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 WASTE AND REPAIR 
 
 MODERN LIFE.
 
 WASTE AND REPAIR 
 
 IN 
 
 MODERN LIFE. 
 
 BY ROBSON ROOSE, 
 
 M.D., LL.D., F.R.C.P.EDIN., 
 MEMBER OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, 
 
 Author of " Nerve Prostration and other Functional Disorder 
 
 of Daily Life" " Gout and its relation to Diseases 
 
 of the Liver and Kidneys" etc., etc. 
 
 LONDON : 
 
 JOHN MURRAY, ALBEMARLE STREET 
 
 1897.
 
 PREFACE. 
 
 "*HE Author desires to express his thanks 
 
 to the Editors of the Fortnightly Review 
 
 and the New Review for permission to reprint 
 
 articles which have already appeared in the 
 
 pages of those Magazines. 
 
 I * 
 
 , .
 
 CONTENTS. 
 
 PAGE 
 
 I. INTRODUCTION I 
 
 II. THE WEAR AND TEAR OF LONDON LIFE . n 
 
 III. REST AND REPAIR IN LONDON LIFE . -34 
 
 IV. THE ART OF PROLONGING LIFE . . -58 
 V. CLOTHING AS A PROTECTION AGAINST COLD . 94 
 
 VI. A CONTRIBUTION TO THE ALCOHOL QUESTION 112 
 
 VII. FASTING AND ITS PHYSIOLOGY . . .144 
 
 VIII. THE SPREAD OF DIPHTHERIA . . . 163 
 
 IX. THE PROPAGATION AND PREVENTION OF 
 
 CHOLERA . . . . . .187 
 
 X. INFECTION AND DISINFECTION . . .218 
 
 XI. THE LONDON WATER SUPPLY . . . 272 
 
 XII. HEALTH-RESORTS AND THEIR USES . .310 
 
 INDEX . . .351
 
 I. 
 
 INTRODUCTION. 
 
 r I ^HE Essays collected in this volume were 
 
 JL written at frequent intervals during the 
 
 last ten years ; they deal with various subjects 
 
 relating to Sanitary Science and Public Health 
 
 topics always interesting, and perhaps never 
 more so than at the present moment. Various 
 additions and alterations, rendered necessary 
 by the rapid growth of knowledge since these 
 Essays were first published, have been made ; 
 but in the arrangement of them no special 
 sequence has been attempted, save that in 
 one or two cases those which treat of kindred 
 themes have been brought together. 
 
 It is not, of course, claimed that any of the 
 subjects are exhaustively handled, still less 
 that the volume constitutes a complete treatise 
 on Sanitary Science. The author has aimed 
 at presenting the more important details of a 
 
 i
 
 2 INTRODUCTION. [CAP. 
 
 few subjects in an intelligible manner, and at 
 pointing out the lessons to be drawn from each 
 statement. He would be glad to feel that he 
 had caused his readers to take some interest 
 in questions which are of vital importance to 
 all educated persons, not only individually, but 
 also as members of the community, and that 
 he had been enabled to arouse in some minds 
 a desire to become acquainted with the im- 
 portant details of sanitary science. There is 
 no lack of works on Personal and Public 
 Health, written by men thoroughly conversant 
 with the theory and practice of Hygiene, 
 and easily intelligible by any one of ordinary 
 education. 
 
 The sanitary legislation of England may be 
 said to date from the passing of the Public 
 Health Act of 1848, but it was not until 1875 
 that a really comprehensive measure was 
 placed on the Statute Book. Before the pass- 
 ing of the first of these Acts, sanitation was, 
 for the most part, left to the voluntary efforts 
 of individuals, many of whom did good work 
 in certain limited spheres. To go back only 
 as far as the beginning of the last century, 
 we find that the utmost carelessness prevailed,
 
 1-1 LESSONS OF THE GREAT PLAGUE. 3 
 
 and that no effectual steps were taken to pre- 
 vent the occurrence of pestilences now happily 
 banished from our shores. The Great Plague 
 in 1665 no doubt suggested lessons which for 
 a time bore good fruit, but the fire in the 
 following year led to results infinitely more 
 valuable than any reformers could have 
 achieved. It abolished many of the conditions 
 under which epidemic diseases had previously 
 flourished. 
 
 More than a hundred years after the Great 
 Plague, the lessons taught by that visitation 
 had been to a great extent forgotten. It was 
 not until a private individual had visited, at 
 his own expense, most of the jails in England, 
 that the insanitary and inhuman conditions 
 which prevailed in those centres of infection 
 attracted public attention. It is difficult now 
 to realise that in 17/4 the atmosphere of the 
 prisons which John Howard entered was dis- 
 tinctively the atmosphere of typhus, that the 
 prisons were the central seminaries and forcing- 
 houses from which the typhus contagion of 
 those days was ever overflowing into fleets, 
 and barracks, and hospitals, and inspiring a 
 constant terror into courts of justice and the
 
 4 INTRODUCTION. [CAP. 
 
 population at large. Howard's labours, and 
 the evidence he gave before a Committee of 
 the House of Commons, were speedily fruitful 
 in results. Changes were gradually made in 
 the sanitary conditions of prisons, and improve- 
 ment followed improvement. At the present 
 day it must be admitted that a state very near 
 perfection has been arrived at, and that the 
 sanitary excellence of prisons far surpasses 
 that which can be secured for many thousands 
 of honest and well-behaved Englishmen. 
 
 The good effected by Howard was not in- 
 terred with his bones. Not only were prisons 
 reformed, but a new school of action was 
 founded, one which taught ' that continuous 
 investigation and steady perseverance are 
 imperatively requisite in dealing with grave 
 social evils. The fact that prisons could be 
 rendered as wholesome as the best ordinary 
 dwelling-houses must have been a marvellous 
 revelation to those who had long been cog- 
 nisant of the evil, but had regarded it as 
 practically irremediable. 
 
 Howard's experiences of the conditions 
 under which typhus prevailed led him to adopt 
 accurate ideas of its causation. When he
 
 I.] HOWARD'S EXPERIENCES. 5 
 
 visited the prisons on the Continent he found, 
 to his great surprise, that they were free from 
 fever, although they were no less close, 
 crowded, and impure than our own. He brings 
 the result of his observations and inquiries 
 concerning the cause of the jail-fever to this 
 pointed conclusion : " If it were asked," says 
 he, " what is the cause of the jail-fever, it 
 would in general be readily replied, the want 
 of fresh air and cleanliness ; but as I have 
 found, in some prisons abroad, cells and 
 dungeons as offensive and dirty as any I have 
 observed in this country, but in which this 
 distemper was unknown, I am obliged to 
 look out for some additional cause for its 
 production " which additional cause can be 
 no other than the contagious poison emanat- 
 ing from the bodies of those who have the 
 fever. The disease was not generated within 
 the jails, but, once imported there, it was 
 propagated with terrible rapidity. 
 
 The next important discovery in Sanitary 
 Science was that of vaccination, which was 
 first practised by Edward Jenner in 1796. It 
 is needless to describe the circumstances which 
 led to the discovery that by inoculating human
 
 6 INTRODUCTION. [CAP. 
 
 beings with matter taken from an eruption 
 on cows, the individuals so treated could be 
 rendered proof against the contagion of small- 
 pox ; and, further, that the vaccine virus, when 
 transmitted, by engrafting, from one person 
 to another, retained its protective power. The 
 objections made to the practice, and the con- 
 troversies with regard to its efficacy are 
 matters of common knowledge, but the general 
 result of all scientific inquiries has been to 
 confirm Jenner's views. It must be allowed 
 that he placed too high an estimate on the 
 protective powers of vaccination. Complete 
 protection, though not always attainable, is 
 certainly the general rule, and it is equally 
 certain that small-pox in vaccinated persons 
 is almost always milder in type and shorter 
 in duration than the same disease among 
 the unvaccinated. 
 
 Jenner's explanation of the effects of his 
 method was that the vaccine disease is in reality 
 small-pox, rendered mild by passing through 
 the system of the cow ; and this view has 
 been remarkably confirmed by the researches 
 and experiments of Pasteur and others during 
 the last quarter of a century. The sphere
 
 I.] ANTITOXIN. 7 
 
 of protective inoculation has been enormously 
 enlarged, and there is much ground for 
 hope that, by methods analogous to those of 
 vaccination, immunity may be attained against 
 the attacks of many infectious diseases. In 
 the Essay on " Diphtheria " an account is 
 given of the preparation of the antitoxin, 
 with regard to which it may at least be 
 affirmed that its value is distinctly greater 
 than that of any other remedy previously 
 used. The extent of its power cannot as 
 yet be positively estimated, but there is every 
 reason to expect that a more extended trial 
 will only confirm present experience. Other 
 antitoxins have been prepared for the treat- 
 ment of tetanus, cholera, and typhoid fever ; 
 but the experiments hitherto made are not 
 sufficient to justify any final conclusion. 
 
 If we turn to the progress of Sanitary 
 Legislation, we find that since 1875 many 
 Acts have been passed having for their object 
 the improvement of the public health. The 
 Public Health Act itself has been amended 
 again and again, and laws have been enacted 
 for the regulation of canal boats and other 
 movable dwellings, and of offensive trades,
 
 8 INTRODUCTION. [CAP. 
 
 for the sanitation of factories and workshops, 
 the notification and prevention of infectious 
 diseases, the prevention of the pollution of 
 rivers, adulteration of articles of food, and 
 other subjects more or less closely connected 
 with hygiene. All these laws are enormously 
 in advance of any legislation hitherto passed 
 for the protection of the public health. It 
 is scarcely an exaggeration to say that if 
 their administration were perfect, there would 
 be no more insanitary dwellings, no polluted 
 water supply, no accumulation of filth, and 
 no preventable spread of infectious disease 
 in any part of the country. It is in the 
 direction of improved administration and the 
 consolidation and simplification of existing 
 statutes, rather than in any further increase 
 in their volume, that reform is now most 
 needed, 
 
 A few words must be added on Personal 
 Hygiene. The recognition of the fact that 
 every community has an interest in the health 
 and strength of individual members, and that 
 concerted action is necessary in order to 
 obtain practical results, even on a small scale, 
 does not imply that individuals are relieved
 
 I.] PERSONAL HYGIENE. 9 
 
 from the responsibility of taking care of 
 themselves. The most elaborate code of 
 laws, administered with the greatest care 
 and strictness, cannot prevent persons from 
 committing a great variety of acts inconsistent 
 with the maintenance of health. Rules for 
 personal hygiene had been current long before 
 codes of public sanitary law had taken shape, 
 and are not now to be deemed superfluous 
 because many of the conditions of life are 
 regulated by local authorities. For a perfect 
 system of hygiene, we must train the body, 
 the intellect and the moral faculties in a 
 perfect and well-balanced order. At the 
 present day our knowledge of hygiene is 
 advancing with rapid strides in many re- 
 spects it is already sufficient ; and there is 
 no lack of competent teachers and of willing 
 listeners. Much, however, remains to be 
 done before the hope of the sanitary reformer 
 can be realised. When we pass through the 
 over-crowded streets of our poorer districts, 
 and notice the squalid aspect of the inhabi- 
 tants and the evidences of uncleanliness, 
 poverty, and misery, we are tempted to doubt 
 whether any real progress has been made,
 
 10 INTRODUCTION. [CAP. I. 
 
 and we are forced to make many allowances 
 for the moral defects of those whose lives 
 are passed under such conditions. But there 
 are, happily, other numerous classes, very 
 differently situated, whose fate, as regards 
 health, is largely in their own hands, and 
 whose members may hasten the progress of 
 hygiene by attending to their own health, 
 by inspiring others to follow their example, 
 and by aiding municipal and imperial social 
 improvements. That prevention is better 
 than cure is universally admitted ; but the 
 former process is too often neglected, while 
 the latter is frequently unattainable.
 
 II. 
 
 THE WEAR AND TEAR OF LONDON 
 LIFE. 
 
 " ' Why, sir, you find no man, at all intellectual, who 
 is willing to leave London. No, sir, when a man is tired of 
 London, he is tired of life ; for there is in London all that life 
 can afford.' " BOSWELL'S Life of Johnson. 
 
 THIS opinion was delivered after an ex- 
 perience of forty years of London life, 
 and when the speaker was close upon his 
 seventieth year. Johnson's dogmatism on this, 
 as on other subjects, was based upon deep 
 conviction ; he repeatedly dilates on the 
 advantages of London, its pre-eminence over 
 every other place for variety of enjoyments, 
 for comfort, and for intellectual advantages 
 of all kinds. He never so much as hints at 
 the existence of any possible drawback. It 
 may be taken for granted that Johnson's 
 opinion as to the advantages of living in 
 London is tacitly adopted by many classes
 
 12 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 of persons at the present day, and with good 
 reason. To the ordinary Englishman desirous 
 of enjoyment, or intellectual culture, or of 
 professional success, no other place in the 
 civilised world offers equal facilities for com- 
 passing the objects of his desire. Even by 
 people who have no particular aims in view, 
 life out of London is not unfrequently regarded 
 as a kind of vegetative existence. A much 
 more important and numerous class, embracing 
 those who are forced by the nature of their 
 avocations to spend nearly all their time in 
 London, are wont to adopt the same opinion, 
 tempered, perhaps, in many cases by an 
 appreciation of the drawbacks attendant upon 
 their mode of life. 
 
 Admitting to the full all the advantages, 
 I propose to consider some of those disadvan- 
 tages connected with London life which are 
 daily becoming more and more prominent. 
 I shall refer more especially, and from a 
 medical point of view, to those evidences of 
 " wear and tear " which are the direct results 
 of over work, excitement, and anxiety, and 
 which are so often witnessed among states- 
 men, politicians, and professional men of all
 
 II.] THE STRAIN OF MODERN LIFE. 13 
 
 classes actively engaged in London. What 
 is the price which so many of them pay for 
 their advantages of position and for their 
 reputation ? Besides answering this question, 
 I shall endeavour to point out how some at 
 least of the drawbacks might be obviated. 
 
 It is not my intention to reopen the con- 
 troversy which took place some years ago 
 on the subject of over work. It was asked 
 by Mr. Greg and others whether society at 
 large was really suffering from an amount 
 of work, physical and mental, injurious to 
 the individual, and therefore to the human 
 race. To this question very diverse answers 
 were given. Some authorities said bluntly 
 that in their opinion more ailments arise from 
 idleness or from want of occupation than 
 from over work, and that for one instance 
 of mischief arising from the latter cause, 
 half a dozen might be met with belonging 
 to the former category. Others, again, pro- 
 bably those who had met with more workers 
 than idlers, expressed a different and a more 
 guarded opinion ; at least with reference to 
 the proportionate influence exercised by two 
 such widely different causes. It cannot, I
 
 14 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 think, be shown that, provided all proper 
 precautions are taken, mental work even of 
 the hardest kind, and pursued for an almost 
 indefinite period, really injures the nervous 
 system of the individual thus occupied. In- 
 deed, as a matter of fact, it is almost invari- 
 ably followed by an entirely opposite result. 
 The human body is a machine so constructed 
 that work is a necessity for its continued 
 existence and well-being ; the amount of work 
 it is capable of doing is in strict proportion 
 to the power of the mechanism, and while 
 other machines having no power of repair 
 tend to become weaker and worn out by 
 use, the strength and capacity of the nervous 
 and muscular systems of the human body 
 are increased by exercise, provided that the 
 latter is regulated by certain well-known laws. 
 Injurious effects resulting from hard work 
 are almost always traceable to neglect of 
 obvious precautions. 
 
 There are of course immense differences 
 among men as regards capacity for perform- 
 ing mental work of any kind. Previous 
 training, constitution, and temperament are 
 potent factors in determining the amount
 
 II.] WEAKNESS OF BRAIN. 15 
 
 which each is capable of doing. Some men 
 can stand an enormous amount of mental 
 strain without any apparent injury ; others, 
 from what may be called, for want of a better 
 term, " weakness of brain," are incapable 
 of anything requiring mental tension. The 
 worst consequences are noticed in people of 
 moderate brain power, who, in the absence 
 of proper training, attempt the performance 
 of severe mental labour. Their case is similar 
 to that of those who suddenly engage in 
 trials of strength and endurance after an in- 
 sufficient amount of training, and who either 
 exhaust themselves by overtaxing their nervous 
 energies, or induce disorders of the heart or 
 lungs, or strain of some portion of the muscular 
 system, by the violence of their efforts. When 
 a man is being prepared for great muscular 
 exertion, he undergoes a course of training 
 in which the severity of the work assigned 
 to him is gradually and cautiously increased, 
 and the same rule should be adopted for 
 those whose mental powers are about to be 
 severely taxed. If this condition be fulfilled, 
 if a proper amount of sleep can be obtained, 
 and if the appetite remains at its normal
 
 1 6 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 level, the brain will bear almost any amount 
 of steady strain in the form of severe mental 
 labour. 
 
 With regard to health, it is needless to 
 dilate upon the advantages of the combination 
 of health of body with that of mind. Such 
 a combination when it exists cannot be suffi- 
 ciently prized. The fact, however, remains 
 that not a little of the brain-work of the 
 world is done by men whose standard of 
 health is extremely low ; and a weak and 
 ailing condition of body has been proved to 
 be quite compatible with great ability for 
 severe mental exertion. Such cases are, how- 
 ever, the exception ; their existence serves to 
 demonstrate the compensatory power existent 
 in the human frame. 
 
 Ordinary experience teaches us that mono- 
 tonous mental toil is far more trying than 
 even a greater amount of work of a diversified 
 character. The same law holds good in 
 respect of bodily labour. When all the muscles 
 are exercised, none are specially fatigued, 
 unless the exercise be immoderate in character. 
 But when only one set of muscles is called 
 into play for lengthened periods, weakness
 
 II-] WASTE OF ENERGY. 17 
 
 or even partial paralysis is a not unfrequent 
 result. The last point, referring to the effect 
 of anxiety and worry, will be more appro- 
 priately considered after I have endeavoured 
 to sketch those features of London life which 
 may be said to necessitate an undue amount 
 of wear and tear. There is little doubt that 
 in many cases it is not the amount of work 
 that is mischievous, but the absence of proper 
 regulations, the attempt to carry on simul- 
 taneously several different occupations, and 
 the worry and anxiety which such attempts 
 cannot fail to cause. As evidence of the fact 
 that many men at the present day attempt 
 to live three or four lives at once, I will 
 give a few examples out of many that have 
 come under my notice, taking them from 
 among politicians and the professional classes 
 of the metropolis. There is perhaps little 
 or nothing that is novel in the details I am 
 about to give, but I feel assured that the 
 lessons which may and should be drawn from 
 them are far too much neglected. 
 
 I will take for my first sketch the experience 
 of a barrister in good practice. As a general 
 rule, a barrister begins his daily work at his 
 
 2
 
 1 8 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 chambers about half- past nine. After a short 
 stay there he passes the next five or six hours 
 in court, either engaged in a case or cases, or 
 waiting for them to come on. While thus 
 waiting he occupies himself with other work 
 e.g., reading briefs, drawing pleadings, etc. 
 If his attendance be not required in court, he 
 would be working in his chambers, writing 
 opinions, consulting reports and standard 
 authorities in support of such opinions and 
 contentions. Whatever his occupations, he 
 spends but a few minutes over lunch ; whether 
 heavy or light it is despatched in the least 
 possible time. His ordinary work detains him 
 at his chambers till seven o'clock, when he 
 goes home to dinner, generally taking with 
 him documents and books to be studied at 
 night. If this were a complete sketch of a 
 barrister's work, it would be absurd to say that 
 any undue amount of wear and tear was 
 necessarily associated therewith. But his legal 
 duties are perhaps the least arduous of those 
 that fall to his lot. As a general rule a 
 barrister, ambitious of rising in his profession, 
 must seek other spheres of activity besides the 
 law-courts. It is almost an absolute necessity
 
 n.l A BARRISTER'S LIFE. 19 
 
 that he should enter the House of Commons, 
 and to get there he must expend not a little 
 time and trouble, and make, perhaps, several 
 unsuccessful attempts. As a member he must 
 be in his place at four, or as soon afterwards 
 as he can leave the law-courts. The sittings, 
 of course, vary much in length ; even at the 
 present day, important divisions may require 
 the attendance of members till long after mid- 
 night. When Parliament rises for the vacation 
 the work of the circuit begins, to be varied in 
 some cases by frequent journeys to London 
 for professional purposes. The work of the 
 Attorney- or Solicitor-General, or of a leading 
 Queen's Counsel, though in some particulars 
 different from that of the ordinary barrister, 
 is quite as continuous. The law officers of 
 the Crown have, of course, much private legal 
 business to transact in addition to the duties, 
 professional and Parliamentary, connected with 
 their offices. Society, moreover, claims a share 
 of the successful barrister's time. Other con- 
 ditions being favourable, to be seen by the 
 public greatly assists the aspirant to success ; 
 and when a good position has been attained, 
 the homage which society demands often
 
 20 WEAR AND TEAR OF LONDON LIFE [CAP. 
 
 involves additional and heavier sacrifices. If 
 to these details of a barrister's work be added 
 his correspondence, private and professional, 
 and the duties connected with his home, 
 family, and friends, it is obvious that his brain 
 and nervous system must be exposed to a 
 strain which, unless due care be taken, and 
 the individual be possessed of an unusual share 
 of mental and bodily vigour, is only too likely 
 to induce serious disorder. As in other cases, 
 the fittest survive, but many drop out of the 
 race. To not a few barristers a robust con- 
 stitution and a powerful physique are of more 
 value than any other qualification. 
 
 The duties of a judge, though sufficiently 
 engrossing, are of a less arduous character than 
 those just detailed. A judge's work, heavy as 
 it often is at the present day, is carried on with 
 evenness and regularity, and with little or no 
 excitement. It has, moreover, been preceded 
 by a long course of training ; but it can be 
 easily shown that a judge's position is no 
 longer one of dignified ease. In London his 
 duties in court occupy him for five or six hours 
 daily, during which time he must give the 
 closest attention to the evidence and to the
 
 II. J A PHYSICIANS LIFE. 21 
 
 arguments of the opposing counsel. He must 
 take notes as a case progresses, and carefully 
 prepare the summing-up for the guidance of the 
 jury. Such a resume is often a perfect model 
 of lucidity and reasoning, and demands the 
 exercise of mental powers of the highest order. 
 Attendance at assizes, the hearing of election 
 petitions, the consideration of appeals and of 
 Crown cases reserved, are the remaining duties 
 which a judge discharges before the public ; 
 and if to these be added many social duties 
 which necessarily fall to his share, it must be 
 admitted that the total is sufficient to test to 
 the utmost the fullest vigour both of mind 
 and body. 
 
 The daily work of consulting physicians and 
 surgeons in London is scarcely less arduous 
 than that of a barrister, but it is of a more 
 agreeable and far less exciting character. 
 Medical men, too, spend a large portion of 
 their time in their own houses, and the con- 
 trast between a physician's study or consulting- 
 room and a barrister's chambers must often 
 attract notice. No one has as yet explained 
 the preference manifested by lawyers (as shown 
 by the state of their chambers) for dust, 

 
 22 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 darkness, and discomforts in general. Such 
 a state of things would not be allowed to exist 
 in an ordinary dwelling-house inhabited by 
 persons claiming to belong to the civilised 
 classes. A consulting physician in London 
 begins his work soon after eight A.M. He 
 probably has a patient or two to visit at that 
 early hour, and on his return will find others 
 waiting who have been allowed to come before 
 the regular consultation hour. Patients con- 
 tinue to arrive, and are seen in turn until the 
 list is exhausted a process which is sometimes 
 not completed till one or even two o'clock. 
 Then luncheon must be rapidly despatched, 
 and if the physician or surgeon be connected 
 with the large London hospitals, he must, twice 
 a week at least, visit the patients under his 
 care. These visits are always made early in 
 the afternoon, and after this duty is discharged 
 there are private patients to be seen at their 
 own houses, consultations to be held, and, in 
 the case of members of a hospital staf lectures 
 to be delivered perhaps three or four times a 
 week. Consultations in the country take up 
 more or less of a physician's time ; these are 
 usually held in the afternoon. By seven or
 
 II-l WORK AND ENJOYMENT. 23 
 
 eight o'clock the work is generally over, so far 
 as attendance on patients is concerned ; and 
 after dinner the physician's time is, if he so 
 chooses, at his own disposal. He must, how- 
 ever, keep himself well acquainted with what- 
 ever is going on in the medical and scientific 
 world generally. He must therefore devote 
 some time to the medical journals and reviews, 
 and to a perusal of any specially important new 
 book. It generally happens that the evening 
 is the only portion of the day that he can spare 
 for these subjects. Then there are the various 
 medical societies, such as the Medico-Chirurgi- 
 cal, the Medical, the Clinical, etc., meetings 
 of which are held weekly or fortnightly during 
 eight months of the year. Literary labour often 
 makes further demands upon the physician's 
 time ; and if he wishes to become popular, he 
 must, like the barrister, pay some attention 
 to the claims of society, and not fail to appear 
 as often as possible at receptions, conversa- 
 ziones, dinner-parties, etc. A life spent in the 
 manner thus imperfectly sketched has a large 
 share of enjoyment of the best kind : mind 
 and body are kept fully employed, and under 
 favourable conditions at least a fair measure
 
 24 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 of success is generally attainable. Of course 
 there are drawbacks ; at the beginning, and 
 for some years afterwards, the res angusta 
 domi, the scarcity of patients, and the necessity 
 for keeping up what are called " appearances," 
 often give rise to very serious forebodings, 
 and middle life is not unfrequently reached 
 before the income is found to balance the 
 expenditure. 
 
 A glance at the work imposed upon mem- 
 bers of Parliament will suffice to show that 
 it involves no ordinary amount of wear and 
 tear. Work begins in the Committee-rooms 
 at noon ; the House assembles at four, and 
 the sittings are often prolonged till mid- 
 night. Before the adoption of the twelve 
 o'clock rule, readers of the debates had become 
 quite familiar with the announcement, " The 
 House was still sitting when we went to 
 press " ! A newly elected member of Parlia- 
 ment has a great deal to learn before he be- 
 comes conversant with his duties, and he is 
 fortunate if he finds time to make himself 
 even moderately well acquainted with the 
 Blue Books, papers, etc., which are annually 
 published. Besides his duties at Westminster,
 
 II.] LIFE IN PARLIAMENT. 25 
 
 he must attend to his constituents, must show 
 himself among them from time to time, and 
 must be ever ready to listen to complaints, 
 suggestions, or even dictates. The work 
 of a Cabinet Minister varies with the office 
 he fills, the state of public business, and acci- 
 dental circumstances. He begins the day by 
 making himself acquainted with the contents 
 of the daily papers, and perhaps by giving 
 a few minutes to his private correspondence. 
 The study of official papers, Blue Books, etc., 
 will occupy him till eleven o'clock, the ordinary 
 time of attendance at his office, where he 
 remains until the meeting of the House to 
 which he belongs. The sittings in the House 
 of Lords are generally very short ; they rarely 
 last more than an hour or two. In the House 
 of Commons they are only too apt to run to 
 the opposite extreme. In addition to official 
 work, not a few hours are required for pre- 
 paring Parliamentary speeches and extra- 
 Parliamentary discussions of various kinds. 
 Besides being in constant communication with 
 his secretaries, a Cabinet Minister has fre- 
 quently to consult various officials, and to 
 grant interviews to those who can show any
 
 26 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 cause for requesting them. If in charge of 
 any important measure in Parliament, he must 
 be present during every debate upon it, and 
 often make speeches in its support. Replies 
 to questions have to be carefully prepared, 
 assistance being, of course, given by the 
 permanent officials of the department. Attend- 
 ances at Cabinet Councils and meetings of 
 the Privy Council, at State balls and concerts, 
 at dinners and meetings of every conceivable 
 kind, absorb a large portion of the time un- 
 occupied in Parliamentary work ; and if to 
 these items be added the multifarious duties 
 of a private character which almost necessarily 
 devolve upon him, it will be readily admitted 
 that the work of a Cabinet Minister at the 
 present day is such as to tax to the utmost 
 even the highest degrees of mental and physical 
 vigour. The diversified character of his work 
 would appear to be its redeeming feature. 
 
