' \\tf-UNIVI v^LOS-ANGElj> , C.S.I. Want of precision in the term " epidemic." Practical nature of the question to be discussed. Special class of epidemic diseases to which it refers. Of these cholera may be taken as the type. Difficulty of finding words to describe such epidemics which involve no theory of their causation. All theoretical questions to be avoided. First mode of prevention employed in many countries, Quaran- tine. Its aims. Impossibility of attaining them on land. Procedure in sea quarantine. Nature of the evidence required to prove that benefit has been derived from it. No satisfactory evidence of this kind. The history of cholera over the world, and especially in Europe, proof of its failure. The assumptions on which it is based purely hypothetical and opposed to facts. The evils to which it gives rise great and undoubted. The tyranny of the whole system. Powerful for evil but powerless to do good. Second mode of prevention, Medical Inspection. The procedure adopted. Much good no doubt effected; but the system cannot be credited with the arrest of epidemics. Third mode, Sanitary Improvements. Their value as the best and only efficient means of checking epidemic disease proved by experience. The theory on which this good result depends a matter of com- parative unimportance. Quarantine ignores all such improvements, and this is one of the strongest, if not the si longest, objection to be urged against it. Hygiene : Section I. Mesures a prendre a regard des Navires provenant de regions contaminees on suspectes pour empecher 1'importation en Europe des Maladies Exotiques transmissibles. PAR Professor PROUST, Paris. The Communicability of Cholera from Country to Country. BY ROBERT LAWSON, LL.D., Q.H.P., Inspector-General of Hospitals. To draw up a plan to prevent the extension of a disease, say cholera, from one country to another, with any prospect of success, it is necessary to have a general acquaintance at least with the different factors which contribute to the result, and of their mode of operation. The existing information on these points falls far short of these require- ments, and its increase has been enormously impeded by the belief that man himself is the chief agent in diffusing the disease ; and by interpret- ing the evidence obtained from various sources with an undue bias in favour of the theory. There has been, in short, and still remains, a most serious error in assuming that personal communication is the principal factor ; and a no less extensive error in the methotls and reasoning by which the central idea of diffusion by man was advocated. Necessity for a complete change in all these respects ; the character and causes of cholera must be derived from a critical examination of all the evidence nature presents, and from a study of the methods she herself adopts, instead of from our a priori deductions. Cholera occurs in two different forms : = simple cholera or cholera nostras, of little severity, and attributed to local causes; and Asiatic epidemic, or malignant cholera, always a serious disease, and by many attributed to a poison given off by those labouring under it to others, and so diffused until it becomes epidemic. Since 1832, when cholera visited Europe in the epidemic form, cholera nostras has been observed to fluctuate every few years, and with the milder cases occur a certain number presenting all the characters of the malignant disease ; these cases occur singly or in small groups, but in every instance they accompany epidemics of varying severity, at no very great distance off, and are under the same " epidemic influence." Those who support the theory that man diffuses cholera are, neces- sarily, required to show that persons under the disease must arrive at points where it has not yet appeared, before it commences in these latter, and that the first attacks in the new locality have been in persons exposed to the imported cases : but there are now a good many instances of epidemics springing up in localities at a distance from where the Hygiene : Section /. 9 disease was already prevailing, and without any trace of importation, and where those first attacked had resided in the country for many months in succession without communication with any previous case. Such were the outbreaks at Southampton in 1865, and New Orleans in 1873, and at Toulon and South of France in 1884, all of which were most carefully investigated on the spot. The only other conclusion open is that the necessary factors were supplied by epidemic influence ; and if supplied in one instance, supplied in all ; where there appears to have been importation at the commence- ment of the outbreak, it must not be assumed that the disease was communicated by man, unless the epidemic influence can be excluded, as at present it cannot. It seems probable that the exciting factors are conveyed by the air, whether fully or only partially developed, and consequently it is not in our power to exclude them : but much may be done by hygienic and other local means to limit their development in the localities they reach, and so to avoid excessive mortality. Australasian Quarantine, BY J. ASHBURTON THOMPSON, M.D., D.P.H., &c. The amount of traffic which has to be dealt with, an important consideration in all questions of practical quarantine. The Australasian Sanitary Conference of Sydney, N.S.W., 1884 ; attended by delegates of each of the six Governments, and by the Speaker ; their resolutions unanimous ; accepted by each Government, and presented to each Parlia- ment ; the principles embodied in them described ; they have not been modified since 1884, and are therefore those received in Australasia at the present day. Definitions of Ancient Quarantine, of quarantine, of Limited Quarantine. Medical Inspection, the outcome of England's local conditions ; is exactly suited to them ; not necessarily suitable, therefore, where local conditions different from England's. Proposi- tion I. : The degree of protection which quarantine measures can afford varies inversely with the ease of communication between the infected country and the country to be defended. Difference between English and Australasian conditions described. The Conference re- jected Ancient Quarantine as a principle of action, and on account of easy and daily interchange of population between the six Territories, decided to regard Australasia as constituting one epidemiological tract, and (consequently) to relinquish all quarantine as against each other. Then, before adopting resolutions which would affect others, put themselves in order by declaring, in Proposition II., Quarantine can yield protection commensurate with its cost only to countries whose internal sanitation is good ; and they recognised defects inherent in all quarantine measures by declaring, in Proposition III., The function of quarantine is not to exclude infection but to lessen the entering 10 llyytene : Section I. number of foci of infection, and thus made it clear that exclusive reliance not placed by them on quarantine as a defence against imported disease. Ha\ ing thus indicated what should be refrained from, proceeded to say what should be done. Aphorism : Nations whose internal sanitary organisation is not perfect cannot afford to refer the observation of suspects to the country at large. Decided consequently that Limited Quarantine should be employed against ships actually carrying cases of exotic disease, that is, that vessels and equipment should be cleansed forthwith and held for delivery to owners at earliest possible date, but that the ship's company should be detained in isolation for periods slightly in excess of recognised clinical incubation-periods. Medical Inspection thus rejected as a principle of action not less than Ancient Quarantine, but still not inconsiderately; when imported disease is one already familiar ashore, the circumstances seen to resemble England's, and then Medical Inspection must (not might or could) be used. Accordingly, in case of scarlatina or the like, patients removed to ordinary isolation hospital (not quarantine), quarters cleansed, and ship discharged in usual way after five or six hours' detention. These principles strictly adhered to by Government of New South Wales since 1884. If not quite so closely by other five Governments, the reason probably political rather than commercial or scientific. Notes of quarantine establishments in New South Wales. Two crucial examples of practice : (a) Rapidity ; (6) Effectual pre- vention of fresh infection among ships' companies while in quarantine. Contribution to the study of Causes favouring the Spread of Diphtheria. BY Dr. E. SCHREVENS, Tournai. By investigating carefully how the ravages committed by diphtheria are distributed over the different districts, one can attain more easily to a precise knowledge of the external conditions which favour the harbouring of diphtheritic germs, and which result in such germs being brought into a locality. Investigations made by the author in Belgium with this object. Thanks to the figures kindly furnished by Dr. Kuborn, the distribution of diphtheria throughout the different provinces of Belgium for the 10 years from 1871 to 1880 has been determined. The same having been done for typhoid fever, it was noticed that where this latter disease committed the greatest ravages the same fact was observable in the case of diphtheria ; and that where diphtheria secured its smallest number of victims the number of deaths caused by typhoid fever diminished equally. This parallel rise and fall of the mortality caused by typhoid fever and diphtheria is shown in two Hygiene : Section I. 11 diagrams placed near each other on the same sheet ; in the first, the parallelism is less evident, because one province, East Flanders, forms an exception to the rule I have just laid down ; in the second diagram this province is omitted, and the parallel march of diphtheria and typhoid fever stands out clearly. On what does this relation, this agreement rest ? On this fact, that these two diseases must he con- sidered as fcecal diseases, as B. Russel, of Glasgow, has remarked. The bacilli of Loftier, like the bacilli of Eberth, develope admirably, prosper, and extend wherever filth and rubbish of all kinds are stored up or spread out; there exists, however, this slight difference between the conditions which are severally favourable to them : impurities on the surface of the soil suit the bacilli of Loftier in a special degree, while impurities of the subsoil please the bacilli of Eberth better. Even the exception formed by East Flanders tends to confirm this rule, inasmuch as it is perfectly clear that its surface ought to be more easily cleared of all impurities by reason of the numerous watercourses which furrow it. A further proof that it is, in a special degree, impurities of the surface which serve to harbour diphtheritic germs in certain localities, is the exaggeration of mortality from diphtheria in country districts compared to what obtains in towns ; density of the population is not of the least influence on the increase of the mortality due to diphtheria ; but the surface of the soil is much better protected in towns against impurities of all kinds. Another circumstance which may foster diphtheria in a locality is the breeding of certain species' of animals presenting a great receptivity for diphtherogenic germs : for example, Italian fowls and game-cocks. The transmission of diphtheria to man by these animals is so well established by the observations collected by the author for several years past that he feels persuaded of the need of further attention being paid to this subject. Finally, a third condition which necessarily fosters diphtheria in a locality is the negligence exercised in the application of measures of disinfection and isolation. Every case of diphtheria must be notified to the local authority, who will see to it immediately, that all the children of the sick person's family be kept away from school as long as any danger of contagion exists. In every case disinfection must be rigorously attended to and performed by special agents. Notification and disinfection ought to be obligatory. The altitude of the locality does not probably exercise any very great influence. One would suppose that diphtheria would be specially prevalent in low, damp places. Recent observations by the author on the progress of diphtheria in three contiguous parishes of the district of Ath, (Eudeghien, Ostiches, and Mainvault, show that in each of these parishes there was a principal seat of the malady, and that in the three parishes this seat was in precisely the most elevated hamlet of all, a fact which from the first appears somewhat strange. One may, perhaps, conclude that Loftier' s bacillus does not like too much damp, and that it is in this respect that its character differs from the bacillus of Eberth. 12 Ifyyiene: Section I. As it may also be interesting to investigate the causes which make the ravages committed by diphtheria vary from year to year, a diagram is shown giving the mortality from diphtheria in Belgium amongst 10,000 inhabitants from 1851 to 1889. Contribution a 1'etude des Causes favorisant les Endemies Diphteritiqnes. PAB Dr. E. SCHKEVENS, de Tournai. En reeherehant avec soin comment les ravages occasionnes par la diphterie so repartisseiit dans les differeuts districts, on parviendni l)lus facilement a connaitre d'une maniere precise les conditions exterieurcs qui favorisent 1'entretien des germes diphteritiques et qui font suivre 1'apport de ces germes dans une localite, d'une veritable endemic. Je tiens a communiquer au Congres les etudes que j'ai faites dans ce sens pour la Belgique : grace a des chiffres qui m'ont etc gracieuse- meut fournis par M. A. Kuborn, President de la Societe Royale de medecine publique, j'ai etabli la repartition de la diphterie dans les differentes provinces de hi Belgique pour la periode decennale de 1871 a 1880. Ayant fait le meme travail pour hi fievre typho'ide, j'ai remarque que la ou. cette derniere maladie exercait plus de ravages, on constatait le meme fait pour la diphterie, et que ia ou la diphterie i'aisait moius de victimes, le chiffre des deces amenes par la fievre typho'ide diminuait egalement; j'ai represente cette marche parallele de la mortalite par fievre typho'ide et par diphterie dans deux diagrammes rapproches 1'un de 1'autre sur la meme feuille : dans le premier, le pandk'lisme est moins evident parce qu'une province fait exception a la regie que je viens de poser, c'est la Flandre Orientale ; dans le second diagramme, je fais abstraction de cette province et la marche parallele de la diphterie et de la fievre typho'ide ressort a 1' evidence. A quoi tient cette relation, cette concordance? a ce fait qu'on doit considerer ces deux maladies comme des maladies fecales, ainsi que 1'a dit B. Russel de Glasgow; les bacilles de Loffler comme les bacilles d'Eberth se developpent admirablement, prosperent et font souche la ou sont con- serves, od s'etalent des immondices, des detritus de toute espece; mais il existe cependant une legere difference dans les conditions qui leur sont propices : au bacilles de LofHer conviennent surtout les souillures de hi surface du sol, tandis que les souillures du fond, du sous-sol, plaisent mieux aux bacilles d'Eberth. L'exception que forme la Flandre Orientale vient meme confirmer la regie, en ce que Ton s'explique parfaitement que sa surface doit etre plus facilement debarrassee de toutes les souilluivs [)ar suite des nouibreux cours d'eau qui hi sillonnent. Hygiene : Section I. 13 Ce qui prouve encore que ce sont surtout les souillures de la surface qui servent a entretenir les germes diphteritiques dans certaines localites, c'est 1'exageration de la mortalite par diphterie dans les communes rurales comparativement a ce qu'elle est dans les villes ; la densite de la population n'influe en rien sur 1'augmentation des desastres provoques par la diphterie ; mais la surface du sol est bien mieux protegee dans les villes contre les souillures de toute espece. Une autre circonstance qui peut entretenir la diphterie dans une localite, c'est 1'elevage de certaines especes animales qui presentent une grande receptivite pour les germes diphterogenes, par exemple les poules italiennes, les coqs de combat. La transmission de la diphterie de ces animaux a 1'homme est tellement bien etablie par les observations que j'ai recueillies depuis plusieurs annees, qu'il y a lieu selon moi de porter son attention de ce cote. Enfin, une troisieme condition qui entretient necessairement la diphterie dans une localite, c'est la negligence apportee dans 1'application des mesures de disinfection et d'isolement que 1'hygiene recommande. II faut que tous les cas de diphterie soient signales a 1'adminis- tration communale qui veillera immediatement a ce que tous les enfants de la famille du malade soient tenus eloignees des ecoles aussi longtemps que peut exister un danger de contagion. II faut que dans chaque cas la disinfection soit rigoureusement soignee, et pratiquee par des agents speciaux. La denonciation et la disinfection doivent etre obligatoires. Quant a 1'altitude de la localite, je suis dispose a croire qu'elle n'excerce pas une bien grande influence. On pouvait croire en effet que la diphterie se perpetuait surtout dans les lieux bas et humides ; j'ai eu tout recemment 1'occasion d' observer la marche de la diphterie dans trois communes contigues de 1'arrondissement d'Ath, (Eudeghien, Ostiches et Mainvault; il y avait dans chacune de ces communes un foyer principal et dans les trois communes, fait qui me parut des 1'abord assez etrange, ce foyer diphteritique se trouvait precisement dans le hameau le plus eleve ; on devrait meme croire que le bacille de Loffler n'aime pas trop 1'humidite, c'est par la que son caractere differe de celui du bacille d'Eberth. Comme il peut etre aussi interessant de rechercher les causes qui font tant varier d'annee en annee les ravages occasionnes par la diphterie, j'ai dresse un diagramme donnant la mortalite par diphterie en Belgique par 10,000 habitants de 1851 a 1889 ; je le joins a mon envoi, et crois devoir m'abstenir ici de toutes les reflexions qu'on peut en deduire. 1 I Hygiene : Section 1. Diphtheria in Minnesota. BY Dr. HEWITT, Minnesota. Diphtheria in Massachusetts from 1871 to IHSS. BY S. W. ABBOTT, M.D., Secretary of the State Board of Health. 1. GENERAL DESCRIPTION OF THE STATE. Its topographical and climatic features. 2. ITS POPULATION, NATIVE AND FOREIGN. Growth ; Character ; Density ; Cities and old towns. 3. VITAL STATISTICS. Birth-rates, 40 years ; Death-rates, 40 years ; Death-rates of rural and of manufacturing districts ; Infectious disease rates. 4. MORTALITY FROM DIPHTHERIA in State from 1858-1888. Diphtheria by counties, 1871-1888 ; Characteristics of counties, as to topography and population. 5. CLASSIFICATION BY CITIES AND TOWNS. Death-rates from diphtheria ; Characteristics of those having specially high and specially low rates from diphtheria ; Comparison with Dr. Longstaff's and other tables upon diphtheria. 6. EFFECT OF SANITATION IN MASSACHUSETTS AND ENFORCEMENT OF LOCAL LAWS, or of legislation as to infectious disease upon diphtheria prevalence. The Relationship between the Occurrence of Diphtheria and the Movements of the Subsoil Water, BY MATTHEW A. ADAMS, F.R.C.S. The author, by daily observation of the height of the subsoil water, extending over a period of 6^ years, and other concurrent meteorological events, as well as by those respecting the occurrence of diphtheria within the Maidstone Urban Sanitary District, has collected a large number of facts which point to the conclusion that there is an intimate relationship between the circumstances relating to the height of the subsoil water and the prevalence of diphtheria. He finds the range and method of movement of the subsoil water varies greatly with the year, in some years there being a single hi^li tide, and a single low tide ; the high tide occurring generally during the Hygiene : Section I. 15 first quarter, and the low tide during the third or at the junction of the third and fourth quarters ; at other times, the fluctuations are much more broken and irregular, and at the same time the range between the extremes of high and low tides is much less. In the latter case, according to his experience, diphtheria prevails in an epidemic form, but in the former it does not prevail. The conclusions he arrives at are, that the organism of diphtheria inhabits organically polluted surface soil, and that, subject to suitable con- ditions of environment, especially as respects moisture, temperature, and food, it thrives and multiplies in the soil, the micro-organism thus produced being liable to displacement from the interstices of the polluted surface soil, and to dispersal into the superincumbent air ; in this manner determining outbreaks of the disease. So that, given the existence of the pathogenic organism, two sets of factors at least are engaged in the production of a state of affairs that culminate in an outbreak of diphtheria. first. Those that promote and support the growth of the germ in the soil, such, for instance, as moisture, temperature, air, food, and so on. Secondly. Agents of dispersal, by which the germs already existing in the soil are driven out and distributed into the atmosphere, and so come to be breathed by man and animals ; for example, sudden rainfall, rise of subsoil water, lowering of barometric pressure, &c. Diphtheria in Havre. BY Dr. GflBERT. Appearance of diphtheria at Havre about 1860. Limited to the Graville Quarter. In 1864, epidemic of diphtheria close to Ingouville. From this date the number of deaths constantly increased, and the disease, which at first was confined to only a few localities, spread throughout the town. The severity of the disease increased until 1885, when a brigade de salubrite was formed as an annexe to the Bureau d'Hygiene. The dwellings occupied by diphtheritic patients having been regularly dis- infected, the mortality curve has since decreased to such an extent as to justify the hope of its total extinction, provided all the medical men of the town furnish accurate information to the Bureau d'Hygiene. 1C Hygiene: Section 1. La Diphtherite an Havre. PAR Le Docteur GIBEBT. Apparition dc la diphtherite nu Havre vors 1'annee 1860. Fixee dans le quarticr de Graville. En 1HG1, epidemic de diphtherite a la cote d'lngouville. A partir de cette epoque le nombre de deces va constamment en augmentant, et la maladie, qui n'occupait que quelques foyers, sc iv pand dans toute la ville. La gravite de la maladie augmente jusqu'au 1885. A partir de 1885, ou une brigade de salubrite fut creee comme annexe du Bureau d'Hygiene, et ou tous les logements desdiphtheritiques furent reguliere- ment desinfectes, la courbe de la mortalite flechit, de telle maniere que Ton pourrait esperer son extinction si tous les medecins de la ville renseignaient exactement le Bureau d'Hygiene. A Local Examination of the Difference in Susceptibility to Diphtheria between Old and New Residents. BY CHARLES E. PAGET, M.K.C.S., D.P.H., Medical Officer of Health for the County Borough of Salford. This paper contains the results of an inquiry for the purpose of learning if any difference in susceptibility to disease could be detected between the old residents of unhealthy places in a town and the new- comers to them, such as has been observed in different countries. The inquiry was made in the borough of Salford during the prevalence of a severe epidemic of diphtheria, which lasted during the three years 1888, 1889, and 1890. A summary is given of the conclusions arrived at in respect of the causes and maintenance of the diphtheria prevalence in the borough. Table I. shows the comparative incidence of diphtheria attacks in each of the four districts of the borough during the years 1883 to 1890. Four other tables are given showing all the cases of diphtheria occurring in each of the four districts of the borough during the years 1889 and 1890, arranged in respect of ages, and in periods of residence from under one month to three years and upwards. A summary of these tables, so far as relates to the percentages of cases occurring after certain periods of residence, is also given. It is then maintained that the chief differences of the districts thus indicated correspond in large measure with the differences of the districts in respect of their general sanitary circumstances and of their Hygiene: Section I. 17 general mortality rates. In other words, as the people of a district were more subjected to the continuous in.fluence of their insanitary surroundings, they were found less fitted to resist the diphtheria infec- tion. The result arrived at appears to be that the relative incidence of diphtheria during an epidemic period, in respect of length of residence, was dependent to no small extent on general sanitary circumstances. On the Spread of Diphtheria in Europe. BY Dr. JULES BERGERON. The object of this paper is to obtain information : A. As to the increase of diphtheria in Europe during the last 50 years ; or, should statistics for so long a period not be forthcoming, subsequent to 1860, since which date the extension of the malady throughout France has been rapid and continuous. B. As to probable cause of its extension in all countries where this has been duly observed. The uninterrupted progress of diphtheria in France for a number of years past will be shown by statistics obtained from several large towns. La Diphterie, sa Marche en Europe depnis 50 ans, PAR Dr. JULES BERGERON. La communication du Dr. Jules Bergeron a pour but de pro- voquer la production de renseignements et, s'il le peut, de documents precis : A. Sur la marche de la Diphterie en Europe, depuis 50 ans, ou tout au moins, si les statistiques manquent pour une epoque aussi eloignee, depuis I860, epoque a partir de laquelle les progres de cette maladie sont devenus, en France, rapides et constants. B.-> Sur les causes probables de son extension dans tous les pays ou cette extension a ete dument constatee. La communication a aussi pour but de mettre en evidence, par 1' expose des donnees statistiques recueillies dans plusieurs grandes villes de France, les progres ininterrompus de la Diphterie, dans ce pays, depuis un certain nombre d'annees. i p. 1 034. E. & S. 26. IS Hi/tjicnc: Section T. Diphtheria, with Special Reference to its Distribution, and to the Need for Comprehensive and Systematic Inquiry into the Causes of its Prevalence, in certain Countries, and parts of Countries, with a view to its Prevention. BY EDWARD C. SEATON, M.D., F.R.C.P., Ac. No climate appears to give immunity from the prevalence of this disease, but the tropics suffer less than cold and temperate climates. During the present century, in Europe, France has been the principal centre for diphtheria. But, from accounts given by Dr. Hewitt, the health officer for the State of Minnesota, U.S., certain tracts of country in that great State are even more remarkable centres of diphtheria. In England, Longstaff has studied the distribution of the disease. He has taken his facts from the abundant statistics of the 26 years ending 1880, and has graphically displayed in a shaded map the local mortality. This is shown to be light in Devonshire, Cornwall, and the Midlands, and heavy in Norfolk and Wales. The disease does not obey the law which determines the prevalence of others of the zymotic group. Unlike them, it prevails more in the country than in towns. But there has been observed of late years an increasing incidence of diphtheria upon the more dense populations as compared with the less dense. Another remarkable feature in the prevalence of diphtheria is that its mortality has risen in England synchronously with the adoption of extensive works of water supply and sewerage during the last 15 years. The reduction of enteric fever is, by common consent, ascribed to these improvements. It may be that the mortality from diphtheria would have been greater but for these improvements, but of this there is no proof. The author re-asserts his belief that (contrary to the doctrine almost universally taught, there are but slender grounds for supposing that diphtheria is influenced favourably or unfavourably by what are generally termed sanitary conditions. He gives instances from his own experience in support of this assertion. The same point has been referred to by physicians who have had special opportunities of observation, and latterly it has been dwelt on by Dr. Thorne- Thorne, F.R.S., in his admirable lectures at the Royal College of Physicians. The importance of these main considerations, namely (1.) The prevalence of the disease in strikingly different degree in countries in the same latitude and with similar climatic conditions, and also in parts of countries close to each other ; (2.) The fact that it has not apparently been influenced favourably by the adoption of sanitary measures which have been generally found effective in reducing the death-rate ; prove the urgent necessity for a comprehensive inquiry by our Government, acting in this respect with the Governments of other countries, into the causes which determine the prevalence of diphtheria. Hygiene: Section I. 19 Such an inquiry should take into account what has already been ascer- tained with regard to the occasional causation and spread of the disease by milk, and the influence which schools have on its production and spread, and also the subsidiary influence of dampness, dirt, overcrowding, &c. ; but its main object would be to ascertain the local conditions and cir- cumstances which account for the disease being endemic and becoming epidemic. To ascertain these, the inquiries must, of course, be made in countries marked by freedom from the disease as well as in those which suffer from it. The Effects of Alcoholism on Public Health. BY JOHN G. PHILLIPS, Secretary to the Sceptre Life Association. A brief statement of the experience of the Sceptre Life Association. The Sceptre Life Association was established in 1864 to effect assur- ances chiefly upon the lives of members of religious bodies, as the founders of the Association believed that a lower rate of mortality prevailed among that class of people than among the general public. As it was believed that total abstinence from intoxicating drinks was conducive to longevity, a separate section was formed for total abstainers, with the result that up to the end of 1883 a much lower death-rate prevailed in that section than in that for non-abstainers. The quinquennial valuation to the end of 1888 was made by Mr. H. W. Manly, an actuary of high repute, who adopted the Institute of Actuaries' H M Table as being more accurate than the Carlisle Table, which had previously been employed. Mr. Manly in his report states : " In order to arrive at a fair division on the present occasion, " I have compared the actual claims in each section during the past " five years with the claims that might have been expected according " to the Institute of Actuaries' H M Table. ..." The result is given in an interesting table. A comparison of the average ages at death in both sections proves that any deductions from the mere ages at death without reference to the ages of the living groups from which they are drawn is most misleading ; the number of deaths was for the seven years ending 1890, 527 in the General Section, and the average age at death 51 '5; while during the same period the deaths in the Temperance Section numbered 174, and the average age at death was 44-8. The percentage of deaths from diseases of the heart, brain, nerves, and digestive organs, is much lower among abstainers. Up to the end of 1888 the number of policies issued by the Association was upwards of 20,000, of which 11,227 were in force at B 2 20 Hygiene: Section I. that date, 6,700 being in the General Section, and 4,527 in the Temperance Section. The latter is now gaining ground much more rapidly, as out of 4,112 policies issued since 1885, 2,404, or upwards of 58 per cent., are in that section. The Relation of Alcoholism to Public Health, and the Methods to be adopted for its Prevention. BY Prof. WESTERGAARD, of Copenhagen. 1. Difficulties arising from the imperfections of the statistics of the consumption of intoxicating liquors, the effect of this consumption on public health depending not only on the average quantity consumed per head of population, which is in many cases the only statistical fact at hand, but also on the distribution among the different elements of the population. 2. The extension of intemperance appears indirectly through certain social phenomena, such as divorces, the numbers of persons engaged in the liquor trade, the numbers of drunkards in poor-houses and lunatic asylums, offences against the law caused by alcoholic excess, &c. 3. The effects of habits of intemperance on health indirectly measured through the mortality in certain professions, such as publicans and beersellers. Experiences of life offices (" The United Kingdom Temperance Institution ") instructive, if the investigations are sufficiently detailed and scientific. The average age at death of persons with different habits as to intoxicating liquors (Neison, Isambard Owen) is an imperfect measure, the average age at death being often very discrepant from the mean duration of life ; but observations of the causes of death among such persons are very instructive, as well as the comparative numbers of temperate and intemperate persons. Observations on sickness and mortality from different causes, which directly or indirectly indicate alcoholic excess ; liver diseases (cirrhosis), delirium tremens and chronic alcoholism (the statistics as to these two causes in certain cases reliable). Suicides, pneumonia, and alcoholism. 4. Private efforts for diminishing alcoholism. Public coffee rooms, temperance societies, bands of hope. Drunkards' homes for the cure of habitual inebriates, with or without State assistance. Efforts to produce pure alcohol ; fines for adulteration of alcoholic drinks. Proposals as to declaring inebriates minors, and for punishing crimes committed in a state of drunkenness as severely as those committed in a sober state. 5. Excise and duties on intoxicating liquors. An increase of the excise and of duties seems to diminish the consumption, but not in proportion to the increase of duty. The State monopoly in Switzerland, leaving a part of the surplus to the cantons for the counteracting Hygiene: Section I. 21 of alcoholism, is reported to have had good sanitary effect ; this system has occasioned a decrease of consumption. 6. It is, moreover, most important to render the access to spirituous liquors difficult. The prohibitory system (Maine-laws), against manufacturing and selling of intoxicating liquors, but usually allowing the import and sale of the same in the " original packages." Several facts show that this system is ineffective, tempting, as it does, to a surreptitious liquor traffic. The same objections may partly be raised against the " local option " system, leaving to a town, a village, or a larger district of the country to vote for local prohibition, but fraud is more easily detected under this system. The third popular American system, the high licence system, seems to be more effective, lessening as it does the opportunity for intemperance by reducing the number of drinking saloons, and causing those who pay the high licence to help the authorities in the conviction of breakers of the law. A limitation of the number of licences recommendable (Dutch system) ; the Gothenburg system adopted in Sweden, Norway, and Finland : under this system licences are given to companies, which are only allowed to give the shareholders a fixed rate of interest, leaving the surplus for the benefit of charitable institutions. 7. A limitation of the hours during which the saloons are allowed to be opened is quite necessary, especially on Sundays (in Norway, sale of spirits forbidden from Saturday afternoon till Monday morning). The Hospital and Ambulance Organization of the Metropolitan Asylums Board for the Removal and Isolation of Infectious Disease. BY Deputy Surgeon-General BOSTOCK, C.B., and Sir VINCENT K. BAERINGTON. On the Need of Special Measures for the Prevention of Consumption, BY ARTHUR EANSOME, M.D., F.R.S. Consumption is both curable and preventable. The first proposition is proved by (1) the evidence of healed phthisis in a large proportion of bodies examined after death in public institutions. (2) by the testimony of many eminent physicians. (3) by returns from consumptive hospitals. Its preventability is shown by the results of the drainage and ventilation of barracks, public institutions, and towns. Cases of cured phthisis are peculiarly liable to a recurrence of the disease, and the number of susceptible persons in the general population mav be countedjby hundreds of thousands. 22 Hyyiene: Section I. The amount of preventable mortality to be dealt with greatly exceeds that by any other disease ; the total annual death-rates by preventable epidemic diseases being about 45,000, whilst those from tubercular maladies exceed 70,000. There are many predisposing causes of the disease such as those incidental to occupation which need attention from I he legislature, but the chief object of measures of prevention should be to cut off the supply of the bacillus from without especially, (1) by the ingestion of tuberculous milk or flesh meat. (2) by the inhalation of tuberculous dust. The first of these requirements may be Heroinplished by the more thorough and more scientific inspection of meat markets and dairy farms, and by the greater solidarity Ix-tween in-liaii and rural sanitary authorities. The second needs a thorough knowledge of the chief sources of infection by tubercle. The vitality of the bacillus has been shown by the researches of Koch, Bollinger, (Jalticr, Cornet, and others, and it has been proved that the spread of the disease is greatly promoted by residence in damp, ill-ventilated, and filthy dwellings. Evidence has been adduced by Dr. Irwin, of Oldham, Dr. Flick, of Philadelphia, and by the author of the existence in towns of tuberculous areas, and infected houses. The duty of sanitary authorities is therefore to treat phthisis as a disease analogous to leprosy, cholera, and enteric fever, in that it is a disease scarcely, if at all, directly contagious, but which may spread by means of material thrown off from the bodies of the patients. It should be combatted by the time-honoured methods of (1) notification of cases ; (2) disinfection ; (3) hospital accommodation, and (4) general sanitary measures, such as ventilation, drainage, and reconstruction of unhealthy areas. Under the recently passed Notification of Diseases Act many local authorities have included enteric fever and cholera; there would be nothing to prevent them from including a disease that is chiefly spread by infective sputum. Disinfection of sputum and other excreta could then be insisted upon. Hospital accommodation could be provided for those who were without proper lodging or accommodation, and lastly, the other measures of sanitary reform would not only protect persons from the danger of infection, but would render their bodies more fit to repel the attacks of this and other diseases. The Influence of Soil on the Spread of Tuberculous Eisease. BY Professor FIJJKELNBURG, Bonn. Hygiene: Section I. 23 The Topical Distribution of Pulmonary Phthisis in Havre ; and the Connexion of the Disease with Crowding, Alcoholism, and Poverty, BY Dr. GIBERT, Havre. Phthisis in Havre is every year making positively frightful ravages. The annual death-rate amounts to not less than 5 per 1,000. This number varies in a highly instructive ratio in the different quarters although incident on the same social class. The influence of the density on population is manifest ; hereditary influence is practically nil ; that of alcoholism is considerable. De la Distribution Oreographique de la Phthisie Pulmonaire dans la Ville du Havre. Rapports de la Phthisie avec la densite de la Population, avec 1'Alcoolisme et avec la Misere. PAR Le Doeteur GIBERT. La phthisic au Havre fait chaque annee des ravages vraiment effrayants. Le chiffre annuel n'est pas moins de 5 deces par mille vivants. Le chiffre varie dans des proportions fort instructives, suivant les quartiers, dans la meme couche sociale. L'influenoe de la densite de la population est manifesto ; 1'influence hereditaire est nulle ou presque nulle ; 1'influence de 1'alcoolisme est considerable. To what Extent can Legislation Assist in Diminishing the Prevalence of Consumption and other Tubercular Diseases, BY J. EDWARD SQUIRE, M.D., London, M.R.C.P., &c. The chief regulations directed against the spread of tubercular diseases on the Continent are briefly reviewed. The effect of these and their advantage are discussed. Any protective measures against tuber- culosis must proceed on the hypothesis that infection may come from human beings and from animals. The occurrence of tubercle pre- supposes the presence of the bacillus tuberculosis, and its development implies certain conditions which constitute a predisposition for those under the influence of such conditions. 