding scarcity of food, and was not commu- nicable from one person to another. It has since been observed in America, and, as I have said, recently broke out in northern Germany. I lately had the ad- vantage of conversing with Dr. Sanderson, the physi- cian sent by the English government to study the epidemic, and it appears to have agreed closely with the malady which invaded us. You will have perceived, then, that a great deal of alarm was extensively created about these epidemics, and the English Privy Council deemed it necessary to issue full instructions to the authorities of seaport towns, in case ships from these infected countries should arrive. Scarcely inferior in virulence, and more disastrous in the prolonged illness which it produces, is the epidemic fever which at closely recurring intervals has depopu- lated our poor land. I shall mention a few of the most remarkable of these epidemics, the more especially as 14 IRISH FEVER EPIDEMICS. they convincingly show the very principal dependence of fever upon an insufficiency of food an evil, I trust, we may consider, at least to a great degree, preventible and not on climatic conditions beyond our control. 1729 Most severe epidemic, great distress, and want of food ; weather not remarkable. 1740 Dearth of pro- visions almost amounting to famine ; weather favour- able ; 80,000 died, or, according to another authority, Dr. Butty, one-fifth of the population. 1817-18 Corn saved was green in the husks; potatoes scanty, wet, unripe. One million and a-half of cases occurred in this epidemic. Early in 1846, just when great anxiety was being felt for the safety of the potato crop, Sir D. Corrigan published his famous pamphlet, urging the dependence of fever upon scarcity of food, and advising that all available precautions should be adopted. His anticipations were, as most of my hearers remember, awfully realized, for in the three terrible years following 579,721 cases were treated in the hospitals alone. The disease usually known as the " ship-fever," which fol- lowed, destroyed thousands of the wretched emigrants scarcely a vessel escaped ; and to show its malignity, I may mention that in one, the Loosthank, 329 out of 349 passengers caught the contagion, and of these 117 diel. The influx of destitute and fever- stricken Irishmen into many British towns spread widely the contagion, and that into Liverpool was so enormous, that the death-rate of the town was raised to 70 per 1,000, more than double its average, being the highest mortality ever re- corded in any modern city so that it well deserved the name of the " hospital and cemetery of Ireland." As regards the prevention of typhoid or intestinal fever, what can we hope for ? I will answer in three sentences from the most recent and very highest autho- rities : " Every year in England more than 100,000 human intestines, diseased in the way already described,, continue each for the space of a fortnight or thereabouts IRISH FEVER EPIDEMICS. 15 to discharge upon the ground floods of liquid charged with matters on which the specific poison of a com- municable disease has set its most specific mark." " By subjecting the discharges on their issue from the body to the action of powerful decomposing chemical agents, they may be entirely destroyed. Typhoid fever ought, therefore, soon to disappear from every return of disease, whether in military or civil life." " The grand fact is clear, that the occurrence of typhoid fever points unequivocally to defective removal of excreta, and that it is a disease altogether and easily preventible." I will not add a word of comment upon these deliberate opi- nions of three of the most scientific physicians living. When typhus, the other variety of Ireland's epidemic enemy, is most indubitably spread by over-crowding, want of ventilation, miasmatous pools and dung-heaps Lt the very doors, bodily filth, and deficient food, may we not hope it is equally remediable ? There is little doubt that the susceptibility to epidemics, and the great mortality they have produced in our land, were due to the miserable and squalid state of our down- trodden peasantry, subsisting, just at the verge of civilization, upon the potato. How have Irish physicians acted when pestilence is prostrating their fellow-men, and depopulating their be- loved country ? Most nobly ; and their conduct, as set forth in Drs. Cusack and Stokes' well-known paper, " On the Mortality of Medical Practitioners in Ireland," cannot be too often held up for admiration and imita- tion, although it is to be hoped that improved sanitary measures will never allow the recurrence of so costly and unnecessary a sacrifice. There had been attacked with fever during the years from 1819 to 1843, 560, or nearly one-half of the physicians of public institutions, and nearly 45 per cent, of the deaths amongst them were due to this contagious disease. In 1847, 123, or two-thirds of the entire deaths of medical practitioners, 16 THE IRISH PHYSICIANS. were due to fever ; or, in other terms, 40 out of every 1,000 living being a proportion of more than forty times as great as the Eegistrar-General's returns show for the English population. Many British towns, re- ceiving our afflicted countrymen with the seeds of typhus upon them, suffered fearfully from the epidemic of 1847 ; and the labours of one Edinburgh physician, Dr. Gairdner, now Medical Officer of Health for Glasgow, are worthy of record. The infirmary was so over- crowded that it contained twenty times its usual number of cases, and became a huge focus of contagion, and to serve in it was certain infection to doctor or nurse. Addi- tional wards were improvised out of two garrets mat- tresses and blankets being placed on the floor. One night at ten o'clock, after the harassing duties of the day, Dr. Gairdner had to see over one hundred new patients in these rooms, through which he could not walk without stooping, and in which it was necessary to kneel or sit upon the floor to examine the pulse or tongue of each patient. Of twenty-two resident physi- cians, twelve took the fever, three having had it before ; of nine attending physicians, six had previously the disease, and the three remaining now contracted it. The ranks of these officers lost four by death, and "paid this heavy tribute of the medical profession to the un- duly severe pressure thrown on them by the carelessness of the community in not anticipating and providing for the approach of disease." Such services, though they may not equal the brilliancy of military heroism, sur- pass it in usefulness, and should meet with adequate public recognition. As a painfully striking instance of the evils of igno- rance among students of my own profession, of the danger of infection carried from the dead body to females in the puerperal state, I may tell you that from 400 to 500 deaths in the Lying-in Hospital of \ 7 ienna were annually traced to this cause ; and so little attention is BARKACKS SCURVY. 17 practically bestowed upon a free supply of pure air in these days, which in our vanity we call " enlightened," and in places upon which one would have thought official wisdom was concentrated, that the Commissioners who, five years ago, investigated the cubic space and ventila- tion of the barracks throughout our country, found that nearly half our soldiers were living in but 400 cubic feet of space each a condition under which it was impossible for robust health to be maintained, and that some were condemned to almost certain death by having less than 250 feet. It has been indeed truthfully said, that " the saddest pages in the history of all nations are those which treat of the wholesale sacrifice of human life, through ignorance or neglect of the simplest means of preserving health or averting disease," and I am afraid we must acknowledge that our art has scarcely preserved an equal number of human beings. A most gratifying example of the benefits of sanitary reform and scientific construction of dietaries is afforded by scurvy a disease which some years ago destroyed more of our sailors than every other sickness, the casu- alties of the ocean, and the efforts of our enemies all combined. Sir Richard Hawkins tells us he himself knew over 10,000 mariners to have died of scurvy within twenty years, and it likewise renders other diseases more frequent and fatal by its debilitating effects. By the use of lemon-juice, which Sir Gilbert Blane discovered to be powerfully preventive, fresh animal food, and proper ventilation, no such disease now ever appears except, indeed, where ignorance of these measures, or greed of gain by adulteration, substitutes other acids for the lemon -juice i Thus on board our transport ship Tas- mania, scurvy raged among our Indian soldiers return- ing home in 1860, mainly because sulphuric acid had been, with murderous dishonesty, substituted for lime- juice. In America, unsanitary influences are so rife, that one 18 PUBLIC INSTITUTIONS. of the rarest things to be seen is a hale elderly man, and Dr. Nicholl, in his recent most able and interesting work, " Forty Years in America," confesses to a dege- neracy of the Anglo-Saxon type among his countrymen, and attributes it to their unwholesome food, and, on the part of the females, to injurious habits in respect to clothing and domestic arrangements. The legislature have done their duty respecting sani- tary measures in such establishments as prisons, bar- racks, and hospitals, which are wholly under official in- spection, and disease and mortality have been immensely reduced. I trust on future occasions, by data afforded by the system of vital statistics now inaugurated in this country for its returns I shall make my text to interest you with Irish facts and figures exhibiting improvement ; but now I must content myself with the following in- stance of the superior health and more efficiently checked disease among the inmates of Salford prison than among the neighbouring factory operatives. The former suffer but half as many days of sickness as the latter ; and an attack of diarrhoea among the prisoners, produced by the bursting of a sewer, was checked without a single death occurring as soon as the cause was ascertained ; whereas 248 deaths from this disease, produced by very similar causes, were recorded in 1856 in the same district. The sanitary measures which it will be the business of these lectures to more fully illustrate, may be enforced by the Nuisances Removal Acts, and a few others amal- gamated with the Public Health Act of 1866. It is to be regretted that, in this department of legislation, every good sanitary statute does not apply to Ireland as well as to our more favoured sister island, and that all their provisions are not consolidated into one act of easy re- ference. Those admirable enactments, the Local Govern- ment Act, 1858, and the Public Health Acts, 1848 and 1858, introduced by our late honoured Viceroy, then Lord Morpeth, do not extend their benefits to Ireland. THE EFFECTS OF SANITARY REFORM. 19 Their regulations apply to towns in their ordinary status of health, but they should be carried on with increased vigour on the threatening or visitation of any epidemic. I acknowledge that there is some difficulty in statisti- cally demonstrating the permanent reduction of deaths which have accrued from the sanitary labours of medical officers of health ; but all will grant that they have had their share in reducing the death-rate of London gene- rally from about 26 to 28 per 1,000, and of some parts of it to a lower rate than that of the most salubrious rural districts ; and in the words of the Registrar- General, " If the mortality of London were confined permanently within the limit represented by the mean rate of the last three years (1859, 1860, 1861), the effect of that reduction in the population, as it exists at present, would be that more than 4,000 persons would survive annually, whose lives would drop under the mean rate derived from the twenty years 1840-59 ; and if the measures that have been already adopted are not relaxed, the amount of benefit will be increased as the population that is the sulject of it is increased." But so far from regarding the improvements which sanitary science has already accomplished as having attained so high a perfection as these remarks seem to imply, I feel that they are as yet merely initiatory move- ments. Many lives are lost from casualties in many cases beyond the control of human foresight, as, for instance, shipwreck, by which 1,500 of the picked men of the people annually perish on our coasts, or are de- stroyed by such appalling calamities as the recent con- flagration of the Santiago chapel. All of these deaths justly excite the sympathy of the public. Will not, therefore, the most strenuous efforts be made to check preventible deaths, scores of times more numerous, be- cause they occur in a less sudden and perhaps less ap- palling manner ? Some years since the salubrity of the country, as in- 20 THE COUNTRY AND TOWNS. dicated by the average age and the death-rate, was very much greater than that of towns; for instance, the average duration of life among the labouring population of Wiltshire was 33, while it was but 17 in the manu- facturing town Manchester ; but in 1863 the death-rates of urban and rural districts were .very nearly equal : thus, in St. Giles', London, but 13'G died out of each 1,000 living, and but 17 in the Cavendish sub- division of the Marylebone district a proportion the same as in Glendale, Northumberland, and the Isle of Wight, which have bten reckoned the most healthful places in Britain. But no town surpasses Liverpool in the evidence it affords of benefits resulting from sanitary precautions. In 1842, one-third of its labouring population lived in cellars about twelve feet square, sometimes less than six feet high, often without windows, and only lighted and ventilated by a door frequently below the level of the street. Its death-rate was 38 in 1846 ; but up to 1864, owing to the philanthropic labours of the late Dr. Duncan and his most able successor, in carrying out improved sewerage, closing of cellars, preventing over- crowding, especially in the low lodging houses, and se- parating contagious cases, it had been reduced to 24, or less than two-thirds its former rate, and thus it may be estimated from the population of that city that 4,000 lives have been annually saved. During the past two years, the fearful mortality by fever and cholera indicate that insalubrious agents are still most potent in that vast and changing population. The Registrar- General's returns show that one-half the deaths of England, and nearly two-thirds of those in ill-regulated towns, occur from diseases which are either wholly or partially preventible, such as typhoid fever, diarrhoeal complaints, pulmonary diseases, ner- vous affections of infants, and the contagious fevers of children. Besides these 50,000 deaths, at least twenty attacks of illness will correspond to each of them, and PREMATURE, YET PREVENTIBLE DEATHS. 21 this gives annually 1,000,000 cases which the hygienist may strive to prevent. Most of these deaths are premature not removing the old and enfeebled, who should have shortly succumbed under any circumstances, but striking down the hale of both sexes, who are productive members of society, and whose loss throws a number of orphans and aged people as a burthen on the public. Fever is one of the most powerfully pauperizing agencies, being especially apt to remove those of the middle, or most valuable period of life. Thus, of 2,537 cases of fever collected some years ago by Dr. Southwood Smith, 68 per cent, were between twenty and forty years of age, but 17 per cent, below that period, and 15 per cent, above it. Widows and orphans are thus plunged from independence into pauperism, which, as they become habituated to idle de- pendence, is rarely recovered from ; and it has been found that even when the children, having grown up, leave the poorhouse and marry, their habits are improvident, and they frequently relapse into the conditions under which they were reared. Such premature deaths must in this country, above all others, be most severely felt, by adding to taxes which are already at least sufficiently high and still worse, by thinning the labourers for agricultural or manufacturing enterprise, they must help to further defer our long hoped-for prosperity. Among the evils attributed to the condensing of po- pulation within towns, which is a striking feature of modern days, I will, on the present occasion, allude to but one. Consumption and allied diseases slay about 100,000 yearly in England, Ireland and Scotland, and these deaths are distributed in almost exact proportion to the density of the population. This pernicious effect of the varied evils of over-crowding, I can best illustrate by some figures referring to three divisions of London : 22 DENSITY OF POPULATION : ITS ALLEGED EVILS. RELATION OF DENSITY OF POPULATION TO MORTALITY FROM LUNG DISEASE. Three London Divisions. Deaths annually out of 100,000 living. Square yards to each person. Consumption. Other pulmonary diseases. 180 119 35 375 405 485 659 771 914 It has been often inferred, from misinterpretation of the views of an eminent statist, that mortality is in direct proportion to the simple density of population ; but this observation is a proof of how fallacious statistics may become if handled unphilosophically. Density of population is very commonly accompanied by impure air, scanty water, insufficient drainage, and such con- current evils which may exist and produce the worst effects amidst a sparse population. Condensation of in- habitants, on the other hand, so far from being lamented as an evil, seems a necessity of modern civilization, and to such condensation most of its triumphs are due ; but at the same time it devolves on the authorities, and espe- cially upon those whose wealth is amassed by the toil of the poor, to see that it shall be stript, as far as possi- ble, of evils not necessarily concomitant. Of successful efforts, under these circumstances, to preserve the health of towns, I cannot give you a more forcible example than those of the Macclesfield Board of Health, cited by Lord Shaftesbury. When they began their labours the death-rate was 33 for the last five years it has been but 26 ; so that counting the popula- tion as stationary, 1,015 lives have been saved; 28,420 less cases of sickness have occurred ; three years have been added to the average duration of life ; the morta- , SUCCESSES OF SANITARY EFFORTS. 28 lity of children under one year has decreased 16 per cent. ; and, lastly, there have been 27 per cent, less zymotic diseases. I will next illustrate the advantages to be derived from health inspection during the outbreak of an epidemic. Small-pox prevailed epidemically in London during the earlier months of 1860, and in order to make vaccina- tion as general as possible, examination of all young persons was determined on, and the zeal with which it was carried out is recorded in the official report to the Privy Council. " The extent to which this examination was carried varied in the different unions ; but it was carried to a large extent in all of them, and in the great majority was effected in a very complete manner indeed by the medical officers of health, with a zeal and assiduity of which I cannot too highly express my admiration. Forty thousand children were examined in a very short space of time. Infected localities were also visited by the health officers, often house after house, and every adult and child was examined as to their protection." The results of this labour will best appear in the follow- ing 'figures : The deaths by small-pox at the patients' homes were, in January, 129; February, 136; March, 144 ; but in April and May, when the preventive mea- sures might be fairly expected to tell, the deaths were but 78 and 57, and chiefly occurred amongst the un- vaccinated. When giving an account, in a future lec- ture of the recent epidemic of cholera, many more striking instances will come before us. Sanitary organization, however, will always be incom- plete and very generally inoperative without the aid of the popular educator for a thorough system of inspec- tion of the circumstances prejudicial to health in indi- vidual cases will be always resented by those who do not understand the advantages accruing, and the appropriate maxim ot our city, obedientia civium, urbisfelicitas, will not be realized. The teachings of hygiene do good, not 3 24 PHYSIOLOGY AND HEALTH SUBJECTS OF EDUCATION. only by suggesting rules for individual management, but also by preparing the popular mind for measures of sanitary reform, the proposal of which among the igno- rant or parsimonious often meets with apathy, or still further, opposition. With regard to the effect of exter- nal agencies on the health of our bodies, ignorance and desperate negligence prevails even amongst the most re- fined classes. I know I am making a most trite remark when I say, that the humblest in the land for whom state education is provided should be taught something of the structure and functions of the human body, and the means for preserving it in health, and I only do so because the subject has never formed portion of the knowledge imparted in our schools. Very recently in the univer- sities the matter has received some attention. In America I find they have been in this particular in advance of us, for in some of the States there are spe- cial enactments requiring physiology and hygiene to be taught in the public schools. Prof. Parkes exclaims : " Were the laws of health and physiology better under- stood, how great would be the effect ! Let us hope that matters of such great moment may not always be considered of less importance than the languages of ex- tinct nations, or the unimportant facts of a dead history." As an anatomical lesson for my medical hearers, and an eloquent tribute to the wonders of human construc- tion, let me quote from Dr. Holmes, the first of Ameri- can litterateurs, " AN ANATOMIST'S HYMN THE LIVING TEMPLE. " Not in the world of light alone, Where God has built His blazing throne, Nor yet alone in earth below, With belted seas that come and go, And endless isles of sunlit green, Is all thy Maker's glory seen Look in upon thy wondrous frame, Eternal wisdom still the same ! " THE LIVING TEMPLE." 25 *' The smooth, soft air with pulse-like waves Flows murmuring through its hidden caves, Whose streams of brightening purple rush, Fired with a new and livelier blush ; While all their burthen of decay The ebbing current steals away, And red with Nature's flame they start From the warm fountains of the heart. 41 No rest that throbbing slave may ask, For ever quivering o'er his task, While far and wide a crimson jet Leaps forth to fill the woven net, Which in unnumber'd crossing tides The flood of burning life divides, Then, kindling each decaying part, Creeps back to find the throbbing heart. " But warm'd with that unchanging flame, Behold the outward moving frame, Its living marbles jointed strong, With glistening band and silvery thong, And link'd to reason's guiding reins By myriad rings in trembling chains, Each graven with the threaded zone Which claims it as the Master's own. " See how yon beam of seeming white Is braided out of seven-hued light, Yet in those lucid globes no ray By any chance shall break astray. Hark, how the rolling surge of sound, Arches and spirals circling round, Wakes the hush'd spirit through thine ear With music it is heaven to hear. " Then mark the cloven sphere that holds All thoughts in its mysterious folds, That feels sensation's faintest thrill, And flashes forth the sovereign will ; Think on the stormy world that dwells Lock'd in its dim and clustering cells ; The lightning gleams of power it sheds Along its hollow glassy threads ! 26 STATISTICS OF DUBLIN. " Father ! grant Thy love divine, To make these mystic temples Thine, When wasting age and wearying strife Have sapp'd the leaning walls of life ; When darkness gathers over all, And the last tottering pillars fall, Take the poor dust Thy mercy warms, And mould it into heavenly forms." During the few remaining minutes of this hour's lec- ture, I will invite your attention to the present sanitary state of Dublin, as far as it can be displayed by a system of death-registration but six months old, and a Medical Officer of Health but a fortnight in office. The first half-yearly report of the Registrar- General will be pub- lished to-morrow, but through his kindness I may anti- cipate it with one fact. During the twenty- six weeks ending 2nd July, 1864, there were 3,414 deaths regis- tered within the municipal boundary, and this, calcu- lating on the ratio of the first half of the year, would give a death-rate of about 27 for every 1,000 living. I trust the time will come when sanitary statistics will be taken on so philosophical a scheme as to bring home to the mind of the most indifferent or selfish the chances of health or life in every class of street. For the three years, 1839, 1840, 1841, the death-rate was estimated at 30, and but 17 in the surrounding country; and con- sidering the absence of many manufactures which pre- judice the health of English towns, though they enrich them, the impression that mortality is high in Dublin has been very general, and is constantly expressed in the writings of great medical authorities of former days. Short (1750) asserts, " that sickly years are more fatal in Dublin than in London." Eutty (1772) remarks, ' ' that those who know the situation of the poor here can be at no great loss to account for the frequency and mortality, especially of fevers, several families being in one room, which must undoubtedly contribute not only to the propagation, but also to the malignity of these diseases." THE DEATH-RATE OF DUBLIN. 27 The status of disease in Dublin is shown by the medi- cal tables of the last census, so admirably arranged by Sir William Wilde, for in a population of 254,293 per- sons, 5,646 " laboured under temporary or permanent disease on the night of the 7th April, 1861," and of these, 1,763, or over one-third, were ill of diseases which were plainly preventible, or to be much dimin- ished by attention to sanitary conditions, such as fevers, scrofula, consumption, dyspepsia, rheumatism, debility, &c. It has been calculated that out of 100 children of the labouring classes born in Dublin, but 34 live to be 20, 20 to be 40, and only 14 to be 50. These figures applied to the present male population of the city, indi- cate that about 20,000 men will die between the ages of 20 and 40, and 10,000 between 40 and 50. Such premature deaths cannot be attributed to want of pro- vision of curative medicine for in no city in the empire are there more skilful and zealous physicians for the poor but must, in a great proportion of instances, be assigned to ignorance of, or inattention to, the teachings of preventive medicine. Over- crowding, impure air, in- sufficient water, imperfect sewerage, debility, pauperism, contagious scourges, death, widowhood, orphanage, and high taxation, have been, then, in this city sequential terms. In 1844, the death-rate of children under five years of age was estimated to be 40 per cent., and so very great a mortality is a test of their being some most in- salubrious agencies at work, such as impure air, confined space for exercise, want of breast-nursing, and scanty supply of cow's milk. Such causes, and those influences connected with a city life which induce an early puberty and arrest of growth, have set their mark on the chil- dren of the labouring class in the more crowded parts of Dublin, who are remarkable for stunted proportions and scrofulous, precocious aspect characters which will be 28 OVER- CROWDING IN DUBLIN. intensified in future generations, if the causes which pro- duced them be not corrected. The density of the population and the over-crowding of some of the poorer districts of our city are shown in the following tables : DENSITY OF POPULATION. Census 1861. Popu- lation. Houses. Average to each house. Acre- age. Average to each acre. Dublin City . . St. Michan's . . 254808 20085 23001 1417 11 14 3592 122 71 165 St. Nicholas' . . 11322 922 12-3 58 195 POORER DISTRICTS. Streets and Alleys. Houses. Rooms. Beds and Straw. Inhabi- tants. Average to each room. Average to each bed. 134 2102 11214 14850 40319 3-59 2-71 The second table I give on the authority of Mr. Nugent Robinson, the Secretary of one of the Com- mittees of the Corporation. Instances of much greater over-crowding I could very easily adduce from my own experience, but I prefer to offer you the evidence of others. The following extract from Dr. Willis's essay " On the Sanitary State of Dublin" is striking and, after twenty years, still true, as I have had lately many opportunities of knowing : " In some rooms in these situations it is not an unfrequent occurrence to see above a dozen human beings crowded into a space not fifteen feet square. Within this space the food of the wretched beings, such as it is, must be prepared ; within this space they must eat and drink men, women, and children must strip, dress, and sleep. In cases of illness THE ROOMS OF THE POOR. 29 the calls of nature must be relieved, and when death re- leases one of the inmates, the corpse must, of necessity, remain for days within the room. Let it not be sup- posed that I have selected some solitary spot for this description. No, I am speaking of an entire district, and state facts incontrovertible. I indulge in no theories as to the causes which produce this state of things, but I state the results. They are, that every cause that can contribute to generate contagion exists here in full vigour, and that disease in every aggravated form, with all its train of desolating misery, is rarely absent." An intel- ligent practitioner has informed me that some years ago in Cole-alley, he attended 5 persons in fever at the same time, and that there were 15 other persons in the same room. It is surprising we do not hear of infants being suffocated by overlying, for in the West Middlesex district, London, it is stated that 150 children annually lose their lives in this way, or by the want of fresh air when covered by the bed-clothes. The air in nearly every one of the rooms of the poor I have visited is most foul, the windows very rarely being made to open above, and are almost never opened at the bottom ; in many sleeping rooms there are no fire-places, and thus at night, when every crevice is closed, the air is so poisonous that the inmates are only saved from suffocation by the endurance which habit produces. The sunlight, which is most healthful and purifying to the air, rarely enters such rooms, as they are surrounded frequently by very high houses, and the windows are darkened by dust. What has been done to remedy these fearful evils by providing fit habitations for the poor ? The Towns Im- provement Clauses Act declares, that no cellers less than seven feet high, without a window, and of which more than two-thirds is below the level of the street, shall be inhabited ; and upon this authority our Corporation has done immense good by closing over 3,000 such dens. There are many alleys and courts which should be pulled 30 MODEL TENEMENT HOUSES. down, for they are too dilapidated and ill- constructed to be repaired such as Gill's-square, Calford's-court, and many places in the parish of St. Michan's ; and in the case of many courts, they should be converted into tho- roughfares by removing the end houses. The Rathmines and Rathcoole Railway, which will pass through Exchequer-street, Fade-street, Stephen- street, Wood-street, Bishop-street, and Kevin-street, will remove many wretched dwellings ; but it is much to be desired that benevolent and enterprising men will en- deavour to substitute other more decent houses for the poor, as has been done on so large a scale by the Im- perial Government in Paris, while the magnificent im- provements in that city are being carried out. Should this be neglected, the only effect will be to drive the poor from one nest of unwholesome dwellings to others in the neighbourhood, and thus make matters worse than before. The only achievements in this direction in this city, which I am aware of, have been made by Mr. Thomas Vance, Dr. Evory Kennedy, and Alderman Martin. Mr. Vance has built houses capable of accommodating thirty families in the most comfortable way, in Chapel-lane, Lower Bridge-street baths, lavatories, wash and mang- ling rooms being provided free of expense, and he is adopt- ing the same plan in Bishop-street and Kevin-street. Dr. Kennedy has erected admirable houses off Summer-hill, which are now set in rooms. I believe that no pecuniary loss has resulted from these most praiseworthy efforts ; and if they were carried out extensively, as by a com- pany like those in London, where they are commercially successful, the moral, social, and sanitary conditions of the poor of Dublin, would be- amazingly elevated. I shall now bring forward the statistics of one dis- ease namely, fever because it is an unwelcome visitor from which we are never free, and is most largely pre- ventible by sanitary measures; yet some years ago, FEVER IN DUBLIN. 31 within twelve months, 80 cases had occurred in one house, 50 had been admitted into hospital from another, and in a third, at the same time, 15 persons were lying ill of it. At the same period it was shown that fever was more rife in places where there were sewers with imperfect traps than in those altogether undrained. Last January (1861) was not remarkable for any clima- tic condition likely to promote the spread of fever, yet 229 cases were admitted during that month into the Hardwicke, Cork-street, and Meath Hospitals. These institutions have received 35,657 patients with fevers during the past ten years, as seen in this table, of which most of the figures are given on the authority of that benevolent nobleman, Lord Talbot, who has given such zealous aid to our medical charities : Year. Admissions. Deaths. Mortality per cent. Proportion of cases to population. 1854 4396 385 8-75 1 in 57 1855 4492 362 8-60 56 1856 3721 266 7-15 68 1857 3534 268 7-58 72 1858 3108 229 7-35 81 1859 3466 226 6-50 73 1860 2848 196 6-95 89 1861 3310 209 6-31 77 1862 3218 220 6-84 79 1863 3564 222 6-23 71 10 years. 35657 2583 7.27 7 These returns only show portion of the cases which have occurred, for many are treated at their homes, or in the poorhouses and some general hospitals. In the 104 registered lodging-houses throughout the city which are regularly inspected by the Corporation officers, but one case of fever occurred last year, which is a very gratifying instance of the benefits of sanitary efforts. If, then, it be true that Dublin has been more un- 82 CONCLUDING REMARKS. healthy than needs be, I feel confident that the autho- rities into whose custody its well-being is entrusted, are determined that it shall be so no longer. Their achieve- ments in improving the drainage of the city, closing un- inhabitable cellars, inspecting lodging-houses, slaughter- yards, bake-houses, and other premises where nuisances are apt to arise, and, above all, their labours to procure an abundant supply of pure water, show that they are at least not behind the times in their appreciation of the value of sanitary reforms. I rejoice to say that I am now associated with them in such good works, and if in performing the duties of Medical Officer of Health I shall attain the same measure of success which has fol- lowed the labours of my colleagues in other cities, and become the humble instrument by which discomfort or disease among the citizens shall be diminished, or mor- tality reduced, I feel that no energy which I can com- mand could be better rewarded. I shall avail myself of the powers which the favour of the Town Council has conferred on me to make myself minutely acquainted with the causes which operate on the health of this city, with the condition and habits of the labouring population, and with the remedies and appliances which have been devised elsewhere, or which may be suggested here to bring about a better state of things. I am well aware that the favourable reception which I have received from so large and influential an assem- bly is not due to my own merits as a lecturer, but to the practical importance of the topics with which I have had to deal. The intelligent portion of the Irish com- munity have come to recognize the necessity of sanitary reform, and are resolved that, so far as in them lies, Ireland shall not lag behind other civilized nations in cleanliness, temperance, or in physical and moral well- being. With such a conviction abroad, and such a re- solution generally diffused among the natural leaders of CONCLUDING REMARKS. 33 public opinion, the work of the conscientious lecturer, however moderate be his talents, becomes prolific of good ; at all events, animated with this hope, I shall labour earnestly to render my future lectures less un- worthy of your approbation. However inadequate may be my powers, or indeed the powers of any single person, to cope with the multi- farious topics included under the term of " Public Health," I trust that I shall keep steadily before me an adequate ideal of what that term really denotes. As the health of the individual means more than the mere absence of specific disease as it means the pleasurable and vigorous performance of every physical and intel- lectual function, the health of a community means not merely that it is not decimated with zymotic diseases, wasted with famine, or poisoned with miasms, but that it enjoys the highest degree of vitality that it is suscep- tible of, and has opportunities for all manly exercises and all innocent and beneficial plensures. The physical type of the Irishman, as has been proved on every battle-field in Europe, on the prairies of the West, and in the wild Australian bush, is inferior to that of no other variety of our species ; while his patient endurance under severe trial, and happy freedom from crime, render his race worthy of strenuous efforts towards the amelioration of his social and sanitary con- dition. We are blessed with a fertile soil and a genial climate ; our coasts swarm with food a rich harvest for Cornish, Manx, or Scottish industry ; and although no great arsenal or dockyard gives employment to our people, our harbours and estuaries are not surpassed by any in the sister kingdom. There is no reason why our people should not be industrious, cleanly, healthy, and prosperous, if only we resolve they shall be so, and that we endeavour to undo, by every legitimate effort, the evils which have gathered upon us through indifference or neglect. LECTURE II. AIR ITS IMPURITIES, AND POLLUTION FROM FACTORIES. As the prime necessity of human life is air, the first and last act of our existence to breathe it, and the most essential condition of health is its purity, all-sufficient Nature provides the most perfect means for accomplish- ing these requirements. The atmosphere around us extends to the distance of forty-five miles from the sur- face, but with uniformly decreasing density, and thus forms a covering for the earth in thickness about 1-1 60th of its diameter. This medium has the effect of mo- derating and diffusing the heating and lighting rays of the sun, which, were it absent, would scorch the living world, and submit us daily to a sudden and painful transition from glaring sunshine to total darkness at sunset, and the reverse at sunrise. In becoming rarified by the sun's heat, endless motion is produced in the atmosphere, giving rise to winds varying in force from the gentle breeze to the all-destroying tornado. The sun's heat raises water from the lakes and oceans, and steeps the air with moisture, which returns again to earth as refreshing rain, after washing the atmos- phere and becoming charged with the foods of plants. So vast a quantity as 90,000 cubic miles of water thus circulates every year through the atmosphere. Without an atmosphere all would be silence the thousand cheering murmurs of natural moving objects about us, entrancing music, and articulate speech could have no existence. THE PROPERTIES OF AIR. 35 The physical properties of this fluid are chiefly nega- tive, so that our senses do not readily perceive its pre- sence a circumstance which accounts for the negli- gence with which we treat it, taking no care that we shall aid Nature in preserving its purity. It is, when pure, transparent, colourless, inodorous, tasteless, and so elastic that it may be condensed to nearly the specific gravity of water, or expanded by a dull, red heat to thrice its volume never, however, losing its proper gaseous condition. It is ponderable, 100 cubic inches at 60 of temperature and 30 of barometric pressure weighing 31 grains. A still stronger impression of its weight will be conceived when it is remembered that a column of air one inch square will weigh 15 Ibs., or will balance such a column of mercury 80 inches, or of water 33 feet high ; but the pressure of this great superin- cumbent weight is unfelt by us, because of its perfect diffusion, the force in one direction, upon the surface of our bodies, being resisted equally in another. The air decreases in density so rapidly that four-fifths of the atmosphere by weight is within eight miles of the earth, leaving but one-fifth for the remaining thirty-seven miles ; so that at the utmost limit 1 cubic inch would have expanded to 12,000, and it also loses 1 of heat for each 350 feet of ascent. The boiling point of water is a fair indication of the weight of the air, and thus the height of any place may be ascertained while it is 212 at sea level, it is but 187 at the summit of Mont Blanc. Concerning the chemical composition of the atmosphere I shall be brief, and after directing your attention to its usual constituents, I shall one by one explain the uses of those that are healthful, and which fulfil purposes in the economy of man, and the effects of those that are hurtful. Everything which can assume the gaseous form may be found occasionally in the atmosphere ; but in the fol- lowing table is displayed the 86 THE NORMAL CONSTITUENTS OF AIR. Composition of Air and its occasional Impurities. Oxygen ... ... 20-61 Nitrogen ... ... 77'95 Aqueous Vapour ... 1-40 Carbonic Acid ... ... *04 Organic Matter Ozone Ammonia Nitric Acid Carburetted Hydrogen }- ... Variable, Sulphuretted Hydrogen Sulphurous Acid Chlorine Carbonic Oxide, &c. J Oxygen has been long regarded as the essential mate- rial of air, but as its effects would be too stimulating if pure, it is diluted by four times its volume of nitrogen a gas whose negative properties admirably fit it for this office. By volume the amount of oxygen in the 100 parts is 20 '80, and so perfect is the admixture of gases by diffusion that, at great heights, at the sea level, in the open country, and in the confined city, it varies but little from that standard : Paris 20-93 London sea level 20-92 Open country ... 21-00 When this uniformity was first discovered, the chemist was almost disbelieved, as every one felt the difference between the bracing country air and that of the crowded city ; but we shall see hereafter that these characters depend on far different constituents than the essential gases oxygen and nitrogen. Oxygen is the supporter of combustion, and so much is thus used that it is calculated that one ordinary iron- smelting furnace consumes daily over sixty tons weight, Simplon (6000 ft.) 19-98 Snowdon (3570 ft.) 20-65 Mt. Blanc (16000 ft.) 20-96 OXYGEN OZONE. 37 or as much as 200,000 men would require in the same time. In the human body oxygen is the great motor power. Introduced by breathing into the air-cells of the lungs, which number five or six millions, it is seized by the red cells of the blood, carried throughout every tissue to combine with its carbon and hydrogen, thereby producing combustion and extricating heat; and as oxidation is the source of all functions of the human body, it is con- cerned alike in such diverse acts as the contraction of our muscles and the production of thought. Complete denial of oxygen must, then, prove rapidly fatal, and a diminished supply should be injurious ; but so perfect are nature's provisions for affording an equable supply, that we do not meet with death or disease from this cause unless produced by violent mechanical means. In 1840, Schonbein discovered at the platinum pole of the galvanic battery, while decomposing water, a body which, from its peculiar smell, he named " ozone." It is not a new body, but oxygen, either in an allotropic form or in some peculiar electric state. It is evolved while the electrical machine is being turned, when sparks are transmitted through a confined portion of air, and is most readily prepared by placing a clean stick of phos- phorus, covered by distilled water, in a large bottle of air with a close-fitting stopper. When the bottle is kept at about 65 for from twenty to forty minutes, the phosphorus is oxidized, and ozone is set free in the air above it. Its chemical powers are those of pro- ducing the most intense oxidation and bleaching of all organic colours ; for instance, uric acid is converted into urea a change which, by the way, is wanting in the human body when affected by gout and litmus blue is discharged. But the property which interests us most is that of disinfecting all foul organic effluvia by oxida- tion, and therefore its absence is a fair presumptive test that such matters are being emitted in the vicinity, and 38 OZONE AND ITS HEALTHFUL INFLUENCE. vice versa. It is Nature's great scavenging agent, and is for this purpose being constantly generated by electrical disturbances. Ozone is contained in the alkaline per- manganates hence (as I shall presently explain) their eminently disinfecting power and in chlorate of potash, to which fact I would assign much of the remarkable influence of that salt in decomposing the morbid mat- ters in rheumatic fever and some other blood diseases. To discover the presence of ozone in the air, slips of clean calico, about three inches long and one broad, should be soaked in the following mixture : Dissolve 10 grains of pure iodide of potassium in 2,000 grains of distilled water, add 100 grains of starch in fine powder, mix, and gently heat till the solution thickens. One of these slips, when dry, should be suspended in this box of perforated and blackened tin arranged in spirals, contrived by Mr. Lowe, which, while excluding the light, admits a free current of air, and which, according to this meteorologist, should be suspended at a few feet from the ground for twenty-four hours. If ozone has been present the slip will be browned, the shades dif- fering according to the amount of the gas present, and they are comparable by a chromatic scale ranging over ten degrees which has been constructed. When wetted, the colour changes from brown to an iron grey, or the well-know blue tint due to the action of the iodine on the starch. Ozone abounds in sea air, for Faraday found it readily at the shore at Brighton, while no trace could be discovered in the town ; neither could Angus Smith detect its presence in the air of Manchester, which is so polluted by the smoke of the factories. In March, 1864, I made several experiments in the way above described, and 1 was unable to discover ozone in many streets and close places within the city ; but in the centre of Stephen's-green it was abundant, the calico slip being stained in one hour and a-quarter. At Kingstown eastern pier three-quarters of an hour EXPERIMENTS TO DETERMINE OZONE. 89 produced an equal effect. It is stated never to have been found in the interior of inhabited houses ; but I found that when the slip was suspended in my bed- room, in Stephen's-green, west, five feet from the win- dow, which was left open, it was coloured in four hours, but was not at all affected in twenty-four hours when the windows and doors were kept closed. Fixed to the sill the stain was apparent in three hours. I should in candour state that many able chemists have assigned the effects produced upon this test to the action of acids, chlorine, or organic matter in the atmosphere ; but it should be remembered that the slips are stained at sea and at high levels, where these sources of fallacy are most unlikely to exist, while they are unaffected in large towns, in which such matters are abundantly generated. Moreover, the production of the most decided effects in cold and wet weather, especially at night, with a westerly wind, and after a fall of snow, and their non- occurrence for precisely one-third of the days in the year, entirely set aside these objections. As regards the occurrence of certain zymotic diseases during the absence of ozone, surmises are plenty ; but the following facts, noted by my late lamented friend, Dr. Herbert Barker, after two years of most accurate me- teorological observations, are reliable. Of 315 cases of diarrhoea, 246 took place during its absence ; of influ- enza, 81 out of 109 ; of meazles, 26 out of 36 ; of ague, 9 out of 11 ; of typhus, 6 out of 7 ; and of erysi- pelas, 12 out of 13. On the contrary, small-pox and scarlatina were more prevalent while ozone was disco- verable. Mixed but not combined with the atmosphere, there is always a variable amount of watery vapour, 0'35 grains being the utmost quantity which 100 cubic inches at 57 can take up. This is equivalent to about 017 of its volume. As the temperature increases the air becomes more dry, and is capable of absorbing more 4 40 WATERY VAPOR IN THE AIR. water. The most healthful amount of vapor may be considered as about 70 degrees, the utmost satura- tion being about 100. A dry air is very irritating to the breathing passages, as it absorbs moisture as well as heat from them. The rise in temperature is, however, necessary, for if air be admitted directly through the wind-pipe, when that tube has been cut suicidally, or by the surgeon, its coldness excites fatal bronchitis. The spontaneous evaporation which supplies water to the atmosphere varies with the motion of the air as well as with temperature facts which were demonstrated by Dalton. He exposed a vessel of water, six inches in diameter, at various temperatures, to still, gently mov- ing, and briskly moving conditions of the atmosphere with the following results : Temperature. Grains of water evaporated. Still. Gentle. Brisk. 40 ... 1-05 1-35 1-65 50 ... 1-50 1-92 2-36 60 ... 2-10 2-70 3-30 212 ... 120- 154- 189- While water is evaporating much heat is rendered latent by the vapor, and is abstracted from the wet sur- face, so that water may be even frozen by producing evaporation around it ; thus it is that we are the more apt to take cold with wet clothes the warmer the air about us is, and the danger can be avoided by wrapping round us a dry covering to check evaporation a prin- ciple the Scotch shepherd follows when he rolls himself in his plaid, which he has kept dry during the shower. The aqueous vapor in the air is essential to vegetation and to animal respiration, but if it be decreased or in- creased beyond the normal point, injury results ; and we shall hereafter see that one of the evils of want of ven- tilation is that the air of our rooms becomes almost saturated to the utmost by the moisture evolved from WATERY VAPOR CARBONIC ACID. 41 the lungs and skin of the inmates, and from the com- bustion of our lighting agents. About l-2000th of the volume of air is carbonic acid, more in summer, less in winter. So perfect is the dif- fusion of gases, that although this gas is one-and-a- half times as heavy as air, there is no more of it on the surface of the earth, at sea level, than at the summit of Mont Blanc. Indeed, in very high places, from the absence of vegetation which in other situations removes it, there is found the greatest proportion of this gas. Nature's means, then, for distributing this gas are per- fect. Are those of art ? Let the following facts an- swer: Professor Roscoe found the amount of carbonic acid in the air of the gallery of a theatre to be nine times, and that of a crowded school-room eight times, as much as in the surrounding open air ; and Leblanc found it respectively five, ten, and twelve times as abundant in the air of three Paris hospitals as in the atmosphere outside them. Combustion, respiration, fermentation, and decay produce this gas so abundantly that animal life would be extinguished, did not plants proportionally remove it, in performing their function in that organic cycle which has always been regarded as one of the marvels of creative perfection. The deadly lake of Java, whose borders are strewn with human and other skeletons, and the Grotto del Cane, are well-known natural lurking places for carbonic acid ; and brewers' vats and deep wells are artificial ones, due to the generation of the gas being more rapid than can be removed by diffusion ; and death has often occurred from entering them until purified by free airing or the action of slaked lime. Near Swords a lamentable instance recently occurred, in which five persons lost their lives in a manure-tank, the last four having successively endeavoured to rescue the first victim. The teaching of the poor in the laws of life and health would have ob- viated this and many other distressing calamities. It is 42 THE INJURIOUS EFFECTS OF CARBONIC ACID. often said that if air in such situations will support the burning of a flame, it will sustain life ; but this test in some cases has been fallacious. Other sources by which the atmosphere of towns is polluted are the carbonic acid and ammoniacal gases which issue from intramural churchyards and burial- vaults, the air in the latter having been found by Dr. Waller Lewis always so impure as to extinguish flame. Legal enactments have to a great extent checked this evil in England, and, as I shall in another lecture prove, there is pressing need for their extension to Ireland. In manufacturing towns the amount of carbonic acid evolved is enormous ; thus Angus Smith calculates that in Man- chester 15,000 tons are daily thrown into the atmos- phere. Although no one can doubt the poisonous nature of carbonic acid when introduced freely into the lungs, the belief, however, that more harm is done by the organic matter, which in expired air is its constant companion, than by that gas itself, gains support from the fact that it may be freely introduced into the stomach, as when we drink soda water and other effervescing beverages, with useful instead of hurtful effects. In over- crowded rooms, when the window is opened, the carbonic acid rapidly escapes, but not so the organic matter, which adheres closely about the furniture, &c. Carbonic oxide is far more poisonous, by destroying the power of the red cells of the blood for conveying oxygen. Undiluted carbonic acid and other irritating gases as nitric oxide, nitrous acid, chlorine, and ammonia are instantly re- fused admission by the ever- watchful muscles which guard the opening of our breathing passages. Ammonia from animal and vegetal putrefaction, and nitric acid formed by the combination of the nitrogen and oxygen after electrical changes, are pretty constantly to be found in the atmosphere, whence they fall in rain to nourish plants. Upon man we are unaware that they produce SULPHURETTED HYDROGEN SEWER GASES. 43 influence either healthful or hurtful; and with that selfishness which views as useless all things which do not plainly benefit him, they have been called " acci- dental constituents." I now proceed to those constituents of the atmosphere which serve no useful purpose, but, on the contrary, are most injurious to human health ; and remember that man, not Nature, is to be blamed for their presence. The gases which untrapped sewers and cesspools emit into the air are mainly sulphuretted hydrogen, sulphide of ammonium, carbonic acid, and nitrogen. As regards the noxious influence of the first on animals, the ex- periments of the late Dr. Herbert Barker are very con- clusive. A dog was placed in an atmosphere consisting of 12 cubic inches of sulphuretted hydrogen to 5,820 of air, or about 2 per 1,000. " Within a minute he fell on his side and was seized with tremors ; the action of the heart became irregular, and within four minutes the respiration had apparently ceased. It returned, how- ever, and became very rapid. He was exposed one hour forty-eight minutes. He next became universally cold, jerking of his muscles followed, and he died eight hours after removal. The most frequent post-mortem condi- tions in this and similar experiments were extreme ful- ness of the right side of the heart, and a crenated and broken-up state of the blood cells." In one case "but one was natural." I shall quote another experiment. " A common hedge-sparrow was put into the box as before with six cubic inches of sulphuretted hydrogen (to 5,826 of air). Within two minutes he fell down in- sensible, and continued in this state for the space of one minute. The respiration then became very hurried and gasping. He rose, but staggered a good deal, and fell again on his back. Six minutes after the commence- ment of the experiment he vomited, became convulsed, and died in fifteen minutes." Now, the proportion of this gas to the atmosphere in the vicinity of neglected 44 THE EFFECTS OF SEWER GASES. sewers and of some manufactories may be quite as great as in these experiments, although imperceptible to the senses. This gas issues from fissures torn open in volcanic countries, as at Puzzuoli in Italy, and is disengaged when iron pyrites from coal mines is allowed to decom- pose in the air, or from some ill-arranged chemical fac- tories ; and in all these cases effects very similar to those described above have occasionally followed exposure to it. The air in sewers is generally strongly alkaline from ammonia, its carbonate, or sulphide of ammonium, which faecal matters evolve ; and, in addition, it shows a defi- ciency of one-third of its oxygen, and a very large amount of peculiar organic vapour. Meat very soon taints in sewer-air, and organic matter, including infu- sorial germs, is most abundant. The proportion of sulphuretted hydrogen has been found 25 per 1,000, or 25 times as much as sufficed to kill the animal in the last-quoted experiment. Parent-Duehatelet has been often quoted as having proved that the sewer-cleaners of Paris are not more subject to disease than other workmen, but he has really shown that they were sub- ject to diarrhoea, colic, and sore eyes ; and Dr. Murchi- son has shown that the same class in London is very prone to catch typhoid fever. If, then, we are alive to the pernicious character of sewer gases, with what feel- ings will we regard a sewer under our house, or an un- trapped or badly-trapped gully ! Many sulphur com- pounds are introduced into the air by coal-gas, in 100 cubic feet of which as much as 60 grains of sulphur have been found. The maximum allowed in Gas Acts is 20. The suspended impurities of air include both mineral and organic particles which float about, usually invisibly, but if a ray of sunlight be let through an aperture into a dark room, such particles will be seen in rapid motion. ORGANIC MATTER IN AIR. 45 The mineral are mainly chalky or aluminous dust, which becomes deposited in the lungs, although there are mil- lions of little hair-like bodies fixed along the lining of the breathing organs to fan them out ; and thus it is the in- habitants of cities, and of mines especially, are found after death to have much blacker lungs than those who live in a cleaner air. Spectral analysis has discovered I should rather say exhibited common salt and chloride of magnesium floating about in sea air for ten years ago that delightful writer, the late Prof. Johnston, proved that they were present. But the putrescible organic impurities are those we have most to dread, and they constitute 40 per cent, of the entire dust, or 46 per cent, of those obtained in the air of a ward of the St. Louis Hospital, Paris. Amongst those that are animal are a variety of debris, such as particles of the human cuticle or surface-skin ; during summer, in towns, finely-powdered horse- dung and the grindings of shoe-leather ; germs of minute animals, such as monads, vibriones, and bacteria the latter of which has been shown to cause disease in sheep and pus-cells, all of which are demonstrable by the microscope ; and we have the strongest reasons for believing that the poisons of small-pox, scarlatina, measles, &c., are thus disseminated through the atmosphere, and become capa- ble of producing the disease when moistened or planted in a fit soil namely, the body of a susceptible person. Cotton fibres, starch-cells, spores, and many kinds of fungi, are some of those objects of vegetal origin which the microscope exhibits ; in addition to which there are the odoriferous particles from plants and animal matters which elude all our senses but that of smell. Ehren- berg asserts that he has distinguished by the microscope some hundreds of organic forms in dust collected from the air; and air deprived of them, by being thoroughly filtered, is so remarkably altered that it will not support the processes of putrefaction or fermentation. Most of 46 ORGANIC MATTER IN AIR. the varieties of fermentation are dependent on micro- scopic vegetal forms, but what is known as butyric depends on the presence of a small animal, the vibrio, which can only live when air is excluded. This is a fact which should give confidence in the efficacy of ventilation. There are great difficulties in collecting the peculiar organic matter which emanates from the lungs in ex- pired air. The best method is to suspend a clean and dry glass globe filled with ice in a room as air-tight as possible where a number of people are breathing ; or it may be collected by passing the air through the " aero- scope," an instrument which consists of a funnel with a very small orifice, in which is inserted obliquely, so that the current may impinge on it, a piece of glass moistened with glycerin. The watery vapor containing the organic matter is then deposited on the surface. As much as 240 grains has been set down as the daily amount of this animal matter from the lungs and skin of each indi- vidual, but this is probably an exaggeration. When drawn through water it renders it very offensive. It contains nitrogen abundantly, as it gives a red colour with nitrate of silver, and produces ammonia when dis- tilled with lime. It is said to fix most easily on black surfaces, and all hygrometric substances absorb it, owing to the water with which it is combined. The amount of carbonic acid in the air, which is so readily determined, is not a positive guide as to the amount of organic matter which accompanies it, and until Dr. Angus Smith applied himself to the point, we had no means of mea- suring it. A solution of the permanganate of potash loses colour in contact with organic matter, to which it gives ozone or oxygen. From this instability of tint this salt has been long known as the mineral chameleon. Dr. Smith took measured quantities of air, and added definite quantities of solution of the permanganate, and the less of this was decolorized, the more free was the air of organic purity. EXPERIMENTS TO TEST THE PURITY OF AIR. 47 The following are a few of the striking results he ob- tained with the apparatus, which he named the Septom- eter. In a closely-packed railway-carriage, in his labora- tory where the sewerage was leaky, and in a yard be- hind some filthy houses, there was twenty-five times as much organic matter in the air as on high ground thirty miles north of Manchester; in a bed-room there was three times as much, and the amount was found to have been considerably increased after the room had been slept in. In applying this method to determine the purity of the air in various places in this city, I modified the plan merely for convenience sake. I filled this accu- rately graduated aspirator with water, and attached it to a set of Ure's bulbs, containing a measured number of grains of a solution of permanganate of potash, of strength determined by the effect of oxalic acid upon it. As the water flowed from the aspirator the air bubbled slowly through the solution, the number of cubic inches which passed before the solution was decolorized being an index of its purity. I quote the three following ex- periments upon the same quantity of the permanganate tion as affording the best comparative results : Centre of Stephen's green - 3,000 cubic inches. Dissecting-room, containing about nine subjects 975 ,, Room in Braithwaite-street in which thirteen persons had slept, and before the windows had been opened 850 ,, These quantities of air produced the same effect upon equal measures of the solution ; or, in other words, the air of the human dwelling was nearly three times as im- pure as that of the dissecting-room, and nine times as much so as that of Stephen's-green. A rough estimate 48 CONTAGIOUS PARTICLES IN AIR. of the impurity of the air in any close place may be made by noting the time which is required to decolorize a few drops of Condy's fluid added to a little water in a white saucer. In hospitals the amount of organic matter is immensely greater than in dwellings, and ventilation should be therefore most abundant. The unbearable stench in the houses of the poor in Russia, at the setting in of warm weather, is due to the decomposition of organic matter emitted from the lungs and skins of the inmates, which has been frozen and preserved during the preceding cold months. In this way may be explained the anomalous circumstance that the advent of winter does not check the spread of cholera in that empire. In all over- crowded rooms the air con- tains cells cast from the cutaneous or mucous surfaces of the inmates. The most suggestive fact of all that bear on this sub- ject, and the communicability of disease through the air, is the discovery of pus-cells in the air of a ward, con- taining thirty-three patients, in the Orphan Asylum of Prague, during an epidemic of purulent or contagious ophthalmia for there could not be any doubt as to the manner in which the disease spread from the eyes of one patient to those of others ; and I know of a charity school in London in which 500 cases were thus produced. In the army, ophthalmia is a most frequent cause of dis- charge from service for instance, 9 per cent, of those in 1860. Want of ventilation and of separate means of ablution promoted the spread of the disease, which, however, was chiefly disseminated during the Napoleonic wars among the military, and subsequently the civil population. It is probable that pus-cells dried may re- produce their contagious properties on being moistened, in the same way as dried single-celled plants the proto- coccus, for instance, will germinate when moistened. The poisonous effects of air impregnated with arseni- cal dust, detached from wall-papers and dresses coloured NUISANCES FROM MANUFACTORIES. 49 green with such compounds, attracted much notice a few years ago, and for the sake of those who were forced to work on them, more than of those whose vanity tempted them to encourage their production, the pro- cess should have been suppressed, unless it could have been rendered harmless by scientific expedients. The following are some of the most usual exhalations from factories which have been the subject of legal con- tention under the Nuisances Acts : Sulphurous and even sulphuric acids from vitriol and copper- smelting works ; hydrochloric acid from alkali works ; fumes of arsenic and sulphurous acid from copper and lead-smelt- ing furnaces; carbonic acid and carbonic oxide from cement works ; and from negligently conducted soap and candle manufactories, disgusting rancid oil-gases, and even the injurious substance which chemists term acro- lein, are emitted, which are equally nauseous and delete- rious. Many factories are positive nuisances by the quantity of unburnt carbon they emit in the smoke, and this waste is very often in proportion to the cheapness of coal. Some kinds of fuel are very noxious by the evolution of sulphurous acid an effect which might be prevented by mixing a little lime with it in the furnace. The inhabitants of the south-eastern part of this city have complained that it is infested by certain smells which have been assigned to various causes ; thus, the manure works, chemical works, gas works, and creasote factory, have all had their accusers ; and others assign the stench to the mist which, with an easterly wind, is blown back up the river, charged with the odour of de- composing seaweed and sewage matters which had not been carried out to sea. Yards where rubbish is stored abound in this neighbourhood, and for some months be- fore the complaints began two large sewers had been opened for cleansing, and these may have contributed their fetid exhalations. Amidst such a mixture of per- fumes you will understand it was not very easy to de- 50 NUISANCES FROM MANUFACTORIES. termine with the nasal organ the real offender. In treat- ing this delicate subject, in which equal regard must be paid to the commercial interests involved and the gene- ral salubrity of any city, the duty of the medical adviser is concerned with the question, whether this or that es- tablishment is prejudicial to the health of the citizens. The question whether certain smells are nauseous or not, is a very interesting one for those who live or own pro- perty in the vicinity, but is one which I do not think the legislature contemplates, and of which the physician is no better judge than other people. Prof. Cameron, the City Analyst, and I have examined into some of these alleged causes, and I will notice them fully to show the difficulties which surround the question. Hydrochloric acid and chlorine are the vapours said to be given off from the chemical works, which are often known as " alkali works;" but after a careful exami- nation of many of them, I could not discover any of the former gas in the atmosphere, except immediately near the retorts, and that the chlorine must escape to some amount is admitted and recognized by the enact- ment on the subject, passed in 1864 through the exer- tions of Lord Derby, which compels the absorption of only 95 per cent, of the gas. Some years ago all of it was allowed to escape, as they then had no use for it. The acid is, however, under control, yet that it escapes occasionally is often shown by the corrosion of metals and injury to vegetation in the vicinity ; the slighest trace in air, if passed over a growing plant, will kill it in a couple of hours. Its effects upon animal life differ ac- cordingly as it is concentrated or diluted being in the former cases most suffocating, and in the latter not very palpably hurtful. It has been said that cattle graz- ing near muriatic acid works lose condition as shown by fall of their hair and suffer from disease of the bones. It was shown before the Committee of the House of Lords, in 1860, that plants were injured by this vapour NUISANCES FROM MANUFACTORIES. 51 for two miles round such an establishment as St. Helen's, Lancashire. I would not regard chlorine in the air in small quantity as injurious, remembering its disinfecting powers. The alkali works in Dublin are four, and in them oil of vitriol, muriatic acid, and bleaching powder are ma- nufactured, and the gases which are liable to escape are sulphurous acid, muriatic acid, and chlorine. Com- plaints have been made of these disagreeably- smelling gases by persons living around, and the iron of neigh- bouring works is rusted. On damp days, when the air is so light that these gases do not ascend, and when the wind is blowing from the east, the smell from these works has been perceived at least a mile distant. The smell is, no doubt, unpleasant, but I have had no evi- dence that the gases have been so concentrated as to injure vegetation, and in small quantities they are not injurious to health but, on the contrary, by destroying organic impurity, they may be serviceable. Under the suggestions of Prof. Cameron and myself, the pro- prietors have had great care employed in the stanching of all their apparatus, and a plan has been originated for condensing the waste chlorine by drawing it through lime and water. Their coal is burned so as to emit little smoke. The porter of a neighbouring brewery having been soured by the acids emitted into the atmos- phere from one of these alkali works last year, legal proceedings were entered into and an arrangement was made, under which the chemical works were to be re- moved. Owing to the dilapidated state of the buildings of another of these works, gases escaped freely, and were very unpleasant to those passing near them, but at present they are being repaired. The inspectors under the Alkali Act, Drs. Angus Smith and Blatherick, report that two per cent, only of muriatic acid escapes in the Irish works, but in one-third of the works of the whole kingdom no escape whatever is permitted. 62 NUISANCES FROM MANUFACTORIES. Another manufacturer distils the tar from the gas works, and obtains oils containing carbolic acid in the impure state, or creosote, and pitch from them. Dense fumes occasionally escape from the melted pitch, but they do not extend far, and I cannot regard them as very deleterious. In other premises, also at the eastern end of the city, the ammoniacal liquor from both the gas works is received through pipes, and treated with oil of vitriol, or muriatic acid, to obtain salts of am- monia. Sulphuretted hydrogen escapes, and until Prof. Cameron and I visited the premises this pernicious and abominably stinking gas was sent into the air through a high chimney, and, under certain atmospheric conditions, it occasionally descended, to the serious detriment of the citizens. At our suggestion the pro- prietor has made arrangements by which this gas is carried through a fire and thus destroyed. In the manure works blood is dried, and if it be not kept till it decomposes, or if it be not charred, no smell ought to issue ; and fish offal is dissolved by sulphuric acid to mix with greaves, coprolites, wool, and other re- fuse. Upon three separate occasions I have not been able to detect sulphuretted hydrogen or ammonia in the air about this yard ; and the smell, which is disagreable no doubt, depends on some organic matter probably a fatty acid emitted from the fish under the action of the sulphuric acid. It had given great annoyance to the congregation of a church which is immediately opposite, but as the vapour is very dense, it is not wafted to any considerable distance. Chloride of lime having been freely used about the yard, the nuisance was somewhat abated. The owner is under promise to mix the mate- rials in covered vessels, and to draw the vapor into a tall chimney, and unless these precautions are adopted before he re-commences the manufacture this season, I shall feel it my duty to advise prosecution. The soil in this neighbourhood seems soaked with sulphur com- NUISANCES FROM MANUFACTORIES. 53 pounds, for some water which I obtained from a shallow well contained sulphuretted hydrogen abundantly, and smelt very badly. This, in my opinion, is due to the lime water charged with sulphur compounds or what the workmen call " blue Billy water," which has been used for purifying gas being cast into the sewer. In both the gas works, the mode of purification had been by the wet lime process, and the resulting refuse was conveyed into open tanks for the purpose of allow- ing the undissolved lime to settle from it. This lime was afterwards used as luting for the retorts, and the water is pumped under the furnaces where it is con- sumed. At the open part of the sewer in Benson-street, which has been recently covered in, about thirty yards from where the boy was suffocated in July, 1864, this refuse water might have been often seen. I believed that sulphuretted hydrogen escaped from the tanks while the refuse was exposed to the air, from the luting of the re- torts, and from the water while being dried upon the fur- nace pans ; and I am convinced that such escape was most injurious to the health of the workmen and surrounding population. My opinion was painfully verified by the suffocation of three men by sulphuretted hydrogen in a pit dug in the premises of the Alliance works in Septem- ber, 1865. The lime refuse must have percolated from the tanks into the surrounding earth. Unwilling that so great, and in the beginning so expensive a change should be urged upon the companies without my opinion being supported by London and other authorities, I wrote to the Medical Officers of Health of nine English districts. All condemned the lime process, and approved of the iron process, except one eminent chemist, who stated that with proper precaution the wet lime process need not be a nuisance injurious to health. I also con- sulted several eminent gas engineers, and quoted autho- rities such as " Muspratt's Chemistry," " Barlow's Che- mistry of Gas Lighting," " Hughes' Treatise on Gas 54 NUISANCES FROM MANUFACTORIES. Works," and thus produced much evidence upon the noxious character of the wet lime process in a populous town. In order to determine the matter by personal in- quiry, the Corporation commissioned me to examine the works in London and other English towns during Octo- ber, 1865, and I accordingly visited the London, City of London, Phoenix, Equitable, Chartered, Imperial, York, and Scarboro' Works, and ascertained that, in all, the lime process had been found to produce nuisance, and that, therefore, the oxide of iron process had been substituted. It may not be out of place if I briefly sketch the oxide of iron process, as I saw it carried out in London. Oxide of iron, or ferruginous clay, mixed with saw- dust, is exposed to the gas, from which it takes the sulphur, and the carbonic acid is taken afterwards by a little dry lime, and the resulting chalk is in no way injurious. The iron mixture containing the sulphur is exposed in thin layers to the atmosphere, when s me of the sulphur is discharged in a perfectly harmless state, and the re- maining iron is again ready for use or " revivified." After being used several times, too much sulphur is re- tained, and it is therefore sent to the oil of vitriol maker, who burns the sulphur into that acid. These manufacturers are glad to supply the oxide of iron ready for use, on the condition of getting it back charged with sulphur ; but the gas companies might sell the sul- phur charged with iron to them at a profit. In some London works the ammonia of gas is very perfectly fixed by Dr. Odling's mixture, which is saw-dust steeped in oil of vitriol. In none of the works I visited did any odour exist ; and, further, the gas was very free from sulphur, ammonia, and carbonic acid. In the Phoenix works the wet lime process was, for some years, con- ducted with the additional step of burning the spent water in a special chamber; but it was found difficult to manage, and occasionally the great quantity of sulphu- rous acid proved a great nuisance. NUISANCES FROM MANUFACTORIES. 55 The dry lime process, while it does not catch the im- purities as well as the wet lime, produces a solid refuse so noxious that it is necessary to carry it away to sea in air-tight barges. The only company which we now have has entered into a contract for the erection of purifying chambers by the iron process, during summer, when alone exten- sive changes can be made in gas works, and they will be in action immediately. Gas refuse contains many compounds which, by the addition of an acid, give off prussic acid and sulphu- retted hydrogen. Now, it was dicovered lately that much of the stench from the eastern end of the city re- sulted from this admixture in the sewer which drained the gas works, the factories where their refuse is used, and the waste acid of a vitriol works. Upon the pro- prietor of the latter making a sewer direct to the Liffey, the nuisance has been much abated. His acid refuse had also done much damage by corroding the sewers and the tide-gates, and other fittings connected with them. The position of the 129 slaughter-houses scattered through the densest parts of the city is a subject which demands the earnest attention of the Dublin Council. Notwithstanding the best water supply and sewerage, the earth in the neighbourhood of these places becomes imbued with the blood and refuse of the animals, and the air becomes polluted, much to the injury of the health of the surrounding residents. Whenever the earth in the vicinity is turned up for the laying of sewers or gas- pipes, it is found black, damp, and stinking. The plague in London, in 1349 and 1861, raged particularly in the neighbourhood of Smithfielcl, because of the pollu- tion of the ground by offal, and all slaughtering in the city was forbidden by Edward III. A vigilant inspec- tion of these houses is very difficult, on account of their scattered position, and a reliable or constant exajnina- 5 56 POLLUTION FROM SLAUGHTER-HOUSES. tion of the meat is impossible. In order to prevent the sale of unwholesome meat, whether rendered so by decomposition, parasitic animals, or other diseases, a careful examination, with the aid of the microscope, of every suspected carcase is much to be desired, but at present is quite unattainable. The driving of animals through the streets, and afterwards the carrying of their carcases on men's backs, is much complained of. The erection, therefore, of two, three, or four abattoirs and meat markets in different quarters of the city is, for such reasons, most desirable. The most suitable place on the north side is, certainly, the Cattle Market ; and on the south the square bounded by William-street, Exchequer-street, George's-street, and Stephen-street would give space for an extensive market as well as abattoir. There are no slaughter-houses in the city of London; the butchers all slaughter at the abattoirs adjoining the metropolitan market at Islington, and carry the meat in covered carts to their stalls. The houses and sheds in which cows are kept have been inspected repeatedly by our sanitary sergeants, but there are no legal powers to remedy such evils in them as over-crowding, the want of sewerage, and water- supply, and it would be very desirable that the pro- visions of the Metropolitan Management Act on this matter should be extended to Ireland. As an example of the mode of procedure in cases of other injurious trades being carried on in populous neighbourhoods, the following case against a chandler and fat-boiler, at the request of persons living in the vicinity, may be reported. Evidence was given as to the nuisance by residents of the neighbourhood and by me. I also deposed that the premises were so small, and in so densely populated a place, that it would be very difficult to carry on the trade inoffensively, and that the proper remedies were as follows : The erec- tion of a chimney ten feet higher than any of the houses INJURIOUS TRADES. 57 around, the placing of a copper funnel over the boiler, which should then open into the chimney, glazing the windows, and hanging cloths wet with potash through the premises, which act by seizing the acid vapors. The magistrates made an order to discontinue the boiling of fat until these steps were completed, under a penalty of 5 per day. The owner subjected himself to this penalty on two occasions, but afterwards relinquished the boiling of fat, and has since merely melted pure tallow, which does not create nuisance. Another simi- lar factory, which is close to an hospital exercise ground, was so offensive as to prevent the convalescents taking exercise. Organic matter is also thrown into the air from the trade of cleansing and drying the guts of oxen, sheep, and pigs, and from the making of size ; but with a free water supply, good sewerage, and care, enforced by regular inspection, no nuisance occurs except in very hot weather. The boiling of bones in what are oddly called " marine stores," produces hurtful odors, but they may be pre- vented or much diminished by the erection of a funnel over the boiler, and the raising of the chimney. As the rags in these places are often infected with contagious diseases, or filled with vermin, it is most desirable that they should be cleansed and disinfected ; and the most ready way of so doing would be a chamber heated to 212 such as I shall afterwards describe. The emission of smoke from factories is most inju- rious to health by obstructing sun-light which is essen- tial to the development of the human body by the en- trance of sooty particles into the lungs, and by compel- ling the roomkeepers in the vicinity of these factories to keep their windows closed, so that they suffer from a total want of airing. It is also injurious to the general appearance of cities. 113 such establishments in Dublin, including breweries, distilleries, foundries, printing- offices, malt-houses, and inauy others, ware noticed to 58 PREVENTION OF SMOKE. take steps for the consuming of the smoke of their fur- naces, according to the 108th section of the Towns' Im- provement Clauses Act, 1847. A special apparatus for this purpose entailing great expense, and not being always effectual, the following simple directions to ma- nagers and stokers were issued : INSTRUCTIONS FOR THE PREVENTION OF SMOKE. Unconsumed smoke in the atmosphere having been shown to be detrimental to the health and property of the citizens, and otherwise injurious to the city, and, moreover, its prevention having been proved to be very feasible, the Committee are determined to exert the powers conferred on them under 10 and 11 Vic., cap. 34, sec. 108, for the prevention of smoke ; but before doing so, they have had prepared the following simple instructions for the direction of the owners, managers, and stokers of all establishments where fuel is burned in places other than ordinary fire-grates. 1. The complete combustion of fuel depends on the admission of just enough air to the furnace. Too small a quantity allows some of the fuel to pass off in smoke, or in an imperfectly burned condition, producing GREAT WASTE ; but if the amount of air admitted be too great, the heat will be reduced to an ineffective degree. When black smoke is seen to issue from the chimney, let the door of the furnace be opened. The draught entrance must be kept free of fuel or ashes at all times. 2. The furnace should never be choked up with fuel. 3. Before adding fresh fuel, most of the red coal at the front of the furnace should be raked to the back, and the fresh fuel placed upon the remnant in the front, so that all the matter issuing from the fresh fuel shall be burned by the bright fire at the back. 4. Large coal should be broken into pieces the size of the fist before being added to the furnace. 5. The quantity of red coal on the floor or bars of the PREVENTION OF SMOKE. 59 furnace should be equally distributed, and never less than three inches deep. 6. All furnaces and boilers hereafter to be erected shall be constructed under the superintendence of a competent engineer, and with the view to the prevention of, and the exit of, unconsumed smoke. DIRECTIONS FOR STOKERS. 1. No black smoke ought to issue from the chimney of the furnaces. 2. To prevent this (when charging the furnace), push most of the red coal to the back of the furnace, and spread the remainder evenly to a depth of not less than three inches, and place the fresh fuel upon the red fire nearest the door. 3. The pieces of fresh fuel must not be larger. than the fist, nor added in such quantity as to choke the fur- nace, as this prevents a sufficient quantity of air from entering, and thereby wastes the fuel and causes smoke. 4. If black smoke should issue from the chimney of the furnace, it must be your fault, and a fine will, there- fore, be inflicted. When, however, it does occur, open the furnace door, stir up the black coal, and bring it in contact with the red fire. N.B. The Committee issue these instructions as suggestions only, and the owners or managers of fur- naces are not thereby relieved in any way whatever from the obligation to use all other means for the like object, or from their legal liability in regard to smoke issuing into the atmosphere from their furnaces, or in any way to prejudice the legal rights of the Corporation to enforce observance of the statutes. These suggestions have been very generally followed, and the atmosphere has been thereby rendered much less murky. Very constant supervision is required. Stokers very often neglect to put back the fire before 60 ODOROUS PARTICLES IN THE AIR. adding fresh fuel, and may not be above feeling interest in the profits of dealers of that article. As an in- stance of more complicated and expensive machinery for consuming smoke may be mentioned the chain fur- naces employed at Mr. Guinness's brewery, where nearly thirty tons of coal are daily burned, and yet the amount of smoke is less than that of some factories, where not one-tenth the amount is used. In the same great estab- lishment Chanter's " rocking bars" are also used with good effect. Prideaux's apparatus for the consumption of smoke has been very greatly praised ; it allows the en- trance of air freely when coal is put on, but lessens the supply during the intervals of coaling. Besides the gaseous impurities and suspended parti- cles which I have heretofore spoken of, there are other matters in the atmosphere too subtle for chemical tests, or for vision assisted even by the most perfect artificial aids ; but man is endowed with another sense by which they may be detected namely, that of smell. There is little doubt that we are made sensible of odours by incon- ceivably small particles emitted from the odorous body, despite the often quoted experiment with a single grain of musk, which, after several years' exposure in a room which it perceptibly scented, was found not to have lost appreciably in weight. Another fact which shows the infinite minuteness of odorous particles is, that a single grain of a compound of the metal tellurium, if swallowed by a healthy man, will render his companion- ship intolerable for months. Speaking of such disgust- ing substances, Prof. Johnston remarked : " It may not be impossible to employ them as weapons of offence or defence. Imitating the habits of the skunk in this re- spect, we might far surpass it in the intensity and offen- siveness of our artificial stinks. Squirted from the walls of a besieged city, projected into the interior of a forti- fied building, or diffused through the hold of a ship of war, the Greek fire would be nothing to them ; and as NOXIOUS GASES. 61 for the stink-pots of the Chinese, they must be mere bagatelles to the stenches we can prepare." For simi- lar purposes it has been seriously proposed to fill shells and other projectiles with kakodyle, one of the most deadly of substances, both on account of its inflamma- bility and the arsenic it contains. Many of the noxious gases give us warning of their presence by their disagree- able smell ; but as I have before mentioned in respect to sulphuretted hydrogen, they must not be considered innocuous when so diluted with water that the mixture with air is inodorous ; and they injure, not so much by actual or marked diseases, as by general depression, greater liability to catch diseases, and to bear up against them. LECTURE III. AIR CONTINUED VENTILATION WARMING DISEASES DUE TO IMPURE AIR. THE quantity of air we in- hale at each ordinary breath we take, is most variable, and even an average quan- tity cannot be positively stated, which is to be re- gretted, being desirable as a datum on which to found principles of ventilation. One peculiar source of fallacy arises from the fact of our breathing more vigorously when attention is fixed on the act. The round number of 20 cubic inches is pretty near the truth, and it is worthy of note what a small proportion this bears to the utmost quantity we can in- hale. An ordinary man of five feet eight inches in height, and ten stone weight, can expire 240 cubic inches from his lungs, as can be shown by this instrument Hutchinson's spirometer h,ere figured. The dry gas-meter I shall now use, which, by the way, was manufactured in Ire- land, and displayed in our National Exhibition, makes The Spirometer. HUTCHINSON'S SPIROMETER. 63 a much more handy and truthful instrument for deter- mining the quantity of air we expire. The greatest amount ever expelled 464 cubic inches was by an individual whom I might call a giant, as his height was seven feet and his weight twenty-two stone ; and the least 46 cubic inches - from Don Francisco the dwarf, who was but twenty-nine inches high and forty pounds ill weight. Women can take in much less air than men. The instrument is very reliable in examining lives for insurance, as any wide departure from the normal stan- dard is indicative of some obstructive disease of the lungs, preventing their full expansion. The amount of air breathed in varies remarkably with the dress of the body ; thus a man was found to breathe nearly one-third more air when his ordinary clothing was removed from him. When such are the effects of our loose habiliments it cannot be necessary to descant upon the evils of tight-lacing. But were it not that woman breathes especially by the top of the chest/ even greater injury would result. The air in pass- ing through the mouth and breathing passages is warmed to nearly the heat of the body, and is strained of dust and other suspend- ed matter by myriads of hair-like projections on the surface, which are con- stantly fanning to and fro. In the lung the air-tubes divide many times, and at last end in these dilata- tions ; two of each, with the Structure of the Lung. air-cells which jut from them, are here represented These air-cells, it is calculated, amount to the astonish- 64 QUANTITY OF AIR REQUIRED. ing number of 600,000,000 ; and on such a vast surface the blood is exposed to the air, by which it is freed of carbonic acid and supplied with oxygen. This all-impor- tant gas is then conveyed in the arterial blood all over the body, being required in the performance of every vital act. By examining the expired air it will be found to be warmer, more moist as one perceives on a frosty day because of the condensation of the vapor to have lost about 4 per cent, of its oxygen, and to have gained about an equal amount of carbonic acid gas. The proportion of the latter varies however remarkably, being increased under the following circumstances cold, at noon, during spring, the taking of food, muscular exertion, and lastly in youth. The amount of air required depends, then, on phy- siological data, which are not by any means positively settled. An ordinary man, I have stated, breathes in about 20 cubic inches of air about eighteen times per minute ; but as every fifth inspiration is more vigorous, the round number, 400 cubic inches, seems to me a fair amount to assign as the quantity each man breathes out per minute equal to 24,000 cubic inches per hour. Fresh air contains, as we have before seen, but 0'4 per 1,000 of carbonic acid; that which has been breathed contains 40 volumes per 1,000, or 100 times as much, besides many more noxious ingredients, which we shall for the present exclude from consideration, as the car- bonic acid is so much more readily measured. Now, to dilute the air expired by one man in an hour, so that it shall contain but its just proportion of carbonic acid, there must be added about 1,660 feet of fresh air. The commissioners who investigated the state of the bar- racks some years since recommend but 1,200 cubic feet per hour for the rooms. The permanent regula- tions in the military service merely regard space per man, and allow the following : In barracks 600, in huts 400, in home hospitals, 1,200, or in those on EFFECTS OF GAS AND CANDLES. 65 foreign stations, 1,500 cubic feet. The French com- mission on the subject recommended 5,000 cubic feet per man in hospital during any epidemic, and in the Hotel Dieu, which is being rebuilt, 3,500 is counted upon. Allowance should be made for the abstraction of oxygen and addition of carbonic acid, which lighting agents produce, and calculations may be made on the datum, that one cubic foot of coal gas produces two cubic feet of carbonic acid, and will require thus about 1,800 cubic feet of air to dilute it down to a standard not injurious. An ordinary candle, six to the pound, will produce about an equal quantity of carbonic acid and much watery vapor. I may here mention that the unconsumed smoke of a smouldering candle is as hurt- ful as it is unpleasant, and a death has resulted from its poisonous effects. Some half-intoxicated fellows, for the purpose of teasing a boy who lay asleep in the corner of a room in which they were drinking, held a smoking candle under his nose for intervals during half- an-hour, when he became insensible, and he died with convulsions on the third day. Deaths have also resulted frequently from the gases evolved from burning sub- stances such as hay, if ignited by the practice of servants sleeping in lofts. Such effect of aerial poisons will not surprise us when we remember the immense surface which our lungs present (nearly twenty square feet) rapidly absorbing them ; and that re-breathed air is to be counted among such poisons will appear from the sickening and disgusting odour of the concentrated emanations from the lungs of several people : such will never be forgotten by any one who has had occasion to perceive it while arranging the outlet on the roof of a crowded building. In approaching the subject of ventilation, I feel by no means confident that I shall not disappoint many of my hearers, for I shall be very brief, thinking that upon no subject has more been uselessly written and more inge- 66 nuity wasted. In saying this, I do not for a moment undervalue the advantages of fresh air, as will, indeed, be apparent from my preceding remarks ; for, on the contrary, I look on all rooms, hospital wards, &c., as positively injurious to health unless the air in them be as inodorous as that of the free atmosphere about them. Although it is quite within the power of man, I do not, however, anticipate that the contrast between town air and country air, to which Milton alludes, will ever dis- appear : " As one who long in populous city pent, Where houses thick, and sewers annoy the air ; Forth issuing on a summer's morn to breathe Among the pleasant villages and farms Adjoined, from each thing met conceives delight." We have seen that Nature's provisions for the removal of foul air were among the most perfect and plainly bene- ficent of her wondrous works, so that in constructing means for the exit of air which has been breathed, we have but to endeavour to copy her. And the devices which animals instinctively adopt for the like purpose are equally interesting and instructive. Let us study, for instance, the operations of the bees to whom the work of ventilating the hive has been entrusted. The air can only enter at the door, as all the rest of the hive is plastered with propolis, a waxy matter with which the bees make their hives air-tight. There are gangs of from ten to twenty working bees each, according to the heat of the weather, stationed at the entrance, who ventilate the hive by vibrating their wings with great rapidity, and each gang is relieved when on duty about half- an - hour. If a greater need for air be excited, as when they are roused by shaking the hive, or letting into it some disagreeable vapour, the number of ventilators and the efforts of each are greatly augmented. The movements of the atmosphere which heat gives rise to, and the diffusive power of the air itself, tend to keep it con- stantly pure for the uso of man. THE LONDONDERRY. 67 The most appalling of all calamities due to ignorance of the want of fresh air the suffocation of nearly. 100 passengers on board the steamship Londonderry which must be fresh in the recollection of manj 7 of my hearers, is the best and, to us, most interesting instance of the fatal effects of total want of ventilation I could detail. This vessel left Sligo for Liverpool on the 2nd of Decem- ber, 1848, and stormy weather coming on, the captain forced 200 steerage passengers into their cabin, which was 18 feet by 11, and 7 feet high, thus allowing but 7 feet of cubic space for the breathing of each person. The captain now battened down the 'hatches, and lest a breath of air should enter, covered over the entrance with a tarpaulin nailed down. An indescribable scene of horror followed, and when the mate came to the cabin, 72 were already dead, and several others were expiring with fearful convulsions, and with blood starting from their nostrils, ears, and eyes. They were thus con- demned to a death more horrible than if the ship had been submerged, through the captain's ignorance of the value of fresh air, which was separated from them but an inch or two. With a calamity so recent before the minds of ship captains, we would suppose no death from similar causes would ever again occur ; but in a schooner lying along our quays during February, 1864, a sailor was smothered for want of ventilation in the forecastle. The black-hole of Calcutta, and the prison in which 260 out of 300 prisoners from Austerlitz rapidly died, are other well-known cases which it must be unneces- sary to describe. In contrast with such cases, remember the beneficial effects of ventilation in the saving of human life, as in the following instance. During the 25 years following 1758, when the Rotundo Lying-in Hospital was founded, 17,650 infants were born alive; 2,944 of them died, or about 1 in 6. The hospital, which up to this time wa-^ unventilated, was altered so as to allow a free supply of 68 PRINCIPLES. OF VENTILATION. air ; and for the following 25 years but 550 out of 57,072 died, 1 in 104 a mortality 17 times less ! The effects of impure air on horses can be more easily ascer- tained than upon men, because there is greater similarity of food and other circumstances among them. The mortality of the French cavalry horses was, up to 1836, 190 per 1,000 annually; improved ventilation of the stables reduced it to 68, of which more than half is by glanders. In our army, 20 per 1,000 is the average, and glanders is very rare, and is evidence of want of care. The objects which we are to accomplish by ventilation are as follows : To remove from our apartments all noxious gases produced by combustion, over-crowded respiration, imperfect sewerage, or by decomposing ani- mal or vegetal matter, and to equalize their temperature and humidity. By ventilation there must be removed en- tirely, or at least diluted below an injurious degree, the 960 cubic inches of carbonic acid, and the two and a-half ounces of watery vapour and animal matter ex- haled by each inmate every hour. This latter quantity is given off by the skin and lungs, and becomes increased considerably by the higher temperature which want of ventilation produces. The amount I have stated was estimated by Lavoisier's well-known experiment. He enclosed his body in an air-tight bag and breathed into another, and found that 11 grains were given off every minute from his skin, and 7 from his lungs at 60. Under greater heat and more severe exertion a much greater quantity is exhaled. If one reflected that in a close crowded assembly we are breathing over and over again the air which has passed through the lungs of many other persons, carry- ing from each noxious decomposing matter, that fasti- diousness which makes us refuse the drinking-vessel which the lips of another has touched, would suggest to< us the advantages of clean air. AIR CURRENTS IN HEATED ROOMS. 