 To the ordinary member of the House of 
 Commons, and especially to one who is not 
 as yet hardened by experience, disappointment 
 and a sense of weariness must often make 
 themselves keenly felt. Many a man enters 
 upon Parliamentary life under the idea that
 
 II.] HIGH PRESSURE. 27 
 
 he has an important mission to fulfil, but session 
 after session passes and he finds himself no 
 nearer to the goal. Meanwhile he has had to 
 listen night after night to an incessant flow 
 of talk, the larger portion of which is un- 
 attended by any practical result. Time and 
 energy are alike misapplied and wasted, and 
 though a powerful and huge machine is at 
 work, the results too often appear practically 
 nil. There are at times other reasons for 
 disappointment and disgust. Speeches made 
 and votes given for party purposes in support 
 of measures believed to be mischievous must, 
 in some cases at least, be productive of no 
 ordinary amount of self-contempt. 
 
 It may be objected that the instances to 
 which I have referred are of a numerically 
 exceptional character, that these professional 
 classes constitute a small minority of the 
 population, and that the toil in which they are 
 engaged is very different from that which 
 occupies the remainder of the community. 
 It would not be difficult to show that the 
 differences are those of kind rather than of 
 degree. Evidences of work being carried on 
 at high pressure meet us at every turn. I need
 
 28 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 only refer to the over work in elementary 
 schools, to the " cramming " for competitive 
 examinations, and to the constantly increasing 
 difficulty of the questions as shown by the 
 large number of candidates rejected at public 
 examinations of all kinds. Even in our 
 recreations there are evidences of a similar 
 spirit. In fact, we take pains to turn play 
 itself into work. The best and most popular 
 of our national games, as played during the 
 last few seasons, must often have been any- 
 thing but a recreation (in the true sense of the 
 word) to those engaged in it. If we turn to 
 commercial life, the same features confront us. 
 What is trade at the present day but com- 
 petition in its severest forms ? Incessant 
 struggles to get on, trampling, crushing, 
 elbowing, and treading on each other's heels, 
 are manifest symptoms of the present phase 
 of industrial progress. He who does not 
 move with the crowd is thrust back by the 
 \ iolence of others who put themselves forward. 
 To the question whether any penalties are 
 attached to this manner of living only one 
 answer can be given. Every age is charac- 
 terised by the presence or prevalence of
 
 II.] SLEEP. 29 
 
 special disorders of health which have a more . 
 or less obvious causation. At the present day 
 ''want of tone "is the characteristic feature of 
 disorders in general, and in none is it more 
 obvious than in those which peculiarly affect 
 official and professional men working at high 
 pressure. As might be expected, the signs 
 of this "want of tone," or weakening of the 
 nervous system, vary in different persons ; but 
 the presence of certain symptoms may be 
 regarded as a test of the actual condition. 
 Of these, sleeplessness is the most important ; 
 if allowed to continue, while the individual 
 endeavours to perform his usual tasks, grave 
 disorder of the nervous machinery must soon 
 set in. The restoration of energy, which sleep 
 alone can afford, is necessary for the mainten- 
 ance of nervous vigour ; and whereas the 
 muscular system, if over-taxed, at last refuses 
 to work, the brain under similar circumstances 
 too frequently refuses to rest. The sufferer, 
 instead of trying to remove or lessen the cause 
 of his sleeplessness, comforts himself with the 
 hope that it will soon disappear, or else has 
 recourse to alcohol, morphia, the bromides, 
 chloral, etc. Valuable and necessary as these
 
 3O WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 remedies often are (I refer especially to the 
 drugs), there can be no question as to the 
 mischief which attends their frequent use ; and 
 there is much reason to fear that their employ- 
 ment in the absence of any medical authority 
 is largely on the increase. Many of the 
 "proprietary articles" sold by druggists, and 
 in great demand at the present day, owe their 
 efficacy to one or more of these powerful 
 drugs. Not a few deaths have been caused 
 by their use, and in a still larger number of 
 cases they have helped to produce the fatal 
 result. Sleeplessness is almost always accom- 
 panied by indigestion in some one or other 
 of its Protean forms, and the two conditions 
 react upon and aggravate each other. If rest 
 cannot be obtained, and if the vital machine 
 cannot be supplied with a due amount of 
 fuel, and, moreover, fails to utilise that which 
 is supplied, mental and bodily collapse cannot 
 be far distant. The details of the downward 
 process vary, but the result is much the same 
 in all cases. Sleeplessness and loss of appetite 
 are followed by loss of flesh and strength, 
 nervous irritability alternating with depression, 
 palpitation, and other derangements of the
 
 II.] INSANITY. 31 
 
 heart, especially at night, and many of those 
 symptoms grouped together under the old 
 term, " hypochondriasis." When this stage 
 has been reached, " the borderlands of insan- 
 ity " are within measurable distance, even if 
 they have not already been reached. 
 
 The advocates of what is popularly known 
 as " progress " at the present day will doubtless 
 be surprised at learning (from a distinguished 
 American physician) that the number of the 
 insane is greater in a community in proportion 
 to the political and religious freedom of the 
 population ; that is, to the opportunity they 
 enjoy of working out their own purposes, 
 whether in relation to this world or the next, 
 in the manner most agreeable to themselves. 
 The explanation, of course, is that in such 
 communities the causes of insanity are always 
 numerous and widespread. If Dr. Wood's 
 opinion be well founded, the prospect, so far 
 as this country is concerned, must appal those 
 who are already aware of the marked increase 
 of mental disorder. The fact may, perhaps, 
 constitute a weighty argument in favour of 
 more frequent periods of rest, if not of thank- 
 fulness. We live in an age when preventive
 
 32 WEAR AND TEAR OF LONDON LIFE. [CAP. 
 
 medicine has achieved its greatest triumphs, 
 but the prevention of undue mental strain, of 
 anxiety, excitement, and disappointment con- 
 sequent upon struggles for power, influence, 
 or wealth cannot be reduced to a system or 
 effected by public authority. Individuals, 
 however, might do something to lessen the 
 wear and tear of modern life. A certain 
 amount of anxiety the sensation which Dr. 
 Hughlings Jackson has happily described as 
 <( fright spread out thin" is, of course, una- 
 voidable ; but a much larger proportion results 
 from circumstances for the most part really 
 under our own control, but which we strive to 
 exaggerate and multiply. Many a man might 
 ask himself whether the game he is playing 
 is really worth the candle, and whether less 
 bustle and hurry, or even one of the quieter 
 walks of life, would not, after all, be much 
 more conducive to happiness than a constant 
 whirl of excitement and anxiety. There is no 
 exaggeration in Mr. Greg's remark that "a 
 life without leisure and without pause a life 
 of haste and excitement a life so full that we 
 have no time to reflect where we have been 
 and where we intend to go, what we have
 
 II-] MORAL DISSIPATION. 33 
 
 done and what we plan to do, can scarcely 
 be deemed an adequate or worthy life." 
 
 Such is the life led by far too many at the 
 present day, and its effects are only too manifest. 
 One effect of this high-pressure existence is 
 that it leaves even the successful man who 
 has gained much to retire upon, nothing to 
 retire to ; for literature, science, domestic ties, 
 philanthropic interests, nature itself, have all 
 been neglected and lost sight of during the 
 mad rush and struggle of the last thirty years, 
 and these are treasures the key to which soon 
 grows rusty, and friends once slighted cannot 
 be called back at will. It is, after all, 
 nothing to the purpose to say that more mis- 
 chief is caused by idleness than by excessive 
 work. Idleness is an evil, and deserves to be 
 punished ; work is, or ought to be, a blessing. 
 But is there no middle course between dull 
 stagnation and those results of excessive pres- 
 sure which Mr. Gladstone has termed " moral 
 dissipation?" Perhaps one of the worst features 
 of the present day is the contempt for that 
 aurea mediocritas which, always praised but 
 rarely pursued, is yet assuredly not beyond 
 the reach of those who make it their ideal. 
 
 3
 
 III. 
 
 REST AND REPAIR IN LONDON 
 LIFE. 
 
 BY way of supplementing my remarks 
 on the wear and tear of London life, 
 I propose to offer a few suggestions as to 
 the means whereby these evils might be 
 moderated or lessened. I do not pretend to 
 say that I know of any agent capable of 
 arresting that constant expenditure of energy 
 which results from the proper employment of 
 our faculties. Life involves incessant change, 
 and even decay itself is a manifestation of 
 energy of a certain kind. Waste is harmful 
 only when it is excessive and not speedily 
 followed by processes of repair, and to arrest 
 normal change would be to check the ex- 
 pression of life, or even to cause death. What 
 I do maintain is, that while health is incom- 
 parably the greatest blessing vouchsafed to 
 
 34
 
 CAP. III.] EXCESSIVE BRAIN-WORK. 35 
 
 man, here, in London, many of the conditions 
 under which a constantly increasing number 
 live, militate against its attainment, and by so 
 doing diminish the happiness and add to the 
 sorrows of those who ought to be able to 
 choose between good and evil. I alluded to 
 " want of tone " as a striking peculiarity of 
 many of our common ailments, and by means 
 of a few illustrations I sought to demonstrate 
 some of the causes which tended to produce 
 this condition. The more important of these 
 may be thus briefly summarised : excessive 
 and persistent brain-work without sufficient 
 rest ; brain-work in persons incapable by 
 nature, or by reason of imperfect training ; the 
 endeavour to carry on simultaneously several 
 occupations ; and lastly, over-anxiety and worry 
 connected with daily life, striving after success, 
 disappointed hopes, etc. 
 
 The discovery of the cause or causes is a 
 necessary preliminary to the prevention of a 
 given evil. If, on being discovered, such 
 causes are removed, their effects will cease to 
 be displayed. How, it may well be asked, are 
 such causes as those I have just mentioned to 
 be got rid of? Their existence is but too
 
 36 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 manifest ; is their removal possible ? I believe 
 that with regard to some of them the question 
 might be answered in the affirmative, and that 
 in the case of others their effects might be 
 considerably lessened by the adoption of a few 
 precautionary measures. It appears to me that 
 the responsibility for their widespread existence 
 must be shared by the State, by society in 
 general, and by those individuals who are 
 the principal sufferers. If this statement 
 be correct, it is surely worth while to in- 
 quire what amount of amelioration each of the 
 parties concerned may be asked to contribute. 
 I shall be very brief in my remarks as to the 
 State and society in general, inasmuch as little 
 or nothing in the way of reform can be ex- 
 pected from either of these ; the important 
 points for consideration are the measures 
 which individuals might adopt so as to prevent 
 or mitigate " wear and tear," and to combat 
 their untoward results when once developed. 
 
 That the State is responsible for a large 
 amount of unnecessary wear and tear cannot, 
 I think, be denied ; I will refer to only one 
 of the conditions of modern political life viz., 
 the management of business in the House of
 
 III.] THE CALLS OF SOCIAL LIFE. 37 
 
 Commons. This, at the present day, is such, 
 that diligent attendance during a single Session 
 is sufficient to wear out the physical and 
 mental powers of the strongest man. The late 
 hours, the long sittings, the frivolous question- 
 ings, the weariness and emptiness of many of 
 the debates, furnish an ample explanation of 
 the want of tone and ill-health of many of those 
 who endeavour to do their duty. It cannot be 
 said that these evils are necessary. With 
 regard to the expenditure of time, is it not 
 possible to devise some means whereby the 
 daily work could be got through, say in six 
 hours at the outside ? Would less real work 
 be done if the House of Commons were to 
 meet at half-past four and never sit later than 
 twelve, and if the business were adapted to 
 the time, and not the time to the business ? 
 The practicability of this alteration has been 
 proved by its adoption as a general rule. 
 
 In regard to the responsibility of society 
 for much of the wear and tear of the present 
 day, and to any improvement which can be 
 obtained at the hands of that all-powerful 
 body, it will be difficult to offer any practical 
 suggestions. In a criticism on my previous
 
 38 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 paper, the Spectator asserts that the endurance 
 of the racket of society is altogether voluntary, 
 and infers therefore that it could be dispensed 
 with. No doubt it is voluntary in the simple 
 meaning of the term ; but the obligation to 
 pay court to society is one which cannot be 
 evaded with impunity by those who wish to 
 rise. Disagreeable as the notion may be, it 
 is nevertheless true that being seen in society 
 is often as useful to the professional man 
 as advertising is to the tradesman. " Out 
 of sight, out of mind," holds good in both 
 cases, and in that of the former an increased 
 measure of success is followed by more im- 
 perious demands on the part of society. If 
 advantages are to be retained, their possessor 
 must show that he is able to bear the popular 
 gaze, and the exhibition flatters those whose 
 support will tend to bring further successes 
 within reach. If society-haunting afforded the 
 necessary relaxation to the over-worked brain, 
 it might be excused on that ground ; but 
 unfortunately a heavy price is often paid by 
 men who give to society the time which 
 ought to be devoted to rest or relaxation. 
 
 o 
 
 It is curious that on the other side of the
 
 III.] CAUSES OF WEAR AND TEAR. 39 
 
 Atlantic the claims of society are found to 
 exercise an injurious influence on a very 
 different class. We have lately been told that 
 ill-health from 'over work among American 
 children is attributable not to school-pressure, 
 but to parental ambition and to the " society 
 engagements " of the pupils. 
 
 In a primitive state of society the more 
 important of the laws of health are uncon- 
 sciously obeyed ; but this passive condition 
 of obedience is not possible for the active 
 workers in large cities. They are surrounded 
 by unfavourable circumstances, so common 
 as to be little noticed, and often considered 
 as practically unavoidable even by those who 
 regard them as evils. In the case of indi- 
 viduals the problem which offers itself for 
 solution is twofold viz., how to lessen the 
 causes which induce excessive wear and tear ; 
 and having done all that seems possible in 
 this respect, how to preserve health under 
 those unfavourable conditions which are, or 
 appear to be, irremovable. 
 
 In estimating the amount and character of 
 brain-work which can be performed without 
 causing undue wear and tear, it is obvious
 
 4O REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 that no rules of universal applicability can 
 be laid down. Men's capacities for work 
 differ as much as their features, and very 
 much depends upon previous training ; but a 
 few practical suggestions may not be without 
 value. In my former paper I mentioned 
 two important tests, by the aid of which it 
 could be determined in any given case whether 
 hard mental toil was producing mischief or 
 not : one of these is capacity for sleep, and 
 the second, of subordinate though nearly equal 
 value, the state of the appetite and digestion. 
 If the sleep be normal in amount and re- 
 freshing in character, and if the appetite and 
 digestion remain good, it is certain that 
 no harm is being done. With regard to the 
 quantity of sleep, it is impossible to lay down 
 any hard and fast rule, but six or seven hours 
 are generally sufficient. There is probably 
 some truth in the old maxim that an hour's 
 sleep before midnight is equal in value to 
 two hours afterwards, if only because its adop- 
 tion encourages early hours. The great value 
 of rest as a restorative agent is clearly shown 
 by the fact that a capacity for long, refreshing 
 sleep is regarded by surgeons as considerably
 
 HI-] OCCASIONAL REPOSE. 4! 
 
 lessening the risks of an operation, especially 
 one entailing much shock or prolonged repair. 
 It is also a matter of common experience 
 that persons who sleep soundly and drop off 
 to sleep easily are capable of sustaining a larger 
 amount of mental and corporeal exertion than 
 those who find it difficult to get to sleep, and 
 who wake up several times during the night. 
 Shakespeare recommends as safe counsellors 
 men "such as sleep o' nights." 
 
 There is much difference of opinion con- 
 cerning the desirability of an after-dinner 
 nap. Those who advocate it cite the example 
 of animals ; but these gorge themselves with 
 food whenever opportunity offers, and are 
 heavy and drowsy in consequence. A short 
 rest is, however, different from lethargic sleep, 
 and often appears to do good. Brain-work 
 should certainly be forbidden after dinner ; 
 the interval between it and bed-time should 
 be devoted to recreation and amusement. In 
 the case of elderly people a short nap after 
 a late dinner often aids digestion ; but as a 
 general rule it is better for such persons to 
 make their principal meal at 2 P.M. The 
 digestive powers of most elderly people are
 
 42 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 at a low ebb in the evening. When sleep- 
 lessness is troublesome, relief should be sought 
 for in the discovery and removal of the 
 cause, whenever possible. The condition is 
 often due to indigestion, and when this is 
 the case, the ordinary remedies for inducing 
 sleep are worse than useless. The nervous 
 relations between the brain and the stomach 
 are so intimate, that disorder of the one 
 organ is almost certain to affect the other. 
 Excitement, worry, and anxiety, which have 
 their seat in the brain, interfere with the 
 functions of the stomach, and in like manner 
 anything that unduly taxes the power of, or 
 irritates the stomach, disorders the circulation 
 and nutrition of the brain. The sleeplessness 
 often complained of by gouty persons is due 
 to the poisonous effect of the morbid material 
 upon the nervous system. Excessive smoking, 
 too much alcohol, tea, and coffee, often 
 resorted to by over-worked persons, are 
 frequent causes of sleeplessness. In all these 
 cases the cause is removable, while the effect 
 may be counteracted by appropriate treatment. 
 Nothing is more mischievous, however, than 
 to continue the habits, and to have recourse
 
 III.] EARLY RISING. 43 
 
 to drugs to combat the effects. A due amount 
 of exercise tends to induce normal sleep, and 
 such exercise need not be of a violent cha- 
 racter. A walk of two or three miles daily 
 is sufficient, and is perhaps as much as a 
 busy man can find time for. A ride on 
 horseback the Palmerstonian cure for gout 
 is probably the best form of exercise for those 
 whose minds are constantly at work. It has 
 been well said that a man must come out 
 of himself when in the saddle ; he is forced 
 to attend to his horse and to notice the ob- 
 jects he meets. Walking may be a merely 
 automatic process, and afford little, if any, 
 relief to the mind ; and carriage exercise 
 may be practically valueless, if the mind 
 is not diverted from what had previously 
 occupied it. 
 
 Most people allow that early rising is 
 advantageous, but there are, it is to be feared, 
 comparatively few brain-workers who adopt 
 the habit. They allege, and with some reason, 
 that they can work best at night, because 
 the surroundings are quiet and there is 
 freedom from disturbance. When they state, 
 however, that they themselves feel better
 
 44 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 fitted for work, they are, as a general rule, 
 misinterpreting their own sensations. They 
 feel quiet because they are tired ; one part 
 seems fit for work because the other is too 
 weary to protest. A recourse to tea, coffee, 
 or alcohol helps the mind for a time, but 
 the effect of these stimuli upon the wearied 
 organism is only to increase the penalty that 
 must sooner or later be paid, in the form of 
 sleeplessness and other evidences of nervous 
 disturbance. Morning is the time for work ; 
 after a due amount of sleep the mind is more 
 fitted to grapple with difficulties than after a 
 long and fatiguing day. To those unaccus- 
 tomed to the habit, a strong effort is necessary 
 in order to begin the practice of early rising, 
 and in winter the difficulties would doubtless 
 seem great. Thanks, however, to modern 
 contrivances, a small room can soon be made 
 comfortably warm, and a cup of coffee can 
 be prepared with a minimum of trouble. A 
 man who has done two hours' good work 
 before breakfast feels that he is, to that 
 extent at least, in advance of the majority 
 of his fellow-workers. Dean Hook, we are 
 told by his biographer, considered his morning
 
 III.] DIGESTION. 45 
 
 very short if he did not get to work before 
 half-past five o'clock. 
 
 The state of the digestion has been alluded 
 to as a test of the effect which severe mental 
 work is producing on the system. A man 
 who works hard with his brain must eat a 
 sufficient quantity of food to supply the 
 waste of the nervous tissues. Indigestion 
 with its host of troubles is to be kept at 
 bay, and it is often difficult to accomplish 
 this object. Given, however, a fair constitu- 
 tion, much may be done by ordinary care 
 and forethought. A good appetite for break- 
 fast is an excellent test of the state of the 
 digestion and of the good effects of the 
 night's rest. Captain Dalgetty's plan of 
 securing, on all occasions which offer, " as 
 much vivers as the magazine can possibly 
 hold," is not one to be recommended for 
 ordinary persons engaged in peaceable occupa- 
 tions, but there can be no doubt as to the 
 advantage of taking in a reasonable supply 
 before beginning the more arduous labours 
 of the day. The lateness of the dinner hour 
 at the present day necessitates, for most 
 people, a tolerably substantial meal between
 
 46 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 one and two o'clock ; and if a man is kept 
 hard at work during the afternoon, it is highly 
 desirable that he should take at least half 
 an hour's rest before dinner. Nothing is 
 more likely to produce indigestion than to 
 eat even moderately when mind and body 
 are thoroughly wearied with the day's toil. 
 
 Judging from the enormous number of 
 remedies for indigestion which are being 
 offered to the public, and from the lavish 
 manner in which they are advertised, it would 
 appear that the disorder must be a very 
 common one, and that the remedies supply a 
 want which is urgently felt. In no other 
 country in Europe is there the same profusion 
 of nostrums, and the reason for this difference 
 is perhaps not far to seek. In former days 
 men's stomachs were often overtaxed by too 
 much food ; at present excessive eating is out 
 of fashion, but the digestive organs of many 
 persons are unequal to the task which they 
 are called upon to fulfil. Brain-workers are 
 notoriously prone to suffer from indigestion, 
 some of the causes of which have been already 
 indicated. The fact is that the process of 
 digestion, even of suitable food, makes a
 
 III.] INDIGESTION. 47 
 
 considerable, though unfelt, demand upon the 
 nervous energy of the system. If too much 
 of this energy has been expended in other 
 ways, or is diverted, when most required, into 
 other channels, digestion will be more or less 
 imperfect. Take the case of a man who, after 
 a hard day's work, sits down to dinner at 
 eight or half-past, having taken a hasty and 
 scanty lunch some hours previously. His 
 sensations tell him that he is terribly in want 
 of food, but they do not warn him that he has 
 little or no power of digestion left. He eats 
 freely and rapidly, and one form of discomfort 
 is soon exchanged for another. Digestion goes 
 on very slowly, and the process is far from 
 complete when bedtime comes. The sufferer 
 is weary, but sleep is unrefreshing, and pro- 
 bably broken by dreams or nightmare. He 
 begins the succeeding day weighted with the 
 burdens of its predecessor. Now all these 
 evils and they are no slight ones to the man 
 obliged to work hard with his brains might 
 be prevented by a little forethought. The 
 dinner hour at the present day is far too late ; 
 it would seem that we dine when we are 
 literally unable to do anything else. Seven
 
 48 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 o'clock is quite late enough ; and if that be 
 the fixed hour, a certain time ought to be set 
 apart for luncheon. Then, again, a man who 
 feels exhausted for want of food should eat 
 sparingly, and above all things slowly. The 
 suggestion I have already made, of half an 
 hour's rest before dinner, would, if adopted, 
 avert many of the troubles which are caused 
 by taking food when the stock of nervous 
 energy necessary for digestion has been well- 
 nigh exhausted. 
 
 With regard to the quality and kind of food 
 best suited to men who are working hard with 
 their brains, space will not allow me to offer 
 more than a few suggestions. A man must 
 be very unobservant or very foolish if he does 
 not find out for himself what suits him and 
 what does not ; but few men realise the extent 
 to which our sensations are influenced by the 
 condition of our digestive organs, and what 
 an effect indigestion often produces upon our 
 views of things in general, and our own pros- 
 pects in particular. Under any circumstances, 
 if indigestion is to be avoided, a positive sense 
 of satiety should never be experienced after 
 any meal, for this is beyond the point of
 
 III.] DIET. 49 
 
 healthful indulgence, and really signifies that 
 too much has been taken. That which ought 
 to be attained occurs immediately previous to 
 this, and is characterised by ease and quies- 
 cence. Much improvement has been effected 
 of late in our methods of preparing food, but 
 a great deal remains to be done in this 
 direction. The increased use of vegetables 
 and of fish as an article of diet is a salutary 
 change, combined as it often is with a 
 diminished consumption of meat. The move- 
 ment in favour of great moderation in the use 
 of wine and other alcoholic liquors is also 
 bearing good fruit, though no objection can 
 be raised against the lighter wines, especially 
 if diluted with hot water or some one or other 
 of the aerated waters. The taking of a large 
 amount of fluid with meals, however, should 
 be avoided ; it is apt to become a habit, and 
 is liable to cause and aggravate indigestion. 
 Iced water is not suitable as a drink at meal- 
 times. Its habitual use is one of the causes 
 of indigestion, which appears to be endemic 
 in all American cities. With many brain- 
 workers a little alcohol taken with food 
 decidedly aids digestion, but its use must 
 
 4
 
 ^ 
 
 5O REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 always be followed by rest and not by renewed 
 efforts. The brain is still weary, but the 
 alcohol prevents the weariness from being felt. 
 It is always mischievous to take alcohol 
 between meals in order to stimulate the 
 flagging powers. 
 
 Fresh air, recreation of all kinds, and change 
 of scene are the next most important agents 
 for preventing wear and tear and for removing 
 their effects. I shall only add a few words 
 on these subjects. Under the first I would 
 include ventilation ; for though most of us 
 appreciate fresh air out of doors, there is far 
 too little attention paid to the renewal of the 
 air in our dwelling-houses, and not a little dis- 
 comfort results from this neglect. Windows 
 cannot be always kept open, and the problem 
 of ventilation without draught is no doubt 
 difficult of solution. Tobin's contrivances for 
 the admission of fresh air are about the best 
 that have been devised ; and the simpler form, 
 that of openings in the window sashes, 
 through which the air is projected upwards 
 and then descends, can be adopted in any 
 room. There should of course be outlets for 
 foul air, and the products of combustion,
 
 III.] RECREATION. 51 
 
 wherever gas is used. A great reformation 
 is needed in this respect ; in crowded rooms 
 the evil is often very perceptible. 
 
 I can only just glance at the subject of 
 recreation, though it is a very important 
 means of repair. The term includes a great 
 variety of measures, and even of employments. 
 Change of work is one form of recreation, 
 because, it may be presumed, the new employ- 
 ment occupies a different portion of the brain, 
 and the one that has worked obtains rest. 
 Monotony of occupation is always irksome, 
 no doubt because certain portions of the brain 
 are exclusively occupied. A hard-worked man 
 should think no form of recreation beneath 
 his notice ; he is fortunate if he has a really 
 satisfactory hobby or two. Talleyrand's prog- 
 nostication of the kind of old age that awaited 
 the man who did not know whist is full of 
 truth, if it be applied to amusements and 
 hobbies in general. Perhaps its author would 
 scarcely have recommended whist for an old 
 man had he been able to foresee the bewil- 
 dering modifications which have been made 
 in the way of playing the game. In this, 
 as in other things, the tendency is to turn
 
 52 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 play into work. Let us hope, however, that 
 some of our simpler forms of recreation may 
 be permitted to survive at least for our time. 
 Books remain, and we may be thankful for 
 the stock we already possess. Reading offers 
 the most available means of recreation. Dean 
 Hook's practice in this respect also is worthy 
 of adoption. He tells us himself that he 
 always had a novel in hand. It lasted him 
 a long time, "but when, a man has much 
 to do, a little time thus spent does the mind 
 good." Books, however, should be suited 
 to the occasion. As Bulwer tells us, " when 
 taken indiscriminately, they are no cure for 
 the diseases and afflictions of the mind. There 
 is a world of science necessary in the taking 
 them. I have known some people in great 
 sorrow fly to a novel or the last light book 
 in fashion. One might as well take a rose- 
 draught for the plague. Light reading does 
 not do when the heart is . really heavy." By 
 all means let the recreation be conformable 
 to the tastes of the individual, and adapted 
 to his condition. When a man over sixty, 
 who has led a sedentary life, suddenly and 
 vehemently takes to tricycling, he may feel
 
 III.] HOLIDAYS. 53 
 
 pretty sure that he has failed to catch the 
 meaning of the term " recreation," and that 
 a very different process will certainly develop 
 itself. 
 