24 Hygiene : Section I. The regulations framed for cases of acute infectious diseases, e.g., notification, isolation, and disinfection, cannot be enforced against a disease which is insidious in its onset, protracted in its course, and dependent for its spread on so many conditions besides its infect ivciicss. Inherited tubercle is at present beyond the scope of preventive legislation directly. Acquired tubercle may come from human or animal ini'ection. The former may be most effectually controlled by preventing overcrowding, for, with overcrowding and insufficient ventilation, infectious particles given off into the air accumulate and the infect ion becomes concent rated, whilst the debilitated inhabitants of overcrowded rooms more easily succumb to its attack. This at once opens the important question of the siqx-rvision of homes used as work rooms, where, we are met with the difficulty that inspection of the work room is impossible in these cases without invading the privacy of the home. Possible solutions of this difficulty are discussed, as by the pro- vision of public work-rooms, and by forbidding home work in single room tenements. The .supervision of injurious trades, and the regulations for carrying off dust, &c., in certain manufactures form part of the preventive machinery. The collection of phthisical patients in hospitals or elsewhere, and the possible danger from sputa when not disinfected is considered, as is also the advisibility of providing homes for con- sumptive invalids who cannot be received into hospital, so that they may not be a source of danger in their crowded homes during the last few months of life. To avoid infection from animals the most rational means would be to aim at keeping the animals themselves healthy, by attention to the size and ventilation of stalls and sheds, and preventing overcrowding of cattle kept for the supply of food. The seizure and destruction of suspected meat and milk may be necessary, but great difficulties present themselves in dealing with imported meat. The training of the children of tuberculous parents, and of all children exposed to predisposing or actual causes of tubercle has to be considered. The air-space and ventilation of schools, and systematic physical exercise in fresh air for the children are also factors which cannot be neglected. The Improved Hygienic Condition of Maternity Hospitals. BY W. O. PRIESTLY, M.D., LL.D. During the end of the last century and the first half of the present one, the mortality in maternity hospitals was very large, both on the Continent and in Great Britain. According to Le Fort it was at the rate of 34 per 1,000, while, according to Miss Nightingale, it was only 4'7 per 1,000 when patients were confined at their own homes; or, according to Dr. Matthews Duncan, 8 per 1,000, equal to 1 in 125. The cause of the increased mortality in lying-in hospitals was the Hygiene: Section I. 25 prevalence in these institutions of puerperal fever, 75 per cent, being due to this cause. The infectiousness of puerperal fever, long doubted, was at length established, and also the fact that various poisons brought from the dissecting room from patients suffering from erysipelas, eruptive fevers, and the like 'became the germs of infection which might cost the lives of many patients. The researches of Pasteur, Koch, Lister, and others, had shown that these poisons owed their virulence to the presence of microscopic germs which multiply in the body of patients and produce the deleterious results. Hence it came to be recognised that by preventing the ingress of these germs to the bodies of puerperal patients, comparative safety, even in lying-in hospitals, was attainable ; and the introduction of the antiseptic and aseptic methods has produced not only a remarkable diminution of mortality, but also of the morbidity, or illness incident to the puerperal state. A short sketch is given of the modern methods adopted in several countries to ensure the greater .safety of patients in maternity hospitals, and of the results obtained in Europe and in the United States. The results are very striking, and are attributable mainly to the introduction of the antiseptic or aseptic modes of treatment, although other improvements are not lost sight of. The mortality from all causes in various countries in Europe, according to Le Fort, was 30,394 out of 888,312 deliveries, or 34,21 per 1,000. Dating from 1881, after the introduction of antiseptics, the deaths were only 511 out of 102,961 deliveries; and it is calculated that taking Le Fort's figures as a basis, no less than 3,01 1 lives of mothers had been saved a fact furnishing an instructive study to opponents of scientific research who have not hesitated to charge those engaged in experimental investigations with a desire only to gratify personal ambition. The Influence of the Nile on Mortality in Egypt. BY GREENE PASHA, Director Sanitary Department. Brief topographical description of Egypt and the Nile. Density of population, and mode of life of inhabitants. Water supply Nile sole source of. Dr. Grant Bey on quality of Nile water. Sources of pollution of "Nile, and effects thereof. Sir Guyer Hunter on water pollution in Egypt. Quotations from other writers. Stagnant water does not destroy disease germs. Diagram A. Birth and death rate in 12 chief towns, Lower Egypt, 1886-90. Mortality rises as river falls and becomes stagnant in all except two, Damietta and Rosetta. Details regarding water supply and mortality in Guizeh, Cairo, Mansourah, Alexandria, Daman- hour, Tantah, Mehalla, Zagazig, and Port Said. Low-Nile rise of mortality marked in all during at least three out of the five yi-ars. Excess of deaths over births at same season. 26 Hygiene: Section I. The exceptions : Damietta, topographical description ; account of, by Dr. Chaffey Bey. Sanitary condition certainly not superior to other towns. During the five years deaths never exceeded births, and low- Nile rise of mortality was conspicuous by its absence. Rosetta, topo- graphy ; superior house accommodation ; general low death-rate. Low- Nile rise of mortality absent; low-Nile season on the whole the healthiest part of year. Reasons usually ascribed for summer mortality, such as excessive hoat, general insalubrity, ingestion of unripe fruits, measles, &c. ; all equally operative in Damietta and Rosetta. Some other cause of mortality must exist. In writer's opinion, water supply in fault. Damietta and Rosetta alone of all Egyptian towns unable in summer to use Nile water, as it is there brackish. The store in cisterns at high-Nile. Water supply only difference between them and other towns. Connexion between water supply and mortality in Egypt is consequently evident. Diagram B. Weekly mortality, Cairo and Rosetta, under and over five years.. Marked contrast between two towns. No low-Nile rise at all Rosetta, but Cairo each year produces its mountain. Little children swell death-rate, hence general apathy. Similar mortality among adults would cause panic, as occurs during cholera epidemics. Statistics regarding cholera epidemics compared with those of infants. Pure water, drainage, and ventilation required to bring down enormous mortality. Problem for procuring pure water not difficult. Money only required. Monsieur Prompt's plan. Objection from sanitary point of view. Mr. Cope Whitehouse's scheme. Gain resulting from latter would be equal to five times expenditure, from economical point of view merely. Remarkable confirmation of theory that Nile water, when low, is deleterious. Cisterns of Rosetta not filled, first time six years. People use water new canal. Infant mortality excessive. Statement by local sanitary officer. Table C., births and deaths, Rosetta, 1891. Mortality compared with five previous years. The Prevention of Disease in Growing Towns. BY Surgeon-General BEATSON, M.D., F.R.C.S. During the last 50 years many towns claiming to be health resorts have sprung up in England. All have become more or less unhealthy. Such results may be disastrous to the commercial prosperity of health resorts, and are especially disappointing to those who have believed that country villages can be converted into populous towns without deterioration of health conditions. Hygiene: Section I. 27 The old towns of England were built before the causation or prevention of disease was understood. They became abundant in filth conditions, hotbeds of infectious disease. Epidemics were considered to be importations, suppressible by exclusion or by confinement to localities. Such attempts at suppression have never been fully successful ; the burning of an infected city put an end to the plague ; reduction in the incidence and severity of epidemic disease has since been arrived at under the teachings of sanitary science. During the last 200 years the life habits of the English people have undergone great change ; but wherever a growing town exists, there also exists growing impurity of earth, air, and water in which disease of all kinds has its chief origin. Numerous legislative enactments have been contrived for the prevention of disease, but none has been universally successful because they are mostly optional, and have to be carried out by individuals who have not studied and do not much believe in sanitary science, or who have their own theories as to the nature arid origin of epidemic disease. The writer is no opponent of the germ theory. He regards bacterial organisms rather as results than as originating causes. Disease may be regarded as a condition of the human system, not as a separate self- existing entity ; it may originate " de novo " under circumstances favourable to its development ; and it is often the result, not of single, but of many concomitant causes. The complete prevention of disease in growing towns may perhaps remain for ever an impossibility. Certainly it will not be promoted while people believe that epidemic disease is always an importation and never the outcome of the unwholesome conditions of which they are surrounded ; while the formation and sanitation of towns remains chiefly in the hands of private landowners, town councillors unskilled in sanitary science, local officers of health engaged in the practice of curative medicine, and speculative builders. Finally the writer submits for consideration the desirability of establishing a State Department of Hygiene for the control and guidance of local sanitary authorities, and for the general conservation of public health. The Prevention of Fever in India. BY Surgeon-General Sir WILLIAM MOORE, K.C.I.E., Q.H.P. The prevention of fever should be considered under two heads : What can be done by authoritative sanitary regulations, and what can be done by personal hygiene. And these heads should be considered, first as applicable to Europeans, including soldiers ; and secondly, as applicable to the general population. As regards Europeans much has 28 Hygiene : Section I. been done, but more is required. Time of arrival is not always well chosen, and men go out too young. A greater use should be made of the Indian hills. Over-ventilation of barracks to be avoided. Surface and subsoil drainage about barracks and residences required. Con- servancy. Use of the bath. The " Cummerbund." Food milk supply water. Classes for instruction in hygiene required. The station hospital. For the general population more drainage wanted, especially in irrigated districts, and in connexion with railways and roads. Pure water-supply a sine qua non. Prevention of scarcity of food :i means of diminishing fever. Use of opium. Causes of fever among the natives of India. Unhealthy habits and customs of the Indians. Theory of fever. Prevention of fever to lie accomplished by strengthening the people, by general sanitation, and by diffusing a knowledge of personal hygiene. The State cannot interfere directly in the ordinary internal daily life of the people. All directions for the prevention of Indian fevers tend to the lessening of damp and the avoidance of chill. Extracts from recent reports, supporting the author's views. The Prevention of the Spread of Epidemic Influenza. BY RICHARD SISLEY, M.D., M.R.C.P., Lond. Influenza occurs sporadically and endemically in China. England suffers from an epidemic .only when the disease is imported. The disorder spreads along the lines of human intercourse, and the infective; material is not always wind-borne. The inhabitants -of cities are affected before those of intervening villages. In many cases it has been observed that the first patient in a district has taken the disease with him from some infected town. Instances of this have been reported from Exeter, Frontignan, Mont- beliard, and Brest. It is said in the most important monograph which has appeared in English since the late visitation of influenza, that the early cases are " of " very little importance in a comprehensive view of the course of the " epidemic. They may be looked upon, to use Sir Thomas Watson's " words, ' as the first droppings of a thunder shower ' The " arrrival of the great wave of infective material was not until much " later, and must be taken as indicated by the occurrence of the disease " in large numbers of the population." This simile is more poetic than true. It is not that the isolated drops are followed by a wave of the disease, but each isolated case becomes a centre of infection, and contagion plays a great part in the spread of the disease. The chief means which should be adopted to prevent the spread of influenza are : I. Hygienic. The spread of the disease is less rapid where general hygienic measures are carried out. II. TJie use of Hygiene : Section I. 29 Prophylactics. Quinine is not a certain prophylactic, but there is some evidence in favour of the application of a solution of boric acid to the conjunctivae of those exposed to infection. III. The avoidance of infection is of the greatest importance : i. People suffering from the disease should not give parties or go to public entertainments, ii. Every one, as far as possible, and particularly the aged and those in delicate health, should avoid all contact with patients who have influenza. Hi. Parcels and letters should be disinfected, iv. Great care should be taken not to introduce the disease into public institutions, for experience shows that when once introduced it often spreads rapidly, where many people are congregated in a confined space, v. Elementary schools should be closed. The Prevention of Blindness due to Special Occupations. BY ' Dr. J. C. DVOREMAAL, La Haye. In most cases blindness of this class is caused, in the country, by an insignificant lesion (e.g., the keratitis of harvest -labourers), followed by a serious infection (blenorrhcea of the lacrymal sac). In towns, on the other hand, such blindness is due to grave primary lesion without, or nearly without, infection. It is therefore incumbent, in the country, to prevent infection, and in towns, to avoid local injury. The public should be instructed not to neglect a discharge from the lacrymal sac, and doctors practising in the country should be reminded to treat every dacrocystitis thoroughly, and to secure any corneal wound against infection, by rigorous antiseptic treatment. Traumatic lesions can only be prevented by the combined efforts of manufacturers, engineers, and medical men. Engineers must aid us by so constructing machinery as to prevent the liability to accidents. Manufacturers, foremen, &c., must exercise supervision over their works, and must see that their employes do not neglect the necessary precautions, and that they conform to existing rules. Medical practi- tioners must endeavour to improve the measures available for protecting the work people, e.g., protective goggles, masks, garments, &c. Exhibitions of special apparatus are useful to this end. 30 Hygiene : Section I. La Prevention de la Cecite Professionelle. PAR Le Dr. J. C. VAN DVOREMAAL, Medecin Oculiste, La Haye. Dans la majorite des cas la excite professionelle a la campagne est causee par un traumatisme insignifiant (keratite des moissonncurs) et une infection grave (blennorrhee du sac lacrymal). A la ville c'est causee par un trauinatisme grave sans ou a peu pres sans infection. A la campagne il s'agit done de prevenir 1'infection ; a la ville il s'agit de prevenir le traumatisme. Apprendre au public qu'individu ne doit pas vivre tranquille avec un ecoulement du canal lacrymal, et aux medecins qui vont s'etablir dans les campagnes a soigner une dacryocystite et prevenir 1'infection de la plaie corneenne par un traitement antiseptique rigoureux. Les traumatismes dans 1'industrie ne peuvent etre enraye*s que par le concours des ingenieurs, des fabricants, et des medecins : Les ingenieurs doivent nous aider a construire des machines ou toutes les precautions sont prises pour preVenir les accidents; Les fabricants, contre-maitres, etc., doivent surveiller dans les fabriques et s' assurer que les ouvriers ne negligent pas les precautions necessaires et observent strictement les reglements ; Les medecins doivent s'occuper a per- fectionner les moyens qui protegent le corps de 1'ouvrier; lunettes protectrices, masques, vetements, etc. Les expositions speciales (Amsterdam, 1890) sont un moyen puissant pour nous tenir a la hauteur de ce qui a deja etc fait et surtout de ce qu'il nous reste encore a faire, Observations on Malaria and Enteric Fever (including the so-called Blackwater and Typho-Malarial Fevers), and on the Possible Antagonism between Malaria and Phthisis. BY ROBERT W. FELKIN, M.D., &c. Various reasons are stated for holding that malaria is a definite disease, and that under whatever guise it appears, it is due to the self -same cause. Micro-organisms found in the blood of malarial patients by Laveran and others are then referred to, as well as the confirmation of these observations in India, America, and Africa. A brief outline of malaria as it occurs in Central Africa is next given, its varieties, and its effects upon natives and Europeans. It is next shown that when natives are moved from one area to another they suffer almost as much from malarial fevers as do Europeans. Hygiene: Section I. 31 Enteric fever exists in Central Africa. It is endemic, and, in all probability, epidemic. It is met with at Khartoum, up the White Nile as far as the Victoria and Albert Lakes, and also in the Bahr-el-Ghazal, in Darfour, and in Kordofan. So far as the writer has observed, typho-malarial fever does not exist as a separate disease. He believes that in cases to which this name has been given in America there are really two diseases, malaria and enteric fever, present, one or other giving a predominance to certain symptoms. Blackwater fever has been thought to be a definite and distinct disease, but, from the observations made by the writer in Central Africa, he is inclined to hold that it is simply a severe type of malarial fever, characterised by well-marked symptoms, of which the black water is the most striking and prominent. In the writer's experience there seems to be an antagonism between malaria and phthisis. Wherever malarial fevers were most prevalent in Central Africa, he never had the opportunity of seeing a case of phthisis. Phthisis does exist in Central Africa, but, so far as the writer knows, it is only met with where malaria rarely, if ever, occurs ; viz., in high altitudes. The possible antagonism of these diseases has been pointed out by various observers in different parts of the world, and their observations are referred to by the writer as bearing out his own. The Geographical Distribution, Pathological Relations, and Life History of Filaria sanguinis hominis diurna, and Filaria sanguinis hominis perstans, in connexion with Preventive Medicine. BY PATRICK MANSON, LLJX, M.D. The discovery of the blood worms herein named Filaria sanguinis hominis diurna and Filaria sanguinis hominis perstans suggests an investigation into their possible pathological relations, and into their life histories, with the view to intervention in respect to them of preventive medicine. The facts that these parasites and the disease known as negro lethargy, or sleeping sickness of the Congo, are endemic in the same region, the West Coast of Africa : that neither can be acquired unless in this particular region : and that sleeping sickness may declare itself many years after the endemic region has been quitted, and that these filarias continue to live for many years after the negro has left Africa : suggest a possible relationship between these parasites and this disease. A papulo-vesicular skin disease called craw-craw is endemic in the sleeping sickness region, and sleeping sickness is often accompanied by a similar papulo-vesicular skin disease, probably the same. O'Neil 32 Ifyyiinc : Section I. found a fil;vri;i-liko parasite in the vesicles of craw-craw. Nielly considers a disease he calls dermatose parasitaire which lie found in a lad in France, the same as the African craw-craw; he discovered in the vesicles of the skin in this case the same, or a similar, parasite to ()' .Veil's. Nielly, at the same time, found an embryo iilaria in his patient's blood which was undoubtedly an earlier form of the skin worm. From this the inference may be drawn that, in certain cases, at all events, of sleeping sickness afilaria embryo is present in the blood. Filaria s. h. diurna and Filaria s. h. perstans have both been found in a case of sleeping sickness. These facts taken together amount to a presumptive case against one or other of these parasites as the cause of sleeping sickness. The probable life histories of these worms is then indicated, the Filaria loa being considered the parental form, and an insect, called the mangrove fly, the intermediary host of Filaria s. h. diurna. The parental form of Filaria s. h. perstans is not known but, assuming that the worm of craw-craw, sleeping sickness, and dermatose parasitaire is the same, and that the skin form is an advanced stage of the embryo lilaria found in the blood, then, arguing from the analogy to what happens in the case of the embryo of Filaria Medinensis, which closely resembles this skin parasite, the probable intermediary host of Filaria t. h. perstans is a freshwater animal, possibly a Cyclops. Provided the hypotheses as regards these parasites and the diseases they produce are correct, both disease and parasites may be avoided by securing a pure water supply to which the intermediary hosts of the parasites do not get access. Travellers, missionaries, and others in Africa are appealed to for assistance in clearing up the subject, and for further information. An appendix contains directions for demonstrating in the surest, most rapid, and most effective way the presence or absence of filaria embryos in blood, and of making collections of slides of blood for storage and future examination. On Disinfection, BY Professor PISTOR, Berlin. Public Libraries and Infection. BY J. Y. W. MACALISTER, London. Hygiene : Section I. 33 The Principal and most Efficacious Means of Preventing the Spread of Entozoal Diseases in Man. BY Dr. PROSPERO SONSJNO, of Pisa. This paper deals with the best known human entozoa only, and makes an attempt to classify them practically. The geographical dis- tribution, mode of introduction into the human body, and pathological effects of each of the most important and dangerous varieties is briefly treated. The geographical distribution of local entozoa is shown in a synopsis. The author shows that while rules of personal hygiene are sufficient to prevent the introduction of most of these parasites into the human body, certain State measures may afford greater security against the diffusion of entozoal diseases. The necessary points of personal hygiene are first enumerated and remarked on as follows : 1. Pure spring water, or else boiled or filtered water, alone to be drunk. Drinking water to be preserved in good and well covered vessels. Kiver or lake water not to be imbibed while bathing. 2. Meat, fresh water fish, and vegetables to be well cooked and kept from insects (flies). 3. Depraved tastes for substances not possessed of alimentary qualities (pica or geophagia) not to be yielded to. 4. Special forms of food in use by the natives of countries possessing special entozoa to be avoided, or taken only after thorough cooking. 5. Hands and nails to be kept thoroughly clean, particularly when about to eat. 6. The body to be sedulously kept clear of epioza (mosquitoes, bugs, fleas, &c.), and domestic animals to be handled with caution ; dogs particularly. The author further shows how effective the application of State measures would be, were it possible to enforce cremation or thorough disinfection of human excreta, particularly of fseces, vomita, urine, and sputa ; and specifies the following regulations which should be made obligatory by boards of health, pending the possibility of the more complete measures : 1 . The discharge of sewage, where possible, into the sea. 2. Failing this, the disinfection of the excreta of such public institutions as hospitals, asylums, and schools, with quick lime. 3. The prohibition of nuisances in certain works; such as brickfields, mines, tunnels, rice plantations, and cuttings for canals, and the obligatory provision in such places of special forms of latrine, with tanks to receive the excreta for disinfection. 4. Daily veterinary inspection of slaughter- houses. . 5. Facilities for admitting entozoal patients to hospital. 6. Licensing of pigsties. 7. Destruction of ownerless dogs, and removal of dogs from slaughter-houses. In conclusion, these suggestions are put forward with special regard to hot climates, and more particularly to Egypt, where the author spent 12 years, and where, as he claims to have established in two i p. 1 G34. E. & S. 26. G. 34 Hygiene: Section I. previous publications, the anchylostoma duodenale, filaria sanguinis hoiiiitiix, and l>illlinrzia hcematobia together form an important factor in disease and mortality, especially among the natives. The Disinfection of Scarlet Fever and other Infectious Diseases by Antiseptic Inunction, BY J. BRENDON CURGENVEN, M.R.C.S., &c. Not one of the ordinary disinfectants now in use is suitable for inunction over the whole surface of the body of a young child. Carbolic acid is poisonous, and a 10 per cent, solution in oil has no effect on bacteria. Its vapour, given off at the ordinary temperature, has no effect on bacteria or germs of any description. Jey's fluid is an emulsion of a resinous soap, with creolin, phenol, &c., in solution. Bichloride and biniodide of mercury are too poisonous to use for inunction. Thymol, resorcin, and other germicides, have been tried in lanoline, vaseline, and lard, without success, and to the great discomfort of the patients. Condy's fluid could not be used for inunction for reasons familiar to all persons. Tucker's Eucalyptus Disinfectant has this advantage over all the preceding in that it is entirely volatile, consisting of thymol and some essential oils dissolved in the oil of eucalyptus globulus. It is not poisonous as carbolic acid and the mercury salts. It does not interfere with the action of the skin as fats and fixed oil. Its inunction produces a slight stimulating effect on the skin, and there is a sense of general warmth. The rash appears brighter but fades away rapidly in ordinary cases within 24 hours. The temperature falls rapidly after the com- mencement of the treatment, and reaches normal, or below 99 from the third to the sixth day in uncomplicated cases. The pulse under treatment by inunction falls below 100 on the third and fourth days, and reaches normal about the sixth or eighth days. Desquamation commences soon after the rash disappears, and occurs only on those portions of the skin occupied by the rash, and it ends from the tenth to the fifteenth day. The falling cuticle does not convey any infection. The patients can safely mix with others after the tenth day. No isolation, as now understood, is necessary, as other children can frequent the room of the patient without taking the disease. Albumi- nuria is absent, or it appears only in a slight degree, in all the patients treated by inunction, from not later than the second day. The disinfection of the bedding and the room is accomplished part passu with the treatment of the patient, the volatile oils and their vapour penetrates all clothing and pervades every part of the room. The cases given in the paper illustrate the points advanced. Hygiene: Section I. 35 Cholera in Egypt. BY Dr. SANDWITH, Cairo. Measures for preventing the Spread of Infectious Disease. BY Dr. LEWIS W. SAMBON, Naples. On the alleged Connexion of Vaccination with Leprosy. BY P. S. ABRAHAM, M.A., M.D., B.Sc., F.R.C.S.I. The evidence at present at our disposal bearing upon the question is passed in review, and the principal observations, medical and lay, relating to the subject, criticised. The conclusions arrived at are: 1. That the spread of leprosy, which has been noted in many parts of the world, cannot be put down to vaccination ; 2. That although a priori we may consider that an accidental inoculation of leprosy by vaccination may be possible, there are no clear cases in proof ; 3. That, nevertheless, it behoves medical men in leprous countries to discourage arm-to-arm vaccination among the natives. On the Importance of more Actively Enforcing the Ventilation of Public and other Buildings; suggesting a Standard of Impurity of Air as a Basis of Prosecutions. BY J. P. WILLIAMS FREEMAN, M.D. Sanitary Progress in India. BY Surgeon- General Sir WILLIAM MOORE, K.C.I.E., Q.H.P. Sketch of the origin of sanitation in India, and of the formation of the sanitary department. Amalgamation with the vaccination department. Present strength of the department. Measures taken to obtain the co-operation of the people. Formation of munici- palities. Financial concessions made by Government. Expenditure c 2 36 Hygiene: Section I. on sanitation. Sanitary advance is influenced by material and moral progress. A badly-fed people most liable to the principal diseases of India. Augmentation of the food supply obtained by improved agriculture, by the further utilisation of fish as food, but principally by the extension of irrigation. But irrigation is not an unmixed good, irrigated tracts being generally unhealthy. Superior facilities for the distribution of food obtained by the extension of roads and railways, rendering scarcity and famine much less possible in one district while plenty prevailed in the next province. Salt also rendered cheaper. Advance of education an aid to sanitation. Medical schools. Hospitals and dispensaries. Lady Dufferin's female hospitals. Forest conservancy. Cultivation of the cinchona. Study of meteorology. Registration of births and deaths. The census. Conservancy. Drainage. Vaccination. Ventilation of towns and villages. Water supply. Investigation of the causes of disease. Cholera. Uselessncss of quarantine in India. Preventive system as pursued in India : (1) attention to local sanitation ; (2) removal, when possible, from an infected locality. Endeavours to meet the views Of the Constantinople Cholera Congress of 1864. The pilgrim traffic. International Cholera Congress at Rome. Incubation of cholera, with reference to quaran- tine against Indian ports. Results of sanitation in India. Opinions of the present Indian sanitary officials. The author's opinion. Death- rate of European soldiers and of Europeans in India generally diminished. The severity of, and mortality from, certain diseases lessened, especially cholera at fairs and festivals, and in towns and cities where sanitation has most progressed. Bombay, Madras, and Calcutta : present salubrity compared with the unhealthiness of former times. Increase of population as shown by the last census. The Indians becoming gradually more interested in sanitary matters. Difficulties contended against : the tropical climate ; the varieties of the climate ; the various races of people ; ignorance ; peculiar habits antl internal social life. Sanitation in the Native States. Military sanitation ; although much has been done, more is required. Enumera- tion of such requirements. Appendix, No. 1. Memo, on village sanitation with special reference to the recent Bombay Village Sanitation Act (vide Appendix, No. 2), by Lionel Ashburner, Esq., C.S.I., late Member of Council, Bombay. Appendix, No. 2. Showing the principal improvements made each year in the different provinces. 37 SECTION II. BACTERIOLOGY. This Section will meet in the rooms of the Royal Society, Burlington House, marked C on the Plan. PRESIDENT. Sir JOSEPH LISTER, BART., F.K.S., LL.D., &c. The Hsomatozoon of Malaria. BY Professor A. LAVERAN. The hcematozoon, described by the author in 1880, has, since that date, been recognised by many other observers. Its morphology is now well known ; the chief forms which it assumes are indicated in the diagram (shown, Fig. 1.) A description is given of 1. The spherical bodies ; 2. The flagella ; 3. The cruciform bodies ; 4. The rosette-like bodies. The flagella can only be demonstrated in fresh blood ; the other forms, however, are well seen in preserved blood (microscopic slides shown). The blood in paludism is easily studied by rapid drying and fixation ' of the specimen by heat, followed by staining with a concentrated solution of methyl blue or gentian violet ; a double staining can be effected by successively universing the specimen of dried blood in concentrated aqueous solutions of eosin and of methyl blue, whereby the red cells assume a rosy hue, and the leucocytes, together with the parasitic bodies, are coloured blue. Nuclei have been observed in both the sperical and the cruciform bodies. Two, and even three, different varieties of this haamatozoon have been described (polymorphism). Similar hasmatozoa have been found in different animals frogs, lizards, marsh tortoises, birds. In many species of birds there is to be found a hajmatozoon so similar to that of paludism, that most observers regard the two forms as identical. The similarity is very marked, yet several points of difference exist; thus in the blood of birds the cruciform bodies are not found ; the parasitic element are endoglobular, and never become free, as is often the case with the true paludic hasmatozoon ; and the amtemboid movements of the spherical bodies are much less notable in the case of the organism found in birds' blood. On the other hand, this latter hasmatozoon -has been observed in birds living in non-marshy regions, and it frequently causes no inconvenience to its host, and the inoculation of blood containing this ha>matozoon has 38 Hygiene: Section II. given only negative results. Yet the study of this organism may be expected to throw light upon many obscure points in the life-history of the true hseinatozoon of paludism, with which it presents so many points of similarity. De I'Hematozoaire du Palndisme. PAR Le Dr. A. LAVERAN, Professenr a PEcole du Val de Grau. L'hematozoaire signale par 1'auteur des 1880 chez les maladcs atteints de paludisme a ete retrouve par un grand nombre d'observateurs et son existence n'est plus serieusement contestee. Parmi les nombn-ux travaux confinnatifs des miens qui ont ete publics depuis dix ans je citerai ceux de E. Richard, de Sternberg, de Councilman, de W. Osier, de James, de Marchi^fava et Celli, de Guarnieri, de Pietro Canalis, de Grassi et Feletti, d'Antolisei et Angelini, de Terni et Gardina, de Bignami, de Vandyke Carter, d'Evans, de Metchnikof, de Sacharof , de Khenzinsky, de Romauowsky, de Soulie, de Paltauf, de Baml>erger, de Hochsinger, de Plehn, de Quincke, de Pfeiffer, d'Enrique Morado et de T. Coranado. Les caracteres morphologiques de 1'hematozoaire du paludisme sout aujourd'hui bien connus, je me contenterai de rappeler brievement les principales formes sous lesquelles il se presente, ces formes ont ete reproduces dans la figure ci-jointe (Fig. 1). 1. Corps spherique. Ces elements dont le diametre varie de 1 a 8 ou 10 /* sont libres dans le serum, ou bien ils adherent a des hematics qui palissent a mesure que grandissent les parasites ; ils sont animes parfois de mouvenients amiboides et ils renferment, sauf a leur premier degre de developpement des grains de pigment. 2. Flagella. Sur les bords des corps spheriques arrives a leur developpement complet on aper9oit quelquefois, dans le sang frais, des flagella en nombre variable animes de mouvements tres vifs ; ces flagella finissent par se detacher des corps spheriques et devenus libres ils se perdent au milieu des hematics. 3. Corps en croissant. Ces elements sont cylindriques, plus ou moins effiles aux extremites, d'ordinaire incurves en croissant ; ils mesurent de 8 a 9 /* de long ; vers la partie moyenne on distingue une tache noiratre formee par des grains de pigment. Ces elements peuvent preniU-e la forme ovalaire ou la forme spherique ; ils ne sont pas doues de mouvement. 