69 The different density of cold and heated air produces a constant circulation in the atmosphere of any room, and unless the generation of carbonic acid be very rapid and abundant, as when the space is greatly over-crowded, it will be in this way pretty equally distributed. These currents which the heating of the air gives rise to in a room warmed by an open fire can be demonstrated by weighting a small gas-balloon, such as this, which costs only a few pence, until it is exactly of the same specific gravity as the air. When let loose it will move in the circles sketched in this diagram of a room with a venti- lator, window, and open fireplace. Currents in a heated room. It will be remarked that the course of the balloon in- dicated that there was a current towards the chimney and the ventilator, and that an eddy was produced above the chimney-piece. These latter rapid movements can be best shown by the fumes produced by holding a sponge dipped in hydrochloric acid and held over a saucer filled with ammonia. In such an air-tight room of 424 cubic feet, by careful ventilation 44 cubic feet could be intro- duced per minute, or the whole air changed in less than 70 PRINCIPLES OF VENTILATION WINDOWS. ten minutes, without any perceptible draught. The wind, or air in motion, is a most powerful ventilator, and in every room, for some part of the day, advantage should be taken of it. As it blows across the tops of our chimneys it encourages ' draught, and thus removes foul air. Having explained a few of the principles on which ex- change of air depends, I will bring under your notice a few methods of ventilation, natural and artificial. Amongst the first rank windows, doors, fireplaces, and the permeable structures of which our walls, ceilings, and floors are constituted ; and it may be at once asserted that any room without a fireplace and window opening externally should be condemned as uninhabitable. In mild weather there is no ventilator so efficient as the window left open a few inches at top and bottom especially the former, to allow the heated air to escape. Nevertheless one is struck with the extremely few win- dows which will be found open as he walks through this or most other cities. Bedrooms, at least during the day, should have the windows open. Few of the older houses are so arranged that the window-sash opens down ; this is a grevious builder's error, and even in the poorest houses, where pulleys and weights cannot be afforded, the sash should be made to fall at least a foot from the top. The opening up of the lower sash produces a draught, does not disperse the heated air, and is dan- gerous for the children. In very cold and boisterous weather it is impossible to follow this advice about win- dows, unless some adjustment be made to prevent the external cold from acting too freely on the interior, and this can be accomplished by double sashes or panes, with about six inches of air intervening, which acts as a non-conductor of the low temperature. Strong draughts may be prevented from entering by having a louvred pane, with each slip acting on hinges, so that the amount of open spaces may be regulated. A piece of fine copper WIRE-GAUZE VENTILATORS OPEN WINDOWS. 71 gauze, about nine or twelve inches deep, fixed at the top of the window-frame, makes a good inlet ; and that which is known as Cooke's ventilator, and for the sale of which the " Ventilation and Sanitary Improvements Company" was established, consists of copper gauze fitted to the top of the case, and bent at an angle of forty-five degrees. It may be so arranged by hinges along the angle that it will fold up when the window is shut, but it is less likely to go out of order if it be made stationary. The gauze finely divides the current of air, thereby preventing draught, and excludes the coarser mechanical impurities, as dust or insects. The object of the angular shape of the ventilator is that the upper half shall let out the heated air, and the lower admit the fresh ; and I have found that there is a difference of about twenty degrees in the air which passes through each when a room is heated. Mr. Thomas Greer of this city has obtained a patent for a ventilator on a similar plan, save that it is stationary, semicircular in shape, and draught is prevented between the sashes by india- rubber pads. I may show you that gauze prevents draughts, by blowing through a tube against the flame of this candle, when you see it is scarcely affected if this piece of wire gauze intervenes. This model, which I ex- hibit to you, is one of Greer's ventilators fitted to a win- dow. For small rooms perforated bricks, which sell for three pence each, inserted at the highest point of the outer wall, answer well, except in very stormy weather. The poor are so negligent about fresh air that they frequently paste paper over, or otherwise obstruct such inlets for that gift which alone can keep them healthy. I am an advocate for leaving a small portion of the window of bedrooms open during the night, except in extremely cold or rough weather, and perhaps even then with the arrangements above alluded to, and always with a due regulation of the clothing. I know that during night less air is required, as carbonic acid is generated 6 72 FIREPLACES AND STOVES. much less freely, and that the body is particularly apt to chill ; but I am averse to remaining in such air as your nose perceives when, in the morning, you enter an ill-ventilated bed-room. Moreover, in large manufac- turing towns, the air is less polluted by smoke during night. There are some who object to regarding windows as ventilators on the score of their being constructed for another purpose ; but so far from depreciating their usefulness in admitting light, I would urge that we do not enjoy the benefits of light as much as we should for instance, not half as much as our French neighbors. Although in Dublin (perhaps the worse for us) we do not suffer, like Glasgow or Birmingham, from a murky atmosphere, yet the high houses overshadow the humbler ones, which are stuck here and there without regard to site or aspect ; and the windows of the latter are so dirty as to act as efficient sunblinds. Light, besides its delight- ful cheerfulness, is useful in promoting the destruction by oxidation of organic matter in the air ; and I believe that the cellar-grown man is blanched by the same un- natural want of light as is the underground plant. The limited window-space of English houses is one of the ill consequences of the tax which reflects no lustre on the otherwise brilliant name of William Pitt. A fireplace is a good ventilator, especially when the fire is burning, as then it draws off several thousand cubic feet of air per hour. They are, however, made now so low that they merely ventilate the lower stratum of the air. Stoves are so numerous and various in pat- tern and design as to defy description in my limited space ; but by the kindness of Mr. Bashford, of Ely- place, I am able to exhibit to you a specimen of every approved kind, and you can examine them at your leisure after lecture. The superiority of fireplaces or stoves in rooms over the hypocaust, or hot-flue system, was tested some years ago in St. Patrick's Hospital in this city, for the mortality was greatly reduced when VENTILATORS NATURAL AND ARTIFICIAL. 73 ordinary fireplaces were adopted with proper guards. It was the celebrated Benjamin Franklin who suggested the insertion of an aperture in the flue, near the ceiling, when describing his famous Pennsylvanian fireplace in 1744 : " In rooms where there is much smoking of tobacco, it is also convenient to have a small hole, about five or six inches square, cut near the ceiling through into the funnel ; this hole must have a shutter, by which it may be closed or opened at pleasure. When open, there will be a strong draught of air through it into the chimney, which will presently carry off a cloud of smoke, and keep the room clear ; if the room be too hot likewise, it will carry off as much of the warm air as you please, and then you may stop it entirely or in part, as you think fit. By this means it is that the tobacco smoke does not descend among the heads of the company near the fire, as it must do before it can get into common chim- neys." Doors are ventilators, as you can prove by taking a candle in a close, heated room ; if you place it at the chink above, the flame will be blown outwards by the hot air escaping ; at the bottom, inwards by colder air entering. The air, however, so admitted may not be the freshest, having been used below sfcairs and after- wards sent upwards by its being heated. You will be surprised to hear that even through bricks much inter- change of gases takes place ; and the uawholesomeness of closely -join ted iron houses has been assigned to the difference. Ceilings of old houses often show that there occurs through them a passage of air carrying dust with it, and under the large wooden rafters, where no such pas- sage occurs, the colour is lighter, dust not being fixed into the plaster. Of artificial systems of ventilation I shall mention but few, as I can refer you to Prof. Parkes' admirable trea- tise, where every plan of value is described. That which 74 VENTILATORS NATURAL AND ARTIFICIAL. Miss Nightingale most strongly recommends for hospi- tals, consists in shafts built in the walls, and opening near the ceiling of the room, the opening being louvred to prevent any down-draughts ; and a turret projects from the roof so as to carry off the foul air. In an opening in the opposite wall should be fixed one of these, Sherringham's Inlets, which, having one side hinged, can be arranged to let in any quantity of fresh air. This simple plan is here de- picted. The sectional area of the shaft or air- drain should be in proportion to the size of the room, and one inch for each 50 cubic feet on the top floors, and 60 on the lower would suf- ^^ The gize of i Section of Ventilated Ward. Qr let in barracks was fixed by the Commissioners of 1861 at eleven square inches for each inmate, but remember- ing the expansion of heated air, the outlet might be a little larger. Fresh air might be introduced from a space below the floor of hospital wards, and admit- Sherringham's Ventilating Inlet. ted into them by fine wire gauze set near the beds. The late Dr. Reid advised that air for buildings should be taken from a height, as it would be purer ; and this was done at Guy's Hospital, where a shaft ninety-five feet high is erected, and at the bottom of it the air is warmed by means of hot water. Such air, would be free from sewage gases. Of ventilating roofs EXPERIMENTS ON VENTILATION. 75 or ceilings, one of the most beautiful is that of the Alhambra at Granada, into which there are set several exit tubes of most graceful shape. In public edifices the roof, if somewhat conical, should have the ventilat- ing outlet inserted at the highest part. A principle on which many ventilators depend was first illustrated by Prof. Daniell with the experiment I shall now show you. I place this lighted taper upon a flat dish, and place over it this glass receiver, from the top of which extends a common glass lamp-chimney. You see that air enters under the receiver, as the surface of the dish is not perfectly fitted to it, and the candle burns away the arrangement resembling a room with air admitted below and an outlet above. Now I turn the vessel to one side, and the flame deposits much soot on the side, and the unburned products causes the flame to get dim, and it will finally go out. The experi- ment now shows the condition of a room in which the outlet does not occupy the highest place. If I pour a little water into the dish, so as to prevent the entrance of any air below, the candle, you will find, will become extin- guished as the efforts of the hot air to ascend, and the fresh to descend, through the chimney will mutually counteract each other ; and this state of things resembles a room ventilated only at one point. Now, I will divide the chimney into two by a slip of tin, and then the hot and cold air will each select a passage, and the taper will burn brightly on. This bit of smouldering paper, held above the tube, will show by its smoke being forced up- wards, that the hot air is ascending through this half ; and now by its being drawn inwards that the fresh air is rushing down in this. Watson's, Mackinnell's, and Muir's ventilators are applications of the principle ; but as our experiment shows, they cease to act when by an open door or window the air is admitted below. As an instance of the efficacy of such tubes as Mac- kinnelFs, which is represented in the next woodcut, I may 76 VENTILATORS PLACED AT THE TOP. mention that by them the Chapel Royal, St. James', during the marriage of the Princess Royal, though filled with 1,500 people, was thoroughly ventilated, and kept at a temperature of 58 for five ^ hours. They would be very suitable ventilators for railway carriages, which are wretchedly close and unwholesome as one perceives especially on entering at a midway station. The ven- tilator, as in the American cars, should be at the summit, and should be permanent not sub- ject to the whims of obstinate people, who are ignorant of the advantages of fresh air. Small tubes carried from the ceiling of each room in a build- ing, and opening into a larger P^ conducted to kitchen flue, or any larger flue which may be near, are most effectual in ventilating. A building, not inaptly called the " Barracks," in Glasgow, containing about 500 of the poorest lodgers, was so infested with typhus that 57 cases occurred in the two months before it was ventilated. Such a system of tubes as I have alluded to was adopted, and but four cases of fever occurred in the eight succeeding years. In the Exhibition Palace concert hall there is an ad- mirable ventilation by means of the gasaliers in the ceiling, the air from around them being rarified by the heat, and thence conducted by shafts to the roof. Such a system is most suitable for places of worship and public resort, in which our pl^sical health is at present too often jeopardized. All artificial ventilating apparatus will fail if worked by hand, for workmen, not realizing the danger of aerial VENTILATION OF THE HOUSES OF PARLIAMENT. 77 poisons, will neglect them. In factories, however, where steam power can be applied, some means of producing free currents, like Fairbairn and Lillies' four-guinea fan, does immeasurable good. Its effects were illustrated in a mill near Manchester in an unexpected way namely, by the men asking higher wages, their appetites having increased with the use of pure air. In soap-boiling houses and such places, where fetid animal vapours are emitted, the foul air should be made to pass through and feed the fires, as first devised by Sutton. The introduction of fresh air, the expulsion of foul, the heating in winter, and cooling in summer of the Houses of Parliament, are now achieved by the follow- ing means, devised partly by Dr. Reid, Mr. Gurney, and Dr. Percy. The fresh air, filtered of suspended parti- cles by screens as it enters from the courts, is heated by passing over iron chambers filled with steam, under the floors in the mixing spaces, and then ascends through perforations in the floor, which are covered with horse- hair cloth to prevent a perceptible stream. In summer the air is cooled by wet cloths being placed about the iron chambers, and by spray jets, which by producing abundant evaporation, cool it, supply the proper degree of watery vapour, and free it from much of the putre- factive odour derived from the river during very hot weather. The foul air escapes through the roof, and is thence conducted to an enormous coke fire and chimney in the Victoria Tower. In 1858, however, the stench from the Thames became so great, that canvas wet with chlorides had to be fixed to the windows; and this failing, the air had to be obtained from the level of the belfry, 200 feet high, and then passed through a large room containing fresh-burnt charcoal, which has such a wonderful power of absorbing gas and, by its powerful oxidizing property, the effect of checking putre- faction of organic matter. It is now remarked that any odour, such as that of roast meat, is most rapidly wafted 78 ' ARTIFICIAL MODES OF VENTILATION. from the court-yard through the whole ventilating sys- tem to the House. Methods of ventilation by propulsion of the air into the building have had many advocates, and one of them has been adopted in that splendid building, St. George's- hall, Liverpool, where, however, the most enthusiastic admirer of fresh air must admit that ventilation is ex- cessive occasionally. A gentleman who dined there some time ago on the occasion of some public festival, in- formed me that the table-cloth was with difficulty kept on the table, and few escaped without colds or tooth-aches. The ventilation of coal mines is now managed by a large aspirating shaft, and has been so perfected in some districts that the health of the miners is most perceptibly improved. Surely, every effort ought to be made to make the wretched life of the collier more en- durable ; the dangers of descent and of poisonous gases, and the darkness and dust, are sufficiently dreadful. In copper and lead mines most injurious effects are still produced ; for as there is no danger to life or property by such explosive gases as those which are generated in coal mines, the proprietors are unfortunately more negli- gent in adopting means of ventilation. All the modes of renewing the air we have alluded to depend on making a partial vacuum ; but a plan which may in contradistinction be called the " plenum method," and which first occurred to the wonderful mind of Robert Boyle, may be mentioned. It proposes to condense by pressure the air in the room, and it was said to increase the facility of breathing, and to introduce more oxygen than in ordinary breathing, even to the reddening of venous blood, and thus to exhilarate all the functions. Like many other queer ideas, it has attracted the greedy charlatan, and an establishment in Yorkshire Ben Rhydding I think the place is called has been got up for the cure of many diseases. I must in candour state that the late Dr. Hunt, formerly one of my most intelli- COMPRESSED AIR OVER-CROWDING ROOMS. 79 gent pupils, was a firm believer in this compressed air for pulmonary symptoms, under which he laboured. The last plan I shall allude to is that described and figured by the Commissioners on the Warming and Ven- tilating of Buildings, and also in Tomlinson's most ex- cellent manual on the same subjects. The fireplaces are directed to be arranged back to back in a partition wall. The chimney should be made of vitrified clay-pipes about ten inches in diameter, and outside this there should be another space into which open apertures from near the ceiling of each room, to let out the foul air. Air to feed the fires is to be admitted from without through air bricks, and carried along the floor to below each fire. This plan may appear complicated and ex- pensive, but it will not be really so if arranged during the building of the house. All means for ventilating public buildings, will, how- ever, be abortive if over-crowding be not prevented, es- pecially of those who are inattentive to habits of personal cleanliness. There are few situations more insufferable from closeness than a dense crowd, even if in the open air, and, as an engineer once remarked to me when discuss- ing the ventilation of a building which was referred to us, "it wouldn't be fully ventilated, even if the roof were taken off, if it be crammed with the ' great un- washed.' " As an instance of the accurate information on hygiene which military officers must possess, I will quote Dr. Parkes' rules for the estimation of the ventila- tion of rooms, and the time will come when civil officers will have to be as exact. " The ventilation of a certain room being about to be examined, enter it after being at least fifteen minutes in the open air, and notice if there is any smell. Measure the cubic space, then consider the possible sources of entrance and exit of air ; if there are only doors and windows, notice the distance between them, how they open, on what external place they open, whether there 80 ESTIMATION OR AIR-SPACE. is free passage of air from side to side, whether it is likely the air will be properly distributed. On all these points an opinion is soon arrived at. If there are other openings, measure them all carefully, so as to get their superficies ; the chimney must be measured at its throat or smallest part. Determine then the direction of move- ment of air through these openings by smoke, noting the apparent rapidity. The doors and windows should be closed. When the inlets have been discovered, con- sider whether the air is drawn from a pure external source, and whether there is proper distribution in the room. Then measure the amount of movement in the outlets with an anemometer, or calculate by the table if it seems safe to do so. If the ventilation of the room is influenced by the wind, the horizontal movement of the external air should be determined by Eobinson's anemo- meter, which is now supplied to many military stations. Then proceed to the microscopical and chemical ex- amination, if this is considered desirable, as it will fre- quently be." Until legal enactments were passed to compel the smoke of factories to be consumed, the atmosphere of London and many manufacturing towns could not be said to be transparent, owing to the soot with which it was charged. There is now, however, the greatest im- provement in this respect by more careful stoking and apparatus for consuming the unburnt smoke. It was calculated some years ago that the London people had to spend annually two and a-half millions more for wash- ing than an equal number of country families. Such improvements which I told you in my last lecture the Corporation was determined to enforce will also lead to freer ventilation, for it used to be objected to windows opened, that they deluged the rooms with smuts. The cheap and simple ventilators which I have often urged should be inserted into the outer wall of every room occupied by the poor namely, plates of finely perforated METHODS FOR WARMING BUILDINGS. 81 zinc near the ceiling, would have the additional advan- tage of shutting out much smut or dust. The rooms of the poor which are so close that it is not safe for the physician to enter unless the windows are previously opened of all places, should be thoroughly aired daily ; as the old furniture including those articles which should be banished from every house, namely, bed-cur- tains are soaked with organic matter. It is a popu- lar delusion that ventilation means cooling, whereas many of the plans I have very briefly sketched contem- plate the airing and warming of our buildings at the same time. During exercise, and with proper clothing, the temperature of our bodies, 100, is exactly maintained by the generation of heat within the body ; but while at rest, artificial heat is demanded, at least during winter in cold climates. This is especially the case with infants, old persons, and invalids, in whom the spontaneous pro- duction of heat is not active. The best means of afford- ing it is by radiation, such as from Count Rumford's store, or the innumerable varieties which have been pro- duced out of it ; but in large rooms one source of radia- tion will not suffice, as the effects decrease according to the square of the distance. Then several fires or stores may be used, or some of the methods of conduct- ing heat by hot air, water, and steam pipes or metal plates, may be adopted. The most ingenious plan is that patented by Perkin, in which strong pipes of half- inch bore circulate freely through the room, and pass through a fire the temperature of the water in them being thus raised above 300. The air in rooms heated by most of these methods has a peculiar smell, and a dryness which is hurtful in many pulmonary cases. In prisons and some other public buildings such systems are indispensable. A system of ventilation and warming has just been arranged in the council-room of the Dublin Corporation. There are circulating four-inch pipes under each of the benches, communicating with a boiler and 82 DISEASE IN ILL- VENTILATED HOSPITALS. with a cistern, which secures a constant supply. There are also two fireplaces. Air is admitted under the floor, divided by gauze, and heated by the hot water pipes. The foul air escapes by outlets at the edge of the ceiling, and by two glass domes which are raised upon gauze .supports. This building usually contains from 60 to 200 persons for a meeting of some three hours duration. The expense of the warming and ventilating plan has been about 100. I will now direct your attention to some diseases which we have reason to believe are producible by a want of constantly renewed fresh air ; and I regret to say that it is in the records of hospitals some years back we shall find the most plentiful evidence. Some diseases * have even had the term " hospital" prefixed to them to indicate their dependence on the atmosphere in which they arise, and which has itself been distinguished as " nosocomial air." I shall afterwards allude to the difficulties which surround the proper ventilation of hos- pitals, mainly arising from the fact that many of them, having been originally constructed for private dwellings, become over-crowded when adapted to a purpose for which they were quite unsuited, and from the conflicting wishes of patients, differing as much in their feelings regarding foul or fresh air as in the nature of their diseases. Hospital patients usually dread fresh air as being cold-giving forgetting that it is possible to warm it and break its flow in such a way as to produce no discomfort, much less illness. Restlessness, malaise, the slow healing of sores, and tedious convalescence, have been frequent ill effects of close hospital air, while such horrors as contagious gangrene, erysipelas, and a fearful blood-poisoning we surgeons call pyaemia, positively killed more patients in the hospitals of the eighteenth century than the very advanced surgical skill of their attendants cured. On the curative effects of pure air upon the usually fatal disease which I have last men- WANT OF VENTILATION PROMOTES SCROFULA. 83 tioned, hear the opinion of Mr. Paget, perhaps the most scientific surgeon living : " Of all the remedies I have used, or seen in use, I can find but one thing that I can call remedial for the whole disease pyaemia, and that is a profuse supply of fresh air. In the three most re- markahle recoveries I have seen, the patients might be said to have lain day and night in the wind wind blowing all about their rooms." The contagion of hos- pital gangrene adheres so closely to the wards, that the walls of the New York Hospital had to be taken down as a last resource before the disease was eradicated. Air is plentifully required in hospital wards to oxidize the abundant organic matter which is so freely emitted from the bodies of the sick ; and if they smell foul when one enters for a moment, what injurious effects must the patients suffer who are confined within them for the whole twenty-four hours ? The frequent fever of chari- table institutions some years ago was mainly promoted, if not produced, by want of air and space, as was indeed confessed by the name it commonly bore " the sick- ness of the house." One of the first medical writers who drew attention to the influence of a want of ventilation in producing scro- fulous diseases, including consumption, was our own great Carmichael, who, in 1809, clearly proved that 7 out of 24 of the children of St. Thomas's School, and 6 out of 80 of those in the Bethesda, were affected in consequence of want of exercise and of freely admitted air. The children's wards of the House of Industry were that time so much over-crowded and so ill-venti- lated, that " there was no enduring the air when the doors were first thrown open in the morning," the cubic space to each inmate being under 120 feet. I have visited many schools and boys' homes in which the air was foul and disease-producing, and in one of the latter institutions, during the recent outbreak of cholera, its unhealthiness became notorious. Although very much 84 THE CAUSES OP CONSUMPTION. has been since then written upon the causation of con- sumption by impure air, there is ample room for search- ing investigations upon the subject, entered upon with no preconceived impression. For instance, a full inquiry into the hygienic conditions of the people of the Island of Lewis, west of Scotland, who enjoy so great an im- munity that deaths by consumption occur but at the rate of 16 per 100,000, and of the denizens of crowded parts of London, where they are thirty times more numerous, should lead to conclusive and most salutary results. It has been fully established that domesticated animals are much more subject to consumption than those in a wild state ; the main difference between these two conditions being the want of free ventilation and exercise of the breathing function to the full extent. Babbits, the monkey, sheep, and most other animals, can be rendered artificially consumptive by confining them in close and dark places, and without doubt human life is daily being sacrificed by the same experiment unwittingly made. Exposure to air containing mechanical particles pro- duced by certain employments as needle-grinders, earthenware-makers, stone-masons, bakers, flax-dressers, and cotton-carders frequently excites this disease, which, amongst some of these trades, is known as " grinders' rot." The miners of England number some 300,000, and except in the coal-mines of Durham and Northum- berland, where ventilation is perfect, they die early from pulmonary complaints. The deaths by consumption in the army have been alarmingly numerous, but I feel no doubt they will diminish with improved air space in- sisted on in barracks by the. late Commissioners. The ventilation of ships is certainly difficult, and the great prevalence of consumption amongst seamen of the navy and merchant service some years ago was attributable to its imperfection. Dr. Gay, after a most masterly in- vestigation of the circumstances influencing the health WANT OF VENTILATION PROMOTES FEVERS. 85 of printers, clearly demonstrated that their proclivity to consumption was due to want of ventilation, and among compositors to want of exercise in addition, for they were one-fourth more subject to it than the press-workers. The most enthusiastic support to the argument that foul air is productive of, and pure air preventive of consump- tion, will be found in the well-known writings of Dr. MacCormack. Sea air is that which is certainly the most powerfully preventive, but with unsanitary habits, the disease is often as frequent at sea- side places as we were informed very long ago by Smollett, that authority even on matters medical, for in travelling through Bou- logne, he found scrofula, including rickets, very pre- valent, and attributed the fact to the putrid vapours in the lower part of the town which to my nose, while walking through its streets, during the summer of 1863, smelt even worse than the ill-famed ones of Cologne. The question of the origin of typhus, and the spread of this and other contagious diseases through an insuffi- ciency of pure air, will be perhaps more appropriately considered on a future occasion ; but here I must state the advantages of free ventilation during the treatment of this fever, so frequent in our land 1st, the comfort and more rapid recovery of the patient ; 2nd, the re- moval of danger to the attendants ; and lastly, the pre- vention of the spread of the contagion by its lurking in the furniture of the apartment or clothes of the patient or attendants. Consumption is, I am sure, induced, and contagious diseases spread, by the over-crowded and ill-ventilated state of the rooms in which large numbers of tradesmen, tailors especially, work together. Alcoholic stimulants are made necessary by the depressing effects of the foul air, and much of the intemperance of the artizan class has its origin in this way. If these rooms are lit by gas, as they generally are, the ventilation should be most perfect, for it has been found that an 86 POISONS IN THE AIR. ordinary burner consumes about five times as much oxygen as one man. In introducing the subject of aeriform poisons to your notice, it is important that I should explain some terms by which they are often designated. Malaria is an Italian word signifying " bad air," and miasm, from the Greek, is often used as a synonymous term ; but carbonic acid or chlorine diffused through the air would come within the definition founded on these terms. I shall, therefore, speak of each agent by the name of the disease which it produces, and if any epithet be needed to group together ague-poison, typhus-poison, small-pox poison, and the like, let it be the word "aeri- form." Of the first, I will speak especially here, leaving for another lecture the poisons generated by the human body, for they reproduce themselves, and are therefore communicable from one individual to another. Ague- poison does not present these features, but is endemic and locally atmospheric. The firmest fact concerning the ague-poison is, that it is connected with the decay of vegetal matter ; and that the aeriform bodies so evolved are brought down again to the earth's surface by the dew, is one of the most favourite theories founded on this assumption. Another fact we may rely on is, that heat is one of the most powerful extrinsic agents, for ifc favours organic chemical change, and raises the moisture from the earth's surface which spreads the poison. It has been calculated that marsh poison may diffuse to between 1,400 and 1,600 feet vertically, and about 800 feet along the surface, and the air be still ; but winds will convey it much farther. Trees are supposed to act as a barrier to its spread, either by offering mechanical obstruction or by decomposing the gases it contains. Chemical examination of the air about marshes promises much towards discovering the ague-poison, but as yet it must be acknowledged that the analyses we possess do not determine the point. The gas most constantly and THE NATURE OF AGUE- POISON. 87 abundantly present is light carburetted hydrogen, and next in importance to this a slight excess of carbonic acid. Sulphuretted hydrogen may be found owing to the decomposition of sulphates by organic matter, es- pecially if the marsh be so situated that the sea can be washed over it. The celebrated Prof. Daniell, finding much of this gas in water obtained off the west coast of Africa, believed he had discovered the cause of yellow fever, which was some years ago so fatal there. Organic matter to the amount of 8 grains to the 1,000 cubic feet has been obtained from the atmosphere of marshes, and it is a suggestive fact that it has exactly the same chemical character as the organic matter exhaled from our lungs, turning red with nitrate of silver, yielding ammonia when heated with lime, and blackening sul- phuric acid when drawn through it. Chlorine, and not ozone, destroys this matter, which some regard as the ague-poison. The only plausible grounds that a disease may arise from the entrance of minute animals from the atmosphere into the animal body, is the statement of a recent French writer that splenic apoplexy, or braxy in the sheep, is due to species of bacteria which, floating in the air, enters the creatures lungs and thence its blood. He has inoculated animals with the disease by the blood of those affected. This animal of the air is not destroyed by oil of vitriol, but a heat of 212 kills it. I have no doubt but that, amongst all kinds of suppositions, the theory that the evil of malarious air is the negative one of a deficiency of oxygen, has been advanced ; and the constant concurrence of organic matter which in de- composing so greedily abstracts that gas, the frequent concurrence of a ferruginous soil which might absorb it, and some of the peculiar symptoms of ague, certainly support the notion, if one so hypothetical be allowed for a moment. Marshy air, like other ills, has been saddled with deaths which do not fairly belong to it ; thus, as Dr. Hunter lately demonstrated to the Privy Council, the 7 88 THE NATURE OF AGUE-POISON. awful infant mortality in the fenny districts of Lincolnshire was due to the neglect, drugging, and famishing which the poor innocents were subjected to, their mothers being all day at out-door work. Ague was a frequent disease in Great Britain up to the beginning of the present century, and its almost entire disappearance is due to improved and extended drainage. Perhaps we can explain our immunity from ague in this country, where moisture and organic matter are found plentifully together in our bogs, by the great astringency of the water acting as a preservative ; the same character of the water of bogs fortunately makes them an undesirable residence for toads and serpents. The striking salubrity of large level spaces, such as commons or flat extensive strands, like that of Tramore, will be perhaps more appropriately submitted to you when I come to speak of climate ; and on Saturday, when I trust to have again the pleasure of addressing you, I will offer for your consideration the subject of water, which, next to air, is most essential to life and health. LECTURE IV. WATER ITS IMPURITIES, AND DISEASES PRODUCED BT THEM METHODS FOR THEIR REMOVAL THE DUBLIN WATERWORKS. BEFORE discussing the hygienic questions connected with water, it may seem unnecessary that I should allude to the physical characters of that fluid ; but they are so full of interest, and play so important a part in Nature's great and wondrous cycle, that I cannot avoid recalling to your recollection some such facts. Water when pure is inodorous, tasteless, and colour- less, save in large masses, when its normal tint seems a blue for instance, in the Grotto Azzura, in the Bay of Naples, where it is, moreover, so transparent that small objects can be seen several hundred feet from the sur- face. Other shades, as the brown of our bog rivers or the blackness of that of the Rio Nigro, are always due to organic impurity. Below 32 water is solid ; liquid from this temperature to 212, when it assumes the gaseous form freely, but at all temperatures some vapour is emitted. By, however, avoiding agitation, and very gradually lowering the temperature, water maybe brought to 5 without freezing. Unlike other bodies, which contract or become more dense when changing from the liquid to the solid state, water expands, and decreases in specific gravity from 1,000, at which it forms the standard for all other bodies, to -916 when converted into ice. The sheets of ice which form on our lakes and rivers remain on the surface owing to this fact ; and if they did otherwise, the layers would accumulate, and not only should aquatic animals cease to live, but, by the abstraction of heat, terrestrial life would also perish. This variance from other bodies is thus most providential. 90 PHYSICAL PURPOSES PHYSIOLOGICAL PURPOSES. When we assign 212 as the boiling point, we mean that such is the degree at the sea level ; but as we ascend, the barometric pressure, and therefore the boiling point, proportionally lowers; and the fact has been used in acsertaining the height of mountains. The power of absorbing heat, which water so pre- eminently possesses, gives rise to benefits of vast magni- tude ; for instance, the vapor is thus raised in countries of high temperature, and then distributed in cold and dry regions to moderate their rigorous and arid climates ; and again, in our own bodies, water abstracts heat from the parched surfaces, and when it afterwards evaporates, it produces further coolness. But there are many other functions which it performs in the human body it ren- ders fluid and capable of circulation all the nutriment of the tissues, acts as the great solvent for removing waste matter, and permits that exchange of materials through the membranes which constitutes the process of nutrition and secretion, by which our bodies are built up and their waste matter removed. Nearly four pounds of water as such, in aqueous drinks, or contained in solid food and the more nutritious the latter is, the more thirsty it makea us are daily introduced into each human body, and leaving it again by the skin, the lungs, the kidneys, and the bowels, exercise the cooling and cleansing powers of that fluid. It forms about three-fourths of the weight of the body ; but, indeed, Blumenbach possessed a mummy which, when thoroughly dried, weighed but seven and a-half pounds. I have seen the fact rather smartly described as follows: "Incredible as it may seem, a muscular Life Guardsman is little better than a pumpkin he is only another form of a water melon after all ; if he were put into an hydraulic press he would be able to sink into his shoes with the greatest ease." The amount of water which analysis reveals in each part is proportional to the quantity of blood it receives, and its consequent activity of function ; and in all these re- THE SOURCE OP WATER RAIN WATER. 91 spects the brain and the scarf skin, which respectively contain 789 and 37 parts per 1,000, are most strongly in contrast. Such essential qualities in human struc- tures as pliancy, toughness, and elasticity, would be absent if water did not abundantly exist in them. All water is originally derived from the sea, and being raised from this never-failing source as vapor, returns to the earth as rain, and thus supplies our rivers, lakes, or springs. In percolating through the soil, much of the organic and gaseous impurity of rain-water is oxidized, and therefore spring-water issuing from depths is most pure and wholesome, unless passage through limestone has rendered it too hard. The oxygen which exists so abundantly in the soil serves also the purpose of de- stroying organic matter, for otherwise the neighbourhood of towns would become intolerable from the soakage of refuse into it. Rain-water abounds in gases, such as air which is peculiar in containing about 35 per cent, of oygen, and carbonic acid to the amount of 2J per cent, of the whole gases and in such substances as nitric acid, its salt with ammonia, sulphuric acid, and carbon (if it falls in cities, and is collected after having washed over dusty roofs and gutters), chlorides near the sea, and in some situa- tions, as Paris, iodine has been detected in it. Its solids per gallon average 2-| grains, of which nearly half a grain is organic. From its mawkish taste, and the un- certainty of its supply, it is not generally used for drink- ing ; but its comparative purity has been said to check the frequency of diarrhoea and cholera when used for this purpose. Its softness, or freedom from limesalts, makes it a favourite with the laundress. In arid coun- tries good water has been obtained by exposing woollen cloths to the dew and wringing them out. River, spring, and well water vary much with the geological character of the district they come from, and, in the case of wells, with the depth to which they are 92 RIVER WATER. sunk ; thus, no two waters can be more different than that of a shallow well of some twenty feet, and that from a Paris artesian well 1,800 feet deep. The latter water is usually alkaline for example, that from a well in Southampton 1,360 feet deep contains eighteen grains of carbonate of soda per gallon. Kiver water has usually a moderate amount of gases dissolved in it for instance, about seven cubic inches of carbonic acid per gallon, but they are considerably reduced by exposure. Another mechanical means nitration removes abundant sus- pended impurities of such heterogeneity as clay and sand, infusoria, muscle fibres, biliary and sewage matters, algse, confervas, and fragments of wood, which substances average, for instance, in the water of the Rhine, eight grains per gallon ; and in one year the Ganges deposits enough matter to cover 172 square miles a foot thick. The agitation and exposure to air and to plants which river water is exposed to will eventually purify it. Thus, last autumn the Mississippi, which received all the sewage of Cincinnati when cholera was raging there, supplied good water to Louisville, 300 miles lower down, and that disease did not appear for months after. The salts are usually those of carbonic, sulphuric, nitric, and phosphoric acids, and chlorine, with lime and soda; and these, together with the dissolved organic matter, escape the filter, and are important impurities, notwith- standing the bright and sparkling character of such water. Even thirty grains per gallon of organic matter may be contained in water, and may not apparently hurt those who are habituated to it, except under pre- disposing states of the atmosphere ; then it may sud- denly become injurious. As an example of objects which the microscope discovers in filtered water, I may show those from the water of the Grand Canal, which is supplied to Rathmines Township. Some of these living forms were developed subsequent to^ the filtration at the source. RIVER WATER PUMP WATER. 93 It must not be supposed, because of -the circular shape of the figures in many books on the subject, that all the plants and animals which are depicted are con- tained in a single drop of water ; the portion the minute objects I have shown you were obtained from, was that allowed to settle in a large conical vessel, and the sedi- ment was then placed in the field of the microscope. It is probably a fallacy to regard these little beings as the source of danger in impure water ; on the contrary, they are scavengers for removing the organic decomposing matter which their presence indicates. As models of purity in drinking water may be instanced that of the Loka in Sweden, which, flowing over granite, contains but 3*5 of a grain of impurity per gallon ; that of Loch Katrine, now supplied to Glasgow, which has but 2^ ; and that of the Vartry which we will soon enjoy, and in which but 4 grains per gallon exist. On the other hand, superficial pumps produce in large cities the most impure of natural waters ; for instance, the water of one in Liverpool contains 417 grains per gallon of solids ; and that of Park Crescent, London, which attains the height of filthiness, had, according to that accurate analyst, the late Dr. Dundas Thomson, 43 grains per gallon of organic matter, chiefly derived from sew- age. Among other matters of animal origin may be mentioned butyrate of lime, of which 105 grains per gallon were discovered in a well fouled by a drain, into which this fatty matter must have somehow entered. '.The vegetal matter in river water is chiefly humic acid, and the animal products which are highly nitro- genous and abound in butyric acid, are derived from dead animals and manure and sewage, which soak into the river in highly-cultivated districts or dense populations, especially after heavy rain. The steeping of flax in rivers, or waters flowing into them, is likely to add much organic impurity, and early in the 17th century was pro- hibited by royal edict in Flanders. Another source of 94 CHARACTERS OF GOOD WATER. impurity in shallow well-water of cities, is gas refuse from the works, or the gas itself escaping from leaky pipes and impregnating the earth. Even the most im- pure well waters may be sparkling and cool, and for these reasons have been often reckoned wholesome a grievous error, as we shall see hereafter. The characters of a good drinking water may be enumerated as follows 1. The temperature should be about 10 less than the surrounding air, and not less than 50 below that of the human body. 2. Freedom from taste, except its naturally saline one, and slight pungency from carbonic acid and air, which appear to render it more readily absorbed. It must be remem- bered that matters most deleterious may escape the watchfulness of this sense ; 70 grains of common salt per gallon give no perceptible taste. 3. Absence of smell. 4. Transparency and absence of colour, which latter character, however, is not essential ; for instance, many waters in this country are brownish from peat, but not necessarily unwholesome ; and on the other hand, water charged with sewage products is often bright and colourless, though most deadly. The colour is best tested in a large mass of water, as by looking down through a glass tube some feet long, with a bit of white porcelain at the bottom, as devised by Letheby and Mr. Tich- borne of this city has improved on this simple plan. 5. Alkalinity, which is usually from carbonate of lime ; and 6. A moderate amount of dissolved solids. The Brus- sels Sanitary Congress fixed the maximum quantity of solid matter which potable water might contain at 85 grains per gallon, of which not more than a grain should be organic. This is a standard by which, however, we should not be guided, for few, if any of the waters sup- plied to towns approach this total amount of solids, and some of our best have nearly double the quantity of organic matter assigned. The amount of lime salts is often indicated by the difficulty of cooking peas or other vegetables in some waters. ARSENIC IN WATERS TESTS FOR IMPURITIES. 95 I may mention the amount of saline matter which sea water contains namely, about 2,500 grains per gallon ; but great variety occurs, even to such an extent that 40,000 grains per gallon have been found in the water of a small lake east of the Wolga, owing to enormous evaporation and the rare addition of pure water. In river water the lime-salts are always the most abun- dant, and are derived from limestone, over which it flows, giving up some of its substance to the carbonic acid in the water. When such water is boiled, the carbonic acid is driven off, and the lime- salts are deposited on the insides of the kettles and boilers in crusts, which often become foetid from decomposition of the organic matter mixed with them, and should be removed. Some mineral waters for instance, that of Schwalheim con- tains as much as 2J parts by weight of carbonic acid per 1,000 ; they therefore effervesce as they issue from the earth. The presence of arsenic in some river waters and springs is a significant fact ; -^ of a grain per gal- lon exists in that of the Mersey, and ^ in that of the Weisbaden mineral water. The well-known high tem- perature of this water, and its greasy appearance and taste (very like that of weak chicken broth), make it indeed a surprising natural object. The advantages of a soft water are, briefly, that it is more economical, by the saving of water and soap in ab- lution and washing of clothes, and it saves fuel by boil- ing at a lower temperature, and by forming no crust, which must weaken the heating power of the fire. Much labour is required for removing this incrustation. Soft water is more suited for most culinary purposes for in- stance, the making of tea. In order to fix on your memories the usual impurities of water, I will add to each of these vessels of pipe-water from the South Basin a re- agent which will detect the presence of some substance, certainly injurious if in excess 1. Carbonic acid is shown by whiteness on 96 THE PURIFICATION OF WATER. adding baryta water. 2. Sulphuretted hydrogen (which I have introduced by adding a drop of this sewage water), by giving a brown or black colour with acetate of lead. 3. Sulphuric acid, by chloride of barium producing a whiteness. 4. Chlorides, by nitrate of silver giving a white muddiness. 5. Lime, shown by whiteness on adding oxalate of ammonia. 6. Nitric acid, which sew- age or graveyard pollution will introduce, by evaporating to a small bulk, adding a little sulphuric acid, and then a drop of solution of indigo in sulphuric acid on heating, the blue color will disappear if nitric acid is present. 7. Organic matter, by the decolorization of solutions of permanganate of potash, and several of the metals might be shown to be present occasionally by the tints they give with sulphuretted hydrogen. The purification of water before it is offered for human consumption is a subject of the very highest importance, and yet one which in many communities meets very little attention practically. Some useful changes occur spontaneously in water, such as the settling down of a sediment of several suspended impurities, and the dis- charge of sulphuretted hydrogen, and for this purpose the water on the West Coast of Africa is exposed in small quantities, or is made to flow in divided currents, before being supplied to our troops. On board ship filthy water will certainly clear, but the dissolved organic matter makes it most dangerous. Every care should therefore be taken to procure a proper supply. Organic matter is chiefly to be removed by filtration through charcoal, exposure which promotes its oxidation by boiling, by the addition of such oxidizing agents as per- manganate of potash, or of astringents such as alum or tannin, the former of which is open to the objection of adding to the sulphate by decomposing the carbonate of lime, but it has the advantage of throwing down all finely suspended particles of clay. Astringents of all kind pre- cipitate the coagulable albuminous matters, and in this PURIFYING WATER FILTRATION. 97 way the strychnos potatorum, or " clearing nut," acts when rubbed upon the vessels in which water is kept in many parts of India. For similar purposes chips of oak are thrown into the drinking water in the country round Bor- deaux. Compare these facts with what we read in the Book of Exodus, when Moses used the bark of a tree to render the waters of Mara sweet. The Chinese can scarcely drink the impure water which their filthy towns afford, but prefer to take weak tea as their constant beverage instead. Filtration through sandstone, or various mixtures of sand and gravel, can only remove the coarse mechanical impurities, and therefore but little reliance is to be placed upon it if the original supply has been impure. Such filter-beds are expensive also, as they require frequent renewal ; thus, it has cost the 50,00d people of Toulouse -40,000 within a- few years for such changes in the fil- tering apparatus through which the Garonne water is passed. For domestic purposes, water may be freed from mechanical impurity by this little piece of French sandstone, to which is attached a flexible tube, or by charcoal arranged in a similar way, and which is small enough to carry in the pocket. Finely-powdered animal charcoal, or bone-black (and that from peat is nearly as efficacious), tightly pressed down and frequently changed, is the most reliable medium for filtering water on the small scale, as it will purify 600 times its weight of water that is, lib. to 60 gallons of water ; but it must be always borne in mind no kind or amount of filtration will ever render impure water quite pure or even safe for drinking. This is unfortunately too true from Dr. Frankland's experi- ments, made on the 10th of November, 1866, for he found that the rice-water cholera-stuff, passed through filtering paper and animal charcoal, unchanged as far as we can tell without experiments which can scarcely be made. , r< In this city charcoal filters may be had of Mr. 98 PURIFICATION OF WATER DISTILLATION. Saunders, 33 Dame-street, and Mr. Maguire, 10 Dawson- street, for the small sum of five shillings. The most impure water, if boiled and passed through them, comes out softer, almost free from organic matter, bright, and well aerated.- The successive layers of sand and charcoal make them closely resemble Nature's mode of purifying water. A company in London has contrived Cittern fitted with Char. an ingenious plan, by which the char- coai Filter. coal filter is placed out of reach by being fixed permanently in the cistern, as represented in the adjoining cut. Boiling removes sulphuretted hydrogen from water ; and carbonate of lime, oxide of iron, and some organic matter, are also cast down ; but it also removes carbonic acid and air hence the flat taste of such water. Water should be always boiled where an impure kind must needs be used, and its aeration, and consequent palata- ble and wholesome properties, can be readily restored by tossing from one vessel to another, as is well known. Boiling, being the most reliable and easiest mode of puri- fying, should be always advised in cities where cholera rages and where the supply is suspicious. Dr. Frank- land indeed doubted the efficacy of this means, but, as was shown afterwards, on insufficient evidence. Even distilling water does not abstract all its impurities, for if rapidly brought over the organic matter, carbonic acid, sulphuretted hydrogen, and even some salts, will be found present, especially in the first and last portions. However, the late Dr. Normandy's plan for obtaining potable water for our sailors, by distillation from the sea- water, and subsequent aeration, was a real boon, and like manny other really useful inventions, was simple and closely copied after Nature, for all our waters are originally had by evaporation from the sea. Freezing expels much impurity, and water obtained therefore by CONDT'S FLUID CLARK'S PROCESS. 99 melting ice may be generally relied on. The addition of Condy's fluid most effectually removes all organic matter, and also lead, iron, and other metals, if present as peroxides. The antidotal powers of this permanganate in cases of poisoning by metallic substances have not been investigated, though they promise satisfactory results. The manganese which would enter the system if water was thus purified would not [prove injurious, as it is similar in its actions to iron, and it is, by the way, found plentifully in the bodies of Scotchmen, who use oats so freely in their dietaries. If the potash of Condy's fluid be thought objectionable, permanganate of lime might be used, as in presence of organic matter that earth would fall as the carbonate. About two ounces of Condy's fluid will render a hogshead of very impure water safely potable, and at a charge of less than a penny. Its patentee is, of course, a more enthusiastic advocate than those less directly interested ; for instance, among many other uses, he advises it for daily ablution, asserting that soap leaves behind upon the skin some of the fatty acids. The oxidizing powers of the permanganate are much increased by a temperature of 150. Carbonate of lime in water, although useful in sup- plying the materials of our bones and in conferring a pleasant taste, may be in excess, and thus productive of disease, as we shall see presently. It may be removed, as discovered by Dr. Clark, by means which seem paradoxical namely, adding fresh lime. The action of the process depends on the fact that much of the car- bonate is dissolved by carbonic acid, with which the additional lime forms a carbonate, and both this and the originally contained carbonate are precipitated. Some entangled organic matter also falls. The plan is adopted in many limestone districts, and is carried out on a grand scale at the Herbert Hospital, Woolwich, and other institutions conducted on hygienic principles. The water with which this city will be supplied from the Vartry 100 SOFTENING WATER THE ROMAN WATERWORKS. will be so much softer than that now used, that the daily quantity distributed to the inhabitants will contain ten tons less of lime salts. This will lead to a great eco- nomy of soap, for it is calculated that the interest of the cost of the Glasgow waterworks is repaid by the saving in this particular, and each Dublin citizen will save one penny per week in washing, and something more in the economy of tea, when the supply of soft Vartry water is accomplished. Notwithstanding the vast amount of intellectual la- bour which is lavished on the study of classics, but little of the sanitary knowledge which the Romans must have possessed has been made apparent ; they seem, how- ever, to have been well aware of the superiority of water carried from a distant pastoral district, and hence the magnificence of their aqueducts, of which there were twenty altogether, and one of them has been traced to a distance of sixty miles. Some of the arches were 100 feet high. The reservoirs, or castella, were of two kinds privata for the houses, and publica for the baths, fountains, public buildings, and to supply the re- quirements of trades. A staff of several hundred men conducted the works, and were directed by a curator aquarum. The water was plentifully used in flushing the sewers, the arrangement of which was also on the grandest scale, for the cloaca maxima is 14 feet wide, 32 feet high, and constructed of Albano stone put together most perfectly. Modern engineers, by bring- ing the supply by gravitation from more elevated sites, have rendered waterworks less costly than they must have been in the cities of old. The question of waterworks is one. of the most im- portant of the day, and in London it is now being debated whether they shall bring the supply from Wales or Westmoreland. The distribution of water by pump- ing is expensive. In London, for every 80,000 gallons raised 100 feet, there is an expenditure of one shilling, THE PRESENT SUPPLY FOR DUBLIN. 101 but in smaller places the expense is proportionally greater. To show the greater economy of gravitation I may instance two works completed by Mr. Rawlinson, the famous hydraulic and sanitary engineer. In Ber- wick the 10,067 inhabitants were supplied with water by gravitation for 7,500, or at the rate of 14s. lOf d. per head ; while in Ormskirk, for 5,548 people 7,000, or 1 5s. 3d. per head, was expended on the works, and there will be a heavy yearly expense for steam- pumping. The present water supply of this city is derived from three sources the Grand Canal, which is stored in Portobello and James's- street basins ; the Royal Canal, which fills the Blessington-street reservoir, and to a trifling amount from the Dodder, which is added to James's-street basin. This river, up to 1775, afforded the total supply for Dublin. The position of these re- servoirs within the city must make them subject to pol- lution by careless or filthy people living near, and from dust and smoke. The quality of the water had been long creating suspicion in the minds of medical and scientific men, for it contained some 16 grains of lime- salts and much organic matter per gallon, while its scantiness at all times, and total insufficiency on the occurrence of fires, was apparent to every one. Along the lowest parts of the city, the quays for instance, the head of water is but 50 feet ; over the whole city the average is half that ; and many places are too high to get any supply. Some active members of the Corpora- tion determined that, if possible, a purer and more plentiful supply should be had for the citizens, and a Eoyal Commissioner (Mr. Hawkshaw) was directed, in 1861, to investigate the subject. Evidence as to its unfitness for drinking was given by such eminent autho- rities as Prof. Apjohu, the President of the College of Physicians, Prof. Macnamara, and Dr. (now Sir William) Wilde. That of the Portobello basin was particularly 102 THE PRESENT SUPPLY FOR DUBLIN. condemned, being found to deposit a large quantity of organic matter, which Prof. Apjohn described as fol- lows : "I may add that it was of two kinds a thready or filiform product, which, when examined under the microscope, appeared to be conferva or fresh water algEe, and a membranous substance of a highly cellular structure, having some resemblance to certain of the spongiae. The latter exhibited two appearances occur- ring on the sides of the basin and interior of the mains, partly as an incrustation of slight thickness, and partly as projecting growths, of the size and nearly the shape of the human fingers. The organized products just described were penetrated by numerous maggots, which had the faculty of spinning threads like those of the spider, executed rapid movements, and were capable of inflicting bites. When a mass of the- mixed organic matter just described was placed in a basin of water, putrefaction rapidly set in, and in twenty-four hours an insupportably offensive odour was evolved." In the field of this microscope you will see several species of minute plants and animals from some of our Dublin pipe-water. All kinds of filth, such as drowned animals, manure soakage from tilled fields, and the refuse from the boats plying on the canal which to the boatmen must have been as a house-drain were added to the water. The boatmen were also in the habit of pumping bilge-water into the canal, but on the representation of the Sanitary Committee, the Company has obliged them to carry it by a pipe to the banks. Most of the Pembroke Town- ship has been supplied with water carted from the Grand Canal at Maquay-bridge, where manure boats have added the most disgusting impurities. Prof. Cameron found it contained, total amount of solid matters per gallon, 22-16 grains ; fixed salts, 16'10 grains ; volatile and com- bustible matters, 5-06 grains ; organic matter, 4-20. grains ; nitric acid, large ; nitrous acid, traces. Active THE VARTRY WATERWORKS 103 steps have, however, been since taken by the company and the police to prevent such evident pollution. This purchasing by the Sandyrnount and Irishtown people of water will cease as soon as the Vartry supply is attained ; and indeed it is to be regretted that that inestimable fluid should ever be a matter of barter, for nature in- tended that it should be as free and plentiful as air. The disagreeable flavour of our water is constantly per- ceived by strangers coming to Dublin, but the sense of taste of the inhabitants is in many cases dulled by habit. More easily demonstrable evils resulted from the scanty supply, for water has not been within easy reach of the poor, especially in the Liberties, in part of which the Corporation pipes are not laid down. As an instance, I may mention that Dr. Ryan some years ago ascertained that of the fifty houses in Plunket-street, containing 800 poor, but one had pipes carried to it. Being dependent, then, on fountains, often at a considerable distance, the poor of this city, numbering over 100,000, have either to do without water, or in fetching it to get drenched with rain on wet days, or in stormy weather by the blow- ing about of the water. They have often to wait at the fountain a long time, amid scenes of contention, for their turn ; and from the want of suitable vessels a sufficiency is rarely obtained. The consequence is, that one quan- tity is put through a round of washing operations, the foul-smelling suds polluting the air of the rooms for many hours ; and under such circumstances personal cleanliness or salubrity cannot be hoped for among the poor or labouring class. But better things are in store for us ; a magnificent system of waterworks is constructed to carry water from a mountainous, granitic, and pastoral district 22 square miles in extent, to collect it in an artificial lake 420 acres in area; and in softness, absence of colour, and purity, even without filtration, the water is not surpassed by that of any city in the empire. The rainfall of the district has for the last five years 8 104 THE VARTRY WATERWORKS. averaged nearly 53 inches. The reservoir, or "Lough Yartry," near Koundwood, is 520 feet above the highest part of Dublin, and is capable of discharging 12,000,000 gallons daily, or about 35 gallons for each person in the city and suburbs. Near the reservoir a tunnel had to be bored through the solid rock for nearly 2 miles, and this has unavoidably delayed the works. The valve- house and screen-chamber at Stillorgan, and indeed all the works, are most interesting, and have attracted many strangers to visit them. Air- valves have been placed at all summits, and scouring-valves at all low levels ; and double mains, so as to obviate inconvenience from one being obstructed, have been laid. There will be also telegraphic communication to every part of the works. Forty-five miles of new mains have been laid. About 80$. per head of the 320,000 persons who will be sup- plied will cover all expense, which is a lower rate than in other cities. The composition of this Vartry water is exhibited in this* table of the analyses of four of our most eminent Chemists : Organic matter. Total Solids. Grs. per gal. Grs. per gal. Prof. Apjohn, T.C.D. ) June, 1-70 4-40 Prof. Sullivan. M.I.I, f 1855. 1'25 4'03 Prof. Barker, R.C.S. ) August, 2-24 4-24 Mr. Plunkett, M.I.I. J I860. 1'24 3'29 As regards supply, it will be brought into, or within the easiest access of the house of the poorest, the cost being placed on the landlord, and already over fifty new fountains have been erected in situations where the supply has been scanty. The water will be on constant service and at high pressure a condition always secur- ing greater purity and economy of distribution through a house, and which is of the utmost moment when a fire takes place. The force will be, on the occurrence of such a calamity, increased by turning off the supply flow- ing to other neighbourhoods. Its constant motion will never allow the water to foul in the pipes. Two great FITTINGS FOR WATER-SUPPLY. 105 mains will diverge at Leeson- street bridge, and after en- circling the city, will reunite at its western extremity, sending off in their course numerous inter-communi- cating branches. So far the arrangement resembles the arterial system of the human body, and when house- pipes are adjusted, and a full scheme of sewerage per- fected, the analogy to the circulation in its arterial, capil- lary, and venous subdivisions will be indeed complete. The following rules and regulations, with regard to domestic water supply, have been issued by the Water Works Committee of the Corporation of Dublin : " They will not permit any fittings, pipes, taps, cisterns, or other appliances to be used for taking water from their mains, or using same within any house, premises, or other place, save such as are in accordance with the patterns selected by them from time to time. The Water Works Committee will not be in any way respon- sible for the perfection of any of the fittings, taps, or other appli- ances put up, or to be put up, in any house or premises, for the supply of water from their mains or pipes. " Each householder will be at liberty to employ any of the plumbers or tradesmen he may select, who will undertake to supply fittings of the pattern selected. It will be the duty of each house- owner to make for himself all necessary provision for the per- fection of the cocks, taps, &c., to be put up, all of which must be in accordance with the required rules. The patterns of cocks and other fittings, decided on by the Water Works Committee as those to be used, can be seen at the Engineer's Office, Corporation Stores, Winetavern-street, daily, between the hours of 10 a.m. and 4 p.m. " The public can buy the fittings from any manufacturer or dealer willing to warrant the supply of same, but they must before being used be stamped with the Corporation brand, to ensure the buyer that they are of the proper pattern and bore. All fittings to be stamped at the office provided for that purpose at the Cor- poration Stores, Winetavern-street, the charge or fee for stamping being one penny for each article. The common ground plug-cock will not in any case be allowed to be used. " 1st. Ferrules The Committee will in all cases provide, and fix at the cost of the party buying them, the brass ferrules by which the service pipes are attached to the mains, and the expense will be three shillings in addition to opening street, which will be charged at cost price. " 2nd. Service Pipes, quality of Leads, &c. The lead pipes and 106 FITTINGS FOR WATER-SUPPLY. lead used for lining cisterns is to be alloyed with tin, and to be procured from the Mining Company of Ireland, and the materials must be branded to show that they are prepared agreeably to the Committee's specification. The following is the minimum weight of lead pipes, which has been settled on as suitable and safe to be used in Dublin, considering the heavy pressure which will be on the mains (150 to 250 feet), and no pipes of less weight will be in any case allowed : ^ inch, 5 Ibs. per yard ; f inch, 8 Ibs. per yard ; 1 inch, 1 1 Ibs. per yard. The Water Works Committee are of opinion that in many cases the existing service pipes will be of sufficient strength, and freedom from flaws, &c., to suit the new supply ; they, however, earnestly recommend that when arranging the fittings, the plumbers be required to test the strength of existing pipes for flaws and defects, which can be easily done by the use of a force pump and a pressure gauge fixed on pipe. " 3rd. Stop-Cocks A screw-down stop-cock must be fixed in the street on the service pipe of every house, protected by a metal hinged cover set in a granite flag, of the pattern selected and to be seen at office, and the charge for this work will be five shillings. In addition to this external cock, the Committee strongly recommend householders to have another stop-cock placed on the service pipe within the house, in some convenient place, easy of access, in case they might find it necessary to turn off the water in case of frost, &c., one on each storey is recommended for house supply. " 4th. Nose, Bib, and Stop-Cocks Screw-down stop-cocks only will be allowed, and these to be of the pattern selected by the Committee viz., the pattern known in the trade as Guest and Chrimes's single or double loose movable valve, and Lambert's diaphragm valve cocks. Screw nossels for the supply necessary for the washing of shop fronts, must be arranged according to special agreement. The material and workmanship must in all cases be of the best quality. Ball-cocks to be used, to be of the pattern known as Guest and Chrimes's high pressure loose valve-cock, or Lambert's patent equilibrium ball-cock. As it is usual for plumbers to fix the levers and balls to these cocks, the following length of lever and size of ball must be used : gj ze O f Length of Lever. Size of Ball. Cock. GCEST & CHIUMKS. LAMBERT'S. Inches. Inches. Inches. Inches. Inches. 5 12 5 6 12 7 7 14 8 " 5th. Cisterns All new cisterns if lined with lead, the lead must be alloyed with tin, and be procured from the Mining Com- THE NEW WATERWORKS RESERVOIRS 107 pany of Ireland, who have undertaken to have it prepared agree- ably to the Committee's specification. All cisterns provided with overflow pipes must have those pipes so contrived, that their dis- charging orifice or mouth must be visible to the occupiers of the house, or to the inspector, turncock, or police going their rounds, so as to insure there is no waste of water. The position of waste pipe to be approved of by the City Engineer, or other authorized officer. The top of the house is recommended for cisterns. " 6th. Water-Closets No water-closet will in any case be allowed to be supplied direct from the main or service pipes. All closets must have an apparatus to prevent waste of water, to be approved of by the officers of the Committee. A bath of not more than 60 gallons, and without an overflow-pipe, will be allowed without charge." For the inestimable blessings of a free and pure sup- ply of this health-giving element, not only the present generation, but many future ones, will owe much to the zeal of the Corporation, their Engineer, and the un- paralleled energy of Sir John Gray, M.D., M.P., the Chairman of its Water Works Committee. At foreign MOVEABLE COVERING STONE PAVING LEVEL OF GROUND Filtering Tank. military stations, rain water is collected, filtered, and stored in the way depicted in this wood-cut, copied from 108 CISTERNS LEAD-POISONING THROUGH WATER. that recommended by the Barrack Commissioners, and the supply of Constantinople and Venice is from the same source, stored in conical cisterns under the houses. The material most suitable for cisterns or main pipes is cast iron, but for small vessels, slate or earthenware may be used. Even for house-pipes there is nothing so good as iron, if galvanized to prevent rusting. All sub- stances which allow permeation of fluids should never be used for storing water as soakage from refuse would then readily occur and the tank should be covered to exclude pollution from the air. If the dustbin or cess- pool be close to the water cistern, and the latter un- covered, all kinds of filth may be blown into it espe- cially as servants are careless. Iron precipitates organic matter, as was conclusively shown by Medlock, who found the entire of the organic matter, 2-1 grains, of the water of the Dune Canal, Amsterdam, was thrown down as a brown deposit by remaining in contact with it for forty- eight hours. The nauseous taste of the water was thereby removed completely. Even water rendered im- pure by sewage, urine, or sulphuretted hydrogen, it is eaid, can be rendered fit for drinking by exposure to iron and subsequent filtration. The result is due to the production of the powerful oxidizing agent, nitrous acid, from the nitrogenous organic matter ; and any of the metal which becomes dissolved can have no hurtful effect. Some advise, however, the coating of iron pipes with zinc or varnish, and the mains of our new works will be varnished, both inside and outside, according to Dr. Angus Smith's patent method. The danger of using lead for pipes or cisterns is now well known ; the case of the late royal family of France at Claremont having made the matter notorious. In this case there was T ^ of a grain in the gallon, and one-third of the persons, who drank this water were affected. But even T ^ of a grain per gallon has produced palsy in those who drank this impurity habitually. If the water PROPER QUANTITY OF WATER. 109 contains much organic matter, there is great danger, for the nitrogen so supplied forms nitrous acid which dis- solves the metal ; but very pure water will also act on it thus the extremely pure water supplied to Manches- ter will take up the | of a grain per gallon in twelve hours, and deaths by lead poisoning have thus occurred in that city. Notwithstanding the interest excited by this subject, some facts are as yet undetermined. Thus, we do not know why Thames water will at one time dis- solve lead, and notjat another. One fact, however, is cer- tain this metal, unless alloyed with others should never be used for the storage or conveyance of drinking water. The means for collecting water in countries where it is scarce and impure forms now a portion of military hygienic instruction, and one of the best and readiest means for this purpose is a barrel pierced with holes, and placed inside a larger one, also pierced, the interval being filled with charcoal. Many impurities are thus strained off, and until such plans were adopted, the French soldiers in Algiers are said to have often swal- lowed leeches in drinking. The quantity of water which should be ingested daily under the guidance of the sensation of thirst, varies much, and in these countries averages some three pints ; but in the tropics, where evaporation is so enormous, eight pints are permitted by military regulation. For cleansing purposes and flushing of sewers from fifteen to twenty- five gallons daily per head are said to be requisite, and fully this quantity was to have been supplied to each individual in Liverpool by the new waterworks. How : ever, according to the local act, the mills along the water-course had a primary right, and powers are being sought to obtain a more extensive supply. They boast in New York that the Croton Works allow 300 gallons per head ; yet on the late sanitary survey very many houses were found destitute of supply. The baths of ancient Rome were so enormous that this amount was 110 DRINKING FOUNTAINS. indispensable. In manufacturing towns the quantity should be one-third greater. As long as it is insured that no waste occurs, pure water ought to be supplied abun- dantly within the reach of all, and it is nearly as unfit that water should become a commodity as that air should. In 1817 Lord Cockburn wrote : " Standing in a rainy country, Edinburgh has been always thirsty and unwashed the condition of the city in reference to water positively frightful ;" and that matters in that great city are not much bettered even now, would ap- pear from the forcible " Lectures on Public Health, in relation to Air and Water," of Dr. Gairdner. In large cities drinking fountains are always most useful, and that they are largely partaken of may be learned from the fact that 90,000 drinkers daily have been counted at that in Bethnal Green, London. When we get our new pure and plentiful supply, no better means for exer- cising benevolence, or honouring the memories of our departed great ones, could be adopted than the erection of such fountains, if they can be made at all ornamen- tal, and not allowed to become dry, as most of them in Dublin are. Provided means are taken to prevent waste, the erec- tion of water-closets should be encouraged in every city. The waste-box or cistern now in use serves the purpose of preventing waste. A gentleman lately remarked in my hearing, that such an apparatus would be disar- ranged by the poor, and recommended a member of our Health Committee to try it in a few parts of the city, to see if it would succeed. This gentleman, however, was so confident of its efficacy that he said he might as well advise umbrellas " to, be tried in a few parts of the city." However, with the present scanty supply of this city, I hesitate to recommend the erection of such conveniencies, as I fully agree with Mr. J. H. Owen that the formula W C W is always to be condemned. If I have succeeded in showing the necessity of a WATER CURE. Ill plentiful supply of pure water to the human body, you will not be surprised to hear that many diseases owe their origin or increase to a scanty amount or impure condition of that fluid. The metamorphosis of tissue, or the removal of old material and the deposit of new, which is momentarily taking place in our bodies, is much in- fluenced by the great solvent, water, and it is found to be unduly promoted by too much of this liquid food, and still more hurtfully checked by too little. Evils from excessive thirst are very rarely experienced in these countries at least, but the debility and emaciation pro- duced in those who fanatically pursue hydropathy illus- trate the former condition. I have not time to touch upon the curative powers of water, which have been unfortunately monopolised of late by the grasp of char- latanry although, in truth, this " water cure" is as old as the Deluge, and like it, as Charles Lamb said, " killed more than it cured." At the same time, it is to be re- gretted that calm and judicious physicians have not worked out the real benefits it is capable of conferring vi the cure of disease, for they may equal the innumer- able advantages towards the prevention of sickness, and promotion of health and cleanliness, to be derived from this inestimable gift of Providence. As Baron Liebig has been stated to be favourable to hydropathy, I may be allowed to quote his sentiments in his own words : " The existence of hydropathic institutions those dens of covetous and rapacious gamblers, where the wretched invalid resorts to throw dice for health and life ; the rise and progress of the homoeopathic system, which treats truth with scorn and bids defiance to common sense, loudly proclaim the need which exists for the adoption of settled principles, definite methods of re- search, and a systematic arrangement to guarantee their attainment and retention." The effects of excess of calcareous salts in water are difficult to recognize, as they are insidious and take a 112 LIME SALTS DYSPEPSIA GOITRE. long period for their development ; but a peculiar form of dyspepsia is now often assignable to this cause, as well as diarrhoea and subsequent dysentery. These diseases have become much less frequent in Glasgow since the very pure water supply from Loch Katrine. Prof. Cameron found 84 grains per gallon of sulphate of lime (plaster of Paris) and 168 grains of total solids in the pump water of one of the fashionable clubs in this city, and attacks of diarrhoea and cholera were experienced by some of those who drank of it. That analyst also found nearly 109 grains of the same salt in another pump water, and as it does not naturally exist in the rock formation of Dublin he supposes that it results from the decomposition of sulphide of iron and car- bonate of lime. Horses supplied with water charged with sulphate of lime often lose health, as grooms notice by the roughness of their coat. Bony tumors in cattle, and some forms of calculus in man, have been said to have been more frequent from impregnation of water with this and other calcareous salts. The diseases, however, which have been shown by recent scientific labours indubitably to depend on such causes, are goitre and the lamentable state of semi-idiocy called cretinism which sometimes accompanies it. In Durham gaol goitre was very prevalent some years ago, and it was found that there were 77 grains of lime and magnesia salts per gallon in the water the inmates drank. The disease decreased in those affected, and no new cases appeared after the amount of these salts was reduced to 18 grains. It has been traced over limestone dis- tricts in several parts of England, Switzerland, and India, and in this country the same distribution of the disease has been shown by Dr. Martin of Portlaw, for it was prevalent on the Kilkenny side of the river Suir, where the stratum was limestone, and almost never seen on the Waterford side, where it was old red sand- stone and silesian slate. In Gorruckpore the soil upon GOITRE DIARRHCEAL COMPLAINTS. 113 which many villages is built is so calcareous that some specimens contained 25 per cent, of carbonate of lime, and 10 per cent, of the adults are affected with goitre, and about an equal proportion of the children are afflicted with the pitiable state termed cretinism. The bones of the skull are found so altered in shape and their openings so contracted that it is supposed that the lime and magnesia salts are deposited in them, and this condition is believed by some to be the cause of this kind of idiocy, by interfering with the circulation of the blood in the brain. The dogs and cats are said even to be affected by the lime-salts. Outbreaks of diarrhoea and dysentery are often attri- butable to organic matter in water, more especially if it be that variety which is derived from sewage and is undergoing decomposition. Dr. Greenhow records a notable instance. In the Southwark prison, for one day only, the water was drawn from a tank, the overflow pipe of which communicated with a sewer ; nearly all the inmates were attacked with severe diarrhoea, which in nearly all instances began within the twenty-four hours succeeding the introduction of the poisonous water. The discharges in dysentery are especially hurtful, and are even so when the attack has been due to mere exposure to cold : an example of the origination of a spreading disease is thus afforded. Typhoid fever is now believed to be due to the introduction of sewage matter in this way ; or, according to others, it is necessary that the peculiar morbid matter excreted from the bowels of a patient already attacked should find entrance. In the charity convent at Munich, 31 out of the 120 inmates were suddenly taken ill, 14 with typhoid; and the well- water was found to have been polluted with the dejec- tions of typhoid patients. All sickness ceased when the water was disused. Bedford has been a favourite habitat of typhoid fever. Let me, therefore, read you a few facts from the report of Mr. Simon exhibiting the SPREAD OF CHOLERA BY WATER. nature of its sewerage and water supply : " The drainage of Bedford is most defective. Cess-pools are almost uni- versal; there are said to be upwards of 8,000 of them. They soak all their contents into the soil, for the local act forbids any drainage of them into the sewers. The refuse of 1,300 people thus percolate into the wells from which the water supply is derived." Some months ago nineteen persons in a large house were attacked with typhoid fever from drinking the water of a well, within four yards of a cess-pool. As is often the case with re- gard to the most poisonous water, this specimen was beautifully sparkling, and had no bad taste or smell ; but the microscope displayed crowds of organic forms, and analysis revealed nitrous acid and organic matter in abundance. In the West Indies, dysentery has been often shown to depend on the impurity of water ; and so f[ell was this known, that it was not unusual for guests invited to dinners to bring their drinking water with them. The fearful losses by dysentery at Cuidad Rod- rigo were attributed to the drinking of water which flowed through a cemetery in which 20,000 bodies had ieen hastily buried. I will cursorily allude to the fact, that cholera is due to the use of contaminated water, and will lay before you some of the instances which seem to corroborate that view; and first, of the famous Broad-street pump. The cholera broke out in this neighbourhood in 1854, and killed 500 people in less than one week. Dr. Lankester examined the water of it, and found the re- markable fungus, his representation of which I show you on next page. According to an analysis of the late Dr. Dundas Thomson, it contains over six grains of organic matter derived from sewage. The clearest case where cholera was due to it was that of a lady, who having resided in the vicinity, moved to Hampstead, some three miles dis- tant. The pump-water in Broad-street was so sparkling BROAD- STREET PUMP. 115 and pleasant, that she sent daily for it. She and her niece were the only persons attacked with cholera in Hampstead, and her servant suffered from severe diarr- hoea. This fact of the water of a dangerous source being A represents the spore case, and B one of the branches, with particles moving through it. apparently good, and being often a favourite with those living near, should not be forgotten ; the sparkling cha- racter indeed depends on the impurity of which the carbonic acid is at once the cause and the remedy. These evils ensue from allowing shallow wells to be used into which sewage matter soaks ; and although their unfitness has been often demonstrated, it was not until lately generally understood, for we find three chemists who were appointed to examine the waters of the metro- polis reporting in 1851 : " That the shallow wells of London have never been pronounced unwholesome." I know of a well in Dublin some dozen feet deep, which supplies abundantly water stinking abominably of sul- 116 IMPURE WATER DUBLIN PUMPS. phuretted hydrogen and decomposing animal matter; and Dr. Lankester gives a figure showing the crowd of plants and animals, and their organic food, contained in water from a surface-well at Sandgate, which he tells us produced disease. The sewer water which he also figures is scarcely more crowded with disgusting objects. The wells near grave-yards contain much impurity. I know for instance one in Cork, in which 15 grains of organic matter per gallon exists. It should be remembered that a well of some 70 feet in depth will drain the soil round, if it be loose, for a radius of even 100 feet. If wells be continued as the means of supply for villages, they should be protected by water-coping, to prevent filth from the surface being washed into them during heavy rains. There can be no doubt that serious diarrhoea in ordi- nary years can be traced to the drinking of impure water, especially that contaminated by sewage or other animal matter. In times when cholera is epidemic, the impu- rity becomes more serious by predisposing persons who drink such water to this scourge, or by actually spread - it if the sewage from cholera-haunts finds its way, by soakage or otherwise, into the earth from which the water springs. It was for this reason that Prof. Cameron and I determined to examine the well and pump waters in this city at the recent outbreak of cholera. Many were found very impure, but in the following there was such imminent danger, that we resolved to have them closed forthwith. The results of the Professor's analyses are as follows : St. Nicholas's well, livery stable yard, Francis- street total amount of solid matters per gal- lon, 38-68 grains; fixed salts, 33-08 grains; volatile and combustible matters, 5-55 grains ; organic matter, 4-05 grains ; nitric acid, excessive ; nitrous acid, large. Pump in a stable-yard, Lamb's-court, Corn-market total amount of solid matters per gallon, 39-93 grains; fixed salts, 33-98 grains ; volatile and combustible mat- IMPURE WATER AND CHOLERA. 117 ters, 5'95 grains ; organic matter, 3-86 grains ; nitric acid, excessive ; nitrous acid, large. Pump in Farrell's yard, Marlborough-street, within one foot of St. Thomas's grave-yard total amount of solid matters per gallon (70,000 grains), 41-97 grains; fixed salts, 85-80 grains; volatile and combustible matters, 6'17 grains ; organic matter (estimated), 3'10 grains; nitric acid, large; nitrous acid, none. The dependence of cholera upon impure water has been clear Jy proven by the admirable researches of the medical officers of health in London. Dr. Dundas Thomson says : "But perhaps the most horrible example on record of the fatal effects of impure water occurred in 1854. I found that the Southwark Company's water was of a different composition from the water of the Lambeth Company. When I applied a piece of muslin over the supply pipe of the Southwark Company to the cistern iii my laboratory at St. Thomas's Hospital, a large quan- tity of human excrement was detained, and the impurity in solution was much greater in the Southwark Company than in the Lambeth water, which contained little or no matter in mechanical supension. The Lambeth water was obtained from Hampton, while that of the South- wark Company was pumped up from the river near Vauxhall-bridge. These two companies possessed mains in the same streets, and supplied the houses indiscrimi- nately. Analysis alone enabled me to detect the two waters, as the inhabitants, without consulting their water receipts, were unable to state the source of their supply. And although the population supplied by the two com- panies was precisely in the same condition, except as to water, the cholera deaths in the houses supplied by the Lambeth Company were 37 to every 10,000 ; and in those by the Southwark Company 130 to 10,000, or as 1 to 8J-. I conclude from the data supplied, that 2,500 persons were destroyed by the Southwark water, who 118 WATER IN INDIA SUPPLY FOR VILLAGES. would have been saved if they could have obtained the Lambeth water. It is a remarkable fact that the Lam- beth water, in the epidemic of 1848-9, was more fatal in its effects than the Southwark, the Lambeth Com- pany taking their water lower down the river at that time. The mortality in houses supplied by the Lambeth water was 125 in 10,000, while the deaths in houses supplied by the Southwark water were 118 in 10,000." The same energetic physician records it as a matter of general belief in India, that cholera is producible mainly by water ; and he relates the following instances of the way in which reservoirs of that inestimable fluid are treated : " One large tank, I recollect, which was used for the supply of water, had located on its banks several faquirs, who had resided there for years. One of these who had made avow to allow his nails to grow for twelve years, attracted my attention particularly by the remark- able appearance of his nails, which resembled ram's horns in being twisted and indurated to the extent of six inches. I was desirous of getting a specimen of his cast-off nails for my museum, but he replied it was part of his vow to throw them into the tank, where also all excretions were deposited, and where his ablutions were performed, ac- cording to his own statement. These waters contained much organic matter in solution, a considerable amount in suspension" I endeavoured to prove in foregoing lectures that the circulation of pure air was a duty we owe to ourselves as well as to our neighbours, and that allowing it to be confined and fouled, was doing serious injury to others ; and the same consideration is of even greater weight with regard to water. When it is remembered, there- fore, that diarrhoea, cholera, and typhoid fever, are pro- pagated by means of contaminated water, and that pro- bably other diseases have a similar origin, no arguments are needed to prove that a supply of that requisite, pure and above all suspicion, is desirable for our towns ; yet SUPPLY OF WATER FOR VILLAGES. 119 every town in Ireland, with three or four exceptions, derives its supply from superficial wells or pumps, or from the rivers passing through ; and such sources are rarely, if ever, free from pollution. Some years ago Dr. Voelcker, the eminent chemist, found that the water of many superficial town-wells contained three times as much organic matter as the tank liquid with which Mr. Mechi was manuring his land. I believe the geological structure of Ireland does not often afford artesian wells, but deep wells or pumps, the circumference of which should be of cemented brick, and puddled to prevent all soakage, and placed in situations away from cesspools, should be freely provided in small towns and villages. For larger towns Sligo, for in- stance a supply from a lake, stream, or catchment basin in a pastoral district, should be always obtained and distributed by pipes to all houses in the town. For the borough I have name/l a water bill is now before Parliament, under which it is proposed to carry a supply from a river three miles from the town, and this is one of the many benefits which dread of cholera has wrought. A river which has passed a town should never be used as a source for drinking water, even if the sewage should have been utilized on the land. The sewage water from the town of Croydon, after being irrigated over the farm for the purpose, passes limpid and apparently pure into the river Wendle. I have examined it, however, microscopically and chemically, and find it loaded still with organic matter. Indeed, when kept, it throws down a filthy sediment and smells badly. A year ago, at the Society of Arts, Mr. Baily Denton, the eminent engi- neer, proposed a mode of water supply for small villages which was approved by other eminent engineers and sanitarians. It was that the water of under- drainage, which has filtered through four feet of earth, and which is remarkably pure, should be collected in the most pas- toral neighbourhood of the village. For a village of 100 9 120 AGUE YELLOW AND MARSH FEVERS. houses from 7 to 12 acres would suffice, and the whole expense, including the purchase of a reservoir % of an acre in extent, to give water for the four summer months when wells are dry, would be 415, which a yearly pay- ment cf 5s. 3d. on each house for 30 years would refund. We are told that in the middle ages, when pestilence seized upon a town, the citizens put to death the physi- cians, believing they had poisoned the wells an accusa- tion which has often been made since even the days of Thucydides and they built over all these sources of polluted water. Such suspected pollution was also often made a pretext for persecuting and expelling the Jews from the towns. When cholera spreads in some towns where the authorities provide no safe water-supply, they will deserve punishment, although of a milder nature than that which the barbarism of the dark ages inflicted. That yellow and marsh fevers are due to the water the patients have drunk, is credited by many mainly on such evidence as the following. All on board a ship which had watered at Jamaica, except those who messed at the captain's table, were attacked by yellow fever. The water used by the captain and his friends was brought in the out voyage from Europe. The transport ship Argo, which in returning to Marseilles took in a water-supply at a creek in Algiers, and many on board were seized with ague, while no case of that disease occurred on board a companion ship which made the same voyage, but did not water off Algiers. Ague is rife in Indian villages, where they drink ditch and marsh waters, and the disease is more rapidly produced, and is far more fatal, than when caught by the air. Prof. Parkes thinks that the ex- traordinary decline of the disease in England may be due to the purer water now used. Many diseases for example, yellow fever and boils were at one time believed to be producible by sulphu- retted hydrogen in water, but that gas abounds in the. Harrogate and other sulphur springs, which give rise to no such effect. PARASITIC DISEASES. 