 The last point for consideration is that 
 which refers to change of scene and holidays. 
 No doubt much of the value of health-resorts 
 is due to the change of scene which is con- 
 nected with them, though other factors co- 
 operate in the production of the good effects. 
 A hard-worked man, compelled to live in 
 London for many months in the year, con- 
 fidently expects to receive the greatest benefit 
 from a sojourn at the seaside, or among woods 
 and green fields ; and some men while working 
 in London have endeavoured to get as much 
 fresh air as possible by spending their nights 
 at least in the country. Such a plan, unfor- 
 tunately, seldom, if ever, succeeds ; most men 
 who try it soon become aware of its drawbacks. 
 To get really fresh country air, uncontaminated 
 by the smoke of London, one must go at 
 least a dozen miles from the metropolis, and 
 to do this daily, necessitates a double railway 
 journey, besides the drives to and from the 
 stations. The man whose business in London
 
 54 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 begins at ten, and is over by four or five 
 o'clock, may live twenty miles from his office, 
 but the professional man, with longer and less 
 definite hours of work, does better by keep- 
 ing close to his post. He ought, however, to 
 avail himself of every opportunity of getting a 
 short change in the country, or at the seaside, 
 at some one or other of the many suitable 
 places within easy reach, such as Brighton, 
 Margate, Seaford, Eastbourne, and the rest. 
 It must be admitted that there is some diffi- 
 culty in finding comfortable quarters for such 
 short holidays as from Saturday to Monday. 
 Lodging-house keepers do not lay themselves 
 out for visitors of this kind, and hotels are 
 for the most part uncomfortable places, 
 especially on the days mentioned. Those 
 who could afford it would do well to rent 
 a small cottage in the country, which would 
 serve as a retreat whenever a holiday could 
 be obtained. In the number of health-resorts 
 within easy reach, the hard-worked Londoner 
 is exceptionally fortunate as compared with 
 the dwellers in most continental capitals. An 
 occasional change and rest, if only for thirty- 
 six hours, in pure air, would help many a
 
 III.] ANNUAL HOLIDAYS. 55 
 
 man to get through months of hard work 
 with ease and satisfaction. Even from a 
 money point of view, to be always "up to 
 the mark " would to many men be equivalent 
 to a considerable addition to their income. 
 
 The subject of an annual holiday is the 
 last to which I shall refer ; there can be no 
 doubt as to the advantages of this means of 
 rest and recreation. Where to spend a holiday 
 and how best to enjoy it are topics which 
 should frequently engage the thoughts of a 
 man who is working at high pressure. The 
 idea of a holiday, even if the realisation 
 be somewhat distant, lessens present dis- 
 comforts, and the carrying out of a well- 
 devised plan enhances the enjoyment when 
 the time arrives. The number of ways in 
 which a holiday may be profitably spent is 
 almost infinite. Yachting, boating, fishing, 
 etc., will suit those who require bodily rest ; 
 while walking, riding, and other forms of 
 active exercise will suggest themselves to 
 a different class. A drive through several 
 English counties, with leisurely visits to all 
 places of interest, might serve as a very 
 pleasant occupation for five or six weeks.
 
 56 REST AND REPAIR IN LONDON LIFE. [CAP. 
 
 Something definite should be aimed at and 
 done during each holiday ; an active-minded 
 man must have occupation of some kind even 
 in his hours of recreation. A change of work 
 is indeed a form of rest, and happily there 
 is no lack of subjects for every variety of 
 mind. While enjoying the fresh air of the 
 seaside, the professional man can prosecute 
 some branch of natural science for which he 
 has a liking, or can indulge in a course of 
 his favourite authors ; when travelling abroad, 
 the language of the country, its history, and 
 works of art will afford an ample field both 
 for recreation and pleasant employment. By 
 such means as these, mind and body are alike 
 renewed and invigorated. 
 
 I have thus described the principal measures 
 which we ought to take if we wish to reduce 
 to a minimum the wear and tear of London 
 life. They may be briefly described as " rest 
 and repair," and their adoption to a greater 
 or less extent is within the power of most 
 men. I am far from advocating any undue 
 anxiety or unnecessary care with regard to 
 health, but seeing as I do many instances 
 of men breaking down under hard work, and
 
 III.] " MENS SANA IN CORPORE SANO." 57 
 
 in some cases never regaining their previous 
 condition, I have been led to offer these few 
 remarks by way of advice and warning. If 
 over work and worry cannot be lessened, 
 common sense tells us that we should en- 
 deavour to mitigate their effects in every 
 possible way, and the best method of com- 
 passing this object is to preserve the mind 
 and body in such a condition as will enable 
 them to perform satisfactorily every function 
 which can reasonably be required of them. 
 If this result cannot be attained, the question 
 of reducing the amount of work will demand 
 a prompt solution. The acquirement of fame 
 and fortune is but a sorry exchange for 
 health and vigour. Non est vivere, sed valere 
 vita.
 
 IV. 
 THE ART OF PROLONGING LIFE. 
 
 I "'HE doctrine that a short life is a sign of 
 JL divine favour has never been accepted 
 by the majority of mankind. Philosophers 
 have vied with each other in depicting the 
 evils and miseries incidental to existence, and 
 the truth of their descriptions has often been 
 sorrowfully admitted, but they have failed 
 to dislodge, or even seriously diminish, that 
 desire for long life which has been deeply 
 implanted within the hearts of men. The 
 question whether life be worth living has 
 been decided by a majority far too great 
 to admit of any doubt upon the subject, and 
 the voices of those who would fain reply in 
 the negative are drowned amid the chorus 
 of assent. Longevity, indeed, has come to 
 be regarded as one of the grand prizes of 
 human existence, and reason has again and 
 
 58
 
 CAP. IV.] DURATION OF HUMAN LIFE. 59 
 
 again suggested the inquiry whether care or 
 skill can increase the chances of acquiring it, 
 and can make old age, when granted, as com- 
 fortable and happy as any other stage of our 
 existence. 
 
 From very early times the art of prolonging 
 life, and the subject of longevity, have engaged 
 the attention of thinkers and essayists ; and 
 some may perhaps contend that these topics, 
 admittedly full of interest, have been tho- 
 roughly exhausted. It is true that the art in 
 question has long been recognised and practised, 
 but the science upon which it really depends 
 is of quite modern origin. New facts con- 
 nected with longevity have, moreover, been 
 collected within the last few years, and some 
 of these I propose to examine, and further to 
 inquire whether they teach us any fresh means 
 whereby life may be maintained and prolonged. 
 
 But before entering upon the immediate 
 subject, there are several preliminary questions 
 which demand a brief examination, and the 
 first that suggests itself is, What is the natural 
 duration of human life ? This oft-repeated 
 question has received many different answers ; 
 and inquiry has been stimulated by scepticism
 
 60 THE ART OF PROLONGING LIFE. |_ CAP - 
 
 as to their truth. The late Sir George Corne- 
 wall Lewis expressed the opinion that one 
 hundred years must be regarded as a limit 
 which very few, if indeed any, human beings 
 succeed in reaching, and he supported this 
 view by several cogent reasons. He pointed 
 out that almost all the alleged instances of 
 abnormal longevity occurred among the 
 humbler classes, and that it was difficult, if 
 not impossible, to obtain any exact information 
 as to the date of birth and to identify the 
 individuals with any written statements that 
 might be forthcoming. He laid particular 
 stress upon the fact that similar instances were 
 altogether absent among the higher classes, 
 with regard to whom trustworthy documentary 
 evidence was almost always obtainable. He 
 thought that the higher the rank the more 
 favourable would the conditions be for the 
 attainment of a long life. In this latter sup- 
 position, however, Sir George Lewis was 
 probably mistaken : the comforts and luxuries 
 appertaining to wealth and high social rank 
 are too often counterbalanced by cares and 
 anxieties, and by modes of living inconsistent 
 with the maintenance of health, and therefore
 
 iv.] BUFFON'S OPINION. 61 
 
 with the prolongation of life. In the intro- 
 duction to his work on " Human Longevity," 
 Easton says, " It is not the rich or great . . . 
 that become old, but such as use much exercise, 
 are exposed to the fresh air, and whose food 
 is plain and moderate as farmers, gardeners, 
 fishermen, labourers, soldiers, and such men 
 as perhaps never employed their thoughts on 
 the means used to promote longevity." 
 
 The French naturalist, Buffon, believed 
 that if accidental causes could be excluded, 
 the normal duration of human life would be 
 between ninety and one hundred years, and 
 he suggested that it might be measured (in 
 animals as well as in man) by the period of 
 growth to which it stood in a certain propor- 
 tion. He imagined that every animal might 
 live for six or seven times as many years as 
 were requisite for the completion of its growth. 
 But this calculation is not in harmony with 
 facts, so far, at least, as man is concerned. 
 His period of growth cannot be estimated at 
 less than twenty years ; and if we take the 
 lower of the two multipliers, we get a number 
 which, in the light of modern evidence, can- 
 not be accepted as attainable. If the period
 
 62 THE ART OF PROLONGING LIFE. [CAP. 
 
 of growth be multiplied by five, the result will 
 in all probability not be far from the truth. 
 
 If we seek historical evidence, and from it 
 attempt to discover the extreme limit of human 
 life, we are puzzled at the differences in the 
 ages said to have been attained. The long- 
 evity of the antediluvian patriarchs when con- 
 trasted with our modern experience seems 
 incredible. When we look at an individual, 
 say 90 years of age, taking even the most 
 favourable specimen, a prolongation of life to 
 ten times that number of years would appear 
 too absurd even to dream about. There is 
 certainly no physiological reason why the ages 
 assigned to the patriarchs should not have been 
 attained, and it is useless to discuss the subject, 
 for we know very little of the conditions under 
 which they lived. It is interesting to notice 
 that after the Flood there was a gradual 
 decrease in the duration of life. Abraham is 
 recorded to have died at 175 ; Joshua, some 
 five hundred years later, " waxed old and 
 stricken in age " shortly before his death at 
 1 10 years ; and his predecessor, Moses, to 
 whom 1 20 years are assigned, is believed to 
 have estimated the life of man at threescore
 
 IV.] LONGEVITY. 63 
 
 years and ten a measure nowadays pretty 
 generally accepted. 
 
 There is no reason for believing that the 
 extreme limit of human life in the time of the 
 Greeks and Romans differed materially from 
 that which agrees with modern experience. 
 Stories of the attainment of such ages as 120 
 years and upwards may be placed in the same 
 category as the reputed longevity of Henry 
 Jenkins, Thomas Parr, Lady Desmond, and a 
 host of others. With regard to later times, 
 such as the Middle Ages, there are no precise 
 data upon which any statements can be based, 
 but there is every reason to believe that the 
 average duration of life was decidedly less than 
 it is at present. The extreme limit, indeed, 
 three or four centuries ago, would appear to 
 have been much lower than it is in the nine- 
 teenth century. At the request of Mr. Thorns, 
 Sir J. Duffus Hardy investigated the subject 
 of the longevity of man in the thirteenth, four- 
 teenth, fifteenth, and sixteenth centuries, and 
 his researches led him to believe that persons 
 seldom reached the age of 80. He never met 
 with a trustworthy record of a person who 
 exceeded that age.
 
 64 THE ART OF PROLONGING LIFE. [CAP. 
 
 To bring the investigation down to quite re- 
 cent times, I cannot do better than utilise the 
 researches of the late Sir G. M. Humphry, 
 Professor of Surgery at Cambridge. In 1 886 he 
 obtained particulars relating to fifty-two indi- 
 viduals then living and said to be 100 years old 
 and upwards. The oldest among them claimed 
 to be 1 08, the next 106, while the average 
 amounted to a little more than 102 years. 
 Many interesting facts connected with the 
 habits and mode of life of these individuals 
 were obtained by Dr. Humphry, and will be 
 referred to in subsequent paragraphs. 
 
 A short account of the experience of a few 
 life-assurance companies will conclude this 
 part of my subject. Mr. Thorns tells us that 
 down to 1872 the records of the companies 
 showed that one death among the assured had 
 occurred at 103, one in the looth, and three 
 in the QQth year. The experience of the 
 National Debt Office, according to the same 
 authority, gave two cases in which the evidence 
 could be regarded as perfect ; one of these 
 died in the iO2nd year, and the other had just 
 completed that number. In the tables published 
 by the Institute of Actuaries, and giving the
 
 IV.] LIFE ASSURANCE COMPANIES. 65 
 
 mortality experience down to 1863 of twenty 
 life assurance companies, the highest age at 
 death is recorded as 99, and I am informed by 
 the manager of the North British Life Office in 
 Edinburgh, that from 1863 onwards that age 
 had not been exceeded in his experience. In 
 the valuation schedules, which show the highest 
 ages of existing lives in various offices, the 
 ages range from 92 to 95. It is true that one 
 office which has a large business among the 
 industrial classes reports lives at 103, and in 
 one instance at 107 ; but it must be remem- 
 bered that among those classes the ages are 
 not nearly so well authenticated as among those 
 who assure for substantial sums. There is, 
 moreover, another source of error connected 
 with the valuation schedules. When a given 
 life is not considered to be equal to the average, 
 a certain number of years is added to the age, 
 and the premium is charged at the age which 
 results from this addition. It follows, therefore, 
 that in some cases the ages given in the 
 schedules are greater by some years than they 
 really are. 
 
 Taking , into consideration the facts thus 
 rapidly passed under review, it must, I think, 
 
 5
 
 66 THE ART OF PROLONGING LIFE. [CAP. 
 
 be admitted that the natural limit of human 
 existence is that assigned to it in the book of 
 Ecclesiasticus, " The number of a man's days 
 at the most are an hundred years " (chap, xviii. 
 9). In a very small number of cases this limit 
 is exceeded, but only by a very few years. 
 Mr. Thorns' investigations conclusively show 
 that trustworthy evidence of no years having 
 been reached is altogether absent. Future 
 generations will be able to verify or reject 
 statements in all alleged cases of longevity. It 
 must be remembered that previous to the year 
 1836 there was no registration of births, but 
 only of baptisms, and that the registers were 
 kept in the churches, and contained only the 
 names of those therein baptized. 
 
 Whatever number of years may be taken 
 as representing the natural term of human life, 
 whether threescore-and-ten or a century be 
 regarded as such, we are confronted by the 
 fact that only one-fourth of our population 
 attains the former age, and that only abou 
 fifteen in 100,000 become centenarians. It is 
 beyond the scope of this article to discuss the 
 causes of premature mortality, but the con- 
 ditions favourable to longevity, and the causes
 
 IV.] HEREDITARY LONGEVITY. 67 
 
 to which length of days has been assigned, are 
 closely connected with its subject. 
 
 A capability of attaining old age is very 
 often handed down from one generation to 
 another, and heredity is probably the most 
 powerful factor in connection with longevity. 
 A necessary condition of reaching advanced 
 age is the possession of sound bodily organs, 
 and such an endowment is eminently capable 
 of transmission. Instances of longevity char- 
 acterising several generations are frequently 
 brought to notice. A recent and most in- 
 teresting example of transmitted longevity was 
 that of the veteran guardian of the public 
 health, the late Sir Edwin Chadwick, who, 
 when entertained at a public dinner on the 
 occasion of his reaching his goth year, in- 
 formed his entertainers that his father died at 
 the age of 84, his grandfather at 95, and that 
 two more remote ancestors were centenarians. 
 
 It is difficult to estimate the influence of 
 other contingencies which affect longevity. 
 With regard to sex, Hufeland's opinion was 
 that women were more likely than men to 
 become old, but that instances of extreme 
 longevity were more frequent among men.
 
 68 THE ART OF PROLONGING LIFE [CAP. 
 
 This opinion is to some extent borne out by 
 Dr. Humphry's statistics : of his fifty-two cen- 
 tenarians, thirty-six were women. Marriage 
 would appear to be conducive to longevity. 
 A well-known French savant, Dr. Bertillon, 
 states that a bachelor of 25 is not a better life 
 than a married man of 45 ; and he attributes 
 the difference in favour of married people to 
 the fact that they take more care of themselves, 
 and lead more regular lives, than those who 
 have no such tie. It must, however, be 
 remembered that the mere fact of marrying 
 indicates superior vitality and vigour, and the 
 ranks of the unmarried are largely filled by 
 the physically unfit. 
 
 In considering occupations as they are likely 
 to affect longevity, those which obviously 
 tend to shorten life need not be considered. 
 With respect to the learned professions, it 
 would appear that among the clergy the average 
 of life is beyond that of any similar class. It 
 is improbable that this average will be main 
 tained for the future : the duties and anxieties 
 imposed upon the clergy of the present genera- 
 tion place them in a very different position 
 from that of their predecessors. Among
 
 IV.] PROFESSIONAL AND LITERARY PURSUITS. 69 
 
 lawyers, there have been several eminent judges 
 who attained a great age, and the rank and 
 file of the profession are also characterised 
 by a decided tendency to longevity. The 
 medical profession supplies but few instances 
 of extreme old age, and the average duration 
 of life among its members is decidedly low, 
 a fact which can easily be accounted for : 
 broken rest, hard work, anxieties, exposure to 
 weather and to the risks of infection cannot 
 fail to exert an injurious influence upon health. 
 No definite conclusions can be arrived at with 
 regard to the average longevity of literary and 
 scientific men, but it might be supposed that 
 those among them who are not harassed by 
 anxieties and enjoy fair health would probably 
 reach old age. As a general rule, the duration 
 of life is not shortened by literary pursuits. 
 A man may worry himself to death over his 
 books, or, when tired of them, may seek 
 recreation in pursuits destructive to health ; 
 but application to literary work tends to pro 
 duce cheerfulness, and to prolong rather than 
 shorten the life even of an infirm man. In 
 Professor Humphry's " Report on Aged 
 Persons," containing an account of 824 indi-
 
 7O THE ART OF PROLONGING LIFE. [CAP. 
 
 viduals of both sexes, and between the ages 
 of 80 and 100, it is stated that 48 per cent, 
 were poor, 42 per cent, were in comfortable 
 circumstances, and only 10 per cent, were 
 described as being in affluent circumstances. 
 Dr. Humphry points out that these ratios 
 " must not be regarded as representing the 
 relations of poverty and affluence to longevity, 
 because, in the first place, the poor at all 
 ages and in all districts bear a large proportion 
 to the affluent ; and, secondly, the returns are 
 largely made from the lower and middle 
 classes, and in many instances from the 
 inmates of union-workhouses, where a good 
 number of aged people are found." It must 
 also be noticed that the " past life-history " 
 of these individuals showed that the greater 
 proportion (55 per cent.) "had lived in com- 
 fortable circumstances," and that only 35 per 
 cent, had been poor. 
 
 Merely to enumerate the causes to which 
 longevity has been attributed in attempting 
 to account for individual cases would be a 
 task of some magnitude ; it will be sufficient 
 to mention a few somewhat probable theories. 
 Moderation in eating and drinking is often
 
 iv.] DR. HUMPHRY'S INQUIRIES. 71 
 
 declared to be a cause of longevity, and 
 the assertion is fully corroborated by Dr. 
 Humphry's inquiries. Of his fifty-two cen- 
 tenarians, twelve were recorded as total 
 abstainers from alcoholic drinks throughout 
 life, or for long periods ; twenty had taken 
 very little alcohol ; eight were reported as 
 moderate in their use of it ; and only three 
 habitually indulged in it. It is quite true 
 that a few persons who must be classified as 
 drunkards live to be very old ; but these are 
 exceptions to the general rule, and such cases 
 appear to be more frequent than they really 
 are, because they are often brought to notice 
 by those who find encouragement from such 
 examples. The habit of temperance in food, 
 good powers of digestion, and soundness of 
 sleep are other main characteristics of most 
 of those who attain advanced years, and may 
 be regarded as causes of longevity. Not a 
 few old persons are found on inquiry to take 
 credit to themselves for their own condition, 
 and to attribute it to some remarkable pecu- 
 liarity in their habits or mode of life. It is 
 said that Lord Mansfield, who reached the age 
 of 89, was wont to inquire into the habits of
 
 72 THE ART OF PROLONGING LIFE. [CAP. 
 
 life of all aged witnesses who appeared before 
 him, and that only in one habit, namely, that 
 of early rising, was there any general con- 
 currence. Health is doubtless often promoted 
 by early rising, but the habit is not necessarily 
 conducive to longevity. It is, as Sir H. 
 Holland points out, more probable that the 
 vigour of the individuals maintains the habit 
 than that the latter alone maintains the vitality. 
 If we pass from probable to improbable 
 causes of longevity, we are confronted by 
 many extravagant assumptions. Thus, to take 
 only a few examples, the immoderate use of 
 sugar has been regarded not only as a panacea, 
 but as decidedly conducive to length of days. 
 Dr. Slare, a physician of the last century, 
 has recorded the case of a centenarian who 
 used to mix sugar with all his food, and 
 the doctor himself was so convinced of the 
 " balsamic virtue " of this substance that he 
 adopted the practice, and boasted of his health 
 and strength in his old age. Another member 
 of the same profession used to take daily doses 
 of tannin (the substance employed to harden 
 and preserve leather), under the impression 
 that the tissues of the body would be thereby
 
 IV.] THE ALCHEMISTS. 73 
 
 protected from decay. His life was protracted 
 beyond the ordinary span, but it is question- 
 able whether the tannin acted in the desired 
 direction. Lord Combermere thought that 
 his good health and advanced years were due, 
 in part at least, to the fact that he always 
 wore a tight belt round his waist. His 
 lordship's appetite was doubtless thereby kept 
 within bounds ; we are further told that he 
 was very moderate in the use of all fluids 
 as drink. Cleanliness might be supposed to 
 aid in prolonging life ; yet a Mrs. Lewson, 
 who died in the early part of this century, 
 aged 1 06, must have been a singularly dirty 
 person, We are told that instead of washing 
 she smeared her face with lard, and asserted 
 that " people whow ashed always caught cold." 
 This lady, no doubt, was fully persuaded that 
 she had discovered the universal medicine. 
 
 Many of the alchemists attributed the power 
 of prolonging life to certain preparations of 
 gold, probably under the idea that the per- 
 manence of the metal might be imparted to 
 the human system. Descartes is said to have 
 favoured such opinions : he told Sir Kenelm 
 Digby that although he would not venture to
 
 74 THE ART OF PROLONGING LIFE. [_ CAP - 
 
 promise immortality, he was certain that his 
 life might be lengthened to the period of that 
 enjoyed by the patriarchs. His plan, however, 
 seems to have been the very rational and 
 simple one of checking all excesses and en- 
 joining punctual and frugal meals. 
 
 Having thus endeavoured to show the 
 extent to which human life may be prolonged, 
 and having examined some of the causes or 
 antecedents of longevity, the last subject for 
 inquiry is the means by which it may be 
 attained. Certain preliminary conditions are 
 obviously requisite ; in the first place there 
 must be a sound constitution derived from 
 healthy ancestors, and in the second there must 
 be a freedom from organic disease of important 
 organs. Given an individual who has reached 
 the "grand climacteric," or threescore-and-three, 
 and in whom these two conditions are fulfilled, 
 the means best adapted to maintain and 
 prolong his life constitute the question to be 
 solved. It has been said that " he who would 
 long to be an old man must begin early to be 
 one," but very few persons designedly take 
 measures in early life in order that they may 
 live longer than their fellows.
 
 IV.] GROWTH, MATURITY AND DECLINE. 75 
 
 The whole term of life may be divided into 
 the three main periods of growth and develop- 
 ment, of maturity, and of decline. No hard 
 and fast line can be drawn between these two 
 latter phases of existence : the one should pass 
 gradually into the other until the entire picture 
 is changed. Diminished conservative power 
 and the consequent triumph of disintegrating 
 forces are the prominent features of the third 
 period, which begins at different times in 
 different individuals, its advent being mainly 
 controlled by the general course of the preceding 
 years. The "turning period," also known as 
 the "climacteric" or "middle age," lies between 
 45 and 60 ; the period beyond may be con- 
 sidered as belonging to advanced life or old 
 age. The majority of the changes char- 
 acteristic of these last stages are easily recog- 
 nisable. It is hardly necessary to mention 
 the wrinkled skin, the furrowed face, the 
 " crow's feet " beneath the eyes, the stooping 
 gait, and the wasting of the frame. The 
 senses, notably vision and hearing, become less 
 acute ; the power of digestion is lessened ; the 
 force of the heart is diminished ; the lungs 
 are less permeable ; many of the air-cells lose
 
 76 THE ART OF PROLONGING LIFE. [CAP. 
 
 their elasticity and merge into each other, so 
 that there is less breathing-surface as well as 
 less power. Simultaneously with these changes, 
 the mind may present signs of enfeeblement ; 
 but in many instances its powers long remain 
 in marked contrast with those of the body. 
 One fact connected with advanced life is too 
 often neglected. It should never be forgotten 
 that while the " forces in use " at that period 
 are easily exhausted, the " forces in reserve " 
 are often so slight as to be unable to meet the 
 smallest demand. In youth, the vires in posse 
 are superabundant ; in advanced life, they are 
 reduced to a minimum, and in some instances 
 are practically non-existent. The recognition 
 of this difference is an all-important guide in 
 laying down rules for conduct in old age. 
 
 In order to prolong life and at the same 
 time to enjoy it, occupation of some kind is 
 absolutely necessary ; it is a great mistake to 
 suppose that idleness is conducive to longevity. 
 It is at all times better to wear out than to 
 rust out, and the latter process is apt to be 
 speedily accomplished. Every one must have 
 met with individuals who, while fully occu- 
 pied till sixty or even seventy years of age,
 
 IV.] POWER OF MIND. 77 
 
 remained hale and strong, but aged with 
 marvellous rapidity after relinquishing work, 
 a change in their mental condition becoming 
 especially prominent. There is an obvious 
 lesson to be learnt from such instances, but 
 certain qualifications are necessary in order to 
 apply it properly. With regard to mental 
 activity, there is abundant evidence that the 
 more the intellectual faculties are exercised the 
 greater the probability of their lasting. They 
 often become stronger after the vital force has 
 passed its culminating point ; and this retention 
 of mental power is the true compensation for 
 the decline in bodily strength. Did space 
 permit, many illustrations could be adduced to 
 show that the power of the mind can be 
 preserved almost unimpaired to the most 
 advanced age. Even memory, the failure of 
 which is sometimes regarded as a necessary 
 concomitant of old age, is not infrequently 
 preserved almost up to the end of life. All 
 persons of middle age should take special pains 
 to keep the faculties and energies of the mind 
 in a vigorous condition ; they should not 
 simply drift on in a haphazard fashion, but 
 should seek and find pleasure in the attain-
 
 78 THE ART OF PROLONGING LIFE. [CAP. 
 
 ment of definite objects. Even if the mind 
 has not been especially cultivated, or received 
 any decided bent, there is at the present day 
 no lack of subjects on which it can be agree- 
 ably and profitably exercised. Many sciences 
 which, twenty or thirty years ago, were 
 accessible only to the few, and wore at best a 
 somewhat uninviting garb, have been rendered 
 not merely intelligible, but even attractive to 
 the many ; and in the domain of general 
 literature the difficulty of making a choice 
 among the host of allurements is the only 
 ground for complaint. To increase the taste 
 for these and kindred subjects is worth a 
 considerable effort, if such be necessary ; but 
 the appetite will generally come with the 
 eating. The possession of some reasonable 
 hobby which can be cultivated indoors is a 
 great advantage in old age, and there are 
 many pursuits of this character besides those 
 connected with literature and science. Talley- 
 rand laid great stress on a knowledge of whist 
 as indispensable to a happy old age, and 
 doubtless to many old people that particular 
 game affords not only recreation, but a pleasant 
 exercise to the mind. It is, however, an un-
 
 IV.] MENTAL TASKS. 79 
 
 worthy substitute for higher objects, and should 
 be regarded only as an amusement and not 
 as an occupation. 
 
 Whatever be the sphere of mental activity, 
 no kind of strain must be put upon the mind 
 by a person who has reached sixty-five or 
 seventy years. The feeling that mental power 
 is less than it once was not infrequently 
 stimulates a man to increased exertions which 
 may provoke structural changes in the brain, 
 and will certainly accelerate the progress of 
 any that may exist in that organ. When 
 a man finds that a great effort is required 
 to accomplish any mental task that was once 
 easy, he should desist from the attempt, and 
 regulate his work according to his power. 
 \Vith this limitation, it may be taken for 
 granted that the mental faculties will be far 
 better preserved by their exercise than by 
 their disuse. 
 