4. Corps en rosace. Elements regulierement segmentes, avec un petit a mas de pigment au centre ; les segments prennent la forme spherique au bout de quelque temps et 1'element se desagrege. Les corps en rosace paraissent correspondre comme 1'a dit Golgi a un des modes de multiplication de Thematozoaire. Enfin on constate Hygiene: Section II. 39 dans le sang des malades atteints de paludisme, des leucoytes melani- feres. La melanemie, si prononcee chez les sujets qui succombent a des acces pernicieux, avait attire depuis longtemps 1'attention des observa- teurs, mais on ne s'expliquait pas pourquoi il y avait formation de pigment. La constatation de parasites pigmentes a donne la solution de ce probleine ; les leucocytes s'emparent des parasites et c'est ainsi qu'ils deviennent melaniferes. Les flagella ne peuvent etre etudies que dans le sang frais, mais les autres elements se voient bien dans le sang conserve : (quelques prepara- tions histologiques des paratises du paludisme montrees). La dessiccation rapide et la fixation par la chaleur reussissent tres bien pour 1' etude du sang palustre, on colore a 1'aide d'une solution concentree de bleu de methylene ou de violet de gentiane ; on peut obtenir une double coloration en faisant agir successivement, sur le sang desseche, une solution aqueuse concentree d'eosine qui colore les hematics en rose et la solution aqueuse concentree de bleu de methylene qui colore en bleu les leucocytes et les elements parasitaires. Quelques observateurs disent avoir reussi a mettre en evidence des noyaux dans les corps spheriques et aussi dans les corps en croissant. Golgi et Pietro Canalis admettent trois varietes d'hematozoaires du du paludisme, Grassi et Feletti en admettent deux. Les differentes formes sous lesquelles se presente le parasite du paludisme paraissent appartenir a un meme sporozoaire polymorphe, amsi que 1'auteur a essaye de le demontrer recemment. (Du Paludisme et de son hematozoaire, Paris 1891.) Des hematozoaires analogues au parasite du paludisme existent chez diff erents animaux. Tel est le drepanidium ranarum decrit par Gaule et Ray Lankester, tels sont surtout certains hematozoaires des lezards, de la tortue des marais et des oiseaux dont nous devons la connaissance a Danilewsky. On trouve dans le sang de plusieurs especes d' oiseaux un hemato- zoaire si voisin de celui du paludisme que plusieurs observateurs ont pu soutenir qu'il s'agissait d'un seul et meme parasite. Grassi et Feletti, Celli et Sanfelice ont etudie apres Danilewsky cet hematozoaire des oiseaux ; mais 1'auteur a reussi a le retrouver dans le sang du geai et de 1'alouette. Ce parasite se recontre le plus souvent a 1'etat d'inclusion dars les hematics ; il se presente a son premier degre de developpement sous 1'aspect de petits elements spheriques de 1 /* environ de diametre hyalius, formant des taches claires dans les hematies dont la forme est conservee ; on distingue d'ordinaire au centre de chacun des elements parasitaires un ou plusieurs grains de pigment. (Figure 2.) Ces petits corps grossissent et les grains de pigment se multiplient a 1'interieur Tantot 1'hematozoaire garde la forme spherique en se developpaut, tantot il prend une forme allongee ; il a alors 1'aspect d'un vermicule dont le grand axe est parallele au grand axe de Thematic qui le renferme et dont les extreinites se replient parfois autour du noyau. se deforme, se renfle, le noyau est refoule et disparait quelquefois. 40 Ilifyicne: Section II. Arrive a son developpement cnmplrt I'hematozoaire devient libre ; il se prosente alors sous la forme d'un corps allonge on Bph6riqtK du volume d'un leucocyte environ, pigmente. Les grains do pigment sont animes p:vrfoi.s d'un mouveiuent tres vif et les corps spheriques donnciit. nais-aiHH' a (les flagella qui ont la plus grande ressemblance avec les fla^i-lla du sang palustre ; enfin on observe quelquefois des corps eii rosace ou segmentes. L'analogie tie ce parasite avec I'homatozoaire du paludisrae est tres grande; il existe toutefois de notables differences: on n'obscrve pas dans le sang de 1'oiseau de corps en croissant, les elements parisitaires de 1'oiseau sont endoglobulaircs jusqu'a la derniere phase de leur existence, lantlis que dans le sang palustre on les trouve souvent a 1'etat libre; les mouveiuents amibo'ides des corps spheriques sont bien plus marques dans rhematozoaire du paludisine que dans 1'hematozoaire de 1'oiseau. D'autre part 1'hematozoaire decrit ci-dessus s'observe chez des oiseaux provenant de regions non palustres, et souvent il ne donne naissance chez les animaux qui en sont porteurs, a aucun trouble morbide. Enfin et surtout, si 1'heuiatozoaire des oiseaux etait identique a celui du paludisme on devrait reussir a inoculer 1'heniatozoaire du paludisme aux oiseaux, or, jusqu'ici, cette experience n'a donne que des resultats negatifs. En 1889 et 1890 1'auteur a injecte a plusieurs reprises dans les veines du geai, du sang palustre et le resultat de ces experiences a etc negatif ; Celli et Saufelice ont inocule sans plus de succes du sang palustre a differents oiseaux. Les hematozoaires des oiseaux decrits par Danilewsky paraissent done appartenir a une autre espece que Pheinatozoaire du paludisme ; 1'etude de ces parisites, les plus voisins de ceux du paludisme que Ton counaisse, n'en est pas moins interessante ; on peut esperer en effet qu'elle facilitera celle de hematozoau-e du paludisme et qu'elle permettra d'eclaircir quclques uns des points encore obscurs de 1'histoire de ce parasite. The Bacteriology of Asiatic Cholera. BY Professor HUEPPE, Prague, and Professor KLEIN, F.R.S., London. The Month as a Source of Infection. BY Professor MILLER, Berlin. I. Local and general diseases which have been traced to the action of mouth bacteria : 1. Caries of the teeth. 2. Diseases of the dental pulp. 3. Diseases of the pericementum. 4. Alveolar abscess (cases with Hygiene : Section II. 41 fatal termination). 5. Ostitis, osteomyelitis, periostitis, necrosis (frequency of cases terminating fatally). 6. Dental fistulas. 7. Septicaemia of dental origin. 8. Pyaemia of dental origin. 9. Meningitis of dental origin. 10. Complications produced by impeded eruption of wisdom teeth. 11. Pyorrhoea alveolaris. 12. Disturbances of the alimentary tract. 13. Diseases of the lungs, (a) croupous pneumonia, (b) gangrene. 14. Chronic swelling of the lymphatic glands. 15. The infectious anginas. 16. Angina Ludovici. 17. Diseases of the maxillary sinus. 18. Pneumococcus abscesses. 19. Disturbances through resorption of products of putrefaction from the mouth. 20. Stomatitis ulcerosa, scorbutica, &c. 21. Actinomycosis. 22. Noma. 23-29. Pharyngoniy- cosis, stomatomycosis, thrush, stomacace, aphthae, herpes labialis, parotitis. 30. Diptheritis. 31. Tuberculosis. 32. Syphilis. 33. Infections following operations in mouths. 34. Infections through wounds with dental instruments. II. The pathogenic bacteria of the mouth, with special reference to the micrococci of sputum septicaemia (pneumococci), to micrococcus tetragenus, spirillum sputigenum, and certain pathogenic kinds here described for the first time : Method of examining saliva for pathogenic bacteria. Original investigations. Results of inoculations with the saliva of 111 healthy persons: Death of the -animal followed in 101 cases. Two groups of pathogenic bacteria in the mouth, one producing speedy death through septicaemia, the other producing extensive suppuration. Comparative frequency of different pathogenic bacteria of the mouth. Various species of micrococci which produce sputum septicaemia : Micrococcus of sputum septicaemia I. (pneumococcus). Micrococcus of sputum septicaemia II. Micrococcus of sputum septicaemia III. Micrococcus of sputum septicaemia IV. Micrococcus tetragenus. Megacoccus buccalis muciferens. Bacillus buccalis muciferens. Bacillus buccalis septicus. Bacillus pneumonias. III. Prophylactic measures. Methods of determining the action of antiseptic solutions upon the bacteria of the oral cavity (a) by incorporating the antiseptic with the secretions of the mouth and determining the time necessary for complete sterilisation, (6) by determining approximatively the number of bacteria in the mouth before and after the use of the antiseptic, (c) by deter- mining the action of the saliva upon animals, before and after rinsing the mouth with the antiseptic. Results. Lantern demonstration of photomicrographs of diverse pathogenic bacteria of the mouth, &c. 42 Hygiene : Sectioti II. Die Mundhdhle als Infektions-Herd, VON Professor MILLER, Berlin. I. Lokale and allgemeine Erkrankungen, welche auf den Einfluss der Mundbakterien zuriickgefiihrt wordon sind : 1. Caries der Zahne. 2. Krankheiten der Zahnpulpa. 3. Krankheiten der Wur/dhuut. 4. Alveolar- Abscess (Fiille mit todtlichem Ausgang). 5. Ostitis, Osteomyelitis, Periostitis, Necrose. 6. Zahnfisteln. 7. Septicucmic von den Ziihnen ausgehend. 8. Pyaemie von den Zahnen ausgebend. 9. Meningitis von den Zahnen ausgehend. 10. Komplikationen verursacht durch den erschwerten Durchbruch der Weisheitszahne. 11. Pyorrhoea alveolaris. 12. Storungen im Verdauungstraktus. 13. Krankheiten der Lungen. 14. Chronische Anschwellung der Lymphdriisen. 15. Die infektiosen Anginen. 16. Angina Ludovici. 17. Krankheiten der Kieferhohle. 18. Pneumokokkus - Abscossc. 19. Erkrankungen hervorgerufen durch Resorption von Faulniss- produkten aus der Mundhohle. 20. Stomatitis ulcerosa, skorbutika u. s. w. 21. Aktinomykose. -22. Noma. 23-29. Pharyngomykose, Stomatomykose, Soor, Stomacace Aphtha, Herpes labialis, Parotitis. 30. Diphtheriris. ' 31. Tuberculosis. 32. Syphilis. 33. Infektionen nach Operationen im Munde. 34. Infektionen durch Wunden mit zahuarztlichen Instrumenten beigebracht. II. Die pathogenen Bakterien der Mundhohle, mit besonderer Beriicksichtigung der Mikrokokken der Sputum- Septicaemie (Pneu- mokokken), des Mikrokokkus tetragenus, Spirillum sputigenum und gewisser anderer, pathogener, hier zum ersten mal beschriebener Pilzarten. Methode der Untersuchung des Speichels auf pathogene Muudbakterien. Eigene Versuche. Ergebnisse von Impfungen mit dem Speichel von 111 gesunden Individuen. Der Tod des geimpften Thieres erfolgte 101 mal. Zwei Gruppen von pathogenen Bakterien im Munde : (a) die einen schnellen Tod durch Septicaemie herbeifiihren ; (b) die eine bedeutende Eiterung verursachen. Frequenz des Vorkommens verschiedener, pathogener Bakterien der Mundhohle. Verschiedene Arten von Mikrokokken, welche Suptum-Septicaemie erzeugen : Mikrokokkus der Sputum-Septicaemie I. (Pueumokokkus). Mikrokokkus der Sputum-Septicaemie II. Mikrokokkus der Sputum- Sept icaemie III. Mikrokokkus der Sputum-Septicaemie IV. Mikro- kokkus tetragenus. Megakokkus buccalis muciferens. Bacillus buccalis muciferens. Bacillus buccalis septikus. Bacillus pueumoniae. III. Prophylaktische Massregeln. Verfahrungsmethoden um die Wirkung des Antiseptikums auf die Bnktrrien der Mundhohle zu bestimmen : (a.) Vermengung des Autiseptikums mit den Mundfliissigkeiten und Bestimmung der zur Sterilisation erforderlichen Zeit. Hygiene: Section II. 43 (b.) Approximative Bestimmung der Zahl der im Munde vorhan- denen Bakterien vor und nach der Anwendung des Antiseptikums. (c.) Erprobiing der Wirkung des Speichels auf den Thierkorper vor und nach deni Grebrauch des Antiseptikums. Resultate. Demonstration von Photo-Mikrogrammen verschiedener pathogener Muiidbakterien etc. mittels des Projektionsapparates. Dental Caries. BY HENRY SEWILL, M.R.C.S., L.D.S., Past President Odontological Society of Great Britain. [Abstract of remarks accompanying lantern demonstration.] Dental caries or decay is a process of disintegration commencing invariably at the surface of the tooth, and due entirely to external agents. Caries traceable to the same series of causes, remote and direct, and accompanied by similar tissue changes occurs in teeth and in blocks of ivory re-fixed in the mouth by artificial means. By subjecting extracted teeth to the action of the same agents under the same conditions as to temperature, moisture, and presence of micro-organisms as exist in the mouth, caries can be artificially produced which is indistinguishable from that occurring in living teeth. The active agents in caries are acids and micro-organisms. The great bulk of acid is the product of fermentation of the organic matter commonly present in the mouth and lodged around the teeth. These acids are often assisted in their action by acid secretions. Fermentation being due to action of micro-organisms, bacteria must be considered a prime factor in causation of caries. Proliferation of organisms amidst the fibrils and in the organic basis of dentine is an essential feature of the disease. The predisposing causes of caries are : (1) inherent defects in enamel which render the tissue at parts, or throughout, easily acted upon by acids ; (2) crowding and irregularity of the teeth which give rise to retention of debris on their surfaces ; (3) vitiation of the buccal secretions. The first and second of these causes govern the incidence of decay. The rapidity of progress of caries is mainly governed by the inherent qualities of the tissues. These vary extremely. (Slides will then be shown.) 1. Section of normal enamel. 2. Section of normal dentine. 3. Transverse section of normal dentine. 4. Section of tooth showing inherent defects in enamel and dentine. 5 and 6. Sections of enamel showing inherent flaws. 7. Section of dentine showing inherent structural defects. 8. Section of carious dentine at orifice of cavity of 44 Hygiene : Section II. decay. 9. Deeper section of same tooth. 10. Section showing point of junction of carious and unaffected dentine. 11. Section of dentine in last stages of caries; tubes filled mainly with cocci. 12. A similar section, tubes filled with leptothrix. 13. Transverse section of carious dentine in advanced stage. 14. Scrapings from carious cavity showing various organisms. 15. Section of "pipe stem" dentine. Prophylaxis of dental caries is to be accomplished by prevention of the predisposing causes. Production of faultless dental tissues can only be brought about by improvement of the race and of the heredittu-i/ qualities of the individual. Little or nothing can be done to influence the structure of the teeth in the individual after birth, or in the foetus through the mother. Crowding and irregularity of the teeth are due to smallness and malformation of the maxilla, a characteristic of civilisation. Vitiation of the secretions of the mouth is to be prevented by maintenance of a high standard of health and by local hygiene. Sections will be exhibited under the microscope showing various phases of (1.) Ordinary caries. (2.) Caries in teeth worn on a frame as artificial substitutes. (3.) Caries artificially produced in extracted teeth. The Behaviour of Bacteria in the Small Intestine. BY Dr. ALLAN MACFADYEN, London. Some Fermentations excited by Specific Micro-Organisms, BY PERCY F. FRANKLAND, Ph.D., B.Sc. (Lond.), F.K.S., Professor of Chemistry in St. Andrew's University, Dundee. The author has for several years past been devoting much of his attention to the investigation of some of the chemical reactions induced by pure growths of micro-organisms. Of such chemical changes the author has studied the following : (1.) The oxidation and reduction of combined nitrogen. The author examined the effect of growing a large number of micro-organisms of various origin in suitable media containing ammoniacal salts on the one' hand and salts of nitric acid on the other. In no case was any appreciable oxidation of the ammonia obtained, whilst in a number of cases the nitrates were reduced to nitrites, and this reaction served in some cases as a convenient means of distinguishing between bacteria which otherwise re- sembled each other very closely. Hygiene: Section II. 45 The author has, however, ultimately succeeded in obtaining from soil the organism inducing the nitrification of ammonia. In this investigation the process of gelatin-plate culture was utilised as a negative check on the purity of the cultures obtained by the dilution method, only those nitrified solutions being regarded as pure which failed to give any growth on inoculation into gelatin. The degree of oxidation obtained with these pure cultures was that of nitrous and not nitric acid. (2.) The fermentations of carbohydrates, polyhydric alcohols, and oxy acids. (a.) By the bacillus ethaceticus. The author has isolated and described in detail a bacillus to which he has given the above name in consequence of the products ethyl alcohol, and acetic acid to which it gives rise when grown in suitable solutions of glucose, mannite, and calcium gly- cerate. The other products are formic and succinic acids, the latter in very small quantity, together with carbonic anhydride and hydrogen. The organism also ferments dextrin, starch, cane-sugar, milk-sugar, and galactose, but curiously not dulcite. By means of this bacillus the author has succeeded in obtaining an optically active glyceric acid from the ordinary one which is well known to be inactive, and is thus demonstrated to consist of equal molecules of two oppositely active glyceric acids, of which the organism destroys one by fermentation and leaves the other intact. (6.) By the pneumococcus of Friedldnder. The author has extended the observations of Brieger on the fermentation- products of this organism. He has studied the fermenta- tions which it induces in glucose and mannite, the products being ethyl, alcohol, acetic acid, carbonic anhydride, and hydrogen, with smaller quantities of formic and succinic acids. The organism also ferments dextrin and cane-sugar, but, like the b. ethaceticus, has no action on dulcite. On a New Pyogenic Micro-Organism . BY Professor MAX GRUBER, Vienna. ** < Fsorospermosis as a Possible Cause of Epithelial Tumours. BY SHKKIDAN DELEPINE, M.B., Edinburgh, B.Sc. Lausanne, Lecturer of Pathology, St. George's Hospital, London, with a microphoto- graphic demonstration by Andrew Pringle, Esq. I. Discussion of the conditions which a parasite must fulfil before it can be supposed to be a possible cause of malignant epithelial tumours. II. Psorospermia or gregarinae seem to fulfil many of these conditions. III. Psorospermosis produces in the liver of the rabbit tumours undistinguishable (histologically) from papilliferous adenomata (proliferous cysts). IV. Kesults of a search for psorospermia in a number of epithelial tumours of the skin, gastro-intestinai mucous membranes, liver, and various other glands in man. Frequency of appearances simulating or suggesting psorospermosis. V. Absence of definite proof of the psorospermic nature of these lesions. VI. Cultivations of psorospermia and stages observed within and outside the body. (This communication will be accompanied, if time permits, by a magic lantern demonstration of microphotographs taken from numerous specimens prepared by the author and photographed by Mr. Andrew Pringle.) Paget's Disease and Psorospermosis. BY SHERIDAN DELPINE, M.B., &c. The author gives the results of his examination of a series of cases of inveterate eczema of the breast, with reference to the occurrence therein of coccidia or psorosperms. Whilst in three out of five cases he observed bodies similar to those described by MM. Darier and Wickham, he regards their nature as not yet absolutely determined. A series of micro-photographs is exhibited showing the appearances met with in Paget's Disease, and also in those of undoubted coccidial affections of the rabbit's liver ; and the best methods of staining, &c., for their demonstration are referred to. - >~ ooo - Hygiene: Section II. 57 An Exposition of the Reasons for considering Cancer to be an Infective Disease, BY CHARLES A. BALLANCE, M.S., F.R.C.S., Lecturer on Practical Surgery, Assistant Surgeon for Diseases of the Ear, St. Thomas's Hospital, Surgeon to the National Hospital for the Paralysed and Epileptic, Queen Square, and Assistant Surgeon to the Hospital for Sick Children, Great Ormond Street, &c. ; and by SAMUEL G. SHATTOCKJ F.R.C.S., Lecturer on Surgical Pathology, and Curator of the Pathological Museum, St. Thomas's Hospital. The authors briefly recount their attempts at the cultivation of micro-organism from malignant tumours, and their experiments of transplanting portions of living tumours removed from the human subject into various of the lower animals. They also recount experiments made by inoculating animals with the psorospermial material obtained from the livers of recently killed rabbits. They discuss the reason for believing that cancer is a micro- parasitic disease under the headings of its local nature in certain cases, the facts relating to auto-inoculation, the geographical distribution of the disease, especially in England, the character of the secondary infections, the latency sometimes observable in their manifestations, the cancerous cachexia, and the increasing prevalence of the disease. They conclude from the above considerations that cancer is in all probability a micro-parasitic (animal or vegetable) disease, although no positive demonstration of the living nature of the virus is as yet forthcoming. An Investigation into the Parasitic Nature of Cancer. BY MM. Professor DUPLAY and Dr. CAZIN, Paris. Bacteriology of Vaccine Lymph, BY Dr. S. MONCKTON COPEMAN, Local Government Board, London. The work carried out on the bacteriology of vaccine lymph has had special reference to the following points : 1st. To determine whether the essential principle of the lymph is really particulate, or not ; this entailing a repetition of the experiments of Cohn, Burdon-Sanderson, and others. 58 Hygiene: Section II. 2nd. Since it is apparently particulate, an inquiry has been made experimentally as to the different organisms which can be separated from vaccine lymph by various methods, and effect of their inoculation on the lower animals. 3rd. Attempts have been made to determine the best methods for the storage of lymph, and to cultivate the active organism of vaccine outside the animal body. Ueber die neuere Behandlungsweise der Tnbercnlose nach Koch. VON Professor EHRLICH, Berlin. Nachdem der Vortragende die Bedeutung der Koch'schen Ent- deckung fur die Zukunft der Medicin erortert, geht er an der Hand des zur Zeit schon vorliegenden Materials auf die praktisch so wichtige Frage nach der zweckmassigsten Art der Behandlung ein. Wohl allgemein sieht man das Princip der Heilung in der localen Beeinflussung, welche das Tuberculin in einzig dastehender Weise auf das specifisch erkrankte Gewebe ausiibt. Zur Erzielung heilender Effecte sind stiirmische, ausgedehnte Entziindung oder Necrose bedin- gende Reactionen weder erforderlich noch wiinschenswert. Kleinere, aber dafiir stets und stets wiederholte Reizungen, die eine Vernarbung tuberculoser Herde begiinstigen, sind das, was jetzt erwiinscht wird. Der Kernpunkt dieser Behandlungsform besteht also darin, die speci- fische Reizbarkeit des tuberculosen Gewebes moglichst lange zu erhalten und sie nicht, wie das bei den grossen Dosen und schnellen Steigerungen der Fall war, vorzeitig zu vernichten. In dieser Richtung bewegen sich eine Reihe von Methoden, die von Moritz Schmidt, Biedert, Guttmann und Referenten, Langenbuch, angegeben sind. Allen diesen Verfahren ist gemeinschaftlich die Verwendung kleiner, gerade minimale Reaction hervorrufender Dosen. Die Vorziige derartigen Vorgehens bestehen darin, dass bei Vermeidung unerwiinschter Nebenwirkungen die Heil- wirkung ganz und voll zum Ausdruck kommen kann. In dieser Beziehung ist besonders zu betonen, dass die pathologisch-anatomischen Befunde, die dem Tuberculin zur Last gelegt wurden, ausschliesslich aus der Zeit stammen, wo man noch mit grossen Djsen, vielfach auch an zu weit fortgeschrittenen Patienten, operierte. Selbstverstandlich sollen bei der Behandlung alle therapeutischen Hilfskrafte, die der Hygiene und der Diatetik, der Chirurgie und der Pharmakologie voll herangezogen werden. Im Vordergrund dieser Bestrebungen stehen die sogenannten combinirten Behandlungsver- fahren ; Ziel derselben ist es, in die durch das Tuberculin erschlossenen erkrankten Gewebe heilkraftige Potenzen einzuf iihren. Auf diesem Wege sind schon von Maragliano und Langenbuch glanzende Resultate erzielt worden, die eine baldige Verwirklichung aller Hoffnungen, welche die Koch'sche Eutdeckung erweckt hat, in nachste Aussicht steUen. Hygiene: Section II. 59 Zur Chemie des tuberculbsen Eiters nnd des Eiters iiberhaupt, VON KAMSAY WRIGHT (Toronto) und TH. WEYL (Berlin). Den Ausgangspunkt unserer Arbeit bildete eine bereits ver- offentlichte Beobachtung, nach welcher sich aus den Leibern der Tubercelbacillen ein mucinartiger Korper isoliren lasst, der wegen seiner toxischen Eigenschaften als Toxomucin bezeichnet wurde. Wir wiinschten nun zu erfahren, ob im tuberculosen Eiter ein ahnlicher Korper vorhanden sei. Zu diesem Zwecke stand uns Eiter aus tuberculosen Leberabscessen von Rindern, also der Eiter perlsuchtiger Thiere zur Verfiigung. Wenn man denselben mit circa 10 Volumina einer 1/ Natronlauge im Dampfkochtopfe eine Stunde digerirt und nach dem Erkalten durch Leinwand filtrirt, fallt 10/ Essigsaure aus dem triiben Filtrate, einen auch im Ueberschusse des Fallungsmittels kaum loslichen mucinahnlichen Korper. Derselbe ist auch in ver- diinnten Mineralsauren unloslich, wird dagegen durch concentrirte Schwefelsaure leicht zu einer braunen Fliissigkeit gelost. Er wird durch langeres Kochen mit 3/ HC1 kaum angegriffen. 3/ Schwefel- saure zersetzt ihn bei Digestion unter 1^ Atmosphare-Druck nur ausserst langsam. Die erhaltene schwefelsaure Losung zeigt Furfurol- Reaction. Durch Pepsin und Salzsaure findet keine Verdauung statt. In verdiinnter Natronlauge ist der Korper leicht loslich. Soweit die chemischen Eigenschaften dieses Korpers bisher festgestellt sind, gehort derselbe zu den Mucinen, resp. Mircoiden (Hammarsten). Aehnliche Korper haben wir iibrigens auch aus den Lebern tuberculoser Meerschweinchen, aber auch AUS MENSCHLICHEM NICHT TDBERCULOSEM Eiter und aus den Lebern normaler Meerschweinchen isoliren konnen. Da der Korper durch kalte Natronlauge von 1/ nicht oder nur in Spuren dem Eiter entzogen werden kann, liegt die Vermuthung nahe, dass derselbe im Eiter nicht praformirt, sondern nur das Zersetzungs- produkt einer uns bisher unbekannten Substanz darstellt. Um iiber diesen Punkt Aufschluss zu erhalten, haben wir eine Anzahl Sub- stanzen, welche den Eiweissstoffen nahestehen oder Eiweissstoffeent hielten, in ihrem Verhalten zu kochender 1/ Natronlauge untersucht. Wu* erhielten einen derartigen Korper aus den auf Agar geziichteten Culturen von Aspergillus niger, aus kauflicher Bierhefe, aus den mucinhaltigen Submaxillardriisen des Rindes und aus Witte's Pepton. Aus Blutalbumin, Eieralbumin, Eigelb, Lieberkiihn's Alkalial- minat, Kleber, Wolle, Seide, Leim und Casein wurde ein mucinartiger Stoif nicht erhalten. Der aus tuberculosem Eiter erhaltene mucinartige Korper schien in einigen Versuchen im Stande zu sein, tuberculose Meerschweinchen zu heilen. Professor Wright behalt sich vor, diese therapeutischen Versuche GO Hygiene: Section II. fortzusetzen. Wir haben dann eine eingehende Analyse des tuberculosen Eiters vorgenommen und bei dieser Gelegenheit in demselben ein Kohlehydrat (Hexose) gefunden, welches dem thierischen Sinistrin von Hammarsten nabe zu stehen scbeint. Ueber diese Dinge werden wir an einem anderen Orte ausfiibrlicber berichten. 61 SECTION III. THE RELATIONS OF THE DISEASES OP ANIMALS TO THOSE OF MAN. This Section will meet in the rooms of the Geological Society, Burlington House, marked D on the Plan. PRESIDENT. Sir NIGEL KINGSCOTE, K.C.B. The Propagation and Prevention of Babies Results obtained at the Pasteur Institute. BY Dr. Eoux, Paris. On Babies, BY GEORGE FLEMING, C.B., LL.D. 1. Rabies is a purely contagious disease, due to a virulent principle, and is, as a rule, transmitted from a diseased to a healthy creature by inoculation. 2. Inoculation and infection take place through wounds, which are generally inflicted by the teeth of diseased creatures, i.e., those affected with rabies. 3. The creature which is the chief, if not the sole, propagator of rabies, is the dog. 4. It is exceedingly probable that if the canine species were freed completely from rabies, this scourge would be no longer known. 5. In the interests of the human species, no less than of dogs and other animals, this terrifying, most painful, and always fatal disorder, should, if possible, be suppressed. 6. Rabies, of all known contagious diseases, is perhaps the one which could be most easily extinguished. 7. The measures for its extinction must be based on the fact that the dog is the propagator of the malady ; that the contagion is trans- mitted by dog bites ; and that to relieve a country of the presence of the disease, all rabid and suspected dogs should be exterminated, and only dogs from other countries in which the malady is unknown, be permitted to enter. If allowed to come from infected or suspected countries, then they should undergo a period of quarantine equal at least to the longest period of latency of the disease. 8. To free a country entirely from rabies, dogs should not be allowed to bite when at large, by compelling them to wear an apparatus that will prevent their doing so. A tax should also be imposed upon 62 Hygiene: Section III. all dogs, without exception, higher for pleasure than useful rk or other flesh-meat is salted and dried, or otherwise prepared, with the adoption of every possible precaution against the rise into these places of ground air, or the introduction into them of morbific or unwholesome emanations. Infectious Udder Diseases of the Cow in relation to Epidemic Diseases in the Human Subject. BY Dr. E. KLEIN, F.R.S. In several epidemics of scarlet fever brought about by milk, Mr. Power has established that the infectiveness of the milk was not due to contagion from a human source, but that probably a pathological condition of milch cows undiscovered before 1885 played a prominent part in giving to their milk the power to produce scarlet fever in the human subject. In an epidemic of scarlatina occurring in the north of London, towards the end of 1885 and beginning of 1886, Mr. Wynter Blyth showed that it was attributable to milk coining from Panter'sfarm at Hendon. Dr. Cameron, medical officer of health for the Hendon list lict, has, with Mr. Power, conclusively proved that all ordinary sources of contagium as insanitary condition of the farm, cases of human scarlet fever, &c. were excluded from the Hendon milk, and they further showed that the milk possessed infective power for a succession of days and weeks. The conclusion arrived at was that the cows themselves were the source of the contagium. They found cows at that farm actually affected with a contagious eruptive disease of the teats and udder ; further, that the disease had been introduced into the farm by two cows recently acquired. Mr. Power and Dr. Cameron conclusively proved that the spread of the scarlet fever, by particular sections of this milk, was dependent on the presence of the udder disease amongst particular cows of the farm. The nature of the cow malady, described in the full paper, was definite, both as to its local manifestations, and as to the pathological condition of the viscera, as also in its non-communicability to the milkers' hands. Various objections have been raised against the conclusions thus arrived at, but on analysis will be found unessential to the main points, and also based on incorrect data. After the Hendon disease, two further outbreaks of scarlet fever could be referred to a similar cow disease. A second epidemic disease, referable to cow disease, is the Edinburgh disease. In this instance milk coming from a particular dairy had been proved by Drs. CVnerill and Woodhead, to have caused amongst Hygiene : Section III. 67 children of a school a febrile disorder, accompanied by swelling and inflammation of the mucous membrane of the throat, not being scarlet fever or diphtheria. In this instance the milk was derived from milch cows affected with an eruptive disease of the udder, and with visceral disease. The disease, as observed by myself, had definite characters, described in the full paper. In both the Hendon and Edinburgh diseases the stoppage of the milk consumption was coincident with the termination of the spread of the disease in the human subject. A third epidemic disease referable to cow disease is diphtheria. Mr. Power has shown that in several epidemics of diphtheria brought about by the consumption of milk, the latter had most probably received infective power direct from the cow, and not from a human source. In this respect the epidemic of diphtheria prevailing in 1886 in Yorktown and Camberley, deserves specially to be mentioned. Although the cows of the incriminated dairy were said to have been healthy during the prevalence of the diphtheria epidemic (8th to 18th October), there was one cow in that dairy which at the beginning of November still had at the site of a " "a scab or crust. This was more marked in an epidemic of diphtheria at Barking, in 1888, investigated by Dr. Mason, where an eruptive disease of the teats and udder of the milch cows was very conspicuous, and in another milk-diphtheria epidemic in Croydon, 1890, investigated by Dr. Philpot. I have experimentally produced in cows, by inoculation under the skin of the shoulder with cultures of the diptheria bacillus, an eruptive disease of the udder, which is described in the full paper, and which belongs to the same category of eruptive diseases as the above ; visceral disease in these cows was also a prominent feature. At a particular stage of the eruptive disease experimentally induced, the milk of the cows was shown to contain the diphtheria bacilli. On Cholera Asiatica; Diphtheria; Immunity with reference to Phagocytosis ; and on Tuberculosis. BY E. KLEIN, M.D., F.R.S., &c. Dr. Klein intends : A. On Cholera Asiatica. To demonstrate the several species of cholera comma-bacilli isolated by Dr. D. D. Cunningham from typical acute cases of cholera ; and further to show that the method first described made by Koch for showing the specific pathogenic action of the cholera bacilli on the guinea-pig are not evidence of these microbes being the cause of cholera in man, since other microbes, liquefying gelatine, possess under the same methods of experimentation the same effect on the guinea- pig as the cholera bacilli. E 2 68 Hygiene: Section III. B. On Diphtheria. To describe diphtheria in the cow after inoculation with culture of the diphtheria bacillus, and to show the presence of the diphtheria bacilli in the milk of such cows in several instances ; also to describe a new species of pseudo-diphtheria bacillus. C. On Immunity with reference to Phagocytosis : (a.) To describe several diseases artificially produced in animals, in which, owing to the chronic and attenu- ated character of an otherwise fatal disorder, the phagocytes might have been expected to be present, but in which they were altogether absent ; on the other hand describing an acute, rapidly fatal infectious disease in animals, in which amongst crowds of foreign bacilli, numerous phagocytes were also present, which evidently were without any influence on the course and virulence of the disease. (6.) To describe certain chemical changes induced in the frog and rat by which these animals became susceptible to anthrax, the morphological and biological conditions as regards the lymph cells remaining unaltered. D. On Tuberculosis. To describe experiments showing that the tubercle bacilli attenuated in virulence by cultivation, on being again passed through animals gradually re-acquire their former full virulence. -X>CK Eegulation of the Milk Supply with reference to Diseases transmissible by Milk, BY Dr. OSTEBTAG, Berlin. Most countries have till now paid but slight attention to the sanitary question of the milk supply, and have contented themselves with forbidding the sale of adulterated milk or of milk from diseased animals, without taking proper steps to ensure obedience to their orders. A praiseworthy exception to this is to be found in the Italian law of provision supplies of August 3, 1890. It is the undeniable duty of the State to see that only pure milk enters the market. The consumer is not in a position to guard himself against tli<- manifold dangers which attend the consumption of milk. Milk may contain the most harmful ingredients, in spite of white colour sind sweet taste. Such milk can only be banished from the market if the milk supply is controlled by Government officials. Only pure milk Hygiene : Section II I. 69 can be tolerated in the market ; that is, milk obtained with the greatest cleanliness from healthy animals, and possessing normal physical qualities and a certain degree of strength. For sanitary reasons the following kinds of milk must be excluded from the market : (1.) Milk which, without being necessarily prejudicial to health, is peculiar in colour, taste, or consistence [nauseous milk]. (2.) All milk that is prejudicial to health, or which is suspected on good grounds of being so. To the first group belongs colostral milk, blue, red, and yellov. milk ; further, slimy, thready, bitter, salt, as well as abnormally smelling milk, and milk that has been made impure by mud or other substances. The milk of animals that have been fed on poisonous fodder, or that have been treated with certain medicaments, and of those suffering from tuberculosis, malignant pustule, cow-pox, aphthae, or generally ill in consequence of some process inducing ulceration or ichor, must be regarded as prejudicial to health. The possibility of milk being of a hurtful nature is suggested in all the other feverish ailments common to milk-yielding animals, as also by the different forms of inflammation of the udder. Again, milk which has already been drawn may become infected by immediate contact with sick persons (typhus, cholera, &c.), or through being kept in rooms where such persons are. Finally, through being carried in unsuitable (metal) vessels, injurious substances may find their way into the milk. In order to guard against these dangers it is requisite : (1) that all dairy farms be licensed; (2) that all animals kept for milking be examined by a veterinary surgeon from time to time ; (3) that the owners of dairy farms be bound to provide only good undamaged fodder ; further, to give immediate notice of the illness of any milch cow to the attending veterinary surgeon, and, until he gives leave, not to send the milk of the diseased animal to market ; (4) that the business of milking be performed with the most punctilious cleanliness, and that no person suffering from any infectious illness be employed to milk ; (5) that the mixed milk obtained by milking be cooled and stored in special rooms, not in living or sleeping rooms ; (6) that it be transported only in suitable vessels ; (7) that during the prevalence of aphtha? only boiled milk be brought into the market, whilst all milk which must be considered nauseous or injurious be excluded from the provision market. Likewise, at the outbreak of any epidemic in a house where dairy farming is carried on, the sale of milk be forbidden. (8.) In obtaining the so-called " milk for children," especially strict regulations must be carried out as to the feeding of the milch cows, cleanliness in milking, and the cooling and proper mode of transport of the milk. 70 //j/i/it tic : Strtiun III. Regelung der Milchversorgung mit Hinsicht auf iibertragbare Krankheiten. VON Dr. OSTERTAG, Berlin. Hislang glaubten die meisten Staaten in Bezug auf Milchvcrsorgung ilnv IMlicht ert'iillt zu haben, wenn sie den Consumcnten vor financieller Schadiuung durch rc^clinassi^e Controlle der Marktmileh auf ihren Fett^eh'ilt 7M schiitzen suchten. Der sanitaren, mindesteus ebenso wichtiijeii Seitc der Milchversorgung ist geringere Beachtung geschenkt worden. In den betreffenden, auf den Milchverkelir bey.uglichen Ver- ordnungen ist lediglieh der Verkauf von vcrandcrter oder von kranken Tieren stammendcr