121 It may be regarded as almost proven that the eggs or embryos of many parasitic worms such as the common round worm of children, the guinea worm, and broad tapeworm, the rare one in this country gain entrance into the human body by means of the water we drink ; for, as no one believes now in the doctrine that they are spontaneously generated, in either our food or drink they must lie concealed. The influence of a scanty water-supply in promoting typhus and skin diseases, I shall speak of in a future lecture. LECTURE V. INFLUENCES OF SOIL AND CLIMATE ON DISEASE CLIMA- TOLOGY OF IRELAND. THE plants which man consumes as food, and those which feed the animals he makes subservient to his uses, derive their sustenance from the soil or surface- crust of the earth ; the atmosphere and waters which surround him also are influenced most powerfully by this soil, so that it becomes nearly as important a factor in determining questions of public health as the air we breathe or the water we drink ; and again, as there is a constant mixture in nature of air and water, and as the varying conditions of these constitute the science of meteorology, I have thought that the subjects of soil and climate should next engage us. All soils consist of crumbled rocks broken down by the action of air and water, and mingled with vegetal and animal matters ; but they may be arranged in three classes according to the preponderance of each constituent thus, calcareous soils contain carbonate of lime plentifully, the sandy possess much silica, and the clayey consist almost entirely of alumina. The farmer delights in a mixture of these, which, under the name of loam, has been always re- garded as most fertile. Besides the vaster metamorphoses which heat in past epochs has wrought in the geological features of a coun- try, changes are constantly occurring in the nature of soils ; for instance, the clay or lime is washed from the higher to the lower levels, leaving but the barren quartz behind. In drier countries winds will act similarly, and will carry off the richer soil as dust to other districts ; or if blowing from the sea, they may render sterile cultir, ... vated fields, by covering them with sand. By the wind CONDITIONS OF SOIL. 123 also are carried those innumerable germs of plants which clothe with vegetation coral islands shortly after they have been projected from the bosom of the ocean. Water along the banks of rivers carries away and sorts various soils, and give rise to what are termed alluvial deposits ; and lastly, dying trees or smaller plants accu- mulate and blacken into humus or peat in situations where shallow water rests on an impermeable bottom circumstances which concur in so large a portion of the western and central districts of this island. In other countries vegetal matter acted on by fire in past ages has given us coal ; and from the excretions of animals such rich mines of agricultural wealth as the guano of Peru or the coprolites of England have resulted. The degree to which each variety of soils retains heat is the first hygienic circumstance concerning them I shall notice. Sand excels all others in this respect, and if its capacity be represented by 100, that of light clay will be 76, pure clay 66, calcareous matter finely pow- dered 61, and humus or peat 49. The suitableness of a sandy soil for bivouacking in the colonies depends on its great retaining power for heat. The capacities of these soils in absorbing and holding moisture is in re- verse order ; and with regard to humus, so great is its thirst for water, that it will attract fifty times as much in a given time as a sandy soil. In the ordinary sea-sand there is contained two gallons of water per cubic foot, and even in the densest limestone half-a-gallon. The per- meability of soils to water and to air, and their capability in lodging subsoil water, have, as we shall see hereafter, a most important bearing on the generation of cholera and typhoid fever. Even the colour of a soil is an item in its climatic features the dark-coloured absorb- ing and radiating heat, the light- coloured reflecting it. Humus and clay have, moreover, the property of retain- ing organic matter, some of which must, however, un- dergo destruction by oxidation or else the accumulation 124 SOILS AND SITES. t of vegetal debris in forests, or of animal refuse near cities, would render whole districts uninhabitable. Vegetal matter is slowly destroyed for instance, the soil of the Tuscan Maremma contains 80 per cent., and to this is probably owing its malarious effects. The affinities of different soils for heat, moisture, and organic matter, have an important bearing on the ques- tion of what are the proper sites for camps or hospitals, a subject on which Miss Nightingale has the following apposite remarks : " As the object to be attained in hospital construction is to have pure dry air for the sick, it will be evident that this condition cannot be fulfilled if a damp climate be selected. It is a well-known fact e. g., that in the more damp localities of the south of England, certain classes of sick and of invalids linger, and do not recover their health. Again, retentive clay subsoils keep the air over entire districts of the country always more or less damp, and soils of this character should not be selected as sites for hospitals. Self- draining, gravelly, or sandy subsoils are best. River banks, estuary shores, valleys, marshy or muddy ground, ought to be avoided. It may seem superfluous to state that an hospital should not be built over an old graveyard, or on other ground charged with organic matter and yet this has been re- cently done. Although hospitals are intended for the recovery of health, people are very apt to forget this, and to be guided in the selection of sites by other con- siderations such as cheapness, convenience, and the like ; whereas, the professed object in view being to secure the recovery of the sick in the shortest time, and to obtain the smallest mortality, that object should be distinctly kept in view as one which must take pre- cedence of all others." Such principles also should guide the immigrant in choosing his settlement in our colonies. The configuration of the ground is also important, for EFFECTS OF CULTIVATION ON SOILS. 125 a flat or concave surface will allow the accumulation of water, which can scarcely be drained off, but must escape by evaporation, and promote malarious and other dis- eases, as I have already ascertained to be the case with some of the most populous districts in our city. Every rural physician will be able to call to mind the spots where fever most frequently requires his presence, and they will be usually found to be the low-lying misty places, especially if cesspools add organic matter to the air, for the moisture of the atmosphere renders the latter much more hurtful. The amount of vegetation is important in determining the salubrity of any place ; thus while herbage is always useful, brushwood, by preventing the access of the sun's rays, evaporation, and the movement of the air, is most injurious ; and lastly, trees, if not too close, serve the healthy purposes of moderating wind, affording shade, and checking the spread of malaria. Cultivation has usually rendered unhealthy places much more salubrious, although when first commenced in countries where the soil abounds in decomposing organic matter, ague and similar maladies have quickly followed when the earth was first turned. Cultivation will, moreover, always be the great spoliator of land, if means be not taken to re- store to it the constituents which are abstracted from it by plants ; and the evils of this error are very apparent in some colonies, especially in those regions of North America which have been cultivated for the first time. For instance, a settler establishes himself upon a fertile spot, and in a few years so exhausts it of materials which he takes no care to replenish, that it becomes barren, and he is forced to desert it to inflict the same injury on another district. From like causes the Cam- pagna, which once supported thirty flourishing cities, is now a desert. Such results could not occur if the land had had restored to it, by manuring with animal and vegetal refuse, the elements of which it had been de- 126 ALTITUDE AND DISEASE. prived. The physical or geographical circumstance which most closely influences the salubrity of a district is its elevation, which, if moderate, affords most favour- able conditions ; and the natives of elevated districts are always hardier and more enterprising than those who dwell on plains. In ancient history, mountaineers were nearly always the conquerors, lowlanders the conquered. The atmosphere of elevated localities is usually cold, dry, and free from such organic or artificial gaseous im- purities as I have spoken of in previous lectures ; and as refuse rapidly drains off, the water is usually pure. Elevation is the chief climatic condition which is pre- ventive of consumption, and in California and some Alpine situations, cure of the disease is believed to fol- low a change to mountainous residences. That it is the open air exercise which produces the good effects would seem from the fact, that on the Swiss heights the men are free from consumption, whereas the women, who work with the needle in close rooms, are very sub- ject to it. You will remember the facts I submitted to you, showing the connexion between altitude and typhoid fever ; yet the latter disease, while generally traceable to imperfect sewerage, has been observed among the hunters on the Rocky Mountains by Dr. Hammond, the late Surgeon- General of the United States army. The salts of mountain springs and streams varies with the geolo- gical substrata, and as they are often calcareous or mag- nesian, the proclivity of the inhabitants of hills, or the valleys between them, to goitre or cretinism, is thus accounted for. Sunlight does not act on mountainous places so freely as on the plains, and this want of insolation, in conjunc- tion with the low temperature, produces that stunted and blanched or etiolated character occasionally seen. The obstruction to light which the smoke of cities, where manufactures are carelessly conducted, is highly promotive of consumption and general enfeeblement. THE DUBLIN MOUNTAINS. 127 Even in the hottest climes India, for example elevated spots with moderate temperature occur, and are taken advantage of in that country for the erection of sanitaria for our troops. The bracing air and exhilarating scenery which may be enjoyed upon mountains are remark- ably efficacious in promoting recovery from debilitating diseases, and I regard the Dublin mountains as perfect sanitaria, from some experience of their powers in re- storing health to patients whom I have urged to reside on them for some weeks. The breathing capacity of those dwelling at great altitudes for instance, the Inca Indians is most enormous ; and this may account for the preventive power of such residence over consump- tion, for greater efforts are required to inhale enough oxygen in such a rare atmosphere, and the chest be- comes enlarged and the lungs expanded even the upper parts of them, which are especially prone to disease from being disused, now dilating. Circulation, and all the nutritive functions to which it ministers, becomes more active. Long-continued residence at great heights is, however, said to be injurious to those born in lower regions'; thus, the monks of St. Bernard cannot remain at their hospice, which is 7,668 feet above sea level, for more than a few years. Plains differ very widely in a sanitary point of view accordingly as they are high tablelands, or are sunken between elevated lands ; the former are most healthful, as exemplified in the interior of Spain, which presents the strongest contrast in salubrity with the coast ; the latter frequently have an alluvial soil, and are highly promotive of malarious disease. In Mexico there are, however, malarious marshes at a level of 6,000 feet above the sea. Valleys in the midst of mountains, or what are in this country so often called " punch-bowls," are insalubrious from a want of free circulation of air. The plains at Walcheren, on which an army of 43,000 men almost entirely perished in a few months, are below 128 CORK LATITUDE. high-water mark, and are surrounded by dykes, the soil being principally sand. The sea-shore is healthful because of the purity of air, its abundance of ozone, and the delightful freshness and stimulating influence of the scenery, more especially the exquisite alternations of light and shade which the ocean presents. The humidity of the air, and the cold winds which often prevail during the winter and spring months, make it, however, an undesirable resort for many pul- monary and rheumatic invalids. Places at the mouths of rivers are much less healthy, as organic matter in abundance collects about them, more especially if the river has been the main sewer of the town. In India nearly one-third of the surface is covered with alluvial deposit, and hence much of its unhealthiness till drained and cultivated. The prevalence of ague, fever, and other zymotic diseases in Cork, and its high death-rate, as well as that of Limerick, seem to be partly explicable in this way. Latitude, or distance from the equator, is an important factor in determining the complex question of climate ; but disturbing influences, some of which I have already set before you, render the subject one of peculiar diffi- culty, which even the profound Humboldt acknowledges when he says : "If the surface of the earth consisted of one and the same homogeneous fluid mass, or of strata of rock having the same colour, density, smoothness, and power of absorbing heat from the solar rays, and of radiating it in a similar manner through the atmosphere, the iso-thermal, iso-theral, and iso-chimeral lines would all be parallel to the equator. In this hypothetical con- dition of the earth's surface, .the power of absorbing and emitting heat would everywhere be the same under the game latitude." As an instance of these disturbing circumstances, I may mention insular position, for temperature and other climatic features are more equable in islands than on CITIES STABILITY OF TEMPERATURE. 129 continents, owing to the power which the ocean has to distribute heat and moisture ; seasonal changes are, therefore, less sudden, and periods of rain or drought less prolonged. Our own island, warmed as it is in addi- tion by the gulf- stream issuing from the Gulf of Mexico, illustrates these natural advantages, as also does that not sufficiently valued bathing-place, the Isle of Man, which in coolness of summer and mildness of winter is not equalled by any part of the mainland of the British Isles. I have perhaps, dwelt at sufficient length on previous occasions on the circumstances which depress the salu- brity of cities, when talking of the impurities which pollute their atmosphere, and the difficulties which attend their purification by natural means, because of the scantiness of vegetation and the close and irregular v/ay in which their streets are too often built. I shall, therefore, now merely mention the fact, that the tem- perature of towns is kept higher than in the surround- ing country by the numerous fires, by over-crowding, and by the absorption of heat by stone and brick. The mortality of cities is for these reasons somewhat greater than that of rural districts, other things being equal, but they are free from diseases of malarious origin. The first climatic condition of which I shall note the effects on the health of man is temperature, and in esti- mating this item, the annual and monthly mean must not be the only information recorded, for the maximum and minimum, as well as the rapidity with which they fluctuate, are really more important, especially in their influence on the breathing organs, including the skin. Two places may have mean temperature of 65, yet in one the fluctuations may be between 30 and 100, while in the other the climate may be so equable as to range but from 60 to 70. The variations in the for- mer case are especially pernicious if they occur with suddenness, as is painfully illustrated in that grave of 130 DRY AND MOIST HOT CLIMATES. our countrymen, New York. The poor emigrants who arrive there with bat a single suit of clothes are pro- strated in hundreds by bronchitis, or by its frequent re- sult in ill-fed persons, pulmonary consumption. I may mention that the mean daily temperature can be readily determined in any place by observing the degree exactly at sunset, as Humboldt discovered. The method which the same philosopher recommends for ascertaining the mean annual temperature namely, examining water just as it issues from a spring is not reliable, for depth and other circumstances produce every variation in springs between those that are near the freezing point to those that are thermal almost to ebullition. What everyone knows of the effects of the hot dry air of a bath upon the human skin is true of the influence of a hot dry climate, for both extremely promote cuta- neous action, which, by the evaporation of the perspira- tion, obviates to a great extent their great heat. No very high temperature is endurable in moist air, for per- spiration cannot be then so free, and diseases of inter- nal organs ensue from the excessive rush of blood to them. In hot climates India, for example the skin acts so freely that little water is left to carry off the waste matter from the kidneys ; the lethargy which prevents exercise produces torpid livers, and these cir- cumstances effect the types of disease which prevail. Without proper ventilation in caps, the heat of the head may be raised so high as to endanger the due circulation of the constituents of the blood or the action of the nerve currents. In parts of Australia the solar rays heat the ground so powerfully, that it is stated matches are in- flamed if they fall on the earth. In Africa, on the other hand, it is not the tropical heat which is so baneful, but the great humidity and the rank vegetation which covers the uncultivated parts of the country. This last-named condition has been partially removed, and the awful' mortality of British troops on its western stations has DRY AND WET YEARS. 131 been much diminished. Of 1,658 soldiers sent there in the eight years ending 1830, 1,298 died, and only 83 remained fit for service. The dampness of the air is so great that all steel instruments, even the ladies' needles, have to be kept immersed in oil. As in other humid regions of the torrid zone, the diseases are malarious, such as yellow fever and ague ; or are such as are ren- dered more frequent and fatal by its influence, diarrhoeal and dysenteric complaints, for example. These latter diseases produce in India also the greatest numbers of deaths. The effects of dry and moist years upon disease are quite evident in our own country ; about one in every five is extremely dry, and then fevers or cholera prevail, because of the difficulty with which excreta are washed away ; and one in ten is excessively wet, when influenza is the zymotic we hear most of. A cold, damp air rapidly abstracts the heat from the body, and is often said to " chill one to the bones." A dry wind is said to sup- press the development of small-pox, which it is said for this reason cannot be inoculated in some parts of the west coast of Africa. The year 1860 was excessively wet all over England, and the summer temperature was very low. The deaths were very few, and in Birming- ham were lower than for twenty-four years before. Observations made at Greenwich indicated that positive electricity was very scanty in the atmosphere during cholera epidemics. The effects of electricity, however, upon the health and disease of man is a subject on which but little has been as yet satisfactorily deter- mined. Cold is our most powerful depressing agent, and if intense and prolonged, it extinguishes life by injury to the nervous system, as has been generally known since Captain Cook's graphic account of its effects on the sur- geon of his expedition. Dr. Solander was returning with Sir Joseph Banks and nine others from a botanical ex- 132 EFFECTS OF COLD. cursion in Terra del Fuego to the ship, during extreme cold, and finding that some of the party were showing drowsiness, he warned them most forcibly of the danger of sleep " whoever sits down will sleep, and whoever sleeps will wake no more." He himself was, neverthe- less, the first to lie down, begging to be allowed to die in peace. His companions, however, roused him, and he afterwards saved the lives of others who would have succumbed to fatal sleep. Covering exposed parts with oil is a very useful protective, which Xenophon men- tioned. The influence of cold weather on mortality is manifested by the larger returns of the Registrar- General when it occurs, especially if combined with wind, which, by constantly removing the stratum of air which the human body has heated, increases its cooling and depressing effects. When the 'temperature in Lon- don falls from 45 to 27, it is calculated that about 400 persons perish, which constitutes a greater increase of mortality than is produced by most cholera epidemics. Bronchitis is the cause of death so excited, and in that city during other weeks which have been remarkable for heat, but 40 deaths have often occurred from that disease. It is upon the very young and very old that cold exerts its most fatal power, as the heat-producing function is less active ; and to them especially should such seasonable charity as blankets, clothes, or food be supplied. The greatest natural cold namely, 91 below zero ever observed was in 55 N. Lat. ; and India is said to present the extreme of heat namely, 120 ; so that man is capable of living within a range of 200, which is a faculty possessed by no other animal. The cold climates are such as lie between 55 of north and south latitudes and the poles, and the place which has the lowest annual mean namely, l'6u is Melville Island. The range I have mentioned includes most of the north of Ireland and Scotland ; but a bounteous.. Providence has sent us the Gulf Stream, which mitigates TEMPERATE CLIMATE ANCIENT IRELAND. 133 the rigorous climate which, from the position of the island, would be ours. The diseases said to be due to intense cold are often more justly attributable to a com- bination of this condition with humidity ; they are of the rheumatic, scrofulous, pulmonary, and diarrhoeal types. In arctic regions, too, low temperature, com- bined with such degenerating influences as deficient light and scanty food, has stunted the races which in- habit them ; but they are free from the ills (consumption included) which a faulty civilization has inflicted upon other races. As was quaintly said by a Danish writer more than a century ago of Greenland : " The tempera- ture of the air is not unhealthful, for, if you except the scurvy and distempers of the breast, they know nothing here of the many other diseases with which other coun- tries are plagued, and these pectoral infirmities are not so much the effect of the excessive cold as that of nasty foggish weather, which this country is very sub- ject to." The term " temperate climate" is usually bestowed on all those between 30 and 55 of northern and southern latitudes, and in them a wider range of temperature has been observed than in the arctic or torrid zone ; for in- stance, the Surgeon-General of the United States tells us that at Fort Kent, a range of 129, or from 39 to 190, occurred in the year 1845. As an example of one of the most favoured climes in this zone, I will con- fine your attention to our own island. Descriptions of the climate of Ireland are contained in the writings of the Four Masters, and concerning later periods, in those of Boate, Molyneux, and Rutty, and all seem to indicate that it has undergone no remarkable change within a period extending over many centuries. Now, as then, its principal features are the general pre- valence of westerly winds, of severe easterly gales in spring, which have been complained of by almost every ancient writer, the comparative mildness of winter and 134 THE CLIMATE OF IRELAND. the coldness of summer, dampness at all seasons, and a generally equable temperature. The last-named condi- tion, as I have observed, is due to its being surrounded by sea, and to the influence of the Gulf Stream, for while parts of the Continent Prussia, for example are annually covered with snow, and the Elbe is not un- frequently frozen, our northern lakes are scarcely ever frozen, and the myrtle blooms in the open air at Glen- arm in the same latitude namely, 55 N. Few parts of this country are more than 300 feet above the sea level, so that but about one degree of temperature is thus lost by elevation. The superficial features of Ireland account to a great degree for the mildness and dampness of its climate, and foremost among such features must be noted the abundance of lakes, rivers, and bogs, which so plenti- fully yield water to the clouds by their evaporation. The vastness of the Shannon, " spreading like a sea," as the poet Spenser has it, would, in so small an island, alone account for its humidity, which, however, is not so excessive as to deserve Lord Macaulay's description, " Ireland is a marsh, saturated with the vapours of the Atlantic." The geological substrata are mainly lime- stone, granite, quartz, and sandstone, and they are clothed with soils of more than average fertility, except where bog (or vegetal matter carbonized by moisture not by heat, as coal is) prevails. The mean annual temperature may be set down at 50, the winter average at Dublin being 41, and the summer 61, our city being in latitude 53 20' N., and 6 17' longitude W. In Belfast, I find the summer average is 64, the winter 40, or the annual mean 52. The severity of our winter rarely sets in till after Christ- mas, and the amount of frost is below that of England. If our climate depended only on its latitude, and was not warmed by the Gulf Stream, the winter mean woul- to H Ib., and every child as much as it desires. Eat it slowly. If you are very poor, spend nearly all your money on bread." I have not time to tell you of the influence of food upon the prosperity, physical energies, or mental capa- cities of communities, nor the degeneracy which an im- poverished national dietary will produce, not only in 192 FOOD AND POPULATION. those who are subjected to it, but in their descendants. Its connexion with crime is conclusively shown by the fact, that in years when food is scarce there is always an increase of the number of committals. Malthus believed the food of a country increased in an arithmetical proportion that is to say, increased as 1, 2, 3, 4, 5 ; while the population of a country would, if unchecked, increase in a geometrical proportion, as 1, 2, 4, 8, 16. " Therefore," said he, " if the natural in- crease of population were not somehow checked, the time would inevitably come when the people must starve. Nature, however, in his opinion, provided such checks ; namely, pestilence and epidemics, as well as the disease which is constantly carrying off the population of our over-crowded towns. War is also another check. For these checks there is one satisfactory substitute to be found, and only one that is celibacy, and other forms of moral restraint. Unless we diminish the births, is is of very little use, he argued, trying to diminish the deaths." He then referred to the effects of vaccination. ' ' I have not the slightest doubt, that if the introduc- tion of the cow-pox should extirpate the small-pox, and yet the number of marriages continue the same, we shall find a very perceptible difference in the increased mor- tality of some other diseases." Again, " The operation of the preventive check war the silent, though cer- tain destruction of life in large towns and manufactories, the close habitations and insufficient food of many of the poor, prevent population from outrunning the means of subsistence, and, to use an expression which certainly may at first appear strange, -supersede the necessity of great and ravaging epidemics to destroy what is redun- dant." If such reasoning were just, sanitary efforts were quite useless. But it is contrary to what we observe in every thriving population, where the means of living, wealth, and health, owing to sanitary reform, are increasing step FOOD AND POPULATION. 193 by step with the increase of the people. He erroneously applied the same principle to man which Darwin has applied to inferior creatures, forgetting how great a controlling influence is afforded by the mighty intellect of man. The effects of food upon the passions and feelings is also a tempting subject for the popular lecturer on physiology and the poet, for old Prior has it " Observe the various operations Of food and drink in several nations. "Was ever Tartar fierce and cruel Upon the strength of water gruel ? But who shall stand his rage and force, If first he rides, then eats his horse. Salads, and eggs, and lighter fare, Turn the Italian spark's guitar. And if I take Dan Congreve right, Pudding and beef make Britons fight." LECTURE VIII. FOOD CONTINUED VEGETARIANISM ALCOHOL ADUL- TERATION DISEASES DUE TO SCANTY OR IMPROPER FOOD. VEGETARIANISM has so ma*ny respectable supporters who perse veringly advocate its principles, that it is necessary to inquire if they rest on a scientific basis. Animals are either herbivorous, carnivorous, or amphivorous that is, fed by both the vegetal and animal kingdoms, which certainly contain the same elements of food, but in different proportions and under widely various forms. An herbivorous animal the sheep, for instance has large, flat, and rough teeth, to bruise the grass it crops with the incisors ; a quadruple stomach, from which the food is again returned to the mouth as the creature " chews its cud ;" and a digestive canal twenty- eight times longer than its body, such a complicated appara- tus being required to convert the grass into the very dissimilar matter of its own body in fact, into mutton. The tiger, on the contrary, has sharp teeth only, to tear flesh, a single stomach, and a short intestine, the food it devours being so similar in composition to the com- ponents of its own body. Man has incisor teeth to cut the food, canines to tear it, and molars to bruise it, for the infinite variety of the matters he consumes needs all these operations. If it be objected that no other ani- mal is really amphivorous, and that man's teeth differ from those of all other animals, another peculiarity can be appealed to namely, that there is no break in their posi- tion for the round of the whole jaw. His stomach is single, and the digestive canal medium, being some five times the length of his body. I will now show you by these anatomical preparations the peculiarities of each, VEGETARIANISM. 195 and you see here represented the various kinds of human teeth. The dates of the appearance of each kind is The Human Teeth. very regular so much so, that the age of children be- fore admission to factories can be thereby calculated. These physiological facts, and the experiments I have alluded to, prove the necessity of a mixed diet, and the only anatomical resemblance which, since the days of Rousseau and Shelley, vegetarians have fairly relied on is, that the female of bimana and of some herbivora have each two breasts. The adoption of a purely vegetable diet would tend to lower the physical power of man and the prosperity of nations, as we may judge by reflecting on the instances of those compulsory vegetarians, the ill- fed labourers of our own land, and the worse fed Hin- doos. There are, on the other hand, parts of the world where edible vegetables are not to be had ; and at a recent public meeting at the Rotundo, the advocates of this folly had to acknowledge that they would avoid the Arctic regions, which produce no food for them. Dr. Hayes, the Arctic voyager, says : " Feed the locomotive on willow twigs, and on a frosty morning it will be very likely to cease its operations ; feed the Esquimaux hunter on wheat bread or maccaroni, and he will quickly freeze to death." But vegetarians, so called, by no means restrict them- selves to a vegetable diet; on the contrary, if the eggs and milk they consume be calculated not to speak of the microscopic creatures they must swallow iu water and 196 ALCOHOL FOR AND AGAINST. food they take their full share of animal diet, and sup- press as much or more animal life as the beef-eater, the direct infliction of pain being indeed avoided. It is this last reflection which has enlisted many of the tender- hearted in the ranks of those who abhor flesh. I wonder it has been never inferred that this quality of the vege- tarians has been due to their food, for in this way there is no doubt that the temper and habits of animals can be affected to wit, the wild and the domestic cat. Alcohol in some form enters into the diet of nearly every nation, such various substances as rice, cocoa- nut honey, milk, aloe, juniper-berries, grapes, and cereal grains, being used to form respectively the arrack, toddy, mead, koumiss, agua ardiente, gin, wine, ivhiskey, and beer, while all contain the same intoxicating agent. Consist- ing principally of carbon and hydrogen, it seems capable of acting as heat-giving food, and these elements of it are rapidly oxidized out of the body. Those who use alcohol habitually take less heat-giving food, and it un- doubtedly saves the muscular and fatty tissues, so that weight is really gained. The amount of carbonic acid evolved indicates the waste of our body, and it is lessened by the taking of alcohol, and as every traveller knows hunger returns less rapidly ; but no one can assert that with a sufficiency of food it is at all necessary, and on the whole abstainers enjoy the better health. , The fact, however, argues for a high rate of diet in those from whom we wish to keep alcohol. It quickens the circulation, and thus diffuses warmth through the body and stimulates the brain ; so that every practical physician will convince you of its use in the treatment of disease. Such are the chief arguments for alcohol put forward mainly by Baron Liebig. Now hear the other side. Those who object to its use under any cir- cumstances assert 1st, that it precipitates the soluble part of our food; but when freely diluted it can scarcely act thus on the peptone, or nutritive material which is ALCOHOL FOR AND AGAINST. 197 made from the meat we consume ; 2nd, that as a heat- giving agent it is inferior to fat, and indeed the testimonies of Arctic voyagers, and of some recent experimenters, is against the warming power of alcohol ; and 3rd, that if it stimulates, depression to an equal extent must fol- low as a reaction, so that nothing is gained ; but so far as regards the treatment of a passing illness there is no force in this objection. No one can deny that in large doses it acts as a poison an ounce of pure alcohol will kill a middle- sized dog ; in habitual small quantites it in- jures the nervous sys- tem, leads to fatty degeneration of the tissues and, as an instance, I show you the diseased condi-< Which the arte- Arteries of Brain injured by Fat. ries of the brain undergo from this cause. It also pro- duces a fermentible condition of the blood which is more favorable to the catching of contagious diseases, and a fatal result from them. When speaking of cholera, I will give you some evidence of this. As an instance of fever, however, arising with temperance strictly preserved, I may mention that a fearful epidemic is now raging in Scoiion, Lancashire, a village in which there is no dram- shop. If teetotallers neglect other sanitary reforms, they must be regarded as mere riders of a hobby. The alcohol of drinks which contain it, is absorbed directly from the stomach, conveyed to the liver, both of which it often renders diseased and there are no better known anatomical preparations than the drunkard's stomach and the drunkard's liver and acts especially 198 ALCOHOL AND CHOLEll A. on the brain, in which it produces its intoxicating effects by delaying the due receipt of blood. A fluid contain ing enough alcohol to be inflammable has been distilled from the brains of those who have died after drinking to excess. Teetotallers ride their hobby to the death, as may be gleaned from the following proceedings at the North Union Board during the late cholera epidemic. It was proposed to placard our city with a poster which had been drawn up by the United Kingdom Alliance, and from which the following are extracts : " It is a most remarkable circumstance that persons given to drinking have been swept away like flies. In Tiflis, containing twenty thousand inhabitants, every drunkard has fallen all are dead not one remains. Dr. Sewell, of Washington, said that ' of two hundred and four cases of cholera in the Park Hospital (New York), only six of the persons were temperate, and all these re- covered, w T hile one hundred and twenty-two of the others died.' At Montreal, after twelve hundred had been attacked, it was stated in the public journals that ' not a drunkard who has been attacked has recovered of the disease, and almost all the victims have been at least moderate drinkers.' Dr. Bronson, writing from that city, said : ' The disease has searched out the haunt of the drunkard, and has seldom left it without bearing away its victim. Even moderate drinkers have been but little letter off! So strong is my opinion on this point, that were I one of the authorities, and had the power, I would placard every spirit shop in town with large bills containing the words " Cholera sold here." So strongly convinced were the Board of Health in the city of Wash- ington that an open liquor shop was nothing more nor less than a ' cholera nest,' and that the sale of liquors ' exposed the people more than all things else to this disease, that they assumed the re- sponsibility of declaring that grog-shops were nuisances, and they closed them for three months.' " It was resolved to refer the document to me, and I submitted a report from which the following is an extract: " I do not hesitate to say that the present epidemic has shown that intemperance is a strong predisposing cause of cholera. By far t he- greatest daily number of cases has been on Mondays, because the Saturday night and Sabbath have been spent in debauchery by the improvident classes, and several of the victims have been very in- temperate. However, the placard of the United Kingdom Alliance ALCOHOL. 199 greatly exaggerates this influence, as many of the victims have been children, who of course did not'partake of intoxicating drink, and .women, who have done so in a much less degree than men. Un- cleanliness and overcrowding have been much more powerful pre- disposing causes of cholera, as they also are of drunkenness, for the public-house is a tempting resort from a close, filthy, and over- crowded room. Efforts, therefore, to improve the wholesomeness of the dwellings of the poorer classes are the most practical and efficient means of promoting temperance. \Vith reference to the placard itself, I could not advise its circulation, as I do not believe the statements I have italicized in the copy supplied to me. In any further recommendations which I may publish by direction for the Sanitary Committee, I will continue to warn the poor against intemperance, more especially while our city is afflicted with cholera." The Alliance, however, persevered, and alarmed our citizens by the poster on every dead wall. The late Dr. Miller compared the action of alcohol to the screw which urges the oil-lamp, as you can raise the wick and cause a bright flame, to the loss of the wick ; but the comparison does not hold good, for alcohol, if not a fuel to supply combustion in the human body, is certainly an agent to prevent the burning of other fuel within it. Another hit at alcohol I must confess my anatomical experience contradicts it is that so great are its preservative powers, "that the brain of an intem- perate man needs no preparation for the dissecting-room, and will keep for an astonishing length of time," there- fore say they, alcohol prevents the digestion of food. It may be well to allude briefly to the composition and properties of a few of our usual alcoholic drinks. Beer contains about five per cent, of alcohol, and about the same quantity of starchy matter, which may be reckoned as food, and but half-a-part per cent, of albuminous or tis- Bue-producing food. This drink will therefore increase weight, and its bitter principles certainly increase appe- tite, but if taken in excess gouty and bilious complaints very readily arise, and an unhealthy bloated fatness is produced. Brewer's draymen, who drink much beer or 14 I 200 ALCOHOL BEER WINES SPIRITS. porter, are well known at every hospital to suffer from gangrenous and suppurating sores on the least injury being received. The hops are supposed to be tonic, but many bitters, and cheaper bitters, might be substituted. Pale ale contains much less saccharine matter, and the pecu- larity of those made in Burton is said to depend on the presence of much sulphate of lime in the water, which does not extract the sugar from the malt. With regard to wines, the strength of various kinds, and even specimens of the same kinds, is most uncertain, the amount of alcohol varying from some 5 to 13 per cent, in champagnes, to 16 to 25 in sherries. Dr. Hoffman found the sherries in the Queen's establishment to be of only the first-named rate. The chief value of wine con- sists in the salts of the vegetal acids, which give it high anti-scorbutic properties, and it can never be considered so hurtful as ardent spirits, although we cannot regard it, with Sanctorini, as the " milk of old age." The pro- portion of alcohol in whiskey, gin, and brandy, varies from 50 to 60 per cent., while rum averages some 10 or 15 degrees higner. With regard to the effects of spirits on the human race, Prof. Parkes truly observes, " the misery which the use of alcohol produces is so great that it may be truly said that if alcohol were unknown, half the sin, and a large part of the poverty and unhappiness, would dis- appear from the world ; nor does any one entertain a moment's doubt that the effect of intemperance in any alcoholic beverage is to cause premature old age, to pro- duce or predispose to numerous diseases, and to lessen the chance of living very greatly. If spirits neither give strength to the body, nor sustain it against disease are not protective against cold and wet, and aggravate rather than mitigate the effects of heat if their use, even in moderation, increases crime, injures discipline, and ini- pnirs hope and cheerfulness if the severest trials of war have been not merely borne, but most easily borne, ALCOHOL PERMISSIVE BILL. 201 without them if there is no evidence that they are pro- tective against malaria or other diseases then I con- ceive the medical officer will not be justified in sanction- ing their issue under any circumstances." The mortality of persons who are intemperate between the ages of 21 and 30, is five times greater than that of those who are abstemious. Of the spirits used in these countries gin is by far the most injurious, because of its exhausting effects through the kidneys. Rum, from the sugar it contains, supports the heat of the body and is the least injurious. Besides the evils which strong drink produces on the people, it must be remembered that the money expended on its purchase is most enormous, exceeding, in fact, the imperial taxation of the kingdom. If the sum were saved, it would suffice to banish pauperism. Wherever alcoholic drinks have become the habitual beverage of a nation, crime and pauperism have resulted, and the consump- tion of them is proportioned to the facilities which exist for procuring them. These are the facts on which the United Kingdom Alliance ground their arguments for a permissive bill to allow the majority of the rate- payers in any place to take measures prohibiting the sale of intoxicating drinks. They appeal to the Public Health Act of 1848, and the acts for suppressing lotte- ries and betting-houses, as being greater encroachments on the liberty of the subject, which were wise, and followed by the best results. That good citizen, James Haughton, is, of course, ecstatic in its favour : " This constitutional mode of dealing with an acknowledged evil of immense magnitude is, indeed, a bright and cheering light on our horizon. The manufacture and common sale of intoxi- cating liquors have always been looked upon as occupa- tions dangerous to the well-being of society. They have ever been hedged round with limitations and regula- tions, such as are unknown in trades really beneficial to the community. Such limitations and regulations being 202 ALCOHOL ASYLUM FOR DRUNKARDS. found by experience utterly inefficacious, the " Permis- sive Bill" is but the logical sequence of those innumer- able acts of parliament passed since the reign of Eliza- beth, to moderate the tide of misery ever flowing from the liquor traffic." Dr. Mackesy, ex-President of our College, has most ably advocated the establishment of reformatories for dipsomaniacs, or drunkards, under legal restrictions similar to those which govern lunatic asylums. The patients either to be admitted voluntarily or by order of magistrates, after due medical testimony and inquiry. The writer of the most temperate article on teetotal- ism I have met, in the Journal of Social Science, July, 1866, sums up as follows : " Intemperance is, by uni- versal assent, pronounced the greatest vice of our age, and its effects obstruct the path of the reformer in every field of labour. The general use of intoxicants is sanc- tioned by the example of the good, and the educated, and the wise. If its use were confined to those who, by their excesses, bring burthens upon the State, the system could not last a year. It is not the habits, tastes, and inclinations of the vulgar which sustain the practice of drinking, but the example of the intellectual, the well- conducted, and refined. The drinking habits of the country do not acquire respectability through the ine- briate, but through the moderate drinker. This drink is consumed by all classes, under the belief that it is a good and nutritious article, necessary to sustain health, or at least a source of innocent enjoyment." In order to show that such repressive measures are beyond the function of legislation, Milton has been quoted: "Next, what more national corruption, for which England bears ill abroad, than household glut- tony ? Who shall be the rectors of our daily rioting ; and what shall be done to inhibit the multitude that fre- quent those houses where drunkenness is sold and har- boured ? Our garments also should be referred to the ALCOHOL SUNDAY-CLOSING. 203 licensing of some sober workmasters, to see them cut into a less wanton garb. Lastly, who shall forbid and sepa- rate all idle resort, all idle company ? These things will be and must be, but how they shall be least hurtful, how least enticing, herein consists the grave and governing wisdom of the State." Very great advantage would ac- crue from the closing of public-houses on Sundays in the same way as other shops. It would tend to increase religious observance of the Sabbath, which by too many of the poor is spent in the tavern, their wages being then in their hands ; and Monday is often not a day of work from the effects of the previous day's debauch. The closing of these houses on Sundays in Scotland, arid in the dioceses of Cashel and Ferns, has been so bene- ficial, that an influential association has been formed in this city for the purpose, and great numbers of respect- able vintners will support the movement. There cannot be a doubt that if sanitary measures, especially includ- ing efforts to improve the dwellings of the working classes, had been made some fifteen or twenty years earlier, the glorious labours of Father Mathew would have borne fuller fruit than they have done. " I think," says Prof. 0. W. Holmes, "you will find it true, that before any vice can fasten on a man, body, mind, or moral nature must be debilitated. The mosses and fungi gather on sickly trees, not thriving ones, and the odious parasites which fasten on the human frame, choose that which is already eni'eebled. There is no fancy in saying, that the lassitude of tired out opera- tives, and the languor of imaginative natures in their periods of collapse, and the vacuity of mind untrained to labour and discipline, fit the soul and body for the germination of the seeds of intemperance. Whenever the wandering demon of drunkenness finds a ship adrift, no steady wind in its sails, no thoughtful pilot directing its course, he steps on board, takes the helm, and steers straight for the Maelstrom." 20-4 TEA COFFEE COCOA. Tippling is the peculiar fault of his countrymen, and this is not to be wondered at when a strong spirit was detailed in the Western States at eightpence a gallon. Its recent rise in price may be attended with salutary effects. We are given the credit for being a more drunken nation than we are ; it has been found by analysing the revenue returns that England consumes twice as much, and Scotland nearly twice as much spirits per head as Ireland. With us a little drink " goes farther," owing to our excitable and underfed condition. The consump- tion of alcoholic drinks is however rapidly increasing ^ince 1852, and even then it was nearly double that of 1842. The non-alcoholic beverages are so well known that scarcely any allusion need be made to them. Tea and coffee are certainly stimulant without subsequent depres- sion, and they invigorate the system against fatigue, cold, and the inroads of disease, while cocoa is nutri- tive in a higher degree. They contain a similar active principle, thein or caffein, and it must not be forgotten even by teetotallers that this matter, extracted from the beverage they laud so much, is poisonous in large doses. Dr. Lankester killed a frog with half a grain of it, the creature being first paralysed and then convulsed before death. Thein and kreatin, one of the principles of meat, are very similar, and both seem to have invigorating power irrespective of their nutritive value : about 2 per cent, of coffee or tea consists of this active ingredient. Dr. E. Smith epitomizes the subject thus : " Tea is useful to the corpulent, the over-fed, after a full meal at the end of the day when the food has accumulated in the sys- tem, when digestion and other vital changes proceed slowly ; for the old, for hot climates, for the sedentary, for those who do not perspire freely, for those who eat much starchy food, for soldiers on the march in hot climates ; and as a restorative in cases of drowning, or wherever it is desired to increase the respiratory functions. Tea is hurtful in the absence of food, after a long ADULTERATION. 205 fast (as at breakfast) to the poor and ill-fed, the spare, and the young. It is not adapted to sustain exertion, to prison dietaries, to low temperatures, or to hot climates when the appetite is defec- tive and the skin active, or to those who perspire too freely; neither should it be taken with our principal meal." It has been well remarked that of all evils which afflict us, those that are cumulative or gradual are the most dangerous, because they are insidious, and therefore less preventible, their cause being obscure. Such an evil of vast magnitude is the adulteration of food and drugs, which, by excluding nutritive or medicinal substances, or introducing those that are injurious, does harm both negatively and positively. " Caveat emptor " is, however, the spirit of most of the earlier legislation on this sub- ject, and to many the motto seems to convey a sufficient remedy ; but when it is remembered that most of these adulterations cannot be detected with our unaided senses, but require considerable scientific knowledge, some legal protection is indispensable, especially in the case of the poor. As an example of the universality of adulteration, I shall quote a paragraph from the work of our country- man, Dr. Hassall, who has made the subject exclusively his own. After giving a list of deleterious articles used for adulteration, he says : " It may so happen, and it doubtless does sometimes occur, that the same person, in the course of a single day, receives into his stomach some eight or ten of the articles above enumerated. Thus, with the potted meats and fish, anchovies, red sauces, or cayenne, taken at breakfast, he would consume more or less bole Armenian, Venetian red, red lead, or even bisulphuret of mercury. At dinner, with his curry or cayenne, he would run the chances of a second dose of lead or mercury ; with the pickles, bottled fruits, and vegetables, he would be nearly sure to have copper adminis- tered to him ; while if he partook of bon-bons at dessert, there is no telling what number of poisonous pigments he might consume. Again, in his tea, of mixed or green, he would certainly not escape without the administration of a little Prussian blue, and it might be worse things ; if he were a snuff-taker, he would be pretty sure to be putting up his nostrils from time to time small quantities of either some ferruginous earth, bichromate of potash, chromate of 206 A SAMPLE OF ADULTERATION. lead, or red lead; finally, if he indulged himself with a glass or so of grog before going to bed, he would incur the risk of having the coats of his stomach burned and irritated with the tincture of cap- sicum or essence of cayenne. If an invalid, his condition would be still worse ; for then, in all probability, he would be deprived of much of the benefit of the skill of his physician through the dilution and sophistication to which the remedies administered for his relief were subjected. This is no fanciful or exagge- rated picture, but one based upon the results derived from the repeated analysis of different articles as furnished to the con- sumer. That the definition of the word " food" is somewhat unsettled, would appear from the recent decision of a London magistrate. A fellow was summoned for selling as ketchup a decoction of putrid horse liver. The jus- tice dismissed the case, being of opinion that ketchup was not food ! An appeal to the superior courts is not yet decided. The addition of water to malt liquors was so great in London that the late Dr. Normandj 7 found beer sold at the publicans 50 per cent, weaker than that at the brewers with which it was professed to correspond, and the drinkers of that beverage must feel still more uneasy when they read the offer of a candid and ingenious ad- vertiser in the Times, to enable brewers to manufacture it " without stock or outlay." " The advertiser's many testimonials," it is added, " will vouch for the above, and for having effected economy generally, indepen- dently of saving 5 per cent, in malt, imitating beers in vogue, restoring and applying sour beers, without expo- sure, detection, sediment, or delay, leaving brightness." Some of these foreign substances which are found in so many foods are plainly deleterious ; but on the other hand, the public mind has been often needlessly alarmed by chemical analyses announcing the presence of poison- ous agents, which, however, were present in such infini- tesimal quantity as to be entirely harmless. In this city the Corporation has wisely appointed an able analyst, ADULTERATION REMEDY. 207 Prof. Cameron, and for a charge of 2s. 6d. any citi- zen may have any article which he suspects carefully examined. In order to prosecute any seller of an adul- terated article, the buyer must give him the option of going with him to the laboratory to see that the article is not exchanged. The following are a few of the results obtained by Prof. Cameron. Since 1862, over 100 specimens of milk have been analysed, and nothing but water found to have been added as an adulteration. This ranged from 20 to 45 per cent, above the natural amount. Sugar was not found adulterated, but it con- tained frequently iron, which blackened tea and the sugar mite. Filtered or white sugar is now universally pre- ferred. Coffee was found badly ground and stale in many cases. In one case a mixture sold as coffee was proved to consist of roasted wheat, cocoa-nut, dust, and 5-^ per cent, of millstone grit, no coffee whatever being present. The vendor was convicted before the Lord Mayor. Spirits were only weakened. During the present year Prof. Cameron examined about 80,0001bs. of meat, 25,000 Ibs. of which was condemned, chiefly because it came from diseased animals. Trichina was never pre- sent. Forty samples of foods were examined during the same period, and in many cases a very satisfactory result followed namely, that the article was supplied to the person or institution complaining, of a much better qua- lity afterwards. In Paris, tradesmen convicted of selling adulterated articles are obliged to post up in their shops a record of the conviction, the penalty, and the time daring which this public notification is to be given. It has had the best effect, milk and other articles being supplied of much better quality than with us. It is the duty of the authorities in charge of the departments to fix some standard beyond which extraneous matters become posi- tively hurtful ; and from the physician who has wit- nessed the injurious effects of these hurtful matters in many instances, can alone reliable data be obtained for 208 FATTY HEART CORPULENCE. instituting such a legal criterion. The great attention paid to the subject of adulteration for the last few years has had the beneficial effect of improving the quality of ' Buch articles as confectionery and sweetmeats, and may have had something to do with the vast increase which has occurred in their manufacture. The quantity of such products made in the United Kingdom in 1855 was only 8,000 tons, it now exceeds 25,000 yearly. In a former lecture I alluded to some effects which were due to the introduction of too great a quantity of tissue-producing food, and I stated that such results were rare, as we are soon made aware of, at least, any sudden excess of such food. The same cannot be said of heat- producing food, for if it lie used in excess of the require- ments of the system, it becomes stored up under the skin and in the abdomen, and the evils of corpulence follow. Fat is so bad a conductor of heat that, in being deposited under the skin, it fulfils the same purpose as if it were submitted to combustion namely, the preservation of the body at an equable temperature of 100, one nearly always above that of the surrounding air. When heat- producing food is supplied in excess, the surplus not being burned off, is loaded at first under the skin, and by the unwieldy condition it gives rise to, exercise be- comes difficult and fatiguing, and thus produces dis- ease. From the fat which the blood-vessels pour upon them, the muscles become infiltrated with oil a condi- tion most readily seen in the flesh of the over-fed and stall-fed ox. A fully-fed ox has been found to consist of fat j to the extent of half its weight, notwithstanding the low specific gravity of that substance. There is a muscle on which life is more dependent than almost any other organ in the body, I allude to the heart ; and if fat is laid upon it, it becomes so encumbered that its healthful ac- tion is much impeded ; but the more dangerous condition, fatty heart a professional term which has become to a great degree popularized, is often found in the leanest, and CORPULENCE BANTING'S DIET. 209 depends on a morbid conversion of its substance into fat, and not on a mere deposition. The fibres of the heart become just like those of stall-fed meat, which I showed you in my sixth lecture, and I contrasted them with those of healthy muscle. It is curious that the deposit of fat at the edge of the transparent coat of the eye indicates this serious disease, and for this reason is watched for in examining lives for insurance. *" The subject of obesity or corpulence has become so "fashionable," and so con- stant a matter of consultation and of table-talk, that I must discuss it for a few moments, and in doing so I cannot avoid analysing Mr. Banting's profitable, though but sixpenny, pamphlet. This person, a retired cabinet- maker, some 68 years of age, 5 feet 5 inches high, and 202 pounds, or 14 stone 6 pound weight, not being, as he says, " quite insensible to the sneers and remarks of the cruel and injudicious in public assemblies, public vehi- cles, or the ordinary street traffic ; nor to the annoyance of finding no adequate space in a public assembly, if he should seek amusement or need refreshment " and not being able to "stoop to tie my shoe, so to speak, nor attend to the little offices humanity requires, without consider- able pain and difficulty, which only the corpulent can understand ; I have been compelled to go down stairs slowly backwards to save the pain of increased weight upon the ankle and knee-joints." He joyfully tells us that by the regimen I shall just now quote to you he re- duced thirty-five pounds (or two and a-half stone) in thirty-eight weeks, and became free from all the trou- bles he so Bitterly complained of. He extravagantly lauds the surgeon who suggested the remedy to him, urges all fellow-sufferers to consult him, and that they may have need to do so he mentions that some medicine, or, as he describes it, " the balm of life in a wineglass of water a most grateful draught, as it seems to carry away all the dregs left in the stomach after digestion," is part of the cure. 210 BANTING'S DIET. The name of this miracle-worker was at first only to be learned by letter, but in a subsequent issue he gives the name in full, and it is one which is very familiar to the readers of the advertising columns of the daily news- papers, and notwithstanding Mr. Banting's anxious en- deavours to show the contrary, the whole affair seems very like a "doctor's puff." His generosity, however, seems profuse, for he has issued an appeal to the public for the erection of an hospital, to be named the " Middlesex County Convalescent Hospital," and as a thank offering for himself, Mr. Banting heads the list with the very handsome donation of 500. I shall quote his dietary verbatim : " For breakfast, I take four or five ounces of beef, mutton, kidneys, broiled fish, bacon, or cold meat of any kind, except pork ; a large cup of tea (without milk or sugar), a little biscuit, or one ounce of dry toast. For dinner, five or six ounces of any fish but salmon, any meat except pork, any vegetable except potato, one ounce of dry toast, fruit out of a pudding, any kind of poultry or game, and two or three glasses of good claret, sherry, or madeira champagne, port, and beer for- bidden. For tea, two or three ounces of fruit, a rusk or two, and a cup of tea without milk or sugar. For supper, three or four ounces of meat or fish, similar to dinner, with a glass or two of claret. For nightcap, if required, a tumbler of grog (gin, whiskey, or brandy, without sugar), or a glass or two of claret or sherry." Now, you will see that in this generous bill of fare, which, almost ignoring the question of quantity, aims at excluding heat- producing food, there is nothing new, and that a similar one would have been prescribed by any scientific or judi- cious practitioner for similar circumstances. I will not criticize the style of the pamphlet, for its author lays down all pretensions to elegance of diction at an early page ; but I think after two or three editions it might have been freed from such palpable errors as talking of the saccharine matter of butter, &c. Although from CORPULENCE HUNGER STARVATION. 211 sudden, ill-advised, and excessive adhesion to the plan, injury has resulted for remember great loss of weight must indicate the removal of some heavier material than fat I think, on the whole, good has been done by this brochure, for it has drawn attention to the hygienic questions connected with food. The cure of corpulence is then easj T , if the obese be not infirm in will, as has been asserted, and depends on forcing the system to burn off the heat-producing food or fat already accumu- lated, by denying any further supply of starchy, saccharine, or fatty matters, such as potatoes, turnips, sugar, and sweetmeats, fermented liquors, fat meat, or butter. Such a regimen is surely easier than taking large potations of vinegar, from which bad results have followed ; but em- lonpoint is too much dreaded even by the softer sex, and therefore with Lewes I would say, " Young ladies, be boldly fat; never pine for graceful slimness and romantic pallor ; but if Nature means you to be ruddy and rotund, accept it with a laughing grace which will captivate more hearts than all the paleness of a circulating library." One more hygienic remedy I would insist on namely, clean- liness, so as to engage our third lung, the skin, in the removal of fat. Some persons who have been using such an altered dietary as I have detailed, remark that they can bear hot oppressive weather much more com- fortably. It is astonishing how long fat animals will bear starvation ; a fat pig which was confined under a fallen bank of chalk, was found alive at the end of 160 days, but it had lost 120 Ibs. in weight. Thinning rapidly is really a serious diseased condition, and is too often owing to imperfect mastication of food which is generally wanting in fat or starchy material, and the cure is often easy if they believe in these facts. In- dividual peculiarities however, especially restlessness of mind, will keep some persons thin, feed how they may. In looking for examples of diseases produced by scanty food, deficient especially in nitrogenous ingredient, I 212 HUNGER STARVATION THIRST. regret to say we need not to go from home, for in the . famine years we had sad experience, and even to this day many ailments of our agricultural peasantry depend on their unvaried and very starchy diet. Hunger, although a universal feeling of man, has not been satis - lactorily accounted for by physiologists. Mere distension will relieve it, we are told, in the case of those who eat clay for the purpose. When sufficient food is withheld, man rapidly wastes, the fat first, the nervous tissue last, and their debris is carried through the lymphatic vessels, the body actually living on itself. Death occurs the sixth day, or as soon as the loss of weight equals two-fifths. Thirst is not a feeling of the mouth and throat, no more than hunger is of the stomach alone, so that it was said a man might be hungry without a stomach, and thirsty without a throat. It is worthy of note that an equal weight of ice or of tepid water are far superior to cold water in the power of slaking thirst. You have been, perhaps, in the habit of regarding dyspepsia as the rich man's torment, but every dispensary physician will tell you that half his cases consist of that unpleasant malady. It has been said that " at forty a man is either his own physician or a fool," but this pre- supposes know- ledge of the principles of health which is not possessed by our humbler people. The digestive organs become deranged by the great bulk of potatoes which must be used in order to extract sufficient nutriment from them ; thus ten or twelve pounds was considered a fair average daily quantity for a working man. Acidity is readily produced from so much starchy food, and heartburn, or waterbrash dependent on this cause, is very frequent among the potato-fed poor, as was also dropsy of the abdomen. The author of " Rab and his Friends," tells of a mode of cure which many other physicians have found efficacious : "One day a Labouring man came to me with indigestion. He hud a sour and burc stomach, and heartburn, and the -\vatcibrash, DISEASES PKOMOTET) BY POTATO DIET. 213 and wind, and colic, and wonderful misery of body and mind. I found he was eating bad food, and too much of it ; and then, when its digestion gave him pain, he took a glass of raw whiskey. I made him promise to give up his bad food and his worse whiskey, and live on pease-brose and sweet milk, and I wrote him a pre- scription, as we call it, for some medicine, and said, Take that, and come back in a fortnight, and you will be well.' He did come back, hearty and hale no colic, no sinking at the heart, a clean tongue, and a cool hand, and a firm step, and a clear eye, and a happy face. I was very proud of the wonders my prescription had done ; and having forgotten what it was, I said, ' Let me see what I gave you.' ' Oh,' says he, I took it.' Yes,' said I, but the prescription.' ' I took it, as you bade me. I swallowed it.' He had actually eaten the bit of paper, and been all the better of it ; but it would have done him little, at least less good, had he not trusted me when I said he would be better, and attended to my rules." Perhaps the homeopathisfcs will argue that the iron of the ink with which the prescription was written wrought the cure ! Our poor are so ignorant and careless in the matter of cooking that they do not half boil the Indian meal, and it escapes the digestive organs, and is a fruitful source of the dyspepsia still so frequent among the poorer classes. I think that in many cases of indigestion and irritability of the stomach a little solid food is pre- ferable to slops, for it is more in accordance with the habit of the organ, the difference according to disease being in quantity not quality. When a considerable number of the annual reports of the Registrar- General are published, I feel confident we shall find consumption more frequent in this than in most other countries. I think poor diet most strongly promotive of this disease. Scrofula was scarcely known among the New Zealanders till tho potato became their staple food it is now most prevalent. Eickets, another scrofulous disease, consist- ing in a want of lime-salts, must be a frequent con- sequence of potato diet, as that root contains but a trifling quantity of lime and magnesia. Ophthalmia is very frequent in this country, producing a large proper- 214 FOOD INFLUENCES EYE-DISEASES AND FEVEK. tion of blindness namely,! in every 843 of the popula- tion; in the United States, where the food is highly nitrogenous, the ratio is but 1 in 2,489 ; and in Norway, where it is very oily and starchy, 1 in 540, the greatest proportion of any country which we are aware of, of those which have a system of vital statistics. Females and children are more subject to ophthalmia than males, and this, as well as the high general ratio, I think can be explained by the very unnitrogenous food of our peasantry, and the very unvaried dietaries of our poor- houses. It should never be forgotten that in Magendie's dogs thus fed, or the Hindoos subsisting on rice and rancid butter, the transparent coat of the eye was always the first to die, being itself very highly nitrogenized and not freely supplied with blood. I have before mentioned the dependence of fever upon insufficient food, and I be- lieve that it acts as follows : It depresses the stamina, and as the introduction of new tissue material expels the old, the waste matter will accumulate in the blood of the ill-fed man, who becomes from these two conditions more susceptible of the contagious diseases, and less able to bear their exhausting effect. So convinced was Dr. Graves of the curative effects of food in such cases, that he never ceased to preach and practise the doctrine, and often said the most suitable epitaph for him would be, "He fed fevers." I accuse the potato, or any starchy food which may be substituted for it, of being promotive, along with some concurrent causes, of one other disease rheumatism, which is very frequent, especially in its chronic form, among the poor of this country. This disease is believed to be due to some acid in the blood lactic it was sup- posed to be by Dr. Prout, but I have for a long time seen reason to believe it was carbonic acid ; but either of them would be yielded by the over-abundant ingestiou of starchy or saccharine food. Scurvy, the next disease produced by scanty or im- DIETIC DISEASES. 215 proper food which I shall refer to, is one now rather of historic interest, having been the most prolific of all causes of death at sea. While the scientific principles on which the victualing department of the navy is con- ducted have banished the disease from that service, it pretty often appears in merchant vessels owing to the culpable neglect of the owners. Cook's voyage, in which 112 men were out for 113 days with the loss of four men only, and that not by scurvy, proved a strong contrast to Lord Anson's voyage. Vegetables, sugar, malt,fporta- ble soup, and lemon-juice led to the immunity, other wholesome practices being added. That the seat of the disease is the blood, and that it is due to a want of its proper materials supplied as food, nre the two most posi- tive facts concerning it which we are possessed of. That potash is the deficient material was an opinion started by Dr. Aldridge of Dublin, and forcibly supported by Dr. Garrod, who explains the preventive powers of lemon- juice by the fact of its containing citrate of potash, and the efficacy of vegetables by their possession of this alkali. Some alkali is necessary for the blood, as the burning of such substances as sugar, the great supporter of heat, is dependent on the presence of thatagent, and also for keep- ing the albumen fluid yet incapable of oozing through the coats of the vessels. A solution of albumen, and such we may regard the blood, will take forty-nine times as long to pass through an animal membrane as solutions of hydro- chloric acifl. The copious oozing of blood, or of some of its component parts, in cases of scurvy has some connexion with these facts. This question I have discussed at more length in my " Manual of Physiology and Disease." Prof. Parkes has given several sound reasons for the belief that a deficiency of lactic acid and vegetal acids, the salts of which yield carbonates in the blood, is the real nature of scurvy. Carbonates themselves would be useful, but fresh vegetables, rare meat, and lemon-juice are more agreeable and thoroughly reliable 15 216 8CURVT. preventative and curative agents. The Merchants' Ship- ping Act in this particular seems to be, for want of inspec- tion, a dead letter, and it is much to be desired that a judicial inquiry should be held on every case of death by scurvy in this kingdom. Mr. Simon forcibly re- marks i " This fragment of the science of preventive medicine is now well known to all the world. It was scurvy which used to decimate our navy, and rendered long sea voyages almost impossible ; it was mainly by scurvy that Anson in his celebrated voyage of 1740-2 lost, within the first ten months, nearly two-thirds of his crew, and during the remaining period about half of the survivors ; and it was against scurvy that Cook had attained his triumphant suc- cess, when in 1775, after three years' absence, he brought back a healthy crew which out of 112 men had lost only one by disease. Cook's great example gradually got to have its due weight. Twice, indeed, in the next 20 years, our royal fleet had scurvy enough to endanger its existence. But then the better knowledge and better practice began to make effectual way. The year 1796 was (says Sir Gilbert Blane) marked 'as an era in the history of the health of the British navy ' by the general introduction of lemon- juice; and an illustration of the effect of this change is that at Haslar Hospital, which even in the year 1780 received 1,457 cases of scurvy, scurvy is now an almost unknown disease." In the Admiralty lemon-juice, Prof. Galloway has found ninety-one grains of pure phosphoric acid, and thus may be supplied the deficiency of phosphoric acid which is abstracted from meat by the old, and I trust exploded, system of salting. Phosphorus is found in some form in the following components of our bodies blood, muscle- juice, gastric juice, bones, brain, and other solid organs ; and any deficiency in the supply of it must lead to most injurious consequences upon each of these. The blood and juice contained in the flesh are prevented from oozing the one into the other during Tiealth by the alkaline state of the former and the acidity of the latter, and both these properties are dependent on phosphoric acid, combined in the case of blood with an excess of soda. The oozing out of blood and the muscular debility which are two most prominent symptoms of scurvy, may be now readily DISEASES DUE TO DISEASED MEAT. 217 explained. A dusky -hue of skin, coldness, palpita- tion, and other signs of impeded breathing which occur in the disease, may be due to a want of phosphate of soda, which is of essential importance in bringing carbonic acid to the lungs, and even the softening of bones and the separation of their ends, and lastly, the prostration of nervous power, seem capable of a similar explanation. Such arguments are advanced by Prof. Morgan to show the superiority of meat prepared by his process over salted provisions in preserving the health of our seamen. The effects of decomposed sausages and other meat have been sometimes so sudden and fearful that it is supposed a special poison is developed, and such food would appear to have the effect of lowering resistance to contagious diseases, for the Faroese, who indulge the de- praved taste of putrid meat, are mowed down when mea- sles or small-pox is once imported. Meat slightly tainted can be sweetened by boiling the joint with three or four ounces of charcoal. Some of the diseases which infest the animals we con- sume as food are capable of producing serious conse- quences to man if their flesh is partaken of. Sheep, it is well known, suffer much from " flukes " in the liver, and this parasite is transferable to man if the liver be eaten. The flesh has not been shown to be unwholesome, but the liver is so disgusting that it is surprising it could ever be sold as food. The animals cannot be cured, but the disease may be prevented. This rot in sheep rapidly spoils the value of the animal and the food it affords for man. Prof. Simonds says : " In many parishes in Devonshire, where I investigated the malady, five-sixths of the sheep perished or were sold for a few shillings each, for slaughtering, to the detriment of the health of the poorer classes," and Dr. Bellingham of St. Vincent's Hospital was one of the first writers to notice the injury to sheep which the filari-a produces by lodging in their lungs, stomach, and intestines. Prof. Gamgee estimated 218 MEASLY PORK. that half-a-million of sheep were affected by it, in 1862, in the United Kingdom. In the pig the disease termed " measles," and recognized by knowing buyers by small blisters which form under the tongue, is due to an ani- mal, the cysticercus, lodging in the flesh, and it becomes developed in man's body into that formidable tenant tapeworm. A measle from the pig is here figured. Measles affected over 2 per cent, of all the pigs, and was still more frequent among the pigs reared in cabins in Ireland some years ago, for reasons which are too dis- gusting to mention ; but an extensive curer tells me it is rare now, since the j stock is reared by larger farmers. One tapeworm is capable of produc- ing 85,000,000 of the creatures which Measle frcm the Pig. produce measles ; and if they were not destroyed, measles would soon become a universal dis- ease. The measly carcases are not by any means re- jected as they should be, for as the salt gets more readily into the holes the little animals make, they are easily cured. By thorough salting and smoking and careful cooking they would be destroyed, and there is more danger of their being introduced in under-done pork ; but to avoid danger to public health, all measly pork ought to be seized. That the measly pork will pro- duce tapeworm in man was shown by inducing a crimi- nal, on gaining a reprieve, to eat plentifully of this food, and in two months his body was infested with tapeworms. In India, tapeworm was common a few years since owing to the filthy feeding of the pigs ; and my friend, Dr. Leared, has shown that one-fifth of the deaths in Iceland occur by the same cause ; and he sug- gests that the dogs which are there the great propaga- tors of the parasite should be cured by the medicines which we know surely expel it. Measly or " spotted" TRICHINA DISEASE. 219 pork may be known by white specks scattered very thickly through it. The trichina spiralis is another little creature which may, in a similar manner, find its way into man's flesh, and there give rise to, during its migrations, a fever re- sembling typhus, but producing awfully severe muscular pains. The great names of Hilton, Paget, and Owen are connected with the discovery of this worm, about 1834, in the flesh of man ; and in 1836 six bodies were dissected in this city which contained it. It has since appeared very rarely. It is said to be spread by rats about slaughter-houses, which pigs afterwards devour. Till lately we had no case where, after the fatal result, we were enabled to discover the parasite ; and the zeal of one naturalist carried him so far, that for the purpose of examining it, he proposed to " harpoon " one of the muscles of the living patient, and in a bit of flesh so procured, the size of a hemp-seed, seven of the animals were found. In the little Saxon town, Heltstadt, the eating of one pig in October, 1863, produced 158 cases of trichinous disease, and led the English Privy Council Trichina in Meat. to scientifically study the subject. In one morsel of flesh, one-fifth of a grain in weight, 58 trichina were found, which would give 28,000,000 if the whole mus- 220 TRICHINA DISEASE. cles were equally affected* The sketch on the previous page, adapted from those of Dr. Thudichum, represents one of the worms containing several eggs and young ones within it, and coiled up in the midst of muscular fibres. The fat of pork, and the heart and other organs may be eaten, as they never contain the parasite. There is nothing new in our restrictions in these matters, for by Edward II. it was enacted that a butcher should not sell swine's flesh " mezzeled," or dead of the murrain. For the first offence the butcher was to be " amercied ;" for the second, to have the pillory ; for the third, to be imprisoned and fined ; for the fourth, to abjure the town. Henry VII. decreed that " No butcher shall kill any flesh in his scalding-house, or within the walls of Lon- don, in pain to forfeit for every ox so killed 12d., and for every other beast 8^., to be divided between the king and the prosecutor." The flesh of animals which iiave died of anthrax, malignant pustule, splenic apo- plexy, ovine small-pox, and other diseases, would be probably most injurious if partaken of by man, but upon this point positive evidence is wanting. It must not be supposed from the rarity of well-proved cases that the eating of flesh of diseased animals is safe, for it must be remembered that the fearful effects of meat infested with trichina was only lately discovered. The army regulations are imperative that no flesh from a diseased animal shall be used but in civil populations. Pleuro-pneumonia was first introduced into the United Kingdom by the importation of some Dutch cattle into Cork, about the year 1840, which indeed was an event of truly disastrous consequences. It resembles human contagious maladies in the protection which the first attack confers, and hence the success of inoculation. The flesh of oxen which have died of pleuro-pneumonia, or contagious lung distempers, is very commonly sold not by the butchers who supply the richer classes, but by those who, in the wretched neighbourhoods, pawn it on LUNG DISTEMPER. 221 the poor. In September last, the matter was brought before the Lord Mayor, as the Clerks of the Market had seized the carcases of some beasts which had been slaughtered while suffering from this distemper. Prof. Cameron, the City Analyst, and I expressed our opinion that the food was not fit for human use, but as the question was one touching the interests of graziers very largely, the evidence of the most celebrated chemist in Dublin and of two able surgeons was procured, to attest that they could not discover by chemical analysis or microscopic examination any peculiarity in the meat. We urged that animal poisons are unfortunately not to be discovered by these aids, which are not used in the detection of similar human diseases, and testified that we thought the food of an animal affected with a conta- gious blood-disease unwholesome, and certainly not aa good as that from healthy oxen. The Lord Mayor decided in this case against the Clerks of the Market, but the matter is by no means set at rest. The following communication, which the Lord Mayor received from Prof. Ferguson, was laid before the Sani- tary Committee of the Corporation a few weeks since : " Veterinary Department of the Privy Council Office. " MY LORD I am directed to inform you that it has been reported to the Commissioners of Police, on most reliable authority, that almost every night sick and even dead cattle are conveyed in carts to a slaughter -yard in , where they are dressed, to be sub- sequently sold as human food. " I also beg to direct your lordship's attention to the fact that neither microscopic nor chemical examinations are able, in the majority of cases, to discover any difference between the meat of sound and diseased animals, even when the latter had been found, on careful judicial examination, to have poisoned the persons who have partaken of it. The cases of poisoning at Newtownards in June last, resulting from the eating of the meat of a diseased calf, afforded an example of this fact. According to the sworn evidence of some experts, the meat in question did not differ in appearance from that of a healthy animal, nor could the professional men who examined it discover any poisonous principle in it, although th 222 LUNG DISTEMPER. evidence that the eating of it had poisoned several persons, and in two instances fatally, was so clear that the coroner's jury brought in a verdict to the effect that the deceased had died from having partaken of poisoned veal, and four of the persons implicated in selling the same are held to hail to appear at the ensuing Down- patrick as -izes to take their trial for said offence. It is desirable to add that Dr. Hodges, who analyzed the stomachs of the poisoned persons and their contents, could not discover any trace of poison therein, although there was no doubt that the deaths had been caused by an animal poison contained in the meat of the diseased calf. This may be regarded as confirmatory of the statements re- cently made by the Corporation's regular medical and chemical officers, Drs. Mapother and Cameron, to the effect that the meat of diseased animals, even when in an absolutely poisonous state, may present all the ord naiy appearances as well a, the microscopic and chemical characteristics of sound meat, fit for human food, although it should on no account be sold as such, particularly to the poor, whose digestive organs are too frequently enfeebled by habitual privation, and are therefore less able to resist the poisonous influence of food derived from the carcases of diseased animals. Such meat, when given to dogs, as I have frequently stated to your lordship, has a tendency to produce severe diarrhoea, and I re- spectfully submit to your lordship should not be sold as human food, particularly at a time like the present, when even from com- paratively slight errors in diet, the digestive organs too frequently become affected with rapidly fatal diseases, such as cholera. " It has been argued that cooking destroys all the poisonous principles in the meat, no matter how diseased may have been the animals from which it has been taken ; but that such is not the case, has been proved by the fact that some of the veal that caused poisoning at Newtownards had been no less than twice cooked previous to being eaten. " Apologizing for thus again intruding the subject upon your lordship's notice for re-consideration, and begging the favour of being made aware of your ultimate decision relative to the meat of diseased animals when reported as such, I have the honour to be, my lord, your lordship's obedient servant, " HUGH FERGUSON, H.M.V.S." I could add little to Prof. Ferguson's full and truth- ful report. Lung distemper being a communicable blood disease, must render the flesh of the animal unwhole- some, although it may not sensibly alter it ; for it must be confessed, that the chemist and microscopist are LUNG DISTEMPER. 223 equally powerless in the detection of animal poisons. The disease is very similar to human typhus, in which the muscular tissue becomes rapidly broken down and loses its cross marking, and the muscular prostration is often so great, that early in the distemper the beast is not able to stand. If the animal were allowed to die of the disease, its flesh would be still more unfit for food. There are many other cattle diseases which have been ascertained to be communicable to man when the flesh is eaten, and if a vigilant inspection were rendered possible by the limitation of slaughtering to two or three abattoirs, much injury to public health could be pre- vented. The conveyance of infected cattle to this city, where they are sold not in the markets, but without commission in the yards of some salesmasters, greatly tends to spread communicable disease among healthy stock ; and Prof. Gam gee says that our slaughter- houses are " very improper establishments for the pur- pose to which they are applied ; the putrid emanations are such that meat cannot be long kept in them, or in shops adjoining them." The loss by seizure in the city of London, where inspection is most vigilant, is but TtyT of the meat sold, or 2s. 6d. in every 100, and great good is done to the poor in the way of preventing dangerous food being sold to them. Dr. Letheby, one of the greatest authorities on the matter, says: " The practice in the city of London is to condemn the flesh of animals infected with certain parasites, and of animals suffering from fever or other acute inflammatory affec- tions, or from lingering disease, as well as of animals that have died from natural causes, and all meat in a high state of putrefaction, and meat tainted with physic." Among the Jews and in Austria there are very strin- gent rules, and in that country no calf under three weeks old, or weighing less than forty pounds, is allowed to be used as food. In Italy, the milk from cows with foot and mouth disease is not allowed to be sold, but in 224 SWILL MILK ABATTOIRS. cases of more severe disease the secretion of milk is for- tunately arrested by nature. In New York great injury has resulted from the use of such milk, and in other States that fluid is said to convey a fatal disease, which the cow contracts from pasture. The argument so often used in opposition to sanitary efforts namely, that death has not been shown to be produced from this spe- cial cause, would equally apply in opposition to removal of some of the filthiest nuisances. Milk rapidly gene- rates fungi and vibriones, and Dr. Parkes suggests that by the decomposition of that fluid, digestive ailments may arise in children, and that the disease known as "thrush" may be connected with them, for fungi are found in the blister that forms. The swill milk, or that from cows fed on distillers' grains and wash, is notoriously unwholesome in New York. Dr. Letheby believes that many cases of illness are pro- duced by the eating of meat from diseased animals, and during 1861 the sanitary officers of the city of London seized 141, 458 Ibs. of meat, of which 78,697 Ibs. were from diseased animals slaughtered, and 33,619 Ibs. from beasts that had died. Prof. Gamgee has seen "a carcase dressed, and portions of it prepared for sale as sausage meat, and otherwise, although thoracic disease had gone to such an extent that gallons of fetid fluid were re- moved from the pleural sacs, and that large abscesses existed in the lungs." Owing partly to the noxious air which surrounds them, and partly to intemperance which is common, the mortality among butchers is only exceeded by that of one employment, the vintners, ac- cording to Dr. Farr. I have before alluded to the expediency of erecting abattoirs for our city, but I may now state that that erected lately at Fountain-bridge, near Edinburgh, is a model for our guidance, and not a slaughter-house exists in that city. The premises of the abattoir cover four and a-quarter acres, thus affording space for all the ABATTOIRS. 225 accessory trades. The measure is since 1765 established in Paris. In the year 1810, Napoleon, moved by a report of the Institute, of physicians, and by complaints of citi- zens, issued his celebrated decree of the 15th October, regulating the position and management of all industrial establishments under three heads, according to the ex- tent of their insalubrity or inconvenience. First, those which ought not, on any account, to be carried on in towns ; the second, those which, though not absolutely forbidden, ought only to be sanctioned when the pro- cesses are conducted so as not to be injurious or incon- venient to the neighborhood ; the third, those which may be placed in any part of the city. Foremost among the first class were placed abattoirs, slaughter- houses, knackers' yards, and other businesses concerned Adth the flesh, skins, blood, and entrails of animals. Fat melting in Paris is done outside the city, and mainly in the abattoir, in which there are forty-eight such establishments. The Emperor also ordained that all private slaughter-houses in the city of Paris should be closed, and public abattoirs constructed by the munici- pality outside the barriers. An excess of flesh-producing food does not give rise to such evident ill consequences as we have seen an over- amount of heat-producing material does ; but if combined with such concurrent influences as sedentary habits, gout, produced by the accumulation of a nitrogenous acid in the blood, is sure to follow. I have not been able to produce any statistics on the point, but I feel sure that butchers are more subject to apoplexy and enlargement of the heart than most other men, unless the ill effects of over-feeding be prevented by free exercise. Good food has a peculiar power in preventing para- sitic skin diseases, as rich blood does not seem suitable soil wherein they may thrive. I think that the great rarity of scald-head, which depends on a little plant, 226 DIET IN DISEASE. may be explained by the improvement in the food of the peasantry which has of late years occurred. The subject of the diet advisable in various diseases is not suitable for a popular audience, but I have long in- tended to publish for my professional brethren some principles on the subject, which I think, nearly as much as medicine, influence the recovery of the sick. LECTUEE IX. HEALTHY SKIN BATHS CLOTHING. THE most appropriate introduction to what I shall have to tell you of baths and clothing will be, I think, a sketch of the structure and function of that much neglected organ, the skin. It is composed of two prin- cipal layers, the scarf skin, which you readily peel off, or which is raised by a blister, and the true skin, contain- ing the means by which we feel, and the glands which throw off perspiration and other matters. The scarf skin is quite devoid of feeling, as you perceive when testing the sharpness of a razor upon your hand, and therefore is placed over the sensitive layer, to blunt this property. It is very impervious to water likewise, and thus prevents the escape of that fluid from the tissues of the body, and being a bad conductor of heat, it prevents the injuries which would result from sudden changes of the temperature. The scales of which the scarf skin is composed are being constantly renewed by the true skin, and those of the surface are cast off, as can be most readily perceived on the scalp, where they go by the name of "dandruff" which I may parenthetically tell you is derived from two Saxon words signifying " itch " and " dirt " but after fevers the rest of the body throws off its scarf skin abundantly. The scarf skin is composed of albumen, and thus it is that the soda of which soap is composed is capable of softening or dissolving part of it, and thereby removing the dirt which may have been fixed in it. The thickness of this covering varies with the pressure to which it is subjected, that of the palms of the hands and soles of the feet, and that of the face, being the extremes in this respect, and owing to the scantiness of hair, man's skin is thicker than that of most other animals. 228 THE STRUCTURE OF THE SKIN. It is in its deepest layer that the colouring matter which distinguishes various individuals and races is situated. The colour of the dark races is of use in tropical climates by absorbing the heating rays of the sun, by which perspiration is increased, and its sub- sequent evaporation cools the surface. In such climates the skin is very active, and aids the lungs and liver in their purifying operations. The true skin has upon its surface numerous projections, containing nerves, and which are the organs of touch, whereby we are made acquainted with the conditions of external objects, and much danger is avoid- ed. The elasticity of the skin, and the softness of the cushion of fat beneath it, prevents these ten- der projections from receiving injury when even strongly press- ed on. An immense number of blood- The Vessels of Skin. vessels permeate the skin, so that the finest needle cannot be thrust in with- out wounding some. The capillaries of two ridges of the skin are here figured. This great vascularity is promoted by heat or moisture applied to the surface, and diminished by the contrary ; so that you will readily understand how the circulation of internal organs can be affected by changes in this outer one. The occurrences, blushing and pallor, show that emotions created in the brain are capable of influencing the circulation in the skin. The glands, or twisted tubes which we find in the skin, are the struc- tures which are most closely connected with the preper- vation of health, and they are of two kinds first those short ones which you see represented by the sides of THE STRUCTURE OF THE SKIN FLESHWORMS, 229 the hair in the centre of the next diagram, a little animal, which nearly always exists in them, being also seen. They open into the hollow in which the hair is set, and pour out a soft fatty matter, very like ordinary tallow, after it has become solid from its flow outwards being pre- vented by the blocking up of the orifice. They are large upon the face, and when the contents of a tube is squeezed they assume a spiral form, and being tipped by black dirt have been popularly believed to be a "flesh- worm," but are rather nests of worms, for as many as twenty of the little crea- tures I have just mentioned may be found in the mass by the microscope. The unctuous matter serves many important offices it renders pliant the skin, obviates the vicissitudes of heat and cold, and it pre- vents the injuries which would result from the rubbing toge- ther of contiguous surfaces. It must from its highly nitro- genous composition be regard- ed as waste tissue-matter, from Which the blood is purified, and Sectional Diagram of Skin. which cannot be retained without injury to health. The longer and more spiral tube to the left of the dia- gram is that through which the perspiration is expelled. You see it is rolled up into a circular ball at the deeper end, and opens obliquely or in a valve-like way at the pores on the surface of the scarf skin. The magnitude of this system of " drainage tubes " will be best learned 230 PERSPIRATION. from Erasmus Wilson's calculations ; the average number to the square inch of skin may be stated as 2,800, for upon the palm of the hand there were 3,528, and even on the heel, where they are least numerous, 2,268. Taking the surface of an ordinary man as being equal to 2,500 square inches, the number of perspiratory tubes will be 7,000,000 and as eacjh is about one-quarter of an inch long, there will be about twenty-eight miles of this tubing throughout the entire skin. No one will deny that serious results must follow if this drainage system be obstructed, and I will presently ofier you abundant evidence of the fact. From these pores there is constantly issuing vapour, which is known as insensible perspiration, and occasionally upon increased exercise, or when chemical change in muscles is more abundant, or during greater heat, it becomes condensed into drops of sweat. The evaporation of this fluid serves the use- ful physical purpose of keeping the temperature uni- formly at 100, as the conversion of the water into steam plentifully abstracts heat. In tropical countries the colored races are kept cool by the great evaporation of sweat, the heating rays of the sun being absorbed more readily. The giving of perspiration is much checked by a moist air, and thus it is that while Chabert, "the fire king," and Sir F. Chantrey's workmen, could enter a chamber of which the temperature was 400, the air being dry, could not endure a moist atmosphere of one- third the temperature. Waste matters, the products of the chemical changes of the body, are also got rid of by the perspiratory tubes, as will be seen by the fol- lowing analysis of sweat : Water 995-03 Animal matter, including urea (HO Sulphates 1'05 Chlorides 2'40 Acetic, lactic, and formic acids, fatty matters, &c. 1'45 1000-00 BREATHING BY THE SKIN. 231 The Rev. Prof. Haughton has found no urea or other nitrogenous substance in it. The daily quantity of sweat has been computed at three pounds at ordinary temperatures ; but in such em- ployments as gas-makers and stokers that quantity has been given off hourly, and this without exhaustion, as they are given gruel to drink plentifully. Of solids, including putrescible animal matter, it is computed that 100 grains are daily got rid of when the skin is perform- ing its functions healthily, or much more by the action of a Turkish bath, and the worst results must ensue from its retention in the blood. Even disease illustrates the purifying nature of the skin, and the eruptions which follow the introduction of small-pox and other contagious poisons are but efforts of Nature to free the system from them. The skin is also a great respiratory surface, and gives off the products of its combustion as carbonic acid, the amount of which is greatly increased by a vegetable diet. If the skin of any animal be coated with an impermeable varnish, the breathing through it ceases, and the animal dies in an hour or two, as effectually suffocated as if its windpipe had been stopped. The compensating action in this regard which exists between the lungs and skin is best illustrated in disease ; for instance, when the lung is injured by inflammation of its texture, the combustion and consequent extrication of heat by the skin becomes excessive. As it is quaintly, but not inaccurately, phrased by an old writer, the skin serves to " discharge the fuliginous recrements of the blood, with the steams arising from the subjacent parts, and to ventilate the flame of the circulating blood that it may not be oppressed or suffocated." The last faculty of the skin I shall allude to, is its power of absorbing various substances placed in contact with it; painters, mirror-silverers, and the victimg^of cancer- quacks, have been often poisoned by the lead, 16 232 ABSORPTION BY THE SKIN SENSATION. mercury, or arsenic introduced through this channel. The scarf skin, and the oily matter with which it is smeared, is, however, a very effectual guard against the absorption of injurious matters and contagious poisons, which would readily gain entrance, as they do through the lungs, if it were not present. However, that animal matters may penetrate has been shown by Mr. Ceely, for he has often vaccinated without scratching the skin, by merely leaving the lymph upon the surface covered with a little blood, and patients who, from diseases of the food-passages could not be fed in the ordinary way, are said to have been supported by baths of milk and soup. The palms of the hands and the soles of the feet allow absorption readily, as no oily matter is spread over these situations. The skin is also the great medium of sensation, which is accomplished by innumerable nerves and peculiar bodies formed in them; but I will not further allude to this function than to say that we are made aware of changes of temperature, so frequent in this variable climate, and of any hurtful physical condition of sur- rounding objects, by this endowment of the surface. I trust I have convined you of the prime necessity of carefully attending to the functions of this all-important organ, for I believe that health would be preserved and life prolonged if we ourselves were, as Sir Astley Cooper phrased it, as assiduously "groomed" as our horses. That eminent sanitarian, Mr. Chadwick, puts this fact in a very practical way : " Skin cleanliness augments the nutritive effects of food. It has been found on positive comparison of results with the same quantity of the same food, that pigs that are subjected to regular skin cleansing by being washed, put on' one-fourth more flesh than the pigs that are nnwashed, and that the pork of the washed pigs is the finest and the ' best eating.' It should, therefore, be preached to the poor, as an additional inducement to skin clean- liness, that the same food which is required to make four children that are kept dirty thrive, will serve to make five thrive whose skins are daily washed and kept clean." EVILS OF A NEGLECTED SKIN*. 