 Somewhat different advice must be given 
 with regard to bodily exercises in their refer- 
 ence to longevity. Exercise is essential to 
 the preservation of health ; inactivity is a 
 potent cause of wasting and degeneration. 
 The vigour and equality of the circulation,
 
 8O THE ART OF PROLONGING LIFE. [CAP. 
 
 the functions of the skin, and the aeration of 
 the blood, are all promoted by muscular activ- 
 ity, which thus keeps up a proper balance and 
 relation between the important organs of the 
 body. In youth, the vigour of the system 
 is often so great that if one organ be sluggish 
 another part will make amends for the defi- 
 ciency by acting vicariously, and without any 
 consequent damage to itself. In old age, 
 the tasks cannot be thus shifted from one 
 organ to another ; the work allotted to each 
 sufficiently taxes its strength, and vicarious 
 action cannot be performed without mischief. 
 Hence the importance of maintaining, as far 
 as possible, the equable action of all the bodily 
 organs, so that the share of the vital processes 
 assigned to each shall be properly accomplished. 
 For this reason exercise is an important part of 
 the conduct of life in old age ; but discretion 
 is absolutely necessary. An old man should 
 discover by experience how much exercise 
 he can take without exhausting his powers, 
 and should be careful never to exceed the 
 limit. Old persons are apt to forget that 
 their staying powers are much less than they 
 once were, and that, while a walk of two or
 
 IV.] EXERCISE. 8l 
 
 three miles may prove easy and pleasurable, 
 the addition of a return journey of similar 
 length will seriously over-tax the strength. 
 Above all things, sudden and rapid exertion 
 should be scrupulously avoided by persons 
 of advanced age. The machine which might 
 go on working for years at a gentle pace often 
 breaks down altogether when its movements 
 are suddenly accelerated. These cautions may 
 appear superfluous, but instances in which their 
 disregard is followed by very serious conse- 
 quences are by no means infrequent. 
 
 No fixed rule can be laid down as to the 
 kind of exercise most suitable for advanced 
 age. Much must depend upon individual 
 circumstances and peculiarities ; but walking 
 in the open air should always be kept up 
 and practised daily, except in unfavourable 
 weather. Walking is a natural form of exercise, 
 and subserves many important purposes : not 
 a few old people owe the maintenance of 
 their health and vigour to their daily " con- 
 stitutional." Riding is an excellent form of 
 exercise, but available only by a few ; the habit, 
 if acquired in early life, should be kept up as 
 long as possible, subject to the caution already 
 
 6
 
 82 THE ART OF PROLONGING LIFE. [CAP. 
 
 given as to violent exercise. Old persons of 
 both sexes fond of gardening, and so situated 
 that they may gratify their tastes, are much 
 to be envied. " Fortunati nimium, sua si bona 
 norint ! " Body and mind are alike exercised 
 by what Lord Bacon justly termed " the purest 
 of human pleasures." Dr. Parkes goes so 
 far as to say that light garden or agricultural 
 work is a very good exercise for men past 
 seventy : "it calls into play the muscles of 
 the abdomen and back, which in old men 
 are often but little used, and the work is so 
 varied that no muscle is kept long in action." 
 A few remarks must be made, in conclusion, 
 with regard to a new form of exercise some- 
 times indulged in even by elderly men. I 
 allude to so-called " bicycling " and " tricycling." 
 Exhilarating and pleasant as it may be to 
 glide over the ground with comparatively little 
 effort, the exercise is fraught with danger for 
 men who have passed the grand climacteric. 
 The temptation to make a spurt must be often 
 irresistible ; hills must be encountered, some, 
 perhaps, so smooth and gradual as to require 
 no special exertion none, at least, that is 
 noticed in the triumph of surmounting them.
 
 IV.] FOOD. 83 
 
 Now, if the heart and lungs be perfectly sound, 
 such exercises may be practised for some time 
 with apparent impunity ; but if (as is very 
 likely to be the case) these organs be not 
 quite structurally perfect, even the slightest 
 changes will, under such excitement, rapidly 
 progress and lead to very serious results. 
 Exercise unsuited to the state of the system 
 will assuredly not tend to the prolongation 
 of life. 
 
 With regard to food, we find from Dr. 
 Humphry's Report that 90 per cent, of the 
 aged persons were either "moderate" or 
 " small " eaters, and such moderation is quite 
 in accord with the teachings of physiology, 
 In old age the changes in the bodily tissues 
 gradually become less and less active, and 
 less food is required to make up for the 
 daily waste. The appetite and the power of 
 digestion are correspondingly diminished ; and 
 although for the attainment of a great age 
 a considerable amount of digestive power is 
 absolutely necessary, its perfection, when ex- 
 ercised upon proper articles of diet, is the 
 most important characteristic. Indulgence in 
 the pleasures of the table is one of the common
 
 84 THE ART OF PROLONGING LIFE. [CAP. 
 
 errors of advanced life, and is not infrequent in 
 persons who, up to that period, were moderate 
 or even small eaters. Luxuries in the way of 
 food are apt to be regarded as rewards that 
 have been fully earned by a life of labour, and 
 may, therefore, be lawfully enjoyed. Hence 
 arise many of the evils and troubles of old age, 
 and notably indigestion and gouty symptoms 
 in various forms, besides mental discomfort. 
 No hard and fast rules can be laid down, but 
 strict moderation should be the guiding maxim. 
 The diet suitable for most aged persons is that 
 which contains much nutritive material in a 
 small bulk, and its quantity should be in 
 proportion to the appetite and power of 
 digestion. Animal food, well cooked, should 
 be taken sparingly and not more often than 
 twice a day, except under special circum- 
 stances. Dr. Parkes advocates rice as a 
 partial substitute for meat when the latter is 
 found to disagree with old persons. "Its 
 starch grains are very digestible, and it 
 supplies nitrogen in moderate amount, well 
 fitted to the worn and slowly-repaired tissues 
 of the aged." Its bulk, however, is sometimes 
 a disadvantage ; in small quantities it is a
 
 IV.] ALCOHOLIC LIQUORS. 85 
 
 valuable addition to milk and to stewed 
 fruits. 
 
 The amount of food taken should be divided 
 between three or four meals at fairly regular 
 intervals. A sense of fulness or oppression 
 after eating ought not to be disregarded. It 
 indicates that the food taken has been either 
 too abundant or of improper quality. For 
 many elderly people the most suitable time 
 for the principal meal is between one and 
 two P.M. As the day advances the digestive 
 powers become less, and even a moderately 
 substantial meal taken in the evening may 
 seriously over-task them. Undigested food is 
 a potent cause of disturbed sleep an evil 
 often very troublesome to old people, and one 
 which ought to be carefully guarded against. 
 
 It is an easier task to lay down rules with 
 regard to the use of alcoholic liquors by elderly 
 people. A few years ago, the Collective In- 
 vestigation Committee of the British Medical 
 Association issued a Report on the Connection 
 of Disease with Habits of Intemperance, and two 
 at least of the conclusions arrived at are worth 
 quoting. " Habitual indulgence in alcoholic 
 liquors, beyond the most moderate amounts,
 
 86 THE ART OF PROLONGING LIFE. [CAP. 
 
 has a distinct tendency to shorten life, the 
 average shortening being roughly proportional 
 to the degree of indulgence. Total abstinence 
 and habitual temperance augment considerably 
 the chance of death from old age or natural 
 decay, without special pathological lesion." 
 Subject, however, to a few exceptions, it is 
 not advisable that a man sixty-five or seventy 
 years of age, who has taken alcohol in modera- 
 tion all his life, should suddenly become an 
 abstainer. Old age cannot readily accommo- 
 date itself to changes of any kind, and to many 
 old people a little good wine with their meals 
 is a source of great comfort. To quote again 
 from Ecclesiasticus, " Wine is as good as life 
 to a man, if it be drunk moderately, for it was 
 made to make men glad." Elderly persons, 
 particularly at the close of the day, often find 
 that their nervous energy is exhausted, and 
 require a little stimulant to induce them to 
 take a necessary supply of proper nourishment, 
 and perhaps to aid the digestive powers to 
 convert their food to a useful purpose. In the 
 debility of old age, and especially when sleep- 
 lessness is accompanied by slow and imperfect 
 digestion, a small quantity of a generous and
 
 IV.] SELFISH REGARD FOR HEALTH. 87 
 
 potent wine, containing much ether, often does 
 good service. Even a little beer improves 
 digestion in some old people ; others find 
 that spirits, largely diluted, fulfil the same 
 purpose. Individual peculiarities must be 
 allowed for ; the only general rule is that which 
 prescribes strict moderation. 
 
 It is not to be inferred from the hints given 
 in the preceding paragraphs that the preser- 
 vation of health should be the predominant 
 thought in the minds of elderly persons who 
 desire that their lives should be prolonged. 
 To be always guarding against disease, and 
 to live in a state of constant fear and watch- 
 fulness, would make existence miserable and 
 hasten the progress of decay. Selfish and 
 undue solicitude with regard to health not only 
 fails to attain its object, but is apt to induce 
 that diseased condition of mind known as 
 hypochondriasis, the victims of which are 
 always a burden and a nuisance, if not to 
 themselves, at least to all connected with 
 them. Addison, in the Spectator, after de- 
 scribing the valetudinarian who constantly 
 weighed himself and his food, and yet became 
 sick and languishing, aptly remarks : "A
 
 88 THE ART OF PROLONGING LIFE. [CAP. 
 
 continual anxiety for life vitiates all the relishes 
 of it, and casts a gloom over the whole face 
 of nature, as it is impossible that we should 
 take delight in anything that we are every 
 moment afraid of losing." 
 
 Sleep is closely connected with the question 
 of diet : " good sleeping " was a noticeable 
 feature in the large majority of Dr. Humphry's 
 cases. Sound, refreshing sleep is of the utmost 
 consequence to the health of the body, and no 
 substitute can be found for it as a restorer of 
 vital energy. Sleeplessness is, however, often 
 a source of great trouble to elderly people, and 
 one which is not easily relieved. Narcotic 
 remedies are generally mischievous ; their first 
 effects may be pleasant, but the habit of de- 
 pending upon them rapidly grows until they 
 become indispensable. When this stage has 
 been reached, the sufferer is in a far worse 
 plight than before. In all cases, the endeavour 
 should be made to discover whether the sleep- 
 lessness be due to any removable cause, such 
 as indigestion, cold, want of exercise, and the 
 like. In regard to sleeping in the daytime, 
 there is something to be said both for and 
 against that practice. A nap of " forty winks "
 
 IV.] WARMTH AND CHILLS. 89 
 
 in the afternoon enables many aged people to 
 get through the rest of the day in comfort, 
 whereas they feel tired and weak when de- 
 prived of this refreshment. If they rest well 
 at night, there can be no objection to the 
 afternoon nap ; but if sleeplessness be com- 
 plained of, the latter should be discontinued 
 for a time. Most old people find that a re- 
 clining posture, with the feet and legs raised, 
 is better than the horizontal position for the 
 afternoon nap. Digestion proceeds with more 
 ease than when the body is recumbent. 
 
 Warmth is very important for the aged ; 
 exposure to chills should be scrupulously 
 avoided. Bronchitis is the malady most to 
 be feared, and its attacks are very easily 
 provoked. Many old people suffer from more 
 or less cough during the winter months, and 
 this symptom may recur year after year, and 
 be almost unheeded. At last, perhaps a few 
 minutes' exposure to a cold wind increases the 
 irritation in the lungs, the cough becomes 
 worse, and the difficulty of breathing increases 
 until suffocation terminates in death. To 
 obviate such risk, the skin should be carefully 
 protected by warm flannel clothes, the out-door
 
 9O THE ART OF PROLONGING LIFE. [CAP. 
 
 thermometer should be noticed, and winter 
 garments should always be at hand. In cold 
 weather the lungs should be protected by 
 breathing through the nose as much as pos- 
 sible, and by wearing a light woollen or silken 
 muffler over the mouth. The temperature of 
 the sitting- and bed-rooms is another point 
 which requires attention. Some old people 
 pride themselves on never requiring a fire 
 in their bedrooms. It is, however, a risky 
 practice to exchange a temperature of 65 or 
 70 for one fifteen or twenty degrees lower. 
 As a general rule, for persons sixty-five years 
 of age and upwards, the temperature of the 
 bedroom should not be below 60, and when 
 there are any symptoms of bronchitis, it should 
 be raised from five to ten degrees higher. 
 
 Careful cleansing of the skin is the last point 
 which needs to be mentioned in an article 
 like the present. Attention to cleanliness is 
 decidedly conducive to longevity, and we may 
 congratulate ourselves on the general improve- 
 ment in our habits in this respect. Frequent 
 washing with warm water is very advantageous 
 for old people, in whom the skin is only too 
 apt to become hard and dry ; and the benefit
 
 IV.] AVERAGE DURATION OF LIFE. 9 1 
 
 will be increased if the ablutions be succeeded 
 by friction with coarse flannel or linen gloves, 
 or with a flesh-brush. Every part of the skin 
 should be thus washed and rubbed daily. The 
 friction removes worn-out particles of the skin, 
 and the exercise promotes warmth and excites 
 perspiration. Too much attention can hardly 
 be paid to the state of the skin : the comfort 
 of the aged is greatly dependent upon the 
 proper discharge of its functions. 
 
 Such, then, are the principal measures by 
 which life may be prolonged and health main- 
 tained down to the closing scene. It remains 
 to be seen whether, as a result of progress of 
 knowledge and civilisation, life will ever be 
 protracted beyond the limit assigned to it in 
 a preceding paragraph. There is no doubt 
 that the average duration of human life is 
 capable of very great extension, and that the 
 same causes which serve to prolong life materi- 
 ally contribute towards the happiness of man- 
 kind. The experience of the last few decades 
 abundantly testifies to the marked improvement 
 which has taken place in the public health. 
 Statistics show that at the end of the septennial 
 period, 1881 87, 400,000 persons were alive
 
 92 THE ART OF PROLONGING LIFE. [CAP. 
 
 in England and Wales whose death would 
 have taken place had the mortality been in the 
 same proportion as during the previous decade. 
 It may be reasonably expected that as time 
 goes on there will be an increase in the 
 proportion of centenarians to the population 
 as a whole. 
 
 The question whether long life is, after all, 
 desirable does not admit of any general answer. 
 Much depends upon the previous history of 
 the individual, and his bodily and mental 
 condition. The last stages of a well-spent 
 life may be the happiest ; and while sources 
 of enjoyment exist, and pain is absent, the 
 shuffling-off of the mortal coil, though calmly 
 expected, need not be wished for. The picture 
 afforded by cheerful and mellow old age is a 
 lesson to younger generations. Elderly people 
 may, if they choose, become centres of im- 
 proving and refining influence. On the other 
 hand, old age cannot be regarded as a blessing 
 when it is accompanied by profound decrepi- 
 tude and disorder of mind and body. Senile 
 dementia, or second childishness, is, of all 
 conditions, perhaps the most miserable, though 
 not so painful to the sufferer as to those who
 
 IV.] OLD AGE. 93 
 
 surround him. Its advent may be accelerated 
 by ignorance and neglect, and almost assuredly 
 retarded or prevented by such simple measures 
 as have been suggested. No one who has 
 had opportunities of studying old people can 
 shut his eyes to the fact that many of the 
 incapabilities of age may be prevented by 
 attention to a few simple rules, the observance 
 of which will not only prolong life and make 
 it happier and more comfortable, but will 
 reduce to a minimum the period of decrepi- 
 tude. Old age may be an incurable disease, 
 admitting of but one termination, but the 
 manner of that end, and the condition which 
 precedes it, are, though not altogether, cer- 
 tainly, to a very great extent, within our own 
 power. 
 
 NOTE. Since the above was written, the civilised world 
 has lost its most noted centenarian in the person of 
 M. Chevreul, the famous French chemist, who died on 
 April Qth, 1889, aged 102 years and 7 months. Only a few 
 days before his death he went in his carriage to see the Eiffel 
 Tower, in which he took a lively interest. Throughout his 
 long life he had worked hard, sparing neither mind nor 
 body, and it would seem that his faculties were preserved 
 with but slight impairment up to the time of his death 
 The senior member of the medical profession, Mr. W. 
 Salmon, died May loth, 1896, aged 106 years.
 
 V. 
 
 CLOTHING AS A PROTECTION 
 AGAINST COLD. 
 
 FOOD and raiment are primary necessaries 
 of life, and the mutual relation between 
 these requisites is so close that a deficiency of 
 one may to some extent be compensated by 
 a full supply of the other. When both are 
 decidedly defective in quantity, marked sym- 
 ptoms soon become developed ; exposure to 
 cold intensifies the results of insufficiency of 
 food. On the other hand, the effects of chronic 
 starvation are mitigated and warded off for 
 a time by the application of heat. The 
 machinery of the human body must be kept 
 at a certain temperature, the maintenance of 
 which is provided for by the combustion of 
 the materials of food. Clothing prevents the 
 too rapid escape of the heat thus generated. 
 If good cookery be the most important of arts, 
 
 94
 
 CAP. V.] THE HUMAN TEMPERATURE. 95 
 
 the second place may be fairly assigned to 
 proper forms and methods of dress. I propose 
 to submit a few considerations on clothing as 
 a means of keeping the body warm, that is, of 
 preventing undue loss of heat at times when 
 the external temperature is far below that of 
 the body. 
 
 Owing to the common use nowadays of the 
 clinical thermometer, most persons are aware 
 that the normal temperature of the human body 
 is about 98'6 Fahr. It is, however, subject 
 to important daily fluctuations, which have to 
 be considered in estimating any decided altera- 
 tions. It is sufficient here to notice that the 
 human temperature falls to its lowest about 
 one or two o'clock A.M., while the maximum 
 daily temperature occurs some time in the 
 afternoon. These variations are influenced by 
 food ; but as they occur in fasting persons, 
 they are not altogether dependent upon the 
 supply of nourishment. Exercise has a de- 
 cided effect in raising the temperature, a fact 
 of which every one is conscious. The appli- 
 cation of cold, as by a cold bath, lowers the 
 temperature of the skin, but raises temporarily 
 that of the internal organs, as it causes an
 
 96 CLOTHING AND COLD. [CAP. 
 
 increased volume of blood to be forced into 
 them. In hot countries the bodily tempera- 
 ture is raised, at all events in new-comers. 
 
 Perhaps the most wonderful phenomenon 
 connected with the bodily temperature is the 
 preservation of its general level under all 
 external circumstances of heat and cold. This 
 power seems to exist in man in a higher 
 amount than in most other animals, since he 
 can not only support but enjoy life under 
 extremes which would be fatal to many. The 
 accounts of degrees of cold frequently sustained 
 by Arctic voyagers are almost incredible. We 
 read of temperatures 80, 90, and even 102 
 below the freezing-point. On the other hand, 
 in the tropics the temperature often rises 
 through a large portion of the year to 1 1 o 
 or even higher, and we know that workmen 
 can remain in furnaces at a temperature of 300 
 or more without inconvenience. In all these 
 cases the air must be dry and still ; similar 
 extremes of heat or of cold accompanied by 
 moisture would prove intolerable. 
 
 This power of spontaneous regulation of the 
 temperature resides in a mechanism whereby 
 more or less blood is sent to the skin as a
 
 V.] LOSS OF HEAT. 97 
 
 result of relaxation or of contraction of its 
 blood-vessels. When the skin is heated, its 
 vessels relax and contain a surplus of blood, 
 which, if exposed to ordinary external in- 
 fluences, rapidly becomes cooler. Heat is lost 
 in three ways viz., by radiation, conduction, 
 and evaporation, the amounts given off by these 
 means varying according to circumstances. It 
 is estimated that about 70 per cent, of the 
 whole amount of the animal heat passes 
 off through the integument. If the skin be 
 freely exposed to cool air, much heat is lost by 
 radiation ; if the air be dry and in motion, a 
 still larger quantity of heat becomes latent by 
 the evaporation of the water excreted by the 
 sweat-glands. Thus it is that, under normal 
 conditions, a rise in the bodily temperature 
 causes a flow of blood to the skin, followed 
 by cooling. A man warmed by exercise, and 
 exposed to a current of air, rapidly becomes 
 chilled, and perhaps catches cold. Lowering 
 of the temperature, on the other hand, 
 diminishes the quantity of blood in the skin, 
 so that radiation and conduction of heat from 
 the surface are reduced to a minimum. Evapo- 
 ration and radiation from the internal surface 
 
 7
 
 98 CLOTHING AND COLD. [CAP. 
 
 of the lungs constitute another means whereby 
 heat is lost ; but for our present purpose it 
 is unnecessary to do more than notice the fact. 
 
 The main use of clothing is to protect the 
 body generally and to maintain it at an equable 
 and proper temperature. Civilised man, who 
 is compelled to wear artificial clothing, is so 
 far less favourably situated than the lower 
 animals, who are provided with sufficient 
 natural covering. This drawback is, however, 
 more than counterbalanced by the opportunities 
 which clothing affords of rendering the wearer 
 comparatively independent of external circum- 
 stances of climate. 
 
 The materials used for clothing are derived 
 mainly from the animal and vegetable king- 
 doms. It is only necessary to mention the 
 most important, and to refer to their properties. 
 
 From the animal kingdom we get wool, silk, 
 furs, skins, leather, and feathers. The vege- 
 table kingdom supplies us with cotton, flax, 
 and their derivatives, and likewise with hemp, 
 jute, indiarubber, gutta percha, etc. Wool is 
 by far the most important article of clothing ; 
 it is a modification of hair, and is furnished 
 by the sheep, goat, camel, and other animals ;
 
 V.] WOOL AND SHODDY. 99 
 
 wool consists of round fibres, made up of a 
 number of little cornets which have become 
 united. Under the microscope, the surface of 
 the fibres is seen to present imbricated scales 
 which all take one direction. These scales 
 cause woollen fibres to adhere tightly together 
 and make it difficult to unravel woollen cloths. 
 Under the influence of moisture and pressure 
 the interlacement becomes very close and firm, 
 owing to the interlocking of the scales. The 
 finest wools have the most numerous and 
 pointed serrations ; as many as 2,800 per inch 
 have been counted in specimens of the finest 
 Saxony wool. In old and worn wool these 
 scales become indistinct, and are more or less 
 obliterated. Besides forming cloth of various 
 kinds, wool is made up into flannel, blankets, 
 kerseymere, etc. Alpaca is the fleece of a genus 
 of animals inhabiting South America ; mohair 
 is obtained from a particular kind of goat. 
 
 Shoddy is a modification of wool ; its manu- 
 facture has developed into a large industry. 
 It is made from old woollen cloth and woollen 
 goods of all kinds ; even old stockings, no 
 longer worth darning, are convertible into 
 shoddy. Having fulfilled their course, during
 
 TOO CLOTHING AND COLD. [CAP. 
 
 which each article has perhaps clothed many 
 different individuals, woollen materials of all 
 kinds find their way to the shoddy-mill, in 
 which they are torn asunder. After undergoing 
 various processes of cleansing, the fibres are 
 re-spun and re-woven with a certain admixture 
 of fresh wool. If the original fabrics have 
 been of good quality, the cloth containing the 
 shoddy will present a very respectable appear- 
 ance, but the wearing properties will be more 
 or less impaired. The jagged serrations will 
 have been worn away, and the fibres no longer 
 cling to each other with the same degree of 
 tenacity. After the shoddy-making process 
 has been repeated several times, the fibres 
 split up and become quite smooth. 
 
 Shoddy is now absolutely necessary for the 
 clothing of mankind. If its manufacture were 
 to cease, at least half our population would be 
 deprived of woollen clothing. Even the best 
 cloth may contain an appreciable amount of 
 shoddy ; the cheaper kinds may be almost 
 entirely composed of it. Its presence is diffi- 
 cult to detect ; the resisting power of cloth is 
 the best means of determining whether shoddy 
 has been mixed with new wool. Cloth ought
 
 V.] SILK AND FUR. IOI 
 
 to bear a certain weight before tearing, and 
 at the Government Clothing establishments a 
 machine is used by which the force required 
 can be measured. Cloth containing shoddy 
 is not only weaker and less resistant, but it is 
 a less efficient protector against cold. 
 
 Silk is yielded by the silkworm, and consists 
 of very fine tenacious filaments. It is the 
 strongest of all textile materials, but unfortu- 
 nately is capable of blending with many 
 chemical substances in such proportions as to 
 produce articles which may contain as little as 
 10 per cent, of true silk. Several salts of iron 
 and tin, tannin, sumach, gambier, and other 
 substances are capable of converting silk into 
 expanded fibres, consisting of a conglomeration 
 of more or less of these materials. 
 
 Fur has been used as an article of clothing 
 from the earliest times. In Arctic countries 
 it is, of course, indispensable. The combi- 
 nation of leather and hair is specially adapted 
 to protect the body from wind and cold. 
 Felt is made from the hair removed from 
 the leather. The compactness and cohesive- 
 ness of felt are mainly due to the serrations 
 already described as typical of hair.
 
 IO2 CLOTHING AND COLD. [CAP. 
 
 Materials for clothing derived from the 
 vegetable kingdom require only a short notice 
 in this article. Of these, cotton is the most 
 important ; it consists of minute, exceedingly 
 hard fibres, which absorb water slowly and 
 scantily, and conduct heat much more rapidly 
 than wool. As an article of clothing, linen 
 closely resembles cotton, but it is a better 
 conductor of heat, and absorbs water more 
 freely. 
 
 The question as to the best material for 
 clothing cannot be answered off-hand or in 
 a few words. It has been urged that the 
 " natural clothing " of animals is the " natural " 
 and only proper clothing for the first of all 
 animals man. Dr. Poore thinks that an 
 assertion of this kind is "in some degree 
 similar to the old dogma that animal heat 
 was different from other kinds of heat a 
 plausible theory, which the hatching of eggs 
 in incubators by means of artificial heat has 
 done much to explode." 
 
 The fact, however, remains that for certain 
 purposes woollen clothing, furs, and skins 
 cannot be replaced by any other materials. 
 Experience teaches us that such is the case,
 
 V.] SOURCE OF WARMTH. 1 03 
 
 and an explanation is not far to seek. In 
 common language, certain fabrics are described 
 as " warm," while others are classified as 
 " cool." It is hardly necessary to say that 
 neither warmth nor coldness is a property of 
 the materials themselves. Some feel warm 
 because they prevent the escape of the natural 
 heat of the body that is, they are bad 
 conductors of heat ; others feel cold, because 
 they permit the bodily heat readily to pass 
 off, and the cooler temperature of the air is 
 no longer antagonised in the same degree. 
 The source of the warmth is within the body, 
 in like manner as the heat of a furnace is 
 derived from the materials in process of 
 combustion within it. 
 
 Now wool is a bad conductor of heat, and 
 it owes much of its power in this respect 
 to the amount of air entangled in the meshes 
 formed by its fibres. The conducting power 
 of linen and cotton is nearly twice that of 
 wool. There is much probability in Dr. 
 Poore's view that the power of different 
 clothing materials in keeping the body warm 
 depends more upon the amount of air en- 
 tangled than upon the substances used in the
 
 IO4 CLOTHING AND COLD. [CAP. 
 
 construction of the fabric. Different materials 
 are habitually woven in different ways, and 
 " the fact that one material is warmer than 
 another is often due to the fact that it lends 
 itself by its nature to a particular mode of 
 manufacture. Woollen materials are always 
 more porous than linen fabrics, and it is 
 mainly owing to this fact that the one is 
 warmer than the other." Air, in common 
 with gaseous bodies in general, is an extremely 
 bad conductor of heat ; but this property 
 cannot be easily demonstrated, owing to the 
 extreme mobility of particles of air. If such 
 motion be hindered or retarded, the con- 
 ductivity of air becomes very small. We 
 make use of this property of air in various 
 ways. If we wish to keep a liquid warm, 
 it is placed in a vessel and surrounded by 
 shavings, straw, and the like, which entangle 
 large volumes of air in their meshes. A 
 more obvious illustration is afforded by double 
 windows, which are often used in cold climates 
 to keep rooms warm. The effect is really 
 due to the non-conducting layer of air 
 interposed between them. It is for the same 
 reason that two shirts are warmer than one
 
 V.] WIND AND CLOTHING. 1 05 
 
 of the same material, but of double the 
 thickness. The Chinese and Japanese adopt 
 the plan of wearing many layers of clothing, 
 each layer being formed almost exactly like 
 its fellow ; by diminishing or increasing the 
 number of layers, the wearers protect them- 
 selves against the vicissitudes of climate. 
 