Milch verboten, ohne class besondere Massnahmen zur wirksamen Unterdriickun^ tics Verkauf s soleher Milch gctroffen worden waren. Eine riihmliche Ausnahtne macht in dieser Beziehung das italienische Nahrungsmittelgesetz vom 3. August 1890. Der Staat hat die unabweisbare Verpflichtung, dat'iir zu sorgen, dass nur gute Milch in den Verkehr gelange. Denn der Consument ist nicht im stande, sich vor den mannigfachen Gefahren zu schiitzen, welche mit dem Genuss von Milch, verbunden sein konnen. Trotz weisser Farbe und sussem Geschmacke, kann Milch die schiidlichsten StofFe beherbergen. Solche schadliche Milch kann nur dann aus dem Verkehre verbannt werden, wenn die Milchgewinnung und der Milch- hantlel polizcilich uberwacht werden. Im Verkehre darf nur gulc, ikalische Eigenschaften nnd eine gewisse Haltbarkeit besitzt. Vom Verkehre dagegen muss ausgeschlossen werden aus sanitaren Griinden : (1.) Milch, welche, ohne gesundheitsschadlich zu sein, Abweichungen in Farbe, Geschmack oder Consistenz zeigt (ehelerregende Milch). (2.) Alle Milch, welche gesundheitsschadlich ist oder beziiglich deren der begriindete Verdacht besteht, dass sie gesundheitsschadlich sei. Zu der 1. Gmppe gehort die Colostralmilch, die blaue, rote, gelbe Milch, ferner die schleimige, fadenziehende, bittore, salzige, sowie ab- norm riechende und die init Schmutz oder anderen Stoffen verun- reinigte Milch. Zu der Gruppe der gesundheitsschadlichen Milch ist zu rechnen die Milch von Tieren, welche mit toxisch wirkenden Futterstoffen gefiittert oder mit gewissen Medicamenten behaudelt werden, ferner die Milch von Tieren, welche an Tul>erkulose, Milzbrand, Pocken, Aphthenseuche leiden oder in Folge eines mit Eiterung oder Verjauchung einbergenden Processes allgemein erkrankt sind. Die Moglichkeit einer gesundheitsschadlichen Beschaffenheit der Milch ist fcnicr N-gclirn bei alien iibrigen fieberhaften Allgemeinleiden der Milcliticrc, sowie bei den verschiedenen Formen der Euterent- landqng Hygiene: Section III. 71 Schliesslich kann die bereits gemolkene Milch noch unmittelbar inticirt werden dutch kranke Menschen (Typhus, Cholera, u. s. w.), ferner durch Aufbewahrung in Raumen, in welchen sich solche Menschen befinden. Durch Transport endlich in ungeeigneten (Metall) Gefassen konnen schadliche Stoffe (Metalle) in die Milch iibergehen. Zur Abwehr dieser Gefahren ist es erforderlich : (1.) Dass alle Milchwirtschaften einer polizeilichen Genehmigung unterliegen. (2.) Dass alle Tiere, welche zur Milchgewinnung aufgestellt wer- den, tierarztlich untersucht und von Zeit zu Zeit controllirt werden. (3.) Dass die Besitzer der Milchwirtschaften gehalten werden, nur gutes, unverdorbenes Futter zu verabreichen, ferner jede Erkrankung eines Milchtieres sofort dem zustandigen Tierarzte anzuzeigen und bis zu dessen Entscheidung die Milch des erkrankten Tieres nicht in den Verkehr zu geben. (4.) Dass das Melkgeschaft mit der peinlichsten Sauberkeit ge- schehe, und dass Leute, welche an einer Infectionskrank- heit leiden, zum Melken nicht verwendet werden. (5.) Dass die ermolkene und gesammelte Milch nach dem Melken abgekiihlt und in besonderen Milchkammern, nicht aber in Wohn- oder Schlafraumen aufbewahrt werde. (6.) Dass der Transport nur in geeigneten Gefassen geschieht. (7.) Dass bei Aphthenseuche die Milch nur gekocht in den Verkehr gebracht wird, alle iibrige Milch aber, welche als ekelerregend oder gesundheitsschadlich angesehen werden muss, vom Verkauf als Nahrungsmittel fur Menschen ausgeschlossen wird. Ebenso ist beim Ausbruch einer epidemischen Krankheit in einem Hause, in welchem eine Melkerei oder ein Milchhandel betrieben wird, der Verkauf der Milch zu verbietcn. (8.) Bei der Gewinnung der sog. Kindermilch miissen ganz be- sonders hohe Auforderungen in Bezug auf Fiitterung der Milchkiihe, Sauberkeit der Milchgewinnung, auf Abkiihlung und geeigneten Transport derselben gestellt Werden. The Inspection of Meat with regard to the Prevention of Disease. BY FRANCIS VACHER, M.B.C.S., Medical Officer of Health for Birkenhead. Modern research has forced on the attention of the medical pro- fession, that there is no line of separation marking off the diseases of animals from those of man. A truth so obvious should have been clearly recognised long since : but, that while the conditions of health and causes of disease in man have been studied by physicians and medical 72 Hygiene: Section III. officers of health, the conditions of health and causes of disease in the lower animals have been studied by veterinarians. Both studies are closely related branches of the same subject, and can be most profitably pursued together. The- diseases of animals used for food and their relation to the diseases of man can nowhere be so well studied as in the public abattoir. Unfortunately in this country public abattoirs are not generally provided, and in those that exist the bulk of the interesting pathological material presented is wasted ; because we have as a nation no properly organised system of meat inspection. Split carcases, dressed and cold, are viewed and passed without the viscera or any part thereof being produced, and their fitness for food is commonly decided by a nuisance inspector or market constable. The only slaughter-houses in many large urlmn districts are private ones, behind shops ; and in these efficient inspection is impossible. There is little or no check on diseased or dead animals being dressed in rural districts and brought into towns uninspected ; and even when a carcase infected with disease is seized, it has to be taken before a justice, and if he refuses to order its destruction it must be returned to the owner, and is of course sold as wholesome meat. The necessary reforms will not be easily effected, but nothing less will accomplish the object sought. They are as follows : I. The general provision of public abattoirs. II. Closing of private slaughter- houses. III. Licensing and registering of all butchers and their premises. IV. Appointment of com pot out inspectors of meat. V. General .systematic inspection of animals and meat intended for food. VI. Appointment of competent assessors to sit with magistrates and assist them when necessary in the hearing of cases relating to diseased meat. On the alleged Danger of consuming the apparently Healthy Meat and Milk of Tuberculous Animals. BY Professor BANG, Copenhagen. The great majority of investigators agree that the essential source of tul>erciilosis in man is to be found in man himself ; but nearly all admit that man can contract the malady by the ingestion of meat or milk from animals affected by tuberculosis. As to the extent of this danger opinions differ. In France, a presidential decree has forbidden the sale and use of milk from tuberculous cows ; but Professor Bang regards the application of these measures as impossible in countries where tuberculosis is prevalent ; and, moreover, they do not seem to him to be necessary. Professor Bang describes a number of experiments which he has made on this subject with tuberculous cows. Of 58 cows whose milk was inoculated into rabbits and guinea-pigs, there were nine in which the milk pn.ved virulent. On the whole, he thinks the milk of a tuberculous cow with udders apparently healthy is not in the great majority of cases Hygiene: Section III. 73 dangerous, though it is undoubtedly so sometimes, and is always suspicious. As to meat, Professor Bang thinks the experiments by others show that the muscular tissue is so unfavourable a nidus for the tubercle bacilli that they do not multiply in it. The number of bacilli found in the meat of tuberculous animals must always be very limited. A series of experiments which Professor Bang has made upon the virulence of the blood of 20 cows extremely tuberculous gave negative results in 18 cases, and positive results in two cases only. He thinks the seizure of the meat of every tuberculous animal too severe a measure. So long as the tuberculosis is strictly localised the meat is not a source of danger. Where the malady is generalised, the consumption of the meat may be dangerous, although it is not so always. The eating of undercooked meat should be discouraged ; but the best means of avoiding danger to the health of man is to take all possible measures for preventing the propagation of tuberculosis amongst our domestic animals. On the Transmission of Tuberculosis from Animals to Man by means of Flesh and Milk derived from Tuberculous Animals. BY Professor M'FADYEAN and G. SIMS WOODHEAD, M.D., &c. The evidence as to the transmission through the flesh of tuberculous animals is very conflicting, apparently in great part because the methods used are different and the conditions are not uniform. Do human beings ever contract tuberculosis through the ingestion of tubercular material derived from the lower animals ? As the result of a large number of observations made on tuberculosis in children, we think this question can probably be answered in the affirmative. Is the flesh of tuberculous animals capable of setting up tuberculosis (a) when introduced en masse, (6) when the expressed juice only is exhibited ? Our experiments go to prove that the juice only does not, in most cases, contain a sufficiently large number of bacilli to set up tubercle, even whe^n inoculated into small rodents, but from the fact that we have observed tuberculous masses in the muscles of the buttock of tuberculous cattle, we must accept the fact that tubercle bacilli may sometimes, perhaps rarely, be present in considerable numbers in this position. Of three cows slaughtered on one day at one slaughter-house, well-defined tubercle was found in the muscles of the buttocks of two animals ; in one of these there was tuberculosis in almost every organ and part of the body ; in the other there were only a few nodules in the lung and in some of the glands, there was certainly no pleural or peritoneal tubercle, and all the other organs were unaffected a very important case. The records of a number of positive feeding experi- ments made by various observers go still further to prove that tubercle bacilli are actually, in certain cases, present in the muscles or in the 74 Hygiene: Section III. intcrmuscular connective tissue and are there a possible, though perhaps a comparatively rare, source of danger. A resume" of our own and previous experiments indicate that this source of danger is not frequently present, but that it may exist in a certain proportion of cases. Milk. Hitherto too little attention has been paid to this subject in this country : this has been the outcome of our inability to diagnose with certainty the presence of the earlier styles of tuberculosis in cattle. We consider that the conditions of the udder in tuberculous cows and of the conditions under which tubercle bacilli are found in milk should be more carefully studied, and that there is a necessity for thorough and frequent examination of all dairy cattle, because of the rapidity of the onset of tuberculous disease in the udder. Tubercle bacilli in milk. Relation of numbers in milk to virulence of affection in inoculated animals. Number of bacilli necessary to set up tuberculous changes. Bactericidal action of milk on tubercle bacilli not yet proved. Extent to which milk must be diluted in order to render it inocuous. A resume of observations already made. Bang points out that different results have been obtained in different cases by various observers, because they have experimented on different animals. Necessity of drawing special attention to this subject, as it is now agreed that although in the later stages tubercular mammitis is readily diagnosed, there appears to be a period during which it is clinically impossible to make it out (except by inoculation of small animals) ; at this stage tubercle bacilli are present in the milk in very small numbers, though in sufficient numbers to render the consumption of such milk dangerous for weakly children. The Infections Diseases of Animals communicable from Animals to Man, or vice versa. BY Professor PERRONCITO, Turin. Actinomycosis, BY EDGAR CROOKSHANK, M.B., London. Actinomycosis is not really a new disease, but it was not recognised until comparatively recently as a specific micro-parasitic affection. There can be no doubt, from the writings of Professor Dick, that actinomycosis in cattle was extremely prevalent in Scotland from 1827- 1839. In other parts of Great Britain it has probably been equally prevalent since, though lost sight of under the names of wens, clyers, crewels, scrofulous, tubercular or strumous abscesses, polypus, lymphoma, cancer of the tongue, schirrous tongue, indurated tongue, ulcerated tongue, cancer of bone, bone-tubercle, osteo-sarcoma, fibro-plastic degeneration of the bone, spina ventosa, and carcinoma. It was not Hygiene : Section III. 75 until 1887, when Professor Crookshank established the etiology of wens, and investigated several outbreaks of a disease which proved to be actinomycosis, that it came to be generally recognised that actinomycosis in cattle was in some counties one of the commonest diseases of cattle in this country, and more recently the disease has been found to be equally prevalent in our Australian colonies, and in the United States. Cases of actinomycosis in the human subject were met with at an early date. So long ago as 1848, M. Louis had a patient with pulmonary disease, supposed to be cancerous, and in pus from this case M. Lebert, of Zurich, discovered and accurately figured the tufts of club-shaped elements with which we are now so familiar. In late years nearly 200 cases have been described in the human subject, of which over 5 per cent, occurred in this country. Professor Crookshank thought there were two points especially worthy of discussion. In the first place some manifestations of actinomycosis are still liable to be mistaken for tuberculosis. Morbid specimens exhibited in illustration of this. How far would this account for the very high percentage of cases of tuberculosis in cattle, which had been reported by some observers ? The question also arose, whether cases of actinomycosis ought to be placed in the same category as cases of tuberculosis, and condemned as unfit for food. If n6t, the distinction between the two diseases became a matter of practical import- ance, and the close similarity between the two diseases must be brought home to the minds of both medical and veterinary inspectors. With regard to inter-communicability of the disease between different species of animals, including man, the author has failed to find any evidence in support of the theory from chemical observation. He has trans- planted the disease from the human subject to a calf, but he is not of opinion that the disease was contagious, in the ordinary sense of the term. In fact the negative evidence as to infection of man from the cow, supports the view that the disease is derived from a source in common. Anthrax and its relations to "Workers in various Trades, BY Professor CHAUVEAU, Paris. On Anthrax and its relations to Workers in various Trades, &c, BY W. DUGUID, F.R.C.V.S. Names by which the disease is known : Anthrax, Charbon, Miltzbrand, &c. Geographical distribution. It is known over the whole surface of the globe, and has been described by travellers in all parts of the world. 76 Hygiene: Section 111. History. Anthrax has no doubt been known from the earliest tinifs, and probably some of those devastating plagues spoken of in the early and middle ages as attacking animals and spreading to mankind were anthrax; but, owing to the want then of the exact methods of investigation we now possess it was often confused with other diseases. It was not until recent times when the microscope had been for some time used in the study of medicine that we were able with certainty to distinguish anthrax from other diseases. Discovery of the bacillus anthoracis. Until the rod-shaped micro- organism which is characteristic of anthrax was discovered, the appearance of the disease was attributed to many different causes according to the conditions under which different observers had opportunities of investigating outbreaks. This was the first disease in which a micro-organism was con- stantly found, and with the discovery of the bacillus of anthrax a new era began in the study of contagious or transmissible diseases. Anthrax is primarily a disease of animals, more particularly of ruminants. In all countries outbreaks of anthrax are most common, and usually begin among cattle and sheep, and are from them transmitted to other animals and man. Susceptibility of different animals to anthrax. While some kinds of animals are extremely susceptible to infection, there are others which possess an amount of infection-resisting power which approaches almost complete immunity. Transmission of the disease : When few animals, cattle or sheep, die at intervals on a farm, it is seldom the source from which the infection came is satisfactorily made out, the weight of evidence is, however, in favour of the idea that it is usually by ingestion; the transmission to other animals and to man afterwards may take place in different ways, the chief of which are inoculation, ingestiou, and inhalation. Different forms anthrax assumes, according to the mode of infection, in man : Malignant pustule ; intestinal anthrax ; wool-sorters' disease. Occupations in which infection most frequently occurs. Different forms anthrax assumes in animals. Prevention : As anthrax is primarily a disease of animals, and usually transmitted from them to man. Consider the prevention in animals first : Legislation, inoculation (protective), disposal of carcases. Prevention in man : Legislation. Destruction of dangerous animal products ; disinfection of dangerous animal products. Hygiene: Section III. 77 Veterinary Hygiene, BY FRED. SMITH, M.R.C.V.S., F.I.C. The scope of veterinary hygiene is extensive the breeding, rearing, and management of animals, the fattening of cattle, and the training of horses. The laws of health in respect of water, air, ventila- tion, food, stables, drainage, and with horses, labour, saddles and harness, care of the feet, shoeing, &c., if attended to, induce health and vigour, and prolong life. The eradication and suppression of epizootic diseases is the second branch of veterinary hygiene : its importance to the United Kingdom, which has to draw much of its supply of animal food from other countries, cannot be over estimated, and its neglect has caused us the cattle plague with its enormous financial loss. The third branch of veterinary hygiene deals with the inspection of animals for meat and milk production. The final decision must always rest with the medical officer, who, in all cases, should be assisted by the veterinary expert. Lastly, the production of animal lymph for human vaccination. How far is the veterinary profession in this country prepared to accept these heavy responsibilities, and what is the nature of the training given to the student to admit of his becoming an expert ? The hygienic training of the future veterinary profession is neg- lected, and support is asked for the following resolution : " Seeing the " immense advantage to be derived from the application of Veterinary " Hygiene, the Seventh International Congress of Hygiene and " Demography respectfully urges the Royal College of Veterinary " Surgeons to institute examinations in Veterinary Hygiene, and to have " the subject taught in the schools." Veterinary and human hygiene overlap in many places, in food inspection more than in any other branch ; hence the medical officer of health should have some insight into the pathology of those animals intended for food, and this subject should form part of the examination held at our universities for the diploma in public health. The value of veterinary hygiene to the State cannot be over estimated ; its services have been demonstrated on a large scale in the army for many years past, by the absolute eradication of glanders, farcy, mange, canker of the foot, specific ophthalmia, &c., which formerly prevailed in the army but are now practically unknown. Resolution asking Government to undertake a periodical horse census, and that the annual losses amongst horses in his country from disease and injury be recorded. 79 SECTION IV. INFANCY, CHILDHOOD, AND SCHOOL LIFE. This Section will meet in the Theatre of the University of London, Burlington Gardens, marked E on the Plan. PRESIDENT. J. Kr. DIGGLE, M.A., Chairman of the London School Board. The Scientific Observation and Study of Children in Schools, and the Classes into which they may be Grouped. BY FRANCIS WARNER, M.D., F.R.C.P. The scientific study of children should be grounded upon observation. The following remarks are made upon the observation of 50,000 children seen in schools. It was found convenient to employ schedules for recording observations, separating points in physiognomy and develop- ment from those due to nerve action ; among the latter a number of new signs (postures and movements) have been introduced for the purposes of such inquiry. By obtaining the teacher's report on each case noted, it became possible to obtain information concerning the correlation of visible signs and mental status. The following classes of pupils may be defined, and their number and distribution determined by observation : 1. Children well made, with nerve-system acting well, and mentally bright normal children. 2. Children well made, nerve-system acting well, but dull at school work. 3. Children presenting various defects in development. 4. Children presenting abnormal nerve-signs. 5. Children presenting defects in development and abnormal nerve signs. 6. Children presenting defect in development and abnormal nerve-signs, also indications of low nutrition. 7. Eye cases of various kinds (ophthalmia is not included in my tables). 8. Deaf children. 9. Children crippled, deformed, or maimed. 10. Epileptic, feeble minded, imbeciles. 11. Cases exceptional in mental status. 12. Children delicate and thin. The teachers generally acknowledged that the dull children in the school had been selected by observation. The greatest number of visible defects was found in boys ; the nerve-signs varied greatly with the methods of school training. The kind of material collected in a school, as well as the outcome of training, may be defined and to a large extent determined by observation indepen- dent of oral examination. In resident schools there are few thin children, but certain nerve-conditions are very prevalent, though not equally distributed in all .schools. 80 Hygiene: Section IV. In day schools there appears to be a large percentage of pupils irregular in attendance, on account of physical weakness. Low nutrition appear* to be largely dependent upon conditions of low development. Many children with small heads, especially ^'irls, appear to be intelligent ami >liar|>, but are delicate. A class of children presenting certain nerve-signs are ill balanced and over-mobile, but usually mentally bright, while other nerve-signs are usually associated with low mental status. A list of " children mentally exceptional " has been prepared. Eye cases are very numerous, and ophthalmia in all stages is present in some day schools. Physical examination by inspection is useful, (1) as a means of selecting cases for special mental report ; (2) as supporting or confuting a report founded on mental tests only. Physical Indications of Injurious Schooling. BY OCTAVIUS STURGES, M.D., Physician to the Hospital for Sick Children. The object of the Paper is to direct the attention of school teachers to nervous disorder in children, and especially in girls, due to circumstances of school life, such as overwork, punishment, the excitement of examinations, harsh treatment, and so forth, and to suggest a few simple rules for the detection of such disorder. Some examples are quoted in illustration of the modes of origin, development, and progress of St. Vitus's Dance in children. The restlessness, over-movement, and inattention due to wayward- ness, temper, insufficient food, and other causes are contrasted with the similar symptoms of St. Vitus's Dance, and it is shown how intelligent observation will enable any teacher to separate infallibly the one from the other. Finally, some characteristics of St. Vitus's Dance are described and illustrated by examples, and some simple tests are mentioned for the discovery of St. Vitus's Dance in school children at its commencement. Eingworm in Elementary Schools. BY MALCOLM MORRIS, F.R.C.S., London. Hygiene: Section IV. 81 Epidemics in Schools. BY CHARLES EDWARD SHELLY, M.A., M.D., Cantab., Medical Officer to Haileybury. Schools are especially susceptible to epidemic influences, because each consists of a closely -aggregated population of youthful individuals who are to a great extent unshielded by the protective influence of a previous attack. Such epidemics (the school premises being as they always should be healthy) originate outside the school, i.e., the infection is imported. Special facilities exist for this infection from without ; notably : The exposure of susceptible children to infection during ordinary life while at home for the holidays and during " exeats," &c. Contact with the outer world while resident at school. Non-protection by a previous attack ; this is favoured by the general spread of hygienic knowledge, which ensures greater care and protection of the young at home (before they are sent to school), especially in the higher strata of society ; and diminishes in an increasing ratio with advancing age during school-life. Day schools are specially open to infection from without. Individual protection is thus more frequently attained ; and epidemics, though more common, are less extensive. The attendance of day scholars increases the risk and frequency, and somewhat diminishes the extent, of epidemics in boarding schools. Boarding schools are more isolated communities. Epidemics are relatively infrequent, and consequently more extensive. The establishment and spread of an epidemic is favoured by : The aggregation of susceptible material ; the amount of this existent in any given case is proportionate mainly to the age of the scholars, i.e., practically to the number who are or are not already protected by a previous attack (which may be regarded as a natural form of prophy- lactic inoculation) : all epidemic diseases are (for different periods) self -protecting. The attainment of the " explosive ratio " : When the number of unprotected reaches a certain proportion of the total scholars, an epidemic outbreak may be expected with certainty. This ratio varies with the disease ; for measles, e.g. (in large boarding schools entered at 13 years of age, cere.), it is about one- third ; and the number attacked in a full outbreak will be about three-sevenths of the unprotected, i.e., one-seventh of the whole school. The influence of this explosive ratio explains the tendency of epidemics to recur at approximately regular intervals of time. Checks to introduction of infection: Efficient health-certificate system. Enforcement of efficient quarantine and disinfection after exposure. Age of pupils, as above. Checks to spread of epidemic: Early notification of illness. Early and effective isolation and disinfection of patients. Presence of / p. 1634. E. & S. 26. p 82 Hygiene: Section IV. day scholars (as above). Separate masters' "houses." Subdivision of the school into a senior and a (distinct and separate) junior establishment. Mutual relationship and influence between different epidemic diseases : E.g. : Measles and whooping cough ; rotheln and measles and scarlatina ; scarlatina and diphtheria ; mumps with measles or with rotheln ; vaccination (or small-pox) and typhoid. Influence of seasons. Hospital accommodation to be provided for the several diseases : In typical large boarding school. Deductions allowable on account of : Day boys ; " house " system ; separate junior and senior establishments. Provision for servants ; for disinfection ; for separate laundry. Importance and value of systematic records of disease iu schools. Demonstrations with reference to the Introduction of Upright Handwriting into Schools. BY L. KOTELMANN, M.D., Ph.D., Hamburg. Photographs of children writing an upright and a slanting hand. Specimens of upright writing by school children in the different standards. Narrow copy-books for upright writing with lines for the shortened upper and lower strokes of the letters. Facsimile upright writing from the middle ages. Nuremberg alphabets of upright letters, with instructions for holding the hand and pen. Models for upright writing by Scharff and Kauff. Opinions of teachers on, and written in, upright handwriting. German literature on the subject. Demonstrationen, die Einfiihrnng der Steilschrift in die Schnlen betreffend. VON L. KOTELMANN, M.D., Ph.D., Hamburg. Photographien steil und schief schreibender Kinder. Steilschrift- proben von Schulern aus verschiedenen Schuljahren. Schmale Schreib- hefte fur Steilschrift mit Liniatur fur verkiirzte Ober- und Unterlange der Buchstaben. Facsimilirte Steilschriften aus dem Mittelalter. Niirnberger Steilschriftalphabete mit Anweisung fur Hand- und Feder- haltung. Steilschriftvorlagen von Scharff und Kauff. Urteile von Lehrern liber und in Steilschrift. Deutsche Litteratur iibcr Steilschrift. Hygiene: Section IV. 83 Handwriting (as taught) in relation to Hygiene, BY J. JACKSON. 1. Universality and importance of handwriting: (a) Hand- writing enters into every rank, department, and occupation of life. (b) Forms in tens of thousands of cases the sole means of earning a living, (c) Impossible to over-estimate its importance, since, either directly or indirectly, it forms the basis of all literature, and com- merce, and of all communication between different individuals, classes, and races. 2. Origin and development of the art : Co) The origin of writing was in semi-civilization: 1. In a crude hieroglyphic. 2. In an im- perfect but approximate phonetic. (6) The development of the art has been quite independent of all hygienic considerations and principles ; the progress has been exclusively artistic or caligraphic, and more capricious than scientific. 3. The postures induced, required, and taught in sloping writing : (a) The sideway position of the body in sloping writing is unavoidable. (6) Twisting of the neck 'inevitably follows, (c) Distortion of the spine must accompany the position (a), (d) The right shoulder is pushed up out of its natural position, (e) The wrist is twisted out of its natural direction. (/") Sprawling on the desk and consequent constriction of the chest are thus induced, (g) The oblique view of the writing obtained in the sloping style is injurious to the eyes. 4. The injurious effects upon the system of the postures required in sloping writing : (a) Generally : Health deterioration. (6) Par- ticularly: 1. Spinal curvature. 2. Pulmonary weakness. 3. Short sight. 4. Writer's cramp. 5. (To be given.) 5. Proposed substitution of vertical for oblique writing : (a) The essential difference between vertical and sloping writing is to be found in the down strokes of the letters, which in the former are upright or vertical, and in the latter are more or less oblique, (b) Minor differences are : Continuity and minimum thickness in the upright, with short loops, as contrasted with broken or isolated letters, heavy down strokes, and long loops in the sloping. 6. The hygienic superiority of vertical writing : (a) Its naturalness and simplicity, (b) Its legibility and the absence of optical delusion. (c) Its freedom from all abnormal or constrained postures : i. Of the wrist, ii. Of the shoulder, iii. Of the spine, iv. Of the body. v. Of the eyes, (d) Its consequent superiority in speed, (e) Its ease in teaching, acquiring, and producing. F 2 84 Hygiene : Section IV. The Laws Regulating the Employment of Children in the United States of America. BY Dr. JACOBI, New York. An Objectionable Feature of some Burial Societies in their Relation to Infant Life Insurance. BY CHARLES E. PAGET, M.B.C.S., D.P.H., Medical Officer of Health for the County Borough of Salford. The inquiry into the subject of this paper came about in conse- quence of an investigation into the high infantile mortality which is so common, and depends on so many causes, in large towns, and especially in large manufacturing towns. The difficulty of discriminating between such causes as hereditary predisposition, food, want of cleanliness, of air, soil, and water, and seasonal diseases is recognised, and the diffi- culty of defining infant insurance as a predisposing cause of infant mortality is also fully appreciated. The greater number of such insurances in towns than in country districts is assumed in general terms, and the author is of opinion that it cannot be shown that infant insurance is frequently a cause of infant mortality. But the object of the paper is to draw very prominent attention to certain features in the conduct of some burial and friendly societies, which must be considered to be very reprehensible, and certainly are most objectionable. The circumstances of the societies which are referred to in the paper are such as to make it possible for the claimants for burial-moneys to be seriously exposed to the temptation to take alcoholic drink, the payment for which must be made out of the burial moneys. The societies meet at public houses ; the treasurers are the hosts or hostesses of the houses where the societies meet ; and, as the treasurers are not paid for their services out of the funds of the societies, as are the other chief officers, a certain portion of the burial claims is paid in liquor from the houses, or, if the claimants elect not to take liquor from the houses, then a contribution out of their burial moneys must be left in the hands of the treasurers as payment for services. The rules, or portions of them, relating to this matter, are reprinted in the paper, and the author urges that, in any serious measure for the regulation of infant life insurance, the Legislature should provide 1. That every mutual insurance society should be registered ; 2. That no such society should be permitted to meet in any place in which the payment of wages is forbidden under the Truck Act ; 3. That no chief officer of such a society should have a direct interest in the office of the society; 4. That all the chief officers, if remunerated for their services, should be paid out of the funds of the society ; 5. That no deduction whatever be permitted from the burial or insurance claims, by any officer of the society, for any purpose whatsoever. Hygiene : Section IV, 85 The Care of the Teeth in Childhood. BY GEORGE CUNNINGHAM, M.A. Cantab., D.M.D. Harvard, L.D.S. Eng. Defective personal hygiene is the direct cause of the disease, which is by far the most prevalent of all diseases in childhood and school life. The frequency of dental caries and other diseases of the mouth connected with the teeth, is proved by reliable statistics of the condition of the teeth of school children to be presented in the division of Demography by the Special Committee appointed by the British Dental Association. The frequency of caries due to (1) hereditary disposition in the greater or lesser degree of completeness of tooth structure, (2) hyperaemia from excessive mental work (Magitot, Galippe, and others), (3) mal- position of the teeth, (4) lodgment of fermentable matter upon and between the teeth. The teeth are, or should be, an ornament ; for the medical and the dental practitioner they constitute a machine. On the efficient working of this machine depends nutrition, and on nutrition depends both the physical and mental development of the individual. Poor tooth structure is due, in part at least, not merely to impoverish- ment during tooth formation in the embryo, but also to defective nourishment during infancy and childhood. Insufficient use of the temporary teeth in mastication results in a minimal supply of nourish- ment for purposes of development of the permanent teeth. It also affects the development of the jaws, thus leading to a crowded condition of the teeth, which in itself facilitates the production of caries. With the use of the teeth arises the necessity for the application of personal hygienic precautions. In determining the necessity for these precautions the mouth may be regarded as an incubator ; nay more, for not only are the conditions of heat, humidity, and oxidation perfectly realised, but the bacteria and the culture medium are inevitably constantly present. In a " scientifically clean " mouth there will be no decay. Caries affects the temporary as it does the permanent teeth. Fundamental treatment must begin with the deciduous teeth. The importance of preserving these teeth proved by a consideration of the results of disease and its neglect, such as chronic gum boils, sleepless nights, impaired digestion from inability to masticate food, and swallowing the fetid discharges from abscesses, impaired development of the teeth and jaws, and the production of additional centres of infection for the neighbouring teeth. Details of prophylactic measures suitable in (1) infancy, (2) childhood. 