23 3 The very numerous matters which I have stated the skin itself discharges, and the extraneous particles which the friction of our clothes or the dusty city atmosphere including all those dirts which Lord Palrnerston denned as but misplaced matter soon forms a crust upon this organ which blocks up its openings and otherwise in- terferes with its all-important functions. The salts which form a considerable portion of this crust attract moisture, so that an unclean skin will be always kept damp, and the waste matters may in this way undergo solution and be re-absorbed into the system. Such animal matters, if refused exit by the skin, will seek removal by the kidneys ; but they, however, will fail after a time in ful- filling this work superadded to their own, and that most frequent and fatal malady "Bright's disease," which depends on the obstruction of the tubes of the kidney, often results from a neglected skin, or from the rush of blood to the organ by reduced temperature and sup- pressed perspiration, as was first shown by the late Dr. Osborne, and which I have many times observed. In the army the want of cleanliness was once most disas- trous, and Dr. Rush said that if soldiers grew as rapidly and as spontaneously as blades of grass, uncleanliness would mow them down in a campaign or two. I trust the time will come when, by the improvements of chemical science, the most useful of all the branches of knowledge accessory to medicine, the quality and quan- tity of the cutaneous exhalations, will be investigated with some of that zeal which has largely added to our know- ledge of morbid states of the secretion of the kidneys. Water, especially that which is soft, as its solvent power for saline matter is greater, removes the crust upon the skin of which I have spoken, with the exception of its fatty matter, and this requires the addition of soap, the alkali of which saponifies it. Soft water is far more cleansing than hard, and is less irritating, as every sur- geon finds out in the dressing of sores. Well-made soap 234 EVILS OF A NEGLECTED SKIN. can never be iojurious to the most tender skin, even that of the new-born infant, and all wash-powders are hurt- ful for, in the words of Mr. Wilson, the greatest au- thority on the preservation of the skin, they cannot "fol- low the innumerable apertures of the skin, nor enter the mouths of the pores otherwise than to obstruct them. A skin cleaned in this manner may always be detected by a certain kind of shining, not to say greasy polish, and the whole complexion looks mellowed into a kind of tone, as we say of pictures in which dirt and time have softened and chastened the tints." The same able writer, in his admirable treatise, "Healthy Skin," to which I have to acknowledge many obligations, says : '* As regards the frequency of ablution, the face and neck from their necessary exposure to the atmosphere and the impurities which the latter contains, cannot escape with less than two saponaceous ablutions in the twenty-four hours ; the feet, from the confined nature of the cover- ings which are worn over them, require at least one ; the armpits, from their peculiar formation in reference to the detention of secretions, and also from the peculiar properties of the latter, at least one ; and the hands and arms so many as nicety and a refined taste may dictate. No harm can arise from too frequent ablutions, much evil may result from their neglect." I |believe the in- susceptibility of the face and hands to the influence of chills depends on the frequency of their ablutions. Miss Jane Porter, the novelist, who was always catching cold on the slightest exposure, once remarked to her brother, a physician : " How I wish that my skin were all face." " Try and make it all face," he replied. The most beneficial of all methods of ablution is the general one easily accomplished by the sponge-bath, the water being at first suited to the season, or to the cuta- neous activity of each individual, and no single hygienic observance has perhaps done more to prolong life or pre- serve health. Those who are ready to exclaim, " We THE EFFECTS OF BATHING. 235 have not time every morning for bathing," should remem- ber that it can scarcely take five minutes ; that there are 288 of these five minutes in the day, and that neglect of this observance will incapacitate them for many a five mi- nutes, when hereafter prostrated by illness. A wet towel nd a dry one to follow will be a good substitute, if time and cheapness press. The ruddy cheek, full pulse, and muscular activity in a word, the hale old age of many has been justly attributed to the continuous use for years of daily cold bathing. I must also confess that our art can offer no better prescription for those predisposed to be threatened with consumption. The sponge-bath may be made more stimulating by adding common salt, or Tid- man's artificial sea- salt, to the water, and should be fol- lowed by the vigorous use of a rough towel, such as those called Turkish. Horse-hair gloves are also excellent, and by clapping them together after use, you can prove how much stuff they scrub from your body. A belt of the same material has been found even better than a flannel bandage as a safeguard in cholera times. The first effect of cold bathing is to make the muscles of the hairs, which are depicted in the diagram of the skin on a previous page, passing obliquely to near the root of one of them, contract, and this is evidenced to us by the goose-skin appearance they produce by erecting the hairs. By the contraction of the blood-vessels of the skin much blood is thrown upon the internal organs, which excites these in their return to act more ener- getically, a d what is known as " reaction " takes place. This consists in a freer circulation, the skin becoming redder and hotter, and the breathing and other vital functions being exercised with greater ease ; and unless it follows, health cannot be perfect or the bath suitable. In very cold weather, or in the case of chilly persons, the upper part only of the body may be uncovered at first, washed and clothed with woollen and then the lower half may be treated in the same way. However, 236 THE WARM BATH TUKKISH BATH. in this and all other hygienic practices, there are many individual peculiarities, as it is impossible to frame pre- cise rules to fit every one's circumstances. The warm bath is a valuable means of cleanliness, but is relaxing and oppressive, as very little, if any, perspiration or breathing by the skin can occur in water. The temperature should range about 96, and is unen- durable beyond 104. Of the Russian vapour bath that is, one in which the air is charged with an opaque mist I have no experience ; but as it would impede cutaneous transpiration, my impressions of it are not favourable, although it is esteemed by many. The hot air bath, arranged with a spirit-lamp under a cradle, is very con- venient, and in St. Vincent's Hospital has been found most serviceable. Mr. O'Neill of Henry-street manu- factures a most useful and cheap form. If the more carefully constructed bath which I have next to speak of can be procured within a reasonable distance, it should be preferred to all other hot-air kinds. The baths introduced into this country in 1856 from the East, under the name of the " Improved Turkish Bath," has been regarded as more analogous to the old Roman bath than to the Oriental hammam. Although a description of it may seem unnecessary, as there must be few, if any, of my hearers who have not undergone its operations, yet that will be the readiest method I can offer my opinions on the subject, making any comments I think suitable at each step. The first room you enter is as cool as the outer air, and here you undress, and afterwards dress again, so that from these circumstances the Romans termed it the frigidarium or vestiarium. Swathed round the waist by a light cloth, and with clogs to prevent your feet being burned by the heated tile floor, you enter the second room, or tepidarium, heated by flues carried under the floor, to from 110 to 120, as the thermometer in it informs you. The admission of pure air and the expulsion of impure is accomplished by THE TURKISH BATH. 237 ventilators in the opposite walls near the ceiling, and unless this is carefully attended to, the hour will be by no means healthfully spent. The windows, fitted with stained glass to produce a tinted twilight, are in the roof, which partakes of that Saracenic character of architec- ture on which the whole building is constructed. There is a central seat and several couches of marble with mat- tresses, on which you spread the sheet given to you. Although there is no "direct method for charging the air with moisture in this apartment it must enter from the inner room, and basins of water, with which you are ad- vised to wet your hair, the only part which feels hot, are usually left in it. The sensations in this room are agreeable to nearly every one, and those to whom they are not, are probably those to whom, as I shall tell you, the bath is unsuited, and they should retire to the cold- room, at least for a^while. My pulse usually rises four beats here, and often twenty in the warmest room, and the respiration becomes a little hurried ; but these effects diminish when a general perspiration breaks^out in some twenty or thirty minutes, and you are thereupon fit to enter the sudatorium. The air in this last chamber is heated to about 140, and is charged with moisture, though not visibly so, from the washing-places which adjoin. In the hammam, the temperature of one room is over 200. I think it would be well to have vapour equably distributed by a spray jet of warm water, and regulated by the aid of the hygrometer. Strange enough, the other secretions are not lessened, although so much fluid escapes from the skin. The attendants are so much exposed to a high temperature that they do not require heat-giving food, and lean meat is what they care for. Their employment does not seem to injure their health. I know one fellow who has been about eight hours daily for over eight years in the bath, and he is healthy and muscular. I am very anxious to make some investigations on these and other physiological 238 TURKISH BATH SHAMPOOING. points in connexion with the bath, and will seek the leave of the proprietors as soon as I can find leisure. It appears from the writings of Galen that the Romans took care to have the air of the sudatorium moist. The heat in this room feels to many oppressive, and with others sweating becomes profuse. The curious opera- tion of shampooing is performed here. You are stretched on a couch, and every part of your body is kneaded, squeezed, rubbed, or pulled till your joints crackle, and become so flexible that you feel they are really being dis- located. So relaxed is the system that these operations, which, under ordinary circumstances, would be intole- rable, are really agreeable. A surprising quantity of scarf skin, which no washing could remove, peels off, especially if a glove of camel's-hair or goafs-hair be used, as they are in the East, where also the soles of the feet are scraped with pumice. The deposit of this skin of only a week's date, when collected, is often as large as one's fist. You are then dashed with warm water and lathered with soap applied with a wisp of lyf, the woody fibre of the Mecca palm, and finally washed clean by tepid, and afterwards cold water issuing from a rose with a flexible tube. Adventurous bathers often take a cold douche, or even some, closely copying the Eomans, try immersion in cold water "to close the pores," but some means of restoring one to the normal temperature is indispensable. From this lavatonum you are rapidly conducted to the first room, where, wrapped in your sheet, you recline on a couch or duretta shaped like a spread out W, till quite cool, when you slowly dress, for any hurry or exertion is apt to bring out per- spiration, which makes you liable to catch cold a pro- perly conducted bath, however, having no such effect. I would advocate the use of the bath as a social custom and preventive of disease, for I believe it is the most per- fect means of ablution we possess, and therefore keeps up a cleanly and vigorous condition of the body, and CASES SUITABLE FOR THE TURKISH BATH. 239 braces the person against the vicissitudes of temperature and the liability to catch contagious diseases. There is no doubt also that large evacuations can be accom- plished through the skin more safely than by any other secreting organ. Much more solid matter is contained in the perspiration of those who take the bath for the first time or after a long interval. Nothing escapes through the skin, save what is noxious if retained. This bath should never be used in case of advanced lung diseases, great debility, acute inflammations, or persons who labour under any form of heart disease ; but on the contrary, I think its influence is directly curative in rheumatic, gouty, and scrofulous affections, some skin diseases, and the earlier stages of feverish colds and ague. It is said to have calming effects in the treatment of insanity, and the use of it was suggested from the heavy smell the skin of persons thus afflicted often has. By producing freer action of the skin, especially of its aerating function, I feel sure it is preventive of consump- tion, and curative perhaps in the earlier stages of that malady. It is a substitute, to a certain extent, for active exercise, which the circumstances of some prevent them from enjoying, and in Rome the baths formed part of their great gymnasia, those institutions which had so much to do with the training of that hardy and manly race. The importance of baths among the Romans is evidenced by the number and magnificence of such establishments ; that built by Diocletian was capable of accommodating three thousand persons at a time and so highly valued were they, that those who sought power at the hands of the populace could find no more effectual way of winning their favour than opening such establish- ments gratuitously for a day. In Eastern nations the bath has been, both in ancient and modern times, held in equal estimation, for in the words of Disraeli, " The East is the country of the bath. Moses and Mahomet made cleanliness religion." The Hammam in Jermyn- 240 THE TURKISH BATH. street, London, managed by a company, is the most perfect bath now existing, and corresponds most closely with that of the Turks. In the two years following its erection over 60,000 baths were given. One of its striking features is a douche, constructed of small tubes, with minute apertures, which take the form of a case, in which the body is enclosed, and the water is jetted gradually from the lower to the upper part. There is also a cold bath, which the bather may swim through to return to the cool from the hot chamber. The atten- dants are Hindoos. It was in favour of this establish- ment that Dr. Goolden, Physician to St. Thomas's Hospi- tal, gave the following laudatory evidence : " This has opened a new era, both for man healthy and man dis- eased ; " and a similar one has been added to the New- castle Infirmary through the interference of Sir John Fife, M.D., who has written a treatise in praise of the bath. That accurate observer, Dr. Thudichum, says : " The public in this matter is far in advance of the medical profession. Our duty as doctors of the healing art simply is, to make ourselves acquainted with the uses of this therapeutic instrument." My friend, Dr. Leared, says : " An objection commonly urged against the bath is that it debi- litates so much, that its use should be only occasional, and confined to the vigorous and robust. But consumption is a disease in which debility is a marked symptom, yet the patients submitted to the bath increased in strength and flesh. This convinces me that the bath cannot be considered as a lowering agent, and that it is likely to prove the best treatment for consumption yet applied." You will then remember that I am an advocate for the use of the bath by those in health, and, with proper medi- cal advice, in the treatment of a few diseases ; and in saying this I express no sympathy with the hydropathic practitioner who introduced them into this country. He has done good, for which I believe he has been repaid pecuniarly by their success, and if he be not insensible to ridicule, he should restrain his pamphleteering friends IRISH SWEATING HOUSES. 241 from committing the absurdity of comparing his doings to the unselfish and glorious achievements of Harvey, Hunter, and Jenner, as they have done. The hot-air bath is of very ancient origin, and is a frequent antiquarian relic in this country, especially in the island of Rathlin, where they are constructed like a beehive, with a small opening, and the air inside is heated by a turf fire. They are known as Tig Allui or sweating-houses. Hot dry air is, however, very injurious by drying and congesting the membrane of the lungs, throat, and eyes, producing also turgescence of the little vessels of the brain, and liability to haemorrhage by their rupture. Medicated baths such as those containing iron, as at Spa ; or sulphur, as those of Harrogate are supposed to act by those agents being absorbed ; but all parts of the body, except the palms of the hands and soles of the feet, being rendered impervious by the sebaceous secretion, I doubt the fact. These baths can be easily imitated by the chemist. Time will not allow me to speak of the lamp-bath, or the gaseous-bath, or of such oddities as the mud-bath, or that constituted by the reeking skin of a recently slaughtered animal ; but the subject of sea-bathing is so important that I must devote a moment to it. Sea- water is more stimulating to the skin than fresh water, and reaction is therefore more abundant after it, and its shock, increased by the impulsion of the waves, and chilling effects are soon obviated if such active exer- cise as swimming be carried on. The fresh and bracing air and exhilarating prospects are much concerned in increasing its beneficial effects. It is a popular fallacy that it is dangerous to take a cold bath while warm by exercise ; there is no more suitable time. Soon after the first immersion, which gives rise to breathlessness and even giddiness, a glow, accompained by a buoyancy of the limbs and brave joyous feeling of the mind, succeeds ; and so long as they continue, the bather may remain in 242 SEA-BATHING BATHS AND WASH-HOUSES. the water ; but on the first hint of depression, which will succeed, he should leave it, as the worst consequence will follow from the great abstraction of heat and the congestion of the lungs. A short time since one of our lately qualified surgeons was attacked with most severe inflammation of the lungs, owing to such incautious prolonged sea-bathing. Languor, sleepiness, and weari- ness very often follow from the depression so produced, especially if the redness of the surface, which is so essential, be not attained by friction of the surface with a towel. Dr. Desgenettes, who lived through a service amidst the most pestilential atmospheres of cholera patients in Egypt, and Prof. Padel, who served through the epidemics of cholera and of typhus which had ravaged Florence, attributed their escape mainly to fre- quent complete ablutions with water mixed with vinegar, and to a daily change of their clothes, which they then fumigated. M. Grimaud regards these precautions as a discovery in the science of prevention, and asserts that one may nearly always guard himself against contagion, and pass his life amongst the sick with impunity during the most terrible epidemics, prevention having now be- come " an fond une affaire de toilette et hygiene privee." You will, then, perceive how highly I value baths of every kind, and I must express my deep regret that there is but one institution in Dublin which brings them within the means of the poor and labouring class I allude to the baths and washhouses connected with the Mendicity Institution, Usher's Island. They have, however, per- formed their duties as far as possible. About 18,000 is the annual number of bathers, who, for a few pence, ob- tain every comfort. There were given last year forty- eight baths to the poor gratuitously ; but it is much to be deplored that more numerous opportunities for clean- liness among the destitute classes cannot be afforded in this way. In one year the ten baths and washhouses in the city of London, under the 9th & 10th Viet. NEGLECT OP BATHING BY THE POOR. 213 cap. 74, gave 1,001,041 baths, and 821,474 women used the washing appliances, the receipts for that year being in the former case 13,369, and in the latter 7,264. I have frequently asked the poor at hospitals when they had last bathed their whole bodies, and the answer has been "never " or " not for years," except in the case of young men, who occasionally take a plunge into the sea. Among such health is impossible, and epidemics find easy victims. By the way, our law agent at the Health Committee is an advocate for female sanitary sergeants, who shall compulsorily wash the women and children in our humble houses ; and if such an interference with the liberty of the subject becomes ever admissible, healthi- ness will be much promoted. In a ragged school, the rule that every boy should take a warm or tepid bath as he entered, was carried out with the best results that foul smell which is perceived in any room crowded by the poorer classes was unknown, and contagions diseases were much checked. The change of clothes, and their disinfection by heat for three hours, would be another beneficial step. Washhouses are clearly much to be de- sired, on account of the pecuniary saving to the poor, but still more because " the washing-day," with its inflictions of dirty suds and damp clothes hung through the room, is detested as much by the artizan as his wealthier neighbour, and tends to change domestic habits to a fond- ness for the gin-palace. I feel sure the Corporation, as soon as we have an adequate water supply, will erect baths and washhouses for the poor and labouring classes of our city. Such has been done by municipal authorities elsewhere, and with pecuniary profit as regards the baths. There are many waste plots in the heart of the city which might be devoted to this necessary purpose. Sir E. Kane, in his recent inaugural address at the Statistical Society, forcibly said : 244 NEGLECT OF BATHING BT THE POOR. " I place foremost those means which have for their object to elevate the standard of living, and to increase the vital force to raise the life energy of the people. 1st. To enable, by cleanliness, the skin to perform those functions by which a proper equilibrium of the solid and liquid constituents of our system and the healthly constitution of our tissues are preserved. 2nd. By a proper supply of air to afford to the lungs the requisite means for aerating the blood, and supporting that combustion of the carbonaceous elements of the food by which the temperature necessary for the existence of animal life is maintained. And 3rd. To obtain full access of light, the true vivifier, the great source of energy in nature, without which neither chemical nor physiological action can be duly carried on. If those beneficent agencies are present, the in- fluence of contagious miasma may be comparatively little dreaded. Those sources of disease of which we are only now beginning to have any real or scientific knowledge, are repelled by the energetic vitality of a healthy frame, and exercise their fatal powers in pre- ference on weakened organizations." The intelligent authoress of " Simple Questions and Sanitary Facts," who unfortunately leans to hydropathic quackery, remarks : " But the poor often excuse their dirt on the plea of want of time ? This is only the lying cant of dirt and idleness. If they hare children, let them employ them to lighten their labours ; if they have no family, they have the less to do. A child will be better and more happily employed removing the puddle from before the door, than in making one. Children are quick imitators, and will be sure to copy the habits of their parents. An idle, gossiping mother, lolling against her door, gaping out into the street, will have children like herself, the curse of the neighbourhood they inhabit." Clothing, as every one knows, is of use in preserving the proper heat of the body, and in preventing the inju- rious action of sudden changes of temperature upon the skin of man, who is, of all terrestrial animals, the most scantily supplied by natural protectives. The necessity for artificially maintaining the animal temperature is forcibly put by Dr. Evory Kennedy : " Strange as it may appear, clothes are used equally in cold climates to retain the natural heat, and in warm climates to isolate the body from the surrounding highly elevated atmosphere and burning rays of the tropical sun. The old lady, with her wrap of sbawls and fur-lined hood, wending her way to her whist party in THE MATERIALS FOR CLOTHING. 254 St. Petersburgh, on a December nigbt, has a grange counterpart in the gallant young European officer, mounted on his Arab steed, with his head enveloped in turbaned shaws six inches deep, tra- versing the plains of Hindostan under a burning sun in the month of June. Yet both are practical philosophers despite the blow-hot blow-cold objection." Between the layers of clothes there are also strata of air kept at equable temperature, and which but slowly conduct alterations of it from within or without, and as they are confined by the dress above, they do not freely allow of the admission of colder air from below. It is for this reason that in going from a warm room into the cold, we should put on our extra clothing some time pre- viously, so as to heat this protective stratum of air. Linen, which is so great a favourite in temperate cli- mates, is objectionable on account of its high conducting and bad radiating powers, so that it feels cold, and does not freely distribute heat ; it is also attractive of mois- ture, which it retains and thus keeps a damp instead of a dry medium around our skin. The experiment of test- ing the conducting power of various clothings has been made by covering a metal vessel filled with hot water by each of them, and it was found that while it took 14 minutes to cool when covered with woollen cloth, 12^ sufficed with white flannel, 9f with cotton, and 7-J with linen. Such reasons have caused the entire substitution of cotton or thin woollens for linen garments in warm climates, and the only objection to them is their rougher surface, which occasionally irritates sensitive skins. Not- withstanding this and other objections occasionally made to woollens namely, that as their washing is trouble- some they are apt to store up dirt, and that they disturb the electric state of the skin when rubbing against it I really believe that no other medium is fitted for this vari- able climate to preserve the heat of the body during great cold, or prevent the conduction of intense heat. When linen is put on a perspiring skin the water passes through it, and evaporating still produces cold ; flannel, on the 246 COLOUR OF DRESS WATERPROOF. contrary, absorbs the water and gives out heat. Its non-conducting power is clearly useful on the cold win- ter's day. The wearing of flannel-shirts, or those of merino, which contains about one-third of cotton, during winter or summer, therefore, is now so usual as to realize Boerhaave's maxim, that you should take off your winter clothing at the end of midsummer's day only to put it on the following morning. The only change I would advise would be to wear the flannel inside a linen shirt in winter. to wear it alone in summer, and to constantly use an- other dress of the same material for night. Woollens unfortunately shrink and spoil gradually in the washing, which operation they frequently require as they absorb so much perspiration. We can perceive that since the very general adoption of flannel inner clothing, the num- ber of deaths in the Eegistrar- General's report by bron- chial complaints is very much lessened. You may have heard John Hunter's receipt for rearing healthy chil- dren; it was, "plenty of milk, plenty of sleep, and plenty of flannel." It has been stated on reliable autho- rity that woollen clothing is preventive of malaria in a high degree. Flannel drawers reaching high on the ab- domen and a long flannel shirt, so that two layers shall cover that region, are regarded as a capital safeguard against cholera. Even the colour of dress is not unimportant, as was first demonstrated by Benjamin Franklin. He placed pieces of various coloured cloths on the surface of snow, and found in a given time that the snow under the black was most melted, that under the white the least. Even from this we get hints as to the shades proper for winter and for summer gear ; and we are taught the same lesson from the changes of tint which the covering of animals undergo. The primary importance of such functions as perspiration and respiration, which you know the skin possesses, teaches us the necessity for having our gar- ments made of textures permeable to moisture and air ; ILL-FITTING SHOES FASHION. 247 for this reason the Council of Health of the French army absolutely forbid waterproof clothing ; and I never see an india-rubber coat or galosh without being forcibly reminded of Breschet's experiment, which I think I be- fore mentioned to you. He shaved rabbits and coated them with impermeable varnish, and found they perished in an hour or two of cold and suffocation. Waterproof clothing has been prohibited among the London post- men by Dr. W. Lewis, and on the contrary, ventilating gussets introduced in the coat and trousers with the greatest advantage, especially in the prevention of rheu- matism. For similar reasons I have often recommended persons who suffer from tender feet to wear the cloth known as pannuscorium instead of leather, especially the enamelled kinds, in their boots. It seems to me that the reason gout attacks the feet so often is, that their natural cutaneous action is impeded, and among the Komans these parts were less often affected than the hands, as the sandals only partly covered them. By the way, it may be very well questioned if these sandals, which allow free perspiration of the foot and render frequent washing needful, are not the most natural form of cover- ing. The Countess de Noailles has lately written an able " apology for bare feet," in which she contended that if the wretched boots the poorer children wear were cast away, the feet and ankles would become stronger, and would be kept cleaner, and there would be much less liability to colds and to illness among girls. Mr. Dowie, a boot-maker, suggested that an india-rubber spring should be placed in the middle of the sole, so as to give the foot its full elasticity, and immediately under the arch of the bones of the foot there is a most admirable natural spring of elastic tissue. Dr. John Brown, the well-known author of " Kab and his Friends, remarks : " It is amazing the misery the people of civilization endure in and from their shoes. Nobody is ever, as they should be, com- fortable at once in them ; they hope in the long run, and after much 17 248 ILL-FITTING SHOES FASHION. agony, and when they are nearly done, to make them fit, especially if they can get them once well wet, so that the mighty knob of the big toe may adjust himself and be at ease. For my part, if I were rich, I would advertise for a clean, wholesome man, whose foot was exactly my size, and I would make him wear my shoes till I could put them on, and not know I was in them. Frederick the Great kept an aide-de-camp for this purpose, and, poor fellow he sometimes wore them too long, and got a kicking for his pains. Why is all this ? Why do you see every man's and woman's feet so out of shape ? Why are there corns, with their miseries and maledictions ? why the virulence and unreachableness of those that are ' soft ? ' Why do our nails grow in and sometimes have to be torn violently off ? All because the makers and users of shoes have not common sense, and common reverence for God and his works enough to study the shape and motions of that wonderful pivot on which we turn and progress. Because Fashion that demon that I wish I saw dressed in her own crinoline, in bad shoes, a man's old hat, and trailing petticoats, and with her (for she must be a her) waist well nipt by a circlet of nails with the points inmost, and any other of the small torments, mischiefs, and absurdities she destroys and makes fools of us with whom, I say, I wish I saw drummed and hissed, blazing and shrieking, out of the world j because this contemptible slave which domineers over her makers, says the shoe must be elegant, must be so and so, and the beautiful living foot must be crushed into it, and human natuie must limp along Princes-street and through life natty and wretched." I wish the present style of bonnets, more suited in size to an organ-grinder's monkey than to a fine girl, had been the rage when John Brown was writing ! The square-toed boot universal in America, and those with the inner edge straight not curved inwards, are the most natural, as they allow the expansion of the toes a matter seldom allowed for by our boot-makers, especially as they measure the foot when lifted from the ground. Great comfort is often obtained by having a last carefully shaped for oneself. It is said that the Duke of Welling- ton, being questioned as- to the most essential requisite of a soldier's clothing replied, " A good pair of shoes." What next ? "A spare pair of good shoes ;" and even, thirdly, "A spare pair of soles." One-fourth of the ad- missions to hospital during the New Zealand war were CLOTHING SKIN DISEASE. 249 from "foot soreness." The shape and weight of all arti- cles of clothing should be such as to allow the freest action of the chest and limbs ; and it is allowed that the diminished mortality of our soldiers from heart and lung diseases may be very greatly due to the improvements made of late years in their dress and accoutrements. Upon the necessity of frequent renewals of inner gar- ments, I need make no remark, save that with our pre- sent scanty supply of water, this and other cleanly ob- servances are almost impossible among the poor, unless with the advantages which an extension of the wash- houses I have before alluded to would supply. In both the extremes of life, when heat-producing power is most feeble, additional warm clothing is clearly demanded, and we seldom now see half-dressed poor chil- dren exposed to all weathers under the erroneous notion of making them hardy ; and just as hurtful are the care- lessly given chilling cold baths, which are occasionally, under the same mistaken notion, inflicted upon children. I have alluded incidentally, while describing the func- tions of the skin, to various diseases which interference with them promotes, and I previously told you of the influence which bad food had in promoting them ; but the remaining subject of diseases of the skin itself being more within the province of curative medicine, I will not here further allude to. There are however few, if any, of them which cannot be shown to depend on the con- tact of specific matter from without, or the presence of morbid products within, which the skin makes efforts to remove. Cleanliness then, of course, is even more essen- tial than during health. LECTUEE X. MENTAL AND PHYSICAL EXERCISES THEIR DISUSE, USE, AND ABUSE. IN all my previous lectures the sources of ill-health against which I had occasion to caution you were such as met with no natural support in our own inclinations ; nobody likes bad air, per se, nor impure water, nor adulterated food, nor unwashed skins ; but there is a powerful principle in man which leads him to neglect wholesome exercise of mind or body a principle of indolence or love of ease, so constant, so strong, and so obvious in its operation, that political economists have been led to assume it, in conjunction with the love of gain and of pleasure, as the three great mainsprings of human conduct. There is, no doubt, a natural pleasure attached to exercise, mental or bodily, but it is only discovered as a result, and is not the initiatory cause of exercise. We experience the benefits in some particular case of labor, and then sometimes work systematically with a view to these benefits. But that it is often a strain upon our natural inclinations is proved by the facility with which we relapse into idle- ness, and the pain and difficulty with which those habits are re- acquired is indicated in the aphorism " dolce far niente" which has its analogue in every language. The only exception to this statement is the restlessness or love of exercise which seems natural to children in their sports and gambols, and which seems either a temporary provision of Nature, ceasing when reason asserts its sway, or one which a vicious or neglected physical, education suppresses in adult life. There is no more fatal opponent of the health of any organ than its VOLUNTARY AND INVOLUNTARY MOTIONS. 251 disuse, for it leads to its decay or extinction, by conver- sion generally into what would seem the vilest of our components fat. The removal of the womb when its functions are over, or of muscles when unexercised, are examples of this degeneration. The Author of our being has indeed placed many of our organs beyond our power to injure them ; thus we must use our lungs any attempt to refrain from so doing being attended with most unpleasant and suffocating sensations ; and even any inattention to the act of breathing, which leads to an insufficient supply of air, is compensated for by a sigh. The onward movements of the bowels and the action of the heart must, to a certain extent, go on independent of our will, and it is interesting to remark that they are supplied by a separate nervous system from that which controls our voluntary acts ; but many other organs are left to our own care, and in the long-run a neglect of these leads inevitably to the ruin of all. So unfavor- able to longevity is mental or physical idleness that it may be asserted no great idler ever attains old age. The benefits of exercise may be perhaps considered as a subject belonging rather to the lecturer on physiology than to a lecturer on public health ; but there are some points to be observed respecting exercise which commonly escape notice, and which I am doubly anxious to insist on because of their connexion with sanitary provisions. One of these is, that exercise to be most profitable ought to be as far as possible not systematic, and taken for its own sake, but spontaneous, and incidental to some occa- sion of either business or amusement. So intimate is the connexion between mind and body, that it .is diffi- cult to benefit the latter unless while relieving and plea- santly occupying the former. A man who takes the same walk every day, and meets the same people, does not derive half the benefit from it that he would from the same amount of exercise amid new and interesting scenes. In fact, his inind not being occupied along 252 EXERCISE BY ROUTINE. with liis body naturally reverts to the thoughts which engross him in the counting-house or the study, and thus the intellectual part of his nature derives no relaxa- tion, and the body suffers as a consequence. A hard- reading friend of my own was daily in the habit of walk- ing a regular number of times round the College-park, but that he derived no benefit from this monotonous routine was evident from his morose and melancholy expression all the while. This mental condition is the secret of the marvellous efficacy of a Connemara, High- land, or Swiss tour, to the jaded lawyer, merchant, or student. Even if by a violent effort he banishes 'his business from his thoughts and fastens them on the exer- cise itself, he derives but little advantage ; the exercise becomes a toil, and the most depressing of all toils, because it is unaccompanied by a sense of that which sweetens all labour the sense of progress and useful work done. I have heard that that benevolent nobleman, Lord Kosse, during the famine years, anxious to relieve distress, and equally anxious not to encourage habits of pauperism, paid men so much a day for digging holes in his demesne, and paid them again for the filling of them up. The laborers are said to have manifested the most extreme disgust at the occupation, although the work^vas not harder than most useful labors. It is this sense of the inutility of the work done by the labor in some of the military prisons which constitutes much of the severity of the punishment. And this remark is MS true of mental exercise as of bodily. Who can bear to sit down to a hard mental operation, the learning of a new language suppose, or thp acquisition of a science, merely for the sake of sharpening his intellectual facul- ties. We must be animated with the hope that when we have learned the language or mastered the science, we shall be possessed of somewhat of value which we had not before, and that we shall be more richly fur- nished for the enjoyment and appreciation of the system INTELLECTUAL EXERCISE. 253 of things around us, or else the labor will be intolerably dry and repulsive, and will fail to afford even that dis- cipline which we seek, for all good discipline involves an element of pleasure. The kind of intellectual exer- cise which is most beneficially stimulating is that in which the mind is not merely receptive, but partly, at least, creative ; for instance, in studying any work, if we merely receive the author's statements, feelings of lassitude will much sooner supervene than if we make efforts to judge, methodize, or investigate. The whole- some effects of original mental work are not confined to the intellectual powers alone, but extend to the nutritive and other corporeal functions. Of course, excess of this or any other labor is hurtful, and in the case of original work is peculiarly exhausting. Some of these principles are illustrated in the following extract from my favourite book, " The Autocrat of the Breakfast-table:" " This business of conversation is a very serious matter. There are men that it weakens one to talk with an hour more than a day's fasting would do. Mark this that I am going to say, for it is as good as a working professional man's advice, and costs you nothing : It is better to lose a pint of blood from your veins than to have a nerve tapped. Nobody measures your nervous force as it runs away, nor bandages your brain and marrow after the opera- tion. The men of genius that I fancy most have erectile heads like the cobra-di-capello. You remember what they tell of William Pinkney, the great pleader ; how in his eloquent paroxysms the veins of his neck would swell, and his face flush, and his eyes glitter, until he seemed on the verge of apoplexy. The hydraulic arrangements for supplying the brain with blood are only second in importance to its own organisation. The bulbous-headed fel- lows, that steam well when they are at work, are the men that draw big audiences and give us marrowy books and pictures. It is a good sign to have one's feet grow cold when he is writing. A great writer and speaker once told me that he often wrote with his feet in hot water ; but for this all his blood would have run into his head, as the mercury sometimes withdraws into the ball of a thermometer." Another observation is, that as each kind of business and employment exercises a particular set of organs of 254 COMPLEMENTARY EXERCISES. the body or faculties of the mind, so our amusements ought to be so contrived as to afford rest to those suffi- ciently worked organs or faculties, and call into play those others which ordinarily lie dormant. Nature her- self does this for us in some remarkable instances ; if the eye has been continuously looking at any particular bright colour, and is then transferred to a black surface, the complementary colour of the same figure appears to be delineated on that surface a spontaneous effort of the organ to restore the balance of its powers. To apply this to recreations and exercise. To many, whose ordinary business is of an active kind, involving no in- tellectual operations, except routine or clerk-like ones, yet whose mental powers are superior, chess is a most suitable relaxation. Billiards, on the other hand, is found to be a -better game for those who have much head-work and not enough of exercise. Poetry, history, or philosophy, are the natural reliefs to a mind which has to plod through dry statistics or legal arguments. The last remark I wish to make on this subject is as to the nature of the stimulus. There is a healthy stimulus which puts the whole mind and body into tone, and an unhealthy one, which is followed by depression, and puts the whole mind and body out of tone, (rambling, for instance, excites the mind, or rather the passions, and in such manner (not unlike dram-drinking) that each impulse leaves a craving for a still stronger im- pulse. The brain is in direct communication with every part of the system by the spinal cord and the numerous nerves which pass from it, and the largest of these won- derful conductors are shown in the diagram on opposite page- There is also a second nervous system called the sym- pathetic, the functions and diseased states of which are still very obscure ; but it is certain that the brain and spinal cord and this other system have reciprocal con- trolling power. Nervous System. 256 GUILD TRAINING THE HALF-TIME SYSTEM. So close, then, is the connexion between mind and body, especially in children, that any over-taxing of the former in early life will irreparably injure the latter, which up to the seventh year or so is very rapidly grow- ing, and should not be wasted by the act of thought. A precocious mind and preponderance of the nervous over other systems is often the accompaniment of a puny scrofulous body, and both are the results of a too early and too close application of the mind, while the body is kept confined in the school-room, which, from want of ventilation, is often a direct excitant of disease. In mild weather I have often thought it most desirable that children* should be taught their tasks in the open air, and amid the beauteous natural objects around us. If a child survives after the ill-timed mental forcing to which many of them are subjected, hypochondriasis, dyspepsia, or even epilepsy or hysteria, will be its bur- then. I can fully appreciate the advantages which will accrue to the young of this generation and to future ones from the adoption of that plan of education which is known as " the half-time system," chiefly advocated by Mr. Chadwick, and which, applied to the children of the poor, means half the usual time now allotted to in- struction, is to be divided between short alternate periods of study and light manual labor. This system continued for three or four years say from the tenth to the thir- teenth or fourteenth year would rear up more healthy, docile, and sensible youths, than if the whole time had been devoted to either study or labor alone. Such a system has been carried out in many English districts, especially in the case of the children of factory opera- tives, and it has been found that while the school work has been better done, and the sanitary state of the pupils improved, money was earned by their labour. In one school connected withAkroyd's great factory, 761 children are in this way being reared up to the time when, under the Factory Act, they shall become regular laborers. MENTAL EXERCISE EXCESS LONGEVITY. 257 So far from civilization being in itself repressive of the perfect development of the human body, its continu- ance in health, and the prolongation of its existence, as has been asserted, I feel sure that its influences are in the contrary direction. The uncultivated savage rarely attains to old age ; physical life- shortening influences from without, such as changes of temperature, hunger, or accident, and such exhausting ills as unrestrained pas- sions from within, exert their full power over him who is unblessed with the many resources which education and art have given to cultivated society. It is acknow- ledged by all military authorities, that officers reared in the lap of luxury have not shown themselves to be in- ferior to those whose lot cast them into " slower" places. The wealthy who are slothful and unintellectual, are however, short-lived and habitual invalids ; but that the aristocracy have less chance of life than their humble fellow-countrymen, is a surprising statement, and one which would not gain credence if it came from a less eminent statist than Dr. Guy. He says: ''Luxury, too, like intemperance, tends to undermine health, and shorten life. Hence, the higher orders are short- lived, and we may therefore safely infer unhealthy while they live. Our agricultural labourers, in spite of the many disadvantages to which they are exposed, are much longer-lived than any of the higher classes, and the aristocracy are nearly on a par with the members of benefit societies in Liverpool, the unhealthiest city in England. Of the classes, too, which enjoy the most ample means of self-indulgence, those are the most unhealthy, which possess those means to the greatest extent. Thus, the gentry are more healthy than the aristocracy, the aristocracy more than the members of royal houses, and these last more healthy than crowned heads. Those who occupy the highest places in the social scale are probably, in point of health and longevity, but little raised above the very meanest of their subjects." 258 MENTAL EXERCISE EXCESS. With regard to the time for mental exercise, there is no period when the acquiring or reflecting powers are so active as in the early morning, and study can there- fore be indulged in most profitably. The silence, the cool refreshing air and brightness of the morning, have a most effectual calming effect on the mind. The most successful and healthful students I have known were morning- workers. In Dublin I am sure that later hours at night and laziness in the morning are more habitual than in most other capitals. As examples of the evils of excessive mental labour, I shall briefly allude to those diseases which affect men whose brain is over- worked. The fact that there are such is becoming every day more apparent ; yet the danger to be appre- hended in this respect is not fully realized, although it is a matter of national importance because of the emi- nence of the victims of such errors. The exercise or disuse of our brains is, however, not at all a voluntary matter, or as the American philosopher I quoted a little while ago puts it : " Our brains are seventy-year clocks. The Angel of Life winds them up once for all, then closes the case, and gives the key into the hand of the Angel of the Resurrection. Tic-tac ! tic-tac ! go the wheels of thought ; our will cannot stop them, they cannot stop themselves ; sleep cannot still them ; madness only makes them go faster : death alone can break into the case, and, seizing the ever- swinging pendulum, which we call the heart, silences at last the clicking of the terrible escapement we have carried so long be- neath our wrinkled foreheads." Mere muscular work seems rarely to be injurious, for the recuperative power of that system seems illimitable, and nought but increase of its powers supervenes ; but from excessive brain-work fatal and prolonged diseases arise, and its victims are thus made to pay the forfeit of their ambition. Men of intense and original thought, whether centred upon letters or commercial speculations, men ambitious of power, are those whom we lose in this way, for their brains have not merely to work for their EVILS OF EXCESSIVE MENTAL WORK. 259 own bodies only, but perhaps to guide a hundred other brains or human machines, through whom their great schemes are carried out. Dr. Richardson, whose great literary and practical services in medicine have gained him the gratitude of mankind, in speaking of this error of intellectual men, into which it must be hoped he him- self does not fall, adopts the following appropriate simile : " An electric battery works a single wire from the city to Brigh- ton, and does its work well, and goes on for some months before it is dead or worn out. Can it do the work of a hundred wires ? Oh ! yes it can ; but it must have more acid, must wear faster, and will ultimately die sooner. We may protect the plates, make the bat- tery to an extent self -regenerative, as the body is ; but in the main the waste is in excess of the supply, and the wear is as certain as the day." Men with over- worked brains suffer very similar con- sequences, and induce such fatal diseases as aggravated dyspepsia (attended with great loss of that remarkable element of brain composition, phosphorus), paralysis, apoplexy, softening of the brain, insanity, or premature old age. They also suffer from ordinary ills more severely, so that they can bear no pain or depressing curative measures, and often acquire a morbid sensibi- lity which converts activity into irritability, and seclusion produces nought but moroseness. Self- dislike follows, and suicide that lamentable blot on the civilization of the nineteenth century too often ends this train of pre- ventible misfortunes. The painfully interesting exam- ples of Hugh Miller, Prof. M'Cullagh, and Admiral Fitzroy occur to me in illustration. But even the dis- eases to which the frame succumbs prematurely from mental over-work must be regarded as constituting a kind of " chronic suicide," the sacredness of the body and its claims for support from its in-dwelling master, the mind, not being fitly recognized. An eloquent Presi- dent of the Public Health Section of the Social Science Association declared : " When people say we should think more of the soul and less of the body, my answer is, 260 PHYSIOLOGICAL EFFECTS OF EXERCISE. that the same God who made the soul made the body also. It is an inferior work, perhaps, but nevertheless it is His work, and it must be treated and cared for ac- cording to the end for which it was formed fitness for His service." The physiological system which is most readily and fully influenced by exercise is the circulation. The con- traction of the muscles is due to chemical change of their substance, which the blood feeds with oxygen and with reparative material, and moreover withdraws the waste matter the result of the muscular action. Thus, is created a necessity for an additional supply of blood. The pressure of the muscles upon the deeper veins is their chief means of circulation, for they are not freely pro- vided with valves, as those near the surface are. This muscular activity gives rise to greater action in the digestive and blood-making organs, and likewise in the lungs, liver, kidneys, and skin, by which the waste matter is thrown off, and those organs which may have been lying partially dormant are stimulated into health- ful: vigour. Exercise promotes the breathing process especially, ridding the blood of a greater quantity of car- bonic acid, as is shown by the respective amounts breathed during the following exercises : If 480 cubic inches represent the quantity inspired per minute during complete rest, 7 times as much, or 3,360 cubic inches will be taken in by a person running at the rate of 6 miles an hour, 5 if walking 4 miles an hour, and 4 times if trotting a horse. The giving off of carbonic acid is pro- portionally increased", and an increased amount of food to supply this waste must be provided, and above all the freest flow of pure air is evidently necessary. Exer- cise also urges that neglected, though much talked-of organ, the liver, to remove biliary matters from the blood, and the want of it is readily apparent in the sallow skin, dulled brain, and turbid bowels of the lethargic ; and lastly, the skin is brought into healthful play, for its tern- THE ERECT POSITION MUSCULAR WORK. 261 perature is increased, its secreting function exalted, and its. breathing process is encouraged by the fresh, ever- changing air. Flannel is a most necessary clothing during exercise, and great cleanliness must be observed. Water may be drank in moderation to make up for the loss the waste of muscle discharges through the skin. Heated skin, quickened heart, and rapid breathing are also produced by fever ; but in this case these effects are due to excessive waste without corresponding reparation. I may mention that in standing several muscles are ex- ercised to preserve the posture, and the quickening of the pulse over its rate when lying down shows this, for if the body be kept vertical on a reclining board without exertion, no such acceleration occurs. A glance at this view of man's skeleton will show you that considerable muscular force is expended in maintaining the vertical 262 MUSCULAR WORK. position. For the sake of comparison the skeleton of the most manlike ape is figured alongside. ^ The muscular system is of all the apparatus of animal life perhaps the most important ; most of our daily acts and avocations are performed through its agencies, and the noblest bursts of eloquence or sublimest thoughts could not be communicateid for the improvement or en- lightenment of man without its aid. Will we, then, not exercise and perfect this great endowment ? The Rev. Prof. Haughton, who is pre-eminent as a physiologist, has calculated that the labouring man daily uses his muscles to a degree which may be expressed by saying, that he would raise to the height of one foot from 250 to 350 tons. For the upper ranks of society the force expended, including ordinary avocations, should average 150 tons, which may be regarded as equivalent to walking some 9 miles daily. Dr. Parkes tells us that the hardest day's work he ever knew performed was by a workman in a copper mill. He raised 90 Ibs to a height of 18 inches 12,000 times a day, which is equivalent to raising 723 tons 1 foot high. What are the effects of disuse of muscles ? Their rapid destruction by conversion into fat. When the pregnant womb has accomplished its functions, terminating with the forcible expulsion of its contents, it undergoes reduction to ^ its size. When any set of muscles are prevented from being called into play, by the destruction of their nerve owing to injury or disease, they rapidly waste, and even disap- pear the only means of preserving their properties being to supply, in place of the will, that wonderful and still mysterious agent, electricity. Hysterical girls have been known to lie down and remain for months without any motion, believing that they suffered from spinal disease, and they have occasionally paid the severe penalty of utterly wasted muscles or stiffened joints. A somewhat appropriate cure would be to persuade them that the suitable adviser in their case resided in some distant and EFFECTS OF DISUSE ON ORGANS. 263 inaccessible place, and the exercise in travelling to it would probably remove the hallucination which pre- vented them from relying on their muscles. Another interesting example of the removal of an organ if long disused, perhaps in successive generations, is afforded in all the blind animals found in the mam- moth caves of Kentucky ; and it would be interesting to find whether eyes would be restored to them, if for two or three generations some of them were transferred to the light. On the other hand, of all tissues the mus- cular is the most susceptible of increase, or hypertrophy, as we call it, by augmented exercise witness the black- smith's arm or the opera-dancer's leg. It is for this reason that excessive exercise proves injurious by en- larging the heart, which may be followed by suddenly fatal effects. Too great or too constant use of one set of muscles is also likely to attract disease to them, such as the development of tumours, the materials of which circulate in the blood. The dancing epidemic of the 14th century was a curious instance of hallucination spreading over vast populations ; so excessive were the exertions of those who were afflicted with it, that they often died from sheer exhaustion. Concentration of bodily or mental efforts on one object for a length of time is always injurious, as extreme exhaustion of the strained organs will follow; but the ill effects will afterwards react upon others, and the only mode of attaining anything like perfect exercise is to engage all the mental faculties and groups of muscles in performing it. The proper kind and amount of bodily exercise is so variable with the circumstances of each, that general rules are with difficulty laid down, but the following seem to me judicious: 1. During ordinary health, some part of each day should be spent out of doors, even in weather apparently unsuitable, for cloth- ing supplies a means of obviating all ill effects. 2. It should be as active and general as possible, and carried 18 264 METHODS OF BODILY EXERCISE. to the point of slight fatigue. 3. It should be taken at the best time of the day, which I consider the morning, with the precaution of taking some food, such as a cup of milk or coffee and a biscuit before going out, a sub- stantial breakfast being taken afterwards ; or if this meal be taken early, exercise may be commenced an hour or so afterwards. The celebrated physician Doumoulin having being surrounded at his last moments by several of the most distinguished doctors in Paris, who vied with each other in expressions of regret at his situation, thus addressed them: "Gentlemen, do not regret me; I leave behind me three of the greatest physicians." On their pressing him to name them, each anxiously anti- cipating that his own name would be amongst the number, he briefly added: " Water, Exercise, and Diet," to the no small discomfiture of his disappointed brethren. Among methods of exercise, it is believed that horse exercise, if attainable, is superior to all others. Such manly vigour is in this way acquired that Frederick the Great is reported to have said: "When I consider the physical structure of man, it appears to me that Nature had formed us rather to be postilions than sedentary men of letters." The greater variety of scenery it brings before the mind, the agreeable way in which the attention is fixed upon guiding the movements of the horse, and the rapidity of motion it confers without fatigue, make it most desirable. Prof. 0. W. Holmes thus puts it : " Saddle-leather is in some respects even preferable to sole- leather. The principal objection to it is of a financial character. But you may be sure that Bacon and Sydenham did not recom- mend it for nothing. One's hepar, or, in vulgar language, liver a ponderous organ, weighing some.three or four pounds goes up and down like the dash of a churn, in the midst of the other vital arrangements, at every step of a trotting horse. The brains also are shaken up like coppers in a money-box. Riding is good for those that are born with a silver-mounted bridle in their hand, and can ride as much and as often as they like, without thinking all the time they hear that steady grinding sound as the horse's jaws triturate with calm lateral movement of the bank-bills and promises EQUESTRIAN AND AQUATIC EXERCISE. 265 to pay, upon which it is notorious that the profligate animal in ques- tion feeds day and night. In riding, I have the additional pleasure of governing another will, and my muscles extend to the tips of the animal's ears and to his four hoofs, instead of stopping at my hands and feet. Now, in this extension of my volition and my physical frame into another animal, my tyrannical instincts and my desire for heroic strength are at once gratified. When the horse ceases to have a will of his own and his muscles require no special atten- tion on your part, then you may live on horseback as Wesley did, and write sermons or take naps, as you like." Of boat exercise he says : " You can row easily and gently all day, and you can row your- self blind and black in the face in ten minutes, just as you like. It has been long agreed that there is no way in which a man can accomplish so much labour with his muscles as in rowing. It is in the boat, then, that man finds the largest extension of this volitional and muscular existence ; and yet he may tax both of them so slightly, in that most delicious of exercises, that he shall mentally write his sermon, or his poem, or recall the remarks he has made in company, and put them in a form for the public, as well as in his easy-chair." Dr. Combe truthfully said : " Dancing is a cheerful and useful exercise, but has the disad- vantage of being used within doors, in confined air, and often in dusty rooms and at most unseasonable hours. Practised in the open air, and in the day time, as is common in France, dancing is certainly an invigorating pastime ; but in heated rooms and at late hours it is the reverse, as these do more harm than can be com- pensated by the healthful exercise of the dance." So important are gymnastic exercises and games of agility or strength, and so necessary to preserve the vigour and manly development of our youth, that the hygienist must look with great satisfaction on the exten- sion of cricket as an ordinary game in this country ; while the volunteer movement which, it appears, must be in Ireland, on account of our reputed pugnacity and the attractions we seem to offer to agitators and boasted invaders, denied us has done a vast deal to augment the robust health of the English nation by the regular and systematic exercise in the open air which it entails. The emulation it gives rise to supplies that mental 266 " TRAINING " GYMNASIA. stimulus which I have argued should be associated with every kind of bodily exercise. We learn also much hygiene from the rules of the pugilist or pedestrian when training, whose motto is " Work and Diet." He rises early after sleeping on a hard bed, takes a small quantity of food for example, an egg and takes a moderate walk for an hour, when he bathes and breakfasts after- wards. This meal consists mainly of underdone meat, with perhaps tea butter, sugar, and much milk being excluded. Half-an-hour after breakfast he begins his hard walk of ten or twelve miles, after which he is rubbed down, and takes a cold bath. His dinner con- sists of bread, meat, and a small quantity of vegetables. A little tea is taken instead of supper, and the day is wound up with a short walk just before retiring to rest. This brings them into a perfect state of health, which would render them the most long-lived of our kind, save for the course of dissipation which usually follows the contest. Even in the hottest parts of India bodily exercise is necessary, and the much greater prevalence of disease among the privates than among the officers of our regiments there, has been hitherto due in a great- degree to want of suitable exercise. Of all means of exercising none is more beneficial than the use of the gymnasium. In it time is economized, the companion- ship and rivalry are encouraging, and it is moreover available during the short or wet days of winter. For reasons before stated there should be the freest ventilation in such a building, else it will never approach the usefulness of open-air exercise. In our army all gymnastic exercises are encouraged, and in the French service there is very sensibly added swimming and sing- ing, which latter improves the power of the lungs and affords recreation. Heading aloud for similar reasons is very advisable. A few weeks' gymnastic practice at Aldershot increased on an average the men's chests If inches, and the arm f of au inch. The establish- RAILWAY TRAVELLING PUBLIC PARKS. 267 ment of a good gymnasium seems to me one of the best projects which the directors of the Winter Palace might undertake ; and I am sure thousands of those who are so closely occupied as to render concentrated exercise the only kind possible, would take advantage of it. With respect to railway travelling, which may be con- sidered as a method of exercise, a few remarks seem necessary. You may be perhaps aware that the Lancet that vigorous paper which we have to thank for much sanitary reform in the way of exposure of adultera- tion, and otherwise undertook to investigate this ques- tion a year or two ago. Evidence as to the liability to taking cold was given by Dr. Williams, and he traced many cases of sore throat, earache, and toothache, pleu- risy, rheumatism, and sciatica, to this cause, for which the remedy is simple warm clothing and proper ventila- tion without draught, especially by the roof of the car- riages. Dr. Angus Smith has proved that without means for airing, a " crowded railway carriage while going at the rate of thirty miles an hour, is as unwholesome as the strong smell of a sewer, or as a back yard in one of the most unhealthy courts of one of the most unhealthy streets in Manchester." Dr. Forbes Winslow detailed most graphically the mental and physical fatiguing effects which result from the anxiety to catch the train, hurried breakfast, too rapid efforts to be in time, &c. ; and lastly Mr. White Coopei*, the eminent oculist, avers that much injury to the sight results from the efforts to follow the ever-moving print, which, in railway literature, is not of the best. So that I think a fair case has been made out against too constant railway travelling ; and as much less oxygen is inhaled or carbonic acid exhaled by such pas- sive exercise than by walking or riding, its evil effects should be compensated for by freer exercise, or it will be necessary to set it down as one of the unsanitary in- fluences which may degenerate the race in this nine- teenth century. 268 THE PARK. The provisions that may be made for the exercise and recreation of the public are various ; but foremost among them stands the institution of public parks, gar- dens, and walks, ornamental in appearance, healthy in situation, well drained, and easily accessible to the working classes. In every respect, save the last, our Phoenix Park is unrivalled ; but its great distance from the heart of the city limits its utility to those who have much idle time on hands, or else to those who can have horses and carriages at command. Excepting on general holidays, the Park is but sparingly resorted to by^the humbler classes. How to remedy this is a problem worthy of our best attention. Perhaps the penny om- nibus running on rails, and capable of holding fifty passengers, for which a company has just got permis- sion to lay the lines, will be found to pay ; but if not, I 'see no reason why it should not be partly aided by the authorities, as is the case with the two-sou omnibuses running to all the parks about Paris. If the line of quays be found too narrow for such a tramway, why not devise a new approach ; and if the day ever comes when we will have our river's sides further embanked, as they are now doing with the Thames, we will have room to spare along the quays; or by the narrowing of the river, the water might become deep enough to allow such small steamers with jointed chimneys as ply from bridge to bridge in London, to be adopted by us. Chemistry demonstrates the usefulness of trees and other plants in a city, for besides removing the poisonous carbonic acid and restoring oxygen to the air, for which they are the only agents in nature, they throw out so much moisture that the ill effects of numerous' fires and a concentrated population in heating and drying the air of cities is thereby obviated. A single cabbage plant was found to exhale 19 ounces of water in the 24 hours. Your aqua- rium most clearly shows the compensating and mutually preserving effects of plants and animals. The refreshing GARDENS ACCESSIBLE SPOTS. 269 influence of a garden or green space on the spirits and health of infirm persons and children cannot be doubted. The provisions of the Public Health Act, 1848, concern- ing pleasure-grounds seem more useful and generally ap- plicable than those of any act bearing on Irish towns ; and with regard to pleasure-grounds for the lower classes, no town can be worse provided than Dublin. In some of the poorer parts, accustomed to no play-ground save the noisome alley, the children present none of the fea- tures of childhood. Many spaces from which houses have been removed might be cultivated, or even paved, and appropriated for such purposes, and I can see no objection to opening and planting disused graveyards (as for instance St. Mary's) for public walks, as has been done in other cities. In many of the dilapidated parts of the Liberty, and even in close proximity to our national Cathedral, there are now open spaces which, if converted into " spirit- raising and blood- purify ing gardens" for the recreation of the people, would recompense their owners, and do much to raise our poor from the social degradation under which they surely suffer. During the summer and autumn months, resort to the seaside, if it were only for a few hours, is a great boon to the over- worked and ill-lodged artizan, and to his too often ill-fed and sickly family. Railways have made the sea, and the beauteous hills of Bray, Killiney, and Howth, most accessible ; but they have, at the same time, made these neighbourhoods so commercially valu- able that property has laid its iron hand upon every bit of rock, sand, and shingle, on every breezy hill and every pleasant common near this metropolis, and forbid- den the poor man the purest and best of pleasures, the health and refreshment afforded by the face of Nature. As to field-walks, they are gone from us long ago. In England, there is nothing of which the people are more tenacious, and they have preserved them in plenty. Our 270 ACCESSIBLE SPOTS FIELD "WALKS. humbler fellow- citizens have been, by one means or an- other, year after year I will not say robbed of, but cer- tainly ousted from, every field-walk in the neighbour- hood of Dublin, and the roads lie between stone walls, which cannot be overlooked save when on horseback ; so that the mental concomitant, which I have maintained is necessary to give value to exercise, is lost. There should be an organized movement to restore some of our field- walks, whether by purchase, litigation, or the pressure of public opinion. A few years ago, Prof. Jukes, who, with other Englishmen visiting our land, was astonished at the selfishness with which such places are kept pri- vate, put himself at the head of a committee for the opening of the passes round Bray Head. On this subject I may be excused for quoting the words of one of Scotland's most gifted writers, onco a journeyman mason. Speaking of a very dismal period of his life, Hugh Miller says : " I threw myself, as usual, for the compensatory pleasures on my evening walks, but found in the enclosed state of the district, and the fence of a rigorously administered trespass law, serious drawbacks, and ceased to wonder that a thoroughly cultivated country is, in most instances, so much less loved by its people than a wild and open one. Rights of proprietorship may exist equally in both ; but there is an important sense in which the open country belongs to the proprietors and to the people too. All that the heart and the intellect can derive from it may be alike free to pea- sant and aristocrat ; whereas the cultivated and strictly fenced country belongs usually in every sense to only the proprietor, and as it is a much simpler and more obvious matter to love one's country as a scene of hills, and streams, and green fields, amid which Nature has often been engaged, than as a definite locality in which certain laws and constitutional privileges exist, it is rather to be regretted than wondered at that there should be often less true patriotism in a country of just institutions and laws, whose soil has been so exclusively appropriated as to leave only the dusty high-roads to its people, than in wild open countries in which the popular mind and affections are left free to embrace the soil, but whose institutions are partial and defective." Alluding to the same district, John Stuart Mill says : ACCESSIBLE SPOTS FEMALE EMPLOYMENT. 271 " For instance, the exclusive right to the land for purposes of cultivation does not imply an exclusive right to it for purposes of access, and no such right ought to be recognized, except to the extent necessary to protect the produce against damage and the owner's privacy against invasion. The pretension of two Dukes to shut up a part of the Highlands, and exclude the rest of man- kind from many square miles of mountain scenery, to prevent dis- turbance from wild animals, is an abuse; it exceeds the legitimate bounds of the rights of landed property." It is gratifying to record that many of our great landed proprietors, whose demesnes are favourite resorts, the Duke of Leinster, Marquis of Conyngham, Mr. Lam- bart, Earl of Howth, and others, have acted in a more generous spirit. It may not be an inappropriate conclusion to this lecture if I express my conviction that the efforts which are being made to train females for various industrial employments will be productive of increasing bodily and mental health, while they will be also fraught with social advantages. The objection that employments in- terfere with the fulfilment of the domestic duties may be answered by the fact, that there is a large proportion of our female population who are not so fortunate as to be called to such positions. The successes of one establishment are well illustrated in a recent paper by Prof. Houston : " During the first three years of the existence of the Queen's Institute, 607 pupils have been trained in it, and about 350 of these are known to have found employment, and considering the novelty and difficulty of the experiment, the fact establishes two or three important conclusions. First, that there is a very large number of educated women sorely in need of remunerative employment. Secondly, they prove that women of this class are capable of acquiring any ordinary mechanical art equally well with men, provided they have the time and will bestow the pains necessary for its acquisition. The difficulties under which the Institute has laboured in its efforts to train its pupils have been so great, that its success cannot be measured at all by the number of finished workwomen it has turned out. To have succeeded even in the smallest degree is very strong evidence of the soundness of the 272 FEMALE EMPLOYMENT NEGLECTED OFFSPRING. principle on which it is based. The reports constantly dwell upon the fact that the Institute has been dealing with women of mature years, whose education has in most cases been lamentably de- fective; who have had no training in habits of business; whose fingers have lost the pliancy that belongs to youth ; whose minds are drawn off from the art they are endeavouring to master by the cares of the present hour ; who can at the utmost snatch but a short time from the pressing business of the day to attend the class in which they are instructed ; and who are obliged to accept the first situation that presents itself, whether they are perfect in their trade or not. If in the face of these difficulties three or four hun- dred women have been even moderately qualified for their respec- tive walks in life, may we not safely conclude that if women were educated with the same care as boys, and were early trained in habits of business, and in the practice of some special art, they would exhibit not less skill than men ? " The question is very different, however, with regard to factory hands, and Dr. Bridges of Bradford describes as follows the ill effects of their labour : " I am guilty rather of diminution than exaggeration of the truth in saying that to stand ten hours is a muscular exertion for which a very large number of women are permanently unfit, for which all women who are about to be mothers are unfit without excep- tion. What is true of the mother and her child before birth is also true afterwards, and with many additional reasons, moral as well as physical. The mother is the only fit nurse of the infant, is its only proper educator. For a mother to go into a factory, trusting her baby to' a paid nurse, whose only care is to hush its cry and lull its irritable brain with opiates, is an act of infanticide in which it is not the mother that I blame alone or most." Notwithstanding the abject distress of the operatives in Lancashire in 1862, the death-rate was extremely low, owing to the greater care which the mothers were able to bestow on their offspring when they were thrown out of employment. On the agricultural employment of women the same results follow, as the medical officer of the English Privy Council relates : " The mother, as soon as she can rise from her confinement, goes again to work, leaving, while she is away, her infant to anyone who will pretend to take care of it. Instead of its natural food, en- FEMALE EMPLOYMENT ABUSE OF OPIUM. 273 lively improper stuff is given it. Cow's milk is dear and often quite unattainable by these people, and sugar sop a lumpy mass of bread, water, and sugar is given instead. This is either given cold, or is left on the fire-hob in a cup, seldom or never changed or cleaned, whence the fermented and sooty mass is heaped into the infant's mouth by the nurse, who prefers this mess to cow's milk, under the notion that ' the two milks could never agree.' But this is not the worst. ' So-and-so has another baby you'll see it won't live,' is the neighbourly view taken among these demora- lized populations. And the predicted event soon comes perhaps through the normal operation of the diet perhaps through the almost incredible cruelty of deliberate starvation perhaps through an intentional or unintentional over-dose of the opium which is universally employed. A medical man is called to the wasting infant, ' because there is so much bother with registering.' The mother says the child is dying, and won't touch food. When he offers food, the child is ravenous, and ' fit to tear the spoon to pieces.' Where the coroners have been induced to support attempts to save life ; where inquiry has been made, and severe admonition, with an appearance of a chance of committal; also, where the registrar has pretended to refuse registration without medical certificate in families notorious for their loss of infants in these cases an amendment has taken place. Bad as is the star- vation of infants, another practice is more common and more lethal ; this is the drugging with opium. Occasionally they are the subject of inquests ; sometimes they are recorded as cases of ' overlying ; ' but by far the most common end is the simple regis- tration and burial as cases of ' Debility from birth no medical attendant,' l Premature birth, fyc.' " In the town of Spalding, Lincolnshire, 297 Ibs. of opium were sold in one year, or 127 grains for each in- habitant of the district. LECTURE XL SANITARY ARCHITECTURE HOSPITALS. AFTER Medicine, the professions most concerned in the preservation of the public health rank those of the architect and engineer, and that they have been alive to this responsibility is evident from the constant attention which the subject has received in the columns of their influential organ, the Builder, and its younger sister, the Dublin Builder. When speaking of ventilation, water supply, baths, and public parks, and the ap- proaches to them, I had occasion incidentally to trespass upon the domains of these most useful professions in laying down the principles upon which these sources of health depend, and I shall now endeavour to apply their teachings to the case of hospitals, lodging houses, and the dwellings of the poor, and afterwards bring before you a few facts connected with sewerage, and proposals for the utilization of refuse. Hospitals have existed for fifteen centuries, and have been regarded as institutions where every aid which sci- ence or benovolence can command, should be brought to bear on the care of the sick. It seems, therefore, almost ridiculous to insist that they shall at least do the sick no harm ; but it was once necessary, for in the older civil hospitals the mortality was very much greater in them than among patients suffering from the same diseases out of them ; and as regards military hospitals, Sir John Pringle, in 1764, was stating an undeniable fact when he asserted that " hospitals are among the chief causes of mortality in armies, on account of the bad air and other inconveniences attending them." The only ones , which he found at all wholesome were those that had broken windows and other dilapidations. They were, ANCIENT HOSPITALS MISS NIGHTINGALE. 275 again, called " dismal prisons, where the sick are shut up from the rest of mankind, to perish by mutual conta- gion ;" andPouteau also, at about the same period, asks, " Des hopitaux servient ils done plus pernicieux qu' utile a I'humanite ?" The immortal John Howard pointed out that severe surgical cases never recovered owing to ill ventilation ; for instance, in the Leeds Infirmary no case of compound fracture or trepanning survived. Of modern hospitals no such remarks can be made, and although there is ample room for improvement in their construction and regimen, they have made vast advances towards perfection in the last eight or nine years. This we owe chiefly to that female Howard and greatest of living philanthropists, Florence Nightingale. Her ex- traordinary labours during the Crimean campaign, when, forgetful of home, friends, or fortune, and unmindful of personal fatigue or danger, she unceasingly strove to save the health and lives of our soldiers, have been re- cognized by a grateful nation ; but her efforts to improve hospitals at home are less known. It is sad to have to record that she has been reluctantly compelled to relin- quish her most useful labours owing to her own shattered health. Her work is the most comprehensive treatise on the subject in our language, except, perhaps, the re- port of Dr. Bristowe and Mr. Holmes, the two distin- guished investigators who, in 1863, were commissioned by the Medical Officer of the Privy Council " To ascertain the influence of different sanitary circumstances in determining in different hospitals (as compared with one another, and where practicable with private practice) more or less success- ful results for medical and surgical treatment ; particularly among patients who are submitted to surgical operations, or have under- gone accidental injuries, and among patients suffering from infec- tious fevers and other kinds of acute disease, and among puerperal women ; and with particular reference to the different degrees in which recovery is delayed or prevented by accidental morbid com- plications." We haveoften discussed the dangers of bringing into 276 HOSPITAL STATISTICS. crowded space too many healthy individuals, and the danger of aggregating sick people too closely is always to be feared inthe construction and management of hos- pitals. The sick are brought there for the convenience of nursing and medical aid, but so much matter of a hurtful character emanates from the sores and dis- charges of the sick in various complaints, that unless there be the freest ventilation, many of those who are admitted to be cured are positively injured. Hospital infection, or pyemia as we call it, is the re- puted cause of a considerable number of deaths, but as Mr. Holmes has recently remarked, " There is a necessity for some careful method of studying the condition of the wards and of the atmosphere of the wards in various states of weather, and at various times of the day and night. It is only by a long series of observations of this nature that the assertions which have been put forth with regard to the origin of hospital diseases from germs present in the air, or deposited on the walls or furniture of the wards, can be verified or refuted." Mortality in different hospitals varies most widely, and there is no doubt that it is capable of being reduced in those of the highest average by well- organized hygienic improvement ; for instance, in twenty-four London hos- pitals, which, on an average, contain 4,214 patients, there occurred during the year 1861, 3,828 deaths, or 90'84 per cent, per annum upon the inmates, nearly every bed yielding a death within the year ; in twenty- five provincial hospitals capable of containing 2,248, 886 deaths, or 39'41 per cent. ; and in the Margate Sea- Bathing Infirmary, where there were 133 patients, 17 deaths, or 12-78 per cent. Much of the mortality among soldiers in India and other tropical places is not to be set down to the climate alone, but to the abuse of alcohol, and the unwholesome state of their barracks and hospitals which till lately existed. " Facts such as these," says Miss Nightingale, "have sometimes raised grave doubts as to the advantage to be derived from hospitals at all, and have led many a one to think that STATISTICS OP DUBLIN HOSPITALS. 277 in all probability a poor sufferer would have a much better chance of recovery if treated at home. However, Dr. Bristowe and Mr. Holmes successfully refute this argument by enumerating the influences which determine the death-rates : " 1st, the position of hospitals in relation to the poor who make use of them ; 2nd, the pressure on the resources of hospitals in consequence of disproportion between the accommodation which they are capable of affording and the number of those applying for relief ; 3rd, the relative numbers of medical and surgical beds ; 4th, the admission or exclusion of cases of infectious disease ; 5th, the admission or exclusion of incurable affections ; 6th, the admis- sion or exclusion of those who are moribund or dead; 7th, the admission or exclusion of eye diseases, skin diseases, and the like ; 8th, the admission or exclusion of trivial cases ; 9th, the system of admission by subscribers' letters, and on special taking-in days ; and 10th, the carrying on of clinical instruction, or, generally, the degree of interest manifested by the professional staff of hospitals in the study of their profession." Each of these they most ably discuss, and the 5th they exemplify as follows : " No one would consider the hospital at Brompton as unhealthy because its death-rate varies from 13 to 19 per cent. ; no one would consider the Dublin Hospital for Incurables a pest-house because during one year there were 24 admissions and 13 deaths; or re- gard (which would be scarcely less absurd) the order of the garter as a fatal gift, because the death rate, calculated on the admissions, amounts to 100 per cent." They very justly conclude that " The health of hospitals, so far as we can ascertain, is influenced in a far greater degree by conditions belonging to hospitals them- selves than by conditions of external atmosphere, of site, of soil, and the like. And we may add, the healthiness of hospitals is less dependent on the form and size and distribution of wards than it is on ventilation, drainage, cleanliness, and proportion of inmatet to space. A hospital of defective construction may by careful at- tention to these latter conditions be rendered, even in a large town, comparatively healthy ; and a hospital built on the most approved plan, and occupying the choicest site, may be rendered in the highest degree unhealthy by their neglect." If well- ventilated rooms r assiduous nursing, the best 278 FEVER HOSPITALS. medicines, and the fittest food, could be secured at the patients' home, along with that high-class skill and con- stant attention which even the foremost in the medical and surgical professions bestow on hospital patients, I have no doubt that the result to which Miss Nightingale alludes would follow ; but you will see at once these cir- cumstances are impossible, and therefore, under existing conditions, hospitals must be relied on for the treatment of the severer cases of illness or accident ; and their ad- vantages are, at least in this city, fully appreciated by the poor, the greatest anxiety to gain admission being constantly displayed. The death-rate in the Dublin hospitals is much lower than that which Miss Nightin- gale gives for the twenty-four London ones, as appears from the following figures which I obtained in 1864 : In the nine general hospitals in this city namely, Adelaide, City of Dublin, Jervis- street, Mater Miseri- cordiae, Meath, Mercer's, Richmond, St. Vincent's, and Stevens', there were admitted from 1st January to 31st December, 1863, 11,991 patients, of whom there died 552, or 46 per 1,000 ; but even this mortality is made greater, in proportion to that among cases treated at their own homes, by the following circumstances some of our dispensary medical officers are also hospital sur- geons, and most of them are connected in some way or other with these institutions, and while anxious to do the best for the suffering poor, they prefer to have the more acute and serious cases in hospital under their more constant supervision, where also these examples of disease confer the important, though indirect, benefit of serving humanity, by training scientific physicians and surgeons. The difference in mortality in hospitals depends also upon selection of the cases ; for instance, in those with large clinical classes, striking and severe examples of disease will be naturally sought for, and sent there by the numerous practitioners who have been educated at the institution. Dr. Guy, the great medical REFUGES OVER-CROWDED HOSPITALS. 279 statist, has shown that the mortality of Guy's, Bartho- lomew's, King's College, and University College hospi- tals, range from 110 to 115 per 1,000, owing to the gravity of the cases admitted for their hygienic and cnrative arrangements, which are the first in the world. To render the statistics of our hospitals more readily comparable with those of London, I have computed from the Census Reports that on the 7th April, 1861, there were in the eight existing hospitals for the Mater Mis- ericordise was not opened 703 patients, and allowing the death-rate to be proportional to what I have ascer- tained for last year, we would have a per centage of 74 deaths instead of 90, or that of the twenty-four London hospitals. As I have said before in respect to other branches of medical statistics, it would be very desirable that by the extension of registration to hospital mor- talities, we would be enabled to obtain fuller and more accurate numbers. In a previous lecture I have endeavoured to show that some diseases owe their origin, and many their un- toward course, to want of ventilation, and I may here express my conviction that with a full regard to the necessity of fresh air in these institutions, the most contagious cases might be mixed up with ordinary patients. But as this perfect airing is not attainable, and for other reasons such an arrangement is not advisable, the innate virulence and unmanageableness of contagion I think has been too much dreaded, to the neglect of simple precautionary measures, as is seen throughout all the old quarantine laws. So close was the affection of contagious matters for substances in particular conditions considered to be, that it was once laid down that feathers just plucked from birds could not be admitted from a plague-stricken country without the most imminent danger. Miss Nightingale argues that fever patients should be mingled with ordinary patients, and if any others catch the infection, it is a 19 280 OVER-CROWDED HOSPITALS. proof of so wretched a sanitary state that we may expect fevers to arise without any germ at all. Sir Gilbert Blane and Prof. Gregory, and Alison, have promul- gated similar views. I may, however, mention the fact, to be explained as it may, that there is scarcely a year that the life of some zealous student is not sacrificed, if his benevolence has led him to too close a contact with infectious cases, and the latest instance of death by typhus occurred in the person of one of the residents in Sir P. Dun's Hospital, who had been most energetic during the cholera epidemic. Separate fever hospitals were first advocated by Dr. Haygarth of Chester, and have since met with general favour, for their advantages are patent. They remove from the filthy homes of the poor the source of disease, which will infect the rest of the family and even the neighbours, and the rich become attacked by the con- tagion being carried by servants who will visit their relatives when stricken down. By want of ventilation, and the lurking of the poison or continuance of its causes in their homes, the poor get relapses, whereas if removed to hospital their homes can be purified during their absence. In the Cork-street and Hardwicke fever hospitals of this city there were admitted 2,353 patients last year; and probabty 500 were treated in other hospitals. Now, as one patient may be fairly calculated to infect four others, and as 1 in 8 of those attacked die, it may be justly inferred that these admirable institutions have prevented 11,412 cases, and 1,424 deaths by fever. Highly, however, as I value these benevolent and admirably conducted establishments, I must acknowledge that till every effort is made to prevent by pure air and water, by perfect sewerage, and as far as possible by good food, in this and other cities, the occurrence of fever, the treating of the disease, may be compared to the task of Sisyphus. lu Glasgow there has been legal power for the cshib- REFUGES OVER-CROWDED HOSPITALS. 281 lishment of houses where the families of persons struck down with fever may take refuge during their treatment, or the purification of their dwellings, and such have been erected with the most signal advantage. If similar steps were taken by the benevolent of this city, the spread of fever would be much checked, and the misery which falls on a family when the head of it is removed to hospital greatly relieved. But, indeed, under the Public Health Act there is now power for the Poor Law Guardians to establish refuges of the kind, and they did so during the recent cholera epidemic with most signal advantage, as I shall hereafter tell you. Dr. Murchison advocates the establishment of sepa- rate fever hospitals, and records the following facts : In the first six months of 1862, 1,107 cases of typhus were under treatment in the London Fever Hospital, and the mortality was 20-95 per cent., while out of 348 patients under treatment in six of the general hospitals the mortality was 23'32 per cent. ; 1,080 cases were admitted into the Fever Hospital, and communicated the disease to 27 persons, 8 of whom died, while 272 cases admitted into the above general hospitals commu- nicated the disease to 71 persons, 21 of whom died. Dr. Parsons, of New York, in speaking of the Belle- vue Hospital, says : " Until quite recently this hospi- tal has been the most prolific fever nest in the district, if not the whole city ; for not only were cases of typhus fever brought here for treatment, but from these cases the fever was disseminated throughout the hospital, proving fatal to patients that otherwise might not have been exposed to the disease, and to the resident physi- cians and surgeons of the hospital." In one of the best arranged London hospitals 167 cases of fever were admitted in 1865, and 13 persons, including 6 nurses, caught the contagion. As the fullest ventilation is required in such hos- pitals to burn off the peculiar poison of the disease, 282 OVER- CROWDED HOSPITALS. they should be never over- crowded. I will adduce for you some instances of evils from the agglomeration of a number of sick under one roof evils which are nimost wholly avoidable, and which will never, I fervently trust, be reproduced on so great a scale. In one of the Scutari hospitals there- were at one time 2,500 sick and wounded, and two out of every five of them died a proportion not, however, equalling the mortality by disease during the first seven months of the Crimean campaign, for 60 per cent, per annum of the troops died, a death rate as high among the soldiers as that of the sick in cholera or plague times in cities. In one month there were in the Scutari hospitals 80 cases of that fearful fruit of sanitary mismanagement, " hospital gangrene." Sanitary improvements, mainly promoted by Bliss Nightingale, reduced the mortality among the sick dur- ing the last six months of the war to nearly the rate of deaths among the healthy of the Guards at home. In times long gone by, the Hotel Dieu, Paris, contained in 1,200 beds as many as 7,000 patients. This was accomplished by multiple beds, and by these being used in turns, " forms being provided on which the sick whose turn it was to be out of bed could rest in the meantime." One out of every four patients used to die. Its air was such as to be called " a most foul and pestilential con- gregation of vapours." One-fifteenth of the women delivered within it died, and one-third of the children. The itch and other contagious diseases were almost universal among the patients, surgeons, and attendants, and the institution was a vast focus in this way for spreading disease. Even five years ago the illustrious Malgaigne declared that, as regards sanitary conditions, the hospitals in Paris " were the most detestable in 3^urope." St. Thomas's Hospital, London, was, up to 1741, remarkable for its high death-rate (1 in 10) ; but, after ventilation and other alterations, it fell to 1 in 15-6. One lesson more, which, from having occurred THE SITE AND CONSTRUCTION OF HOSPITALS. 