 When the air is in active motion as well 
 as cold, the necessity for non-conducting 
 coverings is still more obvious. Wind carries 
 off the layers of air in contact with the body, 
 replaces them by colder air, and promotes 
 evaporation whereby the temperature is 
 lowered to an almost indefinite extent. Every 
 one knows the sensation caused by wind 
 blowing on damp clothes or on the wet skin, 
 and the intense cold thus experienced. To 
 obviate this effect, the wind must be prevented 
 from reaching the surface of the body, and 
 for this purpose skins and furs are the 
 most efficient coverings. These constitute 
 extremely warm clothing, and cannot be 
 dispensed with in many parts of the world. 
 It is perhaps well to repeat that these articles 
 possess no warmth in themselves. When 
 worn, they prevent the natural heat of the
 
 IO6 CLOTHING AND COLD. [CAP. 
 
 body from being rapidly dissipated and 
 neutralised by the external cold air. Next 
 to these come thick, coarse, woollen fabrics 
 which entangle and retain large volumes of 
 air. These are especially suitable whenever 
 great fluctuations of temperature have to be 
 encountered. 
 
 Besides the properties already mentioned, 
 there is another peculiarity connected with 
 wool which enhances its value as an article of 
 clothing viz., its power of absorbing water, 
 which penetrates into the fibres themselves 
 and causes them to swell, and also occupies 
 the spaces between them. This property is 
 a very important one as regards health. The 
 normal skin gives off nearly a pint of water, 
 in the form of perspiration, during twenty-four 
 hours, and this fluid disappears by evaporation. 
 The passage of liquid into vapour causes heat 
 to become latent, and the bodily temperature 
 is thus lowered, as may be clearly observed 
 some little time after exertion. If dry woollen 
 clothing be put on immediately after exercise, 
 the vapour from the surface of the body is 
 condensed in and upon the wool, and the 
 heat which had become latent in the process
 
 V.] COTTON AND WOOLLEN CLOTHING. IO/ 
 
 of evaporation is again given off. Flannel 
 clothes, therefore, put on during perspiration 
 always feel warm, whereas cotton and linen 
 articles allow the perspiration to pass through 
 them, so that the evaporation and cooling 
 processes are unchecked. There is, there- 
 fore, an obvious reason for selecting flannel 
 clothing for wearing after active exertion. 
 An individual who is perspiring freely is 
 far less likely to take cold when clad in 
 flannel than when clad in linen or cotton. 
 Dr. Poore thinks that by adopting a looser 
 method of weaving the material, cotton might 
 be made to acquire properties similar to those 
 of wool. If linen or cotton be woven " in a 
 loose porous fashion, these fabrics then become, 
 as heat-retainers, scarcely inferior to wool." 
 
 Woollen fabrics cause a sensation of warmth 
 in virtue of another peculiarity which they 
 possess. They often present a rough surface, 
 which, coming into contact with the skin, 
 causes friction, and therefore more or less 
 warmth. The irritation thus produced is 
 intolerable to some persons, but if it can be 
 borne with for a short time the skin often 
 gets accustomed to the sensation.
 
 108 CLOTHING AND COLD. [CAP. 
 
 The colour of the materials has some influ- 
 ence on the warmth of clothing. Black and 
 blue absorb heat freely from without, but white, 
 and light shades of yellow, etc., are far less 
 absorbent. This difference can be demon- 
 strated by experiment ; the same material, 
 when dyed with different colours, will absorb 
 different amounts of heat. In hot countries 
 white coverings are universally worn, and 
 sailors and others wear white clothing in hot 
 weather. With regard, however, to heat given 
 off from the body, the colour of the materials 
 used as clothing makes little if any difference. 
 Red flannel is popularly supposed to be 
 warm, though it is no better in this respect 
 than similar materials of equal substance but 
 white or grey in colour. Dark clothing is 
 best for cold weather, because it more freely 
 absorbs any heat that is obtainable. 
 
 Waterproof clothing is very valuable under 
 certain conditions. It protects against cold, 
 rain, and wind ; but it is an exceedingly hot 
 dress, for it prevents evaporation, and con- 
 denses and retains the perspiration. Save 
 for very short periods, it should never be 
 worn by persons taking active exercise. For
 
 V.] PROTECTION AGAINST WET. 
 
 those, however, who are not exercising their 
 limbs to any great extent, but are exposed 
 to wet and cold, waterproof materials are an 
 excellent protection. Woollen should be worn 
 underneath in order to absorb perspiration, 
 and the waterproof should be taken off as 
 soon as the necessity for it has passed away. 
 Ventilating \\;aterproofs are sometimes offered ; 
 but a real combination of this kind is an 
 impossibility. If a garment let out air and 
 perspiration, it will let in wind and wet ; 
 if thoroughly waterproof, it will not admit 
 of any true ventilation. 
 
 With regard to woollen clothing as a pro- 
 tection against wet, it must be remembered 
 that fabrics of this kind, especially if loosely 
 woven, absorb an enormous amount of water. 
 A man clad in thick woollen clothes, and 
 walking in rain for some hours without other 
 protection, is conscious of great weight and in- 
 convenience. Under similar conditions, cotton 
 and linen garments are speedily saturated, 
 and the wearer soon becomes chilled. 
 
 Garments made of pure silk are exceedingly 
 comfortable, but very expensive. Thin silk, 
 worn under flannel, adds greatly to the pro-
 
 I IO CLOTHING AND COLD. [CAP. 
 
 tection afforded by the latter against chills, 
 and likewise prevents the unpleasant sensation 
 of friction. Thin silken socks, worn under 
 merino or woollen ones, form a good remedy 
 for cold feet. 
 
 The principal conclusions to be drawn from 
 the foregoing paragraphs may be thus briefly 
 stated : 
 
 i. As a protection against cold, woollen 
 garments of equal thicknesses are much 
 superior to either linen or cotton, and should 
 always be worn for underclothing. Furs and 
 leather are serviceable against great cold, 
 and especially against severe wind. Water- 
 proof clothing should be reserved for very 
 wet weather, and generally for persons who 
 are not taking exercise when exposed to it. 
 
 2. The value of several layers of clothing 
 as compared with a single warm garment 
 should be borne in mind. An extra layer 
 even of thin material next the skin is often 
 very valuable. 
 
 3. As a protector against cold, a garment 
 should not fit closely to the body, but should 
 be comparatively loose and easy, so that a 
 layer of air is interposed between it and the
 
 V.J GENERAL RULES. I I I 
 
 skin. A loosely woven material is warmer 
 than one of an opposite character. 
 
 4. For wearing at night, woollen clothing 
 is not generally desirable : cotton or linen is 
 far better. The blankets constitute the 
 woollen covering, and ought to protect the 
 body sufficiently. 
 
 5. Lastly, it must always be remembered 
 that the source of heat is within the body 
 itself, and not in the clothes. Proper food 
 coupled with a due amount of exercise will 
 produce heat ; the function of clothing is to 
 retain the heat thus generated.
 
 VI. 
 
 A CONTRIBUTION TO THE 
 ALCOHOL QUESTION. 
 
 IN modern scientific treatises, articles taken 
 as food are divided into two classes 
 food-stuffs and food-accessories. The first 
 includes those animal, vegetable, and mineral 
 products which are familiar to every one and 
 are found necessary to life ; the second, those 
 beverages and condiments which have come 
 to be regarded as essential to comfort. Con- 
 troversy concerning the first class can scarcely 
 be said to exist ; the advocates of vege- 
 tarianism sometimes make themselves heard, 
 but neither their precepts nor their examples 
 are sufficient to overcome the force of habit 
 and the dictates of common sense. The case, 
 however, is far different with regard to one 
 of the articles contained in the class of food- 
 accessories. Certainly no subject of its kind
 
 CAP. VI.] THE EVILS OF DRINK. I 1 3 
 
 has attracted more attention or given rise to 
 more controversy. 
 
 The interest attaching to the use of alcoholic 
 drinks is in great measure due to the terrible 
 accumulation of evils, moral and physical, with 
 which their abuse is associated. What man- 
 kind might have been in the absence of alcohol 
 it is useless to speculate ; the manifold changes 
 which human beings undergo as a result of 
 immoderate use are too easily discernible to 
 require description. Too many of us can 
 recall instances in which the ruin caused by 
 alcohol entitles it to be called " the devil in 
 solution." 
 
 There can be no difference of opinion as 
 to the mental and physical degradation due to 
 this agent, and to it alone ; but, on the other 
 hand, we are confronted with the very remark- 
 able fact that the use of alcohol dates from very 
 early times, and that it is well-nigh universal 
 among civilised nations. It would appear, 
 indeed, that the amount of alcohol consumed is 
 proportionate to the degree of civilisation, and 
 that, as regards capacity for work, the advan- 
 tage is clearly with those races which use 
 alcoholic drinks. 
 
 8
 
 114 THE ALCOHOL QUESTION. [CAP. 
 
 The widespread use of alcoholic drinks is 
 due to the fact that their production is effected 
 in the easiest possible manner, and that the 
 requisite materials are to be found in most 
 parts of the world. Given a solution of sugar, 
 a ferment, and a due degree of heat, and 
 alcohol is more or less rapidly formed. The 
 sugar is broken up into carbon dioxide, most of 
 which escapes in the form of gas, and alcohol, 
 which remains in solution. The manufacture 
 of alcoholic fluids is usually associated in our 
 ideas with complicated apparatus, " plant," and 
 large establishments ; but these are requisite 
 mainly because the products have to be 
 supplied on a large scale, and in the form of 
 palatable beverages. In the islands of the 
 Indian Archipelago, and in- many parts of 
 Africa, an intoxicating drink is readily obtained 
 by making incisions into a palm-tree, catching 
 the juice in a suitable vessel, and allowing it 
 to stand for a few hours. 
 
 Many questions are connected with the use 
 of alcoholic drinks, and some of them justly 
 excite the deepest interest, and for the follow- 
 ing reasons : (i) the enormous consumption 
 of such drinks in the United Kingdom and in
 
 VI.] EFFECTS OF ALCOHOL. 115 
 
 other European countries ; (2) the amount 
 invested in their production and distribution ; 
 (3) their value, or otherwise, when taken in 
 moderation ; (4) the manifold evils, in the 
 shape of poverty, crime, and disease, caused 
 by excess. A consideration of the best means 
 of inducing temperance or abstinence is in- 
 vested with peculiar interest. 
 
 The effects of alcohol, in small, moderate, 
 and large doses, have been minutely studied by 
 a host of competent observers ; and yet much 
 difference of opinion exists as to the terms in 
 which its general action may be accurately 
 described. It is usually regarded as a stimu- 
 lant ; indeed, as the stimulant par excellence. 
 On the other hand, in the opinion of some 
 well-recognised authorities, the notion con- 
 veyed by the word " sedative " would best 
 express the action of alcohol. In order to 
 ascertain what ground there is for this latter 
 view, it is necessary to refer to the effects of 
 alcohol ; they are conveniently divided into 
 three stages, known respectively as excitement, 
 intoxication, and coma or insensibility. 
 
 i. A small or moderate dose of alcohol (say 
 two tablespoonfuls of brandy), properly diluted,
 
 Il6 THE ALCOHOL QUESTION. [CAP. 
 
 produces in an ordinary individual more or 
 less distinct evidences of excitement. The 
 heart beats more frequently and with more 
 force, the superficial vessels are dilated, and 
 hence the skin of the face and hands appears 
 flushed, the eyes are animated and perhaps 
 somewhat reddened, the intellectual faculties 
 are excited, the individual is more disposed to 
 joy and pleasure, cares disappear, and ideas 
 flow with greater rapidity and ease. Under 
 the influence of a somewhat larger dose, many 
 persons exhibit a strong disposition to talk, 
 very few are noticed to become taciturn ; 
 indiscretions of various kinds are apt to be 
 committed. It has been often asserted that 
 the true nature of the individual is brought out 
 by alcohol ; this question will be subsequently 
 referred to. In any case, it is obvious that 
 alcohol has a specific action upon the nervous 
 system, the different parts of which it affects 
 in a more or less definite order. It acts upon 
 the nervous structures in a twofold manner : 
 first, by coming into contact with them, and, 
 secondly, by increasing and accelerating the 
 circulation through them. Dr. Brunton thinks 
 that the nervous tissues are affected in the
 
 VI.] INTELLECTUAL DISORDERS. I I J 
 
 inverse order of their development, the highest 
 centres being affected first and the lowest last. 
 Thus the power of judgment usually goes first, 
 while the imagination may be lively and the 
 emotions more than usually active ; so that, 
 after a man becomes incapable of discussion, 
 he is combative, affectionate, or lachrymose. 
 The motor centres may be next affected, either 
 after or before the perceptive centres, so that 
 the speech may be uncertain and thick while 
 the power of judgment is little affected, or the 
 speech may remain tolerably distinct after the 
 power of clear conception is entirely gone. 
 This condition, however, belongs rather to the 
 second stage. 
 
 2. This is characterised by disorder of the 
 intellectual functions and of the will, manifested 
 by delirium and loss of power over voluntary 
 muscles. To quote again from Dr. Brunton, 
 the cerebellum appears to be affected some- 
 times before and sometimes after the cerebrum. 
 This depends partly upon the constitution of 
 the individual, and partly upon the quality 
 of the alcoholic liquor. The affection of the 
 cerebellum gives rise to double vision and 
 inability to walk, from the relations of surround-
 
 Il8 THE ALCOHOL QUESTION. [CAP. 
 
 ing objects being no longer correctly perceived. 
 After both cerebrum and cerebellum are 
 paralysed, the spinal cord may still retain 
 its functional activity, so that the man who 
 cannot walk may be able to ride, owing to the 
 reflex contraction of certain large muscles of 
 the thigh produced by the impression of the 
 saddle. This second degree is often accom- 
 panied by nausea and vomiting, a sense of 
 exhaustion, and an irresistible desire for sleep, 
 which may continue for some hours. When 
 the person awakes, he is conscious of head- 
 ache, thirst, malaise, loathing of food, and 
 other disagreeable feelings. The varieties 
 of the phenomena observed depend in the 
 main upon the temperament of the individuals. 
 A classification of drunkards can indeed be 
 founded upon these peculiarities. Thus the 
 surly, the melancholic, the nervous, the choleric, 
 and the phlegmatic drunkard may be easily 
 distinguished. 
 
 3. Coma or insensibility. This state, in 
 which there is profound unconsciousness, is 
 most often observed when large quantities of 
 spirit have been swallowed in a short time. 
 In many of its features it resembles apoplexy,
 
 VI.] DESTRUCTION OF DIGESTION. Iig 
 
 and mistakes are not infrequently made. Re- 
 covery is, of course, the rule ; but death may 
 ensue from paralysis of the heart or of the 
 muscles of respiration. 
 
 The effects of the prolonged use of excessive 
 quantities of alcohol, though differing in form 
 in different individuals, are for the most part 
 easily recognised. Digestion suffers ; the 
 appetites of drunkards are seldom normal ; 
 sickness and distaste for food are very common 
 symptoms. The liver is very prone to become 
 affected ; the condition known as gin-drinker's 
 liver has been recognised and studied from 
 a very early period. It may doubtless be 
 caused by other kinds of spirit ; but the dram- 
 drinker usually selects gin because of its low 
 price, and hence the disease of the liver is 
 called after the name of the particular spirit 
 which generally occasions it. If alcohol be 
 never taken in the neat state, but always 
 freely diluted with water, there is far less 
 chance of its causing this form of disease. 
 
 It is, however, in the nervous system that 
 the effects of the chronic abuse of alcohol are 
 most clearly marked. The tremulous hand, 
 the quivering lips and tongue, and the un-
 
 120 THE ALCOHOL QUESTION. [CAP. 
 
 steady walk are among the earliest signs. 
 The will becomes weakened and the moral 
 sense blunted ; we meet with drunkards who 
 are so completely the slaves of their tyrannical 
 appetite for drink that they are ready to gratify 
 it at any sacrifice. The explosions known as 
 delirium tremens, which constitute a connect- 
 ing link between intoxication and insanity, are 
 due to poisoning of the blood and perverted 
 nutrition of the brain ; they are a measure 
 of the degree in which the nervous system 
 is implicated. But there are other results, 
 less familiarly known perhaps, but of graver 
 significance, and due to the implication of 
 many of the large nervous trunks. These 
 latter become inflamed, hardened, thickened, 
 and painful, and there is loss of power in the 
 limbs. This condition is more often seen in 
 women than in men, and the lower extremities 
 most frequently suffer. Complete paralysis 
 is sometimes thus produced. 
 
 This sketch of the physiological action of 
 alcohol would seem to prove that the effects 
 of small doses are clearly of a stimulating 
 character, but that these sooner or later pass 
 off and are succeeded by others of an opposite
 
 VI.] SEDATIVE EFFECTS OF ALCOHOL. 121 
 
 kind. After large doses, the stage of excite- 
 ment is very short, while the phenomena indi- 
 cative of depression are apt to be very marked. 
 The expression "dead-drunk" is not a whit 
 too strong to describe the condition which 
 alcohol is capable of producing. The total 
 loss of motor power and the almost complete 
 abolition of sensation closely resemble death. 
 It is a well-known fact that drunken men 
 often receive serious injuries without any 
 consciousness of pain. But these sedative or 
 anaesthetic effects of alcohol are made apparent 
 in a very different manner, and are capable 
 of being produced even by moderate doses. 
 Dr. Wilks indeed asserts that it is really for 
 the purpose of producing sedative effects that 
 this so-called stimulant is eagerly swallowed 
 by the multitude. He points to the fact that 
 persons under the influence of grief not infre- 
 quently turn for comfort to alcoholic liquors, 
 with the object of drowning their troubles in 
 the bowl. It would be absurd for them to 
 have taken a stimulant to excite greater mani- 
 festations of grief, or to make them feel their 
 troubles more acutely. It would be easy to 
 multiply examples of this kind, and to show
 
 122 THE ALCOHOL QUESTION. [CAP. 
 
 that sedative effects are often sought for ; but, 
 on the other hand, alcoholic drinks are taken 
 under precisely opposite conditions, and 
 obviously for the purpose of stimulating feel- 
 ings which are beginning to be experienced. 
 Dr. Wilks' explanation will hardly account for 
 the use of alcohol on these occasions. He 
 maintains that its quieting effects constitute 
 its great value at the dinner table. " Both 
 Matthew Arnold and Wendell Holmes upheld 
 its advantages in this respect. Without it, 
 the guests would be quarrelling or keenly 
 discussing political or religious subjects with 
 apologies to teetotallers but wine comes in, 
 rubs off the acerbities, and brings all down to 
 the same level of good humour." It is surely 
 more reasonable to suppose that wine in small 
 quantities makes men more companionable by 
 quickening the flow of ideas and by increasing 
 temporarily the power of expression. More- 
 over, it creates a feeling of warmth and comfort, 
 and excites the appetite. 
 
 In most discussions upon alcohol, and almost 
 invariably among teetotallers, spirits, wines, 
 and beer are placed in one and the same 
 category, as if all were equally mischievous.
 
 VI.] INTOXICANTS AND STIMULANTS. 123 
 
 Common experience, however, shows that 
 these liquors differ remarkably in their effects. 
 If we compare wine with spirits, we find that 
 the former possesses certain tonic properties 
 not attributable to the latter. Again, the 
 stimulating effect of wine is more slowly pro- 
 duced and lasts longer than that of spirits. 
 But perhaps the most important distinction 
 consists in the fact that the intoxicating influ- 
 ence of wine is less than that of a mixture, 
 say of brandy and water, containing the same 
 quantity of alcohol, and is not proportionate in 
 different wines to the amount of alcohol they 
 contain. Analysis shows that eight parts of 
 brandy, by measure, contain about the same 
 quantity of alcohol as eighteen-and-a-half parts 
 of port wine. If the intoxicating power of 
 various liquors were proportionate to the spirit 
 contained in them, a pint of port wine would 
 be almost equal to half-a-pint of brandy. We 
 know, however, that such is not the case. 
 Again, champagne contains less alcohol than 
 claret, but is far more intoxicating. It would 
 seem probable that the action of the alcohol is 
 modified by that of the other constituents of 
 the wine. As to the manner in which this
 
 124 THE ALCOHOL QUESTION. [CAP. 
 
 effect is produced, it is impossible to speak 
 with certainty. It may be that the other 
 constituents are in chemical combination with 
 the spirit, for it is generally admitted that a 
 brandied wine that is, a wine to which spirit 
 has been added is more intoxicating than a 
 natural wine of the same alcoholic strength. 
 
 It is, of course, true that some of the most 
 prominent effects of intoxicating liquors are 
 directly due to the quantity of alcohol contained 
 in each, though other ingredients must not be 
 disregarded. Spirits contain about 50 per 
 cent, of alcohol ; wines vary greatly in this 
 respect, the proportion in sherry and port 
 sometimes rising as high as 25 per cent., while 
 it may fall as low as 7 in Bordeaux and Rhine 
 wines. Ordinary beer contains about 5 per 
 cent., but in strong ales this proportion may 
 be doubled. Besides alcohol, brandy contains 
 minute quantities of various ethers. These are 
 more numerous and abundant in wine, and give 
 rise to the odours, in addition to modifying the 
 effects of the alcohol. Beer contains, besides 
 alcohol, a considerable quantity of sugar, with 
 free acid and salts. 
 
 The differences between the effects of these
 
 VI.] ABSORPTION OF ALCOHOL. 125 
 
 three classes of liquors are often clearly de- 
 monstrated in the cases of persons who take 
 habitually immoderate quantities, but confine 
 themselves for the most part to one form of 
 liquor. Hogarth, in his well-known pictures, 
 Beer Alley and Gin Lane, has faithfully repre- 
 sented the differences between topers devoted 
 to malt liquor and dram-drinkers. He has 
 depicted the former as rubicund, corpulent, 
 and bloated ; the latter, as pale, thin, or 
 emaciated. Wine-bibbers are for the most 
 part full-blooded and corpulent. The majority 
 of drunkards, however, do not confine them- 
 selves to one class of liquors ; though the 
 practised dram-drinker usually despises all 
 fluids less potent than spirits. 
 
 Much controversy has taken place on the 
 important question as to whether alcohol 
 undergoes any changes after being taken into 
 the body, or whether it is eliminated un- 
 changed. It is certainly absorbed by the 
 mucous membrane of the stomach, and passes 
 into the blood, by which it is conveyed to all 
 parts of the body. At least a portion very 
 soon begins to leave the tissues, for it can be 
 detected in the breath shortly after it is taken,
 
 126 THE ALCOHOL QUESTION. [CAP. 
 
 and smaller quantities escape by the skin and 
 other organs. In cases of fatal intoxication, 
 the odour of the alcoholic liquor can be de- 
 tected in the fluid contained in the ventricles 
 of the brain, and some authorities have sup- 
 posed that a peculiar affinity exists between 
 the brain-substance and alcohol. More recent 
 investigations have shown that this fluid does 
 not accumulate in any special manner in the 
 nervous tissue. It has also been pretty clearly 
 proved that alcohol, taken internally, is not 
 entirely eliminated as such, but that some of 
 it is decomposed in the system. As to the 
 proportion thus changed, no exact statement 
 can be made ; but, admitting the fact, we 
 cannot deny that alcohol is a food in the strict 
 sense of the word. This inference is supported 
 by those cases in which only minute quantities 
 of ordinary aliment are taken during several 
 months, or even years, but wines and spirits 
 are freely administered, the patient meanwhile 
 showing no loss of weight. Dram-drinkers, 
 likewise, are often very small eaters. In both 
 classes of cases the alcohol, besides acting as 
 a food, doubtless checks waste and retards 
 normal changes. It is sometimes found that
 
 VI.] ALCOHOL AND OPIUM. 127 
 
 persons losing weight on an insufficient diet 
 not only regain the normal standard after a 
 little alcohol has been added, but even go 
 beyond it. 
 
 The effects of alcohol are often compared 
 with those of opium, when taken to produce 
 pleasurable excitement, sensations of comfort, 
 or dreamy repose. In a general way, opium 
 causes less change in the actions of the person 
 indulging in it than is ordinarily observed after 
 the use of alcohol. Its tendency is to act upon 
 the moral feelings and sentiments, and to 
 soften down excesses of all kinds, while the 
 effect of alcohol is more commonly displayed 
 in excitement of the lower propensities. De 
 Quincey's own observations enabled him to 
 estimate these differences with great accuracy 
 and clearness. After asserting that no amount 
 of opium could produce intoxication (though 
 the spirit used to make the tincture might 
 have that effect), he goes on to show that opium 
 differs from alcohol not merely in the quantity 
 of its effects, but in the quality. Wine dis- 
 orders the mental faculties ; opium introduces 
 among them the most exquisite order, legisla- 
 tion, and harmony. Wine exalts the con-
 
 128 THE ALCOHOL QUESTION. [CAP. 
 
 tempts and the admirations, the loves and 
 the hatreds of the drinker ; opium com- 
 municates serenity and equipoise to all the 
 faculties, active or passive. It is most absurdly 
 said of any man that he is disguised in liquor ; 
 for, on the contrary, most men are disguised 
 by sobriety, and it is only when they are 
 drinking that men display themselves in their 
 true complexity of character, which is surely 
 not disguising themselves. In short, the man 
 who is inebriated, or tending to inebriation, 
 is, and feels that he is, in a condition which 
 calls up into supremacy the merely human, 
 too often the brutal, part of his nature ; but 
 the opium-eater (if not suffering from any 
 disease, or other remote effects of opium) 
 feels, according to De Quincey, that the 
 diviner part of his nature is paramount that 
 is, the moral affections are in a state of 
 cloudless serenity. 
 
 In everyday life the practical questions 
 with regard to alcohol are mainly two viz., 
 Is its regular use in small quantities a univer- 
 sal necessity ? and are such small quantities 
 mischievous, salutary, or practically without 
 effect ? It is around these questions that
 
 VI.] IS ALCOHOL A NECESSITY? I 29 
 
 controversy is always raging, and occasionally 
 assuming volcanic activity. Some years ago 
 the columns of the leading journals were 
 occupied for many weeks with letters on this 
 subject. The impartial reader, after carefully 
 perusing the various statements and opinions, 
 many of them supported by facts of personal 
 history, might say with Faust, und bin so 
 klug als wie zuvor, or with Sir Roger de 
 Coverley, that much might be said on both 
 sides of the question. 
 
 Admitting, as we must, that alcohol is to 
 some extent a food, we know that it is not 
 taken for purposes of nutrition by the great 
 mass of those who use it in moderate quantities. 
 Persons who are honest and intelligent say 
 that they take it because they like it ; because 
 it makes them feel more comfortable ; because 
 they enjoy their food better than when plain 
 water is taken ; because it helps them to sleep, 
 etc. Now all these are perfectly valid reasons, 
 and as such ought to be respected. They 
 are not to be thrust aside by the assertion 
 that such an auxiliary is a dangerous one, 
 and that its good effects are much overrated, 
 and, if not, are more than counterbalanced by 
 
 9
 
 I3O THE ALCOHOL QUESTION. [CAP. 
 
 others of an opposite character. Experience 
 is unshaken by such assertions, and is strongly 
 reinforced by the fact that alcohol, in some 
 form or other, is in common use among 
 civilised nations. It may well be asked, Is 
 such experience to go for nothing ? 
 
 It may be granted without demur that, to 
 the healthy individual, alcohol is by no means 
 a necessary article of diet. The same state- 
 ment holds good of tea and coffee. Pleasant 
 and useful as these beverages may be, they 
 are not indispensable ; their introduction was 
 a great innovation, and their use was long 
 confined to the wealthy. They are stimulants, 
 producing a decided effect upon the nervous 
 system ; they are mischievous when taken in 
 excess, and some people abstain from them 
 altogether. Speaking broadly, they supply 
 that craving for stimulants which seems to 
 be innate in the human system ; and, because 
 they do this, their use has become so common. 
 