8C -Hygiene: Section IV. An Experiment concerning Overpressure of Brain. BT Prof. LEO BUBGEBSTEIN, Vienna. It is the experience of every teacher that one hour's steady work with children, even though the subject be an interesting one, produces in them a certain amount of fatigue. To demonstrate the fluctuation of brain-power in children, during one hour's occupation with a familiar subject, simple addition and multiplication sums were given. The figures were printed and constantly varied. There were two classes of girls, containing respectively 35 and 33 children of an average age of 11 years and II years and 10 months, and two classes of boys, containing 44 and 50 children of the average age of 12 years and 2 months and 13 years and 1 month. After 10 minutes work the sums were taken away from the children ; then there was a pause of five minutes, and afterwards they were made to resume work for 10 minutes. This alternation was continued for one hour, so that there were four periods of work each lasting 10 minutes, with pauses of five minutes between them. During the whole experiment, the 162 children worked out 135,010 figures, making 6,504 mistakes. The errors in calculation which occurred in succeeding periods of 10 minutes are given in a tabular form ; and it was found that the increase in the number of mistakes far exceeded the increase in the number of figures calculated. The total number of calculations made by all the children increased, roughly speaking, 4,000, 3,000, and 4,000 in the different periods. During the third period of 10 minutes, the increase of work done was not so great as during the other periods. The number of mistakes also increased, roughly speaking, 450, 700, 350 in the different periods. Here, again, during the 3rd period, the quality of the work was at its lowest. It would appear then from the above, that children of the ages stated, become fatigued in three-quarters of an hour ; that the organic material is gradually exhausted; that the power of work gradually diminishes to a certain point during the third quarter of the hour, returning with renewed force in the fourth quarter of the hour. This experiment seems to demonstrate that continuous work for school children of these ages, even though the tasks are not difficult, should not last longer than three-quarters of an hour; takin- into consideration also the unsatisfactory hygienic conditions under which education is conducted in the greater proportion of schools, with the exception, perhaps, of the higher class of English schools, the following resolutions are proposed : 1st. It is desirable that the question of mental over pressure should be investigated by exact experimental methods. Hygiene: Section IV. 87 2nd. That until the question of over-pressure has been carefully investigated in a proper scientific spirit, school lessons generally should not last longer than three-quarters of an hour. School Hygiene in Belgium. BY Professor HYAC. KUBORN. During recent years the advances made in Belgium in the matter of school hygiene have exerted a most favourable and remarkable influence, especially as regards the physique, the vision, the general health, and the cerebral development of school children. L'Hygiene Scholaire en Belgique. PAR M. le Doct. Prof. HYAC. KUBORN. Les progres accomplis dans ces dernieres annees, en Belgique, ec matiere d'hygiene scolaire, de programmes et de methodes, ont exerce une influence des plus favorables, mesurables, marquees : Sur les deforma- tions du corps ; Sur la vue ; Sur la sante generale ; Sur le developpement psycho-physique du cerveau des eleves. Some of the Laws which Regulate the Growth of the Child. BY W. ARBUTHNOT LANE, M.B., Assistant Surgeon, Guy's Hospital, etc The author considers it a matter of the greatest importance that those who have to do with the education of children should render themselves familiar with the mechanisms of the several skeletal arrange- ments of the human body, and with their physiology, especially during the varying movements of activity and attitudes of rest. This portion of the study of anatomy, namely, its physiology, has unfortunately received but scanty attention from anatomists, and much of what little is stated upon the subject in standard works, is too often incorrect and misleading. To obtain this knowledge it is necessary at the present time to have recourse to papers scattered through trans- actions or journals, or to monographs. To this fact he attributes the 88 Hygiene: Section IV. numerous and often obviously absurd explanations which have been put forward, of the causation of most of the acquired deformities of young life, as, for instance, lateral curvature, the effect being usually regarded a8 the cause, a common error with surgeons and pnthologists. He points out that the form of any particular joint, or combination of joints, is evolved from, and depends for its continued existence, in what is called a normal condition, upon a combination of movements of activity with attitudes of rest, and that if this combination is departed from, the joint or joints undergo very definite anatomical changes in consequence. He illustrates the conditions which result from the habitual use of certain movements of activity by the wonderful varia- tions from the normal which are presented by the joints of labourers, such as sailors, shoemakers, coal-trimmers, Ac., the details of which he has described fully. The almost complete limitation of the several parts of the skeleton to movements of activity, results in an alternation of the anatomical structure of the several bones and joints, at least as different from that of the normal skeleton as the normal skeleton of man differs from that of animals considerably lower in the scale of life. These variations he regards as representing, first, the vexation, and afterwards, the exaggeration of movements or attitudes of activity. If these are developed during young life, while growth is taking plan- at the epiphysial lines, the changes developed by these attitudes or movements in the form of the bones and joints are even more remarkable. In a similar manner the constant assumption of attitudes of rest, and the very rare performance of movements of activity during growing life, result in deviations in the form of bones and joints from the normal, which are even more apparent. Such deformities are especially exaggerated if the nutrition of the child be so imperfect that the density and firmness of the bones become sub-normal. The simple deformities which are developed during growing life he shows to be, first, the fixation, and later, the exaggeration, of normal physiological attitudes of rest. He discusses fully the several laws which govern the development of the above conditions, the hereditary influence they exert, and the manner in which the development of the several resting and rachitic deformities may be obviated. On Physical Education. BY GEORGE WHITE, Esq., B.A., LL.B., &c. A. GROWING IMPORTANCE OF THE SUBJECT seen hi (a.) Increased attention paid to it, especially in elementary schools ; (6.) Recognition of it by Education Department; (c.) Organisations for propagating different and competing systems. Hygiene : Section IV. 80 B. MEANING OP THE TERM " PHYSICAL EDUCATION." (a.) What it includes ; (6.) What it does not include. C. PHYSICAL EDUCATION AS A SUBJECT OF SCHOOL INSTRUCTION. (a.) Within what limits possible, with regard to (1.) Time. Its relation to other subjects in the school curriculum ; (2.) Place. Con- ditions for its healthy prosecution. School structure. (6.) Advantages attendant thereupon (1.) Immediate. e.g., Great help to school dis- cipline; (2.) Remote. Effect of hereditary diseases especially chest mischief minimised. D. CONDITIONS OF ITS BEING TAUGHT SUCCESSFULLY (a.) In Infants' Schools. Desirability of musical accompaniment ; (6.) In Girls' Schools. Kind of dress suitable therefor; (c.) In Boys' Schools. Different kind of exercises. Military drill. E. NOTES AND HINTS ON A LESSON IN PHYSICAL EXERCISES (a.) What it should include ; (6.) Length of time necessary for it ; (c.) How the various exercises should be taught ; (d.) Knowledge required on the part of the teacher. F. TRAINING OF TEACHERS IN PHYSICAL EXERCISES, (a.) Phy- siology basis of knowledge and reading ; (6.) Practical exercises to accompany each section of reading and study. Swedish system of training. G. MECHANICAL ADJUNCTS NECESSARY FOR PHYSICAL EDUCATION. (a.) Consideration of apparatus ; whether requisite or not ; (6.) Musical accompaniment or singing ; whether desirable or not. H. SPECIFIC FORMS OF PHYSICAL EDUCATION ADAPTED TO SCHOOL USE. (a.) Swimming ; (6.) Games, &c. The subject-matter of parts of the paper will, if possible, be illustrated by practical illustrations given by classes of boys and girls from the schools of the London School Board. Physical Exercise in the School a part of the School Hygiene, BY Dr. BROMAN, London. Introductory remarks. Public and elementary schools. Physical education in elementary schools, The necessity for regulated physical exercises. Bad positions conducive to deformities. The true aim of physical education. Its place in the general school- work. The time that should be given to the subject. Present misunderstandings regarding the subject and the way to improvement. 90 Hygiene: Section IV. The Value of Hygiene to Women, BY ALFRED T. SCHOFIELD, M.D., &c., National Health Society. 1. Introductory Remarks. Present condition of hygienic know- 1. (!''. iiinongst women Quotation from Herbert Spencer. General need of more knowledge. Retrogression since the Middle Ages of their proportionate knowledge of these matters as compared with men. Great advance of recent yoars in general education of women is only taking up lost ground. Hygiene remains the most neglected of all the sciences. And yet it is peculiarly adapted for women. None can object to, and all must feel the need of advance in this direction. 2. The Need. Present loss of life from preventable causes. Number of needless sick-beds. Advances made by public sanitation. Quotation from Lord Derby. Nothing can equal in value the private knowledge of hygiene by women. Leading mortal diseases mainly preventable. Proper duration of life. How attained. 3. What is included by Hygiene. All that pertains to the health of the body. The instruction to women should include : a practical course of lectures on physiology, with outlines of anatomy ; a course on nursing, on first aid to the injured, on house sanitation and ventilation, on food and its uses, on cooking, and on those subjects that enforce the five laws of healthy living good air, good food, cleanliness, suitable exercise and rest, proper clothing. 4. Its Value to Women. (a) As Women. In accidents. In understanding and carrying out doctors' orders. On account of the interest and value of the subject. Personal preservation of health, and of beauty. Increases general usefulness in every way. Ls a study peculiarly suited to women from its nature and value. Prolongation of life. Natural versus violent deaths. (b) As Wives. Making a home comfortable and sanitary. Preserving life of husband. Giving him well-cooked and nourishing meals. Nursing him efficiently when sick, (c) As Mothers. Saving enormous loss of infant life from bad food and other causes. Intelligently understanding care of infants and children. Proper food. Proper clothes. Healthy training for body, mind, and spirit, (d) As Mistresses. Instructing servants. Tenants. Seeing to ventilation. Cleanliness. Drains, and all sources of disease. (e) As Governesses and Teachers. Directing studies with regard to health. Posture. Exercise, Calisthenics, &c. (/) As Nurses. Im- mense importance. No quackery. Feeding. Sleeping and general care of children. (g) As Workers. Visiting amongst poor. Great value of hygiene. 5. How to carry out this hygienic education. Hygiene : Section IV. 91 Manual Training in its Relation to Health, BY Sir PHILIP MAGNUS. The advocates of manual training have hitherto regarded it mainly from the educational standpoint as a school exercise, tending to the development . of sense organs and the cultivation of the intelligence. This advocacy has succeeded in giving to this training a very wide extension in England and in other countries, and has led to its recog- nition as a school subject in the Educational Code. A definite system of instruction has been adopted, which varies slightly in this country, but not so much as it differs from some of the systems adopted abroad. The value of this training, not only as an intellectual exercise, but as a help to the maintenance of healthy life in growing children, is a matter of great importance, and this aspect of its usefulness demands as much attention as the intellectual or industrial. In education the corpus sanum has to be considered equally with the mens sana. The depen- dence of one on the other is generally recognised. Manual training serves to exercise organs which call into action brain centres at the very time when such centres need development, and it thus conduces to the more effectual development of the brain itself, and to the conse- quent increased health of the whole body. Experience has shown that manual training, whilst withdrawing time from literary pursuits, does not retard the child's progress in these pursuits. The alternation of sedentary with active lessons quickens the child's vitality, and so tends to stimulate the interest in ordinary studies, and to increase the general cheerfulness. It acts through the intellect and the emotions on the whole body. The necessity of punish- ment, with its depressing effects, is thereby lessened. The introduction of manual training into our schools has been too recent to have enabled its effects to be scientifically ascertained. Something, however, has been done, and much more might be done in this direction. As the system of instruction is extended a record of facts might be kept, with the view of confirming general impressions, and of accurately determining its hygienic value. The effect of such training in increasing muscular development and strength might be ascertained by careful measurements. The progress of children attending classes for manual training might be compared with that of other children. Observations might be made as to their general health extending over a large area of instances. Such observations would be of value not only in confirming the general experience of educationists, but in indicating directions in which tlie system of instruction might be improved, with the view of enabling it to further conduce to the healthful life of school children. As com- pared with drill, and physical exercise, and open-air games, manual training looked at from the physical side would occupy a secondary place. But as a substitute for a part of the ordinary book lessons, it is 92 Hygiene: Section IV. found that besides having a distinct intellectual value, as a school discipline, and also an industrial and economic value, it conduces to the development of the brain and muscle of the child, and to the maintenance of a healthy condition of mind and body. On the Hygiene of the New-born Child. BY Dr. DESUAYES, Rouen. Should any nourishment be given to the new-born child previous to the time at which the mother's milk is secreted ? On this point opinions and customs differ, as with regard to clothing. The latter, however, is necessarily influenced by expediency, by climate, and by usage, but in regard to feeding there ought to be a general consensus of opinion and practice throughout all civilised lands. Various artificial measures commonly adopted, but nature is the proper guide. In practice, two cases must be considered: 1. The mother is able to nurse ; in all such cases the infant should derive its nourishment wholly and solely from the mother's breast; 2. The mother may be, from various causes, unable to nurse her child, in such cases the child should be fed with cows' milk sterilized. How soon may the bottle (always without a tube) be given ? Not before the morrow of the birth, at the earliest. Thefr&num lingrue should never be divided, except it be so short as to prevent suction absolutely. The child, if sleeping naturally, should not be awakened. It should be baptised at home ; despite all precautions, there are risks in taking a young child to church. Advice on such matters as these should be widely disseminated. The plan pursued with this object in Paris, Havre, Rouen, &c. Conclusion. Hygiene de 1'Enfance, PAR M. le Docteur DESHAYES, de Rouen. Hygiene et alimentation de 1'enfant depuis la naissauce jusqu'4 I'allaitement. Que faut-il donner au nouveau-ne, a partir de la naissance jiuqu'u la montee du lait chez la mere ? II y a a cet gard divergence d' opinion, diversite des precedes usites, non seulement dans le vehement, mais aussi dans 1'alimentation. Pour le vetement, cela se concoit ; c'est affaire de milieu, de climat et d'habi- tude. Mais au point de vue de 1'alimentation primitive de 1'enfant, il devrait, ee sernble, y avoir dans tous les pays civilises, conformite d'action. Hygiene : Section IV. 93 En France un certain nombre de medecins, les sages-femmes en general trop peu instruites, les matrones, les parents s'empressent de donner a boire au nouveau-ne des les premieres heures de la naissance, souvent du cafe, du the, quelquefois de 1' eau-de-vie pure ou coupee, et sucree ; d'autres plus sages conseillent quelques cuillerees a cafe d'eau sucree, tiede ou froide, du sirop de capillaire pur ou dilue dans un peu d'eau, de 1'eau de gomme, etc. On devrait, croyons-nous, suivre la nature, et copier les grands mammiferes. En hygiene deux cas se presentent : 1 L'allaitement se fera par la mere : L'enfant aura dans les premiers jours, voire meme dans les premieres heures, le sein maternel; il y trouvera le colostrum; cela suffit et doit suffire jusqu'a la montee du vrai lait : ni breuvages, ni eau sucree, rien que la tetee maternelle ; n'est-ce pas du reste ce qui a lieu dans le regne animal ? 2 Allaitement artificiel : Par suite d'impossibilite materielle, il faut parfois donner a 1'enfant du lait de vache sterilise, pasteurise. A quelle heure, a quel moment 1'enfant doit- il prendre le biberon (biberon sans tube) ? On se hate trop, en general, de le lui donner. L'allaitement artificiel ne doit etre commence que le lendemain de la naissance, au plus tot. Ne jamais sectionner le frein de la langue, ne pas couper le filet, a moins d'impossibilite absolue dans la succion ; en tout cas, c'est affaire au medecin. Ne jamais reveiller un enfant qui dort, d'un sommeil regulier. La constatation des naissances ne se fait plus heureusement en France a la mairie, mais a domicile, ou plutot sur simple declaration. II devrait en etre de meme pour le bapteme : 1'enfant porte a 1'Eglise, malgre toutes les precautions, se refroidit frequemment. Voila de sages conseils, pratiques, et que je voudrais voir le Congres International de Londres recommander aux municipality's, au corps medical et aux families : Rien de plus facile a 1'aide de pan cartes ou petites notices enseignees dans les ecoles et repandues a profusion. Quelque chose de semblable se fait dans les grandes villes, a Paris, au Havre, a Rouen, mais il y a lieu de generalises Un Congres International a un double but : 1 Un hygieniste doit apporter a ses collegues le resultat de ses connaissances, de ses decou- vertes, de sa pratique personnelle ; 2 Mais aussi il doit s'enquerir aupres des memes collegues comment eux-memes procedent, et tirer de leurs conseils, de leur maniere de faire, un enseignement. Neglected Children of Our Towns and Cities. BY WILLIAM MITCHELL, Vice-Chairman Glasgow School Board. 1. Their Social Condition. Ill-housed. Ill-fed. Ill-clothed. Ill- conditioned. Ill-controlled. 94 Hygiene: Section IV. 2. The Causes of such Condition. Loss of one or both parents Intemperance or misconduct of parents. Illness and poverty of parents. Wife desertion by husband. Bad company. Vicious surroundings 3. Rescue and Recovery. Agencies. Imperial and municipal regulations for improved dwellings. Poor children's dinner-table. Day refuges and day industrial schools. Individual and private effort. 4. Value of Children thus Rescued. From a social point of view. From a hygienic point of view. From a national point of view. The Spread of Elementary Education. BY Professor HYAC. KUBORN. La Diffusion de ITnstmction Elemental, et la Criminalite en Belgique, PAR M. le Doct. Prof. HYAC. KUBORN. Les progres de la diffusion de 1'instruction elementaire montrent qu'en Bvlgique celle-ci a la moindre part dans la production de 1'aliena- tion mentale et qu'unc diminution dans la criminalite est en raison de cette diffusion. The Development of the Reformatory and Industrial School System in England. BY Colonel LENNOX PRENDERGAST, J.P., Chairman of the Industrial School Committee of the London School Board. Fifty years ago our criminal children were sent to the common gaols. They went in for their first faults, and came out familiar with evil. If the way in which a people treats its children is the measure of its civilisation, certainly our condition and instincts were not high. Hygiene : Section IV. 95 1 . The first awakening to a higher sense produced the Reformatory Schools Acts. We had come to see that even in treating criminal adults our penal system ought to be penitential ; much more in treating criminal children the system ought to be reformatory. The passing of these Acts led to the formation of a department depending on the Home Office, under which for long years Mr. Sydney Turner formed the outlines of our reformatory school system. The number of schools at the beginning was small. It steadily increased as the benefit of the treatment was tested and proved by the steady diminution of committals of children for breaches of the law, as shown in the returns year by year. 2. But it became evident that a reformatory school, with all its wise mitigations, was after all a penal system, and the poor children committed by magistrates for a trifling theft were marked for life with a stigma. To remedy this the Industrial Schools Acts were passed, and the wise mercy of this further mitigation has become manifest in every year. No stigma attaches to children carefully brought up in an industrial school. They were not really responsible for their childish offences. The vices or negligence or cruelty of their parents were the original cause of their faults. Twenty years ago, when the population of school age was com- pelled into school, the boards were empowered to administer the Industrial Schools Acts of 1866; and in London the board at once assumed this duty, by which it became possible to eliminate from the elementary schools the vicious element. Existing industrial schools were subsidised by the board and contracted with, and for special classes of cases the board undertook to carry on institutions of its own. A further development of the work became necessary in conse- quence of the non-attendance of certain children at school in conformity with the law, and special schools had to be improvised and eventually grafted on to the older system. The school board visitations having disclosed a peculiar class of the population that it was essential should be dealt with and apart from the other children placed in industrial schools, the " Industrial Schools Amendment Act " of 1880 was passed, and by this means a class who were positively being brought up to a life of degradation and vice is by this means being successfully dealt with. The present session of Par- liament has added another detail of legislation, by which it is hoped the return of children to degraded homes on the expiration of their detention in ordinary industrial schools may be avoided, and a long-felt difficulty thus permanently removed. Certain details in connexion with the management of the institutions alluded to are mentioned. Points of contrast and of similarity with poor law schools are pointed out, and the question of dealing with the school population in exceptionally poor districts by what is known as " Day Industrial Schools " is considered. 96 Hygiene : Section IV. The Physical and Moral Training of Orphans. BY Dr. VICTOR DESGUIN. Orphanages, which are establishments intended to receive poor children who, having lost their parents, find themselves destitute, aim at placing these children in a position to gain their livelihood honestly by means of the knowledge there instilled into them, and the physical and moral qualities which they there acquire. The first of these qualities is health, without which no productive work is possible, and which is often, especially amongst the lower classes, the guarantee of morality. . The greater part of these children bring into the world with them some hereditary defect (tuberculosis, syphilis, alcoholism) with which the regime of the establishment has to fight by means of such hygienic modifying treatment as science indicates. Among these the most potent, next to diet, are life in the open air and bodily exercise. The abolition of orphan homes is desirable. Either boarding out, which combines the material and moral advantages of home life, should be recommended, or agricultural colonies. Scrofulous and rickety children should be sent to the seaside. Such orphan homes as are retained should be established in the country, provided with the fittings necessary to develop the body, increase vital resistance, hinder the breaking out of hereditary diseases, combat the development and propagation of tuberculosis, zymotic diseases, and granular ophthalmia. Gymnastics and swimming are indispensable. The staff, composed of healthy, vigorous, and moral persons, able to exercise over the children a preponderant psychical influence, should be capable of studying their characters and dispositions, so as to be able to contend with their hereditary tendencies to vice, and to perceive the aptitudes of each. The diet, housing, and dress must conform to hygienic rules, but must exclude all luxury, all refinement incompatible with the future position of the orphans, such as would warp their judgment. The instruction given should be sufficiently solid to develop their intelligence, but should not be carried far enough to raise them above their after-station. In exceptional cases, children enjoying good health and presenting special aptitudes may be prepared for higher studies. Music and drawing should form part of the regular course. The choice of trades must depend on the tastes and physical qualities of the children. Their apprenticeship must be conducted so as to fit them to exercise their trades even under the worst conditions which they may meet with later in life. Hygiene : Section IV. 97 Hygiene Physique et Morale des Orphelinats. PAR Le Docteur VICTOR DESGTJIN. Les orphelinats, etablissements destines a recueillir les e,nfants indigents qui, ayant perdu leurs parents, se trouvent sans soutien, ont pour but de mettre ces enfants en position de gagner honorablement leur vie, par les connaissances qu'on leur aura donnees et les qualites physiques et morales qu'ils auront acquises. La premiere de ces qualites est la sante, sans laquelle aucun travail fructueux n'est possible et qui est souvent, surtout chez le peuple, une garantie de moralite. La plupart de ces enfants apportent en naissant une tare heredi- taire (tuberculose, syphilis, alcoolisme), que le regime de 1'etablissement doit combattre par les modificateurs hygieniques que la science enseigne. Parmi ces modificateurs, les plus puissants, outre le regime alimen- taire, sont : la vie en plein air et les exercices corporels. La suppression des orphelinats fermes est desirable. II faut recommander spit le patronage (boarding-out), qui reunit les avautages materiels et mpraux de la vie de famille, soit les colonies agricoles. Les scrof uleux et rachitiques seront places dans des stations maritimes. Les orphelinats fermes que Ton conserve seront etablis a la campagne, pourvus des installations necessaires pour developper le corps, augmenter la resistance vitale, empecher 1'eclosion de maladies hereditaires, combattre le developpement et la propagation de la tuber- culose, des maladies zymotiques, de 1'ophthalmie granuleuse. La gymnastique et la natation sont indispensables. Le personnel, compose de personnes saines, vigoureuses et morales, pouvant exercer sur les enfants une influence psychique preponderant^, doit etre capable d'etudier leurs caracteres et leurs dispositions, de maniere a combattre les tendances hereditaires au vice et a reconnaitre les aptitudes de chacun. Le regime alimentaire, 1'habitation, le vetement, doivent repondre aux prescriptions de 1'hygiene, mais exclure tout luxe, tout raffinement, qui sont incompatibles avec la position future des orphelins et fausseraient leur jugement. L'instruction sera suffisamment solide pour developper 1'intelligence, mais ne sera pas poussee assez loin pour en faire plus tard des declasses. Exceptionnellement les enfants jouissant d'une bonne sante et presentant des aptitudes speciales, pourront etre prepares aux etudes superieures. La musique et le dessin feront partie de 1'enseignement. Le choix des metiers dependra des aptitudes des enfants et de leurs qualites physiques. L'apprentissage doit etre conduit de maniere a leur permettre d'exercer leurs metiers meme dans les plus mauvaises conditions, telles qu'ils pourront les rencontrer plus tard dans la vie. i p. 1634. E. & S. 2f>. 98 Hygiene : Section IV. Free Dinners for School Children. BY The Rev. J. LLEWELYN DA VIES, M.A. The natural bias in favour of relieving the sufferings of children. The causes of that suffering. Poverty a recklessness of parents. Proposals for the remedy of this state of things : 1. State respon- sibility for children whose parents are willing to surrender their parental rights, or who are neglected by their parents. This scheme is not at present generally advocated. 2. free dinners. This amounts to a grant of 6d. a week per child to each parent. If this is reasonable, why should it be restricted to the mid-day meal ? More injury is caused by inadequate clothing than by inadequate feeding. The system is not necessarily " pauperising " ; the question is, is it a public benefit ? How are the children to be selected ? If the worst fed children are selected, it is inevitable that they should in the main be the children of the worst parents. If the children of the poorest parents are selected, the worst fed children are not relieved, and the system involves domiciliary inquiries, which must be offensive and cannot be efficient. In the latter case, the system becomes one of mere charitable relief. But dinner- giving is not an effective means for relieving the deserving poor. Importance of maintaining the family relations unimpaired. Analogy from the system of poor law relief. How are spendthrift parents to be dealt with ? Punishment of parents. Diminishing number of such parents. Alms privately given more efficacious than publicly admi- nistered charity. Can Hungry and Half-clothed Children be efficiently Educated ? BY Mrs. BESANT, M.S.B.L. The Need for Children's Convalescent Homes. BY MARIANNE NIGG, Board School Instructress, &c. Convalescent children, particularly those dismissed as convalescent from hospitals, need especial care and nursing. They should be cared for in special convalescent homes. The value of such a home has been proved (example given), notably with regard to special details in con- nexion with the construction and internal arrangement of the building, wearing apparel and linen, special pattern of bedsteads, &c., baths, Hygiene : Section IV. 99 dressing-rooms, garden, playground, and domestic offices. The advan- tages accruing to the child from residence in such a home are described ; mind is benefited as well as body, and the moral sense is strengthened and expanded in correlation with the improvement in physical well- being, to the general and progressive advantage of the community. Conclusions, and reference to Report of the Herzmansky Convalescent Home for Children. Tiber die Nothwendigkeit der Griindung von Reconvalescentenhauser fiir Kinder. VON MARIANNE JSTiGG, Volksschullehrerin. I. Genesende Kinder bediirfen einer besonderen Sorgfalt und Pflege, welche den aus den Spitalern geheilt entlassenen Kindern im hauslichen Kreise mangelt. II. Sie sollen von den Spitalern aus fiir die Zeit ihrer Recon- valescenz in eigenen Reconvalescentenhausern untergebracht und ver- pflegt werden, um dort zu erstarken. III. Die Verpflegung und Betreuung in dem von Frau Amalie Herzmansky gegriindeten I. Muster-Reconvalescentenhause hat sich als erspriesslich erwiesen und zwar in Bezug auf : (a) den Bau des Hauses und dessen innere Einrichtung ; (6) die Kleidung und Wasche ; (c) die zu diesem Zwecke eigens construierten Schlafstellen, Betten mit Einrichtung ; (t?) das Bad ; (e) das Ankleidezimmer ; (f) die Ver- pflegung in der Anstalt ; (ff) den Anstaltsgarten ; (A) den Spielplatz ; (t) das Wirtschaftsgebaude. IV. Besprechung dieser Objecte nebst deren Vdrfxihrung so weit es beim Vortrage thunlich ist. V. Durch den Aufenthalt im Reconvalescentenhause wird das Kind sowohl korperlich als geistig gestarkt und gekraftigt : VI. Korper und Geist erhalten also durch die angezeigte Pflege in der Reconvalescenz, da namentlich diese die Wirkung des korperlichen Wohlbefindens auf das geistige Leben erzielt, eine vortheilhafte Ruck- wirkung, beziehungsweise Anregung. VII. Der am hochsten anzuschlagende Gewinn, den die Menschheit und insbesondere der Staat durch solche Reconvalescentenhauser haben kann, wird die Heranziehung der reconvalescenten Kinder zu gesunden, kraftigen Menschen sein. VIII. Ein weiterer Gewinn, den die Menschheit durch eine solche Pflege ziehen kann, wird auch in der Herbeifiihrung gesunder geistiger und dadurch sittlicher Zustiinde sein. IX X. Schluss und Bericht iiber das von der menschenfreundlichen Griinderin Amalie Herzmansky gestiftete I. Muster-Reconvalescenten- haus zur geneigten Kenntnis. G 2 100 .Hygiene: Section IV. The Care of the Mentally Feeble as distinguished from the Imbecile Child. BY . O E. SHUTTLEWOKTH, B.A., M.D., Medical Superintendent, Royal Albert Asylum, Lancaster. Mentally feeble children, often the victims of their surroundings. Weak bodily health, often inherited tendency to nervous weakness, are causes of defective or irregular mental action. Improvement of general nutrition essential to mental improvement. Under-feeding and over- pressure. Specially adapted education for the feeble-minded pupils found in e'ementary schools : (1) in specially organised classes ; (2) in separate day schools ; (3) in separate institutions. Necessity for distinct arrangements for this class in any truly national system of education. The Care and Treatment of Epileptic, Feeble Minded, and Imbecile Children, BY FLETCHER BEACH, M.B., F.R.C.P., Medical Superintendent of the Darenth Asylum for Imbecile Children. Three perfectly distinct classes of cases are here referred to, and the care and treatment of each should proceed on different lines. With respect to the first class, little has yet been accomplished. Some time ago the Charity Organisation Society suggested that workshops should be provided for them, where they might work during the day, returning borne at night, but the suggestion was not carried out. The author proposes that homes should be prepared for them, where they could be trained mentally and physically, and wliere medical treatment could be pursued. He objects to their being sent to day-schools, because it will be impossible to supervise their diet and hours of sleep, to guard them against states of excitement in their own family, and to ensure that the medicine prescribed is given. The care and treatment of the feeble-minded is a much larger question, and Committees of the Charity Organisation Society and British Medical Association have for some time been working at it. Official bodies have also had the question before them. It is interesting to know that the London School Board have decided to adopt measures for teaching the feeble-minded children under their control. Reference is made to the investigation of the child population of London in 1889 Joy a Committee of the British Medical Association, and to a subsequent one just completed in which 50,000 children have passed under observa- tion. The author suggests that auxiliary schools, similar to those in Hygiene: Section IV. 101 Norway and Germany, should be established for feeble-minded children, in which instruction adapted to their powers of reception should be given by teachers experienced in the methods required to call out the faculties of such cases. If these children are not taught, the girls are apt, as they reach the age of maturity, to lead immoral lives, and, as well as the males, to swell the ranks of the criminal population. The measures to be adopted to remedy this evil are given. Passing to the care and treatment of imbecile children, the author remarks that the accommodation required for them is markedly deficient. Statistics are given which show that at present about 8,000 improvable idiots and imbeciles, who now pass their lives in workhouses, or in the wards of lunatic asylums, have to be provided for. Reference is made to the Committee of the Charity Organisation Society, which considered the question some time ago, and suggested remedies for it, and to another Committee which sat in 1877, and which endeavoured to obtain funds, from the Charity Commissioners, but without avail. The author details the measures required for the further accommodation of this class, and concludes with a short sketch of the kind of training which is given in institutions for idiots and imbeciles. A Proposed Method of Collective Investigation into the Condition of Feeble-minded Children, BY Dr. Phil. LUDWIG STRUMPBLL, Professor at the University of Leipzig. Dr. Med. F. L. A. KOCH, Director of the State Lunatic Asylum at Wiirtemberg. Dr. EMIL SCHMIDT, Leipzig. Dr. Phil. ERNST HASSE, Professor at the University of Leipzig. The results of education in any given child, whether in public or private institutions, depend on its educational flexibility (Bildsamkeit). This is not merely dependent on its mental capacity, but also on the state of its general bodily health. In order to obtain accurate knowledge in regard to the mental and bodily growth of the child it is desirable that the investigation should be conducted simultaneously by medical men and educationalists. Every condition, whether acquired or congenital, under the influence of which the intellectual development of the child is retarded or disturbed, is termed " psychopathic." It is desirable in an inquiry of this character that any. general conclusions should be drawn from collective investigations rather than from the accumulated experience of any single observer. It is recommended that in any given locality or institution all classes and conditions of children should be submitted to the same testa 102 Hygiene : Section 1 V. in order that the anthropometrir jx-culiarities of feeble-minded children may be established on a sound basis. Upon these grounds following resolutions are proposed : " That this Congress do appoint a commission consisting of three persons severally conversant with mental diseases, education, and statistics, whose duty it shall be to inquire into mental feebleness in children ; beginning with small districts, and continue and carry out the same according to a fixed plan. The Congress shall empower the commis- sioners to add to their number and to appeal to recognised authorities for assistance if necessary.'* In order to give the necessary uniformity to the investigation the adoption of the accompanying form is suggested. Should the second division of the Congress fix anthropometric signs other than those therein stated, they may be substituted for our Questions 7 to 16. Suggested Form for Investigation of Mentally Feeble Children. 1 . Town or village. 2. Educational establishment. (The total number of children in the establishment to be given.) 3. Sex. 4. Age, years, months. 5. Place of birth. 6. Religion. 7. Height (bare-footed). 8. Condition of nourishment. 9. Longitudinal and transverse chambers of skull. 10. Colour of eyes. 11. Colour of the hair. 12. Colour of the skin. 13. Eyes, power of vision. 14. Nose, sense of smell. 15. Mouth and larynx. 16. Ears, acuity of hearing. 17. Is there any tendency to epilepsy, chorea, general physical weakness, or other physical deformities ? 18. Are there any somatic signs of degeneration? 19. Other symptoms suggesting mental feebleness, are there reasons to suspect ? 20. Congenital mental feebleness, disposition, taint, degeneration. 21. Acquired mental feebleness, disposition, taint, degeneration. 22. Time of the acquired disease. 23. Does the child live in the house of its parents ? 24. Or is it sheltered in an institution ? If so, which ? 25. Does the child go to school ? If so, where ? In what class is the child ? Hygiene : Section IV. 103 26. Opinion of the teacher as to the child's capability, knowledge and progress. 27. Legitimate or illegitimate. 