283 at home and in the memory of us all, may make more impression. In the Irish famine-fever of 1846-7, the rate of mortality in hospitals and poorhouses was far greater than among the poor creatures who lay in the open air along the hedges, exposed to the inclemency of the weather, and without sufficient food or raiment ; and during the typhus epidemic of 1814 in Paris, those patients who were obliged to be rudely sheltered in the Montfaucon abattoir, where they were freely exposed to wind, recovered far better than those treated in the hos- pitals. With regard to the situation of metropolitan hospitals, while I am fully impressed with the importance of obtaining healthy sites, I do not think all other consi- derations should be ignored, as they are very nearly by Miss Nightingale, so anxious is she to secure the most healthy positions. She seems to fear opposition from teachers of medicine, and remarks that if medical in- struction be an object, it is better that students should watch rapidly recovering than lingering cases, and twice as many cases can thus be submitted to them. Even removal of the hospital to the suburbs of a town, she thinks, would benefit medical education, for " the quiet and studious habits of a college would be substituted for the desultory lecture-hunting and hospital-walking of London." After all, medical education is but a secondary object of these institutions, their primary function being the care of the sick ; and when one reflects on the dis- tance a severe accident or acute case should be carried, or the patients' friends should travel in visiting them at a suburban hospital, we must feel some satisfaction that in this city healthy and extensive sites may be had at short distances from the centre at moderate rates. The first principle of hospital construction, Miss Nightingale asserts, must be, that it shall be built in pavilions or separate blocks, having wards, nurses' rooms, sculleries, lavatories, baths, and water-closets 284 THE HERBERT HOSPITAL, WOOLWICH. unconnected with other pavilions save by a common airy corridor, the building for the administrative part of the establishment being central. The Herbert Hospital, near Woolwich, is the most scientifically constructed hospital in Europe which I have visited, and forms a noble monument to the truly great man after whom it is named. It consists of seven pavilions, the ends of which all project into free air, as will be understood by studying the plan, and which are separated from each other by twice their height in dis- tance. Below the wards there is abasement story, which accommodates the museum, library, medical officers' rooms, and stores. There are but two floors to each pavilion, and each ward has a large end window com- manding beautiful prospects, in front towards the Thames, behind towards the Crystal Palace the latter, however, not being improved by a cemetery a quarter of a mile distant. The baths and water-closets are in the free ends, and the latter are thus thoroughly aired. The drain-pipes are aired by a shaft carried above the roof, a box of charcoal being adjusted to the end. Each ward is 26 feet wide and 14 feet high, which latter measurement is below what we would wish for, and contains 30 beds, making 650 altogether, the cubic space for each being therefore about 1,800 feet. The windows are abundant, there being one for two beds, and arranged along opposite walls, and as the axis of the wards is a little to the east of north, each side will be enlivened by the sun during some part of the day. The central blocks contain the administrative quarters, kitchens, library, and convalescents' day-room ; one end has lunatic wards, and in the other is the operation theatre, with a few beds attached. The conveyance of food, medicine, and coals, and the removal of refuse, will be carried on by means of lifts and shoots in a basement , corridor along the centre, so that no bustle will disturb the patients. Open corridors looking on beautiful gar- 286 CONSTRUCTION OF HOSPITALS. dens will be available for convalescents in fine weather, and a covered one in wet. The wards are warmed by two open fireplaces at the middle of the wards, the flues giving additional heat by being carried under the floors, which, however, are made as fireproof as possible, con- sisting of iron beams filled in with concrete and boarded with oak an arrangement which likewise dulls the noise from the upper to the lower ward. The walls have a most pleasing light coloured and polished surface, to prevent the adherence of dust or organic particles. For similar objects, Parian cement and silicated surface have been recommended. Hot and cold water, softened by the lime process which I before explained to you, are laid aver the whole building. Dr. Parkes has suggested a plan in which the pa- vilions project in radii from a semicircular corridor ; but for hospitals of the size which is usually adopted in this city, two pavilions in a line is the best form. The distance between the blocks should be at least twice their height; there should be but two floors on each block, and only one ward on each floor. The typical size of the ward should be such as to hold about 80 beds, small wards being objectionable for the following reasons : They are hard to ventilate ; corners are multiplied; attendants must be proportionately more numerous ; discipline is preserved with greater difficulty ; and a death has a more depressing effect on the other patients. I look on separate operation wards as most desirable, for while the sufferer has the advantage of greater quietude, other patients do not suffer from the shock, or from the smell of the discharges which so often follow. The superficial area for each bed is a point which has been often overlooked ; no vertical height of the ward will compensate for its deficiency, although it may afford an abundant cubic space ; it should be at least 100 square feet. Clinical instruction, the use of the bath, cleansing, and the isolation of infectious cases, will HOSPITALS PUNCHED ZINC VENTILATORS. 287 be then readily attainable, and with wards fifteen feet high, each patient will have 1,500 cubic feet of space. In a previous lecture I dwelt at some length on the ventilation of hospitals, which, considering the abun- dance of organic emanations, should be the best venti- lated of all buildings, and I stated that air-shafts were necessary to attain perfection of airing, which consists in the air the patients breathe being as pure as the outer air, without their being chilled. Levy, the first of French hygienists, says : " I am far from denying the importance of diet, of curative methods, of careful at- tention, of an efficient administration, &c. ; but all these elements of hospital service are secondary to the ne- cessity for having pure air." In fever, hospitals free access of air is especially required, and no plan can be more effectual than that adopted by the Commissioners of Health during the epidemics from 1846 to 1850. It is described in the following words : " A sheet of zinc or tin plate is punched (not drilled) with holes one-twelfth inch diameter, and half-an-inch apart ; thus prepared, it is inserted in place of a pane of glass in every window, or every alternate window, as required, care being taken that the side on which the burrs project is turned to the weather, so as to throw off the rain. Neither wire-gauze nor perforated zinc of the ordinary kind will be found suitable, as both permit blasts of cold air and rain to pass through them, and the former is liable after some time to become choked with dust. Those who have had practical experience of the importance of ventilation to the sick, and of the difficulty of maintaining it, will appreciate the value of a simple plan that combines utility with cheapness, and which cannot be interfered with by the inmates of the hospital." You are, perhaps, aware that Sir D. Corrigan has for many years advocated this mode of ventilation, and they have been found, during an experience of fourteen years in the Hardwicke and Whitworth Hospitals, superior to all others. As he remarks, they are beyond the reach of the inmates, who have the stongest tendency to close up or obstruct with clothes all ventilators. I am an earnest advocate for numerous windows in 288 WARDS WALLS FLOORS LATE1NES. hospitals, both on the score of ventilation and of light ; the patients, if convalescent, should be enabled to read in bed, or to enjoy the prospect of scenery or gardens, which should always surround the building. The win- dow space ought to be half the wall space, notwith- standing the low temperature of this climate, which may be compensated for by additional production of artificial heat or clothing, or by double sashes or panes, which are very useful in preventing extremes of heat or cold. For similar reasons, the walls and ceilings should be of a light colour ; and to prevent the adhesion of dirt their material should not be porous, but hard and po- lished ; pale green paper (not arsenical), varnished, has been found most economical and suitable in this city ; but Parian cement, if it can be afforded, is the best pos- sible surface. Whitewashing of walls, to be effective for the removal of carbonic acid, must be renewed every three or four weeks, to the intolerable disturbance and even danger of the patients ; and we have already learned that that gas is by no means the most noxious constituent of foul air : ordinary plaster becomes in a few years loaded with organic matter most abundantly. The surface of the floor should be made polished and impervious to moisture, as advantageously adopted in many institutions in this country. The frequent wash- ing of floors is hurtful, as the subsequent evaporation carries up organic matter, and erysipelas has been proved to have been thus rendered frequent. The stairs and landings should be of stone. The furniture should be as little as possible thin mattresses on springs and iron bedsteads being the most advantageous. There are many improvements in bath-rooms and lavatories, sculleries, water-closets, and sinks, which if carefully attended to in hospitals would not only expedite the recovery of its inmates, but inculcate wholesome lessons applicable to their homes when they return to them. Care should be especially taken in building latrines, HOSPITAL STATISTICS. 289 which, projecting at the end of the pavilion, should have the closets along their outer wall ; and for better ventilation, the partitions should not reach the ceiling, and the whole apartments should be aired by opposite windows kept open. The hospitals in this city, though small, are numerous in proportion to the population, and I think we have cause for congratulation in this circumstance, for multiplication of these institutions is more desirable than enlargement. It may be said that extensive fields for clinical study are not presented, but by a system of reciprocal admission to hospital students, as was mooted some years ago, this may be obviated. The distribution of the nine general hospitals I exhibit to you on this map. The report of Dr. Bristowe and Mr. Holmes, to which I have so often alluded, concludes with a special de- scription of each hospital, and it appears that their impressions of those in this city were, on the whole, favourable. A few words about a uniform plan of hospital statis- tics, the advantages of which would be as follows : We could ascertain the mortality of different hospitals in various diseases or accidents ; and as some cases might be more advantageously managed in one hospital than in another, owing to climatic or hygienic conditions, great benefits and economy of the funds should result. The laws which govern disease and the influence of par- ticular remedies could be studied from accurate and copious data, and also the utility of various operations, many of which, from the limited experience of one man, may now be brought into undue prominence. No form could be better for the purpose than that which Miss Nightingale has drawn up, and which has been adopted by the International Statistical Congress, St. Bartho- lomew's, and London Hospitals, and similar institutions. The medical officer of the Privy Council reports on this subject as follows : 290 STATISTICS CONVALESCENT HOSPITALS. " During the present grievous imperfectness of hospital statistics, we cannot accurately compare, even in part (much less in entirety), the success of one hospital with the success of other hospitals, nor, a, fortiori, the healthiness of one hospital with the healthiness of others. And I deem this to be a public wrong, and a bar to scientific progress. But meanwhile, happily for mankind, hospital unhealthiness is not a something about which no judgment can be formed, or which must needs wait unamended till by elaborate comparative statistics we have its exact mathematical measure before us. Sanitary defects, where they exist in hospitals, are appreciable by the skilled daily observers of the sick appreciable in individual cases, and according to common hygienic laws, as causes of disease or interruption of recovery." In Paris, a governmental department (Bureau de 1'Assistance Publique) controls all the hospitals, and yearly publishes their death-rates and other records. Two great convalescent asylums in the suburbs form part of the system of medical relief in that capital. It seems to me by no means necessary to sepa- rate children altogether from adults, as done in the Children's Hospital in London, Edinburgh, and Paris. A separate ward has been used for over 30 years in St. Vincent's Hospital, and this, and the Smyly ward of the Meath Hospital, have shown that isolation of children from the adult patients is very advantageous. I will not enter into the vexed question of hospitals for special cases, nor discuss whether it is politic and just towards the medical profession to receive well-to- do patients for payment, a system which is not adopted in any town in the United Kingdom except Dublin. With regard to abuses which occur in connexion with hospitals, Dr. Markham, now Poor Law Inspector, a few years ago, made the following truthful remarks : " My desire is simply to establish the fact, that our medical chari- ties are not adapted to the present condition of society ; that whilst doing a vast amount of good, they are also doing a large amount of mischief, by teaching the working man improvidence ; that they unduly call upon the benevolence of the generous, and thereby spare the pockets of that very large class of the churlish opulent who " give nothing;" that a very large number of persons are per- DUBLIN HOSPITALS BOARD. 291 mitted to share their benefits who are as well able to pay for relief as the governors of the charities themselves; that the medical profession is thereby robbed to an enormous extent ; and that the plain and simple cure for these evils, is the converting of our hos- pitals and dispensaries into provident medical institutions." In Dublin the House of Industry Hospitals (Richmond Surgical, Whitworth Medical, and Hardwicke Fever), which are supported wholly by Government, as well as, to a certain extent, the Lock, Stevens', Meath, Cork- street Fever, Rotundo Lying-in, Coombe Lying-in, St. Mark's Ophthalmic, and the Incurables, Hospitals, which are partly supported by parliamentary grants, are regulated by a special act, passed in 1856 (19 & 20 Viet. cap. 110). The buildings and land of the House of Industry are vested in the Board of Works ; but in other respects the institution is managed by a Board of Governors, partly nominated by the Lord Lieutenant and partly by the subscribers. Officers of these hospitals and of the Lock Hospital may, if inca- pacitated, receive annuities out of the funds granted by Parliament. The Lord Lieutenant can appoint the Board of Superintendence of the Hospitals, which shall consist of not more than twelve members ; and one-third of those appointed have been medical men. Their duties are, to inquire into the performance of the duties of officers, to superintend the general management of the institutions, to frame, subject to the Lord Lieu- tenant's approval, rules for the purpose, and to report annually to Parliament on these matters. I regret that time will not permit me to give you details relative to each of the many benevolent institu- tions of which Dublin can boast. If it did, I would have no hesitation in canvassing the peculiarities and historical facts relative to each of our hospitals, for so careful is the superintendence over those which are endowed, and over those which Charity that virtue of all most blessed supports, that I would only have to use terms of commendation. With respect to the ad van- 292 CONVALESCENT HOSPITALS. tages of hospitals for incurables, they are, indeed, most truly illustrated by the admirable institution of that nature which we possess in Dublin. In London, or rather its vicinity, there are institutions which may be regarded as convalescent hospitals, but in this country we had, until the present year, no such institution, although its desirability, or indeed absolute necessity, had been often demonstrated, and, first, by the Royal Report on the state of the Irish poor, Dr. Whately, Archbishop Murray, Mr. More O'Ferrall, and Mr. Naper being among the commissioners. The Sisters of Charity have established, in connexion with St. Vin- cent's Hospital, a Convalescent Home at Linden, Still- organ, and I can testify to the advantages in the way of rapid recovery after acute disease, and improvement of scrofulous cases which have already accrued. Funds are being collected for the establishment of another such institution on an adjoining site. The change of air and of scene recruits health most rapidly, and many an arti- zan, if sent back, even after the most successful treatment, to his cheerless and unwholesome dwelling, relapses, or incurs the risk of other maladies. As the Sisters urge, ' ' Few but those who are well acquainted with the differ- ent phases of languor, weakness, and prostration conse- quent on more serious maladies, and at the same time with the privations of the poor, who can so little afford the comforts, or even the time necessary for complete restoration, can judge how great the boon and blessing to them of finding a temporary home where they may freely, and at full ease, breathe the pure country air, and enjoy its energizing effects for a brief interval before returning to their daily cares." These institutions deserve the support of the working classes who lately subscribed 850 for a similar one in Birmingham as well as of the wealthier classes, who can find no nobler cause in which to exercise their benevolence. During the American war the convalescent homes, or " rests," CONVALESCENT HOSPITALS OR HOMES. 293 as they were called, which the Sanitary Commission established, saved thousands of lives. The daily papers, about two years ago, contained most convincing letters upon this subject, recommending that testimonials to departed great onee should take this form, in place of useless erections which have too often disfigured instead of beautified our city, and one of the most influential of them has recently urged that the plots of ground upon which the Martello Towers stand should be allotted for the purpose, as these buildings are now to be removed. Almost any of the twenty-seven plots round Dublin Bay would be suitable, and those at Killiney, Dalkey Island, and Howth, may be preferred, on the grounds of there being frequent trains running near to them by which patients might be conveyed. When the good work of establishing a convalescent hospital is commenced by the co-operation of the committees of various hospitals and there is no better way of economising their funds it may be expected that wards will be gradually added to bear the name, and thus perpetuate the memory of the illustrious whom it was intended to honour. A con- valescent hospital should differ entirely from the charac- ter of a general hospital ; and, if constructed in neat cottages capable of holding about six, will, perhaps, best meet the requirements of cheapness, abundant ven- tilation, discipline, and good example, by which the homes of the poor will afterwards profit. The sketch and plan on following page are copied from those made for the Wilts Herbert Memorial, and published in Miss Nightin- gale's book. In such an institution abundant employ- ment of body and mind would be an important element of cure. It is in warfare that scientific knowledge, with regard to the construction of hospitals, is fully called into re- quisition. The Federals, during the American war, according to the official reports, having 97,751 sick and wounded, constructed numerous provisional hospitals. 294 CONVALESCENT HOSPITAL. PRINCIPAL ELEVATIONS GROUND PLAN CONVALESCENT HOSPITAL. 1. Dining and Day Rooms. 2. Kitchen. 3. Scullery. 4. Larder. 5. Stores . 6. Dispensary. 7. Maid-servants' room.::. 8. Convalescents' Bedrooms. 1). Sisters. 10. Batlis. 11. Corridor. 12. Covered way. 13. Gardener. 14. -S'tcA; From the reports, it would appear that humanity and philanthropy united never made such gigantic efforts. In a few months 214 hospitals, containing 133,800 beds, were erected, and the sanitary commission expended nearly 9,000,000 to assist the government in providing for the patients. It may be right that I should allude briefly to hospital nursing. By the Census of 1851 it appeared that in England alone there were 25,466 SYSTEMS OF HOSPITAL NUTCSING. 295 "'nurses," although no provision till very lately existed for their training. My friend, Dr. O'Sullivan, of the North Infirmary, Cork, thus sketches the faults of paid nurses : " It is not unusual to find that the taking of medicine ordered by the physician has been left to the option of the patient ; meals have been given frequently with great irregularity ; bad cases, unable to feed themselves, have often been left uncared for until it was the nurse's convenience to assist them, or until neighbour- ing patients came to their aid ; food has been left to cool, and oftentimes allowed to go to waste when the patient cannot take it , ' poultices were put on cold, or left on till they were hard, and then not washed off; bed sores were unattended to till they had become so bad that the medical officer's attention was called to them ;' patients were left dirty ; utensils were often left unwashed ; ' patients ordered to remain in bed were as often out of bed ;' they were allowed to smoke in the wards ; their beds were not regularly made up ; patients were allowed to hide their soiled clothes nnder their beds ; and a host of other important, as well as minor details, neglected." The nursing by Sisters of Chanty in St. Vincent's Hospital was established in 1834, and sisters trained in France were placed over it. The system has worked most admirably, and in every way superior to any sys- tem of paid nurses. There is one sister to about every twelve patients. She remains in her office off the ward, or in the ward, from about 7 A.M. to 9 P.M., with short intermissions for meals or prayer. She does all the duties comprehended in the word " nursing ;" but ward- maids, of course, take all the scrubbing and cleansing duties. lam glad to have this opportunity of advocating the system of "hospital sisters," which is carried out in University, King's College, and St. Thomas' Hospitals, London, as I am strongly of opinion that it might be adopted in those hospitals in this city where at present the entire care of the sick is intrusted to paid nurses. In University College Hospital, the sisters come from respectable ranks in society, and belong to the All Saints' Home, an in titution in connexion with the Church of 20 296 SYSTEMS OF HOSPITAL NURSING. England. They each superintend a ward containing fifteen beds, their principal duties being to direct the nurses. In King's College Hospital they are termed " lady nurses ;" they superintend the paid nurses, and it is found that their presence has the greatest influence in elevating the moral tone and civilizing the habits of the patients. At both hospitals their services are ren- dered gratuitously (the sisters and " probationers" in King's College Hospital paying for their board). They are willing to give, but never obtrude, religious instruc- tion and consolation to those who seek it, and it never assumes a controversial character. Miss Nightingale seems to infer that if the entire es- tablishment be administered by hospital nuns, Protestant or Roman Catholic, there will be lower average care of the sick, as " the idea of the ' religious order' is always more or less to prepare the sick for death." This opinion I cannot support, for I, in common with all other medical officers of hospitals under the care of religious orders in this city, have certainly never had to complain of want of anxiety for, or of attention to, mundane mat- ters on the part of these sisters. If, then, sisters in these London hospitals be so really useful, they seem required in even a greater degree for our poor uneducated, and previously uncared-for. The step has been taken in Dr. Stevens' Hospital, under the superintendence of some benevolent ladies, and a lady who acquired the system in the nurse-training depart- ment established by Miss Nightingale. There can be no doubt that many of our devoted fellow- country women will readily apply themselves to the beneficent task ; and besides the care of the sick, another field of useful- ness will be opened, namely, the training of nurses for the rich at their homes, which had been previously unattended to, save in the case of those who are called to succour mothers in their hours of trial. LECTUEE XII. DWELLINGS OF THE LABOURING CLASSES LODGING HOUSES TENEMENTS BUILDING ACTS. HAVING in my earlier lectures referred to the over- crowded and wretched state of the dwellings of the poor in Dublin, I will not dwell on this part of the subject at any great length now. I endeavoured to show that " out of dirt comes death," just as surely as from the accidental causes with which Providence removes us, and although bad air does not burn, suddenly poison, or drown him who inhales it, it depresses, removes appetite and energy, and keeping the flow of life at a low ebb, predisposes to mortal disease. Such evils were brought to light a short time since in that most neglected part of London, Bethnal-green, where very many deaths occurred from a kind of blood-poisoning due to over-crowding; and the effects upon children of the same crying evil is exposed under the title of " Infanticide without Inten- tion" in Mr. Godwin's most able book entitled, "Another Blow for,; Life," as being most rife in every part of London. As is the home, so are the people in regard to moral and social state, and although the nests of crime which infest the worst parts of London have happily no analogue here, yet there are "filthy dens in which men, women, and children, are brutalized and destroyed." The instance given by Mr. Rendle, a Metropolitan Medical Officer of Health, is most applicable to the condition of our city poor : " Let us picture to ourselves the man of the alley come home from his work ; the house is filthy, the look of it is dingy and repulsive, the air is close and oppressive ; he is thirsty, the water-butt, 298 DWELLINGS OF THE LABOURING CLASSES* decayed, and lined with disgusting greeu vegetation, stands open nigh a drain, and foul liquids, which can- not run off, are about it, tainting it with an unwhole- some and unpleasant taste ; the refuse-heap with decay- ing vegetable matter is near, and the dilapidated privy and cesspool send up heavy poisonous and depressing gases." Is not the sumptuous gin-palace a tempting resource ? The most crying evil of large cities is the degraded state of the tenemental dwellings of the poor, some of whom are thereby lowered almost to that state of phy- sical and moral decline which in American cities is recognized by a name less elegant than expressive " tenant-house rot." The dwellings of the poor in cities, towns, and rural districts in Ireland are ill-constructed, dilapidated, over- crowded, and unwholesome. Let me attempt the de- scription of one or two in each of these situations but if they were photographed, or sketched by an artistic pen, they would excite as much interest as the exposure of Bethnal-green. Gill-square is a blind court, opening by a narrow archway, under one of the houses in Cole- alley, Meath-street, in this city. Built on three of the sides of a square of about fifty feet, there are nine three- story houses ; the roofs are broken, the walls present a most unsafe and tumbledown aspect, the windows are boarded up for more than half their space ; beings whose dirty, ill-clad, and spiritless aspect it is saddening to be- hold, overcrowd every room to the utmost ; there is but one yard for all, and in this, till last year, there was a hovel about eight feet square and ten high, in which three adults were huddled. Here, however, time has wrought improvement, for there now remains but a heap of rub- bish. If I had time, or if it were my province to depict the moral features of the denizens, they would appear of even a more degraded character than the buildings, HUMBLER DWELLINGS IN DUBLIN CORK. 299 and of no place could the words of Kingsley be in every circumstance more truly descriptive : " I turned into an alley 'neath the wall, And stepped from earth to hell. The light of heaven, The common air, was narrow, gross, and dun ; The tiles did drop from the eves ; the unhinged doors Tottered o'er inky pools, where reeked and curdled The offal of a life ; the gaunt-haunched swine Growled at their christened playmates o'er the scraps. Shrill mothers cursed ; wan children wailed ; sharp coughs Rang thro' the crazy chambers ; hungry eyes Glared dumb reproach." Such were the worst parts of London undrained, dilapidated, and thinned by pestilence every few years before the fire of 1666, which therefore cannot be re- garded from every point of view as a calamity. 56 Bow-lane, west, I have described in a recent report to the Corporation, as follows : " Hall and stairs covered with three inches of crusted filth ; first flight so rickety as to be unsafe ; second without a bannister ; floor of second landing broken into two holes about a square foot each, dangerous to life and limb ; ceilings of both top floors broken, and let in rain ; no lower sash in window of back room, so that it had to be covered with a petticoat nailed over it such state would produce colds and rheumatism ; filthy privy, and back yard with- out a sewer prolific causes of diarrhea." Poverty of the owners is not the cause of the dilapi- dation of this kind of abode, for many of the persons who set them have raised themselves to comparative affluence by profits thus gained from the poor. Other such tenement houses are owned by respectable persons, who live perhaps far away and never enter them, but leave them to be managed by the " deputy" or agent, who is not usually of an improving spirit. In propor- tion to space they are highly rented far more so than the gentleman's house. The poor often regard the fixity of windows as the perfection of house architecture, for thus the foul air of back yards is excluded, and in a lew instances I am really inclined to agree with them. 300 DWELLINGS IN SMALL TOWNS AND VILLAGES, Every crevice is carefully closed at night. In many parts of the city there are very high houses set to the poor, especially in neighbourhoods which have declined, and these are extremely hurtful by exclusion of sunlight and free circulation of air from other houses around them. In Cork things are no better, as we learn from recent reports of the Sanitary Committee : " The overcrowding of the wretched tenements in which they live, each house containing several families, ranging in the aggre- gate, in some instances, from thirty to sixty human beings, male and female, in each house ; for which large rents are exacted by the landlords, who will not spend one penny in the cleansing or improvement of their houses, unless coerced by force of the law to do so. Your committee have learned that a practice prevails amongst poor families occupying rooms in these houses, to under- let a portion of their rooms to nightly lodgers an evil which it appears to your committee might be met by the enforcement of the Lodging House Act." The labourers' cottages in small towns are usually built in lanes, and are often placed back to back, ex- cluding all chance of thorough airing, or the provision of sanitary accommodation. They consist of a single room, or a living room, and a sleeping place of about twelve feet square, and eight feet high, which offers for the breathing of the five inmates (the average) and the vagrant, who is almost invariably accommodated with a night's lodging, about 192 feet of space each, 1,000 being the average in public institutions. This would not be so hurtful if there were any means of renewing the air within it ; but from the absence of a chimney in the sleeping room, which is usual, and the small size and immovable state of the pane which represents the win- dow, no ventilation occurs. In such an over-crowded state there can be no decent separation of the sexes. When a death from contagious disease occurs in such an abode, the retention of the body within it is fraught with fearful evils ; and since the abolition of the Vestry Act DWELLINGS TN SMALL TOWNS AND VILLAGES. 301 there were no funds for interment ; and if the relatives were unable to provide them, they had to beg the amount from the neighbours. Sir Hervey Bruce has, however, obtained an Act last session which empowers Poor Law guardians to bear the expenses of interment. Neither in such a room can ablution of the whole body be ac- complished ; and, as I stated to you before, I have fre- quently found persons (especially females) suffering from skin diseases and other maladies, who for many years had never washed any part of their bodies but the face, neck, and hands. Evictions, and the demolition of cabins in the rural districts, have driven agricultural labourers into the small towns ; and, as new abodes in the place of those removed would be subject to taxation, they have not been erected. Besides the fearful over-crowding thus induced, the labourers have to expend their strength in walking long distances to their work. My friend, Dr. Mackesy, of Waterford, has ably drawn attention to these facts. The remedy is that which followed in Eng- land last session upon a masterly demonstration of its necessity by Dr. Hunter of the Medical Department of the Privy Council namely, union rating, for which a Bill was introduced by the Members for Dungarvan and Limerick last year. The mud hovel of the southern and western peasant is too well known by the sketches of English tourists to need any description here. Planted anywhere, regard- less of situation or soil, the low walls, the black, half- rotten thatch, the want of any proper flue, of windows, or of a back door, precluding thorough airing ; the clay floor, which becomes soaked with the pigs' food or more dangerous filth, and which Erasmus, centuries ago, showed was the promoter of fever among the English cot- tiers ; and the adjacent manure heap, are all highly pro- motive of disease. If there be an inner room, it is close and stifling, and 302 DWELLINGS IN SMALL TOWNS AND VILLAGES. so ill-lit that when the doctor pays his visit in the day- time, a candle is required to permit him to see his pa- tient. Although wages is much higher in Connaught now than ten years ago, little improvement has occurred in the domestic habits of the people, as they are igno- rant of the means of preserving health. The admission into the cabin of animals the pig especially has done much to propagate measles and other parasitic diseases, which, as we saw in a previous lecture, are after- wards injurious to man when their flesh is used. These abodes, however, are much fitter for swine than men. Dr. Tucker of Sligo draws the following lamentable picture concerning the hovels of the western poor : " The medical officer of a district has the best opportunity to illustrate this sad state of existence. Some short time since, I noticed the homely hovel of a small farmer (the tenant of a noble- man) which may be taken as the prototype of many in country districts. It was about twelve feet wide and twenty-four feet long. The domestic circle, happy family, or menagerie, that dwelt therein consisted of a sick man, his wife, four daughters, one son, three cows, one horse, two calves, two pigs, and poultry all in one common undivided house no partition. Generally the pigs dwelt beneath the beds, the people in them, and the poultry over head. They can enjoy the prospect of bacon and chickens which they seldom taste. An aboriginal from Maherow, named Heraghy, observed to me, in defence of this sad social state, that ' it was better have that house full than empty.' " The poor are apt to huddle together, especially during winter, and in improved dwellings freer air supply will entail the free use of coal. Habit produces a degree of toleration, else the poorest Chinese whom we are told are often packed in rooms which give but 35 cubic feet of space per head could not survive. Many diseases are produced, promoted, or rendered more fatal among the poor, and, if contagious, spread to the rich, by such conditions as I have sketched a sub- ject which is discussed in other lectures. EVILS OF ILL-REGULATED TENEMENTS. 303 Accidental deaths occur likewise by over-crowding ; thus, during the last ten years, in Liverpool, 828 deaths of infants have been caused by overlying. The other physical and the moral evils which result from the wretched condition of the habitations of our poor, we cannot now discuss, but they are subjects pre- eminently important for the philanthropist and the statesman. The evils which neglected dwellings impress on our countrymen are carried with them when they emigrate to British and American cities, in which the term "Irish " or " Irishtown," applied to a neighbour- hood, is the synonym for " wretched and filthy;" and, galling to our national pride as the expressions are, no candid man can deny that there is some truth in them. Good houses in these cities depress in value at once when let to our countrymen. Any efforts to educate the \ ounger people in healthy and cleanly habits at home would at once produce improvement, and their benefits have been attested by Messrs. Mayhew, when they in- vestigated the condition of the poor Irish in London. It becomes the duty of every man to lend his aid in remov- ing the causes which lead to such universally recognized degradation. The report of the New York Council of Hygiene dis- plays a fearful condition of the tenement houses of that great city nearly half a million resided in 15,000 houses which belong to that class ; and in one of the wards the concentration of population was shown to be 265,000 to the square mile. In one tenant-house, which lodged 504 persons, the annual number of deaths by scarlatina had been 16, from small-pox 6, and by fever, very many. On the day of the inspector's visit, 127 of the inhabitants were found to be ill. It was in this very house that the cholera epidemic of 1854 began. Mr. A. T. Stewart, the great Irish-American merchant, has intimated his readiness to give one million dollars for the erection of tenement houses for the de- 304 ENGLISH LABOURERS' DWELLINGS. serving poor of New York, if the landjequired is pro- vided. There are in Ireland, according to the last Census, 89,374 mud or sod hovels of one room only, and 489,668 mud houses with more than one room, giving an in- crease in Connaught of 5,168 of the latter class since 1841. The average number of persons occupying each of these dwellings is, in towns, 4-53 ; and in the rural districts, 5*24. Now, the remedy for this deplorable state does not lie in the labourer's hands, however great his willingness to pay for better accommodation, but with the landlord, when he recognises the duties which appertain to his property. When a poor tenant complains of any un- wholesome state of his room, a common answer is, " Leave it ; I can let it to plenty of others." The medical officer of the English Privy Council puts such facts respecting the sister country so eloquently and so authoritatively, that I shall read you his lessons rather than my own : " It is scarcely possible for the better-off classes to imagine* where duty has not given them opportunities of practically know, ing, what immensity of baneful influence is included in the evils to which I advert ; and it may therefore be well for me to show what in practice are the forms in which the evils present themselves. By places ' unfit for human habitation' I mean places in which by common consent even moderately healthly life is impossible to human dwellers places which therefore in themselves (indepen- dently of removable filth which may be about them) answer to the common conception of ' nuisances' such, for instance, as those underground and other dwellings which permanently are almost or entirely dark and unventilable ; and dwellings which are in such constructional partnership with public privies, or other depositories of filth, that their very sources of ventilation are essentially offen- sive and injurious ; and dwellings which have such relations to local drainage that they are habitually soaked into by water or sewage ; and go-forth. But beyond these instances, where the dwelling would, I think, even now be deemed by common consent " 4 unfit for human habitation' instances, varying in degree, are innumerable, where, in small closed courts, surrounded by high ENGLISH LABOURERS' DWELLINGS. 305 buildings, and approached by narrow and perhaps winding gang- ways, houses of the meanest sort stand, acre after acre of them, back to back, shut from all enjoyment of light and air, with but privies and dustbins to look upon ; and surely such can only be counted ' fit for human habitation' while the standard of that humanity is low. Again, by ' overcrowded' dwellings I mean those where dwellers are in such proportion to dwelling-space that no obtainable quantity of ventilation will keep the air of the dwelling- space free from hurtfully large accumulations of animal effluvium cases where the dwelling-space at its best stinks more or less with decomposing human excretions, and where, at its worst, this filthy atmosphere may (and very often does) have, working and spread- ing within it, the taint of some contagious fever. In its higher degrees ' over-crowding' almost necessarily involves such negation of all delicacy, such unclean confusion of bodies and bodily func- tions, as is rather bestial than human. To be subject to these influences is a degradation which must become deeper and deeper for those on whom it continues to work. To children who are born under its curse it must often be a very baptism into infamy. And beyond all measure hopeless is the wish that persons thus circumstanced should ever in other respects aspire to that atmo- sphere of civilization which has its essence in physical and moral cleanliness, and enhances the self-respect which it betokens. And as a particular class of cases, in which both evils are combined to one monstrous form of nuisance, I ought expressly to mention certain of the so-called ' tenement-houses' of the poor especially those large but ill-circumstanced houses, once perhaps wealthily inhabited, but now pauperised, and often without a span of court- yard either front or back ; where in each house perhaps a dozen or more rooms are separately let to a dozen or more families, each family with but a room to itself, and perhaps lodgers ; and where in each house the entire large number of occupants (which even in England may be little short of a hundred) will necessarily have the use of but a single staircase, and of a privy which perhaps is placed in the cellar." Dr. Parkes tells the same story: " In my course of inspection of these villages (round Southampton), I was satisfied that the labourers of England live as their rude forefathers did in utter ignorance and contempt of all sanitary laws, and even of the common rules of decency and cleanliness." The means which legislation has heretofore provided for the improvement of ihe dwellings of the humbler 303 LEGISLATIVE REMEDIES. classes have been inspection and the advancement of government loans. Under the Dublin Improvement Act of 1849, and the local acts of three or four other Irish cities, bye-laws were already in force regarding the following matters in nightly lodging-houses: Registration; inspection; number of lodgers ; separation of male and female lodgers ; airing and cleansing ; notice of infectious disease and disinfec- tion ; water supply, and domestic accommodation ; ex- clusion of swine and other animals ; and the keeping of a copy of the regulations in each room. Inspection in towns in Ireland was also allowed in nightly lodging-houses, when the population exceeded 8,000, and the town had been placed under Commis- sioners by the adoption of the Improvement Act of 1854. In England exemption is only granted for those below 200, and in'Scotland below 700. Over-crowding is thus irrepressible in hundreds of towns which fall below that population ; and in Parsonstown, Arklow, Kilrush, Port- law, Roscrea, Macroom, and Boyle, although above it, because they have not adopted any Improvement Act. As an example of a town which is over-crowded by the reception of vagrants at night, I may mention one very near us namely, Swords. As few of the towns which have adopted the Act of 1854 employ any inspector, it follows that nightly lodging-houses are unregulated in Ireland, except in a few of the larger cities. Power to inspect the tenemented dwellings of the poor in the same way as common lodging-houses had been advocated by the ablest writers, and first and most for- cibly by the Rev. Charles Kingsley ; but until the Public Health Act passed last year, Dublin was the only city in these kingdoms to which it had been granted. Such powers were conferred in 1865 under the Dublin Im- provement Act, and were anxiously sought for by Lon- don and other English cities, through their health-offi- cers and representatives. TENEMENT BYE-LA.TVS HOUSE-JOBBERS. 307 The practices of house-jobbers seem to be similar in all countries. The central Board of Health of Belgium, reporting on tenanted houses, says : " In these wretched habitations everything is sacrificed generally to the rapacity of the proprietor. Every repair which affects the health or the comfort of the tenant merely, and that is not neces- sary to prevent the total ruin of the dwelling, is entirely neglected . What is the use of cleaning the walls for people whose habits are filthy ? Why make windows for the entrance of air and light, or repair a sewer, or cleanse an alley covered with stagnant water, for people who are accustomed to pestilential smells ? It is what a proprietor can never understand. Do not believe, however, that these dreadful abodes are rented at their proper value. On the contrary, the unfortunate people obliged to live in these houses, because all better ones are closed against them, in reality pay a higher rent than for a wholesome room in a good house." The advantages attending inspection of nightly lodging- houses induced the Corporation to seek power over tene- ments set weekly at rents under 3s., and the Lord Lieu- tenant sanctioned the bye-laws which were framed in accordance with the Act. The owners of some of these houses, which number about 9,000 of the entire houses in the city, at once formed themselves into a body, with the grandiloquent and scarcely intelligible title of " The Antipolitical Ratepayers' Protective Association," whose object, like that of many similar organizations in England, was to protect themselves from the outlay necessary to render the houses fit for human habitation. By repre- sentations that the dwellings of the poor were in excellent order, that the Corporation were about to apply the bye- laws for the regulation of furnished nightly lodging- houses to tenement dwellings, by memorializing that body, and threatening many of its members with opposi- ion at the next election, and by appeals to the police magistrates, they for some months, to a certain degree, impeded us, notwithstanding the deplorable state of houses, such as I have exemplified, in Gill- square and Bow-lane. In a few days I was able to appeal to 165 808 TENEMENT BYE- LAWS. such houses, the state of which justified the Corporation in their course, and an energetic statement to the same effect was signed by every dispensary physician in Dublin. In May last, however (the question having been argued by most eminent counsel), the police magis- trates decided in favour of the Sanitary Committee, and fined the Secretary of the Association for not having registered a house kept by him. So determined were their efforts to oppose us in carrying out the sanitary bye- laws, that they lodged an appeal to the Court of Common Pleas, in which the decision was confirmed. They com- plain that the term "common lodging-house" is an opprobrious epithet to apply to houses set in tenements. The difficulties of keeping a registry of 9,000 houses, with changing owners, are so great, that I think registra- tion should not be required for "tenement houses," as distinguished from common lodging-houses, in which such a system is necessary. The artizan and poorer classes of this city, who number about 100,000, dwell in some 9,000 houses, each room of which is usually let as a separate tenement. The Corporation gained by the recent Act the power to compel the owners of these houses to put in thorough repair, and keep so, their roofs, walls, and chimneys ; to have their windows kept clean, and glazed, and mov- able at the top or bottom ; and to keep a properly-trap- ped house- drain and other sanitary requisites in good order. The bye-laws came into action on the 15th day of Sep- tember, 1865, and the sanitary sergeants forthwith pro- ceeded to enforce them. Those neighbourhoods which from experience were known to be most filthy and un- healthy were first visited, a copy of the bye-laws was posted in each house, and a familiar explanation of their provisions was given to each occupier of a tenement in it. In many instances the improvements which the sergeants suggested were carried out ; in others they WANT OF AIR. 309 were resisted, and the owners were accordingly sum- moned. The police magistrates, however, adjudged that registration of each of these houses as a public lodging- house was necessary before conviction for any sanitary deficiency could be obtained. The registration of these houses, which number about 9,000, caused considerable delay, and occupied the time of the staff for the first four months. I should mention that the visits of the officers were always most gratefully received by the poor tenants, and the allegations of the house-owners, as to their being intrusions on their privacy and liberty, were quite unfounded. During the first nine months the Act was in operation, 8,974 houses have been visited, 92,707 sanitary defects discovered, and the larger proportion of them corrected. My esteemed friend Dr. MacCormack, of Belfast, the earnest sanitarian, regards the slip of wood which is nailed in to prevent the fall of the upper sash as " the most deadly instrument of destruction in the world." and there is not the slightest exaggeration in the statement. In an attic in this city I was last month called to see a family of nine persons, each of whom had only 170 cubic feet of space. The windows did not open down. The eldest child was removed for scrofulous disease to the Hospital for Incurables. The wages earned by the father, 10s. a-week, was their only support. It is most gratifying that in the amended sanitary legislation, which the Government passed last session, the power of regulating tenement houses was extended to all Irish towns of over 5,000 in population, as well as the power to prevent over-crowding possessed by English Acts. The 35th section of the Sanitary Act, has been extended to Dublin, and the following regulations have been submitted to the Lord Lieutenant. 810 "REGULATIONS FOR TENEMENTS. Regulations for houses, and parts of houses, let in lod^i >gs or oc- cupied by members of more than one family, within the Borough of Dublin, under the Sanitary Act, 1866, sec. 35, others than Common Lodging Houses, within the povisions of the Common Lodging House Act, 1851. Made by the Nuisance Authority of the Borough of Dublin, the 4th day of December, 1866. " Every house or part of a house which is let in lodgings, or oc- cupied by members of more than one family, shall be subject to the following regulations : " 1. That no greater number of persons shall occupy any room in any such house than can be accommodated with 300 cubic feet of space for each (for example, a room 10 feet high, 15 feet long, and 10 feet wide, contains 1,500 cubic feet of space, and may therefore accommodate 5 persons). " 2. That said authority, or any of its officers, may enter and inspect any such houses, or any apartments or appurtenances thereof, without let or hindrance, between the hours of 10 A.M. and 4 P.M., for the purpose of carrying into effect these regulations and the provisions of said Act, or in special cases at any other time, upon the signed requisition of the Chairman of the Com- mittee of said authority, by vote of the Committee, and not other- wise, and may inspect and measure the dimensions of each room, and affix on the door thereof a description of the cubic contents of such room, in a form to be provided by such authority, and any re- moval or defacement of such certificate shall be deemed a breach of these regulations. "3. That the owner of every such house shall have supplied thereto a properly-constructed ash-pit and privy, or water-closet, or privies or water-closets sufficient to accommodate the inhabi- tants thereof, and a properly-trapped house-drain communicating with the main sewer (if any within 100 feet from such house), and if no such main sewer then with a proper cess-pool ; and shall cause such privies, water-closets, ash-pits, cess-pools, and house-drain to be kept cleansed and in proper repair ; and shall also provide for each such house a sufficient supply^of pure water; and keep the roof, external walls, and chimneys of such house in reasonable repair, impervious to wet ; and shall cause each win- dow of such house to be made capable of being opened from the top, or raised from the bottom, or otherwise opened to the extent of the half of each sash, and shall cause the entrance and hail, rooms, stair-cases, and lobbies thereof to be put and kept in g.->o depriving hundreds of thousands of the labouring classes of provision for the future." In 1864, Mr. Gladstone procured the Government Assurance and Annuity Act (27 & 28 Vic., cap. 43). The Postmaster- General has extended it to Ireland, and in no more useful way can the, educated classes serve the poor than by recommending them to take advantage of this means of providing for sickness, the necessities of old age, or death among their families. As the State is not to derive profit from the system, the rates are very low. Persons engaged in dangerous or unhealthy occupa- LIFE ASSURANCE FOR THE POOR. 305 tions, such as miners, butchers, innkeepers, or publicans, cannot assure at the ordinary rates. The premium may be paid even weekly. Mr. O'Shaughnessy selects the following illustrative cases : A tradesman in his twenty- fifth year wishes to assure 50 at death. To effect this, ha may pay once and for all 20, or annually till his death 1 Os. 5d. He may prefer to pay 2s. monthly, which will assure 53 at death. Again, it is sur- prising how soon a labourer in the decline of life wears out. Employers on a large scale must be aware of this, and nothing can then be more deplorable than their fate. Take one of this class, aged twenty-five, and willing to pay one shilling a week till his fifty-fifth year, when his physical powers will begin to decline. He becomes en- titled to 1 a month from fifty-five till the end of his life. Female servants, accustomed during great part of their lives to a considerable degree of comfort, are generally the most destitute of all during their old age. At present, although most of their wants are provided for, their savings can hardly reach a sum sufficient to guarantee them against want when no longer fit for ser- vice. For this class the system of deferred annuities is eminently beneficial. For instance, a female servant in her twenty-fifth year, by paying 1 a quarter, may ob- tain when she has reached fifty an annuity for the rest of her life of about 13. If, as she advances in years, her wages increase, she can add by small payments to this provision. In England in the first twelvemonth 809 proposals have been accepted for insurance to the extent of 60,874, the annual premiums amounting to 1,924, exclusive of eighteen cases in which the pre- miums were received in a single payment. 501 of the insurers decided to pay their premiums yearly, 81 quar- terly, 181 monthly, 3 fortnightly. Sixty-one proposals were declined. No death occurred in the first year. The Act has been extended to many of the larger Irish towns ; but as yet scarcely any business has been done. 366 INCOME OF THE WORKING CLASSES. It may be said that the Irish workman could not spare the premium as well as his English brother ; but it must be remembered that although his wages is lower, the prices of the necessaries of life are proportionately less. Prof. Leone Levi gives the yearly earnings of the British working classes as follows : Ages. England. Scotland. Ireland. United Kingdom. Males. 20 to 60 . . 217,300,000 2,900,000 43,500,000 289,800,000 Under 20. . 15,900,000 2,400,000 4,000,000 22,300,000 Females. 20 to 60 59,500,000 8,950,000 13,000,000 81,450,000 Under 20. . 18,800,000 2,350,000 3,600,000 24,750,000 311,500,000 42,700,000 64,100,000 418,300,000 And ,38,000,000 belonging to them is deposited in friendly societies. LECTURE XY. TOWN IMPROVEMENT IRISH TOWNS. I WILL introduce to-day's subject to you by an anec- dote. Eigord, physician to Philip Augustus, relates that one day the king, walking to and fro in his audience chamber, went to look out of the window for recreation ; some carriages of the citizens happened to pass at the moment, and the substance forming the street being stirred up by the wheels, emitted a stench so vile as to overpower Philip. Urged by this disgust, the king exerted himself to persuade the citizens to pave their streets with stone, and to remove nuisances from the fronts of the buildings, by which means he so improved his capital, that from being named " Lutetia," (lutea a luti fcetore) on account of its dirtiness, it was thenceforth called " Paris," after the beautiful son of Priam. However, in these modern days, pavement of streets by large stones, besides the dangers which it leads to from the slipping of horses, is found to be unwholesome by its retaining in the intervals between the stones organic matter which scavenging does not remove, but which rots, and in hot dry weather is thrown into dust and breathed by us. A macadamized road, with a good fall to the channel at each side, is the best kind of thoroughfare. The mud which is formed deodorizes organic matter, and it can be readily scavenged. The thorough drainage of the site of a city is a matter of the greatest importance, as is also the way in which irregularities of surface are filled up. Unless good arrangements are made to drain the beds of the streams which originally coursed through the ground, the water, following immutable laws, will find its way to the places 368 . DRAINAGE SMOKE IN TOWNS. lowest in the former topography, and there epidemics will rage most, even though there is no apparent damp- ness on the surface of the ground. In the lower part of a city, especially if reclaimed from sea or river, the hygrometer will show an average of twice the amount of moisture in the air than in the higher places, and it is pro- bable that contagions are thus more readily carried or de- veloped if moisture be necessary for that event. In such places rheumatism is always most prevalent, the emis- sion of water by the skin being hindered. The bearing of these questions on cholera I will hereafter fully discuss. The unhealthiness of manufacturing towns depends much on the murky atmosphere ; the registrar of the greatest of them says : " The unhealthiness of Manchester is due to its vitiated atmos- phere ; we have had an unusually dry season, and an extraordi- nary amount of sickness, with excessive mortality. Nothing but the constant rain we have in ordinary years makes a residence within its bounds tolerable. The air is well washed often, and we survive. No plant will live in M anchester without constant wash- ing ; the leaves become coated with soot, the stomata choked, and respiration ceases after a few hours. And that which destroys the life of a plant is breathed by the whole inhabitants of Manchester. This is the life-giving fluid on which they are to live and work. Let any one examine the lungs after death of a person who has been long resident in Manchester, and in the bronchial glands he will find a substance, inhaled soot, as black and thick as ink." The rain which falls is never alkaline as in country places, but acid from the products of the coal. Sir B. Peel, who brought the subject most ably before the House of Commons last session, stated that 2,000,000 tons of coal were yearly burned in Manchester, a propor- tion four times over that of London. Mr. Hanbury, the brewer, saves 2,000 a year by a smoke-consuming apparatus. Besides careful stoking and appliances to burn the coal more thoroughly, which I told you of when speaking of air, I have now to tell you that the following projects are being seriously discussed : hori- THE BLACK COUNTRY. 369 zontal flues opening into two or three vast chimneys out of the town ; precipitation of the smoke by passing through water, and the carrying of the smoke, chimneys being abolished, into the ordinary sewers a few great ventilating and discharging shafts being erected on high suburban places. The effect on the air, plants, and living beings of the smoke- begrimed manufacturing towns would be marvellous if the last-named scheme be fea- sible and be ever adopted. The bad sanitary state of the towns in the Black Country, was most forcibly illustrated by some letters which were specially written for the Birmingham Daily Post in June last. Wolverhampton has still surface drainage, and therefore cellars are filled with foul water, wells are polluted, and cholera raged severely in 1832 and 1849 ; yet since then the dangerous localities have even deteriorated. The death-rate for the last decenniuai is 30-88. " A large portion of the town of Dudley consists of ill-constructed courts, and lanes, and alleys, in which the houses are built back to back, so that there can be no thorough draught of air ; in which foul privies and open soil-pits lie under bed-room windows ; in which there is often nothing but a dilapidated channel or footpath of rough stones and bricks, and oftener no paving at all ; in which surface drainage, garbage, and refuse lie decomposing in malarious puddles ; and in which cholera, fever, and small-pox, whenever they visit the town, find most of their victims." Bilston, is the epidemic centre of the district, one- fourth of the people in 1832 and 1849 having suffered from cholera. Along "the brook" nearly all were at- tacked. It has since been quite sealed up. The decen- nium 1851-60 showed a yearly death-rate of 30-53 in the thousand. As usual there is such another stream in Oldbury, with its consequences, " There is a row of six houses lying off the brook at this point that is, at the back of Park-street and there is not a single resi- dent in that row who, during the late dry weather, when the brook running low was at its filthiest, did not suffer an attack, more or 370 PRINCIPLES OF TOWN GOVERNMENT. less severe, of bowel complaint. There, where the stream, laden with impurities, flows sullenly down between two blocks of crowded dwelling-houses, you may read of strong men stricken down by fever, and their unhealthy offspring cut off at the very threshhold of life ; of the innate dirtiness of mankind, and the carelessness of their rulers ; of that measureless ingratitude which turns the pleasantest of God's blessings into a withering, blasting curse." In many of these large towns, villages 50 years ago, the population is extremely dense ; but in one ward in New York, the population is condensed to the rate of 250,000 to the square mile, which is perhaps the highest in any city in the world. Mr. Tom Taylor, the Secretary of the Local Govern- ment office, has most ably defined the relations which central and local authorities should have in regard to town improvement in the following terms : " 1. To confer powers for such improvement cheaply and effec- tually ; to invest, with the legal character of ' towns,' areas of dense populations not having yet acquired a known and defined boundary, and to fuse into a consistent whole existing local acts and a general measure of town improvement. 2. When such powers are conferred, to forward generally the wise and efficient exercise of them by diffusing the light of a general experience, and by communicating the results of such special inquiries as the central department may be charged to make ; by advising in cases of doubt or difficulty, and generally by assisting, but never super- seding local efforts. 3. To protect posterity by examining and deciding upon applications for lease and mortgage rates. 4. To report to Parliament on the exercise of local powers. 5. To act as a court of appeal against local oppression in certain specified cases, and a court of mandamus in cases of local default." I will, however, revert to this subject when analyzing our present sanitary laws. In February, 1864, I had the honour of reading a short paper at the Statistical Society on the " Sanitary State of Dublin," in which I was compelled to assert that it was most unsatisfactory, because of the insuffi- cient legal powers which then belonged to the Corpora- tion, and because of the imperfect machinery which had UNHEALTH1NESS OP IRISH TOWNS. 371 been organized to carry out the preventive powers which they did possess. In July, 1864, the " Dublin Improve- ment Acts Amendment Act" became law, and so ample were its provisions that it left little to be desired in the way of sanitary legislation, and it would have been the fault of the Corporation and its officers if most substantial benefits did not follow. Being desirous that other towns should share the blessings of so good a measure as the lodging house bye-laws of Dublin, I devoted a few leisure days in the autumn of 1865 to visiting them. Some I have recently revisited, and I regret that I could report in no more favourable terms. I have omitted those of my notes which refer to minute hygienic details. The statistics with which I propose to illustrate the state of disease in each town are as follows : 1st. The death-rate, with which I have been favoured by the Registrar- General. In his inaugural address to the Statistical Society, in November, 1865, the Right Hon. Mr. Justice O'Hagan expressed his opinion that, not- withstanding the Registration Act, a large proportion of the deaths were unrecorded, and there is little doubt that the numbers of deaths in the towns I shall allude to are greater than these figures indicate. Compared, however, with the rates in rural districts they are strik- ing indeed. 2nd. The number of cases of fever which had been treated in the hospital of each union, and those which were seen by the medical officer of each dispensary for the last seven years. I obtained these data from the Poor Law Commission returns ; but as I have struck a yearly average on the assumption that one case of fever is treated at the patient's home for every two admitted into hospital (a ratio which, in some instances, I have found exact), the results are but approximations, and that admirably- worked department cannot be held re- sponsible for them. 3rd. The proportion of inhabitants attacked with 372 UNHEALTHINESS OF IKISH TOWXS. cholera in the epidemics of 1832, 1849, and 1854. These proportions I have derived from the manuscript record of the late Prof. Barker, who for so long a period, in connexion with the Board of Health, cared for the public health of this country; from the report of the Commissioners of Health (1852) ; and from the Poor Law Eeports of 1854-5. A few of these towns suffered in the epidemic of last year. Knowing that any general statement as to the unhealthiness of towns would be likely to meet merely with an apathetic assent, and as registration has only lately permitted the effects of faulty sanitary arrangements to be demonstrated, I will direct my remarks specially to each town, and I must beg for- giveness of the inhabitants if I should represent their localities in an unfavourable light. I will take them alphabetically in each province, but I may here mention that there is a great want of uniformity and codification in the municipal acts of our towns ; Dublin, Cork, Kil- kenny, Limerick, Derry, and Waterford, Belfast, Clon- mel, Drogheda, Sligo and Wexford, are governed under the Reform Act, 1841 ; 18 are still regulated by the Act of Geo. IV ; 71 towns are placed under the superior sta- tute passed in 1854 ; and Galway Rathmines, and Pem- broke are possessed of local acts. LEINSTER. ARKLOW (pop. 4,670) is a most neglected town, its cabins are usually back-to-back, and are filthier and smaller than any I have seen. In one 12 feet long, 5 broad, and slanting from 5 to 8 feet high, the woman who lived in it last autumn received "the Queen's reward," a proof that unwholesome circumstances do not check fecundity. Another poor creature was living in an old coach with a broken roof, planted by the edge of an open sewer. The streets in the " Fisheries " are as irregular as those of the " Claddagh," the ground is below high water mark, and immense pools of the most stinking ABKLOTV A Till OXE. 373 sf nff accumulate between flood-tides. Many dirty water- courses intersect the town. The filthiest drain I have ever seen begins between a double row of some twenty houses, is open to the back-door of one of the houses in the main street, then passing under the floor to open into a main sewer which from its level can have no outfall. Cholera was imported by the Crystal Palace ; thirty yards from the house where the first man was attacked, there is an unprotected superficial well much below the level of the street ; its water is used by all in the vicinity, and the ravages of the cholera were confined for some days to this place. By means of a refuge, an hospital in- habited by the good Sisters of Mercy, and by disinfecting the cabins, the disease was checked, with a low death-rate at the hospital, while up to the time of my visit every case kept at home had died. In one cabin where the man was dying, the wife said to me with quite an air of triumph, " Thank God, he's dying at home I wouldn't let priest or doctor move him." In 1849, when the town was even filthier, it had the luck to escape infection. The noble family to whom the town belongs exhibited the greatest bravery and generosity during the epidemic. Long leases and sub-letting, it is stated, prevent improvement ; but if Arklow could be transferred to English soil, where local government and building Acts prevail, it would not continue for six months to disgrace civilization. ATHLON E (5,902) has suffered from every visitation of cholera. One-eighteenth of the people were attacked in 1849, and on 20th January, 1855, a severe outburst occurred. Some days after, an inspector of nuisances was appointed, who was to notice all owners of premises where nuisances existed, and, if found necessary, to summon them. The death-rate of the union has been 1 in 62. Fever epidemics have been always severely felt, over one-fourth of the people having suffered in that of 1818. The sewerage is very bad, the lanes filthy, the lodging-houses and cabins over-crowded, and the former 374 CHAPEL1ZOD KELLS. are not inspected. The water-supply is from pumps and superficial wells. The graveyard is in the centre of the town, very closely surrounded by dwellings. From the position of the town, divided by the Shannon, to- wards which both halves slope, an efficient system of sewerage might be readily constructed. The Commis- sioners have no local surveyor. CHAPELIZOD (1,958), among other towns in the neigh- bourhood of the metropolis, loudly demands some local authority to prevent the ravages of fever and cholera when they become epidemic. I cannot more forcibly prove this statement than by quoting the following facts from the Poor Law Inspectors report : The town, which had experienced severe attacks of cholera in 1832 and 1849, was visited again in October, 1854 ; and in February, 1855, another outbreak began, and within the week seventeen cases occurred. One case was that of " a factory girl, aged 18, who with seven others of about the same age, and a man, the father of two of the girls, lived and slept in a room not quite twelve feet square." The committee of management had held no meeting for 105 days before this last outbreak, although warned by the former one which had so recently occurred ; and it was not until two days after the last case, the police ser- geant informed the medical officer that steps would be taken for cleansing and whitewashing the houses where the disease had appeared, and for carrying into effect the provisions of the sanitary acts. I might easily multiply facts ; but these, I think, are sufficient to show that in a town of nearly 2,000 inhabitants, some legal power to thin over-crowded rooms, such as that in which this poor girl existed, is called for, and that so tardy and ineffici- ent a local authority as then existed should have been superseded. KELLS (3,224). The death-rate of the district was 1 in 50. Fever is very prevalent, and is nearly three times as frequent m the Kells dispensary district as in the KELLS. 875 whole union, the other districts being more rural. In 1818, one-third of the people were seized with fever. Cholera attacked 1 in 17 of the inhabitants in 1832, and 1 in 12 within seven weeks of 1849. Any one who examines the sanitary state of the town might predict that the death-rate and epidemic-rate would be thus lamentably high. The sewers are too large, made of rubble masonry, flagged on the bottom, and are very imperfect, most of them having gratings which emit the effluvia of the decomposing sewage, and the stench-traps which had been laid were, at the time of my visit, out of order. The lanes and the yards behind the houses were covered with the most noxious kind of filth, for there was no accommodation for most of the houses. The main sewers lead to the eastern end of the town, and open into gripes within twenty or thirty yards of the town, in which, as there was no current, the sewage was drying and putrefying. The river Blackwater, into which the sewage should be discharged, is not half-a- mile from the edge of the town. The water supply is by pumps, sunk, I was told, very superficially, two of them being in most dangerous proximity to the crowded churchyard one within ten and the other within fifty yards of graves. Other pumps were in corners which were also used as the filth depots of the town. The water was very bad in taste, and much complained of. The cabins were as ill- constructed, unaired, and dirty as could be seen in the remotest parts of this country. With regard to other towns, I must acknowledge that the cor- porate funds are insufficient for the adoption of such im- provements ; but Kells has an income of 750 a-year, exclusive of the borough-rate, which the commissioners have never levied. With such abundant funds, they should be surely called on to provide for the health and comfort of their constituents, when death, disease, and dirt so lamentably afflict their town. No medical man is connected with the Town Commission, nor do they 25 376 LONGFORD MAYNOOTHNA VAN. employ a surveyor. But one prosecution under any Sanitary Act took place in the entire county of Meath during 1864. LONGFORD (4,819). The death-rate of the union is 1 in 74. Cholera visited this town severely in 1832, 1849, and 1866, 1-17 of the inhabitants having been attacked in the second epidemic. The neighbouring town of Granard has wholly escaped, because it is high, not intersected by filthy streams, and possesses a good sup- ply of water from deep wells, whereas those in Longford were more superficial, and as the river Camlin runs through the town, the poor people may have made use of its water contaminated with sewage. The commis- sioners have an inspector of nuisances, but filthy lanes of wretched cabins and unregulated lodging-houses abound. The registrar states that during the year 1865 there were severe epidemics of fever, scarlatina, and small-pox. MAYNOOTH (1,497) is but three below the population which empowers the adoption of the Towns Act. 231 cases of cholera occurred there in 1832, and 141 in 1849. NAVAN (3,865). The district has had the very high death-rate of 1 in 48, and that of the entire union is thereby raised to 1 in 54, relatively one of the highest in Ireland, and startling when it is remembered how large a proportion of the deaths in this country are unrecorded. In the first cholera epidemic, 1 in 28 of the people suffered ; but the town was very slightly attacked in 1849, although the neighbouring town, Kells, was so severely visited. Fever, which in the epidemic of 1818 attacked one-fourth of the people, is always very preva- lent in Navan ; and this can be no matter of surprise when one walks through the filthy lanes of hovels, many of which are lodging-houses, in which the town, abounds. The sewers are too few, and, being untrapped, they do more harm than good. The Boyne and Black- OLDCASTLE RATHCOOLE RUSH TULLAMORE. 877 water course through the town, and would afford, as the town is hilly, natural aid to a system of drainage. OLDCASTLE (979). The death-rate in this dispensary district has been 1 in 46, and in the entire union, which is remarkably rural, 1 in 73. About 1 in 78 of the entire union population yearly suffer from fever, which has been partially typhoid, or that variety most clearly produced by the want of sanitary arrangements. Cho- lera has always attacked the town with severity. Not- withstanding this lamentable state of public health in the town and surrounding district, it is unsewered and un- cared for. RATHCOOLE (442) was graphically described by the rector last year. He showed that most of the houses had no back yards, back doors, or windows at the back, and that they were unaired and abominably filthy in front. Zymotics, once introduced, raged. The rector's letter details the usual story of sub-letting, promises of amendment, apathy, interested committees, timid and ignorant nuisance officers, and nothing done after the pressure of an intelligent reporter and the dread of cho- lera had passed away. RUSH (1,453) wants 47 of the required number, but if amalgamated with Lusk, which is only two and a-half miles distant, the combined population would be 2,092. The facts that 237 cases of cholera occurred in Rush in 1832, that fever is never absent, that sewers are most partial and untrapped, that many of the houses are re- markably ill constructed, and that the water-supply is principally by surface wells, into which a copious rainfall washes all kinds of filth, indicated that some sanitary authority was needed, and such was obtained by the Act of July last, but in a late visit I did not discover any amendment. TULLAMORE (4,797). The death-rate has been 1 in 42 in the dispensary district, and 1 in 63 in the whole union. Both the former cholera epidemics visited Tul- 3 78 B ALLYSHANNON B ANGOR ENNISKILLEN. lamore, the first attacking 1 in 25, and the second 1 in 26 of the inhabitants. The rate of mortality on both occasions was about the greatest in Ireland namely, 76 and 65 per cent. The Town Commission has no medi- cal member, and has no nuisances officer. During an outbreak in 1854 they employed a person at a salary of 5s. a- week, a sum which could scarcely obtain the services of an intelligent or active man to inspect or cleanse the town. Not a single prosecution under any Sanitary Act has taken place in* this town, or indeed in the entire county, during 1864. ULSTER. B ALLYSHANNON (3,197). This town has always been subject to epidemics. In the year 1818 " almost every one was attacked" with fever, and in the cholera of 1832, 1 in 9 of the inhabitants suffered. While the steepness of the town and its proximity to the river would render it most easily drained, the sewerage is imperfect, and from the want of water-traps the stench in lanes is most pernicious. The cabins are most wretched and over-crowded, especially in the part named the Purt. The Town Commissioners do not employ an inspector of nuisances or local surveyor. In B ANGOR (2,531) the order for electing a commis- sion has been passed, but no steps have been taken, although no town in Ireland requires its admirable pro- visions more. 1 in 15 was attacked by cholera in 1832, and in 1849 the town was also severely visited. In No- vember, 1857, fever burst out with such virulence that 25 cases occurred in a fortnight, five persons having been attacked in one house. Dr. Knox on that occasion described the houses as ill-ventilated and over-crowded, the drainage unsatisfactory ; and these facts had been previously brought under notice without any material results. ENKISKILLEN (5,774). The death-rate of the union NEWTOWNARDS. 379 is 1 in 72. One in 40 of the population was attacked by cholera in 1832; it wholly escaped in 1849, but suffered severely in 1854-55. There was then no per- manent inspector, and Dr. Hill reported that no steps were being taken for cleansing the dwellings of the poor. Since then two persons are employed to prevent nui- sances, and much of the improved health of the town might be attributed to this fact. As, however, but one prosecution took place in the county during 1864, and but four in 1865, under any sanitary act, we must suppose the inhabitants very obedient, or else the authorities very neglectful. The water-supply is by superficial wells and pumps, which give a very impure water, and partly from the river, into which the sewage of the town flows. The town is under the old imperfect Towns Act, 9 Geo. IV., cap. 82. The sewers are few and inefficient, and they discharge their effluvia by large open gratings here and there through the streets. I am happy to learn, however, that a guardian is agitating the construction of sewers under the Sewage Utilization Act ; and as the town is steep and surrounded at all sides by the branches of the Erne, it could be readily and very perfectly drained. The town has corporate property amounting, I am in- formed, to 1,500 a-year, exclusive of the rates. The churchyard lies in the midst of the town, and, from its crowded state, must exercise a very pernicious influence. NEWTOWNARDS (9,543) has never been spared by cho- lera, and fever is very prevalent. The registrar in Sep- tember, 1864, described it as " dirty, unlighted, and un- watched at night;" but commissioners, three of whom are medical men, have been since elected, and the im- provement is striking. The towns of Newtownards and Bangor are so close together that a commission govern- ing both, with proper officers, could be readily elected, and even Donaghadee might be included. Some steps should be taken to stay the appalling mortality of the union, which is now 1 in 47, and to check the spread 380 PORTAFERRY CARRICK-ON-SUIR ENNIS. of fever, which averages 1 in every 60 of the population yearly. These figures are explained by the fact that the union contains many towns in which sanitary matters are uncared for. PORTA FERRY (1,9 60), another town in the same county, seems no better off. One-tenth of the inhabitants suffered from cholera in 1832, and an outburst of severe autumnal diarrhoea in 1857 invaded thirteen houses. A long drought had rendered the well water scanty and muddy. Cholera was carried into the town last October from Bal- briggan. MUNSTER. CARRICK-ON-SUIR (5,059). The death-rate in the dispensary district attains the appalling figure of 1 in 34, and that of the entire union is 1 in 48. Fever attacks about 1 in every 31 annually, but for the year 1865 it has raged so alarmingly that about one- eleventh of the people were stricken down. In the fever epidemic of 1818, one-sixth of the people were attacked. The cholera in 1832 and 1849, respectively, attacked 1 in 40 and 1 in 23 of the townspeople. The graveyard is in the exact centre of the town, which is also the densest part. The Town Commission employs no surveyor, and appears to be a very apathetic body indeed, for in three consecutive re- ports in 1865 the registrar publicly complained that the sewers are bad and scanty, the houses are over- crowded, and the town is altogether the most dilapidated in Ireland. The registrar of a rural district near Carrick- on-Suir, Rathgormuck, justly complains, of this bad neighbour, from which fever has been imported into his district. ENNIS (7,041). No less than 1 in 24 of the population of the dispensary district yearly suffer from fever, or about 1 in 62 of the people in the entire union. It escaped neither of the epidemics of cholera, 1 in 10 having been attacked in that of 1832, which created such a panic that GLIN K1LMALLOCK. 381 127 of the houses of business were closed ; and 1 in 54 was seized in that of 1849. The death-rate of the entire union was 1 in 65, and of the dispensary district 1 in 42. Scarlatina broke out in a small filthy part of the town during the autumn of 1865, and in a couple of months produced 50 deaths. There is no method of removing sewage save by surface channels, and the water- supply is by pumps and superficial wells. The grave- yard is in the town and surrounded by houses. No medical man has a seat on the Town Commission, and no local surveyor seems to be employed. Dr. Crampton, the Government Inspector, in 1818 reported : " In the town of Ennis many of the poorer classes live in close dirty cellars, the streets narrow, and the population con- densed within a small space. The town also had been remarkably dirty, and full of nuisances antecedent to the visitation of the epidemic" a description which, I fear, is equally applicable at present. In GLIN (999) in 1854 cholera broke out, and Dr. Geary reported that the houses were most filthy and over-crowded : " In the main streets there are offensive open drains immediately behind the houses, and communicating from yard to yard, the con- tents being mixed in some points with the blood of animals slaughtered by butchers in their own houses. Few towns are better situated for drainage. At the village of Tarhert (three miles dis- tant, and with 857 inhabitants), the very same state of neglected sanitary arrangements was observed ; manure-heaps, cesspools, defective and obstructed drains and sewers running behind the houses ; animals slaughtered in houses, and the blood on the floors in the very apartments used for cooking, eating, and sleeping in ; pigs in the houses and rere yards ; over-crowded apartments, and filthy collections of fetid water from underneath the paving, in immediate connexion with the police barracks." Shortly after the date of this report the epidemic spread, and carried off, among others, the chairman of the board of guardians. KILMALLOCK (1,393). The death-rate in the dis- pensary district for the year ending September, 1865, 382 KTLRUSH KINSALE. attained the unequalled height of 1 in 28, and that of the whole union 1 in 60. Much of this mortality is due to fever, for on an average of seven years about 1 person in every 52 persons in the union is attacked with that disease each year ; and in each of its six districts the rate has been as follows : Kilmallock, 1 in 34 ; Bruff, 1 in 53 ; Hospital, 1 in 101 ; Kilfinane, 1 in 45 ; Charleville, 1 in 62 ; Bruree, 1 in 52. Cholera in 1832 attacked 1 in 12 of the inhabitants of Kilmallock. It is below the number for the Towns Act, but by amalgama- tion with a neighbouring town, as Charleville or Bruff, Commissioners might act for the two. KILRUSH (4,593). The death-rate of the district is 1 in 50, and of the union, which is chiefly rural, 1 in 75. Fever attacks every year about 1 in 28. Cholera has on both the visitations spread with great rapidity and virulence, attacking respectively 1 in 24 and 1 in 17 of the townspeople. The graveyard is immediately at the edge of the town. The town is imperfectly sewered, and unsupplied by pure water ; yet no steps have been taken to obtain the Towns Improvement Act, although the inhabitants are more than three times as many as the required number. But one prosecution under any Sani- tary Act occurred during 1864 in the county of Clare. KINSALE (4,850). The death-rate of the dispensary district is 1 in 51, and that of the entire union 1 in 64. In the first cholera epidemic 1 in 13 of the inhabitants were attacked, and one-sixth in that of 1849, Kinsale having suffered more than any other Irish town, except Gort and Ballinasloe, where nearly half the townspeople were stricken by the pestilence. The town a few years ago was unsewered, and the imperfect drains which now exist open into a large cesspool, which is, however, twice daily flushed by the sea. The noxious mud is left be- hind. Many of the houses are built on very sloping cut- away rock, which allows no perfect airing, or no draining whatever, as there are no sewers leading from them, and MACROOM MILTOWN. 383 percolation deep into the earth cannot occur. The water is derived either from filthy surface wells, or from wells near the overfilled cemeteries of the town. A new sup- ply is about to be obtained, but from sources not at all above suspicion. In the epidemics of cholera, the low lying parts of the town, to which an ill- arranged system of sewerage would bring the sewage, suffered far more than the higher portions. No surveyor or inspector of nuisances was employed. MACROOM (3,289). The dispensary district, with the exception of this town, is very much a rural one, yet the death-rate has been 1 in 55. Cholera attacked the town severely in 1832, 1849, and 1854, and fever is stationary there, yet there is no town commission. Dr. Geary reporting in 1854 an unusually filthy state, says, " The want of water is much felt in the eastern side of the town, there being no pump, and the river being some distance away. Here, too, the absence of sewerage, or the defective character of that which has been attempted, tends to perpetuate the uncleanly habits which are found to exist. I am informed by the occupants of large and good-looking houses of business in the centre of the town, that they send all their house and night-soil to be deposited in the river at a late hour at night ; " and people drink the water of this stream, both here and along its course to the Lee. Even the people along the banks of the latter great river would suffer from the sew- age of Macroom, if forced by their own imperfect supply to use its water, until by some miles agitation and aera- tion it had been purified. MILTOWN MALBAY, high above the sea, permeated by the fresh Atlantic breezes, and which from its local advantages ought to be the healthiest town in Ireland, has been always severely visited by cholera, and during April, May, and June 1865, a disease still more pre- ventible namely, typhoid fever has attacked between 55 and 60 of the villagers, who number but 1,330, the 384 NEWMARKET. cause being in every case traced to pollution of the water and of the air by want of sewerage in the neglected parts of the town, where water was also deficient. The medi- cal officer duly reported these circumstances to the Poor Law guardians in April, 1865 ; during May and June the pestilence raged, and on the 15th of August, six weeks after it had ceased, this body first took action to improve the sanitary state of the town ; but between April and September, about 150 cases of fever had occurred. NEWMARKET (1,137). The sanitary state of this town is graphically described in Dr. Geary's report in 1854. Each house has a small yard, in which the house soil and manure float in very offensive water up to the kitchen door. Pigs are frequently kept in the yards, or even the houses themselves. Over-crowding seems to prevail, for in one house, not inappropriately named the " hulk," forty-six persons existed. Very many convicts have been reared in this abode, and the fact is not de- void of connexion with its sanitary state. Opposite the police barracks was found a dangerous collection of nui- sances, drained by a sewer which passed in its course to the mill-pond under the floor of a house, to which there was attached a filthy yard for pigs, which were, however, also free of the house. A wretched man in cholera was found lying on the floor of this hovel, and when thy sewer under the floor was opened, it was found choked with most offensive matter. Opposite this house it was customary to empty the night-soil of several houses, as there had been a drain ; but as at this time it was choked, the filth floated down to the police barracks. Previous to Dr. Geary's visit, the medical officer reported a case of cholera, which was fatal, to the committee and guar- dians, verifying his statement by the evidence of two other physicians ; yet the latter body postponed the consideration of the sanitary state of the town for a week. Sixty-six cases of cholera occurred in 1832 in this village, and it was severely attacked in 1849. TIPPERARY BOYLE CARIMCK-ON-SHANNON. 385 TIPPERARY (5,864). About 1 in every 62 persons of the entire union suffer annually from fever. Cholera did not spare the town either in 1832 or 1849, but at- tacked 1 in 27 of the people in the former year, and 1 in 38 in the latter. The death-rate of this town and the sur- rounding district reaches the high proportion of 1 in 39. The water-supply is by wells and pumps. The grave- yard is in the town, surrounded by houses. There are Town Commissioners under the obsolete act, no medical man is among them, nor do they employ a local sur- veyor or inspector of nuisances. Mr. Charles Moore, M.P. for the county, on a recent public occasion, for- cibly drew attention to the sanitary state of the town. CONNAU Bow-bridge 7 40 City Basin James's-street 17 70 Coleman's Brook Wormwood-gate 29 24 Grand Canal 1 Huband and M'Kenna between J bridges 12 36 Poddle West-end of Coombe. . 23 51 New-Row, south 24 45 Ross-lane 21 40 Chancery -lane 25 50 George's-court 8 30 Essex-street, east 7 25 Old Stream Montagu-court 25 50 > Coppinger's-row 13 28 > Shaw-street 42 18 Church-street 17 30 Strand-street, little . . 11 19 > Strand-street, great . . 11 19 Royal Canal Campbell-row 10 41 , Newcomen-bridge 10 25 > Guild-street 9 19 Tolka Ballybough-bridge . . 14 20 There were others too numerous to mention. In fact, there were very few cases, except in houses built over forgotten streams and pools imperfectly drained. Until the Public Health Committee engaged itself actively, there were many stagnant and foul ditches ; for instance, that in Great Clarence-street, injuring the health of those who lived near. The streets which stand highest above water-mark indeed were notably free from cholera, or what to my 470 RECLAIMED UNDRAINED GROUND. mind more fully demonstrates their salubrity it was introduced, and did not spread; but this rather de- pended on the concurrent absence of water-courses. In the foregoing table it will be seen that elevation bore no very constant ratio to the number of deaths. Mere lowness of surface does not seem to predispose to cholera, for Holland has been always remarkably exempt from the disease. In that country the people are famous for cleanliness. A sudden fall in the city by the gravitation of sewage and sub-soil water promoted the disease notably ; for instance, Cook-street runs along the river Liffey, only 300 feet from it, and 24 above high water mark, while southwards the ground rises so fast that the parallel street, High-street, which is about 200 feet distant, is 36 feet higher. It is much to be regretted that the Connecting Railway, which was to have demolished Cook-street, was not carried out. The district near Ballybough-bridge, or as it is classically called, " Mud Island," and that around St. Laurence O'Toole's Church, is reclaimed land, where drainage is necessarily imperfect, and in which the houses are so wretchedly constructed, that the mere earth, or, at most, boards laid directly on it, forms the floor. To the same character of soil the prevalence of the disease in the neighbourhood of Montgomery-street may be assigned. Hanover-street, East, around which many deaths occurred, is also built on reclaimed land, and I understand that the drainage of that district has been much obstructed since the Grand Canal Docks were constructed. Without the utmost care being taken in draining land reclaimed from the sea, and in building houses thereon, it can never be salubrious. My friend, Dr. Druitt, gave a most able account of Amiens, where cholera raged fearfully during last May and June. It is a city built upon numberless stream- lets of the Somme, the lowest parts being swamps, the AMIENS EAST LONDON. 471 upper crowded with cesspools. So absorbent is the subsoil in the higher levels that these receptacles, it is said, do not require emptying in a century, but their contents must fall to the houses below. The houses of the poor are filthy, and their diet bread and pota- toes ; and they are " ill- washed, ill-aired, poor-blooded people." There is an admirable supply of pipe water, bnt it is suspected that those living on the borders of the streamlets use their waters. The haunts of cholera were the very same which are almost constantly infested by " the miliary sweat" a disease now unknown in these countries, but which is undoubtedly a form of " the sweating sickness," which once devastated Eng- land. The cholera did not confine its attack exclusively to the lower classes, for many physicians and Sisters of Charity had fallen at their posts. In India, ill-drained spots are the habitats of the disease, and artificial cho- lera-fields are made by the mode of cultivating rice. I have collected also numerous facts to show that in that country the disease haunts the course of streams which flow through the towns. Mr. Orton states that in the Limehouse district' in the East of London 200 deaths by cholera occurred within 200 yards of the Regent's Canal, and another area of mischief was bounded on every side but the western by water channels. He thinks the disease did not cross the Thames, because of the tidal current and river breezes. This sanitarian exhibits the careless way houses are located in some parts of London, and describes a group of 120 houses, the boards of the lower story of which rest on the earth. Inquiries among the inmates al- most universally got the following answer : " Never been well since coming in, and the children always ailing ; and my husband says he feels more refreshed when he comes from his work than after he gets up in the morning. And then everything spoils ; meat pat 472 TOP AND BASEMENT STOREYS. into a cupboard is musty in a night ; one can keep nothing. Clothing becomes damaged ; the drugget rots in a month ; boots and shoes, and even the beds we lie on, are mildewed in a week." Good fires in such cases would, I think, be highly protective. Other houses were built on the site of a gravel-pit, the space being filled in by the scavenger with abomi- nable filth. He properly suggests that the Building Act should render a layer of concrete under the floor- ing obligatory. Mr. Orton's report is notable likewise from being the only one which has opposed the theory that cholera spreads by water-supply ; but his argu- ments and facts on this matter, and on the nearly entire exemption of water-drinkers, I think are incon- clusive. It has been remarked that in the many-storied tene- ment houses of Edinburgh, and London, and Paris, both typhus and cholera have been found most fre- quently in the top story and the basement, and one can explain this by remembering that terrestrial ex- halations, distilled just below the latter, would rise towards the roof, at which there is seldom any venti- lating outlet. The same thing has, I find, been true of the late epidemic in Dublin, especially with regard to the basement floors. In many respectable houses the servants were attacked, while the disease did not go upstairs. Drainage, and the laying of impervious foundations, are expensive works ; but the waste of life and health by cholera, fevers, rheumatism, and other zymotic diseases, and by general depression of healthy vigour which they will prevent, will afford ample repayment. These measures take much time, and it will never do to begin them when cholera has already arrived. A Building Act is required before such works will become general, and to prevent speculators building "fever nests," and, I may add, cholera- traps, on any site, BUILDING ACT NUISANCES. 