 No sweeping statement ought to be made 
 as to the necessity for alcohol. In settling 
 the question in any given case, we have to 
 consider the surrounding physical conditions 
 of the individual ; his work, whether mental
 
 VI.] TEMPERATE MEN. 13! 
 
 or bodily, whether hard or moderate ; his food, 
 whether plentiful and suitable, or the reverse. 
 For a man in good health, well-fed, working 
 with his limbs out of doors, alcohol is seldom, 
 if ever, necessary, though it is often a very 
 pleasant adjunct to one or more meals. A 
 man who under such circumstances takes two 
 or three glasses of beer daily is a temperate 
 man, and ought to be regarded as such. I 
 fully agree with Dr. Wilks that, in the class 
 of society to which we belong, the beer-drinker 
 is generally a temperate man ; he seems 
 content with his beverage, and to have no 
 desire for anything stronger. No doubt many 
 a man of this kind could get on almost, or 
 quite, as well with water, but he prefers the 
 beer, and therefore takes it. When great 
 and sustained exertion is required, experience 
 shows that alcohol is useless, if not mis- 
 chievous. Soldiers endure fatigue and the 
 extremes of heat and cold far better if alcohol 
 be withheld. Dr. Parkes says that when 
 debarred from spirits and fermented liquors, 
 men are not only better behaved, but are far 
 more cheerful, are less irritable, and endure 
 better the hardships and perils of war. It is
 
 132 THE ALCOHOL QUESTION. [CAP. 
 
 a well-known fact that drinking is the great 
 source of all crime and insubordination in 
 the Army, and that, although much improve- 
 ment has been effected of late years, the belief 
 is dominant in some quarters that ardent spirits 
 impart strength and vigour to the human 
 frame. The obstinacy with which men cling 
 to this groundless belief would surprise those 
 who attempted for the first time to combat 
 this foolish prejudice. 
 
 For persons compelled to lead a sedentary 
 life, a little alcohol taken with meals may be 
 not only pleasant, but often extremely useful. 
 It is found to help digestion, and to brace 
 up and sustain flagging functions. In old age 
 alcoholic stimulants are often very serviceable, 
 especially in relieving sleeplessness, attended 
 with slow and imperfect digestion. The late 
 Dr. W. B. Carpenter, the most sensible and the 
 most intelligent champion of the Temperance 
 cause, found it desirable, in his old age, to take 
 a little wine, and declared that he was the better 
 for it. I purposely refrain from making any 
 remarks on the use of alcohol ,in disease ; this 
 important topic is unfitted for discussion in 
 these pages.
 
 VI.] IS LONGEVITY A TEST? 133 
 
 The greater longevity of total abstainers has 
 naturally been used as an argument in favour of 
 the practice, and it is one that deserves con- 
 sideration, though it must not be pressed too 
 far. To go to the other extreme, it is quite 
 certain that the high rate of mortality among 
 the intemperate is not sufficiently recognised. 
 Dr. Ransome calculates that from 40,000 to 
 50,000 lives are lost every year from alcoholic 
 indulgence. The numbers shown in the 
 Registrar-General's reports fail to represent 
 the actual mortality from this cause. Dr. 
 Newsholme states that liver disease is perhaps 
 the most trustworthy test of alcoholic excess, 
 and that the mortality it causes is six times as 
 high among innkeepers and publicans, and two 
 and-a-half times as high among brewers as 
 among the generality of males. In these 
 classes the mortality from gout and nervous 
 diseases is also invariably high, and alcohol 
 likewise contributes to the mortality from 
 phthisis. 
 
 The statistics of certain assurance offices 
 apparently yield very striking evidence in 
 favour of total abstinence as contrasted with 
 moderation ; but conclusions thus obtained
 
 134 THE ALCOHOL QUESTION. [CAP. 
 
 are by no means absolutely to be relied upon. 
 We never know what another person means 
 by moderation unless we are fully acquainted 
 with his habits of life and ideas on the subject. 
 When we are able to ascertain the habits of 
 so-called moderate drinkers, it often happens 
 that the qualifying epithet is found to be quite 
 out of place. Assurance offices refer to friends 
 for the characters of applicants, who of course 
 mention those who are likely to speak well of 
 them. Their confidence is seldom misplaced ; 
 a free liver, taking himself as the standard, 
 will return his friend as highly moderate or 
 very temperate. Dr. Wilks quotes an Ameri- 
 can authority to the effect that insurance offices 
 which admit moderate drinkers will always 
 have a larger number of risks, and that from 
 a third to one-half of all the inebriates under 
 his care have life policies. It is obviously 
 unfair to compare total abstainers with a class 
 containing so many drunkards. Companies 
 who admit moderate drinkers, and leave the 
 question of risk in these cases to the judgment 
 of examiners, will always have a large number 
 of these dangerous risks and a larger mortality. 
 " What we want is a comparison between
 
 VI.] TOTAL ABSTAINERS. 135 
 
 total abstainers and really moderate drinkers. 
 We have this in the tables published by the 
 United Kingdom Temperance Association and 
 the Clergy Mutual Assurance. Among the 
 clergy we have abstainers and moderate 
 drinkers, but very few intemperate lives, so 
 that we may well compare them with the total 
 abstainer." Dr. Wilks' states that, so far as he 
 can understand the tables, the clergy, includ- 
 ing the moderate men, have a slight advantage 
 over the total abstainers. We have no 
 statistics enabling a comparison to be made 
 between the lives of spirit-drinkers and those 
 of wine-drinkers. Even if pure examples of 
 both types were procurable in sufficient 
 numbers, it would be impossible to eliminate 
 the influence of other agencies favourable or 
 unfavourable to longevity. It must also be 
 borne in mind that there are at least two 
 classes of total abstainers : those who have 
 never tasted the accursed thing, and those who 
 have become abstainers because at some time 
 or other of their lives they have tasted a great 
 deal too much of it. Even if other conditions 
 were equal, the prospects of longevity for 
 individuals belonging to these two classes
 
 136 THE ALGOHOL QUESTION. [CAP. 
 
 would necessarily be very different. There 
 is another point, already alluded to : we have 
 no right to attribute a definite effect to one 
 cause alone when other probable causes exist. 
 Abstinence from intoxicating drinks may 
 well indicate a man's general character, other 
 features of which will be favourable to long- 
 evity. Total abstainers may be credited with 
 the possession of superior prudence in other 
 matters. Long-lived persons are often early 
 risers ; but it is more probable that the 
 vigorous vitality maintains the habit than that 
 the habit alone maintains the vitality. 
 
 To return to the question of moderation in 
 the use of alcohol, although different persons 
 have very different ideas on this subject, 
 certain experiments made by the late Dr. 
 Parkes and others have enabled a satisfactory 
 and definite conclusion to be drawn. In a 
 strong, healthy man accustomed to alcohol in 
 moderation, the quantity given in twenty-four 
 hours that begins to produce effects which can 
 be considered injurious is something between 
 one and two fluid ounces. If this quantity be 
 exceeded, certain effects indicate the advent 
 of that stage in the greater degrees of which
 
 VI.] EXPERIMENTS. 137 
 
 the poisonous effects of alcohol become mani- 
 fest to all. The experiments were made upon 
 two powerful, healthy men, and the conclusions 
 therefore apply to such alone ; in women, the 
 quantity required to produce decidedly bad 
 effects would in all probability be less. For 
 children (except as a medicine in illness), 
 alcohol is always mischievous, and the very 
 small quantity which suffices to produce in- 
 toxication in them indicates that they absorb 
 it rapidly and tolerate it badly. 
 
 The quantity of alcohol above mentioned 
 must be regarded as the maximum ; but as it 
 is expressed in absolute spirit, it is necessary to 
 ascertain how much it represents of ordinary 
 spirituous liquors. Dr. Parkes tells us that 
 one ounce is equal to two ounces of brandy 
 (or whisky), to five ounces of the strong wines 
 (ports, sherries, etc,), to ten ounces of the 
 weaker wines, or to twenty ounces of beer. If 
 these quantities are increased by one-half (corre- 
 sponding to one and a half ounces of absolute 
 alcohol), the extreme limit of moderation for 
 strong men will be reached. Any additional 
 quantity must be deemed excessive and cer- 
 tainly injurious.
 
 138 THE ALCOHOL QUESTION. [CAP. 
 
 As supplementing Dr. Parkes' estimate, 
 much interest attaches to some experiments 
 made by Sir W. Roberts on the effects of 
 alcoholic fluids on the various stages of the 
 process of digestion. It appears that spirits, 
 in dietetic quantities, have no influence on 
 salivary digestion, but wines, probably by virtue 
 of their acidity, check the activity of this 
 process. Gastric digestion is unaffected in the 
 presence of 10 per cent, of proof spirit ; but 
 20 per cent, retards operations, and 50 per 
 cent, altogether checks them. The retard- 
 ing effect of wine and malt liquors is not 
 proportionate to the amount of alcohol con- 
 tained in them ; something else is present 
 which has a more decided effect in this direc- 
 tion. Sherry and port have the most retarding 
 effect ; half a pint of sherry at dinner would 
 make a mixture in the stomach containing 
 25 per cent, of the wine. This proportion 
 would check digestion, and could only be 
 deleterious. Malt liquors have a less retarding 
 effect, but the latter becomes noticeable when 
 20, 40, or 60 per cent, of these fluids are 
 added. 
 
 The fact that alcohol in somewhat full doses
 
 VI.] DIGESTIVE RETARDATION. 139 
 
 tends to retard digestion raises the question 
 as to whether such retardation can ever prove 
 beneficial. If this question can be answered 
 in the affirmative, do we obtain a reason why 
 alcoholic liquors are so frequently taken with 
 meals ? Sir W. Roberts thinks it quite pos- 
 sible that digestive retardation is sometimes 
 useful, and that men take alcoholic beverages 
 in part with the unconscious purpose of com- 
 passing this result. At first sight, it appears 
 strange that great pains should be taken in 
 cooking to make our food digestible and 
 easy of attack by the digestive fluids, and 
 that we should swallow liquids which render 
 such culinary efforts more or less nugatory. 
 Dr. Roberts explains the incongruity on the 
 ground that if the food be rendered too easy 
 of digestion, there arises a risk that the meal 
 will pass too quickly and wastefully into the 
 blood, and on through the tissues into the 
 excretory organs, and so out of the body, 
 before it has been made fully and econom- 
 ically available for the sustenance of the 
 slow nutritive processes. Moreover, a sudden 
 irruption into the blood of large quantities 
 of newly digested aliment would tend to
 
 I4O THE ALCOHOL QUESTION. [CAP. 
 
 disturb the chemical equilibrium of that 
 fluid, and so interfere with the tranquil per- 
 formance of its functions. It would also 
 tend to produce congestion of the liver and 
 other organs, to the general disadvantage 
 and discomfort of the economy. A too rapid 
 digestion and absorption of food may be com- 
 pared to feeding a fire with straw, instead 
 of with slower burning coal. In the former 
 case, it would be necessary to feed often and 
 often, and the process would be wasteful 
 of the fuel ; for the short-lived blaze would 
 carry most of the heat up the chimney. To 
 burn fuel economically, fires are often damped 
 down in order to ensure slow as well as 
 complete combustion. The same process may 
 often be advantageously applied in the diges- 
 tion of food. There is nothing contradictory 
 in making nutritive materials as digestible as 
 possible, and controlling the rate of digestion 
 by the use of certain accessory articles with 
 food. This explanation refers to ordinary 
 eating and drinking ; but it also throws light 
 on the adage that " Good eating requires good 
 drinking." Immoderate meals are sometimes 
 ended by slow soaking in dilute alcohol of
 
 VI.] STRUGGLE AGAINST INTEMPERANCE. .141 
 
 almost all the food taken. Digestion is thus 
 checked and prolonged, and in extreme cases 
 the abdominal canal gets rid of its contents 
 after a very scanty absorption of their nutritious 
 principles into the blood-vessels. Some of ' 
 the direct consequences of gourmandising are 
 thus obviated. 
 
 I have now alluded to the principal points 
 connected with the use of alcoholic liquors by 
 persons in health. It would be easy to refer 
 to other branches of the subject ; but to do 
 so at any length would transgress the limits 
 of an ordinary article. I would observe, in 
 passing, that the Duchess of Rutland's remarks 
 in the New Review (Jan. 1892) on the best 
 methods of combating intemperance are well 
 worthy of perusal, and very encouraging to 
 all workers in this field, Those who are 
 anxious to know what steps the German 
 Emperor proposed to take in order to combat 
 intemperance will find their wants supplied 
 by Mr. Beatty Kingston's interesting pamphlet 
 on the subject as a whole, Much doubtless 
 remains to be done, but the progress made 
 during the last few decades justifies the 
 brightest hopes for the future. The state of
 
 142 THE ALCOHOL QUESTION. [CAP. 
 
 opinion in most circles with regard to drunken- 
 ness is a striking indication of the progress 
 made, but by no means the only one. Some 
 portion of this improvement is due to the 
 teetotallers, but deductions must be made for 
 the consequences of the intemperate language 
 of many advocates of the latter class. The 
 evils of intemperance can scarcely be ex- 
 aggerated, but to fling strong epithets at those 
 who are really temperate only provokes a 
 reaction in favour of drink. In the early days 
 of the teetotal movement it was the habit to 
 show far more abhorrence for moderate 
 drinkers than for actual drunkards. The latter 
 were represented as victims, the former as 
 seducers, the drunkard being tempted into guilt 
 by the example of the moderate. Fanatical 
 declamation was the rule, and hence it came to 
 pass that a teetotaller was commonly regarded 
 as either a knave or a fool. Had it not been 
 for the well-known eminence and honesty of 
 men like the late Dr. Carpenter, the teetotal 
 cause might have been crushed by the weight 
 of ridicule evoked by those who claimed to be 
 its champions. 
 
 All this is changed now ; there are, of course,
 
 VI.] ALCOHOL A LUXURY. 143 
 
 a few fanatics, some of whom, unfortunately, 
 while always clamouring for the help of legis- 
 lation, too often prevent any good from being 
 achieved by its means. In the opinion of the 
 author, little, if any, improvement can be ex- 
 pected from legislation ; the precepts and 
 examples of the temperate will continue to 
 operate, though without the noise and fuss 
 so dear to the fanatical and ignorant. Let us 
 regard alcohol as a luxury for most of those 
 who take it, as a necessity for some persons, 
 and as a poison for others ; let us educate 
 children to do without it ; let us deal with 
 habitual drunkards as we do with lunatics ; let 
 there be continuity in our views and actions, 
 and let us be very careful not to substitute 
 intemperance of thought and word for in- 
 temperance in alcohol.
 
 VII. 
 FASTING AND ITS PHYSIOLOGY. 
 
 A TTEMPTS to discover the period during 
 -I\ which a human being can exist without 
 food, in the ordinary sense of the term, have 
 often been made, and have excited an amount 
 of interest out of all proportion to their scien- 
 tific value. There is reason to believe that, 
 as might have been expected, serious damage 
 to health was the sole result of the experiment 
 in all cases, and that such damage was but 
 poorly compensated by the pecuniary reward 
 which was the usual cause of the experiment. 
 It is certain that the inducement in some form 
 or other must be enormous to cause a sane 
 man to endure such great and prolonged 
 suffering. 
 
 The human body in some respects resembles 
 a steam-engine ; it performs work and requires 
 
 fuel in the shape of food, which, when con- 
 
 144
 
 CAP. VII.] CONSUMPTION OF FUEL. 145 
 
 verted into tissue, furnishes the motor power, 
 the quantity of food required varying with the 
 work done. We may assume that a plough- 
 man requires more food than a tailor, just as a 
 locomotive burns more fuel than a small engine. 
 When very little work of any kind is done, 
 a very little food goes a long way ; if food 
 be withheld altogether, the machine does not 
 stop, for the body itself can be used to supply 
 the fuel, without the necessity for immediate 
 restoration by means of food. The body, 
 therefore, differs from an engine in one very 
 essential point ; the latter cannot consume as 
 fuel the materials of which it is composed, but 
 all its power is derived from the coal or coke 
 in the furnace, and is in direct proportion to 
 the amount consumed. When the supply of 
 fuel is exhausted, the machine stops. The 
 animal organism, on the contrary, consumes 
 its own body ; it burns its tissues, and not its 
 food ; but the latter is required to make good 
 the loss. Long after the food has been trans- 
 formed into the solids and liquids of the living 
 body, the animal organism can go on work- 
 ing and manifesting all its ordinary powers. 
 There is, however, a limit to this consumption 
 
 10
 
 146 FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 of the tissues ; the man who takes no food 
 resembles a spendthrift who lives upon his 
 capital when the latter is exhausted, the end 
 comes. Meanwhile, in the case of the fasting 
 man, the gradual destruction of his tissues is 
 attended by very marked changes. 
 
 The symptoms of fasting have been very 
 carefully studied by means of experiments upon 
 animals, and the information thus obtained 
 has enabled us better to comprehend the 
 phenomena displayed by human beings when 
 deprived of food. The following were the 
 principal symptoms noticed by M. Chossat, 
 a French investigator : The animals remain 
 calm during the first half or two-thirds of the 
 period ; they then become more or less agitated, 
 and this state continues so long as their tem- 
 perature remains fairly high. Some hours 
 before death the temperature rapidly falls, 
 and the animal becomes still, and remains in 
 any position in which it is placed. As the 
 coldness becomes more marked, the weakness 
 increases, the breathing becomes slower, and 
 insensibility gradually passes into death. One 
 important fact must not be overlooked, inas- 
 much as it illustrates the risks to which Succi
 
 VII.] FASTING ANIMALS. 147 
 
 and others exposed themselves. Chossat found 
 that sudden death was not uncommon in 
 starving animals long before the ordinary time, 
 and that the slightest shock was sufficient to 
 destroy life at once. A pigeon kept fasting 
 for a long time falls down and dies when its 
 claws are clipped ; whereas it would have lived 
 for several days if not interfered with. This 
 sudden death occurs from what is termed 
 "syncope" the heart's action is at once 
 arrested when a sensitive nerve is painfully 
 excited. A very slight smart of pain is quite 
 sufficient to cause immediate death in animals 
 thus reduced to a condition of great debility. 
 There is no reason why the same accident 
 should not occur in the human subject, and if 
 " a fasting man " were thus suddenly to expire, 
 it would be a matter of remorse for those who 
 encouraged him in his attempt. 
 
 The loss of weight in fasting animals was 
 carefully determined by Chossat, and he found 
 that it amounted on the average to 40 per 
 cent., but there was a considerable difference 
 between the extremes, and this seemed to 
 depend upon the amount of fat previously 
 accumulated in the body, those animals in
 
 148 FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 which the fat had been most abundant losing 
 the most weight, but living the longest. The 
 above-mentioned proportion may, however, be 
 exceeded, and the animal may yet survive. 
 Some years ago a fat pig was buried in its sty 
 for 1 60 days under soft, of the chalk of a cliff 
 at Dover ; it was dug out alive at the end of 
 that time, reduced in weight from i6olb. to 
 4olb., or no less than 75 per cent. 
 
 The most remarkable facts connected with 
 the loss of weight are that the fat is almost 
 completely used up, no less than 93 per cent, 
 being removed ; the heart loses 44, the muscles 
 in general 42, the bones 17, while the nervous 
 system loses barely 2 per cent. It is evident, 
 therefore, that death occurs when the stock 
 of combustible material is consumed, and that 
 every other tissue gives up its components 
 so as to save the nervous system as much 
 as possible. 
 
 The immediate cause of death from fasting 
 is, in reality, the reduction of the bodily 
 temperature, which must ensue when all the 
 available combustible material is used up. 
 At first the fall is very gradual, but after- 
 wards the decline is more rapid until the
 
 VII.] EXPERIMENTS IN FASTING. 149 
 
 reduction amounts to nearly 30 degrees below 
 the normal point, and death then takes place. 
 Chossat noticed that if whilst in the state 
 of torpor preceding death the animal was 
 artificially warmed and its temperature raised, 
 some amount of consciousness and muscular 
 power was gradually restored, and if food 
 were then cautiously administered, some of 
 the animals experimented upon escaped from 
 impending death. Young animals kept with- 
 out food died sooner than older ones, and, 
 contrary to what we should expect, no very 
 decided difference was made in the duration 
 of life either by withdrawing or permitting the 
 supply of water. 
 
 The possible duration of life, when all food, 
 save water, is abstained from, is the question 
 which experiments like those, for example, of 
 Dr. Tanner and Succi have at least partially 
 solved. Admitting the reality of the former's 
 fast, it would follow that life can be sustained 
 for forty days on water alone. There are, 
 however, other cases which show that this 
 period may be considerably exceeded. In 
 1831 a murderer at Toulouse, in order to 
 escape public execution, committed suicide by
 
 1 5O FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 abstaining from food for sixty-three days. At 
 first, efforts were made to feed him by force, 
 but his violence was so great that these were 
 abandoned, and only ineffectual persuasion was 
 resorted to. During the sixty-three days, he 
 consumed between eight and ten pints of 
 water, on some days taking only a few drops. 
 In the case of the Corsican prisoner, Viterbi, 
 who committed suicide by starvation, life was 
 prolonged for twenty-five days only. It is 
 stated that he took a little water from time to 
 time. Some years ago the notorious poisoner, 
 William Palmer, when under sentence of death 
 in Stafford Gaol, refused food for several days, 
 in the hope of cheating the hangman. On 
 being told, however, that he would be forcibly 
 fed if he persisted in this course, he at once 
 abandoned it. 
 
 Cases of voluntary abstinence for long 
 periods are not unfrequently met with in 
 medical practice. In one, recorded a few years 
 ago, a lady, aged sixty, much distressed by 
 some family trouble, suddenly refused food. 
 She adhered to her determination, and died on 
 the forty-ninth or fiftieth day, having taken 
 nothing but cold water, with the exception of
 
 VII.] SARAH JACOBS. 
 
 two teaspoonfuls of brandy on one occasion. 
 There were no grounds for suspecting any 
 deception. In another case, also that of a 
 lady, aged eighty, life was prolonged for thirty- 
 three days under conditions of total abstinence 
 from food, a few spoonfuls of water daily 
 excepted. The authenticity of the fast was 
 perfectly assured ; she kept quiet in bed, 
 talked but little, and took little notice of those 
 about her. At the end of the first week 
 delirium came on, but ceased after a few days. 
 There was no craving for food, and, inasmuch 
 as there was no physical exertion, the wear 
 and tear of the tissues was reduced to a 
 minimum. 
 
 The case of the Welsh fasting girl, Sarah 
 Jacobs, which excited a painful interest twenty- 
 seven years ago, was of a very different char- 
 acter. The girl was an impostor, and, aided 
 by her parents and others, had pretended to 
 abstain from food for many weeks, but had not 
 lost flesh. In order to clear up the mystery, 
 she was placed under systematic inspection, 
 and she died eight days afterwards from acute 
 starvation. During the greater part of this 
 time she was cheerful, and exhibited nothing
 
 T52 FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 extraordinary. Later on it was found that she 
 could not be kept warm, and she gradually 
 sank into a torpid state, which continued till 
 death. It was a terrible experiment, and one 
 which was utterly unjustifiable. The girl, who 
 was only twelve-and-a-half years old, should 
 have been taken from her friends and treated 
 in a hospital. There was no emaciation visible 
 after death, and, indeed, more than the average 
 amount of fat was present. The rapidity with 
 which death ensued was due to the want of 
 water. 
 
 Seventeen years have elapsed since Dr. 
 Tanner's prolonged fast, which was begun 
 in New York, June 28th, 1880. He was an 
 eccentric man, of respectable character and 
 strong self-will, who endeavoured to make 
 amends for an assumedly unsuccessful medical 
 career by promulgating various startling 
 theories on the subjects of electricity and fast- 
 ing. During the first nine days, he swallowed 
 only a quarter of a pint of water, which, how- 
 ever, he used freely to rinse his mouth and 
 bathe his feet. He found, however, that 
 further abstinence from fluid was impossible ; 
 on the eleventh day he began to take water
 
 VII.] DR. TANNER. 153 
 
 freely, swallowing about five quarts during the 
 next four days, and gaining in bodily weight 
 about 4^1b. It was only natural that this 
 change should excite considerable doubt as to 
 the reality of his fast. He used to go out daily, 
 taking rides and drives, but spent most of his 
 time curled up in his bed. He was reported 
 to be in very poor condition three days before 
 the expiration of the term ; but he accomplished 
 his task, and, according to his own account, 
 without pain or severe distress. He was never 
 delirious. His experiment was unfavourably 
 regarded by the orthodox physicians of New 
 York, and they declined to witness it. He 
 therefore placed himself under the care of the 
 so-called " eclectics," who undertook the task 
 of watching him. One remarkable feature 
 connected with his fast was that he did not 
 attempt to husband his resources by reducing 
 the action of his lungs and heart to a 
 minimum. 
 
 There is no doubt that some of the con- 
 ditions under which Dr. Tanner was placed 
 were decidedly unfavourable, and there are 
 various circumstances which must exert a 
 modifying influence, and either increase or
 
 154 FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 diminish the period during which life can be 
 sustained in the absence of food. Other things 
 being equal, a stout person has a chance of 
 living longer than a thin one, inasmuch as 
 he possesses a larger store of combustible 
 material which will serve him as fuel. Ex- 
 posure to cold in conjunction with starvation 
 always accelerates death, while a moderately 
 high temperature aids in prolonging life. The 
 presence of moisture in the atmosphere has 
 a similarly favourable effect, inasmuch as it 
 diminishes the exhalation of fluid from the 
 body. It is probably owing to warmth and 
 moisture that persons buried in mines or 
 confined in some similar manner have had 
 their lives preserved beyond the ordinary 
 period. Dr. Tanner's success was, no doubt, 
 favoured by the summer heat of New York. 
 In the case of some miners, four men and 
 a boy, who were imprisoned in a portion 
 of a mine for eight days without food, but 
 within reach of water, all were rescued alive 
 and well. The warmth and dampness of the 
 compressed air were, doubtless, favourable 
 circumstances. In another case, recorded by 
 Fodere, some workmen were extricated alive
 
 VII.] SUSPENDED ANIMATION. 155 
 
 after fourteen days' confinement in a damp 
 vault, in which they had been buried under 
 a ruin. Dr. Sloan has given an account of 
 a still more remarkable instance, in which a 
 healthy man, aged sixty-five, was found alive 
 after having been shut up in a coal-mine for 
 twenty-three days, during the first ten of 
 which he was able to get at a little water. He 
 was, however, much exhausted, and died three 
 days afterwards, although very carefully treated. 
 In morbid states of the nervous system, life 
 may be prolonged in the most extraordinary 
 manner in the absence of food. In a remark- 
 able case, recorded by Dr. Willan, of a young 
 gentleman who starved himself under the in- 
 fluence of a religious delusion, life was pro- 
 longed for sixty days, during the whole of 
 which time nothing but a little orange juice 
 was taken. 
 
 Somewhat analogous to the cases just 
 mentioned are those in which all food is ab- 
 stained from while the person is in a state of 
 trance or partially suspended animation. This 
 state may be prolonged for many days or even 
 for weeks, provided that the body be kept suffi- 
 ciently warm. The most remarkable instances
 
 156 FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 of this character have been furnished by certain 
 Indian fakirs, who are able to reduce them- 
 selves to a state resembling profound collapse, 
 in which all vital operations are brought almost 
 to a standstill. In one case, the man was 
 buried in an underground cell for six weeks, 
 and carefully watched ; in another, the man 
 was buried for ten days in a grave lined 
 with masonry, and covered with large slabs 
 of stone. When the bodies were disinterred, 
 they resembled corpses, and no pulsation could 
 be detected at the heart or in the arteries. 
 Vitality was restored by warmth and friction. 
 It is probable that the fakirs, before submitting 
 to the ordeal, stupified themselves with bhang 
 (Indian hemp), the effects of which would last 
 for some time, and the warmth of the atmo- 
 sphere and soil would prevent any serious loss 
 of heat, such as would soon occur in a colder 
 climate, when the processes by which it is 
 generated are- made to cease. 
 
 The most prominent symptoms of starvation, 
 as noticed in the human subject, are due 
 first, to the special sensations produced by 
 the absence of food and fluid, and, secondly, 
 to the decline in the physical and mental
 
 VII.] SYMPTOMS OF STARVATION. 157 
 
 powers. At first there is great uneasiness or 
 severe pain in the region of the stomach ; 
 this is relieved by pressure, and subsides after 
 a day or two, but is followed by a feeling of 
 weakness and sinking in the same region, 
 accompanied by intolerable thirst, which, if 
 water be withheld, becomes the chief source 
 of distress. The skin over the whole body 
 is withered or shrivelled, and has lost its 
 elasticity ; the countenance becomes pale and 
 cadaverous ; the sufferer has a wild look ; he 
 loses flesh and strength more or less rapidly ; 
 he totters in walking, and becomes less and 
 less capable of exertion. The mental power 
 likewise fails ; at first there is usually a state 
 of torpidity, which may advance to imbecility ; 
 in some cases delirium comes on before death, 
 in others the patient is attacked by convulsions, 
 which speedily bring the scene to a close. 
 After death the state of the body, as regards 
 wasting, resembles that of animals : the fat 
 has almost entirely disappeared, the blood is 
 reduced to three-fourths of its normal amount, 
 and the muscles are extensively wasted ; the 
 brain and nerves alone have suffered slight 
 decrease in weight. If a little water has been
 
 158 FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 procurable, the quantity of blood may be 
 comparatively normal, though the quality is 
 seriously changed. 
 