28. Number of brothers and sisters, including those who have died. Family History. Father's Mother's i 1 ^ K i i Mother. Mother. Father. Mother. Brothers Sisters 29. Calling and position SO. Whether rich or poor - SI. Relationship - - - 82. Mental diseases - S3. Feeble-mindedness 34. Somatic nervous disease 35. Dypsomania 36. Suicidal tendencies 37. Criminal tendencies 38. General weakness 39. Remarks. Date and place of investigation. Signature of observer. Directions for using the above Form. This research concerns only those children which are mentally feeble, and not those who are idiotic or insane. The accompanying form has been prepared, and the authors suggest that it should be used in the investigation. For assistance the following details are given : I. In a given town or village, all those children should be examined who are of an age to attend school, whether they actually go or not. Those children may also be included whose parents dwell in the said place, but who attend school elsewhere. This is of importance, for by adopting this plan, all children of one stock may be considered together. II. The names of the children are not to be stated on the schedule, but the investigator should make a separate list for purposes of future reference in doubtful cases. III. A separate form must be used for each child, and it is suggested that all points having special reference to the child in question should be underlined, whilst others should be struck out. IV. According to Koch, under the term " mentally-feeble " children are to be understood all mental irregularities, congenital or acquired, 104 Hygiene: Section IV. that influence anyone in his personal life, but which, even though in pronounced cases, they do not represent any mental disease, do not allow persons thus afflicted to be considered in the full possession of their normal mental faculties. V. Congenital feeble-mindedness is frequently characterised by certain physical modifications : 1. By signs of degeneration in the narrower sense (stigmata). Such are certain malformations : a. Disproportion between the individual parts of the body, especially between the skull and the face, and individual sec- tions of skull and face, &c. b. Asymmetry in skull and face. c. Malformation of individual parts of the body ; such as retreating forehead ; flattened occiput, &c. 2. By signs of degeneration in a wider sense ; lasting functional anomalies. These appear very early in feeble-minded children ; such are : sensory disturbances, neuralgic troubles, &c. ; motor disturbances, muscular spasm, &c. VI. Feeble-minded children are usually designated as nervous, mentally tainted, peculiar, backward, &c. However, no child is to be put down as feeble-minded in whom the psychical irregularities are not pathological (in a medical sense). VII. When it is possible to distinguish "between psychopathic disposition,, psychopathic taint, and psychopathic} degeneration, this should be done. The causes of acquired feeble-mindedness are most frequently over-study, and diseases of the body, especially those of the membranes of the brain, epilepsy, &c. VIII. As regards the question of heredity in the schedule, it is important that every question should be answered, as negative answers are as? valuable as affirmative. IX. Under mental diseases are to be included idiocy as well as insanity. Careful inquiries ought to be made as regards the mental condition of the relations of the child on both sides, which are to be noted as shown in the form. Abnormal tendencies in the adult, such as dypsomania, attempts at suicide, &c., point very often to the existence of feeble-mindedness in the child. X. Of the somatic nervous diseases note must be taken of epilepsy, which may not yet have led to mental feebleness or to mental disease ; the same may be said of frequent headache, giddiness, &c. Hypo- chondriasis and hysteria are regarded as mental feebleness. XI. In Question 9, the anteroposterior diameter of the skull is to be measured, and the greatest transverse diameter is also to be noted. XII. In Question 24, the institution must be mentioned by its full name. XIII. If any mistakes have been made in filling up the form, it should be destroyed and a fresh one taken, rather than that the errors should be improperly corrected. Hygiene : Section IV. 106 The Education of the Blind. BY Du. CAMPBELL, Principal of the Royal College for the Blind, Norwood. Number and Condition of the Blind. The large majority of the blind found among the poorest classes. The generous efforts that have been made to alleviate the condition of the blind have aimed, too often, at temporary relief and comfort, rather than practical measures for helping the blind to help themselves. Large numbers of the blind continue in the dependent classes through life. Education versus Pauperism. Status of Establishments for the Blind. Educational establish- ments for the defective classes regarded hitherto as asylums, rather than schools. The education of these classes should be placed on a higher plane, made thoroughly practical, and become a part of the national system of education. The institutions of Great Britain charitable, those of the Continent and America national. Physical Education. The vitality of the blind much less than the vitality of the seeing. The recognition of this fact essential to success. A thorough course of physical education and development the true corner-stone of any educational system. Primary Education. An early start more essential with blind than with seeing children. Kindergarten, Modelling, Elementary Technical training, Deportment, Sports, Games, &c. General Education. Educators of the blind must recognize not only the want of one of the five senses, but all the physical defects and mental peculiarities which naturally arise from blindness. Until these fundamental difficulties have been met and overcome it will be impos- sible to give the special training necessary to prepare the blind for useful and active independence. Professional Education and Training. The blind cannot become successful in any trade, calling, or profession, without educational advantages equal to those given the seeing who follow the same pur- suits ; it should begin as early, and be as thorough and comprehensive. Special Schools. To determine the important question whether the Blind should be educated in ordinary schools with the seeing, or in special schools, all the defects and peculiarities of the class must be thoroughly understood, and carefully considered in relation to the difficulties of obtaining profitable employment for the blind. Embossed Systems of Reading and Writing. Many ingenious systems of reading and writing have been devised. With the intelligent blind throughout the world the question of the hour is " dots versus " lines." 106 J/i/f/iene: Section IV. Instruction of Deaf-mute Children by the School Board for London, BY General MOBERLY, Chairman of the Sub-committee on the Instruction of the Blind, Deaf, and Dumb, London School Board. Difficulties of procuring regular attendance in early age. Ignorance as to power of teaching deaf mutes, and as to their capacity for learning, on the part of parents, teachers, and the world in general. The age for commencing instruction. Difficulty of teaching speech different from that used in class. Lip reading. Recommendations from personal experience as to selection of method and place of education. Technical and physical instruction to be encouraged. The Hygiene of Speech in Children. BY Dr. H. GUTZMANN, Berlin. The hygiene of speech is to be studied in the development of speech in a child ; which development is completed in three periods : I. The first period is that in which the child, especially when in a happy frame of mind, produces peculiar " natural sounds." These are as if formed by reflex action, and are caused by the same muscular impulse which moves the child to sprawl, kick, &c. In this period one cannot speak of the hygienic operation of speech. II. In the second period, the child begins in the first place to listen. It learns to distinguish sounds. As the result of listening it begins to imitate. Through imitation the natural sounds of the first period are superseded by the usual sounds of the mother tongue. Within this period lie the first important fixed points of the hygiene of speech. Care must l>e taken (1.) that the child's model of speech be the best pos- sible ; (2.) that a bad model be kept away from the child ; (3.) that children who show but slight inclination to imitate sounds, hear as much talking as possible ; and (4) that the practising of sounds proceed, according to the pedagogic principle, from the easy to the difficult. III. In the third period the child already makes use of speech to express its thoughts. Here lies the centre of gravity of the hygiene of speech. The different points of view are as follows :(!.) In most children there exists a malproportion between the wish to speak and the capabilities of the muscles of speech. Hence stuttering may Hygiene: Section IV. 107 ensue if the performances of a child in the way of speech are not kept under, constant guidance and supervision. A wise severity tempered with gentleness is here the best phrophylactic against faulty speech arising. (2.) At first children are still unable to pronounce various sounds correctly ; they replace certain difficult sounds by others easily formed [lisping]. Much can be affected here by continual correct pro- nunciation before them. (3.) In the lowest class in schools the speech of half the children is still in a state of development. The first reading lessons, if conducted on the physiological principles of speech, may do very much towards insuring clearness and beauty in speech as well as towards guarding against mistakes. Zur Hygiene der Sprache des Kindes. VORTRAG VON Dr. H. GUTZMANN, Berlin. Die Hygiene der Sprache ergiebt sich aus der Sprachentwicklung des Kindes. Die Sprachentwicklung vollzieht sich in drei Perioden. I. Die erste Periode ist diejenige, in der das Kind, besonders wenn es sich in behaglicher Stimmung befindet, eigenthumliche " Naturlaute " bildet. Dieselben sind reflektorischer Natur und entstehen durch denselben Muskeltrieb, der das Kind zum Zappeln, Strampeln u. s. w. treibt. In dieser Periode ist von irgend einer sprachhygienischen Einwirkung keine Rede. II. In der zweiten Periode seiner Sprachentwicklung fangt das Kind zunachst an, zu horchen. Es lernt Tone unterscheiden. Auf Q-rund des Horchens fangt es an, nachzuahmen. Durch die N"ach- ahmung werden die Naturlaute der ersten Periode durch die gebriiuch- lichen Laute der Muttersprache verdrangt. In dieser Periode sind die ersten wichtigen Anhaltspunkte fur die Sprachhygiene. Es wird darauf zu sehen sein : (1) dass das sprachliche Vorbild des Kindes moglichst gut sei, (2) dass ein schlechtes Vorbild vom Kinde fern gehalten werde, (3) dass Kindern, die geringe Lust an der Lautnachahmung zeigen, moglichst viel vorgesprochen werde, und (4) dass die Uebung der Laute nach dem padagogischen Grundsatz " vom leichten zum schweren " erfolge. III. In der dritten Periode der Sprachentwicklung benutzt das Kind bereits die Sprache als Ausdruck seiner Gedanken. Hier ruht der Schwerpunkt der Sprachhygiene. Die einzelnen Gesichtspunkte sind folgende : (1.) Es besteht bei den meisten- Kindern ein Missver- haltniss zwischen Sprechlust und Geschicklichkeit der Sprechmuskulatur. Daraus kann Stottern entstehen, wenn die Sprachleistungen des Kindes nicht unter fortwahrender Leitung und Aufsicht gehalten werden. Eine mit Milde gepaarte weise Strenge ist hier das beste Phrophylaktikum gegen entstehende Sprachfehler. (2.) Die Kinder konnen zuerst noch 108 Hygiene : Section IV. verschiedone Laute nicht richtig sprechen, resp. setzen statt einiger schwerer Lante andere leicht zu bildende Laute ein (Stammeln). Durch fortwahivndes riehtiges Vorsprechen kann man hier sehr viel erreichen. (3.) In drr untersten Klasse der Schulen befindet sich die Halfte der Kinder uoch iii der Spracbentwicklung. Der erste Leseunterricht kann, wenn er nach sprachphysiologisehen Grundsiitzen geleitet wird, fur die D.'utlichkeit und Schonheit der Sprache, wie fiir die Verhiitung von Sprachfehlern sehr viel thun. On the Acnteness of Vision of School Children. BY L. KOTELMANN, M.D., Ph.D., Hamburg. Sharpness of sight in hypermetropic, emmetropic, myopic, and astigmatic school children. Difference between the acuteness of vision of the right and left eye. Sharpness of sight in the different degrees of hypermetropia and myopia in school children. Which see better, school children who have inherited the burden of myopia, or those who have not inherited it ? The influence of age and time spent at school on acuity of vision. Practical consequences affecting school life from the results obtained. Ueber die Sehscharfe der Schiller. VON L. KOTELMANN, M.D., Ph.D. Die Sehscharfe bei hypermetropischen, emmetropischen, myopi- schen und astigmatischen Schiilern. Unterschiede in der Sehscharfe des rechten und linken Auges. Die Sehscharfe bei den verschiedenen Graden von Hypennetropie und Myopie der Schiiler. Sehen erblich belastete oder nicht belastete myopische Schiller besser ? Der Einfluss der Lcbens- und Schuljahre auf die Sehscharfe. Praktische Konse- quenzen, welche sich aus den gewonnenen Kesultaten fiir das Schulleben ergeben. On the Importance o^ Detecting and Treating Defects of Vision and of Hearing in the Children of Board Schools. BY ADOLF BRUNNEB, M.D. Heidelb., &c., Bradford. 109 SECTION V. CHEMISTRY AND PHYSICS IN RELATION TO HYGIENE. This Section will meet in the rooms of the Chemical Society, Burlington House, marked F on the Plan. PHESIDENT. Sir H. E. EOSCOE, LL.D., F.K.S., M.P. On the Air of Large Towns : Methods of its Analysis, BY THE MANCHESTER FIELD NATURALISTS' SOCIETY (Town Gardening Section). The Means at our Disposal for Preventing the Emission of Smoke from Factories and from Dwelling Houses, BY A. E. FLETCHER, F.C.S., F.I.C., &c. Reference is made to the antiquity and persistence of the complaints against black coal-smoke. Action was taken to suppress smoke by Royal edict in 1386. A parliamentary inquiry was held in 1829 and in 1843. Legislation followed in 1853, in 1856, and 1875. The effect of these Acts on the smoke of London has been greatly to diminish the amount emitted from factory chimneys and steamboats on the river. The Metropolitan Smoke Acts are administered by the police, while the smoke clauses of the Public Health Act are in the hands of the local sanitary authorities. Black smoke is the result of imperfect combustion. The conditions to be observed in order to prevent it are : 1. The admission to the furnace of sufficient air; 2. The mixture of that air with the combustible gases ; 3. The ignition of the mixture by exposure to sufficient heat. The difficulty of observing these conditions in a hand-fed furnace is shown. Various mechanical appliances are referred to. Gas firing. Analysis given of fuel gases taken from furnaces where various descrip- tions of coal were consumed. The smoke of domestic fires. Difficulty of correcting the open fire. The general heating of the air of the house by central stove in the basement recommended, and the use of gas as a fuel. 1 10 Hijyienc : Section V. The Chemical Treatment of Sewage, with special reference to the Treatment of the London Sewage. BY A. DUPR, Ph.D., F.R.S. ge must, in the first place, be looked upon as a material to be got rid of without injury to the population, and with the minimum amount of nuisance, without reference to any profit that might be derived from it. The solution of the problem as to which is the best method of sewage disposal is so complicated, owing to the different conditions obtaining in different towns, that no general plan can, or should be, laid down, but each case must be treated on its own merits. Of two plans for the disposal of sewage, both equally effective, the cheaper should be adopted. CHEMICAL TREATMENT. Many processes for the chemical treat- ment of sewage have been brought forward ; but, excluding the proposed electrical treatment of sewage, which has not yet passed its period of probation, and the action of permanganate, of which more later, they may all be said to depend on the action of certain salts of alumina and iron, with or without the use of caustic lime. The main effect of such chemical treatment is the more or less complete clarification of sewage, together with the removal of a certain proportion, generally a small one, of matters held in solution. The character of the effluent, in some measure, depends on the condition of the sewage. Fresh sewage yields a better efliuent than foul sewage ; consequent necessity of some further treatment. LONDON SEWAGE. Difficulty of the Problem. Excessive volume of sewage to be dealt with. Size of area whence it comes, and consequent length of sewers, and foulness of sewage when it arrives at the outfalls. System of London Sewerage. Collecting sewage proper and the rain- water in one system of sewers. Unsuitability of land in the neighbour- hood for sewage farming, distance from the sea. Solution of the Problem, as attempted by the late Metropolitan Board of Works. Chemical processes clarify, but do not remove much dissolved matter. Evil effects of excess of chemicals used. Consequent use of minimum amount of chemicals capable of clarifying the sewage. The clarified sewage deodorised by manganate and sulphuric acid. Resulting efliuent, inodorous and nearly clear, discharged into the river mainly during ebb tide. Portion of the river should be regarded as a sewage farm, does its work in smaller area, as effectively and with far less nuisance than a sewage farm proper. Destruction of sewage in river and on farm due to living organisms, but oxygen necessary. The River Thames capable of dmling effectively with the efliuent. Consideration shows that the river will be adequate to deal with efliuent for some time to come. This period can be prolonged by the proper use of manganate. Beneficial Hygiene: Section V. Ill effects on river of proposed treatment of sewage greater than the mere removal of suspended matter would seem to indicate. Destruction of dissolved matter goes on more or less all the year round. Destruction of suspended matter greatly retarded during cold weather, and nearly the whole year's production has to be destroyed during summer. Summary. The plan adopted is far the cheapest. It will dispose of the London sewage, without nuisance, until London has increased to from 8,000,000 to 10,000,000 inhabitants. When that time arrives, only the sewage in excess of the quantity capable of being dealt with by the river, will have to be differently dealt with, with a corresponding reduction in cost compared with that which would be necessary if the entire sewage had to be so dealt with. Capital, once expended, fixes the minimum yearly expenditure ; outlay for chemicals can be increased or diminished according to circumstances ; hence annual cost can be controlled. The Chemical and Physical Processes employed in the Treatment of Sewage. BY JOHN C. THRESH, D.Sc. (London), M.B., &c. The deleterious organic matters contained in sewage may be divided into two classes : (a.) Those held in solution ; and (6) those held in suspension. The latter again may be divided into (i.) living organisms, and (ii.) dead organic matter. The various processes which have been devised for the removal of these impurities may be classified as follows : 1. Subsidence: (a.) With complete rest; or, (6) by passing through large tanks with a very slow but continuous flow. 2. Filtration : Through screens or filter beds of gravel, sand, cinders, &c. 3. Percolation through materials exerting some chemical or catalytic action on the organic matter : Such as animal charcoal, metallic iron, polarite, magnetic carbide or other compounds of iron, manganese, &c. 4. Precipitation by addition of chemicals capable of combining with certain of the organic constituents with the formation of insoluble com- pounds : Such as the soluble salts of iron, aluminium, zinc, &c., hydrate of lime. 5. Precipitation, &c., by electrolytic treatment : As in Webster's process. 6. Destruction of the organic matter by oxidizing agents : As by the addition of permanganates and acid. 112 flyyicne: Section V. 7. Sterilization : Where destruction of all micro-organisms is cliii'flv aimed at, as in the Amines process; or by the addition of chlo- rinated lime, carbolic acid, and other antiseptics and disinfectants to retard or prevent putrifactive changes. 8. Nitrification : The oxidation of the organic matter by organisms in the surface soil by intermittent percolation of the sewage through specially prepared land. 9. Utilization of the organic matter as food for growing crops : Broad irrigation. No one of these processes, unless it be the last, is capable of giving satisfactory results ; but the extent to which the purification should be carried depends chiefly upon the way in which the effluent is to be disposed of. Where it can be cast with safety into the sea or into a large tidal river, purification need not be so complete as where it must flow into a stream or river which a few miles further down furnishes the water supply to other towns or villages. In the latter case it is abso- lutely necessary that the sewage should be so treated as to deprive it of all specific organisms, and of the largest possible proportion of both suspended and dissolved organic matters. To effect this, a combination of two or more of the above processes must be resorted to. The com- bination to be adopted varies according to circumstances depending chiefly upon the character of the sewage, the position of the town, and the mode in which the effluent is finally to be disposed of. On the Duty of a Locality to Utilise the Nitrogenous Matter in its Sewage for the Benefit of the Nation, BY ALFRED CARPENTER, M.D. The object of this paper is to show that localities have duties to the nation to which they belong. The cost of utilizing sewage may exceed the financial returns from the cultivated lands, and for that excess the locality utilizing the sewage will have to pay, but the author contends that the increased production of crops tends to decreased price, which is a national advantage ; and he expresses the belief that density of population need not involve high priced provisions if the excreta of the population be properly used in agriculture ; and that it is the duty of a nation to produce a sufficient amount of food for the people, so as to be indepen- dent of the foreigner in the event of war. He contends that the non- utilization of sewage leads to conditions which allow of the production of disease germs and the multiplication of epidemics. He supports his arguments by the results which have been attained in Croydon, at the excuse of a twopenny rate, and shows that, for this, there has been a diminished death-rate; illness correspondingly reduced; five-fold pro- Hygiene: Section V. 113 duction of crops on the land, giving employment to many people in the open country, in this way withdrawing them from the crowded towns ; and a great production of meat and milk ; thus, to some extent, ensuring the nation against the fear of famine if war should break out, and supplies from abroad be stopped. The author strongly protests against any measures being taken to destroy the agricultural value of sewage as being opposed to national interests ; and, comparing the sewage of London with that of Croydon, shows that it would be a national advantage to utilize the sewage of London as that of Croydon is utilized, and that the nation would be recouped for this expenditure if the interest on the amount expended were guaranteed by the State. The Power of Soil and Vegetation combined to Destroy Disease Germs, and so prevent the Possibility of the Spread of Enthetic Disease in consequence of Sewage Farming. BY ALFRED CARPENTER, M.D. The author refers to the International Medical Congress of 1881, when he submitted a series of propositions tending to prove that sewage farming was safe. He now reproduces five of the nine propositions then submitted. 1. That the judicious application of sewage in close proximity to dwelling-houses does not depreciate the health of the inhabitants. 2. That the judicious application of sewage to land will satisfactorily cleanse the efliuent water, and fit it for discharge into any ordinary rivulet or watercourse. 3. That vegetables from fields con- tinuously irrigated by sewage are satisfactory food for man and beast, and that animals fed mainly on sewage-grown crops are as healthy as animals fed on ordinary agricultural produce. 4. The germs which spread infectious disease are not capable of reproduction on properly cultivated sewage farms, the chemical and vital conditions of the surface of the soil being contrary to their further development. 5. In order to produce the results described in proposition 4, it is requisite that the sewage be kept near the surface, moving over the land rather than through it in a downward direction. It must be kept within the influence of vegetable root fibrils and of the humus of the soil, and under-drainage is not a necessity. The author supports these propositions by a reference to the experience gained during the. past 31 years on the Beddington Sewage Farm ; proofs being adduced mainly from observations made during the last 10 years. i p. 1634. E. & S. 26. 114 Jfi/f/icne : faction V. On the Hygienic Importance of Copper. BY Professor LEHMANN, of Wiirzbnrg. I. In spite of many investigations, great difference of opinion still exists with regard to the hygienic importance of copper; men attacking and defending the deleterious action of copper have often gone too far in the matter. II. This essay only considers the importance of such copper salts as enter the organism through artificial greening of vegetables, through addition of sulphate of copper to bread, and through careless use of copper vessels. The medical and criminal uses need only be mentioned. III. It is not proved by one well-observed case that copper salts, that is to say, a quantity of 150 200 mg. of copper having entered Ilir- organism of a healthy adult at one time and in a certain dilution in the course of eating and drinking, can cause a disturbance in health worthy of any remark. Such doses only effect quickly passing gastro-intestinal symptoms. Not a single copper salt, combined with an acid not in itself poisonous, has been proved to have any specific poisonous properties. IV. During copious meals about 200 mg. of copper can enter the body with preserves and bread without being noticed to any extent by the senses. Most unclean and unsuitable use of copper and brass ware will seldom cause such a quantity to enter the body of man suspended in bouillon, meat, fat, vegetables, flour stuffs, &c. Only if very acid food is cooked in copper vessels, and is allowed to cool in them, larger quantities of the metal can pass into solution, but not if the food merely remains in the copper vessel. V. Acute severe copper-poisoning by means of preserves and bread has never been remarked in the literature, but, on the other hand, very frequently through the use of vessels containing verdigris. This speaks strongly against the correctness of the last observation. VI. In no case of severe acute copper-poisoning through copper vessels recorded in the literature has it been shown that anything like the amount of copper necessary to injure the organism, that is to say, 150 200 mg. had been taken. These cases were especially attributed to copper, for the reason that no other poisons were found. VII. Ptomaines and toxalbumins were certainly often the true cause of the trouble. In other cases it has been shown that no reason exists for regarding the small quantities, often merely traces of copper, which were found, as the cause of death. VIII. A chronic copper-poisoning through the entrance of small quantities of copper salts (20, 30, or even 50 mg. of copper daily) dees not exist in man or animals, although copper is absorbed in considerable quantities, stored in the liver, and excreted by means of the bile, the intestines, and the kidneys. In spite of the fact that the organism Hygiene: Section V. 115 accustoms itself surprisingly rapidly to .copper, too large quantities can cause harm through a chronic gastro-intestinal disturbance. IX. The phenomena in human beings, attributed to chronic copper- poisoning, are to be partly referred to the action of other poisons (arsenic, lead, carbon-monoxide, &c.), partly to acute copper-poisoning through careless working in copper. X. Deduced from these considerations, a direct injury of acute or chronic character is not to be feared from such quantities of copper as find entrance into the body through moderate and technical rever- dissage, preparation of bread with copper and somewhat careless use of copper utensils in the household ; on the other hand, by means of most carelessly prepared preserves or bread and copper, and treating kitchen- ware in an absolutely reckless manner, it is very likely that acute vomiting and purging can occur, but hardly anything more serious. XI. Hygiene demands the prevention of the use of copper-colouring for preserved vegetables because (a.) The danger of abuse exists (the careless addition of large quantities) ; (5.) There is neither any improved taste of the preserves, nor any additional preservative power gained ; (c.) No reason exists for colouring the preserves more intensely green than they are when freshly cooked. It is in the interest of hygiene to forbid everywhere the useless addition of copper to vegetables ; the transgressor of this rule will be punishable then only on account of possibility of injury to the human health, when quantities of copper of real consequence have been used in the vegetables. The addition of small quantities will be punishable as a falsification and imposition as to the quality, &c., not on hygienic grounds. XII. The addition of copper to bread should be absolutely forbidden, because (a.) There exists the danger of careless addition in large quantities (as shown above) ; (6.) It is possible to bake with spoiled and, under circumstances, injurious flour ; (c.) It becomes possible to add a larger quantity of water (6 to 7 per cent.). XIII. As far as the severe cases of so-called copper-poisoning through the careless use of household utensils is concerned, a severe copper-poisoning of an adult can no longer be considered, unless it can be proved very probable that at least 200 mg. of copper have been consumed by the unfortunate individual. Much more care is to be desired than formerly ; that is, that in legal judgment the possibility of other poisoning, namely, ptomaines and toxalbumins, be considered. A case of copper-poisoning should never be taken for granted, simply because the presence of no injurious substances could be ascertained other than copper, which is so easy to find even in traces. 11 2 110 Hygiene: Section V. Uobcr die hygienische Bedoutung des Kupfers. VON Prof. Dr. K. B. LEHMANN in Wurzburg. (1.) Die hygienische Bedeutung des Knpfers wird trotz zahlreicher Arbeiten hoch immer sehr verschieden beurtheilt; Angreifer nnd Vertheidiger der Schadlichkeit des Knpfers sind vielfach zu weit gegangen. (2.) Thema des -Vortrags ist ausschliesslich die Bedeutung der Knpfersalze, die durch Reverdissage der Gemiise, Kupfersulfatznsatz zum Brot, nachlassige Beniitzung von Kupfergeschirren und dergleichen in den Organisraus gelangen. Medizinische und verbrecherische An- nulling soil \vur gestreift werden. (3.) Es ist durch keinen gut beobachteten Fall beglaubigt, dass Knpfersalze entsprechend der Menge von 150-200 Milligraram Kupfer beim gesunden Erwachsenen in entsprechender Verdiinnung durch Speisen oder Getranke auf einmal eingefiihrt ernste Gesundheits- stdrungen hervorbringen konnen. Solche Dosen bewirken nur rasch voriibergehende Gastrointestinalerscheinungen. Fur kein einziges Kupfersalz mit ungiftiger Saure hat sieh etwa eine specifische Giftig- keit beweisen lassen. (4.) In einer reichlichen Mahlzeit konnen in Conserven und Brot Mengen wohl gegen 200 Milligramm Kupfer in den Korper gelangen, ohne dass sie den Sinnen allzusehr auffallen. Unreinlichste und unzweckmassigste Verwendung von Kupfer- und Messinggeschirren wird kaum je in Bouillon, Fleisch, Gemiise, Fett, MehLspeisen auch nur annahernd eine solche Menge in den Menschen bringen. Nur wenn starksaure Speisen in Kupfer gekocht werden und darin erkalten, konnen bedeutendere Kupfermengen in Losung gehen, nicht beim blosen Stehenlassen. (5.) Wenn dennoch niemals acute schwere Kupfervergiftungen durch Conserven oder Brot, dagegen haufig durch Verwendung griin- spanhaltiger Gefasse in der Litteratur berichtet werden, so spricht dies sehr gegen die Richtigkeit der letzteren Beobachtung. (6.) Bei keiner in der Litteratur beschriebenen angeblichen acuten schweren Kupfervergiftung durch Kupfergeschirre ist dargethan, dass auch nur annahernd die Kupfermengen in den Korper gelangt sind, die notwendig sind, um einigermassen den Organismus zu gefahrden, das heisst, mindestens 150-200 Milligramm Kupfer. Diese Falle sind vielmehr nur deswegen dem Kupfer zur Last gelegt, weil keine anderen Gifte gefunden wurden. (7.) Ptomaine resp. Toxalbumine sind sicher oft die wahre Krank- heitsursache gewesen ; in anderen Fallen lasst sich nachtraglich nur behaupten, dass gar kein Grand vorliegt, die geringen gefundenen Kupfermengen, oft nur Kupferspuren als Todesursache anzusehen. (8.) Eine chronische Kupfervergiftung durch die Aufnahme von kleinon Kupfersalzmengen (20-30, ja wohl 50 Milligramm Kupfer tag- Hygiene: Section V. 117 lich entsprechend) gibt es bei Menschen und Thieren nicht, obwohl reichlich Kupfer resorbiert, in der Leber eingelagert und durch Galle, Darm und Niere ausgeschieden wird. Grosse Dosen konnen, obwohl sich der Organismus iiberraschend rasch an dieselben gewohnt, durch chronische Magen-Darmstorungen schadigen. (9.) Die auf Kupfer bezogenen chronischen Vergiftungser- scheinungen am Menschen sind teils auf die Wirkungen anderer Gifte zuriickzufiihren (Arsen, Blei, Kohlenoxyd u. A.), teils als acute Kupfervergiftungen bei einem unreinlichen Kupferarbeiter zu bezeichnen. (10.) Von diesen Erwagungen aus geleitet, ist eine directe Scha digung acuter oder chronischer Art von den Kupfermengen nicht zu befiirchten, wie sie durch massvolle und kunstgerechte Reverdissage, Brotbereitung mit Kupfer und etwas sorglose Beniitzung kupferner Gegenstande ira Haushalt in den Korper gelangen ; dagegen konnen durch grob nachlassig hergestellte Conserven oder Brot und absolut nachlassig behandelte kupferne Kiichengeschirre recht wohl acute Brechdurchfalle, aber kaum mehr entstehen. (11.) Die Hygiene wiinscht ein Verbot der Verwendung von Kupfer zur Farbung von Gemiise-Conserven, weil (a.) die Gefahr des Missbrauchs (des nachlassigen Zusatzes zu grosser Mengen) vorliegt, (6.) weder Haltbarkeit noch Geschmack der Conserven dadurch gewinnt, und (c.) kein Grund vorliegt, die Conserven intensiver griin zu farben als die frisch gekochten Gemiise. Die Hygiene hat also ein Interesse daran, den nutzlosen Kupfer- zusatz zu Gemiisen uberall zu verbieten ; der Uebertreter dieser Vorschrif t wird aber nur dann " wegen einer moglicherweise eintretenden Beschiidigung der menschlichen Gesundheit zu bestrafen sein," wenn wirklich bedeutende Mengen Kupfer in die Gemiise emgefuhrt sind, Der Zusatz kleiner Mengen wird nur aus nicht hygienischen Griinden als scheinbare betriigerische Verbesserung, Tauschung iiber die Quali- tiit u. drgl. zu bestrafen sein. (12.) Der Zusatz von Kupfer zu Brot ist stets absolut zu verbieten, weil (a.) die Gefahr des nachlassigen Zusatzes in grosser Menge (wie oben) vorliegt, (6.) verdorbene, unter Umstanden gesundheitsschadliche Mehle backfahig werden, und (c.) ein vermehrter Wasserzusatz ermoglicht wird (6-7/ ). (13.) Bei schweren sogenannten Kupfervergiftungen im Haushalt, durch nachlassige Verwendung von Geschirren wird niemals mehr eine schwere Kupfervergiftung bei einem Erwachsenen angenommen werden diirfen, wenn nicht mindestens sehr wahrscheinlich gemacht werden kann, dass mindestens 200 Milligramm Kupfer von dem Verungliickten verzehrt worden ist. Viel mehr als bisher ist zu verlangen, dass bei den foreusischen Gutachten die Mogliclikcit anderer Vergiftungen, uameut- 118 Hygiene: Section V. lich (lurch Ptomaine oder Toxalbumine beriicksichtigt werde. Niemals darf deswegen cine Kupfervergiftung angenomraen werden, wcil von rvrntiirllcM srhudlichen Stoffen kein anderer nachweisbar war tils this selbst in Spuren so leicht zu findende Kupfer. What is the Importance of Magnesia in Drinking Water ? BY PERCY F. FRANKLAND, Ph.D., B.Sc. (Lond.), F.R.S., &c. The author calls attention to the difference of opinion existing at the present day with regard to the hygienic importance of magnesia in drinking water. Some authorities on water view the presence of mag- nesia as of no more consequence than hardness in general, whilst others* consider that the presence of even a few grains per gallon renders the water of doubtful quality for continuous use. It is highly desirable that the possibility of mischief resulting from the use of magnesian waters should be fully discussed and a conclusion arrived at, as it not unfrequently happens that waters which are otherwise of most excellent quality are objected to in consequence of their containing a somewhat larger proportion of magnesia than is usual in this country. Moreover, as the views concerning the importance of magnesia in water are in a vague and unsettled state, comparatively few analysts put themselves to the trouble of determining this base at all, with the result that a large number of waters are in use in which the presence of any excep- tionally large proportion of magnesia is quite unsuspected. The geological formation the magnesian limestone richest in this base is only represented to a very limited extent in this country, but com- paratively large proportions of magnesia are also found in waters from other strata, more especially in those from the New Red Sandstone. The author, after referring to a number of magnesian waters which have come under his notice, invites a discussion of the question, espe- cially with a view to eliciting the opinion of foreign authorities who have experience of the waters in the extensive dolomitic districts of the continent. The Action of Water on Lead. BY J. H. GARRETT, M.D., D.P.H. The action of water upon the lead is a process of oxidation, the main result Ix-ing the production of a white, crystalline, insoluble oxyhydrate of lead. The formation of this insoluble lead-salt is well seen Hygiene: Section V. 119 in all waters which act markedly on lead and are not of acid reaction, such as stale distilled water. All natural waters that have a decidedly acid reaction act on lead, the acid in the water dissolving the oxide as it is formed, and the first result is a clear solution of lead-salt. The quantity of lead thus got into solution is dependent upon the quantity of acid originally con- tained in the water. Much of the lead-salt formed and dissolved by an acid water is, under certain circumstances, ultimately deposited. Waters which are decidedly alkaline by reason of containing con- siderable quantities of carbonate, e.g., carbonate of lime, are prevented from acting on lead by the formation upon the surface of the metal of a closely fitting insoluble coat, which is presumably a carbonate of lead. It is possible that unusual waters exist in which this last named rule does not hold. Certain neutral salts other than carbonate being contained in the water, help or hinder the action, and affect the solution of the oxyhydrate of lead after its formation. The rate of action of water on lead is increased by increase of temperature, at least up to a certain degree. What is the cause of the oxidation of lead in waters that act on this metal, i.e., whence and how is the oxygen derived? a. Is it derived simply from the oxygen of the air which is dissolved in the water ? b. Is it derived by decomposition of water, either by the lead itself displacing hydrogen, or by an electrolysis due to the galvanic action which may result from the lead being invariably alloyed with small quantities of other metals ? c. Is it derived by reduction of the nitrates and nitrites of alkaline bases, or of the other forms of oxidized nitrogenous matter which occur in most waters to a greater or lesser extent?. The Antiseptic Treatment of Food, BY r< -nts .in imvfiitilutcd closet, opening from a small lobby common to three dressing-rooms, heated to a high temperature in consequence of being contiguous to the boilers of an adjoining restaurant. No. 8 illu>trutes a closet which, being without window to the open air, neces- sarily pollutes the atmosphere of adjacent rooms, staircase, and lobby. No. 9 shows another closet, again without window, open to the staircase and adjoining dressing-room, and situated under the cistern for water used for drinking purposes. No. 10 is an arrangement of closets, good enough were they ventilated into the open air, instead of, as is the fact, into a lobby, from which they are imperfectly separated by wooden partitions open between door heads and ceilings. Nos. 11 and 12 explain defective closet arrangements, one in relation to a private box, the other to a ladies' cloak room ; this last being typical rather than unique. Some Insanitary Superstitions in House Building. BY H. H. STATHAM, F.RJ.B.A. Houses in a large town are permeated by an atmosphere laden with impurities, which are constantly being deposited on any surface that will retain them. Hence it is important that the materials used should be such as are not porous enough to retain such impurities, and that construction should be such as to avoid places where impurities are likely to lodge and remain undisturbed. The habitual construction of ordinary houses in England is not in accordance with this require- ment. Floors usually consist of joists, with flooring boards above and a ceiling below. The interspace forms a cavern for the undisturbed collection of whatever matter can find its way through the ceiling and between the flooring boards. In a London school the space between the joists, when a board was taken up, has been found nearly filled up with an accumulation of filthy matter; and even in ordinary dwelling-houses the amount of dirt which is stored between the joists will astonish those who will make the investigation. The orthodox construction of roofs consists also of an outer sloping roof and a flat ceiling beneath it, leaving a large, dark, inaccessible cavern where no one knows what accumulates. The remedy is to do away with these hollow constructions. Construct floors of solid concrete and iron, with wood blocks bedded solid on them. Other flooring surfaces may be employed : tiles ; removable matting as a basis for removable carpets. If a timber floor be employed, double board it above with felt between Hygiene: Section VI. 135 to prevent passage of sound, and leave the joists visible below. There is no absolute occasion for sloping roofs, with modern means and materials ; they may be made flat ; but if timber sloping roofs are employed, the ceiling should be of the strength of a floor, the space between readily accessible, lighted, and utilised for storage, instead of being left a dark, inaccessible cavern. Skirtings of all kinds are a similar evil ; skirtings to baths and waterclosets are totally unnecessary, and leave dark spaces which are never cleansed. Skirtings to walls, if of wood, should be simple and solid, not projected out to produce relief of mouldings, leaving galleries behind. Frames to doors and windows the same. Sash-pulley windows are objectionable, as necessitating a hollow cradling round each window; casements and solid frames preferable. The treatment of the design of windows so as to dispense with curtains would be an improvement; curtains are full of dust in a week. Large furniture and fixtures to be either carried up to the ceiling so as to leave no top for dust to collect, or made with sloping tops, in any case without so-called cornices standing above the top. Plaster cornices with deep hollows undesirable. Picture rods better than hollowed mouldings, which are receptacles of dust. Cisterns should be open to daily inspection. Plaster, finished hard for paint, preferable to wall papers, which at all events should not be of rough or flock surface. Generally, hard surfaces as far as possible, and no dark, inaccessible spaces. Four-inch Drains versus Six-inch Drains. BY G. M. LAWFORD, Assoc. M. Inst. C.E. It is a matter of every-day occurrence to find a 6-inch pipe used for the drainage of a single house, and this size is usually made compulsory by sanitary authorities, whether metropolitan, urban, or rural. As a house drain is frequently dry for several hours at a time, it is obvious that where pipes of this diameter are used there must be a con- siderable extent of surface on which sediment is deposited, and as a natural consequence, during the periods of minimum flow this deposit will decompose, and foul gases will be generated. The author contends that this generation of gases in the house-drain, apart from its being adverse to the principles of sanitation, is preventable, the remedy lying in the use of smaller pipes. Taking as an example the case of an ordinary sized town house, it is shown that without special arrangements for flushing, even a 4-inch drain can scarcely be made absolutely self cleansing, more particularly as the usual gradient is from 1 in 40 to 1 in 60, with a consequent increase of discharging capacity. 