473 and in any way which may be cheapest. The fore- going reflections also show that the pollution of rivers by sewerage, like other outrages upon natural laws, can- not be committed with impunity. It has been often remarked that cholera has prevailed on one side of a river, and not the other ; but the soil on one side of these natural clefts may be favourable, the other not so. I told you of a similar fact when speaking of the in- fluence of limestone in causing goitre. The influence of filthy nuisances in attracting cholera has been often dwelt on ; but Mr. Lee of the Board of Health, in his report upon Liverpool, after the 1849 epidemic, says : " During an inspection of thirty thou- sand houses, I only met three instances in which the house where death from cholera occurred had not a foul open privy against its wall." American writers record the following case, showing the efficacy of cleansing before the outbreak of cholera. In 1849 the Board of Health of Baltimore asked for five thousand dollars for the purpose of putting the city in order against an invasion of cholera, as that disease had already appeared in several neigh- bouring cities. There was a prevalent opinion that this city was on the eve of an outbreak of pestilence. The Mayor called a meeting of the Council, and the money was promptly furnished. Baltimore was in a very filthy condition at the time, and the health officer stated that the appropriation would have been a mere drop in the bucket for cleansing the city, but the general de- termination of all the people was. that if cleanliness could secure immunity from pestilence, the cleanliness should be secured. The city was almost thoroughly cleansed, the exceptions being a miserable hovel about the marshes of the Patapsco river, and one closed filthy alley. The hovel was occupied by an old Ger- man woman and her son, both of whom died with cholera, A man occupied a room opposite the City 474 ELEVATION DENSITY. Hall. He died with cholera, and upon examining his room, it was found that he had been sleeping with his window opening into an alley, and that there was more filth in that alley than in all the rest of Baltimore. These cases were the sum total of mortality from cholera in Baltimore in 1849. The difficulty of explaining the ravages of cholera in a city, by a reference to the relative number of filth depots, or of the proportion of pauperism in various dis- tricts, is shown in the following table, arranged from one by Dr. Littlejohn of Edinburgh, whose recent pub- lication is, perhaps, the most comprehensive sanitary re- port ever issued in these kingdoms : Districts. AUO), / arrest) to express an agent which checks tins development, the word catalytic having the signification of promoting chemical change. Common salt, which has the oldest repute for preserving meat, is very suitable for preserving refuse, and it is cheapest. The neutral metallic salts, chloride and sulphate of zinc, and sulphate of iron, are powerful in checking pu- trefaction, as was first proved by Falcony, who mixed the first with sawdust round dead bodies, and thus preserved them for months. Dr. Rollestone, F.R.S., Professor of Physiology at Oxford, in commenting on Pettenkofer's essay on cholera, argues that a considerable time, even many years, must pass before the organic matters in the soil are so decomposed that the cholera germ can no longer de- velope itself when other necessary conditions are pre- sent. The sewering of cities is a most desirable thing ; but Pettenkofer advises us, in the face of an impending cholera epidemic, to starve the cholera germ by destroy- ing the alkalinity of the sewage. We are, by all means, to avoid any further impregnation of the earth around our dwellings with sewage ; but it would be as foolish for us to expect that, by putting sanitary measures and sewage in force on the spur of the moment, we can nullify tho impurities which years of neglect have accumulated and infiltrated all around us, as it would be for a repentant drunkard to expect that his fluids and tissues would become renovated on the instant of his taking the pledge. Much good may, it is true, be done even at the moment by abating local nuisances ; but they can only be abated at the moment they cannot be nullified ; whereas the personal element of a specific poison can be destroyed in the excreta by the employment of acidifying disinfectants. Sanitary measures may ultimately prove omnipotent against epidemics ; but they must have time allowed 512 DISINFECTION OF CLOTHES. them to acquire it. Copperas is cheap, and most cer- tain for preserving an acid state of sewage, which Pet- tenkofer thinks preventive of cholera development. Chloride of lime favours the alkaline state. Dissolved in its own weight of water, copperas should be placed in every vessel used by a cholera patient, and it then de- stroys the excreta by which the disease is propagated. These measures require to be carefully attended to, and when they have been, as at Zwickau, a most rapid ces- sation of the disease has resulted. With regard to clothes and woollen articles, there is much evidence to warrant us in saying that such highly communicable diseases as cattle plague and small-pox are so conveyed, and the Custom-house officers at London have contracted skin diseases from examining bales of rags. Outbreaks of small-pox in paper fac- tories have been also traced to infected rags. Lord Brougham made public a statement that the clothes from the small-pox and fever hospitals of London were carried in a cart common to those of other institutions and private families to be washed in the centre of the city, and that two of the carters had caught the small-pox. The statement was denied on the part of the Fever Hospital, but not on the part of the Small- pox Hospital. The infected articles should be washed on the premises of the hospital, or disinfected, so as not to endanger the public safety. Dr. Furman, of New York, says : " In the spring of 1861 , we had occasion to attend a young gen- tleman with small-pox, who was clerk in a banking house. Where and how he contracted the disease was unknown to him; hut several weeks after his recovery he learned that he had opened and counted, a few days before his sickness, a large package of money forwarded by a Western bank, whose cashier, residing in the bank building, had recently suffered from the small-pox." In my lecture on cholera I gave you an instance of which clothes seemed to have carried the contagion in cholera for a distance of half-a-mile or so, and similar HOT-AIR CHAMBER. 513 instances are recorded in great numbers ; but I confess I know of no evidence to show that imported clothes or those carried considerable distances conveyed the dis- ease. It is right, however, to be on the safe side, and by the Sanitary Act, the local authority is bound to pro- vide disinfecting apparatus ; but it cannot be legally used unless proof is given that the articles are infected, and this is very hard to get. It was the late Dr. Henry of Manchester who, being called on to apply some method of disinfection to cotton supposed to be infected with plague, suggested the use of heat, as that disease disappears when the temperature rises. He himself wore clothes from typhus and scar- latina patients after they had been exposed to a heat of 00, and did not contract either disease, and vaccine lymph was rendered useless in the same way. Dealers in feathers use the same purifying means. The prin- ciple of heating in an oven, or double iron box with air between the walls, has been applied in Christ's Hospital, Guv's Hospital, Bristol Infirmary, and combined with the burning of sulphur has been adopted in many work- houses ; and it is most efficacious in destroying vermin, including the itch-mite. Dry heat is superior to that of boiling water, as infected clothes are said to have com- municated fever after they were immersed in that fluid. Such an apparatus should be connected with every public washhouse, and in that case would not be ex- pensive. Shortly after the appearance of cholera, the Public Health Committee ordered the construction of a hot-air chamber. The site of the chamber originally fixed on was the mortuary house in Fishamble-street, which had been erected last year, but abandoned at the petition of some ratepayers in the neighbourhood who objected. I advised the use of this building, as many weeks and much expense would be saved, and as it is in one of the most uncared-for districts abounding in cholera and 514 HOT-AIR CHAMBER CLAMOUR. fever nests, and not far from the fever hospitals or the river, along which imported clothing might be carried for purposes of disinfection. However, while it was being erected, the influential and, I regret to say, intelligent persons connected with the locality strongly pressed on the Corporation, who were forced to yield, and the appa- ratus, then abandoned, was therefore not in readiness until after the disease had ceased. I do not hesitate to declare publicly that I believe many deaths by cholera may be attributed to this unreasoning and selfish oppo- sition. I am sure that no one who understands the construction of the chamber, and the way in which the process is conducted, can believe that the slightest danger can befall any one resident near to it, much less a passer-by. If there could, surely no condemned felon, even for a reprieve, would undertake the duty of placing the clothes in the chamber ; and yet there were at the time these objections were urged candidates for the office. It was asserted that a panic would arise in the neighbourhood. This I thought most unlikely, but the residents would have been to blame if it did. An agi- tation was most perseveririgly got up ; and a large placard, announcing that the place was " opened for the spread of cholera," having been pasted on the door by some ill-disposed person, was allowed by those living near to remain up during the whole of one Sunday. The building could then have been ready in fourteen days ; but as it was abandoned, a delay of some months oc- curred in getting another site and constructing the necessary works. The committee failed in obtaining several sites, for the same selfish reasons and misconcep- tions prevailed elsewhere against their benevolent efforts to preserve the health of the poor. I will shortly describe its construction, which will be readily v understood from the accompanying diagram. One end of the building is shut off from the larger room by a cast iron door, and the chamber so enclosed is 12 DISINFECTING CHAMBER. 515 feet by 10, and 8 feet high ; its walls and roof are of brick, and the floor perforated metal. Under this floor Disinfecting Chamber. there are coiled 9 -inch iron pipes, 80 feet in length carrying heated air and smoke from the furnace, by which the temperature of the chamber is raised to from 240 to 300. A high flue is erected, so as to produce no inconvenience from smoke. With the same object coke is burned in the furnace, which is not larger than an ordinary boiler furnace. The covered cart containing the clothes or bedding is brought within the building before they are removed. They are then placed on horses or shelves within the chamber, and heated for three or four hours, and it has been positively shown that all organic or in- fectious matter must be destroyed at the end of this time. No effluvia whatever, except the smoke of the fire, passes through the pipes or escapes from the chimney. The articles which are disinfected in it come from three sources. 1st. Clothes from England ; but as the Sani- tary Act requires proof of their being infected, and as this will be difficult to obtain, very few bales can be retained. 2nd. The bedding and clothes of persons re- 516 DISINFECTION OF CLOTHES. moved to hospital with contagious diseases. The same vehicle which conveys the patient to hospital carries the clothes and bedding and then deposits them in the hot- air chamber. 3rd. The clothes of poor persons who remain at home when afflicted with contagious disease. If, under these circumstances, they die, their clothes are usually sold and disease is thus extensively propagated. Three such chambers have been for years in use in Liverpool two in the midst of the crowded buildings of the Brownlow-hill Workhouse, and the third in the dens- est part of the city Ford-street, between Vauxhall and Scotland-roads. No panic has ever arisen, nor has 'a single case of illness been produced, but there can be no doubt that many cases of small-pox, scarlatina, fever, itch, and other diseases have been prevented. They have been also used with great advantage during the cholera epidemic, 14,218 articles of bedding or clothing from infected houses having been gratuitously purified. By the 23rd section of the Public Health Act, the local authority is called on to provide disinfecting apparatus, and no other means than a hot-air chamber will be effectual or will save the fabrics. Such is recommended by the Poor Law Commissioners, and steps were taken in several Irish towns to erect them when cholera threa- tened, but as the danger became less their ardor cooled. If the local authorities were careless of public health, the erection of such an apparatus could be enforced by higher authority. The present site in Marrowbone-lane seems very suitable from its position with regard to the fever hospital, and from being, in the midst of a district where preventible diseases are, unfortunately, always rife. The building is also surrounded by very free-air space, and being on a Corporation yard, will be always under control of reliable officers. The chamber has been only just completed, so that I cannot speak from any large experience of its efficacy, but I feel sure much benefit will arise. If its present site be found inconveni- INFECTION OF CABS. 517 ent, I would advise the construction of a movable iron chamber which might be drawn by horses from, place to place. In London, no disinfecting chambers being prepared, they burned all the infected bedding and clothing, pay- ing the value to the poor owners. At Sydenham a kiln on high ground was used for the purpose. The conveyance of persons suffering from contagious diseases in cabs and other public vehicles is very im- proper. I have no doubt that small-pox and scarlatina are frequently thus contracted. A well-known London physician employed a cabman to take him to a patient's house. As he was alighting the driver said, " I think its small-pox that ails the lady ; for last week I brought her here just after I had left a case at the Small-pox Hospital ' ' and such was her disease, and so contracted. In this city the hospital patients are conveyed in spe- cial vehicles, but many a patient with catching diseases is necessarily conveyed in our cabs. It would not, of course, be well to interdict cabmen from conveying sick persons altogether ; for distinctions are hard to make, and regulations of the kind would probably lead to extortion from this class, which is not proverbial for civility. The means of disinfecting these vehicles which should be employed, would prevent their use for some hours, and would very probably stain or rot their linings, so that the best remedy for the difficulty is that directed by the 12th section of the Nuisances Removal Act, 1860, namely, the provision of special vehicles, which the public should be urged to use when an occasion arises. It may not be out of place to quote some of the di- rections which were most extensively issued on the out- break of cholera last year. After some information with regard to dispensary and hospital relief and treat- ment meanwhile, it was advised : " 4. Keep the windows open, or partially so, not only in sick rooms but in all rooms, even at night ; sprinkle the iioor with 518 ADVICE IN CHOLERA TIME. chloride of lime mixed with water ; soak all clothes which may have been about the patient in the same mixture, and place some of the chloride of lime in any vessel which is to be used to receive the discharges from the patient, which should be then placed in the privy. Landlords of tenement houses should keep a supply of chloride of lime in the basement storey and yard. " 5. While there is danger from cholera, everyone's diet should be moderate fruit, fish, or other foods not perfectly fresh, should be avoided ; great temperance should be observed, and the water used for drink should be previously boiled, and, when cold, tossed between vessels to restore its taste. Food should not be taken in the sick room, nor until the hands of those who have tended the sick have been washed with chloride of lime and water. " 6. All rooms and yards should be whitewashed, privies and ashpits cleansed, collections of filth or stagnant water removed, and the openings of sewers trapped with water valves. " All complaints lodged at the Office of the Inspector of Nui- sances, City Hall, will be immediately attended to. " Clergymen and all parochial visitors are earnestly requested to aid in the circulation of the above recommendations, and use their influence in carrying them out." The address of the disinfectors was then given, and it was staged that they would at all times act at the request of the relatives of the person attacked, of the physician, or clergyman. The course pursued by these officers was to urge removal to hospital, and give the necessary advice for the purpose, and if this was agreed to, the room and all apertures being closed, it was then filled with chlorine gas disengaged from chloride of lime by pouring vitriol on it. On the third day all the windows and the doors were opened, and after the seventh its habitation was ngain permitted. The greatest benefit resulted. If the patient was not removed, the only steps they were able to take were throwing of chloride of lime on the privy, and about the passages, and advising free airing of the room. As soon as the epidemic had ceased, the disinfectors returned upon all the houses where cholera cases had occurred, and threw upon the privies and into the sew- ers a mixture of carbolic acid and concentrated solution of copperas, which seemed to me most calculated to DISINFECTION OF SEWERS. 519 exterminate the seeds of the disease, which might lurk in sewage. I should also mention that the sewers and street chan- nels in the infected streets, and indeed in all the poorer neighbourhoods, were flushed freely with weak solutions of chloride of lime, and afterwards with carbolic acid, as soon as an ample supply of that agent was procura- ble. The removal of filth, when cholera had broken out in a house, was not allowed until disinfection had been performed. Dry earth, ashes, or, still better, peat mould, was most useful for this purpose, as it dried and deodorized the refuse before it was carted away. 84 LECTURE XXL VITAL STATISTICS OF IRELAND SYSTEMS OF REGISTRA- TION THE MORTALITY OF DUBLIN. IT seemed to me that the course of lectures which it has been my pleasure to deliver to you would be incom- plete if I did not endeavour to give you some succinct view of the present status of disease in Dublin and Ire- land generally. This I am enabled to do b} 7 those admi- rable statistical reports which, for th& last three decades, the Registrar- General and Sir Wm. Wilde have prepared from the Census returns, and by the registers of deaths which are now systematized so ably with the co-opera- tion of the Medical Registrar, Dr. Burke. With very great readiness the general public have given the data for pre- paring these returns, and these distinguished public servants most amply repay the trouble, for when- ever they believe that benefit can arise they most willingly allow their information to be utilized for the public good. What death-returns indirectly imply, a great statesman forcibly expresses. Lord Stanley remarks : " Dry and unattractive as sanitary studies may appear, they be- long to the patriot no less than to the philanthropist ; they touch very nearly the future prosperity and national greatness of Eng- land. Don't fancy that the mischief done by disease spreading through the community is to be measured by the number of deaths which ensue that is the least part of the result, as in the battle the killed bear but a small proportion to the wounded. It is not merely by the crowded hospitals, the frequent funerals, the destitution of families, of the increased pressure of public burthens, that you may test the sufferings of a nation over which sickness has passed ; the real and lasting injury lies in the deterioration of race, in the seeds of disease transmitted to future generations, in the degeneracy and decay, which are never detected till the evil is irreparable, and of which, even then, the cause remains often un- discovered." THE CENSUS 1861 THE INFIRM. 521 The diseases or infirmities under which the people of this country laboured when the Census was taken in 1841, 1851, and 1861, were wisely divided into 1, those of a permanent nature, as deafness, muteism, blindness, lunacy, idiocy, paralysis, epilepsy, lameness, and decrepitude ; and 2, the temporary, which included all the ordinary acute and chronic complaints. Much accessory information has been given by the Commis- sioners : " Viewing a census in the light of a social survey, in which the condition as well as the enumeration of all classes of the people should be considered ; and believing that a knowledge of the nature, causes and extent, as also the distribution and results of the epidemic diseases of this country may tend to assist the legis- lature in future sanitary investigations and improvements, not only in the necessary provision for the destitute, but also in supplying suitable relief to the suffering." With regard to the first disability, inquiries were made " Whether the person was born deaf and dumb, or became so afterwards ; to what cause the malady was attributed ; whether tke persons so returned were paralytic, idiotif , or in any other way mentally or physically affected ; whether other members of the family, either of the present or previous generation, had been mute ; and also as to the education, social condition, and other circumstances, of all the persons so returned." The proportion of those born deaf and dumb to the po- pulation of Ireland was, in 1851, 1 in 1,578, and in 1861, 1 in 1,370. The increase in the last year appears to be due to the emigration, 'which drained off the healthy, leaving these afflicted persons at home or in public asylums. Many noteworthy results were afforded by this searching in- vestigation into the circumstances of the deaf and dumb, and they prove, contrary to the opinion now pretty gene- ral in France, that marriages of consanguinity are prc- ductive of deaf and dumb offspring. Six mutes in a family occurred five times, and seven in one case, in 522 PROPORTION OF MUTE AND BLIND. which " there was neither hereditary predisposition nor any other probable physiological or pathological reason assigned to account for this very remarkable peculiarity." The Status of Disease part of the Report for 1851 re- cords a remarkable case in which the parents were third cousins, and had seven mute children, all females, six of whom were twins. A more recent inquiry ascertained that only one of these now survives, and that this family had eight deaf and dumb children born in it. In fami- lies having a single mute it was most generally a first child, and mutes were most frequent in families of six or seven. In 1851, there was 1 blind person to every 864 of the population a proportion which is larger than most other countries, and due to the ophthalmia which had prevailed epidemically during the years succeeding the famine, for want of food is especially apt to give rise to destructive disease of the eye. I may mention that in Norway, where the food is very poor in nitrogen, the proportion is 1 in 540, and in the United States, where it is the contrary, but 1 in 2,489. The last census gave a higher proportion namely, 1 in 843 in this coun- try than in 1851 ; but, like deaf-muteism, it depended on the blind not having emigrated in ratio to the healthy population. The proportion of lunatics to the whole population is 1 in 821, while in 1851 it was reported at 1 in 1,291. Compared with other countries, Ireland occupies, together with Nova Scotia, Sweden, and Ba- varia, a medium position between the high rate of lunacy in Prince Edward Island, Oldqnburg, and Denmark the average of which countries is 1 in 477 of the popula- tion and the minimum proportion, which is in Pied- mont, Savoy, Holland, and Saxony, where the average ratio is but 1 in 1,931. That there are 1,991 more persons now in Ireland afflicted with lunacy than in 1851 is a fact of the gravest import, although the im- perfection of the method of acquiring information in the HEALTH OF PRISONERS. 523 former census in this particular may have been defect- ive, and the nature of the Irish exodus, to which I have before alluded, may have falsified the returns as compa- rative surveys. With regard, then, to permanent in- infirmities, the following summary gives the compara- tive results of the two censuses : 1851. 1861. Deaf and Dumb, one person in 1,265 1,026 Blind, Insane, Idiotic, Lame or Decrepit 864 843 1,291 821 1,336 825 1,498 1,408 The statistics of the various prisons are given very fully in the Census Keport, and the very learned phy- sician who reviewed it in the Dublin Quarterly Journal of Medical Science makes the following judicious re- marks : " It were well if some inquiry were made as to the vital statistics of the sanitary and mental condition of convicts, as resulting from their very hopeful position. By this we mean any record of how much bread, meat, porter, pudding, and other good things they get ; how many hours they labour during the day, and the amount of work done, as compared with the working hours and work done by honest adscripti glebce; how much clothing, good housing, clean- liness, and amusement is inflicted on these wayward children by a paternal government ; in fact, how much inducement is held out to the honest man to become a rogue." Despite all these advantages, we find that disease was most prevalent 1 in 10 of the prisoners having been under treatment ; and the same writer exclaims : " If all these gentry had been formed into a rogue's brigade, and sent into the trenches before Duppel, or subjected to Prussian tender mercies elsewhere, we might not wonder at the sick in hospital being reported as 1 in 10; but so large a proportion of sick in our quiet prisons at home, with protection from wind and weather, warm clothing, wholesome food, plenty of cleanliness and idleness, a little moderate exercise, and good medical attendance, forcibly suggests some queries to the medical reader. Are the prisons unfit for habitation, as in the days of Howard? Are the clothing and food insufficient or of bad quality, as at the 524 THE DISEASES OF IRELAND. Crimea ? How much or how little illness secures a remission of that terrible judicial sentence, ' hard labour ?' To what extent does malingering prevail in our prisons ? and what sort of pigmies are the natives of the various localities robbed, burned, or other- wise injured by this decrepit set of prisoners ?" With respect to the outdoor employment of prisoners in agricultural work, Inspector- General S. Clarke re- marks : " A more healthy-looking body of labourers could not be seen than the prisoners employed on the convict farm at Dartmoor and on the works at Portland, in England, and Spike Island, in Ireland, Those employed at the Smithfield and Lusk Intermediate Prisons in Ireland appear like so many free labourers, with the exception that they carry on their work in a quieter and more orderly man- ner. In walking over the convict farm at Lusk, the first feeling is astonishment, that a system which appears to work so well should not have been more widely adopted ; and the next is, that it must sooner or later become general." You will readily understand the difficulties which sur- rounded the collection of trustworthy returns of those sick of various temporary diseases on the night the Census was taken, but they are, I am sure, sufficient accurate to allow us to derive conclusions as to the increase or de- crease in various diseases in 1861 as compared with 1851. Ord. 3.Dietic. 1851 Privation 191 I. ZYMOTIC. Ord. 1. Miasmatic. 1851 1861 Small-pox . 888 116 Measles . 1035 1308 Scarlatina . 324 266 Quinsy . 80 176 Whooping-cough 359 153 Fevers . 13777 2350 Erysipelas . 256 228 Ophthalmia . 3883 1307 Influenza . 2330 Dysentery and Diarrhoea . 9729 1139 Ague . 201 81 Rheumatism . 3953 4103 Ord. 2.Enthetic. Syphilis . 824 370 Purpura & Scurvy 149 Dyspepsia . 345 Ord. 4. Parasitic. Itch . 1193 Scald Head . 2042 Worms 283 1861 6 101 526 397 276 259 II. CONSTITUTIONAL. Ord. \.-Diathetic. Dropsy . 1464 952 Ord. 2. Tubercular. Scrofula . 2654 1615 Wasting . 747 275 Consumption . 4182 2650 NOSOLOGY, OR CLASSIFCATION OF DISEASES. 525 This I have done in the foregoing epitome of the number of cases of the most important diseases of the zymotic and constitutional classes, which mainly have concerned us in discussing Preventive Medicine. There is growing up among statists a very general im- pression, that a Census taken every ten years is very fallacious ; and certainly, for the greater number of the intervening years, it is very hard to strike an accurate death-rate, or in any other way to test the rate of sani- tary progress. It is usually done by calculating the increase or decrease during the previous decennium ; but in this country such a means is palpably fallacious. On the appearance of the Census the calculations made on the above mode of correction are often shown to be widely astray. The proportion of males to 100 females over the whole of Europe has been lately estimated at 106, ranging from 108-9 in Russia to 104-7 in Great Britain. I will now give you a very brief sketch of the two schemes of nosology, or the arrangement and classifica- tion of diseases which are used by the English and Irish and by the Scotch Registrars, both of which differ very considerably from that adopted in the Census reports we have just analyzed. The inconvenience of this is ob- vious, and it would be most desirable that before the next Census, at least, they should be similarized. The classification originally proposed by Dr. Farr twenty year ago, seems to me as nearly perfect as the state of medical science then permitted ; but it now requires re- adjustment, and I understand such is contemplated by the co-operation of such authorities as the Medical Re- gistrars of the three kingdoms, and the Medical Officer of the Privy Council, Mr. Simon. I am sure that no classification which will require essential changes with the progress which we may confidently trust medicine will yearly make, will be adopted by this congress of the medical statists, for otherwise much confusion would 526 THE REGISTRATION OF DEATHS. result, and useful and accurate comparisons of the status of disease could not be conveniently made with previous years. Dr. M. d'Espine of Geneva, has for many years followed the following classification, which professes to be arranged upon physiological data : (1) still born ; (2) deaths soon after birth ; (3) deaths from age; (4) death from violence or external accident ; (5) sudden deaths from internal causes ; (6) deaths from acute dis- eases ; (7) from chronic maladies ; (8) undetermined. Meanwhile, the issue of the "Statistical Nosology " by the Registrar- General of Ireland was necessary, in order to get returns at all intelligible or classifiable. I may here mention that I think the willingness with which returns have been made has been due to the very great respect in which that gentleman is held, for the extra- ordinary zeal with which he has devoted himself to ar- ranging the statistics of this country ent'tle him to national gratitude. Most of the medical institutions have lent him their aid ; for instance, the great body to which it is my pride to belong, at a meeting of the Council, held on the 3rd of March, 1864, resolved : " That we, the President, Vice-President, and Council of the Royal College of Surgeons in Ireland, deeply impressed with the importance and value of the lately enacted measure for the regis- tration of births and deaths in this part of the United Kingdom, and anxious to have its provisions fully and accurately carried out, do resolve to promote, as far as possible, the objects of the legis- lature, and earnestly recommend the Fellows and Licentiates of the College to assist the authorities in procuring the statistical infor- mation required under the Act." In the Registrar's Nosology, the diseases which pro- duce death are divided into five classes, which are each subdivided into orders, of each of which I have given but one example to save space. If I have set down a second disease under some of the orders, it is because I have afterwards a remark to make upon it : THE REGISTRAR-GENERAL'S CLASSIFICATION. 527 I. ZYMOTIC DISEASES. Example. 1. Miasmatic Diseases .. .. Small-pox, Fever. 2. Enthetic .. .. Syphilis. 3. Dietic . > . . Scurvy. 4. Parasitic . . . . Worms. 11. CONSTITUTIONAL. 1. Diathetic Diseases Cancer, Gout, Dropsy. 2. Tubercular Consumption, Goitre. III. LOCAL. 1. Diseases of Nervous System Apoplexy, Convulsions. 2. Organs of Circulation Aneurism. 3. Respiratory Organs Bronchitis. 4. Digestive Organs Inflammation of Sto- mach, Painter's colic. 5. Urinary Organs Bright's Disease. 6. Organs of Generation 7. Organs of Locomotion . . Ovarian Dropsy. Inflammation of joints. 8. Integumentary System . . Ulcer. IV. DEVELOPMENTAL, 1. Diseases of Children Teething. 2. Adults Childbirth. 3. Old People Old Age. 4. Nutrition Debility. V. VIOLENT DEATHS, 1. Accident or Negligence Burn. 2. Battle .. Wound. 3. Homicide Poisoning. 4. Suicide Drowning. 5. Execution Hanging. Other Violent Deaths not classed. Sudden Deaths, cause unascertained. Causes not specified or ill-defined. To the classes I do not think any objection could be made, and it is of the utmost importance that preven- tible maladies, although of different seats, should be grouped under one head, such as " zymotic." The sub- division into orders is likewise very scientific, and it is only with regard to the places which a few diseases oc- cupy that I would venture suggestions. I think, for 528 CHANGES PROPOSED BY DR. STARK. instance, that it is high time we should have deaths from typhus and typhoid fevers recorded separately. From the diathetic order of constitutional diseases I would re- move gout to the dietic order of the zymotic, for it is evidently due to circumstances of food or drink. Dropsy is a most inaccurate term, under which deaths from dis- eases of the heart, liver, kidney, &c., are confounded. As convulsions, that destroyer of infants, is usually due to reflex disease excited by bad air or improper food, I would be glad to see it under the zymotic head. Goitre is surely misplaced in the tubercular order, and for rea- sons I have so often mentioned appears clearly dietic. And, lastly, I think it would be advantageous to group painter's colic, which is now registered among the local diseases, with other very preventible ills which arise from special occupations, as steel-grinding, mining, and mirror- silvering, under some such title as " Industrial." As the public should share in the information collected by registration, I am in favour of using popular terms, if as accurate as technical ones ; for instance, consump- tion and water on the brain are surely as suitable terms as phthisis and hydrocephalus, though less pedantic. The system proposed by Dr. Stark, the Scottish Medi- cal Registrar, tabulates every disease under the " organ of the body which was primarily and chiefly affected," and an example or two from the remarks with which that physician elucidates his plan will make its principles more clear : " According to the rule laid down, therefore,"diphtheria must either be classified under diseases qf the organs of digestion, or where I have provisionally put it, under fevers. It seems to me to be so closely allied to cynanche maligna and cynanche tonsillaris, both of which are undoubted forms of scarlatina, that it seems to me we have no choice left us but to place it after scarlatina. For statistical purposes there can be no such class allowed as the tuber- cular ; it would violate all our rules. Every disease now put under that class must be referred to the organ of the body chiefly affected ; so phthisis must be referred to diseases of the respiratory organs ; hydrocephalus to diseases of the brain ; tabes mesenterica to diseases DEATH-KATES IN SQUARES AND STREETS. 529 of the organs of digestion. Whooping-cough and croup are so purely diseases of the respiratory organs, the wonder is they were ever put elsewhere. Diarrhoea, dysentery, and cholera, may be called the leading diseases of the organs of digestion, and that is their undoubted proper place." This extract exhibits the merits or demerits of this plan at large ; but I must say that while the advantages of classifying diseases according to their precise seat, if always aseertainable, are not very evident, the disadvan- tages of separating those which owe their origin to similar morbific agencies and are preventible by similar measures far outweigh them. Sir Wm. Wilde's investigations brought to light in 1841 the suggestive facts that there was in Dublin the most astounding difference in the death-rates of the first class squares and streets, in which it was but 1 death in 122, and such poorer districts as St. Paul's, Linen Hall, and St. Catherine's, in which it was 1 death in 37, 42, and 43 of their denizens respectively. It is much to be feared that these proportions have not been much equa- lized as yet, but the accurate mortality returns we now have will guide our efforts in these directions. Dr. Dundas Thompson showed the same for London district : " But if a low death-rate may be considered as an indication of the healthiness of a locality, then will the Cavendish-square dis- trict, with its 15,000 inhabitant-, stand pre-eminent amongst the other parochial districts. By this rule of estimate, which I think must be regarded as a fair one, it will be found equal in salu- brity to Hampstead, and superior to every other district of London, equal also to the healthiest parishes in the healthiest counties of England, and considerably above Brighton, Margate, Ramsgate, and many of our most frequented and attractive watering places ; and why it is so may be very easily and satisfactorily explained. Its poor population is very small, and there is but little overcrowding ; its streets are wide and airy ; its houses for the most part large, commodious, well built, and ventilated ; its drainage good, and with a considerable fall into the sewers ; its water-supply abundant, owing to the ample cisternage of most of the houses, and beneath its surface lies a substratum of fine sand, which not only preserves dryness, but constitutes also an excellent medium for the infiltra- tion of surface drainage ." 530 THE YEARS 1865, 1866, DUBLIN. It has been asserted also that Irish poor carry with them the disease-generating tendency with which they are afflicted at home into those English, and Scotch, and American towns into which they emigrate, or at any rate that the mortality of many of them is in proportion to the per-centage of our countrymen. In Liverpool, 18 per cent, of the population is Irish, the death-rate is 30 per 1,000. London has a much smaller proportion of our poor countrymen, its general death-rate is 23 ; and Greenock, with 12 per cent. Irish, loses 35 per 1,000 of her inhabitants annually, while Aberdeen, with 2 per cent. Irish, loses but 21. Density of population undoubtedly increases mortality, and in that aspect Dublin is not healthy. The Registrar- General, in 1865, stated the density of population in British cities was according to the follow- ratio : Liverpool (borough) Glasgow (city) Manchester (city) . . Dublin (city) Edinburgh . . . 93-3 . 83-7 . 79-1 . 66-9 . 42-5 Birmingham (borough) . London Bristol (city) Salford (borough) . . Leeds (borough) . . 41-9 38-7 34-5 21-4 10-4 Another evil due to various unwholesome influences I have sketched in previous lectures, is the physical de- generacy of the poor classes in the more crowded parts of Dublin, apparent to any one walking through them. The stunted proportions and listless aspects of the adults, and the pale scrofulous faces, full of precocious knowing- ness, of the children, contrast more widely than, per- haps, in any other country, with the stalwart build or ruddy cheeks of the surrounding rural population. Those city influences which induce an early puberty, and a consequent arrest of growth, are probably unavoidable in dense populations, but among causes of urban degeneracy which are preventible, rank, ill-chosen, and ill-prepared food, scanty supply of cow's milk, inability for breast nursing, alcohol, impure air, &c. Infants are so sus- REGISTRATION OF BIRTHS AND DEATHS. 581 ceptible to unwholesome influences that mortality among them affords a most sensitive test of the public health of any district. In 1844, over 40 per cent, of the children of the labouring classes died under five years. Early mortality is not, however, the only ill effect of neglect of sanitary conditions, for those who survive linger out an unhealthy life, and propagate for generations their physi- cal defects. The Act for the Registration of Births and Deaths in Ireland, 26 Vic., cap. 11, came into operation on the 1st of January last, rendering it a legal offence for the rela- tives not to give notice of a birth within three months, or of a death within fourteen days. There are reasons for believing that it is now working with tolerable accu- racy, at least in the cities. It was not to be expected that it would work with much accuracy at first ; thus for instance : In January, 1864, the first month of registra- tion, 649 deaths were registered, while the burials in the three city cemeteries of persons dying in the city were 896 in the same period. From the Registrar- General's returns it appears that the number of births registered in Ireland during the year 1865 amounted to 145,22774,481 males and 70,746 females; affording a ratio of 25-0 per 1,000 of the population, 5,798,967 in 1861. The number regis- tered in 1864 was 136,643, or 23-6 per 1,000; thus showing an increase of 8,584 births between the two periods. The deaths registered in Ireland during 1865 amounted to 93,738 46,569 males and 47,169 females ; affording a ratio of 16-2 per 1,000 of the population. The number registered in 1864 was almost similar 95,075, or 337 more. During each of the three first quarters of 1866 there died respectively 27,824, 24,763, and 18,751. The number of persons who left the ports of Ireland during the year 1865, according to the returns ob- tained by the Enumerators, amounted to 101,497 ; the 532 MORTALITY OF DUBLIN, ETC. number during the year 1864 was 114,903. During each of the three first quarters of 1866 there left Ireland 25,889, 41,124, and 19,640 persons. The registration in the western and north-western divisions seems most faulty, for in Ballyvaghan, for instance, the annual death-rate upon the returns for the June quarter was only 3' 5 per 1,000, and in Dunfa- naghy for the September quarter, 4*1 per 1,000, while it is universally allowed that the rate of inevitable mor- tality is 17 per 1,000. The mortality of Dublin and some other cities for the past two years is shown in the following table, but being the seat of so many hospitals and deaths, and two work- houses containing each some 3,000 or 4,000 inmates, its rate is necessarily high : Population 1861. Persons to acre. Deaths. Deaths per 1000 1865. 1866. 1865. 1866. Dublin City . . 254808 66-9 6959 7571 28- 29-5 Dublin District .. 314409 32-7 8151 9034 25-9 28-7 London District- 2803989 39-0 73460 80129 26-1 48-5 London (Central) 378058 9948 10282 26-3 27-2 Liverpool 476368 94-8 17290 20202 36-4 42-4 Glasgow 423723 85-4 13887 12745 32-7 3007 In some of the provincial towns the annual rates for the last six months were as follows, but it is confessed that registration was faulty, and it will be seen, from the proportion of population per acre, that in some instances the surrounding district is included. Belfast. . (11-9 to the acre) 24-4 Limerick (5-80 to the acre) 18-8 Cork (6-7 to the acre) 17'4 Waterford (1-7 to the acre) 26-2 This city is divided into seven districts, which may be named after the street in which the Dispensary station is situated. North Side No. 1. Summer-hill District, containing the Mater Misericordia3 Hospital. No. 2. THE DUBLIN DISTRICT. 533 Coleraine-street District, containing the Eotundo Lying- in Hospital and Jervis-street Hospital. No. 3. Black- hall- street District, containing the North Union Work- house, Richmond Lunatic Asylum, and the Richmond, Hardwicke, and Whitworth Hospitals. South Side No. 1. Meath- street District, containing South Union Work- house, Cork-street Fever, and Stevens' Hospitals. No. 2. High-street District. No. 3. Peter-street District, containing the Meath, Adelaide, and Coombe Lying-in Hospitals. No. 4. Grand Canal-street District, con- taining Sir Patrick Dun's and St. Vincent's Hospitals. The death-rates in these districts has been as follows : Deaths per 1,000 living 1865. 1866. Cummer -hill District .. .. 18-1 23-4 Coleraine-street Blackhall-street Do. abstracting workhouse deaths Meath-street Do. abstracting workhouse deaths High-street.. ., Peter-street Grand Canal-street 20-1 19-3 43-4 46-7 31-2 28-1 45-4 46-9 277 25-1 20-4 24-2 21-7 22-8 17-54 17-5 During each of the quarters the annual rate of mor- tality was as follows : Deaths per 1,000 living 1865. 1866. January, February, March .. .. .. 34'4 32-6 April, May, June .. .. .. .. 25'6 28'02 July, August, September .. .. .. 23'8 25-1 October, November, December .. .. 27'0233'03 Zymotic diseases produced in each year 1,483 and 2,309 respectively, and the most prevalent of them may now be considered in detail. 492 deaths were due to fever in 1865, and 480 in 1866, distributed over the dis- tricts as follows : 534 FEVER. Per 1,000 living. 18(55. 1866. Summer-hill .. .. .. ..77 6-8 Coleraine-street .. .. .. . . 3'9 7'0t Blackhall-street, containing the Hardwicke Fever Hospital .. .. .. .. 38-0 32-07 Meath-street, containing the Cork-street Feve* Hospital .. .. .. . 52-0 63'8 High-street .. .. .. 7'6 12-2 Peter- street Grand Canal- street 12-9 10-3 9-3 11-1 During each of the twelve months of each year the deaths by fever were distributed as follows : January, 55-46; February, 41-50; March, 49-41; April, 45-48; May, 36-59 ; June, 45-35 ; July, 28-27 ; August, 24-32; September, 27-21 ; October, 27-39; November, 41-29 ; December, 57-33. The neighbourhoods in which it was most prevalent in 1865 were those placed in the following order : North Side Church-street, Beresford- street, Greek- street, North King-street, Barrack-street, Lower Meck- leuburgh- street, Cole's-lane. South Side Coombe, Skinner's-alley, Meath-street, Patrick- street, West Essex- street, To wnsend- street, Poolbeg-street, Wood-quay. And in 1866 : North Side Church-street, Fisher's-lane, Dispensary-lane, Montgomery-street. South Side Kil- maiiiham, Marrowbone-lane, New-street, Wood-quay, West Essex-street, To wnsend- street, City-quay. And 3,245 cases, or 127 in every 10,000 of the popu- lation, during 1865, and 2,536, or 99 per 10,000, during 1866, were received into the Hardwicke and Cork-street Hospitals from city dwellings. From these hospitals a list of the addresses of each patient admitted during the previous week is forwarded to us on Tuesday, and on Monday night, by the favour of the Registrar- General, we receive the address of every death by zymotic or prevent- ible disease, and those by convulsions which have proved fatal during the previous week. On the following day the houses are visited by the inspector of nuisances or SMALL-POX SCARLATINA MEASLES. 8i his assistants. The state of the ashpit, privy, and house- drain is examined, and, if necessary, orders are given to Lave them put in proper order ; the room where the case has arisen is aired, and directed to be whitewashed. If any fresh case has occurred, the address and regula- tions of the nearest dispensary are given, or the patient is urged to seek admission into hospital, and it is to be regretted that there are not greater powers to compel them. We do not, at present, obtain returns of cases of preventible diseases attended by the fourteen dispensary physicians, but the sanitary sergeants call twice weekly at the dispensary stations, and these gentlemen point out to them any houses which, in their visits, they have ob- served in an unhealthy state. There are fever-carts attached to Cork-street and Hardwicke Hospitals ; but the street cabs must be used for conveyance to other hospitals, which is much to be regretted. Small-pox caused but 23 deaths in 1866, and in 1865 70 deaths, according to months, as follows : January, 13; February, 6; March, 10; April, 15 ; May, 13 ; June, 5 ; July, 2 ; August, 3 ; September, 1 ; Octo- ber, 1 ; November, ; December, 1. The parents, or other responsible persons in any house where a case had occurred were urged to bring their children, or all other unvaccinated persons, to the dispensary of the district, the address and regulations being given ; and they are informed that they subjected themselves to a penalty for not so doing. Information was also given to the dis- pensary medical officers of any unvaccinated children. Scarlatina in 1865 produced 43 deaths, and was most prevalent during August ; and in 1866, 63 died from the disease, the greatest number being in September. Measles, in 1865, caused 157 deaths, and prevailed most during July, August, and September, when 63 oc- curred. In 1866, 34 persons perished, 13 of them in January. The airing of the rooms and of the bed-clothes and dress was insisted on by our inspectors. 35 536 DIAERHCEA CONSUMPTIONCONVULSIONS. The mortality by diarrhceal diseases I gave you in the lecture on cholera. Besides the other cleansing and preventive measures hefore detailed, the flushing of the sewers and surface channels in the poorer streets and lanes was commenced in April, and continued during the dry weather, until October. In most of the streets this was done by a hose from the hydrant ; but when the main pipe was too distant, a water-cart had to be employed. In September the water-traps from the street sewers became dry, and had to be occasionally filled from the hydrants. I also publicly advised cold-boiled, and subsequently filtered water, as our present supply is so impure. The deaths by epidemic cholera, and the means taken to stay it, have been detailed. Consumption produced 969 deaths in 1865, having been most fatal in the months of January, February, and March. In 1866, 829 were destroyed by it, March, April, and September being the most fatal months. No powers existed to enforce ventilation and prevent over- crowding in workrooms, especially those of the tailoring and dressmaking trades, until this year, and as the state of many of them was such as to promote in a high de- gree consumptive maladies, they were loudly called for. Convulsions destroyed the lives of 511 infants in 1865, and of 493 in 1866. As fresh air and sunlight are highly preventive of this and the preceding disease, it is to be hoped that mortality by them will be dimi- nished, when, according to the new bye-laws for tene- mental dwellings, the windows will be glazed and mov- able, and cleanliness and proper sewerage insisted on. The deaths by this disease were nearly one-half less in those neighbourhoods where sewerage and decent, house accommodation have been provided for the inha- bitants, thus indicating that sanitary efforts have already produced effects. REGISTRATION OF DISEASES. 587 A most desirable measure is a registration of diseases, especially those which are preventible namely, the '.vmotic and tuberculous classes and infantile convul- sions. Such is at present carried out by the Manchester and Salford Sanitary Association, and was conducted with the greatest benefit by the Medical Officers of Health in London, until the authorities begrudged the moderate sum the system cost. It might in Ireland be achieved better than perhaps any other European country by our admirably organized Poor Law Medical Staff. Their ordinary returns would be sufficient (for dispen- sary physicians have already books enough to keep), if systematically examined. A good map, showing the geological, topographical, and statistical features of the district, would be a valuable addition to every officer's record-book. Information with regard to the location and frequency from fatal disease would be collected. It is guessed that 1 death represents 28 cases of needless illness, but there are no means in force for accurately determining the matter. I have ascertained that the average number of days of bed-sickness which the labour- ers employed by the Corporation suffer in the year is 6. My friend Dr. M'Cormick, who has for so many years zealously cared for the respectable artizans of the city, tells me that he would make the average somewhat less, In either case, as the number of those who directly or indirectly depend for bread on manual labour is nearly 100,000, it is easy to conceive the misery which results from the temporary illness of the bread-winner. The deaths of the earning members of the families are still more calamitous and lamentable, as at least one-fifth of them are by preventible disease. The number of sick days to each man in the Metropo- litan Police (London) is about 10^ annually, and among working men in the same city about 6. In the police of New York, 16 J days is the average. The decennial enumeration of diseases gives little in- 538 FAULTY REGISTRATION. formation. Sir D. Corrigan, when examined before the House of Commons, said : " As evidence how little these returns of disease obtained by the Census Commissioners were to be depended on, he might mention that in all Ireland, on the night of 31st March, 1851, there was not one person returned as labouring under St. Vitus' dance ; only 4 were suffering from delirium tremens, only 16 under nervous dis- eases, only 14 from bronchitis, only 16 from teething, only 60 from haemorrhoids, only 92 from dyspepsia, only 2 from diabetes, only 4 from scald (though the number in the workhouse hospitals same night was upwards of 2,000)." The Eight Hon. Mr. Justice O'Hagan, in a recent ad- dress to the Statistical Society, showed that the regis- tration was not working as satisfactorily as in England. He said : " As to the deaths in 1864, whilst in England, the proportion of registered deaths to the estimated population, was 2'385, or 1 death amongst 42 persons, and in Scotland the per-centage was 2*382, and the ratio 1 death amongst 42 people ; in Ireland the proportion of registered deaths to the population was only 1'652, in the ratio of 1 death to 61 persons. If the same proportion had prevailed in Ireland as in England and Scotland, the number of registries should have been 135,712 instead of 94,075, making the deficiency 41,637, which is equal to 44 per cent. Neither, as to death registration, has there been much improvement in 1865." The Registration of Births, Deaths, and Marriages Act f 1836, for England, provides a 10 penalty upon under- takers, clergymen, or others concerned in any burial without certificate. This clause, which may have been too harsh to be enforced upon the first introduction of that truly invaluable system into Ireland, might now be adopted. I am strongly of opinion that registration should include still-born children, as a measure likely to check infanticide, and should record the occupation of each person and his residence, when the disease was con- tracted, as well as at time of death. The English certi- ficate also returns the disease which may have preceded or caused the fatal one ; for instance, if an abscess proves fatal after scarlatina, it is useful to know the fact, and the respective duration of the diseases. ASSIMILATION TO ENGLISH SYSTEM. 539 The system is different in each of the three parts of the United Kingdom, which is surely anomalous and in- jurious. The acknowledged failure in obtaining com- plete returns of deaths in Ireland seems to me to de- mand that the Registration Act be assimilated to that of England. The relative or other responsible person is the informant, and if the medical man is not satisfied that the death was from natural causes, and in every case of accidental death, he informs the coroner, and thus great aid is given in the detection of crime. The fact also of a certificate as to the actual cause of death being absolutely necessary causes no severe malady to be neglected, which is often the case in this country, de- spite our admirable system of medical charity. The Me- dical Registrar has suggested to me that the fittest per- son in this country on whom to impose the penalty would be the undertaker, as to many rural graveyards there is no sexton attached. In Paris every death must be certified by the " Mede- cins des Morts." The English clerk registrars have returned such causes of deaths, as " worn-out stomach," " want of vitality," " stricture of the windpipe," " morbosity," " hives." Dr. Lankester's famous calculation that there are 12,000 women in London who had murdered their chil- dren, shows that there is great need for alteration in the law relating to concealment of birth and abortion, as also in that directing registration of births, which should be made compulsory in both the case of still-born and living children. It appears, too, that many illegitimate babies also perish from want of proper food and care, and perhaps the giving of over-doses of physic at the hands of those nurses (?) to whom they are delivered. Dr. Farr has advised the registration of such births, and also a more exact form of certificate of death. This great statist's reports have been so full yet accurate, and 540 REGISTRATION. in such forcible and intelligible language, that he has done more service to sanitary reform than any other living man. The Council of Hygiene of New York testify : " The office and the quarterly reports of the Registrar-General of England, as well as the masterly labours of the medical officer to the Privy Council, have become powerful agencies in working out the most important social and political improvements in that country ; and when the effect of all these researches and measures develops itself, it will be seen that even great wars and political earthquakes are really nothing in comparison with these silent social changes." It is desirable that the certificate as to the cause of death should be sent direct to the registrar, as a certifi- cate stating that a gentleman died of delirium iremens might be thrown into the fire by the relatives, or might lead to the dismissal of the medical attendant. If it be true that in England and Wales more than 50,000 persons perish yearly without any authentic re- cord scientific or coronatorial of the diseases and casualties which destroyed them, such is in much greater proportion the case in Ireland. In the whole of England the deaths of children under one year form over one- sixth of the entire mortality ; and in Lancashire nearly one-fifth. Fever and other infectious diseases of childhood produce both in England generally and in London about one- fifth of all these deaths; and convulsions, a malady quite as preventible, one-fifth in England, and only one-seventh in London a fact which speaks volumes for the working of sanitary measures in the great metropolis, which are as yet neglected in many of the provincial districts and towns. The mode of feeding children is the most potent cause of infant mortality. In France this was shown lately on a very large scale. Among infants suckled by wet- nurses the mortality was but 87*1 per cent., while it was 63-9 among those who were hand-fed. This and other faulty habits conducive to disease, I have ea- IXFANT MORTALITY INFANTICIDE. 541 deavoured to decry in preceding lectures, and the effi- cient remedy lies not in legal restrictions, or even inspections, but in the education of the people in those subjects which promote their physical, social, and con- sequently moral well-being. This will be apparent from the following list of causes of infant mortality, which are quite independent of the diseases which would appear to be unavoidable during infancy parents being sickly by intemperance or transmissible disease, errors in feeding, uncleanliness, close undrained dwellings, want of space for open air exercise or play, exposure without sufficient clothing, and quacking, and drugging. The lamentable prevalence of infanticide in England has attracted much attention, and compulsory registration of all births has been advocated. The Harveian Society has further advised that the mothers should not be employed as nurses unless her own child was well-cared for by some other mother. The crime of infanticide in England and Wales is one-third more frequent in proportion to popu- lation than in Ireland. From the last report of the Registrar- General for England it appears that, excluding those from unspe- cified " zymotic diseases," the greatest number of deaths is from lung diseases, 14 out of 100. Brain diseases caused i\fe ; phthisis, T Vo ; heart disease and dropsy, T Vo ; diarrhceal, TOO ; typhus, ITSO ; scrofula, T oi> ; stomach and liver disease, TOU ; violent deaths, Ton among males, and TO among females. LECTURE XXII. THE POOR OF IRELAND MEDICAL CHARITIES. BEFORE those direful years, 1845-6-7, when distress peril aps unequalled in the world's history prevailed in Ireland, the potato was the sole support of our agcultu- ral population. Arthur Young (1780) contrasts the Eng- lish labourer's diet with "the Irishman's potato- 1 owl placed on the floor, the whole family upon their hams around it, devouring quantities almost incredible ; the beggar seating himself to it with a hearty welcome, and the pig taking his share." Probably no other food could have been produced in sufficient quantity to feed the then over-abundant population, at least by the modes of cul- ture then in practice ; besides, the extremely subdivided state of the land left the cottier so small a patch, that potatoes alone produced from it could support his family, and daily employment was not to be had by which he could earn money to procure better food. Sir George Nicholls, in his report on the condition of the peasantry in 1836, says: "Land is to them the great necessary of life ; there is no hiring of servants ; a man cannot ob- tain his living as a day-labourer ; he must get possession of a plot of land to raise potatoes, or starve." A few weeks exertion in planting, digging, and pitting the pota- toes would suffice to procure the means of subsistence for the year ; and with so little muscular labonr arid con- sequent waste of tissue, so poor a food would support, life at this " zero " of comfort. The report of the Devon Commission, 1843, states : " We noticed with deep regret the state of the cotters and labourers in most parts of the country from the want of certain employment. It would he impossible to describe adequately the privations which they and their families habitually and patiently THE POTATO EMIGRATION. 543 endure. It will be seen in the evidence that in many districts their only food is the potato, their only beverage water ; that their cabins are seldom a protection against the weather ; that a bed or a blanket is a rare luxury, and that nearly in all their pig and manure heap constitute their only property." By the report of the Census Commissioners we find the loss between 1851 and 1861 to have been 753,418, and emigration is now stated to be proceeding at the rate of 1,300 per week. Owing to this diminution, the increase of employment, and other causes, the cottier system has been supplanted by one in which the peasant earns his support by his daily labour, and for this in- crease of physical exertion an increase of nitrogenized food is needed. Another reason why little reliance can be placed on the potato as a national food is, that it has frequently failed, producing in 1739, 1821, 1831-5-6-7-9, 1845- 6-7, and every year since, more or less, the most cala- mitous results. In fact, owing to the humidity of the climate, which seems every year to be increasing, and perhaps some other causes, the soil of Ireland is becom- ing less suitable for the growth of this tuber. Mr. Coulter, the special correspondent of Saunderss News- Letter, informs us that in the parish of Kilnoe, near Scariff, but 200 stones of potatoes were produced per acre in 1864, where 1,500 was an average crop some years back. The potato, too, keeps so badly that it is (inly available as food for ten months in the year, and the surplus produce of an abundant year cannot be pre- served for one of scarcity. Father Mathew, in a letter printed in the Parliamen- tary Papers, 1846, says : " On the 27th July, I passed from Cork to Dublin, and this doomed plant bloomed in all the luxuriance of an abundant har- vest. Returning 3rd August, I beheld with sorrow one wide waste of putrefying vegetation. In many places the wretched people were seated on the fences of their gardens wringing their hands and wailing bitterly the destruction that had lett them foodltss." 544 HABITS OF IRISH EMIGRANTS. Space will will not allow me to attempt a description of the famine years, but I will remind you of the magni- tude of the calamity by mentioning that 3,020,712 per- sons received cooked rations during July, 1847; but Providence having granted an abundant harvest, such relief ceased before October ; and that in the supply of food 1,557,212 was expended during the pressure. Besides this, there was expended immense sums in public works, and in staying the progress of famine fever ; so about 7,000,000 was expended, nearly half of which was a gift from Government. So great was the influx of the destitute into workhouses that over-crowding and consequent fever became alarming, and in the first four months of 1847, 54 officers died mainly by that conta- gion. The authorities seem to have recognized the nu- tritive value of the liguminous plants, for one vessel alone, the U.S. warship Macedonia, carried over 11,388 Ibs. of peas and 19,424 Ibs. of beans. I have often had occasion to record how greatly the sanitary condition of English and other cities was in- fluenced by its proportion of Irish, but amendment is to be hoped for. In an ably essay by Dr. Shaw, F.T.C.D., it is said : " The history of an Irish labouring family settling in Liverpool is somewhat of this kind. There is at first a general relaxation of the moral restraints which the public opinion of the neighbourhood imposes on them at home. Increased wages are earned, but from the absence of all artificial wants they are expended merely in animal indulgences. More and better food is used; spirits, tobacco, and beer, are largely consumed ; but the home is as filthy and dilapidated as ever. A large proportion, indeed, have sunk irre- trievably into profligacy and crime ; but against this may be set the equally large number of those who acquire habits of saving along with the means to save, invest their money in trade, take shops, become superintendents in warehouses, and in various ways struggle up into the middle classes of society. The principal step that remains to be taken, is to ame:iorate the condition of the Irish labourer, to build a better c ass of dwellings for them, and some experiments which have been tried in this direction have proved THE POOR LAW ACTS. 545 both remunerative to the capitalists and highly beneficial to the tenants. No agency, however, would be so potent as this, that the habits of the Irish population at home should be raised, and the stream of immigrants constantly flowing into the great cities of the sister kingdom should carry with them a degree of morality and education and refinement of manners, that would prompt them to make a right use of the increased wages earned in their new sphere." The first Irish Poor Law Act was passed in 1838, and was the production of Mr. Nicholls and G. C. Lewis, then Assistant Poor Law Commissioner, afterwards Chan- cellor of the Exchequer. It conferred the power of ma- nagement upon the English Commissioners, an addi- tional Commissioner being appointed ; unions and elec- toral divisions were defined under it, and the election of guardians was regulated. It contained a clause disqua- lifying any clergyman from filling that office, in which it differs from English Acts, except those governing boroughs. In dispensary committees, where the only objects are the preventive and curative treatment of dis- ease, such disqualification does not exist, for they are the persons best acquainted with the social and sanitary condition of the poor. Eesident acting magistrates were appointed ex-officio guardians, but it was afterwards enacted that their number was never to exceed that of elected guardians. Officers were to be appointed by the guardians, but were to be removable for certain causes by the Commissioners. The system was at first most unpopular, the collection of rates having been forcibly resisted by mobs in twenty-one unions up to 1844, since when it has gradually increased in general esteem. The Acts which followed relate to amendments of financial matters and administrative details mainly. That passed in 1847 first authorized outdoor relief, and appointed relieving and medical officers to supply it, but the latter are now solely regulated by the Dispensaries Act, 1851. The difficulties of guarding against fraud in the granting of relief is lamentably shown by the report of the Com- 546 THE DISPENSARY SYSTEM. missioners of 1847, wherein it is stated that servants and employees of members of the committees were placed on the list, although many of them were well to do. The general order under which all the duties of officers of workhouses and other matters connected with their government are laid down, is of the fullest character. The rules for the regulation of dispensaries direct that the medical officers shall be fully qualified in medicine, surgery, and midwifery ; and that he shall be 23 years of age, a restriction which is much complained of, for many candidates, on having passed all the required exa- minations, are compelled to wait perhaps idly at home for two years, if they are anxious to be employed in the service. In the Army and Navy Medical Department, the age is fixed at 21, as well as in most colleges. The mid- wifery branch of our profession entailed a most harassing amount of duty on officers, but it has been lessened by the appointment of midwives in many instances. Up to 1851, the medical relief of the poor was performed by dispensaries, established under the Act of 1805, in various parts of the country, with ill-defined boundaries ; and in places where there was a scanty number of re- sident gentlemen, no dispensary whatever was often to be found. In 1836, with a population about one-fourth greater than that of 1851, there were but 494 dispensaries in Ireland. The funds were collected from the surrounding inhabitants, an equal sum being added by the grand jury ; but they were failing gradually, and the medical officer, if he was to receive anything like adequate payment for his services, should beg it from the residents. So great was the distance from the dispensary to the remote parts of the district, that it was impossible there could be time or frequent attendance ; and in 1836, in the county Mayo, which contains 2,100 square miles, there was but one dispensary. There was moreover no inspection to see that the medical attendance and appliances were adequate. MEDICAL CHARITIES' ACT. 547 During the three or four disastrous years just preced- ing, the income almost entirely failed. The new system by which the direction of the medical charities was wholly placed under Poor Law administration was objected to by many, and an amendment, proposing that yearly sub- scriptions should be also received, met with warm support, and in the Infirmaries Bill of 1854, it was proposed to confer privileges upon subscribers of twenty guineas to the Union Hospitals, into which these institutions were to have been converted. The medical charities of Ireland were investigated in 1841 by Mr. Phelan and Dr. Corr, and in the same year the first Act to " extend the practice of vaccination," was brought into operation under Poor Law administration. A bill for the regulation of the medical charities was framed, but so powerful was the opposition offered by the medical profession, that it was never brought in. It was not, however, until 1851 that such an Act became law, and the medical treatment of the poor was placed under the direction of the Commissioners (one of whom was to be a medical man), and they were given the power of appointing a sufficient number of medical in- spectors, who superintend the medical relief and the working of the Sanitary Act then in force. The funds under this Act are derived wholly from the rates ; the guardians were to divide the unions into districts, which were to be governed by a committee of ex-officio guardians and elected ratepayers. The medical officers of existing dispensaries were to be continued, and the committees were to have the election of their successors. Regulations for the government of the dispensary system were speedily framed by the Commissioners. The ex- penditure was estimated at 102,700 for the first year, but that for 1865 was 117,039, exclusive of 13,550 for registration expenses. Mr. Rumsey, in his great work on State Medicine, objects strongly to the system established in the place of 548 BOARDS OF GUARDIANS. the voluntary one, mainly because of its pauperizing ten- dency ; but he acknowledges that " the country is much indebted to the medical Commissioner and Inspectors for their arrangements respecting the last cholera epi- demic, and for the really philosophical method in which they treat disputed questions as to the origin and pro- pagation of that pestilence." In arranging the districts, the Boards of Guardians were much influenced by the desire of economy, and the Commissioners in 1854 reported that the average popu- lation to each district was 9,080, and the number of acres 28,000. Many districts had 40,000 acres under the care of one medical officer. By the change, the salaries of the officers, which averaged, in 1854, 75, were not increased, although attendance on the sick was made more arduous and the keeping of books much increased. The construction of the committee, usually elected from unintelligent ratepayers, and their very infrequent meetings, has been often complained of. Many of them, in the more remote parts of the country, cannot read or write, and with a majority the sole leading principle is to lessen expenditure. Such men are incompetent to direct steps for the prevention and cure of disease. The most galling complaint of the dispensary physi- cian has been the enforced attendance on persons who, though clearly not poor persons, bring tickets from mem- bers of the committee. He is bound to attend, but at the next meeting of the committee, which may be many weeks distant, the ticket may be cancelled. Then, how- ever, the attendance has probably ceased, and recovery of due payment cannot be had. It must, however, be allowed that under the old dispensary system the abuse of charitable relief existed to an even greater degree. Payment from the Consolidated Fund, as medical offi- cers of the army and navy are paid, and superannuation, have been often advocated, and very forcibly by that valuable union of the profession, the Irish Medical Asso- SUPERANNUATION REQUIRED. 549 elation, and in a pamphlet by Mr. Ellis, when Presi- dent of the Royal College of Surgeons. Clerks of unions, and such officers, are now superannuated, it being averred that they give their whole time to the duties ; but dis- pensary officers are liable to calls at all times, and in remote districts attendance on the poor forms their whole employment. The Medical Charities Bill, as originally drawn, contained clauses which would have had the effect of absorbing the management of the county infir- maries into the Poor Law system ; but being resisted by the surgeons, who, through the grand juries and county members, were able to make themselves heard in Parlia- ment, they did not pass. I have heard, many able and dis- interested medical men urge that these infirmaries fre- quently receive the servants and dependents of the wealthy subscribers, whose treatment on their respective estates should be paid for. The Commissioners were of opi- nion that arrangements might be made by which arti- zans, small farmers, and servants might be admitted, on the condition of -contributing to their own maintenance. However, by the 25 & 26 Vic., cap. 83, persons suffer- ing from accident or acute disease are admissible into the workhouse infirmaries, and as the county infirmary may be many miles distant, this is an evident advantage. The attempt at amalgamation of the infirmaries failed, owing mainly to the efforts of their surgeons, whose rea- sons were mainly urged in the Medical Press, and in an able pamphlet by one of them, Dr. Little of Sligo. The fever hospitals of the counties were, however, placed under Poor Law administration, and all must allow that great advantages have followed. In discuss- ing, some years ago, the question whether State provi- sion against sickness promotes or represses pauperism, Lord Stanley paid a handsome tribute to our profes- sion : " No class of educated m^n is more hardly worked or scantily rewarded, than are those Medical Officers who devote themselves 550 NUMBER OF PAUPERS TN WORKHOUSES. to the care of the destitute poor ; their claims and grievances de serve, I think, more notice than they have yet received : and, though the power of an Officer of Health, and the exact nature of his functions is a fair subject of dispute, I do not hesitate to say that some such person, charged to detect and make known any gross and perceptible violation of sanitary laws, ought to exist for every part of the country." From the last report of the Poor Law Commissioners it appears that the greatest number of paupers, namely, 63,009, was in the work-house on February, 25, 1865, and of these, 3,413 were able-bodied males, and 8,522 able-bodied females ; and there were then also 12,362 recipients of out-door relief. For the corresponding periods in each of the six preceding years the maximum numbers were 1860, 46,723; 1861, 51,552; 1862, 61,485; 1863,66,976; 1864,66,375; 1865,65,549. The number of fever patients in work-house hospitals on Feb. 11, 1866, was 1,557, somewhat less than on the corresponding day of February, 1865, when it reached 2,211. The total number patients relieved under the Medical Charities Act amounted to 837,669, of which nearly one-fourth were attended at their own homes. Fever was considerably more frequent in 1865 than in 1864, 26,56-> having occurred against 21,586, but the visitation which might have been apprehended did not go farther. Epidemics had regularly occurred at de- cennial intervals between 1816 and 1846, but the pe- riods of 1856 and 1866 have passed without its deve- lopment, a happy circumstance, which is attributable, without doubt, to the better feeding of the people of late years. The drainage of water supply of Irish towns being unimproved, it is probable that it is typhus, not typhoid, which has diminished, and I must again ex- press regret that a distinction is not made between these diseases, which depend upon, and are supported by such different causes. Union rating having been established in England in 1865 mainly upon Dr. Hunter's demonstration of its UNION RATING FOR IRELAND. 551 sanitary advantages, Serjeant Barry advocated the same measure for Ireland last session. In my remarks on the dwellings of the poor, I briefly alluded to the topic. Sir George Nicholls, to whom the establishment of the Poor Law was in great part due, bears strong testimony to the advisability of union rating in his letter in 185tf to Lord Russell, in which also the following noteworthy passage occurs " With respect to emigration, I think it has been already carried farther than was desirable." The comparative expense of pauperism in 1856 on each of the populations of the three countries was Ireland, 2s. ; Scotland, 4s. ; and England, 5s. 6d ; or on each pound of the valuation, Ireland, Is. 2-^d. ; Scotland, Is. 4d. ; England, Is. 5Jd. In England, medical comforts, including food and stimulants, are issued as part of the dispensary relief, but in Ireland the practice was^ not legalized by the Acts. In their circular of Aug. 23, 1865, the Commission- ers justly state that the powers for preserving the pub- lic health " have ceased in many parts of the country to be exercised with sufficient vigilance and activity." In my Fifteenth Lecture I detailed to you the sani- tary state of many of our towns, which, uncontrolled by any central authority, were disgraceful. I do not think that they will be improved until they are regu- lated by some body analogous to the English Local Government Office, and if the Poor Law Commission- ers would undertake the supervision of all local autho- rities, those that are Town Commissioners, as well as those that are Boards of Guardians, a positive and ra- pid improvement would, follow. The Committee of the House of Commons, which investigated the working of the Dublin hospitals, say "'A medical school of the highest repute has been established in Dublin, which is almost" entirely dependent on the indirect mode of support by Parliamentary Grant to these hospital?-. Thesysceui 52 THE HALF-TIME SYSTEM. of instruction pursued appears to possess many advantages. Sir Benjamin Brodie has stated in his evidence, that its continuance is, ' as a national object,' very important. The most eminent physicians and surgeons in Dublin devote a great portion of their time to instruction and hospital attendance. Separate schools are attached to the different hospitals, which has the salutary effect of creating emulation. Museums, founded at great expense, and admirably adapted for their purpose, exist. Except in a very few cases, the salaries of the medical officers are not derived from the funds of the institutions. Their emoluments arise from pupils fees. This system, thus nearly self-supporting, has hitherto been most successful. Ireland has been furnished from Dublin, even in its remote districts, with medical men of sound education. 968 dispensaries have now to be supplied with properly- qualified attendants : the withdrawal of these hospital grants would, in the opinion of your Committee, occasion the ruin of this great educa- tional system ; and at a time when Parliament has shown so munificent a disposition towards the diffusion of knowledge, and the encouragement of science and art, your Committee hope that it will not hesitate to provide an adequate sum for the development of that science which is most beneficial to mankind." I think I have elsewhere referred to the half-time system, but the remarks of the Poor Law Commissioners on this subject, expressed in a circular to their inspec- tors in 1853, are so convincing, that you should hear them. " It has been observed that where the school hours have been limited, and the children employed in the open air, they have assumed a stronger and healthier appearance, whilst they have not fallen back in other branches of knowledge. The Commis- sioners believe it to be of the utmost importance that children who have to live by their labour should be trained to labour early. A boy who has not handled a spade at the age of fourteen will rarely turn out an active labourer, and that it is therefore most desirable that the boys generally should be accustomed to work at the earliest practicable age. It has been observed that the success of all benevolent institutions for the education of the children of the poor, at home and on the Continent, has in no small degree turned on the amount of industrial teaching provided for the children, and that those institutions have been less useful where the chief efforts have been directed to literary attainments. The guardians should, of course, provide the necessary agricultural implements suited to the age and strength of the children." CONDITION OF LONDON WORKHOUSES. 553 Agricultural employment for the adults is also most advisable, and it was the intention and is the desire of the authorities that these institutions should be, as their name implies, workhouses. With regard to the evils of confinement, Dr. Guy expresses too forcible an opinion : "It is highly probable that for every life which the Poor Laws save by averting starvation, a hundred are sacrificed by the imprisonment they indict." Despite every sanitary advantage, the monotony and confinement in prisons keeps up a high death-rate. The condition of the London workhouses created a vast deal of public interest last year. The Lancet, and that most admirable journal, the Pall Mall Gazette, astonished the public by revelations as to their management, and Mr. Farnall and Dr. E. Smith, the Inspectors appointed by the Board, acknowledged that there was very great need for reform. Dr. Smith's statement that wards in a workhouse which allow 500 cubic feet to each inmate might be well ventilated, excited much animadversion, but it must be remembered that in London slums (and in Dublin ones too, as I have mentioned) not one half that amount is available. Deficiency of light, and want of water on Mondays, are notable defects, and Dr. Smith advises " a re-arrangement of the mode in which the medical officer performs his duty is necessary, with a view to the devotion of more time to them. The medical officers should act more generally as sanitary officers, and their recommendations of every kind should be in writing." With regard to the deficiency of inspection, he says : " More than one Inspector of the Poor Law Board should be appointed for the district, and after the example of the Lunacy Commissioners, they should have special and different professional qualifications." According to this recommendations the Board secured the services of so distinguished as sanitarian and physician as Dr. Markham, of St. Mary's Hospital. 554 TREATMENT OF SICK-POOR IN WORKHOUSES. The following statement, signed by the leaders of our profession who joined the Association for the Im- provement of the Infirmaries of Workhouses, indicate the principles which were sought for in regulating these institutions. " Having been requested to express our opinion of the principles which should guide any efforts to improve the State treatment of the Sick Poor in Workhouse Infirmaries, we beg to state that any scheme, in order to be satisfactory, should, in our judgment, be based upon the following principles : " 1. The sick poor should be separated from the able-bodied paupers, and their treatment should be placed under a distinct management. " 2. In lieu of sick wards annexed to each workhouse, consolidated infirmities should be provided, where the following rules of hospital management should be adopted, under skilled supervision. They are those generally accepted in this and other European countries. " I. The buildings should be specially devised for the purpose ; of suitable construction, and on healthy sites. The rules laid down by the Barrack and Hospital Commission may be consulted with advantage on this subject. "II. Not less than 1000 (and for particular classes of cases 1200 to 1500) cubic feet of air should be allowed to each patient. " III. The nursing should be conducted entirely by a paid staff, and there should be not less than one day nurse, one night nurse. and one assistant nurse for each fifty patients. " IV. There should be resident medical officers in the propor- tion of not less than one for each 250 patients. " V. The medical officers should not have any pecuniary in- terest whatever in the medicines supplied, nor should they be charged with the duty of dispensing them. 'VI. A judicious classification of patients should be strictly observed ; the epileptic and imbecile, the acutely sick, and the aged and infirm, being treated in separate wards. " VII. The aged and infirm, the chronically sick, and the con- valescent, should be provided with day rooms separate from the dormitories. Signed, THOMAS WATSON, M.D., Bart.,Pres. Coll. Phys GEO. BURROWS, M.D., Pres. Gen. Med. Council- JAMES CLARK, M.D., Bart. (Phys. to Her Majesty.) WM. JENNER, M.D. (Phys. to Her Majesty). E. SIEVEKING, M.D. (Phys. to Prince of Wales). WM. FERGUSON, Bart. (Surgeon to Her Majesty). JAMES PAGET, (Surgeon to Her Majesty)." LECTURE XXIII. SANITARY ORGANIZATION. TIME will not permit me to give you anything like a history of sanitary measures, but a few allusions to the subject may interest you. So ancient a philo- sopher as Plato advocated the provision of State phy- sicians (ez.>r7roAei larpoouj), who had profoundly studied the laws of health and disease. In the beginning of this course I told you something of the sanitary works of ancient Rome, their neglect in the middle ages, and the resulting frequency of plagues. In Eng- land some attention was paid to the subject at an early date, for we are told that Henry VI. sent commis- sioners of sewers into all parts of the realm, to inquire into the state of the " walls, ditches, banks, gutters, sewers, gotes, calcies, bridges, streams, and other de- fences by the coast of the sea and marsh ground," which were to be " corrected, repaired, and amended." Henry VIII. extended this commission over twenty years, the commissioners taking oath that they would execute the ordinances according to their " cunning, wit, and power, without favour, meed, dread, malice, or affection, " and his successor rendered this commission permanent. Among writers of the eighteenth century, none urged sanitary recommendations more forcibly than did the immortal Linnaeus in his " Dissertation on Habitable Air." Very little of a comprehensive nature was done except within the last thirty years, and the present was indeed the reign of sanitary legislation. I freely acknowledge that within the last few years a great deal of attention on the part of the public, even i'rom the very highest, has been given to the subject of public health, and the truth of Benjamin Franklin's opinion, that ''public health is public wealth," is gene- I 556 LORD PALMERSTON'S VIEWS. rally felt. The first public" act of our gracious Sove- reign, since her bereavement, was to open last Novem- ber the Aberdeen Water- works, and on the occasion her Majesty said : " I have felt that at a time when the attention of the country has been so anxiously directed to the state of public health, it was right that I should make an exertion to testify my sense of the importance of a work so well calculated as this to promote the health and comfort or your ancient city." The Rev. Dr. Haughton has enumerated, among the views which guide people about the management of cholera, the " Will of God theory/' by which maladies clearly dependent on man's neglect are supposed to be unavoidable. Buckle quotes Lord Palmerston's answer to those who begged him to procure the appointment of a public fast in view of approaching cholera : " The best course which the people of this country can pnrsne to deserve that the further progress of the cholera should be stayed, will be to employ the interval that will elapse between the present time, and the beginning of next spring, in planning and executing measures by which those portions of their towns and cities which are inhabited by the poorest classes, and which, from the nature of things, must most need purification and improvement, may be freed from those causes and sources of contagion, which if allowed to remain, will probably breed pestilence and be fruitful in death in spite of the prayers and fastings of a united but inactive people." I may mention that Dr. Klob of Vienna has found myriads of fungi in the cholera discharges. Dr. Jenner, the Queen's Physician, in an able address which he gave as president of the Epidemiological Society, proved a large part of the diseases which are looked on as inevitable to be really the result of igno- rance of the laws of health in the present or past gene- rations, and boldly asserted that an enormous mortality was due " to the neglect of their duties by the wealthy who know and obey laws, but fail to give the poor the means of obeying them, to the inertia of the Legis- lature, its unwillingness to interfere with individual action, its fear of touching vested interests, its dread RESPONSIBILITY OF SANITARY DEFAULTERS. 557 of offending religious prejudices, though they may be the offspring of ignorance." Notwithstanding all the lamentable evidence which the Council of Hygiene in New York has brought for- ward of the death-dealing state of the purlieus of that city, the municipal inspector reported the year pre- viously that " this talk about the number of lives that are lost each year for want of proper sanitary measures is a perfect fallacy." In one house, fever had prevailed with- out intermission for four months, and six deaths by that disease had occurred, besides some sent to the fever hospital, yet no step whatever had been taken by the health officers. In many instances several large houses had only one communication with the main sewer, their house-drains joining so as to save expense in breaking the street. This has led to bad results, for a stoppage near the opening must render useless all the drains. The responsibility of sanitary authorities will not remain much longer unquestioned, for the Warwick- shire coroner has notified that he will hold inquests on deaths by'cholera, as " criminal culpability may attach;" and a gentleman in Louisville, U.S., has sued the corporation for 25,000 dollars damages, his wife and daughter having died, he alleges, through their neglect in draining the street in which he resides. Dr. Farr says : " The precise degree of influence which the various agencies have in causing the high mortality of towns, is not easily deter- mined. Opinions differ as to what fraction of the suffering and death is to be set down to the want of water or of sewerage, crowded lodgings, narrow streets, ill-ventilated workshops, the destitution of skilful medical advice, the neglect of children, doses of opium and overflowings of quackery, slaughter-houses, and rank churchyards." At a meeting the Metropolitan Sanitary Association in September last, the Bishop of London in the chair, the Medical Officers of Health, through their President, Dr. Druitt, suggested that the subscriptions in relief of the sufferers from cholera should be expended in procuring a 558 IGNORANT OPPOSITION. good supply of water, and possibly of milk at reasonable prices, and the erection of baths and workhouses in the east of London, where these necessary meatis of health were sadly deficient, as, indeed, the prevalence of cholera proved. The Jews, in Whitechapel, had erected thirty stand pipes, with great advantage. Dr. Farr, F.R.S., regarded " Any resolution emanating from Dr. Druitt with the greatest respect, representing as he did a body of men who were second to none in their knowledge of the particular subject under considera- tion. His proposition was by no means incompatible with the re- commendation that an appeal should be made to the Government for a royal commission of inquiry, which must be prospective." The motion was, however, withdrawn, Mr. Godwin, F.R.S., editor of the Builder, having proposed, and the majority of those present having agreed to a resolution, calling on the Government to appoint a roj r al commis- sion to inquire into the sanitary state of the metropolis. Mr. Godwin said: " Until public opinion was formed till knowledge on sanitary subjects was more general what improvement could they expect ? What must they look for, when in the present day they heard from a town near Leeds the pretensions of a person to become a member of the local board grounded on such reasons as these that he would oppose all schemes for levying rates for the supply of water ; every measure to obtain public sewerage or the paving of streets ; every measure of that sort, in fact without exception, on the prin- ciple that all such things were a \vasteful expenditure of the rate- payers' money ? "When they saw a placard like that ; when they found doctors themselves expressing opinions contrary to one another and to all that had been proved by experiment for many years why, they had educated men saying that bad drainage did not produce disease. He had in his pocket a letter from a rate- payer in Sheffield stating that assertions made at the late meetings of the British Association had entirely paralysed the efforts of those among the people of Sheffield who desired to obtain proper drainage. Those present must have read on the previous day of an accident in a tank in Ireland (Swords), where four men de- scended one after another to clear away decomposing matter, and each one fell dead as he reached the bad air ; and yet they still found men doubting if the emanations from sewers produced dis- ease." EARLY LEGISLATION. 559 In 1818 an Act was passed legalizing the appoint- ment of health boards, with most extensive powers ; but the Royal Commissioners on the State of Ireland, in 1886, reported that this provision had been rarely acted on. The Metropolitan Sanitary Commission reported in 1848: " That on examination of the actual state of the back streets, lanes, courts, and alleys of the metropolis, it is found that in general little or no improvement has taken place in their sanitary condition since the prevalence of cholera in 1832, and that were this disease again to break out in the present state of these locali- ties, there is no reasonable ground to suppose that the pestilence would not spread as extensively and prove as fatal as on its former visitation." Whenever the death-rate of an English town exceeds 23 per 1,000, or when one-tenth of the inhabitants peti- tion the Privy Council, a thorough inspection of its sani- tory state is at once conducted, and improvement imme- diately follows. I could mention many Irish towns in which the death-rate is one-fourth higher, and in which such palpable causes of disease as surface channels in- stead of sewers, scanty and foul drinking-water, and over-crowded and loathsome graveyards exist, and yet are the inhabitants either ignorant or negligent of their dan- ger, and the local authority, which should care for the health of the town, utterly apathetic. The great disadvantage of the present Sanitary Acts is, that they do not consolidate the authorities for their execution, nor are their clauses consistent with each other. Under the recent Act, the Privy Council may call upon two neighbouring boards of guardians to unite for the purposes of the Disease Prevention Act, but not for any permanent object. Since 1852, the Poor Law Commissioners, to whom is entrusted the sanitary control of all the country, ex- cept corporate and commissioned towns, have frequently circulated in every union the following lamentable facts : 560 A UNIFORM AUTHORITY WANTED. " Typhus fever has long been the scourge of Ireland, attributable in a great measure, no doubt, to causes not removable by the guardians, but also to a very great extent the result of the un- drained filthy state of the worst parts of almost every Irish town, unknown and unvisited by those in better circumstances ; but when once fever is prevalent, it extends its ravages to all classes, and is even more fatal to the rich than to the poor. It may at the same time be observed that any precautions of the kind herein adverted to, which tend to diminish the prevalence or virulence of epidemic or contagious disease amongst the poor, will no doubt tend also to the saving of the rates, by diminishing the demands for relief at the cost of the rates." I regret I must report that little amelioration has yet ensued ; the remedy seems to be, the regulation of these towns, containing 2,000,000 people, as well as the Poor Law districts, by these Commissioners, or some central authority. In Mullingar, which has been always noted for the prevalence of preventible disease, a meeting was called last November to take steps for the sewerage of the town. The expense was estimated at 3,000, one- third of which the lord of the soil, Col. Greville Nugent, M.P., offered to give. The ratepayers, almost unani- mously, decided against improvement. In less than a month cholera was raging fearfully among them. At a meeting of the Statistical Society, a year since, Mr. Conn, P.L.G. of Waterford, noticed the case of a town in his neighbourhood, in which there was the most lamentable need of sanitary improvement, yet none had been effected, as the proprietor of the town (which num- bered 800 houses) had expressed himself content ; and as the ratepayers had no leases, they were by this hint most effectually silenced, and breathed their malaria contentedly. He advocated the appointment of pro- fessional men to examine and report to a central autho- rity on the sanitary wants of localities throughout the country, and contended that local proprietors should be compelled to do their duty in preserving public health. The local inspectors of the small Scotch towns would SCOTCH SHORTCOMINGS. 561 seem to be inefficient conservators of the public health, if the following instance, just recorded in the Medical Press, is illustrative. The inspector constantly reported in flattering terms the state of a town. The Board of Health, however, requested a higher sanitary authority to examine into it. The " inspector's own premises were found to be in a most unsatisfactory condition," and forty cart-loads of filth were taken from the partly open stream in one of the streets which formed the sewer of the village. The town was improved ; one man who carried the cholera into it died. There was no other case ; but the son of this man. who came to visit him from a distant village, returned to die there, and to ori- ginate an epidemic which caused some hundreds of deaths. But one enemy of life is being repulsed in Scotland. The new Vaccination Act is working well, for the Regis- trar of Bridgeton, a district containing nearly 50,000, notes that in 1863 he had 31 deaths from small-pox, and in 1864, 23 ; but the Act having got thoroughly into operation, in the whole of 1865 this disease was fatal in one instance only, and in the first quarter of 1866 in not one. I will now explain to you the system which is organ- ized in Dublin, and that pursued in England, in order that you may see if they be worthy of imitation in Bel- fast, Cork, Limerick, Waterford, Galway, or other cities where nothing analogous exists. The appointment of a Medical Officer of Health is under the 12th section of the Towns' Improvement Clauses Act (10 and 11 Vic., cap. 34), and the duties in it are described as follows : " To ascertain the existence of diseases within the limits of the Special Act, especially epidemics and contagious diseases, and to point out any nuisances or other local causes likely to cause and continue such diseases, or otherwise injure the health of the in- habitants, and to point out the best means for checking or pre- venting the spread of such diseases, within the limits aforesaid, and 502 THE MEDICAL OFFICER OF HEALTH. also the best means for the ventilation of churches, chapels, schools, registered lodging-houses, and other public buildings within the limits aforesaid, and from time to time, as! required by the Com- missioners (i.e. Corporation), to report to them upon the matters aforesaid, and to perform any other duties of a like nature which may be required of him." Dublin and Deny have appointed medical officers of Health. In the latter city Dr. Wm. Browne, F.R.C.S., has held the post for many years with great credit. In this City, as you are aware, the death returns are pub- lished on Wednesdays, and I have, as Medical Officer of Health, the advantage of receiving, the previous Mon- day, the address of every death by preventible disease, in order that the sanitary inspectors may discover and re- move the causes which led to its occurrence. I do trust somewhat confidently that good will result from the har- monious working of the registration and sanitary systems, and I, for my part, will look on the weekly return as my pressure gauge, for it will stimulate our efforts to dimm- ish the removable causes of disease if it tells of increas- ing deaths by preventible maladies ; or if they be decreas- ing, we will endeavour to ascertain the circumstances which have led to so favourable a result. The Registrar General's facts, when popularized and compared with each other, are the truest means of making the ignorant or apathetic perceive the value of sanitary reform. I will next detail very briefly the means which the city now possesses for preventing the occurrence of disease. A complaint-book lies at the City Hall, and in it can be entered notices of any nuisance which has been observed within the city boundary. The inspector of nuisances then visits the locality, gives instruction for its removal, and enters a description of it on the opposite page of the complaint-book. The more remarkable, or those in which a professional opinion seems needed, are specially reported to me, and I give instructions as to the proper means for removing them or abating their in- jurious effects. Lists are received weekly from the regis- FEVER AND DEATH LISTS. 