 If we compare this general description with 
 that presented by Signer Succi after three 
 parts of his fast had been completed, it may 
 appear not a little exaggerated. Succi was 
 pale, thin, and wasted, but the change was 
 nothing like so great as one would expect. 
 Many a patient, convalescent from typhoid 
 fever, has an aspect of greater emaciation 
 and weakness, and certainly could not write 
 a few words with the same degree of firmness. 
 The temperature of Succi's apartment was 
 decidedly high, and the air charged with 
 moisture, both of which conditions are favour- 
 able. He appeared to take no exercise beyond 
 that involved in passing from his bed to his 
 chair, and in sitting up for several hours daily. 
 Besides water (pure and mineral), of which 
 he took about a pint daily, he swallowed a 
 few drops of a so-called " elixir," the com- 
 position of which was kept a secret. If it 
 did not contain morphine, its effects were pro- 
 bably similar to those of that drug. It was 
 said to allay pain and discomfort in the stomach.
 
 VII.] SIGNOR SUCCI. 159 
 
 Various tests were adopted in order to 
 measure the changes that took place in Succi's 
 bodily system, as the result of his prolonged 
 fast. The loss of weight is, of course, easily 
 ascertained. At the beginning of the ex- 
 periment, Succi's weight was about i26^1b. 
 His decrease in thirty days amounted to 28lb. 
 1302., or just 2oz. more than he lost during 
 his last fast, of thirty days, at Brussels. A 
 loss beyond one-fourth of the bodily weight 
 is scarcely compatible with life, but this limit 
 may be reached. He had not, however, the 
 advantage of a large proportion of fat when 
 he began his fast. It has been estimated that 
 a very fat man has about 33lb. of fat at his 
 disposal, and that this quantity would last 
 him for fifty days. Dr. Tanner, during his 
 fast, is said to have lost 32lb. only. In a 
 prolonged fast, such as we are now considering, 
 the daily loss becomes comparatively very 
 slight during the last three weeks. Succi, 
 for instance, on the thirtieth day, lost only 
 6oz., whereas under normal circumstances, a 
 healthy adult loses 2lb. of solid matters daily. 
 
 Besides losing flesh, a fasting man loses to 
 some extent the power of generating heat,
 
 l6o FASTING AND ITS PHYSIOLOGY. [CAP. 
 
 and his temperature therefore falls. The 
 normal temperature of the body is about 
 9&J, and its source is the food taken into 
 the stomach and the oxygen of the air 
 absorbed by the lungs during respiration. 
 Succi's temperature on the thirtieth day, for 
 example, was about two degrees below the 
 normal, a difference not to be wondered at 
 when we remember that he lost only 6oz. 
 in weight in the twenty-four hours, and that 
 all his disposable stock of fat had probably 
 been consumed. Small as the loss may 
 appear to be, the accompanying temperature, 
 if discovered in a sick person, would be 
 regarded as that of collapse ; and if the 
 thermometer marked only 95, there would 
 certainly be extreme danger. 
 
 A marked proof of the diminution in bulk 
 is afforded by the instrument called the 
 spirometer, which enables us to measure the 
 capacity of the lungs. This latter, in Succi's 
 case, if we again take the thirtieth day, was 
 reported to be 1,450 cubic centimetres, or 
 88 cubic inches. These numbers represent 
 the volume of air expelled from the chest 
 by the deepest expiration following the deepest
 
 VII.] TEST OF THE DYNAMOMETER. l6l 
 
 inspiration. The instrument itself consists 
 of a tube, furnished at one end with a mouth- 
 piece, and at the other connected with a 
 gasometer of registered and graduated capacity, 
 into which the person breathes. Now, in 
 health, an adult 5ft. Sin. in height, after taking 
 a deep breath, can expel from his chest about 
 238 cubic inches of air. Succi's chest capacity 
 was at first 2,000 cubic centimetres, and it 
 had, therefore, been much reduced ; but a 
 portion of the difference was doubtless due 
 to the lessening of his muscular power. 
 
 Succi's loss of strength, as shown by the 
 dynamometer, was comparatively small. This 
 instrument consists of a ring of steel, to the 
 inner face of which is attached a brass semi- 
 circular dial, graduated with two rows of 
 figures representing pounds or kilogrammes. 
 When the steel ring is compressed by the 
 hand, its short diameter is lessened and, by 
 means of rack-work, an index moves to and 
 fro on the scale. The power of the muscles 
 of the hand and arm vary with the strength 
 of the person experimented upon, and the 
 dynamometer enables us accurately to ascertain 
 the variations. It must be admitted that 
 
 II
 
 1 62 FASTING AND ITS PHYSIOLOGY. [CAP. VII. 
 
 persons using the dynamometer daily, become 
 more expert in concentrating their strength 
 upon the spring, and a little allowance must 
 be made on this account. Succi's amount of 
 strength, as recorded by the dynamometer, 
 was somewhat exaggerated, but when all 
 allowance is made for increased expertness, 
 the change was very small indeed.
 
 VIII. 
 THE SPREAD OF DIPHTHERIA. 
 
 IN the autumn of 1894 the daily newspapers 
 contained an appeal, of a somewhat novel 
 character, from Sir Joseph Lister, as Chair- 
 man of the Council of the British Institute 
 of Preventive Medicine. He stated that a 
 new and highly successful method of treating 
 a terrible disease, rapidly increasing in 
 frequency, and in its severe forms almost 
 or altogether intractable, had recently been 
 discovered. The marvellous potency of the 
 remedy had been demonstrated by a host 
 of cases in which the gravest symptoms had 
 disappeared under its application ; and certain 
 additional advantages were claimed for it 
 namely, that the treatment was perfectly harm- 
 less, and that it was prophylactic as well as 
 curative in its effects. Such a concurrence 
 of advantages has seldom, if ever, been 
 
 paralleled, and it is not to be wondered at 
 
 163
 
 1 64 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 that the preparation of the remedy involved 
 processes of the utmost delicacy, and was 
 therefore somewhat costly, and that the supply 
 fell short of the demand. The disease referred 
 to is known nowadays as diphtheria a name 
 only too familiar in many households ; and 
 the new remedy has been termed antitoxin. 
 Sir Joseph Lister appealed for funds to enable 
 the Institute over which he presides at once 
 to take in hand the preparation of antitoxin 
 on a large scale. It was fitting that one who 
 has already done so much to prevent disease 
 and to save life should place himself in the 
 foreground of the battle against diphtheria. 
 
 Before adverting to this new treatment and 
 to the steps which led to its discovery, it 
 seems desirable to give a brief sketch of the 
 history of the complaint, and to notice the 
 circumstances which tend to promote its spread. 
 On this latter topic a large amount of evidence 
 has accumulated during the last few years, but 
 some portions of the subject are still involved 
 in obscurity. 
 
 In 1856 a serious disease of the throat began 
 to be very prevalent in this country. Many 
 deaths occurred, and much alarm was naturally
 
 VIII.] BOULOGNE SORE THROAT. 165 
 
 created. It was generally regarded as a new 
 phenomenon; for many distinguished physicians, 
 including Dr. Addison and Sir T. Watson, 
 confessed that they had never met with similar 
 cases. Dr. Watson, indeed, averred that while 
 practising in London for more than twenty- 
 five years, he had scarcely so much as heard 
 of such a disease. Before any outbreak 
 actually occurred in this country, reports had 
 become common that a disease of the throat 
 was causing great mortality at Boulogne. 
 When cases appeared at home, the symptoms 
 were found to be identical with those noticed 
 on the other side of the Channel, and the 
 epidemic was therefore stigmatised as the 
 " Boulogne sore throat." 
 
 It is a very common practice, among in- 
 dividuals and communities, to impute mis- 
 fortunes of all kinds to the agency of others, 
 or at least to external sources, and the history 
 of medicine furnishes several examples of this 
 propensity. The more serious the epidemic, 
 the greater the proneness to seek for its origin 
 in some other country. In the case, however, 
 of this particular outbreak, there was ample 
 justification for applying to the malady, at
 
 1 66 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 least provisionally, the name of the place 
 whence it spread to this country. The epi- 
 demic broke out in Boulogne early in 1855, 
 and lasted until March 1857. The disease 
 was especially common and severe among 
 the English residents a somewhat numerous 
 contingent at that time. It caused 366 deaths, 
 341 of which were among children under ten 
 years of age. Scattered cases began to appear 
 in England in 1855, and in the following year 
 many towns and districts experienced severe 
 visitations. From that time the complaint 
 has seldom been absent from this country, 
 and in recent years there has been a very 
 considerable increase in the number of cases. 
 
 " The term " diphtheria," or rather " diph- 
 therite," was first applied to the disease, in 
 1821, by M. Bretonneau, a physician at Tours. 
 It is derived from a Greek word signifying a 
 prepared hide or piece of leather ; and the 
 disease was so named because of its essential 
 feature viz., the presence of a layer of more 
 or less tough membrane in various parts of 
 the throat. Bretonneau was fully aware of 
 the fact that diphtheria was by no means a 
 new disease. He considered that the out-
 
 VIII.] HISTORICAL EPIDEMICS. 167 
 
 breaks observed by himself were identical in 
 character with some epidemics described by 
 certain Italian and Spanish physicians of the 
 seventeenth century. There is, moreover, 
 good reason for believing that the disease 
 prevailed in very early times. Aretaeus, a 
 Greek physician of Cappadocia, who flourished 
 about i oo A.D., has left a description of a 
 disease which corresponds in all particulars 
 with diphtheria as seen at the present time. 
 He tells us that Egypt and Syria engender 
 the complaint, which thence derived the name 
 of Egyptian and Syrian ulcers. 
 
 In the records of epidemics down to the 
 end of the sixteenth century, there are many 
 statements which would seem to apply to out- 
 breaks of diphtheria. But the first absolutely 
 reliable information about the complaint dates 
 from the end of the sixteenth and beginning 
 of the seventeenth centuries. It comes from 
 Spain, where the disease continued to prevail 
 for more than thirty years. The Spaniards 
 called it Garottillo, which was originally the 
 name applied to the small truncheon used in 
 Spain by the executioner to strangle criminals. 
 A few years later the complaint broke out in
 
 1 68 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 Naples, and afterwards in Sicily, where it 
 caused great mortality among children. 
 
 About a hundred years elapsed before the 
 disease again became prevalent in an epidemic 
 form. In 1739 a very severe affection of the 
 throat was observed in London, and some 
 seven years later it caused great mortality at 
 Bromley in Middlesex, and at Greenwich. A 
 very minute and clear description of the disease 
 and its symptoms was given by Dr. J. 
 Fothergill in 1748. Not long afterwards epi- 
 demics occurred near the Metropolis, and in 
 various towns and villages in Devonshire and 
 Cornwall. In some of these outbreaks scarlet 
 fever and diphtheria were intermingled, as 
 sometimes happens at the present day. 
 Birmingham was subsequently visited. At 
 Chesham, in Bucks, it was especially noticed 
 that the complaint was not confined to the 
 town, which lies in a valley, but appeared like- 
 wise with equal violence upon the neighbouring 
 hills at a distance of five or six miles. Various 
 parts of Europe experienced similar visitations 
 at this period ; and about the middle of the 
 century the disease extended to America. 
 
 Thenceforward the spread of the disease
 
 VIII.] CHARACTERISTICS OF DIPHTHERIA. 169 
 
 can be definitely traced. Bretonneau's Memoirs 
 contain the earliest account of any epidemic 
 during the present century, though Dr. Mac- 
 kenzie, of Glasgow, had noticed isolated cases as 
 early as 1812. The epidemic of Boulogne sore 
 throat in 1855 marks an epoch in the history 
 of diphtheria. There is every ground for hope 
 that 1894 will be known as the year in which 
 the disease was first successfully combated. 
 
 As already stated, the essential characteristic 
 of the disease is the presence of a membranous 
 layer or coating, ash-grey in colour, in various 
 parts of the throat, and sometimes in the nose. 
 But before this appears, or at any rate before 
 it is detected, there is generally more or less 
 headache, weakness, difficulty of swallowing, 
 pain in the throat, and fever. The symptoms 
 are, therefore, both local and general ; and they 
 are liable to present great differences in their 
 intensity and duration. No case, however 
 mild its symptoms, is altogether free from 
 danger. In some forms the patients recover 
 in a few days, never having felt really ill ; in 
 others, after a very serious condition has 
 existed for perhaps a fortnight, improvement 
 sets in and a favourable termination ensues.
 
 I7O THE SPREAD OF DIPHTHERIA. [CAP. 
 
 On the other hand, death may occur two or 
 three days after the first appearance of the 
 symptoms, or may follow at a later period, as 
 a result of one or more of the many com- 
 plications which are wont to occur. Between 
 the mildest and the most severe cases innumer- 
 able gradations exist. The average mortality 
 varies in different epidemics ; it generally 
 ranges between 25 and 40 per cent. During 
 the last few years the number of fatal cases 
 has been steadily increasing in London, though 
 the proportion of deaths to attacks has con- 
 siderably diminished. In the metropolitan area 
 in 1889, the deaths from diphtheria numbered 
 1,617; in 1892, they were 1,969; while in 
 1893, they reached a total of 3,265. During 
 the second quarter of the year 1894, 644 
 deaths were registered from diphtheria, and 
 1,826 from the same cause in England and 
 Wales. Recent observations, extending over 
 eight years, in Prussia, show a yearly average 
 mortality of more than 40,000 children from 
 diphtheria, the number of deaths almost equal- 
 ling the fatality from scarlet fever, measles, 
 and whooping-cough combined. 
 
 The fact that the mortality from diphtheria
 
 VIII.] SANITARY MEASURES. 171 
 
 has more than doubled in London during the 
 twenty years terminated by 1890, and has, 
 moreover, increased to a less extent throughout 
 England and Wales, and especially in many 
 cities and towns, cannot fail to excite alarm, 
 not unmixed with surprise. During this 
 period many sanitary laws have been passed, 
 and their provisions have been vigorously 
 carried out by a numerous staff of well-trained 
 and competent officers. The public, as a body, 
 is decidedly in favour of sanitary measures, 
 and, for the most part, welcomes with avidity 
 any arrangements likely to prevent disease. 
 The beneficial effects of sanitary measures 
 adopted in recent years have been often demon- 
 strated ; deaths from such diseases as scarlet 
 fever and typhoid, which respond directly 
 to sanitation, have undergone a substantial 
 reduction during the period under considera- 
 tion, while the case with regard to diphtheria 
 is of a very different character. It is surely 
 worth while to endeavour to account for this 
 remarkable difference. 
 
 Inasmuch as the spread of diphtheria appears 
 to be unchecked by sanitary measures, some 
 authorities have gone so far as to assert that
 
 172 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 the disease is in the main independent of 
 sanitary conditions or hygienic circumstances ; 
 but this view is nowadays not generally held. 
 It is true that diphtheria sometimes prevails 
 where the sanitary arrangements appear to 
 be excellent, and fails to invade places of 
 an entirely opposite character. The inference 
 would seem to be obvious ; but it is safer to 
 assume that insanitary surroundings of all 
 kinds tend to favour the spread of the disease, 
 perhaps directly, but certainly by lowering the 
 general health and the capacity for resisting 
 infection. In the opinion of many medical 
 officers of health, the existence of surface 
 ventilators from the main sewers in the neigh- 
 bourhood of houses is a possible, and even 
 probable, cause of the spread of diphtheria. 
 In Bristol the sewers have no external means 
 of ventilation through grids and shafts, and 
 the road gullies, after being water-trapped, are 
 carried direct to the sewers. The death-rate 
 from diphtheria is very low, and a similar 
 experience is reported from Woolwich, where 
 there are no surface ventilators connected with 
 the sewers. This question assuredly demands 
 further investigation.
 
 VIII.] EFFECT OF TEMPERATURE. 1/3 
 
 The extraordinary spread of the disease in 
 recent years is probably owing to a variety 
 of causes. Increased means of communication 
 must have exercised a more or less decided 
 influence ; but there are other factors of a 
 still more potent character. It has been 
 frequently observed, during marked epidemics, 
 that certain localities were far more prone to 
 be visited than others, and that such places 
 were among the first to be attacked in 
 subsequent outbreaks. These localities may 
 be regarded as offering specially favourable 
 conditions for the growth and development 
 of the poison introduced from without ; or, 
 according to another theory, the germs of 
 the disease may have lain dormant during 
 the non-epidemic period and reacquired their 
 activity on the return of favourable conditions 
 of an unknown character. 
 
 Season and climate exert but little influ- 
 ence on the development and spread of 
 diphtheria, but the disease is more common 
 in temperate and cold climates than in the 
 tropics. European statistics show that, in 
 many epidemics, the maximum of sickness 
 has occurred in the colder months, and the
 
 174 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 minimum in the warmer. There are, how- 
 ever, many exceptions to this statement. 
 
 Opinions differ as to whether varieties of 
 soil exercise any influence in the development 
 and spread of diphtheria. Dr. Hirsch states 
 that the disease has been as prevalent in 
 elevated as in low-lying places, in mountainous 
 regions as on the level ground, on plains as 
 in valleys, on dry as on wet soil, on the most 
 varied geological formations, on porous and 
 hard rock equally. But recent observers 
 attribute more or less importance to damp- 
 ness of soil in the production and spread of 
 diphtheria. 
 
 It has been already observed that children 
 are far more liable than adults to be attacked 
 by the disease, and the liability is greatest 
 between the ages of three and twelve. The 
 mortality is greater during the first five years 
 of life than at any other period. It is greater 
 among females than among males ; and this 
 difference, which increases with the age of 
 the children, is in great measure due to the 
 larger share taken by girls in attending to 
 household duties and in waiting upon the 
 sick.
 
 VIII.] THE BACILLUS. 175 
 
 As the result of countless experiments and 
 observations, it may now be regarded as 
 certain that the symptoms of diphtheria are 
 due to the action of a specific micro-organism, 
 which was discovered by Loffler. Hosts of 
 other organisms are found in the false mem- 
 brane or coating ; but little, if any, importance 
 can be attached to them, inasmuch as germs 
 of many kinds find an appropriate soil in dead 
 tissues exposed to the air, and even in the 
 mouth itself. It is now claimed that a distinct 
 bacillus, which, when inoculated upon certain 
 animals produces diphtheria, has been isolated 
 and cultivated with success. These organisms 
 have the power of producing a chemical poison 
 in the diphtheritic membrane of the throat, 
 whence it is absorbed by the system. 
 
 Long before the word " bacillus " was coined, 
 observers were agreed as to the eminently 
 contagious character of the malady. The 
 occurrence of several cases in the same house, 
 or in the same street, might, of course, be 
 due to the fact that all the sufferers had 
 been exposed to a common cause ; but many 
 instances are on record proving beyond the 
 possibility of doubt that the disease may be
 
 176 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 distributed from the sick to those about them. 
 In not a few cases medical men have fallen 
 victims to diphtheria, after receiving in the 
 nose or mouth a fragment of membrane 
 coughed up by a patient. Such actual and 
 visible contact with the virus is, however, 
 not necessary, for the poison, in an invisible 
 form, may pass through the air. Moreover, 
 it would seem to cling with great tenacity 
 to clothes and bed-linen, and even to the 
 walls, woodwork, and furniture of rooms in 
 which cases have been treated. Dr. Squire 
 states that in a country house in Scotland, 
 a visitor was attacked by the disease after 
 occupying a room in which a case had occurred 
 eleven months previously. It is probable 
 that the virus can be carried only for short 
 distances by currents of air, for in many 
 epidemics cases are restricted to a few houses 
 or to a single street, and the surrounding 
 neighbourhood escapes. 
 
 It is highly probable that the spread of 
 diphtheria is promoted in a very special 
 manner by the massing together of large 
 numbers of children, as occurs at the present 
 day in many of our elementary schools. This
 
 viii.] DR. THORNE'S INVESTIGATIONS. 177 
 
 view has been forcibly advocated by Dr. 
 Thorne, who has paid great attention to the 
 subject. He points out (i) That school attend- 
 ance brings together those members of the 
 community who are, by reason of age, most 
 susceptible of diphtheria. (2) The children 
 thus brought together are placed, and remain 
 for many hours of the day, in exceptionally 
 close relation with each other. Transmission 
 of the virus is facilitated by the closeness 
 of the mouth of the affected person to the 
 mouth of the recipient, while the collective 
 singing among the children and the consequent 
 forced expiratory efforts must tend to diffuse 
 the exhalations far and wide. (3) The closer 
 the aggregation, and the more defective the 
 ventilation, the greater the risk. (4) Any 
 faulty sanitary surroundings render the children 
 especially liable to receive infection in the 
 presence of any case of diphtheria. (5) There 
 are ample grounds for believing that the 
 aggregation of children in elementary schools 
 constitutes one of the conditions under which 
 a form of disease of particular potency for 
 spread and for death may be, so to speak, 
 manufactured. (6) The danger of school 
 
 12
 
 178 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 aggregation is by no means limited to the 
 period in which the disease is acute. (7) The 
 practice of kissing and of transferring sweet- 
 meats from mouth to mouth, as also the 
 joint use of drinking-cups, etc., must be 
 credited with a share in the diffusion of 
 diphtheria. The fact must always be borne 
 in mind that in not a few cases the disease 
 assumes a very mild form. There may be 
 no appreciable fever, and the general health 
 is little if at all disturbed. Many children 
 retain their appetites, and would, if left to 
 themselves, run about the house as usual. 
 Such cases are especially dangerous to the 
 community, for the nature of the complaint 
 may not at first be suspected. Meanwhile, 
 other children become infected, and may soon 
 present all the symptoms of a terribly severe 
 attack. 
 
 But besides dissemination by contact and 
 through the medium of the atmosphere, other 
 channels of propagation have been discovered 
 during the last few years. Milk may absorb 
 the virus from patients, and communicate the 
 disease to those who drink it. But a still more 
 singular fact has been brought to light in
 
 VIII.] DIPHTHERIA IN ANIMALS. 179 
 
 connection with milk as a medium of propa- 
 gation namely, that epidemics have occurred 
 in which the poison was derived, not from a 
 human source, but from the cows themselves. 
 Dr. Klein has shown that these animals can 
 be successfully inoculated with cultures of the 
 diphtheria bacillus, with the result that an 
 eruptive disease is produced on the teats and 
 udders. A few days after the inoculation, 
 the presence of the diphtheria bacillus could 
 with certainty be demonstrated in the milk 
 of the cow, collected under all precautions. 
 Dr. Klein justly remarks that these results 
 lead in great measure to a right understanding 
 of certain epidemics of milk-diphtheria. It is 
 worthy of note that in cows the poison does 
 not affect the organs of the throat. 
 
 Evidence is likewise at hand of the occur- 
 rence of diphtheria, sometimes with severe 
 changes in the throat, among other domestic 
 animals for example, cats, horses, sheep, 
 and fowls. The popular idea that a cat with 
 symptoms of a cold in the head is a source 
 of danger to children may hold good with 
 regard to a much more dangerous disease. 
 In houses containing patients suffering from
 
 l8o THE SPREAD OF DIPHTHERIA. [CAP. 
 
 diphtheria, cats have been known to present 
 certain peculiar symptoms, " either antece- 
 dently, coincidently, or subsequently, they 
 appear to have some kind of throat illness 
 and cannot swallow ; they sneeze, and their 
 eyes water ; bronchial mischief is noticed early, 
 and the animals often become emaciated, and 
 many die." Although the throat remains 
 free from diphtheritic membrane, peculiar 
 and striking changes are found in many 
 organs of the body. A similar disease exists 
 naturally among cats, and is believed to be 
 equivalent to human diphtheria. Dr. Klein, 
 therefore, considers that the cat is susceptible 
 of diphtheria, and capable of communicating 
 the disease to other cats and also to human 
 beings. 
 
 Enough has been said to show that diph- 
 theria can be propagated through various 
 channels, and to account, in some degree, 
 for the increase in the number of cases during 
 recent years. It remains to consider the 
 measures calculated to check the prevalence 
 of the disease and to describe the remedy 
 lately introduced. 
 
 The notification and isolation of cases ought,
 
 VIII.] NECESSARY PRECAUTIONS. l8l 
 
 of course, to be sedulously carried out ; but 
 there are several difficulties in the way. Sore 
 throat is a very common complaint ; it is, 
 indeed, one of the symptoms of an ordinary 
 cold, and a condition which may pass into 
 diphtheria may exist for many hours without 
 exciting the least suspicion. When cases of 
 diphtheria occur in any locality, all forms of 
 throat disease ought to be carefully investigated 
 and examined by a medical practitioner. The 
 efficient ventilation of schools would do much 
 to check the spread of all infective diseases. 
 If natural ventilation could not be achieved, 
 artificial means of supplying fresh air ought 
 to be adopted, notwithstanding the expense 
 of any such method. When a case of un- 
 doubted diphtheria has occurred among children 
 attending a school, the buildings should be 
 forthwith closed and thoroughly disinfected. 
 As a matter of course, the sufferers should 
 be isolated, and visits from other children 
 should be strictly forbidden. The milk-supply 
 will require special attention, and all insanitary 
 conditions should be remedied as far as pos- 
 sible. The object of sanitarians, however, is 
 to prevent the occurrence of infectious diseases
 
 1 82 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 a task confessedly difficult, though not im- 
 possible. It is, however, a sad mistake to 
 leave things alone until an epidemic occurs ; 
 yet even at the present day this practice is 
 not very uncommon. In a parish not far 
 from London, and containing some 1,700 
 inhabitants, we read that from the spring of 
 1893 U P to February 1894 there were 77 cases 
 of diphtheria, with 19 deaths. The conditions 
 are thus described : The dwellings are fair, 
 the sewerage nil, the drainage nuisances many, 
 and the existing water-supply dangerous in 
 the extreme. 
 
 With regard to the treatment of diphtheria, 
 it is sufficient to say that remedies almost 
 innumerable have been proposed and tried, 
 and, in many cases, with apparent success. 
 There are, however, forms of diphtheria prac- 
 tically hopeless from the very first. Treatment 
 both local and general, is, of course, adopted, 
 but the progress is always from bad to worse. 
 The rate of mortality sufficiently indicates 
 the impotence of medicine. Under such 
 circumstances, the discovery of a method by 
 which very severe forms of the disease may 
 often be successfully combated must be hailed
 
 VIII.] PREPARATION OF ANTITOXIN. 183 
 
 with intense satisfaction. The remedy, now 
 called antitoxin, is the serum or watery part 
 of the blood of animals rendered immune by 
 repeated inoculations. This fluid is analogous 
 to the attenuated vaccine virus of small-pox 
 obtained from a child inoculated with the pro- 
 duct of the virus of small-pox passed through 
 the cow. 
 
 The method of preparing antitoxin is as 
 follows : The animals which are to furnish 
 the antitoxic serum are rendered immune by 
 the subcutaneous injection of the toxin of 
 diphtheria. This toxin is formed when the 
 virulent bacillus is grown in broth : after three 
 or four weeks, the culture is sufficiently rich 
 in toxin to be used. The animals employed 
 are horses in good health, previously shown to 
 be free from glanders. The culture, filtered 
 through a porcelain filter, yields a clear liquid, 
 with which the horse is inoculated by injection 
 under the skin. Gradually, by repeated in- 
 jections extending over two or three months, 
 the horse is brought into a condition in which 
 its serum possesses very high antitoxic pro- 
 perties. The animal does not suffer in health 
 at all, or only to a very slight degree. The
 
 184 THE SPREAD OF DIPHTHERIA. [CAP. 
 
 efficacy of its serum having been ascertained 
 by a test experiment on a guinea-pig, the 
 animal is bled. It suffers little from this 
 operation, which may be repeated, if necessary, 
 in a few weeks. " The animals used are cab 
 horses, sound in constitution, but broken down 
 in limb, who after inoculation live a life of ease 
 and luxury, varied by a periodical phlebotomy, 
 such as our grandfathers submitted to volun- 
 tarily two or three times a year." 
 