130 Hygiene: Section VI. The author therefore considers that under ordinary circumstances a 4-inch drain is ample for an average sized house, and that a 6-inch drain is too large to be kept free from deposit, more particularly as (he majority of the pipe* discharging into it are 3 inches or less in diameter. Automatic flushing is of the greatest assistance in keeping a drain five from deposit, and should lx? adopted in all cases where possible, and more particularly in cases where, from the depth of the main sewer, the inclination of the house-drain exceeds 1 in 60. A tank containing not less than 30 gallons is sufficient to cleanse a 4-inch drain by means of a 2-inch syphon and flushing pipe, and it should be placed at the extreme end or head of the drain, at least 6 feet above the latter point. The author maintains that by using a 4-inch drain laid at a uniform inclination not exceeding 1 in 60, aided by automatic flushing, all refuse and other matters discharged into it will be removed in the shortest time and with the minimum of deposit ; and the removal of extraneous articles can be effectually provided for by making every length of drain accessible from inspection chambers. Another argument in favour of the 4-inch pipe is the increased circulation of air in the drain, as by diminishing the sectional area of the passage, the velocity of the air current is considerably accelerated. To summarise briefly, the objection to a 6-inch drain is the fact that deposits must be formed from which noxious gases are generated, with the probability of contaminating the air in the house, while the advantages of a 4-inch drain are: (1.) Deposit is reduced to a minimum ; (2.) Its size is ample for the discharge of the greatest amount of waste and rain water that can possibly pass into it ; (3.) When combined with automatic flushing at regular intervals, absolute cleansing is obtained ; and (4.) The increased strength of the air currents and the consequential more effectual and rapid purification of the drain. The Insanitary Condition of Tenement Houses in Paris, its Principal Causes, and Practical Remedies for the same. BY KMII.K CACHEUX. It had long been observed that in large cities the death-rate was apt to vary from 16 to 50 per cent., according to particular districts, which led sanitarians to make efforts tending towards equalising so wide a difference. Thanks to the labours of the Society for Improving the Dwellings of the Labouring Classes, founded in 1842, and to those of the Metropolitan Association, the death-rate among the tenants was considerably diminished by improving the condition of humble habita- tions. The death-rate of the metropolis at this day does not exceed 19. Hygiene: Section VI. 137 In Paris the average death-rate is 24, but in the " quartiers excen- triques," it runs as high as 36, and great efforts are being made to introduce an improved style of artisans' and labourers' dwellings. Description of the action taken by M. Picot and by the Societe Philanthropique in Paris. The views propounded by M. Trelat at the Sanitary Congress held at Vienna ; he showed that, even in the mansions of the well-to-do, the health of the occupiers is imperilled by insufficient provision for light, and favoured the expropriation of houses excessive in height, so as to bring every portion of a dwelling-house within the range of the sun's rays. Description of author's attempt to solve the problem of disencum- bering the ground where artisans' dwellings are crowded too closely together by endeavouring to attract the labouring population towards the " quartiers excentriques " and extra-mural communes. Deductions from this experiment : its great practical results less than had been looked for. Opinions differ as to the choice between a suite of rooms or flat in a large block, or a self-contained house for a single family. Tendency of people in good circumstances to crowd into blocks built in flats, where there is a concierge at their service, and where every convenience is placed at their disposal. M. Grodin's Familistere at Guise ; the new style of American Industrial Dwellings, built in flats. Advantages of living in towns to a workman ; to his wife. When self- contained houses are built beyond the town area for single families, the scheme must include a sufficient number of such houses to enable the promoters to provide as much as possible for the use and benefit of the tenants such advantages as are met with in towns, and to reduce to a minimum the charges and burdens imposed upon small house property. The expenses entailed on the tenants of such dwelling ; showing that the extra charges for water supply and sewage removal in a small house increase the rent by 50 per cent., and that if we desire to encourage the construction of dwelling-houses for single families in Paris or in the surrounding districts, the rates and municipal charges would have to be distributed more equitably than they are at present. Principals Causes d'insalnbrite des Maisons Parisiennes a Petits Logements, et moyens pratiques d'y remedier, PAR EMILE CACHEUX. Depuis longtemps on a remarque que dans les grandes villes la mortalite variait de 16 a 50 p. c. suivant les quartiers, c'est pourquoi on a fait de grands efforts pour detruire cette inegalite. The Society for Improving the Dwellings of the Labouring Classes fondee a Londres en 1842 ; grace a ses travaux et a ceux de 1'association metro- politaine creee sur des bases analogues, il fut bientot demontre qu'en 138 Hygiene: Section VI. mm'liorant les petits logeraents on diminuait considerableinent la mortalite de leurs habitants. Aujourd'hui leur mortalite ne depasse pas le chiffre de 19 pour cent. A Paris le taux uioyen de la mortalite est de 24 pour cent, mais dans les qtiartiers excentriques il atteint 36 pour cent, c'est pourquoi on fait de grands efforts pour am^liorer les logements des travailleurs. La campagne entreprise par M. Picot et par la societe philanthropique dans Paris: les resultats. Le rapport de M. Trelat signale au Congres d'hygiene de Vienne ; il a demontre que meme dans des maisons tres ItiMii'iises la sante des habitants etait compromise par le manque ^~< The Epidemic of Typhus in Altona, 1891, and the Filtered Water. BY Herr W. KUMMEL, Altona. Reference to the heavy epidemic in February last in the town Altona, whilst the much more populous town of Hamburg has been nearly totally free from this sickness. Altona filters the water taken 160 Hygiene: Section VII. from the Elbe at Blankenese, whilst Hamburg has no filtration at all, but the water is there pumped from the same river and delivered, without cleansing, to the customers. Hamburg pumps the water from above the" two towns of 750,000 inhabitants, Altona about 12 kilometers below the towns, but the tide goes far above the spot where the Hamburg Waterworks take the water. The Altona water is regularly examined in a most exact manner, to ascertain the number of bacteria present ; three to four weeks before tin- appearance of typhus, the number of bacteria at once increased from 50 to 80 per cubic centimeter to 1,500, and the doctors therefore suggest that the typhus has been spread by the filtered water, and that the number of typhus microbes has been, or must have been, largely increased by the filtration, though no bacteria of typhus were ever found in all our examinations. At the same time, the level of the underground water fell very much, and, following M. Pettenkofer, of Munich, this might have been the cause of the epidemic just as well as the aug- mentation of bacteria in the filtered water. The fever-cases increased very rapidly for a few weeks, disappearing in a very short time, and nearly at the same time the number of bacteria in the filtered water went back to the usual standard. Hardly anything was done to produce this result, some filters, not all the whole area of filtering sand, were cleansed, and the old number of bacteria was again found. Now the question arises : is it possible or probable that the typhus was spread by the water and the typhus bacteria cultivated in the filtration beds or not? The author shows a map of the town with all the cases of typhus, several diagrams showing the rainfall during nine months, the level of under-ground water, the temperature, the number of typhus cases, the number of bacteria in filtered water, and statements of the cleaning of the filter beds ; also the construction of the filters, and the quality and thickness of the sand, &c. The Water Supply of Maritime as distinguished from Inland Towns. BY EDWARD F. "WILLOUGHBY, M.D. Among maritime towns are included those as London and Glasgow, and even Manchester and Paris, which are situated on the tidal reaches of rivers, or at any point in the course of a river where it had ceased to perform its function of fertilising the adjacent lands. They differ from inland towns in the fact that whereas in the latter, especially if their sewage be disposed of by irrigation, the whole of the water taken from the laud, whether from rivers or wells, is, sooner or latter, returned to it ; in the former the water withdrawn from the Hygiene : Section VII. 1G7 land is discharged directly or indirectly into the sea. The effect of this in the case of London : Progressive depression of the level of the water in the wells and the drying up of the rivulets in the basin of the Thames, showing that the volume annually abstracted is already in excess of the supply, and that such a course cannot be persisted in without disastrous effects on the fertility of the country. Maritime towns must m therefore have recourse either to districts where the rainfall is in excess of the local requirements of the vegetation and population, as mountainous areas, moorlands, and lakes, or to a source hitherto entirely ignored by engineers, viz., to supplies- which find their way to the sea without giving rise to rivers ; in other words, which at present run to waste. The South Downs, or chalk hills of Sussex, through which the surface drainage of the Weald, together with the local rainfall, flows into the sea, and from which source Brighton is supplied, furnishes the only instance of the utilisation of such waste water ; though it is believed that the like natural waste takes place into the estuary of the Thames from the chalk hills of North Kent, a conclusion based on geological and hydrological evidence, and held by the late Professor Ansted. Both these sources might be made available for a potable supply to London. Though the case of Brighton and the South Downs is typical, and perhaps alone, in the magnitude and the completeness of the natural waste, now utilized, it is believed that the like conditions will be found to present themselves on almost all shores where lines of hills run parallel to the coast, provided the dip of their strata be not downwards inland. > Proposed "Water Supply for France from Lake Leman. BY G. BITTER. The Influence of the Fluctuations of Ground Water upon Health. BY BALDWIN LATHAM, Mem. Inst. C.E., Mem. Inst. M.E., &c. &c. The examination of the historic records, or of the published mortality tables of this and other countries, shows that there are certain conditions which are found to be present when certain diseases are most rife. It is also found that, after eliminating certain meteorological and other influences which are supposed to affect disease, some particular 1G8 Hyyicne : Section VII. diseases appear to be solely influenced by the hygrometric condition of the ground, and the volume of water present in it. Ground water itself, rxeept when jM)lluted, exercises no influence as a cause of disea-e, but it is merely the measure of the influences which are at work within a polluted soil, and of certain organic changes which take place there, and which lead to the development of a certain class of disease. The actual drying of the ground is a condition which is favourable to the general health in this country, and this circumstance often masks, in the general death rate, the potential influence of certain diseases. The effect of the ground water is most marked in districts which draw their water supply from the ground, and amongst that section of the inhabitants who use such water for dietetic and other purposes, especially in the case of young children. The unhealthy time after the period of excessive low water is that when the first rain begins to percolate through the soil, just as if it washed out matters which had been specially prepared in the dark recesses of the soil into the water, or drove out the ground air specially charged with the poison of disease. Particular epidemic outbreaks, which have become rife at a low water period, can often be traced to particular rainfalls. Those quarters of the year when percolation has first commenced after low water are, without exception, the most unhealthy. There are a number of diseases usually most rife when the ground waters are low: but it is found that the deaths of children under five years of age fluctuate inversely in proportion to the volume of water in the ground ; this is positive proof that ground water, at least, if not the direct cause, is the measure of the influences at work which seriously menace the lives of young persons. Drainage and Irrigation of Land in their Relations to Health. BT RICHARD F. GKANTHAM, M. Inst. C.E. The Author considers that nearly all lands may be made salubrious by the agency of drainage in one form or another ; and points out that while the subject of town drainage has been much discussed of late years, so much attention has not been given to the drainage and irrigation of land in their relations to the health of its inhabitants in the country. Malaria is defined, and its generation in damp soils and swampy grounds described, and the diseases it produces are enumerated. Various instances of outbreaks of ague and intermittent fever are referred to as having been traced to the existence of marshy ground and the disturbance of soil in tropical climates, and the investigations of the State Board of Massachusetts, U.S., are quoted to show the prevalence of intermittent fever in the vicinity of ponds, lakes, reservoirs, streams, Hygiene : Section VII. 169 marshes, drowned lands, upturned soil, and localities more or less infiltrated with sewage. As an example, the lagoons in Corsica are stated to contain an immense growth of confervoid vegetation which drifts to the inner shore, where it accumulates and rots, creating a smell and miasma which are carried by the prevalent winds up the valleys, and cause a high death rate. Undrained lands in the valleys of rivers, and lands subject to floods, give rise to ague, rheumatism, and neuralgia ; and in Dr. Farr's opinion, the drainage of marsh lands, removal of obstructions, and engineering improvements of the water channels, would obliterate countless evils. Irrigation has conferred immense benefits upon India : but the works have produced serious insanitary conditions. Similar ill effects have been felt in the irrigation districts in the plains of Lombardy, where unhealthiness and depopulation by malarious influences have prevailed. Injurious effects of rice cultivation on health ; laws restricting the limits of such cultivation. As a remedy for these evils in India, Dr. Thornton, C.S.I., recommends a system of subsoil drainage where lands are over saturated. Malaria is more prevalent when water has only partly evaporated, or been partly drained off, than when land is completely covered with water, and the danger is less in winter than in spring. The drainage of marshes and swamps, however, is not only accompanied by beneficial effects upon health, but very generally promotes the prosperity of the drained districts, and several examples on a large scale in France, Southern Italy, and Russia, are quoted. Works of arterial and under- drainage recently executed in the fens of Lincolnshire are described in detail, as an example of economy in cost of execution. It is suggested, although accurate statistics could not easily be obtained of the effect upon health, that there are good grounds for further investigation into the subject. The Introduction of Impurities into Water-mains subject to Internal Pressure. BY G. OESTEN, Berlin. When laying water-mains containing water under pressure, but little fear is entertained as to the possible entrance into them of impurities from the surrounding soil, even should a leakage occur in the pipe. For it is generally believed that, under such circumstances, the water would always escape with a force proportionate to the pressure under which it exists in the pipe, thus effectually preventing the intrusion of any foreign matter. Such an intrusion of external matters, however, may and does sometimes happen under the con- ditions of modern water-supply. The conditions necessary to this 170 Hygiene: Section VII. result depend (as theory would indicate) upon the nature and direc- tion of the aperture of leakage and the rate of waterflow within the pipe. If the direction of the leak-flow be either perpendicular to, or form an oblique angle with, that of the current within the pipe, no foreign matter from outside can enter the pipe, whether the rate of flow within it be rapid or slow (diagram shown). But if the leak-flow take a direction forming an acute angle with that of the current within the main (c, in diagram), the escape of water will diminish in proportion as the rapidity of flow within the main increases ; until, with a certain rapidity of current, there will arise, on the principle of the injector, a suction action, drawing external matter through the leak-opening into the main, and carrying it along with the current. This action is indicated in the diagram (Figs. 1-4), which show.s what actually occurred in a house in Berlin. Fig. 3 shows a medium position of the shut-off tap, as found to exist. This position favoured the suction action of the existing leakage. From this leak the water escaped, under certain conditions of pressure ; but when a certain degree of rapidity of current was attained in the pipe, the above-described suction action was set up, and sand was thus drawn into the pipe. This sand accumulated in the various secondary taps in the house, rendering them quite useless. It was while searching for the origin of the sand that the cause above described was discovered. It is therefore obvious that, under certain conditions, a leaking water-main, though containing water under pressure, may absorb impurities from the surrounding soil, and convey them 'elsewhere with its water current. Eindringen von Unreinigkeiten in Druckwasserleitungen. VON Of OESTEN, Berlin. Wenn man Wasserleitungsrohren mit innerem Druck in den Boden legt, so pflegt man nicht die Befiirchtung zu hegen, class Stoffe aus dem Boden in solche Rohren eindringen konnten, selbst wenn Oeffnungen in der Rohrwand entstehen. Man wird vielmehr uberall die Vorstellung haben, dass, wenn in der Wandung eines gefiillten Wasserleitungsrohrs mit innerem Druck ein Loch entsteht, das Wasser unter alien Umstanden mit der dem vorhandenen hydraulischen Druck entsprechenden Kraft ausstromen muss, indem es zugleich jedem fremden Korper den Eintritt verwehrt, und nicht annehmen, dass aus dem das Rohr umgebenden Boden Korper durch die Oeffnung in der Rohrwandung in das Rohr eintreten konnten. Dennoch kann dieser Fall eintreten und kommt in der Praxis der modernen Wasserversorgung vor. Hierzu sind natiirlich besondere Umstande erforderlich. Diese konnen, wie eine einfache theoretische Envagung lehrt, herbeigefuhrt werden durch die Art und Richtung des Rohrdefects und durch die Stromungsgeschwindigkeit im Wasserrohr. Hygiene: Section VII. 17 1 Wenn in einem Wasserrohr die in nebenstehender Skizze durch Pfeil bezeichnete Stromungsrichtung besteht, so mag die Geschwindigkeit der Stromung gross oder gering sein, sofern nur das Wasserrohr unter innerem Druck steht ; es wird sowohl durch eine Oeffnung in der Wandung senkrecht zur Axe a, wie in stumpfem Winkel gegen die Stromungsrichtung b stets Wasser nach aussen austreten, ein Eindringen von Korpern nach innen nicht moglich sein. Anders stellt sich das Verhaltniss, wenn der Leek die Eichtung c spitzwinklich mit der Stromungsrichtung zeigt. In diesem Falle wird, wenn die Geschwin- digkeit der Stromung eine geringe oder gleich Null ist, ebenfalls ein Ausspritzen von Wasser aus dem Leek stattfinden ; mit der Steigerung der Geschwindigkeit des Wassers im Rohr wird das Entweichen von Wasser abnehmen. Bei einer gewissen Stromgeschwindigkeit wird nach dern Princip des Injectors eine saugende Wirkung des Wasser- strahls eintreten ; derselbe wird dadurch fremde Korper in das Innere des Rohrs hineinziehen und mit fortfiihren. In Wirklichkeit ist dieser Vorgang an dem in Fig. 1-4 abgebildeten Absperrhahn einer Hausleitung in Berlin beobachtet worden. Der Hahn ist ein sog. Absperrhahn mit Entleerung. In Fig. 1 ist derselbe geoffnet dargestellt ; die Entleerungsoffnung im Kiiken ist hier durch die Wandung des Gehauses, die im Gehause durch das Kiiken verschlossen. In Fig. 2 ist der Hahn geschlossen dargestellt ; die hinter dem Hahn im Sinne der Stromungsrichtung gelegene Rohrstrecke entwassert sich bei dieser Stellung durch die Entleerungsoffnungen auf dem durch Pfeil angedeuteten Wege. Fig. 3 stellt eine Mittelstellung des Hahns dar, in der derselbe in der Leitung vorgefunden wurde. Diese Stellung beforderte die Sauge- wirkung des entstandenen Leeks. Derselbe hatte sich hier als ein kleiner Kanal von der Entleerungsoffiaung nach dem Innern des Hahns gebildet. Aus diesem Kanal war zunachst Wasser ausgespritzt und hatte die Entleerungsoffnung im Gehause ausgewaschen, wie in der Zeichnung zu ersehen ist. Alsdann aber war bei einer gewissen Stromungsgeschwindigkeit ein -Ansaugen von aussen eingetreten und Sand in die Rohrleitung eingeschleppt worden. Dieser Sand lagerte sich wiederholt in* den Zapfhahnen des Hauses so ab, dass diese un- brauchbar wurden. Als man dem Ursprunge des Sandes sorgfaltig nachforschte, fand man die Ursache. Es wurde nun das Einsaugen von Sand und gefarbter Fliissigkeit durch den im Hahn befindlichen Leek, sowohl in der Leitung, als auch nach der Herausnahme desselben in der Probiranstalt der stadtischen Wasserwerke experimentell ausgefuhrt und festgestellt. Aus Vorstehendem ergiebt sich somit die hygienisch nicht un- wichtige Thatsache, dass eine Druckwasserleitung unter besonderen Umstanden Unreinigkeiten aus ihrer Umgebung aufnehmen und mit dem Wasser fortleiten kann. 172 Hygiene: Section VII. The present State of our Knowledge concerning the Self-Purification of Rivers. BY PERCY F. FBANKLAND, Ph.D., B.Sc. (London), F.R.S., &c. The author refers to the more important experiments which have been made on the subject in this country, viz., those of the Rivers Pollution Commission on the rivers Irwell, Mersey, Darwen, and Thames, and those of the author on the Thames from Oxford to Hampton, and on the Ouse between Richmond and York. These experiments all negative the theory of self-purification as regards dissolved organic matter, although unmistakable improvement is traceable in the case of suspended matter. Of the work of foreign authors, having a similar object, the more noteworthy are those of Hulwa on the Oder near Breslau, of Frank on the Spree at Berlin, and of Prausnitz on the Isarat, Munich. The author reviews the work of these several investigators, who in some respects are out of harmony with each other, Hulwa supporting self-purification, even as regards dissolved organic matter, Frank limiting it to suspended matter, and Prausnitz adopting an intermediate course. X The author refers to his own experiments on the removal of microbes from water by agitation with solid particles, and points out how his results serve to explain the diminution in the number of microbes in river water through sedimentation as observed by Prausnitz and Frank. The self -purification of rivers has frequently been supposed to justify the use of river water, which has received sewage contamination, for town supply, but the author contends that the evidence of purification is wholly inadequate to justify such a course. Unanimity only exists with regard to self-purification by sedimenta- tion, a process which can never guarantee the absence of danger, whilst of the removal of dissolved organic matter to any large extent there is no evidence at all. Of far more importance in securing the greater safety of water supplies from rivers and surface sources generally is their efficient filtration through sand. On the Refrigeration of Water in Cooling Pits, BY Prof. ARTH. OELWEIN, Vienna. One is often placed in the position of having to arrange water supplies for towns and districts where there are no springs of sufficient volume, nor any valley-beds without outlet containing a corresponding depth of water, in which collected surface waters might cool, and where Hygiene: Section VII. 173 the alternatives are either to make new ponds with a depth of 3 to 4 metres, or to use those of this size which may already exist. From Professor Simony's measurements of the temperature of water the peculiar fact was made evident that, in mountain lakes with but a slight supply and discharge, and hence with but little movement, the temperature of the water in midsummer rapidly falls from 20 C. at the surface to from 5 to 4 C. at the depth of 20 m. whereas in lakes with a rapid supply and discharge, and where, therefore, the waters are in constant motion, the fall of temperature is very gradual, and the same fall of 15 to 16 C. is not to be found above a depth of 50 to 60 m. Acting on this fact, Professor Oelwein, when planning a water supply for the town of Iglau (pop. 23,000), where the existing ponds of a depth of 2 to 4 m. had to be used, the waters of which often rose in summer to a temperature of 23 C., cooled the waters of these ponds before discharging them into the filters, by causing a pit, 17'3 m. deep, and containing about 9,000 cb. m., to be dug in the lowest pond ; from the depths of this pit the water was then forced up through the over- lying column of water. The results of this system during three years' working were unvarying ; and in the summer months a cooling of 9 to 10 C. took place, so that when the temperature of the pond waters was at its highest, namely, 23 C., the water drawn from the cooling pit only a maximum temperature of 15 C. Had this pit been dug to a depth of 20 m. the cooling of the water at the bottom of the pit would have been greater by 2 to 3 C., and the maximum temperature in summer would then have fallen to 12 or 13 C. Full details of the process are given in the paper. Ueber Abkuhlung des Wassers in Kiihlschachten. VON Professor AETH. OELWEIN, Vienna. Man kommt oft in die Lage, Wasserversorgungen fur Stadte und Ortschaften auszufiihren, wo weder geniigend reichhaltige Quellen vorhanden sind, noch auch Thalsperren mit einer entsprecheriden Wassertiefe, in denen sich die gesammelten Tagwasser abkiihlen konnen, sondern nur Teiche mit 3-4 m. Wassertiefe entweder neu hergestellt werden konnen oder solche etwa schon vorhanden sind. Aus den Wassertemperatur-Messungen des Professor Simony war die eigentumliche Thatsache zu ersehen, dass in Gebirgsseen, welche nur einen geringen Zu- und Ablauf, daher eine geringe Wasserbewegung haben, die Temperatur des Wassers im Hochsommer bis 20 m. Tiefe rasch um 15-16 C. bei einer Oberflachen-Temperatur von 20 C. abnimmt, wahrend in Seen mit starkem Zu- und Ablauf, also mit starker 174 Hygiene: Section VII. Wasserbcwpgung, diese Temperatur-Abnahme nnr eine sohr langsamo ist, und die gleiche Temperatur-Abnahme von 15-16 C. erst bei einer Wassertiefe von 50-60 m. constatirt wurde. Auf diese Thatsache bin hat Professor Oelwein bei einer Wasser- versorgungs-Anlage der Stadt Iglau (23,000 Seelen), wo die bestehenden Teiche von 24 m. Tiefe, in denen sich das Wasser im Sommer oft bis 23 C. erwarmte, beniitzt werden mussten, diese Teichwasser vor Ablauf derselbcn auf die Filter dadurch zur Abkiihlung gebracht, dass er im imtrrsten Teiche einen ca. 9,000 m. 8 fassenden Schacht ausheben liess, dor 17 '3 m. Tiefe erhielt, aus dessen Tiefe dann das Wasser durch die iiberlagernde Wassersiiule heraufgedriickt wurde. Der Erfolg dieses Systems war in dem dreijiihrigen Betriebe dor gleiche, nnd trat in den Sommermonaten eine Abkiihlung um O-IO C. ein, so dass bei der hochsten Temperatur der Teichwasser, die bis 23 C. stieg, das dem Kiihlschachte entnommene Wasser nur eine Maximal- Temperatur von 15 C. erreichte. Ware dieser Schacht auf eine Tiefe von 20 m. ausgehoben worden, so hatte die Abkiihlung des Wassers an der Sohle des Schachtes noch um 2-3 C. zugenommen, und die Maximal-Temperatur ware dann iin Sommer auf 12-13 C. gesunken. Die Details wollen aus dem dem Congresse vorgelegten Berichte entnommen werden. Eefuse and Refuse Destructors. BY CHARLES JONES, A.M.I.C.E., Baling. The dealing with house refuse is a fruitful cause of much conten- tion. The old methods of disposing of the contents of the dust-bins were most difficult, and the rapid growth of our busy towns has made the dust and refuse question a burning one. Difficulties, expense, and danger of removing refuse to the nearest shoot or barging it away to outside districts. Early attempts to cope with the difficulty : nearly 40 years since furnaces were constructed for the purpose of destroying refuse, and these only in crude forms. This led to the introduction by Mr. Fryer (of Manlove, Alliott, & Co.), of " the Destructor," and further inventions followed ; Pickford with the " Gourmand," one part of which was of the highest importance, viz., that which dealt with the fumes by second fires. Then followed others by Healey (at Bradford), Thwaites, Young of Glasgow, Wilkinson of Birmingham, Burton, Stafford, and Pearson of Burnley with the " Beehive," and Nelson, and several others. No reliable information can be given as to the cost of erection, it being so much affected by site, height of shaft, level of ground, &c. Hygiene: Section VII. 175 The cost of burning per ton of refvise also varies considerably. In some towns the residuum is a marketable commodity, &c. Difficulty of dealing with the gases given off by the material in the first stage of burning, and the dust which escaped from the shaft, which was the cause of serious complaints, and prevented the introduction of the " Destructor." After earnest investigation, and careful considera- tion, " Jones Fume Cremator " was the result, and these complaints are now things of the past. Proofs that the " Destructor," if properly worked, may be used anywhere without the slighest fear of any complaint arising. The gases are subjected to a temperature of from 1,100 to 1,500 F., at little expense of fuel. The heat thus generated is used in a variety of different ways in connexion with tubular boilers for pumping, for pneumatic ejectors, for driving dynamos, and working of various machinery for sanitary works, &c., thus effecting a considerable saving, and after repaying principal and interest, leaving a balance. A result which is infinitely better than the old method of disposing of the refuse by barging and railway conveyance to a distance, &c. The paper is illustrated with diagrams of the different forms of destructor now in use. The Blackburn Refuse Destructor. BY J. B. McCALLUM, M. Inst. C.E., Borough and Water Engineer, Blackburn. The causes that led to the adoption of the refuse destructor in Blackburn. Character of house refuse peculiar to the town. The destructor erected in 1882. Local agitation against the destructor complaining of the nuisance arising therefrom. Trial of Jones's fume cremator. Proceedings taken against the Corporation, Booth v. Cor- poration. Result of trial. Description of tall chimney. Erection of new destructors, cremators, and machinery. Efficiency of destructor, with notes as to power to be obtained from burning refuse. Dust escaping from chimneys. Smell escaping from chimneys. General notes on the destruction of town's refuse by fire. Commercial value of products. Removal of Street Offal and Refuse in Large Towns. BY Dr. WEGL. 176 Jlygiene : Section VII. Burning of House Refuse : Experiments made in Copenhagen, Denmark, BY J. F. MEYER, Chief Director of the Department of Streets and Sewers in Copenhagen. The old methods of getting rid of the house refuse must be abandoned. From a sanitary point of view the destruction by fire is the most satisfactory. In England the house refuse contains much more unburnt coal than in most of the cities on the continent ; it is therefore necessary to try if the burning, which is practicable in England, can be applied also on the continent. To try this the experiments were made. A temporary furnace, arranged like a single cell of a Fryer's Destructor, used. The experiments may be divided into three classes, viz. : 1. With the house refuse without any special preparation. 2. With the house, refuse mixed with fuel, coke breeze. 3. With the riddled house refuse. 1. The combustion of the unprepared house refuse was unsatis- factory ; the mass would not burn continuously. 2. With the mixture in the proportion of 1 fuel to 4 refuse, the results were satisfactory, but this method cannot be recommended. 