563 trars of the fever hospitals of the residences from which patients are taken, and all such houses are visited by the inspector or his assistants, and ventilation, lime-whiting, and cleansing of them is insisted on. The eight sani- tary sergeants of the metropolitan police report weekly to the Sanitary Committee of the Corporation all nui- sances they have discovered, and the means taken for their suppression. All sewer-traps and gullies are kept constantly under inspection, and repaired when necessary, and cesspools are suppressed when possible. Means are being taken to compel the proprietors of over 100 facto- ries to consume the smoke of their chimneys, which is productive of much nuisance and inconvenience to those living near them. Endeavours will be made to remove all lime-kilns from the city, but it is especially in the country they should be suitably protected, for over thirty lives are annually lost owing to the poor wretches who sleep by them being burned or poisoned by carbonic acid. If arrangements were made for the recompense of dis- pensary physicians, lists of all cases of zymotic disease might be received from the dispensary stations in the city ; and the able officers of these institutions, by forms supplied them, would be able to bring under the sanitary department all causes which, if unchecked, might propagate disease. I report every Friday to the Sanitary Committee all deaths by preventible diseases which have occurred for the preceding days, with re- marks on the sanitary state of the city, arid the means adopted for improving it ; and the committee make a monthly summary of these statements public, as they hoped that benefit might thereby arise. Among the occasional duties of the committee will be endeavours to suppress any epidemics which may invade the city ; and I am convinced that this sanitary organi- zation, by urging vaccination, examining water-supply and drainage, and the removal of the poor to hospital when brnuli-pox, cholera, or typhus prevails epidemi- 5G4 THE MEDICAL OFFICER OK HEALTH THE ANALYST. cally saves many lives. From the public we can get most efficient aid, and if the benevolent, whose mission of charity or religion brings them to the dwellings of the poor, will inform the sanitary officers at the City Hall of any comfort and health- destroy ing nuisances they may observe, they will render their house-to-house visitation still more valuable. By an Act just passed, all humble houses set in tenements may be inspected, and the owners of them compelled to keep them in a habitable and whole- some state, according to the bye-laws which, as I told you, were framed by the committee with which it is my privilege to be connected. The City Analyst gives most efficient aid as chemical referee on the various questions which arise, and the duties of that office, as set forth in the 23 and 24 Vic., cap. 84, include the microscopical examination and che- mical analysis of all articles of food or drink purchased in the city, which may be presented to him, for a fee which the Corporation has fixed at two shillings and sixpence. The Inspector of Nuisances occupies himself daily from ten to four in visiting the different localities and premises within the district where nuisances exist, or are likely to exist, observing and taking note, in writing, of their sanitary condition, forwarding measures for their prevention and removal, and using the greatest prompti- tude in the discharge of such duty ; in visiting the bake- houses, so that all may be inspected and reported on at least once every two months ; in inspecting every nui- sance complained of, on the day upon which such com- plaint is made, and, if well-founded, to have same abated without delay. If there are assistants, he should receive their reports every day in writing, and frequently, by personal in- spection, to test their accuracy. When summonses are necessary, he should see that the same are correctly served, and attend court to watch the cases and -'rive evidence. SANITARY INSPECTOR AND SERGEANTS. 565 He should have his own and assistants' work marked out for each day the evening previous, so that all may be at work not later than ten o'clock A.M. There are also eight sergeants of the Metropolitan Police, four of whom receive their pay from corporate funds, and during the past year they have paid 23,539 visits to houses set in tenements, procured the remedy of 32,201 defects without prosecution, and obtained 327 comvictions, no summons having been dismissed. Seven houses were closed as unfit for human habitation. The sergeants also visited nightly lodging-houses on 1,171 occasions ; slaughter-houses, on 1,646 ; and bake- houses, 575 times. The complaint-book is open daily at the City Hall from ten to four, and entries of such complaints as want of sewers, filthy cesspools and privies, the emission of smoke, the keeping of pigs, &c., are made by me, by dis- pensary or other physicians, the police sergeants, house- holders, or other persons aggrieved. Anonymous letters are also received and attended to. Many complaints come for frivolous and vexatious reasons, and much time of the inspectors is occupied with cases in the houses of those who could well afford to pay for the remedy of their grievances. The entries have been 304 during the year 1865, and 473 in 1866, numbers respectively more than three times as numerous as any former year, and which indicates the increased activity of the Sanitary Department. The inspectors visited 4,037 premises complained of, or in which fever had been discovered, during 1865, and 3,219 during 1866. Swine have been removed from many localities by the magistrates' order, on my certificate that their being kept was a nuisance injurious to health. Until the Sanitary Act became law there were under the old Nuisances Acts many examples of the partly unavoidable tardiness in the removal of nuisances, but with the prompt aid of the divisional justices little delay SANITARY MAGISTRATE INSPECTION. is now experienced. I have not met with the unwilling- ness to act in sanitary cases which is assigned to magis- trates elsewhere, notwithstanding the press of business at certain hours in our police courts. I think, however, that a committee of the sanitary authority of at least the larger towns, consisting of magistrates, or gentlemen of similar position, might be entrusted with jurisdiction directly in such cases. A few years ago a sanitary court sat under the presidency of Sir E. Borough, with the greatest public advantage ; and a memorial has been presented to His Excellency praying that the present vacancy among the Divisional Magistrates may be filled with the object of one devoting his time to the sanitary and municipal cases. I believe, therefore, that the sani- tary state of Dublin will contrast favourably with that of any other city in the United Kingdom, when pure water shall be supplied to every house, when sewers are ex- tended, and a few other improvements effected without increased taxation a subject on which our citizens are just now rather sensitive. It is, however, vastly more healthy than 100 years ago, when Dr. Rutty described it, with apparent trutiiiuiness, as the most unwholesome and worst regulated town in Europe. Alcohol lent its aid, for he reckoned that nearly one-third the houses were then ale-houses or spirit shops. The Rev. Charles Kingsley, an earnest and most elo- quent advocate of sanitary reform, says : "I see no good reason why the right of inspection and the power of control should not be extended to all dwellings whatever, with whatever precaution that may be thought necessary to guard against the risk, if risk there be, of intrusion upon domestic pri- vacy, which appears to me a very shadowy danger. Simple in- spection, with publication of the results, by officers not locally connected, will do much to bring about the remedy, which local authorities have the power, but not the will, to apply. Why a permanent staff of Government sanitary inspectors should not be appointed it is difficult to say. We have now factory inspectors, mine inspectors, t>cliool inspectors, and they all work well. Not an argument can be brought against the institution of sanitary in- spectors which was not brought against them." SANITARY SURVEYS. 567 I may add, that for one person who is killed or in- jured by factory machinery, or by any other danger of the system, perhaps a hundred perish or pine from the provocatives of disease which are not sufficiently appre- hended by the authorities. The greatest advantages arise from sanitary surveys of cities. In New York the twenty-nine voluntary health officers have ascertained the existence or non-existence of sewers in every part of their districts, the position of slaughter-houses, piggeries, and of all factories where noxious trades are carried on, and the number of cases of fever which, during the previous year, had occurred in each house. It was proved by the leading physicians who formed the corps, that in some districts the death- rate was twice as great, and the sickness-rate ten times as great in others. These particulars, as well as the geological features, and all other sanitary circumstances, they have had marked down on a large map constructed for that purpose, and the value of such a reliable record can be easily conceived. Professor Gairdner, the medi- cal officer of Glasgow, has adopted a similar plan for that city, and I propose to do so as soon as the new map of the city, on the scale of five feet to the mile, is published. The surveys for the purpose have been completed. I shall here mention that few countries possess so accurate and comprehensive maps as Ireland, and the Ordnance Survey is one of the benefits which in this country we owe to the ability and energy of Sir Thomas Larcom, and he it was who mainly advocated the Geo- logical Survey of Ireland. I will next endeavour to describe the sanitary organi- zation in England, and the amendments of it recently proposed by authorities whose own words I shall quote. The Local Government Office and Medical Department of the Privy Council in London may be regarded as the great central public health authority. When one-tenth of the inhabitants of any town petition the Home Secre- ' 37 566 GOVERNMENT INSPECTION IN ENGLAND. tary, or when the death-rate rises to 23 per 1,000, an inspector competent to examine its water-supply, sewer- age, and other sanitary circumstances, and to investigate the manner in which the Lodging-house, Nuisances, and other Sanitary Acts are carried out, is despatched to it. The appropriate remedies are urged upon the local au- thority, and every aid in the way of loans, suggested bye-laws, instruction and supervision is given by the central office. Although, therefore, the Public Health Act (1848) and the Local Government Act (1858) are, like our Towns Improvement Act, permissive, many hundreds of towns and populous places have been by proper representations induced to adopt their admirable provisions. While a town of 200 inhabitants in Eng- land and 700 in Scotland may adopt the Health Act for works of improvement, none except those of 1,500 can take advantage of the similar measure in Ireland. These Acts, which have lowered the annual mortality of the towns in England by 6 per 1,000, were prepared by such statesmen as Lord Morpeth, Sir G. C. Lewis, and Sir George Grey ; and although it was declared that they should not extend to Ireland, the lamented nobleman I have named, who was then Commissioner of Woods und Forests, expressed a hope that the Public Health Act would afterwards be granted for this country. The medical officer of the Privy Council under the Public Health Act, Mr. Simon, according to his yearly reports, besides the above routine duties, has conducted person- ally, or through assistants, many vitally important inves- tigations throughout England, as those into the causes of infant mortality, the working of the vaccination laws, the food supply, and house accommodation of the labour- ing classes, the parasitic and other diseases of cattle in relation to the supply of meat and milk, the peculiar diseases of various industrial classes, accidental and criminal poisoning,, the prevalence of fever, diarrhoea, diphtheria, and other epidemics. By his officers he also GOVERNMENT INSPECTION IN ENGLAND. 509 inquires into local outbreaks of disease for instance, 31 places were so inquired into in 1863. The preva- lence of eye-diseases, of certain forms of skin-diseases, and of convulsions among the children of the poor, the health of miners, and of linen and muslin workers in Ulster, the dwellings of the agricultural labourers, and the state of burial grounds, to which I before alluded, are subjects of equal importance which in this country have never been approached. Unless the thirty towns de- scribed a few lectures back be exceptional, sewerage, water-supply, and the carrying out of the Sanitary Acts seem to call for systematic and scientific inquiry. Since the last cholera epidemic, the Poor Law Inspectors can- not be said to have been engaged in any investigations similar to those conducted by the medical officer of the Privy Council. Those which were directed to the alleged destitution last year cannot be regarded in such a light, as they did not concern the management of towns, sew- age, water-supply, lodging-houses, nuisances, state of burial-grounds, &c., and indeed they were declared by the Commissioners " somewhat out of the limits of the official business of the department." Thus, while we have for our poor the best organized system of curative medicine in the world, the same cannot be said of our arrangements for prevention. The duties of health officers are so well described in the instructional minute issued by the late General Board of Health, that I shall quote it almost entire : I. The officer of health is appointed first, in order that through him the local sanitary authority may be duly informed of such in- fluences as are acting against the healthiness of the population of his district, and of such steps as medical science can advise for their removal; secondly, to execute such special functions as may devolve upon him by the statute under which he is appointed ; and, thirdly, to contribute to that general stock of knowledge with regard to the sanitary condition of the people and to the preventible causes of sickness and mortality which, when collected, methodized, and reported to parliament by the general board of health, may guide the legislature in the extension and amendment of sauitary law. 570 THE MEDICAL OFFICER OF HEALTH. "II. The duties of officer of health will be to the following effect : " He will make himself familiar with the natural and acquired features of the place, with the social and previous sanitary state of its population, and with all its existing provisions for health ; viz., with the levels, inclinations, soil, wells, and water-springs of the district ; with its meteorological peculiarities ; with the distribu- tion of its buildings and open spaces, paved or unpaved, of its burial-grounds and lay-stalls ; with the plan of its drains, sewers, and water-supply ; with the nature of its manufacturing and other industrial establishments ; with the house-accommodation of the poorer classes, and the facilities afforded them for bathing and washing ; with the arrangements for burial of the dead ; and with the regulations in force for lodging-houses and slaughtering places, for the cleansing of public ways and markets, and for the removal of domestic refuse. And, if he be the first officer of health ap- pointed in his district, he will, without unnecessary delay, furnish to the local board a connected account of these matters, so far as they relate to the public health, making thereon such practical suggestions as he may think applicable. "III. For the proper performance of these duties, special qualifi- cations in science are required. These lie in pathology, including vital statistics, and in chemistry with natural philosophy : " In pathology, because this science implies an exact study of tbe causes of disease in their relation to the living body a study of what they are, and how the act, and why they seem to vary in operation : " In vital statistics (properly a section of pathology) because, by analyzing the composition of various death-rates, and by learning how the pressure of particular diseases differs under different cir- cumstances of climate, season, dwelling, age, sex, and occupation, definite standards of comparison are gained, without which the officer of health could not estimate the healthiness or unhealthiness of the population under his charge : " In chemistry (including the power of microscopical observa- tion) because without such aid there can be no accurate judgment as to impurities cf air and water, dangerous impregnations of soil, or poisonous admixtures in food ; and because the same science also guides the application of deodorizing and disinfectant agents : " In net tural philosophy, because many nuisances are traced, and many questions as to ventilation and over-crowding are answered by its laws; further, because by its aid the officer of health studies the atmospheric changes, and learns the climate of his district important steps in proceeding to speak of its diseases ; and finally, because natural philosophy, in conjunction with chemistry, render* THE MEDICAL OFFICER OF HEALTH. 571 him competent to report on many manufacturing processes alleged to be hurtful to health, and on the sufficiency of such means as are employed to reduce the evils ascribed to them. " The branches of knowledge here spoken of are parts of every extended medical education for curative and preventive medicine are founded on a common basis ; but they are not the parts which have most direct relation to the treatment of disease. The most distinguished practitioner of a neighbourhood may, indeed, happen to be also the person best qualified for a sanitary appointment ; but the reverse must often be the case, for not all members of the medical profession can afford equal leisure to cultivate those dis- tinctive studies ; and it will imply no disparagement of men actively and skilfully engaged in the treatment of disease, if the special qualifications in question should sometimes be found in other mem- bers of their profession rather than in them. " IV. Other avocations desirable. The occupation of an officer of health will not usually be inconsistent with his devoting a por- tion of his time to certain other professional engagements ; but, where possible, it will be well to debar him from the private prac- tice of his profession first, because the claims of such practice would be constantly adverse to those of his public appointment, the duties of which (especially at times of epidemic diseases, when his official activity would be most needed) private practice could scarcely fail to interrupt and embarrass ; secondly, because the per- sonal relations of private practice might render it difficult for him to fulfil with impartiality his frequent functions of complainant ; and thirdly, because, with a view to the cordial goodwill and co- operation of his medical brethren, it is of paramount importance that the officer of health should not be their rival in practice, and that his opportunities of admonitory intercourse with sick families should not even be liable to abuse for the purposes of professional competition. " Objections of this nature will not generally hold against the officer of health being professionally connected with the medical school or hospital of his town. Provided such engagements are not of too engrossing an amount, it will conduce to the efficiency and public estimation of an officer of health that he be thus kept conversant with the practical aspects of his profession, and have given some security for keeping pace with its scientific progress." Dr. Farr has proposed that in every registration dis- trict a medical officer shall be appointed who shall examine every body which has died without medical attendance, and ascertain if the death be free from 572 DR. FARR'S PROPOSED INSPECTORS. suspicion ; if not to order an inquest. He says the following advantages would accrue : "1. The cause of death would in all cases be certified hy one professional witness, and would be recorded as correctly as is practicable in the present state of science. 2. The fact that a given person died at a given place would be attested by the informant as at present, and the evidence would be enormously strengthened by an educated witness. While so large a portion of our informants cannot even write their names, this is of great importance. 3. Secret murders, and attempts on life, and deaths of children and old people from neglect, would rarely escape detection ; they would, other things being equal, be less frequent than they have been in past times. Life would become more secure ; the public solicitude, like a providence watching over all. would cherish the reverence of all classes for human life. 4. The frauds of informants would be less common, and no registrar would again manufacture fictiti- ous entries, thereby throwing discredit on the whole of the national registers. 5. Much trouble would be saved to the public, who are now put to expense in getting corroborative certificates, as it is felt that the present certified copy of an entry is most imperfect evi- dence of the death and identity of deceased persons. 6. The re- gistration medical officer, visiting the dwellings of people in un- favorable sanitary condition, would discover and point out the consequences of those conditions to the families themselves and to the authorities in seasons of cholera, of fever, or other epidemics. The authorities would find it convenient to make him the health officer of the district, and often where such an officer already exists he might discharge the medical registration duties. The Post- master-General would employ the registration medical officer in insurance business, and so would insurance offices, to whom he could render essential service in putting a stop to the numerous frauds which are every day committed at their expense." Mr. Rumsey, after closely analysing the sanitary systems of various European states, advised, last August, " That in addition to the ordinary professional qualifications re- quired by the Medical Act, evidence of special qualifications and of adequate experience be demanded of all candidates for the ap- pointment of health officer ; and that, after a future date to be fixed in the Act, no appointment be valid without a certificate from some examining board to be constituted or recognised for this purpose that the candidate is duly and specially qualified for the om'ce. That officers of health be protected in the exercise of their DR. FARR'S PLAN QUARANTINE. 573 functions, by repealing all enactments which empower local boards to dismiss them, and by vesting the power of removal in the central authority. That officers of health be legally authorized to pro- cure all necessary information from medical officers of Poor Law districts, workhouses, and other public institutions, registrars, and nuisance officers, and that they have free access to all records and books kept by such officers. That the Poor Law Board and the Registrar-General might co-operate with the Privy Council to es- tablish a combination of the Health Office with that v\hich is now proposed by Dr. Farr to be added to the registration machinery ; namely, a Registration M- dical Officer in each superintendent re- gistrar's district, whose duty it would also be to give evidence and make post-mortem examinations at coroners' inquests, and to in- vestigate the causes of uncertified or suspicious deaths. In English seaports no full system of quarantine can be said to have been in action since 1832, when, for reasons I have before mentioned, it failed in excluding cholera. At Southampton steps are taken against the introduction of yellow fever, and at many others a strict watch is kept for cattle plague. In this city I acted under the Privy Council Order in compelling the removal to hospital of sailors ill of cholera ; but nothing short of stopping all maritime intercourse with infected countries could be relied on for keeping out that disease. A committee of the Social Science Association, including Dr. Farr, Sir J. Gibson, Sir J. Liddell, Sir J. R. Martin, Dr. Milroy, Prof. Owen, and others, drew up an admirable report on quarantine, from which I will give you a few extracts : " 1 . As a general rule, vessels from abroad which have remained free from sickness during their voyage, and on board of which no malignant zymotic disease (chronic maladies not included) exists on arrival, and which are found upon examination to be clean, and to have no putrescent or offensive cargo on board, may be at once admitted to pratique without respect to the country from whence they come. 2. When quarantine detention is deemed nepessary, whether from the actual or recent existence of a malignant disease on board, or from the foul and unwholesome state of the vessel, a careful examination should be made of her, and of all persons on board, by the quarantine medical officer, who should have the power and be charged with the responsibility of adopting such 574 QUARANTINE MORTUARY HOUSES. measures as each case demands. The healthy on board need not generally he detained, and the sooner the sick are removed out of the infected vessel to a suitable locality the better. In cases where small-pox is, or has been on board, all unprotected persons, whether among the crew or passengers, should be vaccinated before they are permitted to disperse. 3. Vessels arriving from abroad should be required to pump out their bilge-water, and to have their bilges thoroughly washed out before they are admitted into any crowded harbour or into docks, &c. The hatches also should have been occasionally kept open, and the hold aired as far as possible before arrival and admission. 4. Before bills of health are given to a vessel on leaving a port, an examination should be made by a competent person to ascertain her sanitary state, and the health of her crew and all on board ; and the particulars should be men- tioned in the bill. 5. Medical quarantine officers should be re- quired to keep accurate records of all matters relating to quarantine, and to the condition and circumstances of the shipping (particu- larly of emigrant and immigrant vessels) arriving in and leaving their ports ; and to prepare an annual report from the data so pro- cured, for the information of the local authorities ; and in this report mention should be made of any epidemic visitation which may have occurred in the place during the year. 6. It would materially conduce to a thorough knowledge of the subject, and probably to the speedy adoption of a more rational and uniform practice generally, if the Government of this country instituted an investigation into the results of quarantine, and the working of quarantine establishments in the chief ports of the south of Europe and of the Mediterranean, where the system is still in greatest force, in order to ascertain the actual truth by personal observation on the spot." The erection of decent mortuary houses where the coroner, jury, and medical witness, while making the necessary post-mortem examination, might be accommo- dated, has been long advocated in England, and in some districts such have been erected. A very commo- dious one was constructed a year ago in Fishamble- street, but was abandoned at the request of those living in the vicinity. These inquiries are at present carried on in yards, than which no place could be more unfit, as has been represented by the Police Commissioners, who also complain that the attendance of constables night and day is necessary, to guard the body and prevent mutilation by dogs or rats. CORONERS' INQUESTS. 575 The shortcomings of the coroner's office are de- scribed as follows by Dr. Taylor, the first of all medical jurists : " The conclusion to which experience leads in reference to these inquiries is, that the system affords no certainty for the detection of crime ; that it affords no protection to those who are wrongly charged with crime ; and lastly, that in some cases it screens a criminal by a verdict based upon an imperfect inquiry, in which the important medical facts are either not understood, or are mis- interpreted by the jury. I was once an attendant at a funeral ; it was delayed, and the cause of the delay was simply this an in- quest had been held on the body (a case of very sudden death in a state of health), and a verdict of ' death from disease of the heart' had been returned. There had been no inspection of the body. When the grave-clothes were removed, and the body was examined, it was found to be covered with bruises, and some of the muscles of the thigh were reduced to a jelly. Death had been clearly caused by violence. But an inquiry before a coroner for two days had, with all the usual formalities of medical evidence, &c., re- sulted in a verdict of ' death from disease of the heart.' Within two hours only of the body being put into the ground, it was clearly proved to be an act of murder or manslaughter. The guilty party was tried, convicted, and punished (Key v. Hopley). This case, with several others of a similar kind, establishes two propositions. The coroner's inquest affords no certainty for the detection of crime ; it in some cases tends to screen a criminal. The secrets of the grave are only known to those who practise medical jurisprudence. In the course of the last thirty years, at least fifteen cases of the exhumation of dead bodies have been referred to me. On some of these, inquests had been held, but no inspections were made. Verdicts of death from cholera or natural causes had been returned, and at intervals of from one month to twenty-two months the bodies have been disinterred, and it has been then proved that the de- ceased had died from poison. In Scotland the office of coroner does not exist ; but in place of this there is an officer named procurator-fiscal, generally a skilled solicitor nominated by com- petent authority, and not elected by scot-and-lot voters." In this city, with the acquiescence of both the coroners, the duties of expert or assessor had been per- formed for fourteen years by a distinguished surgeon, who resigned only on attaining seniority among the leading hospital staff to which he belongs. The arrange- 576 CORONERS' INQUESTS. ment was found most advantageous, because of the greater skill in ascertaining the cause of death, and the consequent detection of crime, which a trained witness possessed over an occasional one. When the deceased person had been attended by any practitioner during life, his evidence was of course received. The arrangement was not continued after this gentleman's resignation. The annual number of inquests held in the city of Dublin is about 220. In Ireland the coroners of counties are feed for only 67 cases, and those of cities for 86 ; but in England they are paid for every case they attend, and the office is in many places most valuable. In 1865 there were 24,787 inquests held in England and Wales, and only 3,188 in Ireland, or considerably less than half in pro- portion to population. The Middlesex justices have applied to the Government for a change in the laws ap- plying to coroners, on the following grounds : " They feel strong objections to the payment of judicial services by a fixed fee for each case, and especially where it is in the power of the judge to increase or diminish the number of cases almost at his own pleasure, and without any practical safeguard being pro- vided against unnecessary inquiries. It is not fair to the judge himself that such an inducement should be offered to him to hold needless inquests, or that he should be exposed even to the suspi- cion of doing so. It is unjust to the ratepayers, for it imposes upon them a burthen regulated almost by caprice, and from which they have no appeal. It is contrary to the practice of the entire judicial system of the country, which pays the judges a fixed salary, not measured by the number of cases adjudicated, the country thereby retaining their entire services. Nor does it appear to your committee that the office of coroner is one entitled to an endow- ment considerably greater than that allotted to a county court judge or a police magistrate." The Lancet upon this remarks : " The Middlesex magistrates who object to the expense of post- mortem examinations in cases on which coroners' inquiries are held, will probably be startled by the following statement of facts in the report of the Registrar-General for 1864 : ' 4,478 deaths took place ia which the causes are " not specified," or " ill-defined ;" be- INQUESTS MEDICAL ASSESSORS. 577 sides 3,321 sudden deaths in which the causes were investigated, often vainly, by coroners' inquests.' " Of those deaths for which causes are assigned, a very large number (seventeen per cent, in 1858) are " uncer- tified" by any medical man. I know myself of two in- stances in which counties' coroners had made arrange- ments to employ one medical man constantly upon the consideration of a part of his fee, and as no honourable practitioner would consent, the investigations were usually most imperfectly conducted. Prof. Taylor is an advocate of introducing into our courts of law, and especially our coroners' courts, experts who, having been especially educated to make medico- legal inquiries, would be more competent to decide than most medical men as at present educated. The system could be easily adopted in large towns, and the country might be divided into distiicts, so as to obtain an expert in all questions of scientific research in the coroner's court. In the superior courts, likewise, it is most painful to see crowds of scientific witnesses ranged on each side, and giving evidence on technicalities, the value of which even the judge cannot weigh. Sometimes experts will be retained to prompt counsel in the cross-examina- tion of medical witnesses, and as the questions thus coached up often consist of truisms, misconceptions, and mispronunciations, the proceedings become most ludicrous. A court of assessors, consisting of able chemists or skilled medical jurists, would give aid which could be relied on, and while the system would prevent much in- justice, it would be probably less expensive than the present. I have not had time throughout these lectures to bring before you the moral elevation which follows in the track of sanitary improvement. More able and far more elo- quent speakers have dwelt upon the topic, and it has 578 EDUCATION IN HEALTH. been truly said by one of them, " Space, a free atmos- phere, and cleanliness, have a great deal to do with the possibilities of human virtue." I trust I have shown you in preceding lectures that medicine, directed by modern sanitary science, has be- come a produ tive art, for it has extended the average duration of life to nearer the standard which was ordained for man, by removing many causes of diseases. I have often before lamented that the elements of physiology or the laws of health were not generally taught, but I will read for you the terms in which sixty-five of the most eminent medcal men in London, some years ago, memorialized Lord Granville, President of the Coun- cil of Education : " Our opinion having been requested as to the advantage of making the elements of human physiology, or a general knowledge of the laws of health, a part of the education of youth, we the undersigned have no hesitation in giving it strongly in the affirma- tive. We are satisfied that much of the sickness from which the working-classes at present suffer might be avoided ; and we know that the best-directed efforts to benefit them by medical treatment are often greatly impeded, and sometimes entirely frustrated, by their ignorance and their neglect of the conditions upon which health necessarily depends. We are therefore of opinion, that it would greatly tend to prevent sickness, and to promote soundness of body and mind, were the elements of physiology in its applica- tion to the preservation of health, made a part of general educa- tion ; and we are convinced that such instruction may be rendered most interesting to the young, and may be communicated to them with the utmost facility and propriety in the ordinary schools, by properly instructed schoolmasters." To take a single instance how many thousand infants' lives might be saved, if young females attending national and other schools, were instructed in the duties involved in the care of babies, arid crowds of wretched infants might be rescued from disease and accident in cities, if they were cared in some such institution, while their mothers were earning their support abroad by coster- EXAMPLES OF IGNORANCE AND NEGLECT. 579 mongering or daily labour. Every hospital surgeon knows that apart from starvation-diseases children so deserted often fall by burns or scalded throats. Milton well defines the usefulness of such knowledge : " Not to know at large of things remote From use, obscure and subtle ; but to know That which before us lies in daily life, Is the prime wisdom." A word or two upon woman's mission in the cause. The Ladies' Sanitary Association in London, of which the Hon. Mrs. W. F. Cowper is President, has done in- calculable service by the circulation of tracts, produced by an editing committee consisting ofDrs. Farr, Suther- land, Marshall; Richardson, Sieveking, and other emi- nent sanitarians. A branch was established in Dublin in 1861, and much useful information on sanitary, indus- trial, and domestic matters was diffused in an entirely uusectarian way. I am afraid, however, that the move- ment has been very partially successful. On the 13ih of last month two persons were suffocated in a cabin near Castlebar, by burning coal in an unaired room without a fire-place ; and on the same night, at Kingstown, in a Maryport schooner, one sailor was killed, and another barely escaped, from having lighted a fire in the forecastle where they usually slept, with a cubic space of about fifty feet ! Ignorance mainly did the mischief, but some stringent laws ought to be made for the regulation of merchant ships. Scurvy, unknown in the Navy, is so common among them, that 101 cases were admitted into the Dreadnaught Hospital Ship in 1866. In the following list the result of examinations among ships, made by the Commissioner of the Bristish Medi- cal Journal last year, is given : 580 EXAMPLES OP IGNORANCE AND NEGLECT. Name of Ship. No. of Hands (all told), Cases of Scurvy. Results of examination of Lime-juice. Hermine 17 5 Sulphuric acid. Merrie England 29 10 Stinking. Mary Fry 23 13 Stirling Castle 32 6 Very weak. Hoang-Ho 21 5 Acetic acid. Blanche Moore 35 8 Nasty and nauseous. Saint Andrew's Castle 19 7 Citric acid. Tamerlane 21 4 Nauseous. Marlboro ugh 23 8 Very weak. Galloway 29 6 Short allowance. Tamar 17 2 Very weak. French Empire 27 7 or 8 Citric acid, Eaglet 14 3 Thick and nasty. Geelong 14 9 Taken irregularly. Thorndean 34 2 Spoiled. (Short sup- ply of provisions.) Nevertheless the fullest knowledge of preventive medi- cine which man will ever attain will but postpone the day ; and the physician, as has been fitly remarked by Prof. Aitken, must, above all, " remember that the sphere of his professional exertion is limited and sur- rounded by insurmountable barriers, and that death will eventually come alike to all, reminding him that he him- self must become a victim to the incompetency of his art." LECTURE XXIV. SANITARY LAWS PROPOSALS FOR CODIFICATION. No medical practitioner who has treated disease in this country, especially in its populous towns, could have failed to observe the insufficiency of the legal enactments towards its prevention which we possessed up to last year. Upon me this conviction forced itself more urgently, after I was entrusted by the Corporation with the carry- ing out of the provisions of the Sanitary Acts concerning this city. Having submitted my views to the Sanitary Committee in January, 1865, 1 was directed to draw out a statement of the differences which existed between Public Health Statutes in England and Ireland. This report was submitted to Sir Robert Peel, then Chief Secretary, and by him referred to Dr. W. N. Hancock, who by directions of his successors, the Right Hon. Mr. Fortescue and Lord Naas, drew up a Health Bill, some clauses of which were embodied in the Sanitary Act passed last session. I may mention, as remarkable facts, that notwithstand- ing our present backwardness, the first Sanitary Act for any part of the kingdom (59th Geo. III., cap. 41) was passed for Ireland, and an appeal that its operations should extend to England was made by the famous Dr. Paris and Mr. (afterwards Judge) Fonblanque ; that the first Par- liamentary Reports on Public Health related to Ireland ; and, thirdly, that it was by the notoriously disgraceful state of a Dublin cemetery, Bully's-acre, that public attention was first awakened to the dangers of intramural sepulture. There is now every hope of amendment of inefficunt 582 ENGLISH AND IRISH LAWS. sanitary measures, but when I first wrote on the subject I had to profess myself unable to account for the remarkable exclusion of Ireland from many salutary statutes which should be universal in all parts of the United Kingdom. One would presume that even our most independent patriots should rejoice to see our country Anglicized in this respect at least; but up to the present " politics," in the usual narrow sense of that word, have been more attractive to orators and more exciting to constituencies than the health and well-being of the people, which the lawgivers of ancient empires made their chiefest care. The only important measures which are still ex- clusively English statutes are, the Public Health Acts, 1848 and 1858, and the Local Government Act, 1858, which renders legislation for any town inexpensive. Their most important provision is the power of institu- ting investigations into the health and sanitary regulations of any town or place, upon the petition of one-tenth of its inhabitants, or when it appears that its death-rate exceeds 23 per 1,000 (17 per 1,000 being the standard of health). I would express the hope that any further Act on the subject with which we may be favoured may be compre- hensive, some attempt being made to codify the present statutes. Attempts at legislation in sanitary matters have been often patchwork for example, in 1853, one mem- ber brought in a " Bill for the Prevention of Glanders," whilst the various Factory Acts and the Bakehouse Act concern merely a few special employments. There is probably no division of our statutes which require codification more than those relating to public health. Sanitary provisions have been strung together in a truly miscellaneous fashion. There are none likewise which require more to be assimilated for all parts of the United Kingdom. The Eight Hon. Mr. Cowper describes the change which occurred in, England in 1858 as follows : BOARD OF HEALTH. 583 " For some years we had a distinct sanitary department of the Government represented in Parliament, but it had no power that could be called centralizing in the obnoxious use of that term. It is true, it attempted to guide and to teach, but it had no vocation to coerce. It collected the experience of particular places where experiments had been made, for general information ; it published reports on the most pressing and difficult sanitary questions ; and its advice was sought from all parts of the country on legal, medical, and engineering difficulties. It aimed at becoming the brain of the sanitary body, diffusing energy and guidance through every limb ; but it never assumed the pretension of becoming arms or legs, and of substituting its own action for any other. The powers of the general board of health were doubtless, too limited, and it was taunted with having so little to do. This taunt might have led to the extension of its powers to larger spheres of usefulness, had not its opponents succeeded in its destruction. But out of its ashes rose a phoenix which may hereafter take a higher flight ; the council office is charged with the consideration of public health." The Social Science Association, through Sir B. Brodie, the chairman, presented a petition on this subject, from which the following is an extract : " Your petitioners are aware that under the Public Health Act passed during the last session of Parliament some provision was made for the kind of action to which they refer; but that enact- ment, the only one which confers on Government a right of in- quiring into evils affecting the public health, was passed but for a single year, and its temporary nature, apart from other defects which it has, must have rendered it almost inoperative. While your petitioners greatly regret that the Act in question should have passed in so unsatisfactory a form, they hope that the necessity thus created for its being reconsidered during the present session of Parliament may lead to its being rendered more effectual for its purpose. Your petitioners therefore earnestly pray that your hon- oui'able house will be pleased to re-enact it as a permanent measure with its present essential features preserved, but with such amend- ments adopted as shall enable her Majesty's Government to make searching inquiry into all cases of excessive local mortality, and to report whether adequate means of prevention are employed by the constituted local authorities." The medical officer of the Privy Council has often had to report cases of neglect on the part of local authorities, to remedy which compulsory powers were needed ; and in his last report he details the case of Mailing, in which 38 584 WANT OF CONSOLIDATION. the efforts of the Privy Council to abate a nuisance failed. He quotes the opinion of the Attorney and Solicitor- Generals of the late Government upon this case : " It is evident that the legislature has hitherto thought it suffi- cient to rely mainly on the vigilance and discretion of the local authorities, without providing against any perverseness or voluntary neglect on their part ; and the present case seems to show that in some districts, at all events, further security is required for the public good." A multiplicity of separate Acts is most inconvenient, and reference to several Acts in using any one, entails much trouble. Mr. Woodhouse, chairman of the Por- tadown Commissioners, in an able appeal for amend- ments in the Towns Act, says : " The people of Scotland applied to Government in 1850 to give them a public Act for the management of their small towns. They were promptly met by Government, and a Bill was introduced granting the Commissioners of the Scotch towns the most ample powers and privileges, carefully compiled together in one Act con- taining 440 clauses, all of which were read, examined, and passed in two nights sitting of the House of Commons, without a single division. And it went its course through the House of Lords without any difficulty or delay." The following case will prove the very great disad- vantages of having powers under two different Acts : Tinkler v. the Board of Works for the Wandsworth district. A notice had been served upon Mr. Tinkler to pull down some filthy privies attached to about forty cottages, and construct efficient water-closets under the Metropolis Local Management Act, 1865, sec. 81. This order was not complied with. Another notice was served on the owner (also under sec. 81) that they would, if the work were not done, enter the premises and execute the necessary works at his expense. The owner obtained an injunction from the Court of Chancery to restrain the Board from proceeding with the work. On the 19th November, 1857, Vice- Chancellor Sir J. Stuart decided upon the plea, that although the powers LAST YEAR'S LEGISLATION. 585 sought to be exercised by the Board of Works were conferred by the Metropolis Local Management Act, he thought, under the Nuisances Removal Act, which gave a more satisfactory appeal to the owner, proceedings should have been taken ; the appeal under the former is to the Metropolitan Board of Works ; in the latter it is from the magistrate to the quarter sessions. On appeal of the Board from this decision to the Lords Justices, the injunction was confirmed. On the 16th of August Dr. Hancock reported to Lord Naas the history of the Sanitary Act, 1866, so far as relates to Ireland : " More than a year ago the attention of Sir Robert Peel, as Chief Secretary, was called to the defective state of the laws as to public health by the town council of Dublin, enclosing the report of Dr. Mapoti er, their Medical Officer of Health, upon the subject. Sir Robert Peel directed an inquiry into the matter, with a view to legislation. Other local authorities made representations to the Government, and the Poor Law Commissioners intimated their opinion of the unsatisfactory state of the law, so far as it devolved on them to administer it. " To illustrate the defects complained of, it is sufficient to refer to what happened only one week before the recent Act received the Royal assent. In England precautions against cholera were taken by the Privy Council there putting in force the provisions of the Disease Prevention Act of 1855. In Ireland the Privy Council had to meet the same emergency by issuing orders for putting in force the provisions of the Nuisance Removal and Disease Pre- vention Acts of 1848 and 1849. " The provisions thus put in force in Ireland within the last ten days were all repealed for England in 1855, on the grounds, as stated in the recital of the Act of that year, ' That the provisions of the Acts of 1848 and 1849, so far as the same relate to the pre- vention or mitigation of epidemic, endemic, or contagious diseases, are defective, and it is expedient to substitute other provisions more effectual in that behalf.' Ireland was thus, ten days ago, as to the official powers of meeting the cholera, under the defective provisions of 1848-49, whilst in England the more effectual pro- visions of 1855 were in force. " Upon the report to Sir Robert Peel, instructions were given by the late Government to prepare legislation that would put an cud 586 LAST YEAR'S LEGISLATION. to this unsatisfactory state of affairs, and give Ireland the benefit of all the latest improvements in the law of public health in Eng- land. Accordingly, a Bill was drawn extending to Ireland in one statute, arranged in the form of a code the English statutes up to 1865. Before this Bill was introduced into Parliament it was as- certained that a new code of public health was preparing for Eng- land. A copy of this was obtained, and the Irish Bill recast to include all the latest improvements. The time spent on political matters prevented the English code being introduced, but instead thereof an Amendment Bill was prepared for England. ' At the period of the session when this Amendment Bill was prepared it became obvious that the only way in which Ireland could by possibility be brought up to the level of English legisla- tion on sanitary matters was by adapting this Bill and all the Acts incorporated to Ireland. Mr. Fortescue proposed this course to the home office authorities, and the Irish clauses were added to the Amendment Bill, and a number of Irishmen were placed on the Special Committee to consider the Bill Lord Robert Montagu, Sir Frederick Heygate, Sir Colman O'Loghlen, Sir John Gray, Mr. Fortescue, and your Lordship. " Upon the present Government succeeding to office, your Lord- ship in the Commons, and the Earl of Belmore in the Lords, took charge of the Irish clauses, and though the general clauses under- went lengthened discussion on the recommittal of the Bill in the Commons, there was no opposition whatever to any of the clauses relating to Ireland, and it is a matter of thankfulness, in the cala- mity with which we are threatened, that so far as imperial legisla- tion is concerned, the central and local authorities in Ireland have now all the same powers and authorities as have been granted by the legislature to the most favoured portion of the empire. " If the form in which the measure has been passed is not as- perfect as it would have been if a health code had been passed for England, it is better for Ireland to have the Act that has been passed than to have a measure more perfect in form, but to have lost the whole of the increased powers conferred by the Act of 1866, which would have been the case, if the Irish code as pre- pared at the commencement of the* session had alone been passed for Ireland." It cannot be dcniel that a more comprehensive and comprehensible Act is to be wished for. While advocating the extension of sanitary legislative enactments to Ireland, I will not conceal the fact that some of those which are already in force are not taken TOWNS IMPROVEMENT ACT. 587 full advantage of. I allude to the " Towns Improvement Act," 9th Geo. IV., and to that better statute, the "Towns Improvement Act, 1854." Only ninety-six towns have availed themselves of the advantages of either, and only twenty, according to Dr. Hancock's statistical returns, have appointed surveyors or inspectors of nuisances officers essentially necessary in carrying out any provision for the sanitary condition of the towns. Thus, about half-a-million of Irish towns-people are living without municipal precautions. The main cause of this neglect in the case of the eighteen towns under the old Act appears to be, that the owners of houses under 5 yearly value are exempted from the rate ; and the remedy is to be found in the extension of the opera- tions of the Board of Works to the drainage of towns where sanitary investigations shall demonstrate the pre- valence of avoidable disease, and by the extension of these sanitary measures to Ireland which I have en- deavoured to show have been attended with such happy results in England. As Act of Parliament-making is usually regarded as the statesman's or the lawyer's province, I hesitate to interfere ; but it may not be presumptuous in one who, although belonging to a profession often regarded as un- concerned in legislative matters, has been freely acting under the defective sanitary laws we possess, to suggest a few amendments and consolidations. I have, there- fore, arranged the following propositions, mainly founded on the marginal summaries of English Acts, while the Acts relating to Ireland at present will be found in the Appendix. The verbiage of a Sanitary Act should be most clear , as magistrates will not act if it be at all ambiguous, and local boards will not undergo the expense of an appeal. 1. Interpretation of terms (10 and 11 Vic., cap. G8, 588 SUGGESTIONS TERMS BODIES. sec. 2 ; 17 & 18 Vic., cap. 103, sec. 1). Such words as " owner " or "lodging-house," should be most positively defined ; in the Scotch Act (19 and 20 Vic., cap. 103) the word used is "author of nuisance," signifying "the person through whose act or default the nuisance is caused, exists, or is continued, whether he be the owner or occupier, or both ; and " common lodging-house" "shall signify a house or part thereof where lodgers are housed at an amount not exceeding threepence per night for each person, whether the same be paid nightly or weekly." " Sanitary authority" seems to me a suitable and inclusive term. Such names as " nuisance autho- rity," " sewer authority," "burial authority," &c., lead to confusion, and the title " chairman of nuisance autho- rity " is such as the leading man of a district would take pride in. 2. The Act to apply to all cities and towns and all unions in Ireland. The Municipal Councils, the Town Commissioners, and the Poor Law Guardians to be the "sanitary authority," and each authority to report an- nually to Chief Secretary for Ireland (21 and 22 Vic., cap. 98, sec. 12, 13, 14/15, 16, and 17). Some record of proceedings is surely needed, and the mode adopted in England seems good. The provisions of the above named Act, Local Government, 1858, are very excellent with regard to election of local board and settlement of boundaries, as also t hose of Metropolis Management Act, 1855. This Act, passed through the exertions of Sir B. Hall (now Lord Llanover), sewpt away many obstruc- tive bodies, but there still remained, besides the police commissioners and magistrates, the corporations of London and Westminster, the Metropolitan Board, and the vestries and guardians of thirty-nine districts, to control sanitary matters. A map of London, to show the extent and jurisdiction of the several governing bodies should have fourteen different boundary lines. Enlarge- SUGGESTIONS DISTRICTS BYE-LAWS. 589 ment of districts by union of small ones, is more desir- able in Ireland than reduction. There should be some qualification required for a member of committee under sec. 4 of the Sanitary Act. Mr. Rumsey has forcibly advocated the following amendments in sanitary law. A. Areas of sanitary administration to be extended, so as to in- clude all outlying suburbs and parishes. B. The whole surface of the country "to be divided into sanitary districts, so that every parish may be contained in some sanitary jurisdiction. C. Bound- aries of Poor Law Unions (registration districts) to be recognised and generally employed in determining the areas for sanitary ad- ministration. " D. All local boards, sewer and nuisance authori- ties, &c., to be combined and incorporated within every such sani- tary district. E. Constitution of local sanitary authorities to bu reformed, by adding persons possessing other qualifications than those now required under various enactments. F. A single cen- tral department to be adequately empowered, and aided by divi- sional inspectors, for purposes of investigation, direction, and control. G. Various provisions of former Sanitary Acts to be con- solidated, methods of procedure to be simplified, and power to ini- tiate proceedings to be vested in persons authorized to act as public prosecutors. H. The qualifications and tenure of office of the several classes of officers employed in sanitary administration to be determined by law, or by the central authority. I. Medical officers of health and registration, acting also as medical jurists, to be appointed in the several sanitary districts, on the condition suggested in the preceding pages." 3. Sanitary authorities should all be corporations for the purpose of suing and being sued. 4. Local authority to make bye-laws for the pre- vention of nuisances, especially from trades, and for the conduct of officers ; to be confirmed by Chief Secretary. The Local Government Office London has framed most excellent bye-laws, which are usually adopted by local boards, so that great uniformity exists. 5. The Lord Lieutenant in council may direct inqui- ries, and may appoint an officer who shall report annu- 590 SUGGESTIONS INSPECTION. ally on the state of towns ; or for the purpose an in- spector shall be appointed by the Poor Law Commis- sioners (21 and 22 Vic., cap. 97, sec. 3, 4, and 5 ; 21 and 22 Vic., cap. 98, sec. 79). Such is necessary, to see that occasional inspections which, under the 20th section of the Sanitary Act, 1866, are now compulsory, are carried out. By the 16th section the officer of police is .made the superior authority to discover any default of sanitary duty in the local board ; but it may be asserted the necessary technical knowledge is not possessed. The clause in the bill giving such power to competent per- sons was struck out, and, indeed, unless there was some means for providing them without local expense, the most unwholesome conditions would remain in many places. In the Scotch Sanitary Act, 1856, which is the ost comprehensive and well-managed ever passed i n these kingdoms, two householders may complain of the default of the local authority to the sheriff, who shall then hold an investigation. 6. The Board of Public Works to be the officers provided for the supervision of all works constructed in accordance with this Act (21 and 22 Vic., cap. 98, sec. 79 and 80). 7. Upon petition of a certain proportion of house- holders, or when the deaths in any district appear on the Registrar- General's returns to be above a proportion of 23 per 1,000 of the population, the inspector of the Privy Council or Poor-law Commission to make local inquiry (11 and 12 Vic., cap. 63, sec. 8). 8. After inquiry, in certain cases the Act shall be put in force by order of the Lord Lieutenant in council (11 and 12 Vic., cap. 63, sec. 10). The tenement-house clause (35) of the Sanitary Act can only be put in force when the local authority applies to the Lord Lieute- nant. BUILDING CLAUSES. 591 9. Local authority shall appoint a clerk, officer of health, surveyor, and inspector of nuisances, and make bye-laws for the due performance of their duties (11 & 1*2 Vic., cap. 63, sec. 37, 38, 39, 40). In my Fifteenth Lecture I gave evidence that a permissive clause on this matter will be disregarded. It has been suggested that the constabulary, instead of relieving officers, should carry out the provisions of the Nuisances Act, and that they should receive part of the fines. As this force is more than twice as numerous with us as the analogous body in England, and as their time is not fully occupied, except on occasions of politi- cal excitement, there seems to be no objection to the arrangement. Under the present system it is unde- niable that an epidemic is often at its height before any precautionary steps are taken, and we have no means to " stamp it out." 10. New streets and new buildings shall be built according to plans fixed on by the local authority, with regard to structure of walls, airing, draining, and the provision of yard space of at least 100 square feet, to every house. 21 & 22 Vic. cap. 98, sec. 84, &c. Many English towns possess admirable Building Acts. In Liverpool the authorities are empowered to open all courts which at present are cul-de-sacs a desi- deratum most truly in this city, if our municipal funds would justify the expenditure. By the 22nd section of the Birmingham Act, 1861, it is enacted " Seven Days at the least before beginning to dig or lay out the Foundation of or for any new House or Building, or to rebuild any House or Building pulled clown, to or below the floor, generally called the Ground Floor, the Person intending so to build or re- build, shall give to the Council or Surveyor of the Borough written Notice thereof, mentioning the intended level of the Cellars or lowest Floor, and " the situation of the Privies and Cess-pools or Drains to be built, constructed or used in connection with such House or Building ; and shall at the same time deposit with the 592 BUILDINGS DRAINAGE. Surveyor Plans of the same, drawn on a Scale, with a Block Plan of the site, shewing the proposed Lines of the Drainage of the House or Building, and the Size, Depth, and the Inclination of such Drains ; and it shall not be lawful to hegin to build or re- build any such House or Building, or to build or to construct any such Privy, Cesspool, or Drain until the Particulars so required to be stated, and the said Plans shall have been approved by the Council or their Surveyor ; and in default of such Notice being given or Plans deposited, or if any such House, Building, Privy, Cesspool or Drain be built, rebuilt, or constructed as aforesaid, without such approval, or in any respect in Deviation from the said Plans, or contrary to the Provisions of this Act and the recited Act, or of any Act incorporated therewith, the Offenders shall be liable for every such offence to a Penalty not exceeding Twenty Pounds, and the Council may, if they shall think fit, cause such House, Building, Privy, Cesspool, or Drain, to be altered, pulled down, or otherwise dealt with as the case may require, and the ex- penses incurred by them in so doing shall be repaid by the offender, and be recoverable from him as damages : provided always, that if the Council or their Surveyor fail to signify their or his approval or disapproval of the said Particulars and Plans for the space of Seven Days after due service of the Notice and Deposit of the Plans, it shall be lawful to proceed according to such Notice and Plans." And by the 51st section of the said Act it is also enacted that "The external walls of all buildings exceeding one storey in height, erected after the commencement of this Act, within the borough, shall be throughout of a thickness of not less than nine inches." 11. Houses to be purified, and damp earth under floors to be replaced by suitable matter, on certificate of officer of health, or of two medical practitioners, 11 & 12 Vic. cap. 63, section 60. 12. All sewers shall be vested in local authority, who may cause to be prepared a map, exhibiting the sewer - age of the district, and shall make, alter, or discontinue sewers. 11 & 12 Vic. cap. 63, sees. 41, 43, and 45. The Sewage Utilization Act, 1866, which will be found in the Appendix, has been taken advantage of in a few cases. LODGING-HOUSES NUISANCE. 593 13. No new house shall be erected without a drain, and local authority may, upon report of surveyor that any house is without a drain, cause one to be constructed ; the expense to be recoverable from the owner. 11 and 12 Viet. cap. 63, sec. 49. The works should be superintended by the officers of the local authority. 14. Local authority shall provide a proper supply of water for the district, as by the sections of the Public Health Act, extended to Ireland by the Sanitary Act, I860, and may compel all houses to be supplied at a rate not exceeding 2d. per week. Fountains and drink- ng troughs for cattle should be provided. 15. In towns of over 5000 inhabitants, all houses in which lodgings are let shall be regulated under the Sanitary Act, 1866, sec. 35. This was granted by the Act last August, but I am not aware that bye -laws under it are yet in force in any town except Dublin. 1 6. Local authority of towns may erect and maintain lodging-houses, and borrow money for the purpose from the Public Works Loan Commissioners. This was granted last session under the Labourers' Dwellings Act, to towns, public bodies, and estated in- dividuals. The application from Dublin is the only one I have heard of. 17. The word "nuisances" shall include any pre- mises in such a state from insufficiency of size or other circumstance, as to be a nuisance or injurious to health any well, foul ditch, gutter, water-course, privy, urinal, cesspool, drain, or ashpit, so foul as to be a nuisance or injurious to health, any animal so kept as to be a nuisance injurious to health, any accumulation or deposit which is a nuisance or injurious to health,. 19 & 20 Viet. cap. 103, sec. 18. 594 OVER- CROWDING. Mr. T. Barkers defines nuisances, and cites illustrative cases : "By the Common Law anything which causes injury to the neighbourhood, or to the natural rights of property, is a nuisance. No actual injury need have happened, it is sufficient if the thing complained of be likely to produce it. (E. v. Vantandillo, 4 M. & S., 73.) Thus a building so constructed as to exclude light from other buildings previously existing ; any noxious manufacture polluting the air or water; the stoppage of a water-course, &c., are nuisances. And it has been established by numerous decisions that no length of time will legitimate a nuisance. The remedy is by indictment, or, in private nuisances, by action. E. v. Pappineau, 1 Stra., 686.) But the nuisance may, in certain cases, be removed by the suffering party (Earl of Lonsdale v. Nelson, 2 Q. B., 311.) It is not necessary that a public nuisance should be injurious to health, nor will the presence of one nuisance justify another ; if there be smells offensive to the sense that is enough, as the neigh- bourhood has a right to fresh and pure air, so also have persons passing along the highway (E. v. Neil, 2 C. & P., 85.) Under the 29th section of the Nuisances Act, 1855, now extended to Ireland, the London magistrates ad- judge all rooms to be overcrowded which do not allow 500 cubic feet for each adult, and 300 for each child. It would he better to have this proportion denned as it is in the General Police and Improvement (Scotland) Act, 1862, in which, however, the allowance is not suf- ciently liberal, for it declares that each person over eight years shall have 300 cubic feet of space, and under that age 150, and that no room having less than 700 cubic feet in space shall be the exclusive dwelling of one fa- mily. In the Dublin and many other bye-laws, under the lodging-house section of the Public Health Act, 300 cubic feet is the standard. t There are hundreds of dwellings recorded in our " Sanitary Kegister " at the City Hall as having deve- loped fever and other contagious diseases, in which over- crowding existed to the utmost, and yet no amendment was possible until the Legislature conferred on us the Public Health Act, The following instance, by Dr. G-airdner, the Medical Officer of Health for Glasgow, OVER-CROWDING UNSAFE FOOD. 595 demonstrates the marvellous effect of thinning inhabi- tants in the prevention of typhus. The house No. ^3 Drygate-street, aptly termed " the Rookery," consisted of 48 separate tenements, \vith an average of 4 per- sons to each room, each individual having 126 cubic feet of space, or one-fourth of the minimum space al- lowed for each soldier according to the Barracks Com- mission. In this building 39 cases of typhus had arisen during the year ending June 30th, 1863. Under the Police Act the tenements were thinned, and although fever in the city had doubled, and was prevalent in the very street, but once case occurred in the Rookery dur- ing the succeeding year. The sentence requiring the house to be occupied by more than one family should be omitted, as it is in the Scotch Act, 1856, for it excludes from any amendment many wretched cabins and stables (for even such places are converted to the purpose of human habitation), and which are greatly over- crowded. Any person who will visit Ball's-yard (a closed court off Meath- street;, will find several houses consisting of a single room, of about 1,200 cubic feet in space, thronged with six, seven or eight human beings, and such dwellings are, moreover, not touched by the Common Lodging House Acts. 18. Food unsafe for use should be treated as a nui- sance. The 26th section of the Nuisances Act, 1855, requires some change, for a London magistrate refused to recognise a decoction of putrid horse-livers, sold as catsup, as being within the meaning of the clause. The smoke from a factory is a nuisance under Sani- tary Act, 1866, but not that of a private house an injurious distinction which the committee on the Bill struck out. 19- No offensive trade shall be newly established without the consent of local authority, as is the case in 596 OFFENSIVE TRADES. the Towns Act, 1854 ; but Dublin, for instance, is without any such provision, which is an example out of many of the need for assimilation of municipal law. That measures with regard to trades must be well de- fined and stringent, the following case will shew : Proceedings were taken against the owner of a che- mical factory, in which gas liquor was used for making alum, a fearfully poisonous stench being emitted, as was abundantly proved. The defendant alleged that many other nuisances were produced in the same neighbour- hood, and upon this pretext the magistrate dismissed the summons, remarking that the whole force of the law could not make the place pleasant to live in. Com- menting on this case, the Times remarked " One nuisance, it is evident, can be made to protect another, and fifty in a lump will be perfectly unassailable." The Buildings Act (England), 7 & 8 Viet., c. 84, sec. 55, provides that any person who shall establish or newly carry on any one of certain offensive businesses, therein enumerated, within fifty feet from a dwelling-house, shall be liable to a penalty of 50 a day. 20. A clause similar to that in the Metropolis Act, 1862, directing licensing of cow-houses, and thereby giving powers to compel sewerage, water supply, and to prevent overcrowding in them, and the retention of ma- nure, is very desirable. Such seems now more neces- sary than ever, when there is dread of ivnasion by the cattle plagne, which has re-appeared in the sheds in Islington, where it began in June, 1865. Cowsheds are not well drained, as the owners do not wish to lose the liquid manure; the refuse is often stored till it becomes quite offensive. They are always overcrowded, 1000 cubic feet of space being the proper amount for a cow, and the paving and the water supply is often very bad. Yet attempts to improve the state of things is often met with assertions entirely unfounded, PREVENTION OF DISEASE. 597 that " nothing is so wholesome as the smell of a cow- house." On the contrary, these conditions lead to the development and spread of disease amongst the stock, and the consequent deterioration of the milk or flesh of the animal. 21. Lord Lieutenant in Council empowered to issue orders for prevention of epidemic disease when preva- lent, providing for the speedy interment of the dead, and house to house visitation. The provisions of the Diseases Prevention Act are so good, that it is a pity it is not permanent. 22. Local authority shall provide carriages for con- veyance of infected persons. fco great is the evil resulting from cabs being used for small-pox and other contagious cases, that the provision of special vehicles should be compulsory, and a notice stating where they are to be had should be posted at every cab-stand. The 24th clause of the Sanitary Act, 1866, is merely permissive on the point. 23. Local authority may remove sick persons from lodging-houses to hospital. 19 and 20 Viet., c. 103, sec. 38. The Contagious Diseases Prevention Act, 1864, is di- rected against a disease which taints, perhaps, every fortieth babe, and engrafts hereditary maladies on one- fourth of our race, yet which is repressible, to some extent, at least, by coercive measures. It is to be in force for three years in English military and naval sta- tions, and in Ireland at the Curragh, Cork, and Queens- town only ; but if succe'ssful, I trust all the larger cities in Ireland may share its advantages. 24. Local authority shall be the Burial Board. 21 and 22 Vic. cap. 98, sec. 49 and 19, and 20 Vic. cap. 98. 598 SUPERINTENDENCE OF BURIALS. 25. The Lord Lieutenant in Council or Poor Law Commissioners may appoint a duly qualified inspector to examine the state of existing burial grounds, and the suitability of the sites of any which may be proposed. 18 and 19 Vic. cap. 128, sec. 8. In my 14th Lecture I endeavored to shew that some such superintendence was needed, and I will now quote that eminent legal authority, Mr. Thomas Baker, to prove the advantageous results in England. " During the twelve years since the passing of the first Burial Act in 1852, a great sanitary revolution, as regards the burial of the dead, has quietly taken place in this country. Within this period, some four hundred local Burial Boards have been consti- tuted, and there is scarcely a market town of any consequence which has not already provided, or is now engaged in providing, adequate means for the decent interment of its dead beyond the dwellings of the living. During these twelve years, also, about five hundred Orders in Council have been issued, by which near four thousand old burial grounds, belonging to religious professors of all denominations, have been either closed or placed under regu- lation. Perhaps the majority of these consisted of mere scraps of ground wedged in, as it were, between densely inhabited districts ; each church or chapel being surrounded with its own precinct of corruption. In the new cemeteries, which are commodious and well drained, sufficient space is provided for all sects and all ranks, uniting thus, after the petty contentions and distinctions of life are over, ' all sorts and conditions of men ' into one common fold. Not surcharged burial grounds alone, but the use of vaults under places of worship, have been discontinued under these Acts. Accordingly, in the Metropolis only, nearly one hundred church vaults each, for the most part, occupying the entire space beneath the building have been thoroughly disinfected and permanently built up. An interesting illustration of the cordial manner with which this great social reform has been received by the ratepayers of England, is afforded by the fact that a sum exceeding 1,400,000 has been already raised for the provision of the parochial cemeteries in question. The interment of the dead beneath and around churches has been called a ' distinctive feature of Christian burial ; ' but the persons who make this assertion forget that burial in the time of Christ was extramural. The Widow of Nain was followii i ' her son out of the city. Lazarus was interred in a cave beyond Bethany. The demoniac at Gadara, dwelling among the tombs near the coast, met Josus as he approached towards the town ; and AMALGAMATION OF POWERS. 591) the Holy Sepulchre was in a garden outside Jerusalem. So far from condemning this custom, our Saviour, in one of his strongest figures, would seem to indicate an approval of it : the hypocritical Pharisees were compared to ' whited sepulchres full of dead men's bones and all uncleanness.' The truth is, that we owe the intro- duction of ' Church burial ' to the superstitious observances of the dark ages." 26 Local authority may erect and manage markets, and manufacture gas. Considerable profit would accrue, and might be expended on sanitary improvements. 27. Local authority may lay out grounds for recreation of adults, and play grounds for children. This was made the subject of a special act for England and Ireland (22 Vic. cap. 27), but I am not aware that it has been taken advantage of in this country. 28. The local authority shall be the authority for carrying out the provisions of the Bakehouse Eegulation Act (26 and 27 Vic. cap. 40), and shall exercise the powers conferred by the Towns Police Clauses Act, 1847, in the following matters : Obstructions in streets, fires, places of public resort, hackney carriages, bathing, and also powers conferred by Towns Improvement Clauses Act, 1847, for naming streets and numbering houses, improving streets, removing dangerous buildings, supply of water, prevention of smoke, slaughter-houses, clocks, and public libraries. The above and other minor acts surely need amalga- mation into a code for the regulation of all matters relating to the government of towns. 29. Simplification of forms in taking legal steps. Great obstruction is exper enced from the verbosity of the forms of the Nuisances Act (quoted in the Appendix). The mode of legal proceedings directed by Public Health Act, 1848, and amended by Local Government Act, 1858, seem most advisable. As also are those directing auditing of accounts. Dn- 39 600 SUGGESTIONS. willingness to pay taxes for sanitary purposes would diminish if it was felt that 'the money was judiciously expended. The clauses relating to borrowing powers of these acts are vastly superior to those of the Towns Act, 1854 (Ireland). Loans for the drainage of estates have been freely granted, and are more necessary for the drainage of towns. The taking of land for public pur- poses, with due- compensation, should be granted to sanitary authorities without the expense of a private Act of Parliament. APPENDIX. 29 & 80 Vic., cap. 90 An Act to amend the' Law relating to the Public Health, 1866. WHEREAS it is expedient to amend the law relating to Public Health, be it enacted by the Queen's Most Excellent Majesty, by and with the advice and consent of the Lords Spiritual and Tem- poral, and Commons, in this present Parliament assembled, and by the authority of the same as follows : Preliminary Short Title of Act, 1. This Act may be cited for all purposes as the Sanitary Act, 1866. PART I. AMENDMENT OF THE SEWAGE UTILIZATION ACT, 1865. Definition of " Sewer Authority 1 ' " Lord Lieutenant in Council." 2. " Sewer authority" in this Act shall have the same mean- ing as it has in the Sewage Utilization Act, 1865. The words " Lord Lieutenant in Council" shall mean in this Act the Lord Lieutenant or any Chief Governor or Chief Governors in Ireland, acting by and with the consent of Her Majesty's Privy Council in Ireland. This part to be construed with 28 8f 29 Viet., cap. 75. 3. This part of this Act shall be construed as one with the Sewage Utilization Act, 1865, and the expression, " The Sewage Utilization Act, 1865," as used in this or any other Act of Parlia- ment or other document, shall mean the said Sewage Utilization Act, 1865, as amended by this Act. Power to Sewer Authority to form Committee of its own members and others. 4. Any sewer authority may from time to time, at any meeting specially convened for the purpose, form one or more committee or committees consisting wholly of its own members, or partly of its own members and partly of such other persons contributing to the rate or fund out of which the expenses incurred by such authority are paid, and qualified in such other manner as the sewer authority may determine, and may delegate, with or without conditions or restrictions, to any committee so formed, all or any powers of such sewer authority, and may from time to time revoke, add to, or 602 PUBLIC HEALTH ACT, 1866. alter any powers so given to a committee. A committee may elect a chairman of its meetings. If no chairman is elected, or if the chairman elected is not present at the tim appointed for holding the same, the members present shall choose one of their number to be chairman of such meeting. A committee may meet and adjourn as it thinks proper. The quorum of a committee shall consist of such number of members as may be prescribed by the sewer au- thority that appointed it, or if no number be prescribed, of three members. Every question at a meeting shall be determined by a majority of votes of the members present, and voting on that ques- tion ; and in case of an equal division of votes, the chairman shall have a second or casting vote. The proceedings of a committee shall not be invalidated by any vacancy or vacancies amongst its members. A sewer authority may from time to time add to or diminish the number of the members, or otherwise alter the con- stitution of any committee formed by it, or dissolve any committee. A committee of the sewer authority shall be deemed to be the agents of that authority, and the appointment of such committee shall not relieve the sewer authority from any obligation imposed on it by Act of Parliament or otherwise. Formation of Special Drainage District. 5.* Where the sewer authority of a district is a vestry, select vestry, or other body of persons acting by virtue of any Act of Par- liament, prescription, custom, or otherwise as or instead of a vestry or select vestry, it may, by resolution at any meeting convened for the purpose, after twenty-one clear days notice affixed to the places where parochial notices are usually affixed in its district, form any part of such district into a special drainage district for the pur- poses of the Sewage Utilization Act, and thereupon such special drainage district shall, for the purposes of the Sewage Utilization Act, 1865, and the powers therein conferred, be deemed to be a parish in which a rate is levied for the maintenance of the poor, and of which a vestry is the sewer authority, subject, as respects any meeting of the inhabitants thereof in vestry, to the Act of the 58th year of the reign of King George III V cap. 69, and the Acts amend- ing the same ; and any officer or officers who may from time to time be appointed by the sewer authority of such special drainage districts for the purpose shall have within that district all the powers of levying a rate for the purpose of defraying the expense of carrying the said Sewage Utilization Act into effect that they would have if such district were such parish as aforesaid, and such rate were a rate for the relief of the poor, and they were duly appointed overseers of such parish. * S^cts. 5, 6, 7, appear not applicable to Ireland. PUBLIC HEALTH ACT, 1866. 603 Appeal against constitution of Special Drainage District. 6. Where the sewer authority of any place has formed a special drainage dist;ict in pursuance of this Act, if any number of the inhabitants of such place, not being less than twenty, ftel aggrieved by the formation of such district, or desire any modifica- tion in its boundaries, they may by petition in writing under their hands, bring their case under the consideration of one of her Ma- jesty's principal Secretaries of State, and the said Secretary of State may after due investigation annul the formation of the special drainage district or modify its boundaries as he thinks just. Evidence of formation of Special Drainage District. 7. A copy of the resolution of a sewer authority forming a special drainage district shall be published by affixing a notice thereof to the church door of the parish in which the district is situate, or of the adjoining parish if there be no church in the said parish, and by advertising notice thereof in some newspaper published or cir- culating in the county in which such district is situate ; and the production of a newspaper containing such advertisement, or a cer- tificate under the hand of the clerk or other officers performing the duties of clerk lor the time being of the sewer authority which passed the resolution forming the district, shall be evidence of the formation of such district, and after the expiration of three months from the date of the resolution forming the district, such district shall be presumed to have been duly formed, and no objection to the formation thereof shall be entertained in any legal proceedings whatever. Power to drain into Sewers of Sewer Authority. 8. Any owner or occupier of premises within the district of a sewer authority shall be entitled to cause his drains to empty into the sewers of that authority, on condition of his giving such notice as may be required by that authority of his intention so to do, and of complying with the regulations of that authority in respect of the mode in which the communications between such drains and sewers are to be made, and subject to the control of any person who may be appointed by the sewer authority to superintend the making of such communications ; but any person causing any drain to empty into any sewer of a sewer authority without com- plying with the provisions of this section shall incur a penalty not exceeding 20, and it shall be lawful for the sewer authority to close any communication between a drain and sewer made in con- travention of this section, and to recover in a summary manner from the person so offending any expenses incurred by them under this section. 604 PUBLIC HEALTH ACT, 1866. Use of Sewers ly persons beyond District. 9. Any owner or occupier of premises beyond the limits of the district of a sewer authority, may cause any sewer or drain from such, premises to communicate with any sewer of the sewer autho- rity, upon such terms arid conditions as may be agreed upon be- tween such owner or occupier and such sewer authority, or in case of dispute may, at the option of the owner or occupier, be settled by two justices or by arbitration in manner provided by the Public Health Act, 1848, in respect of matters by that Act authorised or directed to be settled by arbitration. As to the drainage of houses. 10. If a dwelling house within the district of a sewer authority is without a drain, or without such drain as is sufficient for effectual drainage, the sewer authority may by notice require the owner of such house within a reasonable time therein specified to make a sufficient drain emptying into any sewer which the sewer authority is entitled to use, and with which the owner is entitled to make a communication, so that such sewer be not more than 100 feet from the site of the house of such owner ; but if no such means of drainage are within that distance, then emptying into such covered cesspool or other place, not being under any house, as the sewer authority directs ; and if the person on whom such notice is served fails to comply with the same, the sewer authority may itself, at the expiration of the time specified in the notice, do the work re- quired, and the expenses incurred by it in so doing may be re- covered from such owner in a summary manner. Supply of Water to District of Sewer Authority. 11. A sewer authority within its district shall have the same powers in relation to the supply of water that a local board has within its district, and the provisions of the sections herein-after mentioned shall apply accordingly in the same manner as if in such provisions " sewer authority" were substituted for " local board of health" or " local board," and the district in such provisions mentioned were the district of the sewer authority and not the district of the local board ; that is to say, the sections numbered from 75 to 80, both inclusive, of the Public Health Act, 1848, sections 51, 52, and 53 of the Local Government Act, 1858, and section 20 of the Local Government Act, 1858, Amended Act, 1861. The sewer authority may, if it think it expedient so to do pro- vide a supply of water for the use of the inhabitants of the dis- trict by (1) Digging wells ; (2) Making and maintaining reser- voirs ; (3) Doing any other necessary acts ; and they may them- PUBLIC HEALTH ACT, 1866. 605 selves furnish the same, or contract with any other persons or companies to furnish the same : provided always, that no land he purchased or taken under this clause except by agreement or in manner provided by the Local Government Act, 1858. Expenses of Sewer Authority in supplying water. 12. Any expenses incurred by a sewer authority in or about the supply of water to its district, and in carrying into effect the pro- visions herein-before in that behalf mentioned, shall be deemed to be expenses incurred by that authority in carrying into effect the Sewage Utilization Act, 1865, and be payable accordingly. Wells, Sfc.j belonging to any place vested in Sewer Authority, fyc. 23 8f 24 Viet, cap.' 77, sec. 7. 13. All property in wells, fountains, and pumps, and powers in relation thereto, vested in the nuisance authority by the 7th section of the act passed in the session of the 23rd and 24th years of the reign of her present Majesty, chapter 77, shall vest in the sewer authority, where the sewer authority supplies water to its district. PART II. AMENDMENT OF THE NUISANCES REMOVAL ACTS. Definition of" Nuisances Removal Acts." 14. The expression "Nuisances Removal Acts" shall mean the Acts passed in the years following of the reign of her present Majesty, that is to say, the one in the session of the eighteenth and nineteenth years, chapter 121, and the other in the session of the twenty-third and twenty-fourth years, chapter seventy r seven, as amended by this part of this Act ; and this part of this Act shall be construed as one with the said Acts, and all expenses incurred.by a nuisance authority in carrying into effect any of the provisions of this part of this Act shall be deemed to be expenses incurred by it in carrying into effect the Nuisances Removal Acts. Definition of" Nuisance Authority" 15. "Nuisance Authority" shall mean any authority empowered to execute the Nuisances Removal Acts. Power of Police with respect to Nuisances. 16. In any place within the jurisdiction of a nuisance authority the chief officer of police within that place, by and under the di- rections of one of her Majesty's principal secretaries of state,* on * In Ireland by the Lord Lieutenant. 606 PUBLIC HEALTH ACT, 1866. its being proved to his satisfaction that the nuisance authority has made default in doing its duty, may institute any proceeding which the nuisance authority of such place might institute with respect to the removal of nuisances : provided always, that no officer of police shall he at liberty to enter any house or part of a house used as the dwelling of any person without such person's consent, or without the warrant of a justice of the peace, for the purpose of carrying into effect this Act. Section 3 of 23 8f 24 Viet. c. 77, repealed. 17. The third section of the said Act of the session of the twenty-third and twenty-fourth years of the reign of her present Majesty, chapter 77, shall be repealed, and all powers vested in any highway board or " Nuisance Removal Committee" under the Nuisances Removal Acts shall determine, and all property belong- ing to them for the purposes of the said Nuisances Removal Acts shall, subject to any debts or liabilities affecting the same, be trans- ferred to or vested in the nuisance authority under the said Acts : provided always, that this section shall not extend to any vestry or district board, under the Act of the session of eighteenth and nineteenth years of the reign of her present Majesty, chapter 120, intituled An Act for the better Local Management of the Metro- 'polis (18 & 19 Viet. c. 120), or to any committee appointed by such vestry or district board for the purpose of carrying into effect the Nuisances Removal Acts or any of them. Requisition of ten inhabitants equivalent to certificate of Medical Officer. 18. A requisition in writing under the hands of any ten inha- bitants of a place shall for the purposes of the twenty-seventh section of " The Nuisances Removal Act for England, 1855," be deemed to be equivalent to the certificate of the medical officer or medical practitioners therein mentioned, and the said section shall be enforced accordingly. Addition to definition of Nuisance. 19. The word " nuisances" under the Nuisance Removal Acts shall include,* 1. Any house or part of a house so overcrowded as to be dangerous or prejudicial to the health of the inmates. 2. Any factory, workshop, or workplace not already under the operation of any general Act for the regulation of factories or bakehouses, not kept in a cleanly state, or not ventilated in such a manner as to render harmless as far as practicable any gases, vapours, dust, or other impurities generated in the course of the * Additional to those in Nuisances Act, 1855. PUBLIC HEALTH ACT, 1866. 607 work carried on therein that are a nuisance or injurious or dan- gerous to health, or so overcrowded while work is carried on as to be dangerous or prejudicial to the health of those employed therein. 3. Any fireplace or furnace which does not as far as practicable consume the smoke arising from the combustible used in such fireplace or furnace, and is used within the district of a nuisance authority for working engines by steam, or in any mill, factory, dyehouse. brewery, bakehouse, or gaswork, or in any manufactory or trade process whatsoever. Any chimney (not being the chimney of a private dwelling house) sending forth black smoke in such quantity as to be a nuisance. Prov.ded, first, that in places where at the time of the passing of this Act no enactment is in force compelling fireplaces or furnaces to consume their own smoke, the foregoing enactment as to fireplaces and furnaces consuming their own smoke shall not come into operation until the expiration of one year from the date of the passing of this Act. Secondly, that where a person is summoned before the justices in respect of a xiuisance arising from a fireplace or furnace which does not con- sume the smoke arising from the combustible used in such fire- place or furnace, the justices may hold that no nuisance is created within the meaning of this Act, and dismiss the complaint, if they are satisfied that such fireplace or furnace is constructed in such manner as to consume as far as practicable, having regard to the nature of the manufacture or trade, all smoke arising therefrom, and that such fireplace or furnace has been carefully attended to by the person having the charge thereof. Duties of Nuisance Authorities as to inspection of Nuisances, &c. 20. It shall be the duty of the nuisance authority to make from time to time, either by itself or its officers, inspection of the dis- trict, with a view to ascertain what nuisances exist calling for abatement under the powers of the Nuisance Removal Acts, and to enforce the provisions of the said Acts in order to cause the abatement thereof, also to enforce the provisions of any Act that may be in force within its district requiring fireplaces and furnaces to consume their own smoke ; and any justice upon complaint upon oath may make an order to admit the nuisance authority or their officers for these purposes, as well as to ground proceedings under the eleventh section of the Nuisances Removal Act, 1855. As to proceedings of Nuisance Authority under sec. 12 of 18 and 19 Viet. c. 121. 21. The nuisance authority or chief officer of police shall, pre- vious to taking proceedings before a justice under the twelfth section of the Nuisances Removal Act, 1855, serve a notice on the 608 PUBLIC HEALTH ACT, 1866. person by whose act, default, or sufferance the nuisance arises or continues, or, if such person cannot be fqund or ascertained, on the owner or occupier of the premises on which the nuisance arises, to abate the same, and for that purpose to execute such works and to do all such things as may be necessary within a time to be spe- cified in the notice : Provided, first, that where the nuisance arises from the want or defective construction of any structural conve- nience, or where there is no occupier of the premises, notice under this section shall be served on the owner. Secondly, that where the person causing the nuisance cannot be found, and it is clear that the nuisance does not arise or continue by the act, default, or sufferance of the owner or occupier of the premises, then the nuisance authority may itself abate the same without further order, and the cost of so doing shall be part of the costs of executing the Nuisances Removal Acts, and borne accordingly. Power to cause premises to be cleansed or otherwise disinfected. 22. If the nuisance authority shall be of opinion, upon the cer- tificate of any legally qualified medical practitioner, that the cleans- ing and disinfecting of any house or part thereof, and of any articles therein likely to retain infection, would tend to prevent or check infectious or contagious disease, it shall be the duty of the nuisance authority to give notice in writing requiring the owner or occupier of such house or part thereof to cleanse and disinfect the same as the case may require ; and if the person to whom notice is so given fail to comply there-with within the time specified in the notice, he shall be liable to a penalty of not less than Is., and not exceeding 10s. for every day during which he continues to make default ; and the nuisance authority shall cause such house or part thereof to be cleansed and disinfected, and may recover the ex- penses incurred from the owner or occupier in default in a sum- mary manner ; when the ow r ner or occupier of any such house or part thereof as is referred to in this section is from poverty or otherwise unable in the opinion of the nuisance authority, effectu- ally to carry out the requirements of this section, such authority may without enforcing such requirements on such owner or occu- pier, with his consent, at his own expense, cleanse and disinfect such house or part thereof and any articles therein likely to retain infection. Power to provide means for disinfection. 23. The nuisance authority in each district may provide a proper place, with all necessary apparatus and attendance, for the disinfec- t.on of woollen articles, clothing, or bedding which have become infected, and they may cause any articles brought for disinfection to be disinfected free of charge. PUBLIC HEALTH ACT, 1866. 609 Nuisance Authorities may provide carriages for conveyance of infected persons. 24. It shall be lawful at all times for the nuisance authority to provide and maintain a carriage or carriages suitable for the con- veyance of persons suffering under any contagious or infectious disease, and to pay the expense of conveying any person therein to a hospital or place for the reception of the sick or to his own home. Penalty on persons suffering from infectious disorder entering public conveyance without notifying to driver that he is so suffering. 25. If any person suffering from any dangerous infectious dis- order shall enter any public conveyance without previously notify- ing to the owner or driver thereof that he is so suffering, he shall on conviction thereof before any justice be liable to a penalty not exceeding b, and shall also be ordered by such jus- tice to pay to such owner and driver all the losses and expenses they may suffer in carrying into effect the provisions of this act ; and no owner or driver of any public conveyance shall be required to convey any person so suffering until they shall have been fii'st paid a sum sufficient to cover all such losses and expenses. Removal of persons sick of infectious disorders and without proper lodging, in any District. 26. "Where a hospital or place for the reception of the sick is provided within the district of a nuisance authority, any justice may with the consent of the superintending body of such hospital or place, by order on a certificate signed by a legally qualified medical practitioner, direct the removal to such hospital or place for the reception of the sick, at the cost of the nuisance authority, of any person suffering from any dangerous contagious or infectious disorder, being without proper lodging or accommodation/or lodged in a room occupied by more than one family, or being on board any ship or vessel. Places for the reception of dead todies may be provided at the public expense. 27. Any nuisance authority may provide a proper place for the reception of dead bodies, and where any such place has been pro- vided and any dead body of one who has died of any infectious disease is retained in a room in which persons live or sleep, or any dead body which'is in such a state as to endanger the health of the inmates of the same house or room is retained in such house or room, any justice may, on a certificate signed by a legally qualified medical practitioner, order the body to be removed to such proper place of reception at the cost of the nuisance authority, and direct 610 PUBLIC HEALTH ACT, 1866. the same to be buried within a time to be limited in such order ; and unless the friends or relations of the deceased undertake to bury the body within the time so limited, and do bury the same, it shall be the duty of the relieving officer to bury such body at the expense of the poor rate, but any expense so incurred may be re- covered by the relieving officer in a summary manner from any person legally liable to pay the expense of such burial. Places for the reception of dead bodies during time required for post-mortem examination may be provided. 28. Any nuisance authority may provide a proper place (other- wise than at a work -house or at a mortuary house as lastly herein- before provided for) for the reception of dead bodies for and during the time required to conduct any post-mortem examination ordered by the Coroner of the district or other constituted authority, and may make such regulations as they may deem fit for the mainten- ance, support, and management of such place ; and where any such place has been provided, any Coroner or other constituted authority may order the removal of the body for carrying out such post- mortem examination and the re-removal of such body, such costs of removal and re-removal to be paid in the same manner and out of the same fund as the cost and fees for post-mortem examinations when ordered by the Coroner. Power to remove to hospitals sick persons brought by ships. 29. Any nuisance authority may with the sanction of the Privy Council,* signified in manner provided by " The Public Health Act, 1858," lay down rules for the removal to any hospital to which such authority is 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 infected with a dangerous and infectious disorder, and they may by such rules im- pose any penalty not exceeding 5 on any person committing any offence against the same. Provision as to district of Nuisance Authority extending to places where ships are lying. 30. For the purposes of this Act any ship, vessel, or boat that is in a place not within the district of a nuisance authority shall be deemed to be within the district of such nuisance authority as may be prescribed by the Privy Council, and until a nuisance au- thority has been prescribed then of the nuisance authority whose district nearest adjoins the place where such ship, vessel, or boat is lying, the distance being measured in a straight line, but nothing * In Ireland the Lord Lieutenant in Council. PUBLIC HEALTH ACT, 1886. 611 in this Act contained shall enable any nuisance authority to inter- fere with any ship, vessel, or boat that is not in British waters. Power of entry to Nuisance Authority or their officer under sect. 11 o/18 Sf 19 Viet. cap. 121. 31. The power of entry given to the authorities by the llth section of the Nuisances Removal Act, 1855, may be exercised at any hour when the business in respect of which the nuisance arises is in progress or is usually earned on. And any justice's order once issued under the said section shall continue in force until the nuisance has been abated, or the work for which the entry was necessary has been done. Provision as to ships within the jurisdiction of Nuisance Au- thority. 32. Any ship or vessel lying in any river, harbour, or other water shall be subject to the jurisdiction of the nuisance authority of the district within* which such river, harbour, or other water is, and be within the provisions of the Nuisances Removal Acts, in the same manner as if it w r ere a house within such jurisdiction, and the master or other officer in charge of such ship shall be deemed for the purpose of the Nuisances Removal Acts to be the occupier of such ship or vessel ; but this section shall not apply to any ship or vessel belonging to her Majesty or to any foreign government. Provision for raising money in divided parishes. 33. Where the guardians are the nuisance authority for part of any parish only, and shall require to expend money on account of such part in execution of the provisions of the said Acts, the over- seers of the parish shall, upon receipt of an order from the said guardians, raise the requisite amount from the persons liable to be assessed to the poor rate therein by a rate to be made in like mau- ner as a poor rate, and shall have all the same powers of making and recovering the same, and of paying the expense of collecting the rate when made, and shall account to the auditor of the dis- trict for receipt and disbursement of the same, in like manner, and with the same consequences, as in the case of the poor rate made by them.* Nuisance Authority may require payment of costs or expenses from owner or occupier, and occupier paying to deduct from rent. 34. That it shall be lawful for the nuisance authority, at their discretion, to require the payment of any costs or expenses which the owner of any premises may be liable to pay under the said Nuisances Removal Acts or this Act, either from the owner or * Not applicable to Ireland. 612 PUBLIC HEALTH ACT, 1866. from any person who then or si any time thereafter occupies such premises, and such owner or occupier shall be liable to pay the same, and the same shall be recovered in manner authorised by tire Nuisance Removal Acts, and the owner shall allow such occupier to deduct the sums of money which he so pays out of the rent from time to time becoming due in respect of the said premises, as if the same had been actually paid to such owner as part of such rent : provided always, that no such occupier shall be required to pay any further sum than the amount of rent for the time being due from him, or which, after such demand of such costs or ex- penses from such occupier, and after notice not to pay his landlord any rent without first deducting the amount of such costs or ex- penses, becomes payable by such occupier, unless he refuse, on application being made to him for that purpose by or on behalf of the nuisance authority, truly to disclose the amount of his rent and the name and address of the person to whom such rent is payable, but the burden of proof that the sum demanded from any such occupier is greater than the rent due by him at the time of such notice, or which has since accrued, shall lie upon such occupier ; provided also, that nothing herein contained shall be taken to affect any contract made or to be made between any owner or occupier of any house, building, or other property whereof it is or may be agreed that the occupier shall pay or discharge all rates, dues, and sums of money payable in respect of such house, build- ing, or other property, or to affect any contract whatsoever be- tween landlord or tenant. PART III. MISCELLANEOUS. In cities, boroughs, or towns, Secretary of State, on application of Nuisance Authority, may empower them to make regulations as to lodging houses. 35. On application to one of her Majesty's principal Secretaries of State by the nuisance authority of the city of London, or any district or parish included within the Act for the better local government of the metropolis, or of any municipal borough, or of any place under the Local Government Act, 1858, or any local im- provement Act, or of any city or town containing, according to the census for the time being in force, a population of not less than 5,000 inhabitants, the Secretary of State* may, as he may think fit, by notice ,to be published in the London Gazette,-? declare the fol- lowing enactment to be in force in the district of such nuisance au- thority, and from and after the publication of such notice, the nuisance authority shall be empowered to make regulations for the * In Ireland the Lord Lieutenant. t Dulfa Gazette. PUBLIC HEALTH ACT, 1866. 613 following matters : that is to say, (1). For fixing the number of persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family : (2). For the registration of houses thus let or occupied in lodgings : (3). For the inspection of such houses, and the keeping the same in a cleanly and wholesome state : (4). For enforcing therein the provision of privy accomodatiou and other appliances and means of cleanliness in proportion to the number of lodgings and occupiers, and the cleansing and ventilation of the common passages and staircases : (5;. For the cleansing and lime-whiting at stated times of such premises : The nuisance authority may provide for the en- forcement of the above regulations by penalties not exceeding 40*. for any one offence, with an additional penalty not exceeding 20*. for every day during which a default in obeying such regulations may continue ; but such regulations shall not be of any validity unless and until they shall have been confirmed by the Secretary of State : But this section shall not apply lo common lodging houses within the provisions of the Common Lodging Houses Act, 1851, or any Act amending the same. Cases in which two convictions have occurred within three months. 36. Where two convictions against the provisions of any Act re- lating to the overcrowding of a house, or the occupation of a cellar as a separate dwelling place, shall have taken place within the period of three months, whether the persons so convicted were or were not the same, it shall be lawful for any two justices to direct the closing of such premises for such time as they may deem neces- sary, and in the case of cellars occupied as aforesaid, to empower the nuisance authority to permanently close the same, in such manner as they may deem fit, at their own cost. Power to provide hospitals. 37. The sewer authority, or in the metropolis the nuisance au- thority, may provide for the use of the inhabitants within its dis- trict hospitals or temporary places for the reception of the sick. Such authority may itself build such hospitals or places of recep- tion, or make contracts for the use of any existing hospital or part of a hospital, or for the temporary use of any place for the recep- tion of the sick. It may enter into any agreement with any person or body of persons having the management of any hospital for the reception of the sick inhabitants of its district, on payment by the sewer authority of such annual or other sum as may be agreed upon. The carrying into effect this section shall in the case of a sewer authority be deemed to be one of the purposes of the said Sewage Utilization Act, 1865, and all the provisions of the said Act shall apply accordingly. Two or more authorities having re- 614 PUBLIC HEALTH ACT, 1866. spectively the power to provide separate hospitals may combine in providing a common hospital, and all expenses incurred by such authorities in providing such hospital shall be deemed to be ex- penses incurred by them respectively in carrying into effect the purposes of this Act. Penalty on any person with infectious disorder exposing himself, or on any person in charge of such sufferer causing such exposure. 38. Any person suffering from any dangerous infectious disorder who wilfully exposes himself, without proper precaution against spreading the said disorder, in any street, public place, or public conveyance, and any person in charge of one so suffering who so exposes the sufferer, and any owner or driver of a public convey- ance who does not immediately provide for the disinfection of his conveyance after it has, with the knowledge of such owner or driver, conveyed any such sufferer, and any person who without previous disinfection gives, lends, sells, transmits, or exposes any bedding, clothing, rags, or other things which have been exposed to infection from such disorders, shall on conviction of such offence before any justice, be liable to a penalty not exceeding 5 : pro- vided that no proceedings under this section shall be taken against persons transmitting with proper precautions any such bedding, clothing, rags, or other things for the purpose of having the same disinfected. Penalty on persons letting houses in which infected persons have been lodging. 39. If any person knowingly lets any house, room, or part of a house in which any person suffering from any dangerous infectious disorder has been to any other person without having such house, room, or part of a house, and all articles therein liable to retain infection, disinfected to the satisfaction of a qualified medical prac- titioner as testified by a certificate given by him, such person shall be liable to a penalty not exceeding 20. For the purposes of this section the keeper of an Inn shall be deemed to let part of a house to any person admitted as a guest into such Inn. Guardians, 8fc., of the poor to be the Local Authorities for execut- ing Diseases Prevention Act. 40. Where in any place two or more boards of guardians or local authorities have jurisdiction, the Privy Council* may, by any order made under the Diseases Prevention Act, 1855, authorize or require such Boards to act together for the purposes of that Act, and may prescribe the mode of such joint action and of defraying the costs thereof. * In Ireland the Lord Lieutenant in Council. PUBLIC HEALTH ACT, 1866. 615 Evidence of family in case of over-crowded houses. 41. In any proceedings under the Common Lodging Houses Act 1851, if the inmates of any house or part of a house allege that they are members of the same family, the burden of proving such Allegation shall lie on the persons making it. Extension to the whole of England and Ireland of sect. 67 of\\ 8f 12 Viet, cap. 63. 42. The 67th section of the Public Health Act, 1848, relating to cellar dwellings, shall apply to every place in England and Ire- land where such dwellings are not regulated by any other Act of Parliament, and in applying that section to places where it is not in force at the time of the passing of this Act the expression " this Act" shall be construed to mean the " Sanitary Act, 1866" and not the s;\id " Public Health Act, 1848." In construing the said 67th section as applied by this Act nuisance authority shall be sub- stituted for the local board. Local Board in certain cases may adopt Baths and Wash-houses Acts. 43. Local boards acting in execution of the Local Government Act, 1858, may adopt the Act to encourage the establishment of public baths and wash-houses, and any Act amending the same, for districts in which those Acts are not already in force, and when they have adopted the said Acts they shall have all the powers, duties, and rights of commissioners under the said Acts ; and all expenses incurred by any local board in carrying into execution the Acts referred to in this section shall be defrayed out of the general district rates, and all receipts by them under the said Acts shall be carried to the district fund account. Power to Burial Boards in certain cases to transfer their powert to Local Board. 44. When the district of a burial board is conterminous with the district of a local board of health, the burial board may by, resolution of the vestry, and by agreement of the burial board and local board, transfer to the local board all their estate, property, rights, powers, duties, and liabilities, and from and after such transfer the Local Board shall have all such estate, property, rights, powers, duties, and liabilities as if the Local Board had been appointed a burial board by order in council under the 4th section of the Act of the session of the 20th and 21st years of the reign of her present Majesty, cap. 81. 40 616 PUBLIC HEALTH ACT, 1866. Penalty for wilful damage of works. 45. If any person wilfully damages any works or property be- longing to any local board, sewer authority, or nuisance authority, he shall be liable to a penalty not exceeding b. Incorporation of Sanitary Authorities. 46. The following bodies, that is to say, local boards, sewer authorities, and nuisance authorities, if not already incorporated, shall respectively be bodies corporate designated by such names as they may usually bear or adopt, with power to sue and be sued in such names, and to hold lands for the purposes of the several acts conferring powers on such bodies respectively in their several cha- racters of local boards, sewer authorities, or nuisance authorities. Extent of authority to make provisional orders respecting lands under sect. 75 o/21 ^ 22 Viet, sect. 98. 47. The authority conferred on one of her Majesty's principal Secretaries of State by section 75 of the Local Government Act, 1858, to empower by provisional order a local board to put in force, with reference to the land referred to in such order, the powers of the Lands Clauses Consolidation Act, 1845, with respect to the purchase and taking of lands otherwise than by agreement, shall extend and apply and shall be deemed to have always ex- tended and applied to every case in which, by the Public Health Act, 1848, and the Local Government Act, 1858, or either of them, or any Act extending or amending those Acts, or either of them, a local board are authorized to purchase, provide, use or take lands or premises for any of the purposes of the said Acts, or either of them, or of any such Act as aforesaid; and sections 73 and 84 of the Public Health Act, 1848, shall be construed as if the words " by agreement" therein respectively used had been expressly re- pealed by section 75 of the Local Government Act, 1858. Appearance of Local Authorities in legal proceedings. 48. Any local board, sewer authority, or nuisance authority may appear before any justice or justices, or in any legal proceeding, by its clerk or by any officer or member authorized generally or in respect of any special proceeding by resolution of such board or authority, and such person being so authorized shall be at liberty to institute and carry on any proceeding which the nuisance au- thority is authorized to institute and carry on under the Nuisance Removal Acts or this Act. Mode of proceeding where Sewer Authority has made default in providing sufficient sewers, Sfc. 49. Where complaint is made to one of her Majesty's principal PUBLIC HEALTH ACT, 1866. 617 Secretaries of State that a sewer authority or local board of health has made default in providing its district with sufficient sewers, or in the maintenance of existing sewers, or in providing its district with a supply of water in cases where danger arises to the health of the inhabitants from the insufficiency or unwholesomeness of the existing supply of water, and a proper supply can be got at a reasonable cost, or that a nuisance authority has made default in enforcing the provisions of the Nuisance Removal Acts, or that a local board has made default in enforcing the provisions of the Local Government Act, the said Secretary of State, if satisfied after due inquiry made by him that the authority has been guilty of the alleged default, shall make an oider limiting a time for the per- formance of its duty in the matter of such complaint ; and if such duty is not performed by the time limited in the order, the said Secretary of State shall appoint some person to perform the same, and shall by order direct that the expenses of performing the same, together wiih a reasonable remuneration to the person ap- pointed for superintending such performance, and amounting to a sum specified in the order, together with the costs of the proceed- ings, shall be paid by the authority in default ; and any order made for the payment of such costs and expenses may be removed into the Court of Queen's Bench, and be enforced in the same manner as if the same were an order of such Court. Recovery of certain expenses of water supply. 50. All expenses incurred by a sewers authority or local board in giving a supply of water to premises under the provisions of the 76th section of the Public Health Act, 1848, or the 51st section of the Local Government Act, 1858, and recoverable from the owners of the premises supplied, may be recovered in a summary manner. Power to reduce penalties imposed by 6 G. iv., cap. 78. 51. All penalties imposed by the Act of the 6th year of King George IV., cap. 78, intituled " An Act to repeal the several laws relating to quarantine, and to make other provisions in lieu there- of," may be reduced by the justices or court having jurisdiction in respect of such penalties to such sum as the justices or Court think just. Description of vessels within provisions of&G. iv., cap. 78. 52. Every vessel having on board any person affected with a dan- gerous or infectious disorder shall be deemed to be within the pro- visions of the Act of the 6th year of King George IV., cap. 78, although such vessel has not commenced her voyage, or has come 618 PUBLIC HEALTH ACT, 1860. from or is hound for some place in the United Kingdom; and tile Lords and others of her Majesty's Most Honourable Privy Council. or any three or more of them (the Lord President of the Council or one of her Majesty's principal Secretaries of State being one), may, by order or orders to be by them from time to time made, make such rules, orders, and regulations as to them shall seem fit, and every such order shall be certified under the hand of the Clerk in Ordinary of her Majesty's Privy Council, and shall be published in the London Gazette, and such publication shall be conclusive evidence ot such order to all intents and purposes ; and such orders shall be binding and be carried into effect as soon as the same shall have been so published, or at such other time as shall be fixed by such orders, with a view to the treatment of persons affected with cholera and epidemic, endemic and contagious disease, and pre- venting the spread of cholera and such other diseases as well on the seas, rivers and waters of the United Kingdom, and on the high seas within three miles of the coasts thereof, as on land ; and to declare and determine by what nuisance authority or authori- ties such orders, rules, and regulations shall be enforced and exe- cuted ; and any expenses incurred by such nuisance authority or authorities shall be deemed to be expenses incurred by it or them in carrying into effect the Nuisances Removal Acts. Periodical removal of manure in mews, fyc. 53. Where notice has been given by the nuisance authority, or their officer or officers, for the periodical removal of manure or other refuse matter from mews, stables, or other premises (whether such notice shall be by public announcement in the locality or otherwise), and subsequent to such notice the person or persons to whom the manure or other refuse matter belongs shall not so re- move the same, or shall permit a farther accumulation, and shall not continue such periodical removal at such intervals as the nui- sance authority, or their officer or officers, shall direct, he or they shall be liable without further notice, to a penalty of 20*. per day for every day during which such manure or other refuse matter shall be permitted to accumulate,; such penalty to be recovered in a summary manner : provided always, that this section shall not apply to any place where the Board of Guardians or Overseers of the poor are the nuisance authority. Recovery of penalties. 54. Penalties under this Act, and expenses directed to be re- covered in a summary manner, may be recovered before two jus- tices in manner directed by an Act passed in the session holden in the llth and 12th years of the reign of her Majesty Queen Victoria, PUBLIC HEALTH ACT, 1866. 619 cap. 43, intituled " An Act to facilitate the performance of the duties of justices of the peace out of sessions within England and Wales with respect to summary convictions and orders, or any Act amending the same. Powers of Act cumulative. 55. All powers given by this Act shall be deemed to be in addi- tion to and not in derogation of any other powers conferred on any local authority by Act of Parliament, law, or custom, and such au- thority may exercise such other powers in the same manner as if this Act had not passed. PART IV. APPLICATION OF ACT TO IRELAND. Modifications necessary for application of Part I. to Ireland. 56. In applying the first part of this Act to Ireland the follow- ing changes shall be observed: (1). The provisions of the sections numbered from 75 to 80 both included, of the Public Health Act, 1848, and sections 51, 52, and 53 of the Local Government Act, 1858, and section 20 of the Local Government Act, 1858, Amend- ment Act, 1861, referred to in the first part of this Act, shall for all purposes connected with the execution of this Act be ex- tended to Ireland: (2). The Sewage Utilization Act, 1865, shall be amended by substituting in Ireland the sewer authority, as defined by the first schedule to this Act, for the sewers authority as de- fined by said Act. Modifications necessary for application of Part II. to Ireland. 57. The Nuisance Removal Acts as amended by the second part of this Act shall apply to Ireland ; provided, however, that in such application the following changes shall be observed: (1). Sewer authority as defined by the Sewage Utilization Act, 1865, and amended by this Act, shall in Ireland be the nuisance authority for executing the Nuisance Removal Acts : (2). The expenses of executing the Nuisance Removal Acts shall be defrayed out of the funds herein-after provided : (3). The penalties shall be recovered in the manner herein-after provided: ^4). The expressions " Mayer, Aldermen, and Burgesses," " Council," "Borough Rate," "Borough Fund," and " Town Rate," shall in the first schedule hereto have respectively the same meaning as in the Acts for the regulation of Municipal Corporations in Ireland : (5). For the purposes of the 22nd section of the Nuisance Removal Act, 1855, the nuisance authority shall in Ireland have the power of entering land con- lerred by the Sewage Utilization Act, 1865, and shall have the 620 PUBLIC HEALTH ACT, 1866. same power of levying asse sments under the said section that they have of levying any other rates they are authorized by law to impose. How expenses to be defrayed in Ireland when Nuisance Authority not a Board of Guardians. 58. In Ireland, the nuisance authority, not being the guardians of the poor, shall pay all expenses incurred by them in carrying the Nuisance Removal Acts into effect out of the fund in the first schedule in that behalf mentioned, and where such fund arises wholly or in part from rates shall have, in addition to their exist- ing powers of rating all such powers for making and levying any extra rate, if necessary, respectively, as in the case of any rate au- thorized to be made under the provisions of the respective Acts of Parliament under which the nuisance authorities are constituted or authorized to levy rates ; and all provisions of such Acts re- spectively shall be applicable in respect thereof; provided that when the rates to be assessed by such authority are limited by law to a certain rateable amount, such limitation shall not apply or extend to expenses incurred in carrying this Act into execution ; and it shall be lawful for such authority to assess ilie expenses under this Act in addition to such limited assessments. When Board of Guardians is Nuisance Authority, how expenses to be defrayed in Ireland. 59. In Ireland, a nuisance authority, being guardians of the poor, shall pay all expenses incurred by them in carrying this Act into effect out of the poor rates of the Union, and charge the same to the Union, or any electoral division or electoral divisions thereof, in such manner as the Poor Law Commissioners shall from time to time, by general orders applicable to classes of cases, or by order in any particular case, direct. Recovery of penalties in Ireland. 60. In Ireland, penalties under this Act and expenses or com- pensation directed to be recovered in a summary manner, and nuisances and other offences liable to be prosecuted summarily, shall be recovered and prosecuted in manner directed by the Petty Sessions (Ireland) Act, 1851, or any Act amending the same; and all penalties recovered by any authority under this Act shall be * paid to them respectively, and by them applied in aid of their ex- penses under this Act. Any order authorized to be made by jus- tices under this Act shall be deemed to be an order made upon a complaint on which justices are authorized to make orders under the last-mentioned Act. PUBLIC HEALTH ACT, 1866. 621 Modifications necessary for application of Part III. to Ireland. 61. In applying the provisions of Part III. of this Act to Ireland the following changes shall be observed: (1.) Applications for power to make regulations as to lodging houses may be made by any nuisance authority, except a board of guardians, and shall be made to the Lord Lieutenant in council, and the said Lord Lieu- tenant in council shall have the power of declaring the enactments as to lodging houses in the third part of this Act to be in force in any nuisance district : (2.) The said Lord Lieutenant in council shall have and exercise the power in respect of boards of guardians acting together, vested in the Privy Council by the said third part of this Act : (3.) In Ireland any nuisance authority, except a board of guardians, may exercise the powers conferred on local boards acting in the execution of the Local Government Act, 1858, by the said third part of this Act: (4.) Sewer and nuisance au- thorities in Ireland shall be incorporated for the purposes of this Act by the names set forth in the said first schedule hereto ; and such sewer or nuisance authorities may hold lands by such names for the purposes of Burial Ground (Ireland) Act, 1856 : (5.") The penalties under the third part of this Act shall be recovered in like manner as herein-before provided with respect to penalties under the second part of this Act. Modifications necessary for application of Disease Prevention Act to Ireland. 62. The Diseases Prevention Act, 1855, as amended by the Nuisance Removal and Disease Prevention Amendment Act, 1860, and this Act shall extend to Ireland : provided, however, that in such application the following changes shall be observed: (1.) The Lord Lieutenant in council shall have the power with respect to Ireland which the Privy Council has under such provisions for prevention of disease in England: (2.) The commissioners for administering the laws for the relief of the poor in Ireland, herein- after called the Poor Law Commissioners, shall be the authority in Ireland for issuing regulations to carry the provisions of said Act into effect : (3.) The regulations of the Poor Law Commis- sioners shall be authenticated in like manner as orders of theirs under the Dispensary Act, 1851, stat. 14 & 15 Viet., cap. 68, sect. 8 (sect. 2 ?) : (4.) In defraying the expenses of the prevention of disease out of the poor rate of the Union under this Act the guar- dians of the poor shall charge the same to the Union, or any dis- pensary district or electoral division or divisions thereof, in such manner as the Poor Law Commissioners shall from time to time by general orders applicable to classes of cases, or by orders in particular cases, direct. 622 PUBLIC HEALTH ACT, 1866. Committee and Officers under Dispensaries Act to aid Local Au- thority in execution of this Act. 63. In Ireland, all committees, inspectors, medical officers, and other persons appointed or employed under the powers of statute 14th and 15th Victoria, cap. 68 (the Dispensaries Act, 1851), shall and they are hereby required within their respective districts to aid the local authority, and such officers or persons as they shall appoint or employ, in the superintendence and execution of any directions and regulations which may at any time he issued hy the Poor Law Commissioners for the time heing under the authority and by virtue of this Act. The provisions of 14 & 15 Victoria, cap. 68, as to duties and ap- pointment of Medical Inspectors in Ireland incorporated with this Act. 64. In Ireland the provisions of the Dispensary Act, 1851 (sta- tute 14th and 15th Viet., cap. 68), with respect to the duties and appointment of medical inspectors, shall be incorporated with this Act, and the prevention of disease and inquiry into public health under this Act, shall be deemed one of the purposes for which such medical inspectors have been or may be appointed, in like manner as if its provisions had been referred to in the said Act of 1851, instead of the provisions of the said Nuisance Removal and Diseases Prevention Act of 1848. Remuneration to Medical Practitioners for services under the directions and regulations of the Poor Law Commissioners in Ireland. 65. In Ireland, whenever in compliance with any direction or regulation of the Poor Law Commissioners which they may be empowered to make under the laws for the time being as to the public health, any medical officer of a union or dispensary district, or any other medical practitioner specially employed by the guar- dians for the purpose, shall perform any extra medical service in any union or part of a union, it shall and may be lawful for the guardians of the union to determine, subject to the approval of the said commissioners, and if they shall not approve the amount de- termined by the guardians, for the' said commissioners to fix by order under their seal, such remuneration, proportioned to the nature and extent of such services as aforesaid as to them shall appear just and reasonable ; and the amount of such remuneration snail be paid to such medical officer or other medical practitioner by the guardians of the union out of the rates raised for the relief of the poor, and shall be charged either to the union at large, or to such part or parts of the union, according to the nature of the case, as the said commissioners shall in each case direct. PUBLIC HEALTH ACT, 1866. 623 Poor Law Commissioners io make inquiries as to public health in Ireland. 66. The Lord Lieutenant in council may from time to time direct the Poor Law Commissioners to cause to be made such in- quiries as the Lord Lieutenant in council see fit in relation to any matters concerning the public health in any place or places in Ire- land, and the Poor Law Commissioners shall report the result of such inquiries to the Lord Lieutenant in council. Publication in Ireland to be made in Dublin Gazette. 67. Publication shall be made in the Dublin Gazette in any case in Ireland where publication in the London Gazette is required in England. Powers in Secretary of State in England to be exercised in Ireland by the Lord Lieutenant in Council. 68. All powers relating to the execution of this Act in England and by this Act vested in one of her Majesty's principal Secretaries of State, shall, with regard to the execution of this Act in Ireland, in all cases not herein-before expressly provided for, be vested in the Lord Lieutenant or other Chief Governor or Governors of Ire- land ; and all powers relating to the execution of this Act in Eng- land, and by this Act vested in the Privy Council in England, shall, with regard to the execution of this Act in Ireland, in all cases not herein-before expressly provided for, be vested in the Lord Lieu- tenant in council in Ireland. Repeal of statutes applicable to Ireland. 69. From and after the passing of this Act the Acts set forth in the second schedule hereto shall be repealed, so far as they are still in force: provided always, that all proceedings commenced or taken under the said Acts and not yet completed maybe proceeded with under said Acts, and that all contracts and works undertaken byvirtue of said Acts shall continue and be effective as if said Acts had not been repealed. 624 PUBLIC HEALTH ACT, 1866. FIRST SCHEDULE. Application to Ireland. Description of Sewers and Nuisance Authority in Ireland. Description of Sewers and Nuisance District in Ireland. Corporate Name, for the puvp s of suing or being sued, or holding Property, under the Provisions of this Act. Rate or Fund out of which Expenses incurred by Sewers or Nuisance A ut. ority under this Act to be defrayed. The Rt. Hon. the The City of Dub- The Rt. Hon. the The Borough Rate Lord Mayor, Alder- | lin. Lord Mayor, or Borough men and Burgesses Aldermen, and Fund acting by the Town Burgesses of Council. the City of Dublin. The Mayor, Alder- men, and Burgess- Towns Corporate, with exception The Mayor, Al- dermen, and The Borough Rate or Borough es, acting by the of Dublin. Burgesses of Fund. Town Council. the City or Town of The Town Com- Towns having The Town Com- I missioners. Town Commis- missioners of sioners, under the Towns' Im- provement (Ire- land; Act, 1854, or under any Local Act The Township Com- Townships having The Township missioners. Commissioners Coriimissioners 1 under Local Acts. of 1 Any Rate levied The Commissioners Towns under sucii The Lighting J by the Com- appointed by the Commissioners. and Cleansing missioners. 9th of George IV., Commissioners intituled "An Act of the Town to make Provision of for the lighting, cleansing, and watching of Cities and Towns Corpo- rate and Market Towns in Ireland. J The Municipal Com- Towns having The Municipal The Town Fund. missioners. Municipal Com- Commissioners missioners,under of 3 &4 Vic., c. 108, The Guardians of Such part of each The Guardians The Poor Rate of the Poor of each Union as is not of the Poor Union. Union. under another of the Sewer or Nui- Un on. sance Authorit SECOND SCHEDULE. Statutes Repealed. Local Boards of Health Act for Ireland, 1H8 ; Statute 58 Geo. III., c. 47, as. 10 to 15, inclusive. Officers of Health Act for Ireland, 1819 ; Statute 59 Geo. III., c. 41 . Nuisance Removal and Disease Prevention Act, 1848. Nuisance Removal and Disease Prevention Act, 1849. APPENDIX. 625 18 & 19 Vic., cap. 121. An Act to consolidate and amend the Nuisances Removal and Diseases Prevention Acts. WHEREAS the provisions of" The Nuisances Removal and Diseases Prevention Act, 18.8" (11 and 12 Viet., cap. 123), amended by " The Nuisances Removal and Diseases Prevention Amendment Act, 1849" (12 and 13 Viet., cap. Ill), are defective, and it is ex- pedient to repeal the said Acts as far as relates to England, and to substitute other provisions more effectual in that behalf : Be it therefore enacted by the Queen's most excellent Majesty, by and with the advice and consent of the Lords Spiritual and Temporal, and Commons, in this present Parliament assembled, and by the authority of the same, as follows : Recited Acts repealed, except as to proceedings commenced. 1. From and after the passing of this Act the said Acts are by this section repealed as 1'ar as relates to England (and Ireland) : provided always that all proceedings commenced or taken under the said Acts, and not yet completed, may be proceeded with under the said Acts ; and all contracts or works undertaken by virtue of the said Acts shall continue and be as effectual as if the said Acts had not been repealed. Interpretation of certain terms used in this Act. 2. In this Act the following words and expressions have the meanings by this section herein-after assigned to them, unless such meanings be repugnant to or. inconsistent with the context (that is to say), the word " place" includes any city, borough, dis- trict under the Public Health Act, parish, township, or harnlet, or part of any such city, borough, district, town, parish, township, or hamlet ; the word " guardians" includes the directors, wardens, overseers, governors, or other like officers having the management of the poor for any parish or place where the matter or any part of the matter requiring the cognizance of any such officer arises ; the word " borough," and the expressions " mayor, aldermen, and burgesses/' " council" and " borough fund," have respectively the same meaning as in the Acts for the regulation of Municipal Cor- porations, and shall also respectively mean, include, and apply to any royal borough, royal town, or other town having a warden, high bailiff, borough reeve, or other chief officer, and burgesses or inhabitants, however designated, associated with him in the government or management thereof, or any town or place having a governing body therein in the nature of a Corporation or other- 626 NUISANCES REMOVAL AND wise, and to the chief officers and governing bodies of such bo- roughs, towns, and places, and to the funds and property under the management of or at the disposal of such chief officers and governing bodies ; the expression " Improvement Act" means an Act for regulating and managing the police of, and for draining, cleansing, paving, lighting, watching, and improving a place, and an Act for any of those purposes ; the word " owner" includes any person receiving the rents of the property in respect of which that word is used from the occupier of such property on his own ac- count, or as trustee or agent for any other person, or as receiver or sequestrator appointed by the Court of Chancery or under any order thereof, or who would receive the same if such property were let to a tenant; the word " premises" extends to all messuages, lands, or tenements, whether open or inclosed, whether built on or not, and whether public or private ; the word " parish" includes every township or place separately maintaining its poor or sepa- rately maintaining its own highways ; the expression " quarter ses- sions" means the court of general or quarter sessions of the peace for a county riding, or division of a county, city, or borough ; the word "person" and words applying to any person or individual, apply to and include Corporations, whether aggregate or sole ; and the expression " two justices" shall, in addition to its ordinary sig- nification, mean one stipendiary or police magistrate acting in any police court for the district. [Sec. 3 repealed, and 4 relates only to England]. PART I. And with respect to the constitution of the local authority for the execution of this Act, the expenses of its execution, the de- scription of nuisances that may be dealt with under it, and the powers of entry for the purposes of the Act, be it enacted thus : Power to Authority to appoint Committees. 5. The local authority may .appoint any committee of their own body to receive notices, take proceedings, and in all or certain specified respects execute this Act, w^hereof two shall be a quorum ; and such local authority, or their committee, may, in each parti- cular case, by order in writing under the hand of the chairman of such body or committee, empower any officer or person to make complaints and take proceedings on their behalf. [Sees. 6 and 7 repealed]. What are deemed Nuisances under this Act. 8. The word " nuisances" ' under this Act shall include any premises in such a state as to be a nuisance or injurious to health : DISEASES PREVENTION ACTS. 627 Any pool, ditch, gutter, watercourse, privy, urinal, cesspool, drain, or ashpit, so foul as to be a nuisance or injurious to health/: Any animal so kept as to be a nuisance or injurious to health : Any accumulation or deposit which is a nuisance or injurious to health : Provided always, that no such accumulation or deposit as shall be necessary for the effectual carrying on of any business or manufac- ture shall be punishable as a nuisance underthis section, when it is proved to the satisfaction of the justices that the accumulation or deposit has not been kept longer than is necessary for the pur- poses of such business or manufacture, and that the best available n:eans have been taken for protecting the public from injury to health thereby. [Sec. 9 repealed]. Notice of Nuisances to be given to Authority, &c., to ground pro- ceedings. 10. Notice of nuisance may be given to the local authority by any person aggrieved thereby, or by any of the following persons; the s-anitary inspector or any paid officer under the said local au- thority ; two or more inhabitant householders of the parish or place to which the notice relates ; the relieving officer of the union or parish ; any constable or any officer of the constabulary or police force of the district or place ; and in case the premises be a com- mon lodging house, any person appointed for the inspection of common lodging houses; and the local authority may take cogni- zance of any such nuisance after entry made as herein-after pro- vided, or in conformity with any Improvement Act under which the inspector has been appointed. Poiver of Entry to Authority or their Officer. 11. The local authority shall have power of entry for the follow- ing purposes of this Act, and under the following conditions 1.: To ground proceedings. For this purpose, when they or any of their officers have reasonable grounds for believing that a nuisance exists on any private premises, demand may be made by them or their officer, or any person having custody of the premises, of ad- mission to inspect the same at any hour between nine in the morn- ing and six in the evening; and if admission be not granted, any justice having jurisdiction in the place may, on oath made before him of belief in the existence of the nuisance, and after reasonable notice of the intended application to such justice being given in writing to the party on whose premises the nuisance is believed to exist, by order under his hand require the person having the cus- tody of the premises to admit the local authority or their officer ; and if no person having custody of the premises can be discovered, 628 NUISANCES REMOVAL AND any such justice may and shall, on oath made before him of belief in the existence of such nuisance, and of the fact that no person having custody of the premises can be discovered, by order under his hand authorize the local authority or their officers to enter the premises between the hours aforesaid. 2. To examine premises where nuisances exist, to ascertain the course of drains, and to execute or inspect works ordered by justices to be done under this Act. For these purposes, whenever, under the provisions of this Act, a nuisance has been ascertained to exist, or when an order of abatement or prohibition under this Act has been made, or when it becomes necessary to ascertain the course of a drain, the local authority may enter on the premises, by themselves or their officers between the hours aforesaid, until the nuisance shall have been abated, or the course of the drain shall have been ascertained, or the works ordered to be done shall have been completed, as the case may be. 3. To remove or abate a nuisance in case of non- compliance with or infringement of the order of justices, or to in- spect or examine any carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, or flour, under the powers and for the pur- poses of this Act. For this purpose the local authority or their officer may from time to time enter the premises where the nui- sance exists, or the carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, or flour is found, at all reasonable hours, or at all hours during which business is carried on on such premises, without notice. PART II. With regard to the removal of nuisances, be it enacted thus : If 'proved to Justice that Nuisance exists, &c., they shall issue order for abatement. 12. In any case where a nuisance is so ascertained by the local authority to exist, or where the nuisance in their opinion did exist at the time when the notice was given, and although the same may have been since removed or discontinued, is in their opinion likely to recur or to be repeated on the same premises or any part thereof, they shall cause complaint therof to be made before a Justice of the Peace ; and such justice shall thereupon issue a summons re- quiring the person by whose act, default, permission, or sufferance the nuisance arises or continues, or if such person cannot be found or ascertained, the owner or occupier of the premises on which the nuisance arises, to appear before any two justices, in petty sessions assembled, at the usual place of meeting, who shall proceed to in- quire into the said complaint ; and if it be proved to their satis- DISEASES PREVENTION ACTS. 629 faction that the nuisance exists, or did exist at the time when the notice was given, or, if removed or discontinued since the notice was given, that it is likely to recur or to he repeated, the justices shall make an order in writing under their hands and seals on such person, owner, or occupier for the abatement or discontinuance and prohibition of the nuisance as herein-after mentioned, and shall also make an order for the payment of all calls incurred up to the time of hearing or making the order for abatement or dis- continuance or prohibition of the nuisance. Justices' order for abatement. Prohibitive order against future Nuisance. 13. By their order the justices may require the person on whom it is made to provide sufficient privy accommodation, means of drainage, or ventilation, or to make safe and habitable, or to pave, cleanse, whitewash, disinfect, or purify the premises which are a nuisance or injurious to health, or such part thereof as the justices may direct in their order, or to drain, empty, cleanse, fill up, amend, or remove the injurious pool, ditch, gutter, watercourse, privy, urinal, cesspool, drain, or ashpit which is a nuisance or in- jurious to health, or to provide a substitute for that complained of, or to carry away the accumulation or deposit which is a nui- sance or injurious to health, or to provide for the cleanly and wholesome keeping of the animal kept so as to be a nuisance or injurious to health, or if it be proved to the justices to be impos- sible so to provide, then to remove the animal, or any or all of these things (according to the nature of the nuisance), or to do such other works or acts as are necessary to abate the nuisance complained of, in such manner and within such time as in such order shall be specified ; and if the justices are of opinion that such or the like nuisance is likely to recur, the justices may further pro- hibit the recurrence of it, and direct the works necessary to prevent such recurrence, as the case may in the judgment of such justices require ; and if the nuisance proved to exist be such as to render a house or building, in the judgment of the justices, unfit for human habitation, they may prohibit the using thereof for that purpose until it is rendered fit for that purpose in the judgment of the jus- tices, and on their being satisfied that it has been rendered fit for such purpose they may determine their previous order by another declaring such house habitable, from the date of which other order such house may be let or inhabited. Penalty for contravention of order of abatement and prohibition. Authority may enter and remove or abate Nuisance. 14. Any person not obeying the said order for abatement shall,. 630 NUISANCES REMOVAL AND if he fail to satisfy the justices that he has used all due diligence to carry out such order, be liable for every such offence to a penalty of not more than 10.?. per day during his default; and any person knowingly and wilfully acting contrary to the said order of prohi- bition, shall be liable for every such offence to a penalty not ex- ceeding 20s. per day during such contrary action ; and the local authority may, under the powers of entry given by this Act, enter the premises to which the order relates, and remove or abate the nuisance condemned or prohibited, and do whatever may be neces- sary in execution of such order, and charge the cost to the person on whom the order is made, as herein-after provided. Appeal. 15. Any such order of prohibition may be appealed against as provided in this Act. Appeal against order of abatement when structural works are re- quired. 16. When it shall appear to the justices that the execution of structural works is required for the abatement of a nuisance, they may direct such works to be carried out under the direction or with the consent or approval of any public board, trustees, or com- missioners having jurisdiction in the place in respect of such works ; and if within seven days from the date of the order the person on whom it is made shall have given notice to the local authority of his intention to appeal against it as provided in this Act, and shall have entered into recognizances to try such appeal as provided be this Act, and shall appeal accordingly, no liability to penalty shall arise, nor shall any work be done nor proceedings taken under such order until after the determination of such appeal, unless such appeal cease to be prosecuted. If person causing Nuisance cannot be found, Authority to execute order at once. 17. "Whenever it appears to the satisfaction of the justices that the person by whose act or default the nuisance arises, or the owner or occupier of the premises is not known or cannot by found, then such order may be addressed to and executed by such local authority, and the cost defrayed out of the rates or funds ap- plicable to the execution of this Act. Manure, 8fc., to be sold. 18. Any matter or thing removed by the local authority in pur- suance of this enactment, may be sold by public auction, after not less than five days' notice by posting bills distributed in the loca- lity, unless in cases where the delay would be prejudicial to health, DISEASES PREVENTION ACTS. C31 when the justices may direct the immediate removal, destruction, or sale of the matter or thing ; and the money arising from the tale retained by the local authority, and applied in payment of all expenses incurred under this Act with reference to such nuisance, and the surplus, if any, shall he paid, on demand, by the local authority, to the owner of such matter or thing. Costs and expenses of works to be paid by person on whom order is made, or owner or occupier. 19. All reasonable costs and expenses from time to time in- curred in making a complaint, or giving notice, or in obtaining an order of justices under this Act, or in carrying the same into effect tinder this Act, shall be deemed to be money paid for the use and at the request of the person on whom the order is made, or if the order be made on the local authority, or if no order be made, but the nuisance be proved to have existed when the complaint was made or the notice given, then of the person by whose act or default the nuisance was caused ; and in case of nuisances caused by the act or default of the owner of premises, the said premises shall be and continue chargeable with such co ts and expenses, and also with the amount of any penalties incurred under this Act, until the same be fully discharged, provided that such costs and expenses shall not exceed in the whole one year's rackrent of the premises ; and such costs and expenses, and penalties, together with the charges of suing for the same, may be recovered in any county or superior court, or, if the local authority think fit, before any two justices of the peace; and the said justices shall have power to divide such costs, expenses, and penalties between the persons by whose act or default the nuisance arises, in such man- ner as they shall consider reasonable ; and if it appear to them that a complaint made under this Act is frivolous or unfounded, they nay order the payment by the local authority or person making the complaint of the costs incurred by the person against whbm the complaint is made, or any part thereof. Proceedinys before Justices to recover expenses. 20. Where any costs, expenses, or penalties are due under or in consequence of any order of justices made in pursuance of this Act as aforesaid, any justice of the peace, upon the application of the local authority, shall issue a summons, requiring the person from whom they are due to appear before two justices at a time and place to be named therein ; and upon proof to the satisfaction or the justices present that any such costs, expenses, or penalties are so due, such justices, unless they think fit to excuse the party summoned upon the ground of poverty or other special circiuu 41 6P>2 -NUISAKCE3 REMOVAL AND stances, shall, by order in writing under their hands and seals, order him to pay the amount to the local authority at once, or by such instalments as the justices think fit. together -with the charges at rending such application and the proceedings thereon ; and if the am Hint of such order, or any instalment thereof, be not paid within ft urfceen days after the sum is due, the same may, by warrant of tl.e said or other justices, be levied by distress and sale. Surveyors of highways to cleanse ditches, fyc., paying owners, &fc., for damages. 21. All surveyors and district surveyors may make, scour, cleanse, and keep open all ditches, gutters, drains, or watercourses in and through any lands or grounds adjoining or lying near to any highway, upon paying the owner or occupier of such lands or grounds, provided they are not waste or common, for the damages which he shall thereby sustain, to be settled and paid in such man- ner as the damages for getting materials in enclosed lands or grounds are directed to be settled and paid by the law in force for the time being with regard to highways. Power to Authority to cover and improve open ditches, 8fc. 22. Whenever any ditch, gutter, dniin, or watercourse used or partly used for the conveyance of any water, tilth, sewage, or other matter from any house, buildings, or premises, is a nuisance within the meaning of this Act, and cannot, in the opinion of the local authority, be rendered innocuous without the laying down of a sewer or of some other structure, along the same or part thereof, or instead thereof, such local authority shall and they are hereby required to lay down such sewer or other structure, and to keep the same in good and serviceable repair ; and they are hereby de- clared to have the same powers as to entering lands for the pur- poses thereof, and to be entitled to recover the same penalties in case of interference, as are contained in the G7th and 68th sections of the Act passed in the 5th and 6th years of the reign of King William IV., intituled " An Act for consolidating and amending the laws relating to highways in England ;" and such local authority are hereby authorized and empowered to assess every house, building, or premises, then or at any time thereafter using for the purposes aforesaid the said ditch, gutter, drain, watercourse, sewer, or other structure, to such payment, either immediate or annual, or distributed over a term of years, as they shall think jusi reasonable, and after fourteen days' notice at toe least left on the promises so assessed, to levy and collect the sum and sums so .1 the same manner, and with the same remedies in ; racnt thereof, as highway rates are by the law in DISEASES PREVENTION ACTS. 633 force for the time being leviable and collectable, and with the same right and power of appeal against the amount of such assess- ments reserved to the person or persons so assessed as by the law for the time being in force shall be given against any rate made for the repair of the highways ; and the provisions contained in this section shall be deemed to be part of the law relating to highways in England. Provided always, that where such ditch, gutter, drain, or watercourse shall, as to parts thereof, be within the jurisdiction of different local authorities, this enactment shall apply to each local authority only as to so much of the works hereby required, and the expenses thereof, as is included within the respective jurisdiction of that authority. Provided also, that such assessment shall in no case exceed a shilling in the pound oil the assessment to the highway rate, if any. Penalty for causing water to be corrupted by gas washings, 23. Any person or company engaged in the manufacture of gas who shall at any time cause or suffer to be brought or to flow into any stream, reservoir, or aqueduct, pond, or place for water, or into any drain communicating therewith, any washing or other substance produced in making or supplying gas, or shall wilfully do any act connected with the making or supplying of gas whereby the water in any such stream, reservoir, aqueduct, pond, or place for water shall be fouled, shall forfeit for 'every such offence the sum of 200. Penalty to be sued for in Superior Courts within six months. 24. Such penalty may be recovered, with full costs of suit, in any of the superior courts, by the person into whose water such washing or other substance shall be conveyed or shail flow, or whose water shall be fouled by any such act as aforesaid, or it there be no such person, or in default of proceedings by such per- son, after notice to him from the local authority of their intention to proceed for such penalty, by the local authority ; but such penalty shall not be recoverable unless it be sued for during the continuance of the offence, or within six months after it shall have ceased. Daily penalty during the continuance as the offence. 25. In addition to the said penalty of 200 (and whether such penalty shall have been recovered or not), the person or company so offending shall forfeit the sum of -20 (to be recovered in the like mariner^ for each day during which such washing or other substance shall be brought or shall flow as aforesaid, or during which the act by which such water shall be fouled shall continue, after the expiration of twenty-four hours from the time when 684 NUISANCES KEMOVAL AND notice of the offence shall have been served on such person or company by the local authority, or the person into whose water such washing or other substance shall be brought or flow, or whose water shall be fouled thereby, and such penalty shall be paid to the parties from whom such notice shall proceed ; and all mon ys recovered by a local authority under this or the preceding section shall, after payment of any damage caused by the act for which the penalty is imposed, be applied towards defraying the expenses of executing this act. [Sec. 26 repealed.] As to nuisances arising in cases of noxious trades, businesses, pro- cesses, or manufactures. 27. If any candle house, melting house, melting place, or soap house, or any slaughter-house, or any building or place for boiling offal or blood, or for boiling, burning, or crushing bones, or any manufactory, building, or place used for any trade, business, pro- cess, or manufacture causing effluvia, be at any time certified to the local authority by any medical officer, or any two legally qualified medical practitioners, to be a nuisance or injurious to the health of the inhabitants of the neighbourhood, the local autho- rity shall direct complaint to be made before any justice, who may summon before any two justices in petty sessions assembled at their usual place of meeting the person by or in whose behalf the work so complained of is carried on, and such justices shall inquire into such complaint, and if it shall appear to such justices that the trade or business carried on by the person complained against is a nuisance, or causes any effluvia injurious to the health of the inhabitants of the neighbourhood, and that such person shall not have used the best practicable means for abating such nuisance, or preventing or counteracting such effluvia, the person so offending (being the owner or occupier of the premises, or being a foreman or other person employed by such owner or occupier), shall, upon a summary conviction of such offence, forfeit and pay a sum of not more than 5, nor less than forty shillings, and upon a second conviction for such offence the sum of 10, and for each subsequent conviction a sum double the amount of the penalty imposed for the; last preceding conviction, but the highest amount of such penalty shall not fn any case exceed the sum of 200. Provided always, that the justices may suspend their final determination in any such case, upon condition that the person so complained against shall undertake to adopt, within a reasonable time, such means as the said justices shall judge to be practicable and order to be carried into effect for abating ^uch nuisance, or mitigating, or preventing the injurious effects of such effluvia, or -shall give notice of appeal DISEASES PREtENTION ACTS. 635 in the manner provided by this Act, and shall enter into recogni- zances to try such appeal, and shall appeal accordingly. Provided al\vays,that the provisions herein-before contained shall not extend or be applicable to any place without the limits of any city, town, or populous district. Reference to Superior Court at the option of the party complained against. 28. Provided also, that if, upon his appearance before such justices, the party complained against object to have the matter determined by such justices, and enter into recognizances, with sufficient sureties to be approved by the justices, to abide the event of any proceedings at law or in equity that may be had against him on account of the subject matter of complaint, the local authority shall thereupon abandon all proceedings before the justices, and shall forthwith take proceedings at law or in equity in her Majesty's superior courts for preventing or abating the nuisance complained of. Cn certificate of Medical Officer to Authority that House is over- crowded, proceedings may be taken to abate the same. 29. Whenever the medical officer of health, if there be one, or, if none, whenever two qualified medical practitioners, shall certify to the local authority that any house is so overcrow ed as to be dangerous or prejudicial to tbe health of the inhabitants, and the inhabitants shall consist of more than one family, the local autho- rity shall cause proceedings to be taken before the justices to abate such overcrowding, and the justices shall thereupon make such order as they may think fit, and the person permitting such over- crowding shall forfeit a sum not exceeding forty shillings. Authority to order costs of prosecutions to be paid out of the rates. 30. The local authority may, within the area of their jurisdic- tion, direct any proceedings to be taken at law or in equity in cases coming within the purview of this Act, and may order pro- ceedings to be taken for the recovery of any penalties, and for the puni>hment of any persons offending against the provisions of this Act, or in relation to appeals under this Act, and may order the expenses of all such proceedings to be paid out of the rates or funds administered by them under this Act. PART III. With regard to Procedure under this Act. Service of notices, summonses, and orders. 31. Notices, summonses, and orders under this Act may be 636 NUISANCES REMOVAL AND served by delivering the same to or at the residence of the persons to whom they are respectively addressed, and where addressed to the owner or occupier of premises they may also be served by delivering the same or a true copy thereof to some person upon the premises, or if there be no person upon the premises who can be so served, by fixing the same upon some conspicuous part of the premises, or if the person shall reside at a distance of more than five miles from the office of the inspector then by a registered letter through the post. Proof of resolutions of Authority. 32. Copies of any orders or resolutions of the local authority or their committee, purporting to be signed by the chairman of such body or committee, shall, unless the contrary be shown, be received as evidence thereof, without proof of their meeting, or of the official character or signature of the person signing the same. As to proceedings taken against several persons for the same offence. 33. Where proceedings under this Act are to be taken against several persons in respect of one nuisance caused by the joint act or default of such persons, it shall be lawful for the local autho- rity to include such persons in one complaint, and for the justices to include such persons in one summons, and any order made in such a case may be made upon all or any number of the persons included in the summons, and the costs may be distributed as to the justices may appear fair and reasonable. One or more joint owners or ocfupiers may be proceeded against alone. 34. In case of any demand or complaint under this Act to which two or more persons, being owners or occupiers of premises, or partly the one or partly the other, may be answerable jointly or in common or severally, it shall be sufficient to proceed against any one or more of them without proceeding against the others or other of them ; but nothing herein contained shall prevent the parties so proceeded against from recoverihg contribution in any case in which they would now be entitled to contribution by law. Designation of" Owner" or "Occupier." 35. Whenever in any proceeding under this Act, whether written, or otherwise, it shall become necessary to mention or refer to the owner or occupier of any premises, it shall be sufficient to designate him as the " owner" or " occupier" of such premises without name or further description. DISEASES PREVENTION ACTS. 637 Penalty for obstructing execution of tJiis Act. 36. Whoever refuses to obey an order of justices under this Act for admission on premises of the local authority or their officers, or wilfully obstructs any person acting under the authority or em- ployed in the execution of this Act, shall be liable for every such offence to a penalty not exceeding d5. Penalty on occupier obstructing owner. 37. If the occupier of any premises prevent the owner thereof from obeying or carrying into effect the provisions of this Act, any justice to whom application is made iu this behalf shall by order in writing require such occupier to desist from such prevention, or to permit the execution of the works required to be executed, pro- vided that such works appear to such justice to be necessary for the purpose of obeying or carrying into effect the provisions of this Act; and if within twenty-four hours after the service of such order the occupier against whom it is made do not comply there- vith, he shall be liable to a penalty not exceeding 5 for every day afterwards during the continuance of such non-compliance. Penalties and expenses recoverable under 11 and 12 Viet. c. 43. 38. Penalties imposed by this Act for offences committed and sums of money ordered to be paid under this Act may be recovered by persons thereto competent in England according to the pro- visions of the Act of the 1 1th and 12th years of the present re.gn, chapter 43 ; and all penalties recovered by the local authority under this Act shall be paid to them, to be by them applied in aid of their expenses under this Act. Proceedings not to be quashed for want of form. 39. No order, nor any other proceeding, matter, or thing done or transacted in or relating to the execution of this Act, shall be vacated, quashed, or set aside for want of form, nor shall any order, nor any other proceeding, matter, or thing done or transacted in relation to the execution of this Act, be removed or removable by certiorari, or by any other writ or process whatsoever, into any of the superior courts ; and proceedings under this Act against several persons included in one complaint shall not abate by reason of the death of any among the persons so included, but all such pro- ceedings may be carried on as if the deceased person had not been originally so included. Appeals under this Act to be to Quarter Sessions. 40. Appeals under this Act shall be to the court of Quarter Sessions held next after the making of the order appealed against ; 638 NUISANCES REMOVAL AND but the appellant shall not be heard in support of the appeal unless within fourteen days after the making of the order appealed against he give to the local authority notice in writing stating his inten- tion to bring such appeal, together with a statement in writing of the grounds of appeal, and shall within two days of giving such notice enter into a recognizance before some justice of the peace,, with sufficient securities, conditioned to try such appeal at the said court, and to abide the order of and pay such costs as shall be awarded by the justices at such court or any adjournment thereof; and the said court, upon hearing and finally determining the matter of the appeal, may, according to its discretion, award such costs to the party appealing or appealed against as they shall think proper, and its determination in or concerning the premises shall be con- clusive and binding on all persons to all intents or purposes what- soever. Provided always, that if there be not time to give such notice and enter into such recognizance as aforesaid, then such appeal may be made to, and such notice, statement, and recogni- zance be given and entered into for, the next sessions at which the appeal can be heard ; provided also, that on the hearing of the appeal no grounds of appeal shall be gone into or entertained other than those set forth in such statement as aforesaid ; provided also, that in any case of appeal the court of Quarter Sessions may, if they think fit, state the facts specially for the determination of her Majesty's court of Queen's Bench, in which case it shall be lawful to remove the proceedings, by writ of certiorari or otherwise, into the said court of Queen's Bench. Forms to be used as in Schedule. 41. The forms contained in the schedule to this Act annexed* or any forms to the like effect, varied as circumstances may require, may be used for instruments under this Act, and shall be sufficient for the purpose intended. As to protection of authority and its officers. 42. The local authority, and any officer or person acting under the authority and in execution or intended execution of this Act, shall be entitled to such protection and privilege in actions and suits, and such exemption from personal liability, as are granted to local boards of health and their officers by the law in force for the time being. Act not to impair Jurisdiction of Sewers Commissioners, or Com- mon Law remedies for Nuisance, nor Jurisdiction of authority as to the Nuisances referred to in this Act. 43. Nothing in this Act shall be construed to affect the provi- sions of any local Act as to matters included in this Act, nor to DISEASES PREVENTION ACTS. 080 impair, abridge, or take away any power, jurisdiction, or authority which may at any time be vested in any commissioners of sewers or of drainage, or to take away or interfere with any course of proceedings which might be resorted to or adopted by such Com- missioners if this Act had not passed, nor to impair any power of abating nuisances at common law, nor any jurisdiction in respect of nuisances that may be possessed by any authority under the Act intituled " An Act to abate the nuisances arising from the smoke of furnaces in the metropolis, and from steam vessels above London Bridge," or the Common Lodging Houses Acts, the Act for the Regulation of Municipal Corporations, the Public Health Act, or any improvement Act respectively, or any Acts incorporated with such Acts, and authorities may respectively proceed for the abate- ment of nuisances or in respect of any other matter or thing herein- before provided or referred to either under the Acts mentioned in this section or any other Act conferring jurisdiction in respect of the nuisances referred to in this Act, or any bye-laws framed under any such Act, as they may think fit ; and the local authorities con- stituted under and for the purposes of the Common Lodging Houses Acts, 1851 and 1853, shall for the purposes of those Act* have all the powers of local authorities under this Act. Act not to affect navigation of rivers or canals. 44. Nothing herein contained shall enable any local authority* surveyor of highways, or other person, either with or without any order of justices, to injuriously affect the navigation of any river or canal, or to divert or diminish any supply of water of right be- longing to any such river or canal; and the provisions of this Act shall not extend or be construed to extend to mines of different descriptions so as to interfere with or obstruct the efficient work- ing of the same, or to the smelting of ores and minerals, or to the manufacturing of the produce of such ores and minerals. Saving as to rights of mill-owners, &c. 45. No power given by this Act shall be exercised in such man" ner as to injuriously affect the supply, quality, or fall of wate r contained in any reservoir or stream, or any feeders of such re servoir or stream, belonging to or supplying any waterwork es- tablished by Act of Parliament, or in cases where any company or individual are entitled for their own benefit to the use of such reservoir or stream, or to the supply of water contained in such feeders, without the consent in writing of the company or corpo- ration in whom such waterworks may be vested, or of the parties so entitled to the use of such reservoirs, streams, and feeders, and also of the owners thereof in cases where the owners and parties go entitled are not the same person. 610 NUISANCES REMOVAL AND Short Title. 46. In citing this Act in other Acts of Parliament, and in legal instruments and other proceedings, it shall be sufficient to use the words " The Nuisances Removal Act for England, 1855." SCHEDULE OF FORMS. FORM (A.) Order of Justices for Admission of Officer of Authority to private Premises. WHEREAS [describe the Authority] have by their officer [naming him] made application to me A. ., One of Her Majesty's Justices of the Peace having jurisdiction in and for [describe the place], and the said officer lias made oitrh to me of his belief that a nuisance within the meaning of the Nuisances Re- moval Act for EM gland, l,s.j.->, us amended and extended to Ireland by tiie sanitary act, 1866, viz. [describe nuisances'], exist on private premises at [describe situation of premises so as to identify them], within my jurisdiction, and demand of admission to such premises for the inspection thereof has been duly made under the said Act, and refused: Now, therefore, I, the said A. B., do hereby require you to admit the said [name the Authority'], [or the officer of the said Authority], for the purpose of inspecting the said premises. Dated this day of 18 . A. B. FORM (B.) Notice of Nuisance. To the Authority (describing it). I [or We], the person aggrieved by the nuisances hereinafter described [or the undersigned and described inhabitant householders, Sanitary Inspector, or other officer (describing him)], do hereby give you notice, that there exists in or upon the [dwelling house, yard, etc., as he case may be], situate at [giving such description as m>iy be sufficient to idenfi/;/ tin-, premises] in the parish of in your district, under the Nuisance Removal Act. 1855, as amended and extended to Ireland by the Sanitary Act, 1866, the following nuisances, videlicet [describing the nuisance, as thecasf may b ; for , a dwelling house or building a nuisance or injurious to health for want of a privy or drain or sufficient means of ventilation, or, so dilapidated or so filthy as to be a nuisance or injurious to health, or for further instance a ditch or drain so foul as to be a nuisance or injurious to health, or an Accumulation of a nuisance or injurious to health, &c . or swine so kept as to be a nuisance or Injurious to health]; and that such nuisance is caused by [naming the person by whose act or default the nuisam-n is caused, or by some person unknown]. Dated this day of in the year of our Lord 18 . [Signed by Complainant under Section 10]. FORM [C.] Notice to owner or occupier of entry for examination. To the owner [or occupier, as the case may be,] of [describe the premises] situate at [insert a drxrriji/ioii x/a/iricut to identify the premises]. Take notice, that under the Nuisances Removal Act for England, 1855, as amended and extended to Ireland by the Sanitary Act, 18G6, the [Authority 'minting it,] in whose district under the said act the above premises are situate, have received a notice from (name complainant), stating that in <.>' upon the said premises (insert the cause of nuisance as set forth in t, : t is,( or to A B. of or to (giving name of the authority), or to their servants or agents, and to all whom it may concern. County of ] Whereas on the day of com- [or Borough, &c. of plaint was made before esquire, or [ one of her Majesty's Justices of the peace District of acting in ami for the county) or other Jurisdic- or at the case may be}. J tinn) stated in the margin, or before the under- signed, one of the Magistrates of the police courts of the metropolis, or as the case may be], by [or by on behalf of J [the 042 NUISANCES REMOVAL AND authority naming it, as the case may be], that in or upon certain premises situate at in the district under the Nuisances Removal Act for England 1855, as amended and extended to Ireland by the Sanitary Act, 1866, of the complainants abovenamcd, the following nuisance then existed [describe if] ; and that the saidnuisance was caused by the act or default of the owner [or occupier] of the said premises [or was caused by A.B. ] [If the nuisance have been removed, say, the following nuisance existed on or about [the day the nuisance VMS ascertained to exist,] and that the said nuisance was caused. the day of in the year of our Lord 18 FOKM (I.) Order for Payment of Cos's, Expenses, and Penalties. Sec. 20. To (name the person on whom the order is made). County, &c. > WHEREAS complaint has been made before us (or me) for to wit. ) that [recite cause of complainf] : And whereas the said [naming the person against whom the complaint is m'ide] has this day appeared before us, the said justices [or before me the said magistrate of the police courts of the metropolis, or as the case may be], to answer this matter of the said complaint : [or, in case t fie party charged do not appear, say, } And whereas it has been this day satisfactorily proved to us [p> me] that a true copy of the summons requiring the said [naming person charged] to appear before us [or me] this day hath been duly served according to the said Act : now, having heard the matter of the said complaint, we [or I] do adjudge the said [naming the pet son charged] to pay forthwith [or by instal- ments of payable respectively on or before the ] to the said [naming the person or auth rily to whom the cods adjudged are jj'tyablc], the sum of for costs in this behalf, and to [naming the person or authority to whom the expenses are payable'], the sum of for expenses in this behalf, [if penalties are due, add, and the sum of for penalties incurred in relation to the premises,] together with the sum of being the charges attending the application for this order and proceedings thereon; and if the said several sums, amounting in the wholo to [or if any one of the said instalments] be not paid within fourteen days after the same is due as aforesaid, we [or I] hereby order that the same be levied by distress and sale of the goods and chattels of the said and in default of sufficient distress in that bt'half ad- j udge the said to be imprisoned in the common gaol [or house of correction, as the case map be], at in the said county [or as the case may be] for the space of such time, not exceeding three calendar months, as the justices may think fit, unless the said several sums [or sum], and all costs and charges of the said distress [and of the commitment and carrying of the said to the said house of correction or common gaol, or as the case may be,] shall be sooner paid. Given under our [or my] hands, this day of in the year of our Lord, 18 at in the [county, or as the cane may be,} aforesaid. FORM [K.] Warrant of Distress. Sec. 20. To the constable of and to all other peace officers in the said county [or us the case mtiy be], WHEREAS on last past complaint was made before the under- ' signed, two of Her Majesty's j usriccs of the peace in and for the said county of [or M.V tin' i'ii\<' i,, n/i iir \ i or a magistrate of the police courts of the metro- polis or stipendiary nst/iecase maybe] for that [tfcc., as in the oni>'r\\ aii'i thereupon having considered the matter of the. said complaint, we [or I] adjudge the said [set out from Form K the adjudication DISEASES PREVENTION ACTS. 645 nf nu ent of the said several t,ums of and hath elapsed, but the said hath not paid the same or any part thereof within fourteen days after the date lixed by the order for such payment, but there- in hath made default : these are therefore to command you in Her Majesty's name forthwith to make distress of the goods and chattels of the said A.B. and if within the space of days afier the making of such distress the said last-mentioned sums, together with the reasot able charges of taking and keeping the said distress, shall not be paid, that then you do sell the said goods and chattels so by you distrained, and do pay the money arising from such sale over to the clerk of the justices of the peace for the division of in the said "county, \ that he may pay and apply the same as by law directed, and may render the overplus, if any, on demand, to the s-iid ; and if no such distress can be found, then that you certify the same unto me, to the end that such proceedings may be had therein as to the law doth appertain. Given under our [or my] hands and seals, this day of in the year of our Lord, 18 at in the [county] afore- said. A.B. C.D. L. S. Foit>r [L.] Return of Proceedings under Nuisances Removal Act, 1*55, as amended ,-ctended to Ireland by the Sanitary Act, 18G6, by tke~ (name the authority at length). From 25th March, 1855, to 25th March, 1856. Date Notice. By whom given. Nature of Nuisance. Proceedings taken. Remarks : With any special Work done under the Acts without any iNotioe. 1C The Foul Drain- Owner put Several houses being in a like April. Inspector. age from down good position, the highway Sur- House. Drain, on veyor laid down a sewer in Summons, the old watercourse, and without each house was charged a Just i c e s' proportionate sum for the order. same, of which the highest sum was 10s. 18 Two Offensive Abated by Renewed once : but penalty re- April. Neighbours. Cesspool. [X: usance] covered, and no subsequent Authority. renewal attempted. ] ) Jted this 26th day of March, 1856. [To be signed % the chairman of the authority. ] 18 & 19 Vic., cap. 116. An Act for the better Prevention of Diseases, 1865. WHEREAS the provisions of " The Nuisances Removal and Dis- eases Prevention Act, 1848," amended by " The Nuisances Re- moval and Diseases Prevention Amendment Act. 1849," in so far as the same rehite to the prevention or mitigation of epidemic, en- demic, or contagious diseases, are defective, and it is expedient to substitute other provisions more effectual in that behalf: Be it therefore enacted by the Queen's most excellent Majesty, by and with the advice and consent of the Lords Spiritual and Temporal 646 DISEASES PREVENTION. and Commons, in this present Parliament assembled, and by the authority of the same, as follows : Short Title. 1. This Act may be cited for all purposes as the " Diseases Pre- vention Act. 1855." [Sees. 2 and 3 repealed]. Power of Entry. 4. The local authority and their officers shall have the power of entry for the purposes of this Act, and for executing or superin- tending the execution of the regulations and directions of the general board issued under this Act. Power to Privy Council to issue orders that provision herein con- tained for prevention of diseases may be put in force. 5. Whenever any part of England appears to be threatened with or i ; affected by any formidable epidemic, endemic, or contagious disease, the Lords and others of her Majesty's most honourable Privy Council, or any three or more of them ("the Lord President of the Council or one of her Majesty's principal Secretaries of State being one), may, by order or orders to be by them from time to time made, direct that the provisions herein contained for the pre- vention of diseases be put in force in England, or in such parts thereof as in such order or orders respectively may be expressed, and may from time to time, as to all or any of the parts to which any such order or orders extend, and in like manner, revoke or re- new any such order ; and, subject to revocation and renewal as aforesaid, every such order shall be in force for six calendar months, or for such shorter period as in such order shall be expressed ; and every such order of her Majesty's Privy Council, or of any members thereof, as aforesaid, shall be certified under the hand of the clerk in ordinary of her Majesty's Privy Council, and shall be published in the London Gazette ; and such publication shall be conclusive evidence of such order, to all intents and purposes. Power to General Board of Health to issue regulations to carry out such provisions. Local extent and duration of regulations of General Board. 6. From time to time after the issuing of any such order as aforesaid, and whilst the same continues in force, the General Board of Health may issue directions and regulations, as the said Board think fit : For the speedy interment of the dead : For house to house visitation: For the dispensing of medicines, guarding against (lie spread of disease, and affording to persons afflicted by DISEASES PREVENTION ACT. 617 or threatened with such epidemic, endemic, or contagions dise;t:;es such medical aid and such accomodation as may be required. And from time to time, in like manner, may revoke, renew, and alter any such directions and regulations as to the said Board appears expedient, to extend to all parts in which the provisions of this Act for the prevention of disease shall for the time being be put in force under such orders as aforesaid, unless such directions and regulations be expressly confined to some of such parts, and then to such parts as therein are specified ; and (subject to the power of revocation and alteration herein contained) such directions and regulations shall continue in force so long as the said provisions of this Act shall under such order be applicable to the same parts. Publication of such regulations. 7. Every such direction and regulation as aforesaid, when issued, shall be published in the London (Dublin} Gazette, and the Gazette in which such direction or regulation was published shall be con- clusive evidence of the direction or regulation so published, to all intents and purposes. The Local Authority to see to the execution of such regulations, &c. 8. The local authority shall superintend and see to the execution of such directions and regulations, and shall appoint and pay such medical or other officers or persons, and do and provide all such acts, matters, and things, as may be necessary for mitigating such disease, or for superintending or aiding in the execution of such directions and regulations, or for executing the same, as the case may require. And may direct prosecutions for violating the same. 9. The local authority may from time to time direct any prose- cutions or legal proceedings for or in respect of the wilful violation or neglect of any such direction or regulation. Orders of Council, Directions and regulations to be laid before Parliament. 10. Every order of her Majesty's Privy Council, and every direc- tion and regulation of the General Board of Health, under this Act, shall be laid before both Houses of Parliament, forthwith upon the issuing thereof, if Parliament be then sitting, and if not then within fourteen days next after the commencement of the then next session of Parliament. Order in Council may extend to parts and arms of the sea. 11. Orders in council issued in pursuance of this Act for putting 42 648 DISEASES PREVENTION ACT. in force the provisions for the prevention of disease in the said Nuisances Removal and Diseases Prevention Acts contained, in Great Britain, may extend to parts and arms of the sea lying within the jurisdiction of the admiralty ; and the Board of Health for England may issue under this act directions and regulations for cleansing, purifying, ventilating, and disinfecting, and providing medical aid and accommodation, and preventing disease in ships and vessels, as well upon arms and parts of the sea aforesaid as upon inland waters. Medical Officer of Unions and others entitled to costs of attending sick on board vessels, when required by orders of General Board of Health. 12. Whenever, in compliance with any regulation of the General Board of Health, which they may be empowered to make under this Act, any medical officer appointed under and by virtue of the laws for the time being for the relief of the poor shall perform any medical service on board of any vessel, such medical officer shall be entitled to charge extra for any such service, at the general rate of his allowance for his services for the union or place for which he is appointed, and such charges shall be payable by the captain of the vessel, on behalf of the owners, together with any reasonable expenses for the treatment of the sick ; and if such services shall be rendered by any medical practitioner who is not a union or parish officer, he shall be entitled to charges for any service ren- dered on board, with extra remuneration on account of distance, at the same rate as those which he is in the habit of receiving from private patients of the class of those attended and treated on ship- board, to be paid as aforesaid ; and in case of dispute in respect of such charges, such dispute may, where the charges do not exceed 20, be determined summarily, at the place w r here the dispute arises, as in case of seamen's wages, not exceeding 50, accord- ing to the provisions of the law in that behalf for the time being in force; and any justice before whom complaint is made shall determine summarily as to the amount which is reasonable accord- ing to the accustomed rate of charge within the place for attend- ance on patients of the like class' or condition as those in respect of whom the charge is made. Authentication of Directions and Regulations of General Board of Health. 13. The directions and regulations of the General Board of Health under this enactment shall be un relating to the provision of water, is also extended to Ireland. INDEX. Abattoirs, 5,5, 224, Acts (Appendix) 601. Act, Sanitary, 1866, 601. Act, Amendment of Sewage Uti- lization, 1865, 601. Acts, Amendment of Nuisances Removal, &c., 605, 625, 649, 654. Act, Nuisances Removal for England, 1855, 625. Act, Public Health, 583, 601. Act, Diseases Prevention, 1855, 645. Act, relating to diseased meat, &c., 654. Act, Sewage Utilization, 1855, 655. Adulteration, 205. Air, 34. Air, Ozone in, 37. Ague, 86, 431. Alcohol, 196. Influencing lon- gevity, 438. Ammonia factories, 55. Animal heat, 37. Analyst, 564. Arklow, 372. Association, Ladies Sanitary, 580 Assurance for poor, 364. Asylums for drunkards, 2 02. Athlone, 373. Ballyshannon, 378. Bakers, 397. Bangor, 378. Banting's diet, 209. Basements prone to cholera, 472. Bathing, 234. Baths, Turkish, 236. Bazalgette, 340. Barracks, 17. Beans as food, 166. Black-Death, 10, 485. Blood in meat, 154. Bran as food, 168. Bran, 1 78. Bread, Rye, 169. Boyle, 385. Board of Health, 583. Bricks, Ventilation through, 73. Bristowe on hospitals, 275. Broad-street pump, 114. Brown, Dr. J., on dyspepsia, 212. On shoes, 247. Building Acts, 322, 591. Burials, 350, 596. Burial Act Office, 356. Cameron, Prof., 157, 221, 348. Candle factories, 56. Carbolic acid, 510. Carbonic acid, 41. Carrick-on-Shannon, 385, Carrick-on-Suir, 380. Castlebar, 386. Cattle Plague, 491; in Ireland, 498. Cemeteries, 350. Cerebro -spinal arachnitis, 13. Chadwick, Mr., on cleanliness, 232. On burials, 350. Chandleries, 56. Chapelizod, 374. Chemical factories, 49. INDEX. 661 Chlorine, 507. Cholera, 114, 440. Statistics, 442. Contagion, 445. Water, 454. Terrestrial, 462. Old Streams, 467. Reclaimed land, 470. Receptivity, 476. Meteorology, 480. Preven- tion, 488. "Refuges, 490. Clark's process, 99. Cleanliness, 232. Clerks, 399. Climate, 128. Clothing. 244. Coffins, 363. Cold, greatest, 132. Compressed air, 78. Condensation of population, 22. Condy's fluid, 99. Contagion of cholera, 445. Convalescent hospitals, 292. Consumption, 21, 84, 435, 536, Convulsions, 536. Cooking food, 165. Corpulence, 208. Corrigan, Sir D., on ventilation, 287. On fever, 427. On cholera, 449. Coroners, 576. Creasote factories, 52. Crowd-poisoning, 429. Death-rates, 525. Diarrhoea, 432, 536. Diet, Soldiers', 184. Digestion of food, 146. Dining halls, 190. Disease Prevention Act, 625. Dispensaries' Act, 546. Disinfection, 504. Disuse of organs, 263. Diseased meat, &c., Act, relating to, 654. Drainage, 325. Drowning, 414. Dniitt, Dr., 332; 556. Duhlin last century, 26 ; in 1844, 27; in 1866,530. Dwellings of the poor, 297. model, 318. Dyspepsia, 144, 212. Education in physiology, 2 3, 5 7 9. Ennis, 380. Enniskillen, 378. Epi 'emics, 10, 427. Epidemiological Society, 452. Exercise, 250. Factories, chemical, 49. Crea- sote, 52. Manure, 52. Gas, 53. Ammonia, 55. Candle, 56. Rag and bone, 57. Smoke from, 58, 393. Farr on cholera, 464. Registra- tion amendments, 570. Fatty degeneration, 438. Female employment, 271. Fever in Ireland, 13 ; in Dublin, :-Jl, 427, 534. Fever ho.-pitals, 280. Filters, 97. Food, purposes of 145. Diges- tion of, 146. Salts in, 149. Meat, 153. Blood in meat, 154. Morgan's mode of cure, 158. Preserved, 1 62. Horse flesh, 1G4. Cooking, 165. Peas and Beans, 166. Bran, 168. Rye-bread, 169. Potato, 170. Irish dietaries, 172. Heat- making food, 176. Jellies, 177. Bread, 178. Milk, 179. Dietaries, 182. Soldiers' diet, 184. Dr. Smith's dietaries, 186. Dining-halls, 190. Food and population, 192. Vege- tarianism, 194. Alcohol, 196. Spirit drinkers and cholera, 198. Wines, 200. Permis- sive Bill, 201. Asylums for 662 INDEX. drunkards, 202. Tea, 204. Adulteration, 205. Corpu- lencej 208. Hunger and thirst, 212. Diseases due to dietic errors, 214. Scurvy, 215. Parasites in meat, 217. Gardens, 269. Gas nuisance, 53. Gas factories, 53. Glin,381. Gout, 437. Graveyards, Ireland, 359. Hair, 229. Half-time system, 256, 552. Haughton on cholera, 447. Heat a disinfectant, 513. Heat-making food, 176. Holmes on hospitals, 275. Hospitals, 82, 274. Hunger, 211. House of Commons, Ventilation of, 77. Horse-flesh as food, 164. Hygiene, objects of, 7. Influenza, 431. Insanity, 439. Ireland, application of Public Health Acts to, 619. Irish dietaries, 172. Irishmen, 33. Inquests and coroners, 575. Jellies, 177. Kells, 374. Kilmallock, 381. Kilrush,f382. Kinsale, 382. Land, reclaimed cholera, 470 Lead-poisoning, 108. Liffey, 339. Loans, 314, 507. Lodging-house, 306. Longford, 376. Longevity, 257. Loughrea, 386. Lungs,*63. Mackinnell's ventilation, 76. Macroom, 383. Madeira at home, 140. Malaria, 86. Manure factories, 52. Mapother, D. H., plans for cot- tages, 316. Markham, Dr., 290, 553. Maynooth, 376. Measles, 424, 535. Meat, flesh, as food, 153. Meat, &c., diseased, Act relating to, 654. Medical Officer, of Health, 561. Mercurial-poisoning, 403. Middle ages, 9. Miltown Malbay, 383. Milliners, 402. Miners, 78, 434. Mirror-silverers, 403. Mist, blue, 481. Mountains, 126. Morgan's meat curing process, 158. Milk, 179. Milk, Preserved, 143. Model dwellings, 30. Mortuary houses, 354, 416. Mosaic laws, 9. Navan, 376. Nervous system, 254. Newmarket, 384. Newtownards, 378. Norwood, Mr., 344. Nosology, 525. Nuisances, 49, 322, 593. Nuisance Act, 625. Nursing, 294. ' INDEX. 663 Oldcastle, 377. Organic matter in air, 44. Over-crowding, 297, 594. Ozone, 37, 480. Parasites, 217. Parasitic skin diseases, 434. Peas as food, 166. Permissive bill, 201. Perspiration, 230. Plague, 10. Pleuro-pneumonia, 220. Poddle, 329, 468. Poisoning, 412. Poor Law, 542. Portaferrry, 380. Portlaw, 388. Potatoes, 170. Preserved milk, meat, &c., as food, 163. Preventive diseases, 20, 417. Printers, 399. Pumpwater, 93. Public Health Act, 583, 601. Pus-cells in air, 48. Quarantine, 573. Rathcoole, 377. Rags, 57. Rag and bone factories, 57. Railway travelling, 267. Refuges, Cholera, 490. Registration, 325. Robinson, Mr. N., dwellings of poor, 28. Roscommon, 386. Rush, 377. Rye bread, 169. Salts in food, 149. Salts of cholera, 442. Sanitary Act, 585, 601. Laws, 581. Organization, 554. Scarlatina, 423, 535. Scents, 60. Schedules to Public Health Act, 624. Schedule of Forms used in Pub- lic Health Acts, 640. Scrofula, 83. Scurvy, 17, 215. Sewage Utilization Act, 655. Sewerage, 327. Sherringham's ventilation, 74. Shoes, 247. Skin, 225. Sligo, 387. Small-pox, 23, 421, 535. Smoke, 57, 80. Smoke from factories, 58, 393. Soils, 122. Soldier's diet, 184. Spirit drinkers. 198. Spirometer, 62. Stables, 399. Statistics, 520. Starvation, 212. Steel-grinders, 434. Streams, old cholera, 467. Suggestions, 588. Suicide, 259. Sulphuretted hydrogen, 43. Surveys, 567. Sweating sickness, 11, 431. Tailors, 395. Tea, 204. Tenement regulations, 310. Tenements Company, Dub., 318. Terrestrial cause of cholera, 462. Thirst, 212. Tipperary, 385. Torrens', Mr., Bill, 320. Town Improvement, 366, 587. Trades, 594. Tullamore, 377. Typhoid fever, 14, 425. 664 Typhus fever, 15, 426. Utilization of Sewage, 343. Utilization Act, 655. Vartry Waterworks, 103. Vegetarianism, 194. Ventilation, 66. Veterinary instruction, 503. Vital statistics, 520. Warming, 81. INDEX. I Water, 89, j Water, cholera conveyed by, 454. I Watering places, 139. j Watery vapour, 39. Whooping-cough, 432. Willis, Dr.. on dwellings, 28. Wines, 200. Workhouses, 553. Yellow fever, 430. Zvmotic diseases THE END. MUU.A\' Steam 1'rlnting Works, 47 Hee'.-stlvet, Dublin. FOURTEEN DAY USE RETURN TO DESK FROM WHICH BORRC SMI This book is due on the last date stamped below, or on the date to which renewed. Renewed books are subject ro^rnmediate MAR 2 3 1956