3. It was easily seen that to a great extent it was the large proportion of earth, sand, and fine ashes in the house refuse, which prevented its combustion. In using a riddle, through which about one- third to one-fifth vol. was separated, a fully satisfactory result was obtained. The separated part consisted of sand and fine ashes, and a small quantity of organic matter, which, as was proved by some separate experiments, was easily made innocuous. Eefuse Burning. BY W. GEO. LAWS, M.I.C.E., City Surveyor, Newcastle-on-Tyne. Refuse of towns ; what it consists of ; does not vary much in quality, nor in quantity per head. Broadly divisable into three classes, sound material, crude manure, and unsound stuff. The last is the most difficult to dispose of ; the proportion it bears to the whole varies with mode of collection, though not much ; is about one-third of the whole. The hope of utilizing this third fallacious. Theory of treating it by separation, mixing, or otherwise, very plausible ; practice shows the cost rarely falls below realizable value, and generally far exceeds it. Experience leads those who deal with it to the conclusion that true economy lies in getting rid of it as cheaply, but with as little handling, as possible. Hygiene: Section VII. 177 Difficulty of finding sites where it may be safely dumped; objection of sanitary authorities to these deposits. Sending it to sea not possible for inland towns ; not advisable even where possible. Destruction by fire the only alternative. Refuse dgstructors a clumsy expedient, and not a cheap one not at all popular. They are, however, fairly effective, and less costly than more scientific methods. The popular prejudice unreasoning and unreasonable, but not the less formidable for that. The destructor furnace not much improved on ; complications increase cost without improving result. Causes that have led to com- plaint : spreading of dust owing to too small area of chimney and too rapid current. State of material burnt ; per-centage of water ; this must be driven off, steam and fume produced. The fume cremator. Burning capacity of the furnace, about 6| tons per cell per day, or 2,000 tons per annum ; if forced beyond this, stuff not properly burnt. Residue about 30 per cent. ; if properly burnt, is a hard and useful clinker, and sound dry ashes ; may be used for various municipal purposes. Results of five years' working in Newcastle ; quantity burnt, and cost of operation. Capital cost of works, 5,060/. ; if doubled, will cost 8,000/. Rent of site, interest on capital, redemption, repairs, and renewals, labour, analysis of cost of burning, per-centages. Choice of sites for destructors ; difficulties in the way ; importance of easy cartage, and of outlet for residue. Value of destructor as a safeguard. General conclusions. How Best to Dispose of the Refuse of Large Towns. BY MILLER BRUCE, M.D. This question has now narrowed itself down to destruction by fire. It has become impossible to deal with the many and various waste products of the household, in cities, by any other means. Their value as manurial agents is equal to the cost of transport, and year by year the sums paid to the dust contractor for his trouble in disposing of refuse increases. Such being the answers to our query, what then is the best form of destruction ? Is it to be one large or many small destructions ? The objections to large destructions are, (1) the great bulk of the products to be dealt with ; (2) the great expense of transport of the material to be destroyed; (3) the dangers of diffusion of disease, the necessary offensiveness of the process, and the noise of perpetually rumbling carts along the route traversed. The advantages of small local destructions would be proximity, and the saving of the expense in great measure of cartage. It has occurred to me that the best form of destructor would be a portable steam i p. 1C34. E. & S. 26. M 178 Hygiene: Section VII. engine, provided with a suitable fire-box, into which all combustible matter (almost everything, given sufficient heat, is combustible) could be thr *> < Should Compulsory Notification be made General ? BY D. BIDDLE, M.R.C.S., Eng. The experiment of notification, made some 15 years ago, was perfectly justifiable, being initiated upon the householder system, and, viewed a priori, promising well. But men of science, when making experiments, accept the issue, and m are henceforth guided not by their predilections, but by the results. Notification is called a means to an end, that end being isolation. As well call detection of crime a means to an end, that end being imprisonment. Where the dual system is " duly " enforced, people are said to croiod the hospitals ; but surely, the proper aim of sanitation is to lessen these crowds, and to save life. What effect, then, has notifica- tion upon the death-rates ? The 28 large towns of England afford an admirable field for observation, since, until last year, 11 (including London) remained under no system of notification, and 14 had, for four years at least, been under the system now embodied in the Notification Act. Four of the seven principal zymotic diseases are notifiable (small-pox, scarlet fever, diphtheria, and " fever," chiefly enteric), and three non-notifiable (measles, whooping-cough, and diarrhoea). In regard to 20 of the large towns, the differentiated zymotic death-rates are calculated for a period of 20 years (1871-90), and, being corrected by the recent census returns, are placed upon an impregnable basis. The eight additional towns are similarly treated for nine years (1882- 90). Thus, results can be compared in groups of towns having popu- lations extending to millions on either side, and for a period sufficiently long. This period commences five years before the Public Health Act of 1875 came into force and the Vaccination Act was amended. We can thus also compare the glorious effects of those sanitary measures with the meagre results of the much-vaunted later system. The tables given in the paper clearly show that the decline in the death-rates, general and zymotic, which was almost universal in England, received a check in towns under the dual system, and that these had a greater proportion of deaths, actually from notifiable diseases, than occurred in towns under no system of notification. This curious phenomenon happened for several years in succession, and was a n-versal of previous relations between the same towns. In 1886-89, Hygiene: Section IX. 211 the average excess was more than 20 per cent., although the towns under no system had by far the denser population. If better isolation made the difference, compulsory notification is not needed. Other ways in which statistics tell against the system. The dual system is dishonouring to the profession. It also leads to a prolongation of the time which elapses between the onset of illness and the doctor's first visit ; and to hasty diagnosis, so that the information imparted to the sanitary authority is often incorrect and misleading, and " friction " often results. Hence, if by " compulsory notification " be meant the system embodied in the Infectious Diseases (Notification) Act of 1889, a decided negative should be returned to the question which heads this paper. Illustration of the Advantage of the Isolation of Persons exposed to Infection afforded by a Limited Outbreak of Typhus Fever in Leeds during the Spring of 1890. BY J. SPOTTISWOODE CAMERON, M.D., B.Sc., Medical Officer of Health, Leeds. From 11 houses 12 patients who were supposed to be suffering from typhus were taken direct to hospital, and 34, including all the other inmates of these houses, were isolated in apartments provided by the Corporation. Four of these latter developed typhus within a fortnight of their being isolated. It would have been extremely difficult to watch these 34 occupants of the 11 houses during the whole of the incubation period. In the sanatorium they were seen by the house physician daily, and the slightest rise in temperature noted. To this isolation is mainly attributed the rapidity with which an outbreak, one of the cases of which had been in existence a month before anything was heard of it, was so speedily checked. The Sanitary Condition of the British Home Army as to Venereal Disease, previous to, during the Contagious Diseases Acts, and since their Abolition, BY J. BIRKBECK NEVINS, M.D., London, President National (British) Medical Association for Repeal of C. D. Acts. Previous to 1860 alarming. Lord Herbert's Commission. Important improvements recommended, carried out rapidly in camps, seaports, dockyards ; slowly in London, Dublin, manufacturing towns. o 2 212 Hygiene: Section IX. Army divided in Army reports into camps," " seaports," " dock- yards," "London and Windsor," "Dublin," "manufacturing towns," "remaining stations" (about 100 throughout whole country). Previous to Acts. Venereal disease, all kinds, fell 28 per cent, in camps; 29 per cent., seaports; 38 per cent., dockyards; 21 per cent., manufacturing towns ; rose, on whole, in London ; Dublin worst throughout. Fourteen stations put under Acts called "subjected," viz., camps, seaports, two dockyards, five from " remaining." Remainder (about 120) left without Acts called " non-subjected." Fourteen non- subjected " selected " for comparison with " subjected " in Army Reports. London, Dublin, four manufacturing towns, one dockyard, and seven from " remaining " stations. Rest, about 100, discarded from comparison. Results of Acts. " Subjected." Gonorrh&a. Acknowledged failure. Secondary. Never compared in Army Reports. It may not appear in station where primary was contracted. Higher on whole period of Acts by one-thirteenth than in 1866. Primary sores. Only reliable test of Acts. Six years previous to Acts, fell 6' 7 per cent, yearly, with only Lord Herbert's improvements. Six years with Acts in addition, fell only 6' 2 per cent, yearly. Seven years, Acts and also great concealment of disease : First three years increased fall ; Last four years continuous rise. Three years, Acts without concealment, continued rise from 33 to 78 per 1,000. 1883-1884. Acts suspended. Unusual extraordinary accom- panying importation of disease from abroad ; great rise. Five years abolished Acts ; importation ceased. Disease fell < immediately, has fallen ever since, 7 ' 8 per cent, yearly. Fourteen " selected " now-subjected : Disease much above subjected. One hundred " rejected," non-subjected : Disease barely above subjected. Whole period of Acts : Average ratio of subjected stations, 70 per 1,000; of "rejected" non-subjected, 74 per 1,000; of "selected" for comparison, non-subjected, 136 per 1,000. Acts did not increase rate of improvement, when first applied, nor prevent disease from doubling during last seven years' operation. Disease fell more rapidly before Acts existed, and after abolition, than during their operation. Acts can show no proof of sanitary success while in force. The 100 " rejected " non-subjected stations had barely more disease than the subjected, though without many advantages possessed by the subjected. The only apparent advantage the subjected can claim is by comparison with the 14 " selected " non-subjected stations, the worst and most neglected in the whole Army. Evidences of public feeling in the towns under Acts. There is no sanitary ground for desiring restoration of Acts, and the moral and social objections which really caused the nation and House of Commons to insist upon their repeal remain undiminished. Hygiene: Section IX. 213 What Steps should the State take to Prevent the Spread of Venereal Disease ? BY J. BIRKBECK NEVINS, M.D., Pres. Nat. (British) Med. Assoc". for Repeal of C.D. Acts. Legislation can do little. It has tried, and failed. Opportunities for hospital treatment most important. All forms of disease readily admitted into hospitals, whether voluntary or supported by public funds, except primary venereal (gonorrhoea and sores). Secondary admitted, but primary ex-eluded by some voluntary hospitals, and discouraged by others, and also by many poor law hospitals. Necessity for more medical aid for primaries, but the amount of venereal disease in the community at large is much exaggerated. Public opinion, in supporting voluntary hospitals, does not supply provision for these cases. Query. Duty of State to supplement public opinion for this exceptional disease ? Would not that be like patronising vicious prac- tices ? No. It is only providing that this one exceptionally excluded disease should have the chance of medical treatment like all others. How to be accomplished ? Subsidise poor law hospitals, if necessary, in the great army centres. Already done in Portsmouth and elsewhere. Urge poor law guardians throughout the country to remove obstacles to admission of such cases. Urge the managers and medical boards of all voluntary hospitals to admit such cases, and if necessary subsidise beds or dispensaries in proportion to the necessities of the neighbourhood. Assist existing local medical institutions rather than provide special new ones for this one form of disease. Make admission for all ages and both sexes easy, and entrance and discharge absolutely voluntary for patients. Compulsion will be fatal to success. Previously published recommendations and attempts. British C.D. Acts, 18646-9. Compulsory periodical examination of women. Compulsory detention in hospital. Highly penal enactments. Draft Report, House of Lords Committee, 1868. Report, House of Lords Committee, 1868. Royal Commission Report, 1871. International Medical Congress, Vienna, 1873: Dr. Auzias Turenne ; Dr. Cohen. British and Continental Federation Congress, Geneva, 1877. National (British) Med. Assoc". for Repeal of C.D. Acts, Pamphlet; first edition 1880, sixth edition (out of print) 1882. British and Continental Federation Congress, Genoa, 1880. Lyons Commission, appointed by French Government. American propositions : Dr. Marion Sims, Pres. Med. Assoc"., U.S. America, 1876; Dr. Gihon, Med. Director-Gen. U.S. Navy, 1879. Resolution of Municipal Council of Paris, 1880. Select Committee, House of Commons, 1881 : Majority Report ; Minority Report. M. Lecour, Prefect of Police, Paris. East Indian C.D. Acts, 1871: General Order from Coniinander-in-Chief's Office, 1886; Disastrous results. 214 Hygiene: Section IX. On the Duty of the State with respect to the Spread of Venereal Disease. BY J. HOLBOYDE, M.R.C.S., D.P.H., Medical Officer of Health for Chatham. Retrospect of legislation on this subject. Comparative view of the condition of a garrison town prior to. and since, the repeal of the Contagious Diseases Acts, with reference to the amount of prostitution, juvenile depravity, the reclamation of un- fortunate women, the amount of disease, and the deterrent influence of the Acts. Action of the Medway Board of Guardians, and of the Urban Sanitary Authority, in favour of the Contagious Diseases Acts. Suspension of Acts followed by Increase of juvenile prostitution ; increase of illegitimacy ; increase of physical disease in its worst form. Effects of the increase of prostitution on the amount of disease : (1) amongst women themselves ; (2) amongst males of the civilian population ; (3) amongst soldiers. Statistics of Chatham Military District from 1880 to 1890 inclu- sive, showing ratio of admissions per 1,000 strength, both from primary syphilis and from gonorrho3a. Marked increase of disease in the two years immediately following repeal of Acts. Increase subsequently maintained, although at a lower ratio than in period directly succeeding repeal. Explanation of this difference. Desirability of properly controlling prostitution. Comparison of syphilis with other infectious diseases. Summary of experience of Chatham. Necessity of State interference in the interests of the public health. Points on which legislation is desirable. On the Housing of the Poorer Classes, BY S. M. BURROUGHS, F.R.G.S. The chief difficulties in the way of the housing of the poorer classes appear to be : 1 . The necessity of living near their work, which leads to congestion in towns and cities. 2. The dearness of land, which arises partly from the same cause. 3. The rates and taxes upon houses. 4. The average inability to pay for good houses among the working classes. Hygiene: Section IX. 215 With regard to the first difficulty it could be mitigated or removed by free travel, and while this may appear very Utopian to some people, it is, I believe, easily practicable, and that without robbing anyone for the benefit of others. At the present time travelling is made unnecessarily expensive, as many seats are unoccupied and the cost of selling and collecting tickets and keeping accounts of the same is very great. Free travel of course involves the purchase of railways by the State. They now make average dividends of 4 per cent., whereas the Government securities would float at 2 per cent. The saving of interest alone to the public would amount to 10,000,000/. per annum. The strongest objec- tion to free travel is, that if it has to be paid for out of the Consolidated Fund, the pecuniary benefit would go chiefly into the pockets of owners of suburban lands. An illustration of this is afforded by the case of the free ferry at Woolwich. This has made the hitherto swampy and use- less lands on the north side of the river available for building purposes, and a large rental value has been added to the lands of North Woolwich, which previously possesses no rental value to speak of. These increased values are a great deal more than enough to pay for the cost of the ferry ; in fact the abolition of fares on the ferry immediately increased the value of land in North Woolwich. It is observed that the construc- tions of toll roads by making hitherto inaccessible lands available for use increases their value. If the tolls are abolished the land rises still higher in value. The construction of bridges and freeing them from tolls has a similar effect, and the same would be said of railways if travel were made free. The tendency of free travel is to make land in the suburbs equally valuable to that in towns. It is therefore submitted that it is reasonable and just to tax land values imparted by free travel to pay for the same. If the principle is correct that land values created by the public expenditure should be taxed to recompense the public foi the expenditure, it then follows that the cost of constructing roads and streets and sewers and keeping them in order, the expenses of lighting, planting of trees, &c., &c., should be paid for out of the so-called unearned increment upon land which arises on account of public expen- diture and the neighbourhood of a civilised community. The taxation of the unearned increment imparted to land by the community would reduce the selling price of land and thus remove this difficulty. It would also make rates and taxes upon houses and improvements unnecessary, and thus remove the third difficulty. In fact, it would exempt industry entirely from taxation. Finally the increased employment of labour would advance wages. The transfer of taxation from industry to unearned increment would be of the greatest benefit to the working classes. It would make unprofit- able the holding of land out of use, and would at the same time exempt improvements on land from taxation. 217 DIVISION DEMOGRAPHY. This Division includes Industrial Hygiene. It deals with the condi- tions of Communities from a statistical point of view. This Division will meet in the Theatre of the Royal School of Mines in Jermy'n Street marked L on the Plan. PRESIDENT. FRANCIS G ALTON, F.R.S. On the Relation of Occupation to Disease and Mortality, BY W. OGLE, M.D., F.R.C.P. After pointing out the importance of the subject, and the large space taken by occupations in determining death-rate, the writer shows how satisfactory statistics of the mortality in different industries can only be obtained in countries where, as in England, the Census returns give the ages of persons engaged in each industry. He then explains how his statistics were obtained, and gives the following table of comparative mortalities of men, between 25 and 65 years of age, in different occupations ; the death-rate of clergymen, the lowest of all, being taken as the standard of. comparison, and represented by 100. 218 Demography : Division II. COMPARATIVE MORTALITY of MEN, 25 to 65 Years of Ago, in different Occupations, 1881-2-3. Occupation. Com- parative Mortality. Occupation. Com- parative Mortality. Clergymen, priests, ministers Lawyers Medical men Gardeners Farmers Agricultural labourers Fishermen - Commercial clerks Commercial travellers Innkeepers, liquor dealers - Inn, hotel, service Brewers ... Butchers - Bakers ... Corn millers Grocers - Drapers - - Shopkeepers generally Tailors - Shoemakers Hatters ... Printers Bookbinders Builders, masons, bricklayers 100 152 202 108 114 126 143 179 171 274 397 245 211 172 172 139 159 158 189 166 192 193 210 174 Carpenters, joiners Cabinet makers, upholsterers Plumbers, painters, glaziers Blacksmiths Engine, machine, boiler makers - Silk manufacture Wool, worsted, manufacture Cotton manufacture Cutlers, scissors makers Gunsmiths - File makers Paper makers Glass workers Earthenware makers Coal miners Cornish miners - Stone, slate, quarriers Cab, omnibus, service Kail way, road, clay, &c., labourers Costermongers, hawkers, street sellers 148 173 216 175 155 152 186 196 229 186 300 129 214 314 160 331 202 267 185 338 The causes on which the wide differences shown on the table depend are then considered and grouped under seven general headings, as follows : (1.) Working in a cramped attitude, and especially in one that interferes with the action of the thoracic organs. (2.) Overwork, and especially sudden muscular efforts and strains. (3.) Dealing with noxious substances, such as lead, phosphorus, mercury, infected hides, &c. (4.) Working in ill-ventilated and overheated rooms. (5.) Alcoholic excess. (6.) Liability to accident. (7.) Exposure to inhalation of dust of various kinds. These causes are severally considered, and statistical tables given illustrating their action. Demography: Division II. 219 Among these tables are the three following, illustrating respectively the 4th, 7th, and 5th causes : COMPARATIVK MORTALITY of MEN working in Air of different degrees of Purity from Phthisis and Respiratory Diseases. Air. Occupation. Mortality from Phthisis. Diseases of Respiratory Orga'hs. Phthisis and Diseases of Respiratory Organs. Pure - Fishermen Farmers Gardeners Agricultural la- bourers. 55 52 61 62 45 50 56 79 100 102 117 141 Coiifined - Grocers Drapers - 84 152 59 65 143 217 Highly vitiated - Tailors Printers - 144 233 94 84 238 S17 COMPARATIVE MORTALITY of MALES in certain dust-inhaling Occu- pations from Phthisis and Diseases of the Respiratory Organs. Comparative Mortality from Occupation. Diseases of Phthisis and Diseases Phthisis. Respiratory of the Organs. Respiratory Organs. Coal miners 64 102 166 Carpenters, joiners - . - 103 67 170 Bakers - - - - 107 94 201 Masons, bricklayers, builders - 127 102 229 Wool, worsted, workers 130 104 234 Cotton workers - 137 137 274 Quarryinen 156 138 294 Cutlers - 187 197 384 File makers 219 177 396 Earthenware makers 239 326 565 Cornish miners 349 231 580 Fishermen 55 45 100 220 Demography : Division II. MORTALITY of DEALERS in LIQUOR (25-65 Years of Age) from various Diseases, compared with that of Men generally of the same Ages. Mortality of Diseases. Liquor Men Dealers. generally. Alcoholism f>5 10 Liver diseases 240 39 Gout - 13 3 Diseases of nervous system - 200 119 Suicide - 26 14 Diseases^ urinary system - 83 41 Diseases of circulating system 140 120 Other diseases 764 654 All causes 1,521 1,000 Insurance Societies of the Working Classes. BY Dr. VON MAYK, Munich. Bericht liber die sozialstatistische Ausbeute der Arbeiterversichemng. VON Dr. GEORG VON MAYR. Die tlemographische Section des Wiener Congresses (1887) hat mich beauftragt, die Einrichtungen der Arbeiterversicherung und die Gestaltung des dabei anfallenden demographischen Materials an Massenbeobachtungen international zu studiren und dariiber an den Congress zu berichten. Dabei kommt in erster Linie die offentlich- rechtliche Zwangsversicherung, wie sie in Deutschland zuerst eingefiihrt worden ist, in Betracht. Ich schlage Folgendes vor : I. Ojf'entlich-rechtliche Arbeiterversicherung. Eingehendes Detail der internal ionalen Statistik vorzuschlagen ist noch nit-lit am Platz, auch empfiehlt sich Beschrankung der Vorschliige auf die Krankenversicherung und Unfallversicherung. Demography : Division II. 221 A. Inhalt der zu befurwortenden Nachweise : a. Sozialstatistische Nachweisungen, welche sick direkt aus einer wohlgeordneten Buchf'drhrung der Versicherungsanstalten ergeben. 1. Krankenversicherung. () Die Versicherten sollen nachgewiesen werden nach Geschlecht, Alter, Civilstand, Beruf. Das nothwendigste ist die Combination von Geschlecht und einigen Haupt- Alters-und- Berufsgruppen. Dieselben Nachweise sind erforderlich fur diejenigen, deren Versicherrungs-ansprucb fallig geworden ist (Erkrankte, bzw. Gestorbene.) (0) Die einzelnen Krankheitcn sollen nach einigen Haupt- Altersgruppen und mit Beriicksichtigung der Zeit des Krankheitseintritts und der Dauer der Erkrankung nach- gewiesen werden. Bei den hauptsaehliehsten Krankheiten ist Unterscheidung naeh dem Beruf erwunscht. 2. Unfallversicherung. (a) Fur Versicherte und von Unfall Betroffene sind die entsprechenden naehweise wie oben unter 1. (a) geboten. (|S) Die Statistik der Unfalle soil enthalten an sachlichen Nachweisen : 1 . Die Verletzungen nach ihrer Schwere und ihren Folgen. 2. Die Art der Verletzungen und verletzte Korpertheile. 3. Die Zeit des Unfalleintritts. 4. Die Betribseinriehtungen und Vorgiinge, bei welchen sich die Unfalle ereigneten. 5. Die muthmasslichen Ursachen der Unfalle. Erwiinscht ist die Auseinanderhaltung der Nachweise nach Hauptgruppen der Betriebsarten und nach Grossengruppen der Betriebe. b. Indirekt anfallende sozialstatislische Nachweise. Hier kommt namentlich die Lohnstati&tik in Frage. Wo die offenllich-rechtliche Arbeiterversicherung auf die Lohnverhiilt- nisse Bezug nimmt, wird es moglich die Grundlagen einer allgemeinen die gesammte Arbeitermasse umfassenden Lohn- statistik zu gewinnen. Hierzu ist nothig : dass die Unternehmer verpflichtet werden Lohnzahlungslisten aufzustellen und einzureichen, welche die Dauer der Beschaftigung jedes Arbeiters in einem gegebenen Zeit- absehnitt (Rechnungsjahr) und den Betrag des demselben im Ganzen gezahlten Lohnesnachweisin. Hierzu empfiehlt sich weiter : dass gemisehte Aussehiisse (von Arbeitgebern und Artbeit- nehmern) eingesetzt werden, welche die von den einzelnen Unternehmern aufgesteilten Lohnlisten probeweise durch- sehen und in Fall der Beanstandung mit den betreffenden Unternehmern zur Behebung untergelaufener Fehler ins Benehmen treten. 222 Demography : Division II. B. Methode der Gewinnung der Nachweise : Es ist durchaus die Individual- Zahlkarte zur Erhebung zu verwenden. Die Bearbeitung der Statistik soil central bei einem staatlichen Arbeitsamt erfolgen, welches soweit notbig auch bei Aufstellung der Individual-Ziiblkarten inithclfen soil. II. Arbeiterversicherungswesen ansserhalb der ojfentlich-rehthchen Zwangsversicherung : a. Soweit Staatsanstalten in Frage sind, kann das Programm zu I. obne Weiteres angewendet werden. b. Im ubrigen ist in erster Linie erwiinscht, dass die VersicJierungs- anstalten alter Art, welche der Arbeiterversicherung dienen, durch Gesetz verpflichtet werden nicht bloss rechnungsmassij^ Darlegungen sondern auch statistische Nachweise (eventuell imter Bezeichnung der Hauptpunkte in Gesetz) zu liefern. Hierbei komrat neben Androhung von Rechtsnachtheilen auch die eigentliche Strafandrohung in Betcacht. c. Soweit die Voraussetzung zu b. nicht erreichbar ist, bleibt nur der Weg des Ersuchens des Staates an die Versicherungsanstalten um freiwillige Lieferung der oben bezeichneten statistischen Nachweise, wobei allerdings auf Vollstandigkeit und Gleich- inassigkeit derselben nicht zu rechnen ist. Thrift in Great Britain, BY ROWLAND HAMILTON, F.G.S. This paper refers to the very imperfect nature of the statistics avail- able, owing to the simultaneous growth of old methods with new, which gives rise to much " over-lapping " in the work done by various agencies. The prevailing feeling in this country is strongly in favour of spontaneous action in all matters affecting social life, and averse to the extension of departmental government in local affairs. Reference to the " Post Office Savings' Banks " which now hold deposits to the amount of 63,000,000/. in the United Kingdom ; which with 46,000,000/. in the older form of Trustee Savings' Banks, make an aggregate of about 120,000,000^. A large portion of the accounts kept by them are for societies for promoting thrift in many and various practical forms. A very brief sketch is given of the position of " friendly societies," " industrial and provident societies " (better known as " co-operative ") ; of " building societies," chiefly engaged not in actual building, but in granting loans for the purpose, the funds for which are supplied by a very numerous body of shareholders ; also, of " collecting societies " chiefly engaged in the insurance of small sums ; of " cattle insurance societies," " working men's clubs," " certified loan societies," and Demography : Division II. 223 " specially authorised " societies, including those of a scientific and literary character, all having generally some " specially provident purpose " ; to all of which registration is freely offered. No restric- tions are imposed on those working independently for such objects as these, and a large amount of energy which does not come directly under the cognizance of any State department is devoted to them, but there is a growing disposition to accept the advantages thus offered. The problem of the appropriate sphere for this country of State and independent action is engrossing the attention of many zealous and capable workers throughout the country. The reports of the Registrar of Friendly Societies for and up to the present year are referred to. Benefits offered to "Workers by their Employers and by others. BY FREDK. WHYMPER. Indian Factory Legislation. BY H. A. S. HALLETT. Protected classes in this country. Their hours of labour in textile factories, non-textile factories and workshops, and in domestic work- shops. Barely 1 in 240 of the operatives and artizans in India pro- tected by the India Factory Act. Why each person in every work needs protection irrespective to the numbers employed. Protected classes in India, and their hours of labour. Loose limits for hours of labour sanctioned. Such limits condemned and discarded in this country, as they lead to evasions of the Act. Evil effects of night- work. Night-work sanctioned for Indian factories. Long hours and insufficient intervals for rest. Heavy and unwholesome work in cotton- presses. Six and eight hours sufficient for men. Hands worked 8, 10, and 12 days and nights at a stretch, with a rest of half-an-hour in the evening, in the cotton-presses and ginning factories. These works excluded from the regulations of the Factory Act. Condition of Indian workshops. Eeport of Mr. Jones. Women, and children from two years of age upwards, working in unventilated, crowded rooms, choked with dust, amidst poisonous smells. Protection urged for workers in small factories and workshops by Bombay Factory Commission of 1884. Disproof of all statements made by the India Government in excuse for non-application of British Factory and Workshops Act in India. Piece-work as general in England as in India. Operatives standing 12, 13, and 14 hours a day in India, with barely half an hour's interval for rest, are naturally more jaded and less competent for work than 224 Demography : Division II. operatives in England who work only 10 hours a day, with 1^ or 2 hours' interval for rest. Evidence given by managers and agents of Bombay cotton-mills before the Bombay and Lancashire Cotton-spinning Inquiry of 1888 proved machinery is run as fast in Indian as in English mills. Evidence in India before Factory Commissions by factory inspectors, sanitary commissioners, health officers, other medical men, mill-managers, and superintendents of spinning and weaving companies, in favour of fixing the working hours of the mills and sullic-ient intervals of rest in the interest of the general health of the men and other operatives. Absurdity of the plea that a reduction of the India hours to the English standard would prove an obstacle to the development of Indian industries. Proof on every hand to the contrary. Point of injury and cruelty in England is 10 hours a day for women and young persons, and five hours for children. Duty of Government to fix limits and intervals of rest between which these hours may be taken. Present Act disgraceful to the Indian Government and shameful for this country. Home Work in Russia, BY Dr. MADAME TKATCHEFF. The Economic Advantages of Industrial Hygiene. BY B. H. THWAITE, C.E., F.C.S., A. M. Inst. C.E. The early and more recent Factory Acts inforce have a few pro- visions tending in a measure to the desirable condition of factory and workshop healthfulness ; but these conditions were only (and sparsely) adopted by the compulsory force of the legislative enactments. The veil of general ignorance is however being lifted, and the readiness with which members of both sides of the British Houses of Legislature have accelerated the passing of the new Factory Acts con- taining fuller and wider hygienic measures, is a valuable index of the state of the public mind. It is, however, remarkable that employers have not recognised the enormous importance of the healthful condition of their workshops as a first-class economic factor of production. The natural advantages of a bracing climate and a condensed atmosphere, have given British employers an acknowledged initial step in advance of European competitors; but this step has been more than neutralised by indifference to the value of hygienic measures. On the Continent, especially in France, sanitary structural precau- tions have been in several instances adopted with marked success. In one instance, to be fully described, these sanitary improvements resulted Demography : Division II. 225 in an increased output-efficiency equal to 6 per cent. This sub- stantial value applied to an annual output of a value of 100,000/., means an increase of 6,OOOA, amply justifying the additional expenditure involved. We have not, as far as the author is aware, any comparable statistics of the kind in this country. It is of supreme national importance to every country to see that, like its army of fighters, its army of workers should be well supplied with all that nature demands to sustain healthy and vigorous life. Museums of Industrial Hygiene. BY Dr. MIGERKA, &c., Vienna. Temporary Migration of Labour, BY E. G. RAVENSTEIN, F.R.G.S. Migration within France. BY M. LEVASSEUR. The suitability of Tropical Highlands for European Settlement, BY Surgeon-General Sir WILLIAM MOORE, K.C.I.E., Q.H.P. The value of life in a tropical climate is less than the value of life in a temperate climate. Reasons : The modifications produced in the system of the European by a tropical climate are in some degree hereditary. But elevation renders tropical regions bearable by Euro- peans which would otherwise be uninhabitable by them. Most tropical elevations have peculiarities of climate. Yet, short of the snow line, the climate is still more or less tropical. Also, as ascent is made, the density of the air is diminished. As a consequence, many persons experience unpleasant effects at a comparatively slight elevation. Neither are tropical elevations altogether free from the diseases of the low-lands. Fluctuations of physiological phenomena are the charac- teristics according to the seasons. Suitable elevation for Europeans in a tropical climate. But the temperate climate of elevation will not supply the place of the temperate climate of latitude. Indian exj>erience. / p. 1634. E. & S, 16. p 226 Demography : Division II. African experience. Different races in different climates, become even- tually the type of that race which conforms best to environment. An European may live long on a tropical elevation, provided he does not labour in the sun. But all experience and reasoning is against his founding a pure European family. Under precisely similar circum- stances of climate, men, by reason of their different temperaments and constitutions, suffer in varying degrees. Fitness or otherwise for a tropical climate, should be considered more than is often the case before Europeans go there. The suitability of Tropical Highlands for European Settlement. BY CLEMENTS MAKKHAM, C.B. The plateaux of the Andes have been the homes of Europeans of pure blood for upwards of 300 years, and some of the West Indian and Bahama Islands for 200 years. The remarks in the paper refer to the inhabitants of these localities. The Effect of Altitude on the Suitability of Tropical Climates for the permanent Eesidence of European Eaces. BY ROBERT W. FELKIN, M.D., &c. Introductory remarks upon the effect of altitude in the temperate zone, (a.) upon temperature, (6.) rainfall, (c.) atmospheric pressure, (d.) individuals, and (e.) disease. In the tropics there may be said to be three vertical zones of climate : I. A zone extending up to a height of 3,000 feet, having a mean annual temperature of 72 to 82 F. the hot zone. II. A zone from 3,000 to 12,000 feet, with a mean annual temperature of from 41 to 73 C F. the temperate zone. For purposes of description this zone may be divided into two parts the higher and cooler with a mean annual temperature of 41 to 55 F., and a lower or warmer part with a mean annual temperature of 55 to 73 F. III. The zone, having an altitude of from 12,000 to 16,000 feet, with a mean annual temperature of from 30 to 41 F. the cold zone. Each of these zones has peculiarities of its own with regard to the presence or absence of disease, and the higher the altitude of a region the more nearly it approaches the climate of Europe. As we proceed north and south of the Equator, the boundaries of these zones are found at gradually diminishing elevations, and therefore heat, atmospheric pressure, and moisture vary at different latitudes. Demography : Division II. 227 For the permanent residence of Europeans in the tropics a com- paratively high altitude is requisite, and the paper concludes with an attempt to specify those areas within the tropics where favourable conditions may be found. Report on an Inquiry into Leprosy in Egypt. BY Dr. ENGEL BEY. Method of Conducting the Census in Switzerland in 1888. BY M. le Dr. MILLIET, Berne. Eesults of Recent French Census. BY M. BOUFFET, Paris. Demonstration of Electric Counting Machine used in the United States Census. BY A. HOLLERITH. The Influence of Clays and Limestones on Medical Geography, illustrated by the Geographical Distribution of Cancer among Females in England and Wales. ALFRED HAVILAND, M.K.C.S., Eng., Fell. Roy. Med. Chir. Soc., &c. Many years ago the author was struck with the close relation that the high and low mortality from some causes of death bore to certain well marked geographical features in the localities where those causes either prevailed or were infrequent. The first of his series of maps of disease distribution represents the medical geography of certain fatal malignant diseases among females, which were certified by English medical practi- tioners as cancer in some of its forms. This map, which covers the 10 years 1851-1860, plainly demonstrates that the high mortality districts (from these causes) were to be found in the low-lying valley areas *2'2* Demography: Division II. characteris