 The credit attaching to the discovery of 
 antitoxin has been claimed, by many ill- 
 informed Parisian newspapers, for a French 
 physician, M. Roux. As a matter of fact, 
 however, the microbe of diphtheria, antitoxin 
 and its application, were discovered by German 
 physicians, whose experiments and observations 
 have simply been repeated by M. Roux and 
 others. According to the British Medical 
 Journal, M. Roux himself states that Loffler 
 and Klebs discovered the microbe of diphtheria 
 and studied its life-history ; Roux and Yersin 
 demonstrated that the bacillus was capable of 
 evolving toxic material, and Behring crowned 
 the edifice by discovering the antidote. 
 
 Since the introduction of the antitoxin treat-
 
 VIII.] THE USE OF ANTITOXIN. 185 
 
 ment, many reports have been received as to 
 its effects in a large number of cases occurring 
 in our own country, in Australia, Germany, 
 France, Austria, and the United States. The 
 mortality, as compared with that of cases 
 treated in other ways, shows a very remarkable 
 decrease, the percentage of fatal cases having 
 been reduced by one half or more. In no 
 instance has a careful comparison of the statis- 
 tics been unfavourable to the antitoxin treat- 
 ment. This difference cannot be explained by 
 supposing that the cases treated were of an 
 unusually mild character. Among 520 cases 
 at the Trousseau Hospital, Paris, where the 
 treatment was not employed, the mortality was 
 equal to 60 per cent. During the same period, 
 in the Paris Children's Hospital, the mortality 
 was less than 24 per cent., among 448 
 children treated with antitoxin. Similar and 
 even more striking results have been obtained 
 in Germany. In 1895 the Ministry for 
 Medical Affairs instituted an investigation into 
 the effects of antitoxin. The table of statistics 
 included 6,626 patients of all ages, suffering 
 from diphtheria. Of these, 86*5 per cent, re- 
 covered ; 1 2*9 per cent, died, the remainder
 
 1 86 THE SPREAD OF DIPHTHERIA. [CAP. VIII. 
 
 (less than i per cent.) being still under treat- 
 ment. I may mention that my friend, Surgeon- 
 Major General Paterson, late Principal Medical 
 Officer at Aldershot, informed me that the 
 treatment had been employed in about 400 
 cases in that station, and with marvellous 
 results. 
 
 Enough has been adduced to show that 
 in antitoxin we possess the most efficient 
 remedy that has ever been used in the treat- 
 ment of diphtheria. There is, moreover, good 
 ground for believing that the injection of 
 antitoxic serum enables the organism to resist 
 subsequent infection with the microbes of 
 diphtheria. It is satisfactory to know that 
 arrangements have been perfected to ensure 
 the supply of this valuable remedy.
 
 IX. 
 
 THE PROPAGATION AND PRE- 
 VENTION OF CHOLERA. 
 
 THE belief at one time prevailed that 
 epidemic cholera appeared for the first 
 time in India in 1817. The truth is that in 
 that year the disease raged with terrible 
 severity in the Delta of the Ganges ; but it had 
 already on several occasions desolated these 
 regions. In 1781 cholera attacked a force, 
 about five thousand strong, marching through 
 Southern India ; seven hundred died within 
 the first few days, and some three hundred 
 invalids were left behind. Two years later, 
 cholera broke out at the sacred bathing spot 
 at Hurdwar, on the Ganges. It happened to 
 be one of the twelfth years deemed particularly 
 propitious by the Hindoos, and the assemblage 
 of pilgrims was far beyond the common aver- 
 age, amounting, it was said, to nearly two 
 
 187
 
 1 88 THE PREVENTION OF CHOLERA. [CAP. 
 
 millions. The disease broke out on the 
 springing up of an easterly wind during the 
 night, and carried off innumerable persons. 
 Twenty thousand victims are said to have 
 fallen in less than eight days, yet so confined 
 was its influence that the disease did not 
 extend beyond the place of bathing and ceased 
 on the dispersion of the multitude. The 
 reports of the Medical Boards of Bengal, 
 Madras, and Bombay contain accounts of 
 similar epidemics in 1787, 1790, and 1814. 
 
 But the writings of the older physicians 
 render it more than probable that the disease 
 in an epidemic form was not unknown to our 
 forefathers in Europe, and many of the cases 
 described by Sydenham in 1669 would appear 
 to have been true cholera. Inasmuch, how- 
 ever, as none of the visitations described by 
 former writers approached in duration, severity, 
 and extent that which took its rise in Bengal 
 in 1817, no detailed record of them has been 
 preserved. It is not to be wondered at that 
 so terrible a visitation should have almost 
 obliterated the memory of former outbreaks. 
 Starting from its home on the banks of 
 the Ganges, the pestilence invaded the dis-
 
 IX.] EPIDEMICS IN INDIA. 189 
 
 tricts and countries traversed by the Indus, 
 Euphrates, Nile, Danube, Volga, St. Lawrence, 
 and Mississippi. It visited almost every 
 nation of the earth, unchecked by vicissitudes 
 of climate and peculiarities of soil, circum- 
 scribed or limited by no prevailing wind ; and 
 whether it attacked the delicate frame of the 
 Hindoo or the more robust European, the 
 nature of the disease has been essentially 
 the same, and the results of medical treatment 
 have been for the most part unsatisfactory. 
 Everywhere throughout the four quarters of 
 the globe, experience has shown that no 
 difference of race, climate, or temperature has 
 exercised any marked influence on the nature 
 and progress of the disease. 
 
 Various conditions of life, however, as in 
 most other epidemics, have manifested their 
 vast influences for good or evil : as shown 
 amongst the poorer classes by their greater 
 liability to this terrible scourge, and among 
 the wealthier and more comfortably situated 
 classes by their comparative exemption. 
 
 One fact of great importance is that the 
 cholera epidemics which have ravaged various 
 parts of India since 1817, and have spread
 
 I9O THE PREVENTION OF CHOLERA. [CAP. 
 
 therefrom to other countries, have always 
 originated in India. They have never been 
 even supposed to have been imported into 
 any of the ports of India by ships from infected 
 countries, or through any other manner of 
 human intercourse. It may therefore be 
 inferred that the cause of the disease, however 
 latent or submerged for a time, is never 
 actually absent from the soil of India in some 
 of its parts. 
 
 Travelling, then, from place to place, in 
 defiance of all natural and artificial barriers, 
 under opposite extremes of temperature, 
 season, and climate, against adverse winds, 
 over lofty mountainous chains, across wide seas, 
 passing (as Milton describes Satan) through 
 " heat, cold, moist, and dry," how, one may 
 naturally ask, is this terrible disease propagated? 
 
 As Sir T. Watson points out, the first 
 thought that occurs to one's mind is that 
 man also, and man alone, so far as we 
 can perceive, overcomes all these kinds of 
 hindrances to his locomotion, and therefore 
 that the exciting cause of cholera in all 
 probability accompanies and depends upon the 
 movements of human beings over the earth.
 
 IX.] THEORIES OF ORIGIN. 
 
 If we inquire into the views held at various 
 times with regard to the manner in which 
 cholera spreads, we shall find that many 
 differences of opinion have prevailed ; but 
 that at the present day there is a much nearer 
 approach to unanimity. Not very long ago 
 the complaint was pretty generally attributed 
 to some poison present in the air ; it was 
 thought to progress by a succession of local 
 outbreaks, the particular localities being chosen 
 by certain local conditions : first, those which 
 render places insalubrious ; and, secondly, 
 peculiar susceptibility to the disease on the 
 part of the inhabitants of the place. 
 
 A second theory referred the disease to a 
 morbid poison, which undergoes increase only 
 within the human body, and is propagated 
 to the healthy by means of emanations from 
 the sick i.e., by contagion. 
 
 The third theory, propounded by the late 
 Dr. Snow, and therefore deserving of special 
 notice, gives a more specific form to the 
 doctrine of contagion. It supposes that the 
 poison of cholera is swallowed, and acts 
 directly on the mucous membrane of the 
 intestines, is at the same time reproduced
 
 1 92 THE PREVENTION OF CHOLERA. [CAP. 
 
 in the intestinal canal, and passes out, much 
 increased, with the discharges ; that these 
 latter afterwards, in various ways, but chiefly 
 by becoming mixed with the drinking-water 
 in rivers and wells, reach the alimentary canals 
 of other persons and produce the like disease 
 in them. This third theory is now generally 
 accepted, as accounting in great measure, if 
 not entirely, for the epidemic spread of cholera. 
 There are, however, some instances on record 
 for which this theory does not afford a 
 sufficient explanation, and which seem to 
 require a belief in some other modes of pro- 
 pagation. It will be well to take a brief 
 survey of the evidence in favour of the 
 transmission of cholera through the medium 
 of drinking water. 
 
 Prior to 1849 very few of those who had 
 opportunities of investigating cholera appear 
 to have imagined that the specific poison 
 might gain access to the human body in this 
 way. Occasionally, as by Dr. Jameson in the 
 Bengal Report of 1820, and by Dr. Mliller, 
 of Hanover, in 1848, hints were thrown out, 
 but only in a cursory way, as to the effect 
 of impure water in the production of cholera.
 
 IX.] ADVANCES IN KNOWLEDGE. 193 
 
 A decided addition was, however, made to 
 our knowledge in 1849. In that year a severe 
 epidemic of cholera prevailed in London, and 
 carried off 6 per 1,000 of the population. The 
 water used at that time was obtained in part 
 from the rivers Thames and Lea, and in part 
 from shallow wells. Sewers had been con- 
 structed, and closets, which drained into them, 
 were in common use. Hence the river- water 
 had become decidedly more impure than in 
 1832, the date of the previous epidemic, in 
 which the mortality was a little over 3 per 
 1,000. In 1849 it was observed that the 
 population supplied with water from the 
 Thames suffered in direct proportion from 
 cholera according as the water consumed was 
 taken from the river at successively lower 
 points. Thus, of those supplied with water 
 taken from the river at Kew, o'8 per 1,000 
 died of cholera ; among those supplied with 
 water drawn at Hammersmith, the mortality 
 was 1*7 per 1,000; in the West of London, 
 the water being taken at Chelsea, 4*7 per 
 1,000 died; while of those farther East and 
 supplied with water taken between Battersea 
 and Waterloo Bridge, the mortality from
 
 194 THE PREVENTION OF CHOLERA. [CAP. 
 
 cholera was as high as 16*3 per 1,000 of 
 the population. 
 
 If we search the records of a subsequent 
 visitation of cholera in the year 1854, we 
 shall find that a similar rule prevailed, with 
 certain curious features which only pointed 
 to the same conclusion as regards the part 
 played by the water. In 1854 the river 
 Thames was in all probability much more 
 impure than in 1849, yet the South wark 
 Water Company still drew its supply from 
 the river at Battersea, not far from the outlet 
 of one of the sewers. In Bermondsey, which 
 was supplied with water by this company, 
 the deaths from cholera were 13 per cent, 
 higher than in 1849, an excessive difference 
 in proportion to the increase of population. 
 In the interval between 1849 and 1854 the 
 Lambeth Water Company had gone much 
 farther up the river for a supply of water, viz., 
 to a point above the tidal lock at Teddington. 
 It so happened that in certain streets the pipes 
 of the Lambeth and of the Southwark Water 
 Companies interlaced, so that adjacent houses 
 were supplied with water from different sources. 
 On comparing the mortality, it was found that
 
 IX.] OUTBREAKS IN LONDON. 1 95 
 
 in the houses supplied by the latter company 
 with water drawn from Battersea the deaths 
 from cholera were 57*1 per 1,000 residences, 
 whilst in those supplied from the Thames 
 above London and the tidal influence, the 
 mortality was only at the rate of 1 1-3 per 1,000 
 houses. Sir J. Simon, commenting on these 
 facts, justly termed them as amounting to 
 a gigantic crucial experiment performed on 
 half-a-million of people. The history of 
 another outbreak at the East End of London, 
 in 1866, distinctly pointed to the drinking 
 water as the medium of propagation. The 
 outbreak occurred in a certain district which 
 was "almost exactly the area of a particular 
 water supply, nearly, if not absolutely, filling 
 it, and scarcely, if at all, reaching beyond it." 
 
 The lesson to be drawn from another 
 epidemic would appear to be quite conclusive. 
 In 1854 there was a very remarkable local 
 outbreak of cholera in the neighbourhood of 
 Golden Square, Soho. It was investigated 
 with great care and minuteness by a committee 
 appointed for the purpose, and their report 
 contains the most convincing evidence that 
 the poison of cholera, in that instance at any
 
 196 THE PREVENTION OF CHOLERA. [CAP. 
 
 rate, found its way into the body through the 
 water used for drinking. The facts are briefly 
 as follows: During August 1854 there were 
 a few cases of cholera in the locality ; on 
 September ist the disease became very 
 prevalent and very fatal, and the cases went 
 on increasing in number during the four sub- 
 sequent days. The complaint then began to 
 abate. During the month of September 609 
 persons (14' 2 per 1,000) fell victims to the 
 epidemic, which was remarkable for the sudden- 
 ness of its outbreak and the large number 
 of persons simultaneously attacked. It was 
 found on investigation that in the centre of 
 this district there was a certain pump con- 
 nected with a well, and that the radius of the 
 infected area measured less than three hundred 
 yards from the source of supply. The water 
 of this well was much liked by the people who 
 used it ; it was cool, sparkling with carbonic 
 acid gas, and kept well, owing to the quantity 
 of saline matter it contained. On examination 
 it was discovered that the water was contami- 
 nated by leakage and filtration from a cesspool 
 at the time of the cholera outbreak, so that 
 the possibility of the cholera poison gaining
 
 IX.] DRINKING WATER. 197 
 
 access to the water was fully demonstrated. 
 Dr. Snow proved that the outbreak, properly 
 so called, was in great measure confined to 
 the neighbourhood of the pump, and that 
 the water had been habitually used by sixty- 
 one out of seventy-three persons who died 
 during the first two days. In a factory, where 
 the water was daily drunk, 9 per cent, of those 
 employed died from the disease. On the other 
 hand, in the workhouse, where the water supply 
 was drawn from other sources, the deaths from 
 cholera were only one-tenth of the proportion 
 prevalent in the neighbourhood. Moreover, 
 in a brewery in the very street that contained 
 the pump, there was not a single case among 
 the seventy men employed, who did not make 
 use of the water. 
 
 If further proof were wanting of the com- 
 municability of cholera through drinking water, 
 it is furnished with all the force, if not with 
 the reality, of an experiment, by the facts thus 
 stated by Mr. Macnamara, an Indian surgeon 
 of great experience : "I may mention the 
 circumstances of a case in which the most 
 positive evidence exists as to the fact of fresh 
 cholera dejections having found their way
 
 1 98 THE PREVENTION OF CHOLERA. . [CAP. 
 
 into a vessel of drinking water, the mixture 
 being exposed to the heat of the sun during 
 the day. Early the following morning, a 
 small quantity of this water was swallowed 
 by nineteen persons. (When partaken of, 
 the liquid attracted no attention either by its 
 appearance, taste, or smell.) They all remained 
 perfectly well during the day ; ate, drank, 
 went to bed and slept as usual. One of them, 
 on waking next morning, was seized with 
 cholera ; the remainder of the party passed 
 through the second day perfectly well, but two 
 more of them were attacked with cholera the 
 next morning ; all the others continued in good 
 health till sunrise on the third day, when two 
 more cases of cholera occurred. This was 
 the last of the disease ; the other fourteen 
 men escaped absolutely free from diarrhoea, 
 cholera, or the slightest malaise." 
 
 This account contains several points of great 
 interest. In the first place, the choleraic 
 dejections did not touch the soil ; they were 
 swallowed as passed, but after copious dilution 
 with four or five gallons of impure water, and 
 the mixture had been exposed to the light and 
 heat of a tropical sun for twelve hours. It is
 
 IX.] VENTILATION OF ROOMS. 199 
 
 also important to observe that in one case the 
 poison produced its effects in twenty-four 
 hours, and in the others, not until two or three 
 days had elapsed. Lastly, it was evident that 
 the majority of those who drank the polluted 
 water escaped unhurt, an experience which 
 proves that some persons are much more liable 
 than others to take the complaint. A similar 
 rule is often observed in connection with the 
 spread of other infectious diseases. There is 
 still much difference of opinion as to whether 
 the poison of cholera floats about in the air, 
 and is wafted by the winds and carried for 
 considerable distances. The tendency of 
 modern experience is, however, strongly 
 against the theory of air-conduction. Mr. 
 Macnamara only goes so far as to say that 
 in badly ventilated rooms the atmosphere may 
 become so fully charged with the exhalations 
 from patients suffering from cholera as to 
 poison persons employed in nursing the sick. 
 In the same way, people engaged in carrying 
 the dead bodies of those who have died from 
 cholera, or in washing their soiled linen, may 
 contract the malady. He adds that "in a 
 dried condition, the poison contained in cholera
 
 2OO THE PREVENTION OF CHOLERA. [CAP. 
 
 excreta may retain its dangerous properties for 
 a long time." This last statement is, however, 
 at variance with the opinions of recent 
 observers. 
 
 The not unfrequent outbreak of cholera 
 among the crews of ships after they have been 
 at sea for several days has been thought to 
 prove the communicability of the disease 
 through the medium of the atmosphere. Dr. 
 Bryson, however, in a report published some 
 years ago, stated that the medical records of 
 the naval service had been searched in vain 
 to discover an instance in which either cholera 
 or yellow fever had made its appearance 
 among a ship's company unless one or more 
 of the men or officers had previously within 
 at most twenty-one days been exposed in 
 some house, ship, or locality where the in- 
 fectious virus which emanates from persons 
 ill of the one or the other of these diseases 
 existed. The spontaneous origin of either 
 malady, far away from an infected locality, is 
 unknown in the naval service. 
 
 In connection with the above statement, the 
 account of an outbreak of cholera on board 
 the emigrant steamer Dorunda, in 1885,
 
 IX.] OUTBREAKS ON BOARD SHIP. 2OI 
 
 possesses considerable interest. This vessel 
 left Blackwall on October 2oth of that year, 
 and rather more than a month later put in at 
 Priok, Batavia, for coaling. No cargo was 
 taken on board, only fresh vegetables and 
 fruit were obtained for the saloon table. 
 Distilled water from condensers was used 
 throughout the voyage, and no water was 
 shipped at Priok. A case of cholera (with 
 somewhat doubtful symptoms) occurred on 
 board four days after leaving Priok ; the 
 patient recovered. Seven days afterwards an 
 unmistakable case presented itself, with a fatal 
 result in twelve hours. From December loth 
 to 23rd there were other cases, and in all 
 seventeen deaths. None of the officers, crew, 
 or saloon passengers were attacked. The 
 saloon passengers had landed at Priok, and 
 passed the night there. It was well known 
 that cholera was then epidemic in Batavia. 
 The belief was entertained by the ship's 
 officers that the infection existed in some sand 
 brought on board at Priok for the purpose 
 of cleansing the decks. This sand was very 
 black, and imparted a peculiarly offensive smell 
 to water. It was used only for two days,
 
 2O2 THE PREVENTION OF CHOLERA. [CAP. 
 
 around the berths of the single and married 
 men, and then thrown away. 
 
 In this case there was no ground for sup- 
 posing that the drinking water had become 
 polluted. The fact that the disease occurred 
 only among the steerage passengers was some- 
 what curious. Some of these, however, had 
 gone on shore at Priok, and all had eaten more 
 or less fruit, which they bought for themselves 
 probably in great abundance, as it was very 
 cheap. It is difficult to estimate the degree of 
 probability attaching to the view that the in- 
 fective material was contained in the sand and 
 taken into the system through the lungs. Such 
 a mode of communication cannot be regarded 
 as impossible, especially if credit is to be given 
 to the following account of a case in which 
 other channels of infection seemed to be 
 wanting. 
 
 On March 28th, 1866, the steamship 
 England left Liverpool with about one thou- 
 sand two hundred passengers for Halifax. 
 Cholera broke out five days afterwards, and 
 carried off some three hundred persons. As 
 the ship bore up for Halifax, she was hailed 
 by a pilot who was cruising in a boat with two
 
 IX.] CONTROVERSIES. 2O3 
 
 other men ; he agreed to bring the ship into 
 the quarantine harbour at Halifax, and, having 
 been told that there was a fatal disease on 
 board, laid his boat alongside, sent up his 
 papers to the captain in a basket that had been 
 lowered from the ship, and was then taken in 
 tow. Having brought the ship up to the 
 quarantine harbour, without having boarded 
 her, he rowed ashore with his two comrades. 
 On the night of April loth, or two days after 
 he had thus come remotely into contact with 
 the England, he was taken ill with cholera, and 
 three days afterwards cholera broke out in his 
 family. Almost at the same time one of his 
 two companions sickened, and gave the disease 
 to his three children. According to statements 
 in the Army Medical Reports for that year, the 
 whole Western hemisphere was at that time, 
 and had been for years, quite free from cholera. 
 The discovery of the essential and specific 
 cause of cholera would go far to determine 
 many questions regarding the spread and 
 propagation of the disease. An account of the 
 controversies which have taken place on this 
 subject would fill a large volume. In the 
 minds of the speculative, the disease has been
 
 2O4 THE PREVENTION OF CHOLERA. [CAP. 
 
 vaguely associated with astral influences, the 
 approach of comets, various meteorological 
 phenomena, the presence of ozone in the air, 
 peculiar electrical states of the atmosphere, 
 mists of various colours, etc. No facts, how- 
 ever, exist to prove anything more than a 
 merely accidental connection between any of 
 these circumstances and the appearance of 
 cholera, and nothing certainly to authorise 
 the suspicion that they stand towards each 
 other in the relation of cause and effect. 
 
 The theory that cholera is due to invisible 
 animalcules was advanced many decades ago, 
 and was supported by many facts connected 
 with the outbreak and spread of the disease. 
 Nearly fifty years ago Pacini alleged that he 
 had discovered such organisms ; but his obser- 
 vations turned out to be valueless. In 1884 
 Dr. Koch stated that the causal agent of 
 Asiatic cholera was a peculiar species of 
 bacterium, which can always be demonstrated 
 in the intestinal contents and in the dejecta of 
 persons suffering from the disease. It is not 
 found in the intestinal contents of healthy 
 persons, nor in those suffering from other 
 diseases ; it is exclusively confined to the
 
 IX.] DR. KOCH'S THEORIES. 2O5 
 
 cholera intestine, and its numbers are directly 
 proportionate to the severity of the attack. 
 
 Koch's theory, based on his discovery of the 
 micro-organisms, is now almost universally 
 accepted. Our knowledge of the life-history of 
 the bacilli found in cholera patients is, how- 
 ever, far from being complete. We know that 
 these micro-organisms take the form of minute 
 curved rods, the largest among them measuring 
 om< y i2ooo tn f an mcn m length, whilst the 
 smallest are less than half this size. Only 
 those persons who are conversant with the use 
 of the microscope can form a proper idea of 
 such minuteness. Sometimes a dozen or more 
 organisms are united together so as to form 
 a long screw-shaped thread. 
 
 These bacilli are vegetable parasites, which 
 increase and multiply within the body to an 
 enormous extent, and with marvellous rapidity. 
 With regard to the nature and mode of growth, 
 and multiplication of bacteria in general, we 
 know that these organisms are exceedingly 
 minute plants, some of which live as parasites 
 within the human body. They multiply by 
 fission or simple division, and in some species 
 by the formation of spores or seeds. These
 
 2O6 THE PREVENTION OF CHOLERA. [CAP. 
 
 latter are highly important, inasmuch as they 
 possess greater powers of resistance and 
 stronger vitality than the parent organism, so 
 that the continuance of the species is effected 
 by them, from one season to another, under 
 conditions which would destroy the fully formed 
 parasite. Bacteria, as a rule, are killed by a 
 temperature of about 212 Fahr. The spores, 
 however, of some species require a temperature 
 of 250 to 270 Fahr. to destroy them com- 
 pletely ; hence ordinary boiling is far from 
 being sufficient. 
 
 Many species of bacteria e.g., those which 
 cause fermentation are altogether innocuous, 
 so far as man is concerned, but others are the 
 direct causes of disease. It has been suggested 
 that those belonging to the second class are 
 the result of transformation of innocent forms, 
 that they have been evolved by a process of 
 natural selection. According to this view, the 
 infective bacteria have not always possessed 
 their noxious qualities, but have acquired 
 them somehow in the course of ages. It is 
 certain that such changes would require long 
 periods for their production ; but in view of 
 the modifications of virulence which can be
 
 IX.] THE BACILLI OF CHOLERA. 2O7 
 
 artificially caused in the micro-organisms of 
 several diseases, the theory of transformation 
 must be regarded as not altogether im- 
 probable. 
 
 We have no definite knowledge as to the 
 manner in which the bacteria set up the pheno- 
 mena of disease. In some cases they have an 
 obvious local action ; in others they cause 
 general symptoms, such as fever and wasting ; 
 in a third class both forms of action are mani- 
 fested. The mischief wrought, of whatever 
 kind it may be, is not the result of mere 
 contact. It would appear that the living 
 organisms secrete or produce a poison which 
 is conveyed through the fluids of the tissues, 
 and is the cause of the local and general 
 changes. This explanation is supported by 
 the rapid poisoning sometimes witnessed after 
 animals are inoculated with anthrax. Death 
 may occur within twenty-four hours, though 
 the organisms are, by that time, very sparingly 
 diffused. The fatal result is due to poison, 
 doubtless produced by the organisms, but not 
 as yet isolated. 
 
 But to return to the bacilli of cholera. One 
 important part of their life-history is wanting,
 
 2O8 THE PREVENTION OF CHOLERA. [CAP. 
 
 for no spore-formation has been clearly ob- 
 served, and their mode of multiplication is 
 as yet doubtful. The spores of some kinds 
 of bacilli, when dried, retain their vitality for 
 months or years ; those which may be pro- 
 duced by the micro-organism of cholera do 
 not possess this property. It is stated that 
 if fluids containing cholera bacilli, or linen 
 impregnated with them, once become dry, no 
 further development can be brought about 
 under the most favourable circumstances. If 
 this assertion be correct, we must adopt the 
 conclusion that no living cholera bacilli can 
 be contained in any material which is in a 
 dry or dust-like state ; and as it is only from 
 completely dry surfaces that particles of dust 
 can be detached and carried to other localities 
 by currents of air, it follows that the transport 
 of living cholera bacilli by the air, and the 
 production of infection in this way, are im- 
 possible (Fliigge). It is, however, admitted 
 that cholera bacilli may be transported through 
 the air for short distances when infective fluids 
 are agitated and bubbles are detached, as, for 
 instance, when waves strike against a quay or 
 on the wheels of a water-mill, or when the
 
 IX.] EXPERIMENTS WITH BACILLI. 2OQ 
 
 soiled linen of cholera patients is being washed ; 
 in these cases small bubbles of fluid containing 
 bacilli may be brought by currents of air into 
 contact with predisposed individuals. 
 
 The statements above quoted are founded 
 upon the results of many experiments fre- 
 quently repeated, and conducted with the 
 greatest care. The bacilli are cultivated in 
 suitable media, and their behaviour is watched 
 under various conditions. It may be that all 
 the natural circumstances favourable to the 
 growth and development of cholera bacilli have 
 not as yet been ascertained and imitated. The 
 conditions which promote their increase in water 
 have been very closely studied. The fluid must 
 contain organic material in solution, and not 
 exhibit any acid reaction. Meat infusion and 
 milk are very suitable media. It was alleged 
 that in the Hamburg epidemic the substances 
 used to disinfect the river really promoted the 
 development of the cholera bacilli, inasmuch 
 as they killed large numbers of fish, which, 
 undergoing decomposition, supplied an abund- 
 ance of organic material to the water. 
 
 A few words as to the measures to be taken 
 to arrest the spread of cholera. We must
 
 2IO THE PREVENTION OF CHOLERA. [CAP. 
 
 act upon the theory that the disease is com- 
 municable, and that it is disseminated chiefly 
 or exclusively by the dejections of cholera 
 patients. Recent experience distinctly shows 
 that drinking water is the vehicle by which 
 the poison most often gains access to the 
 body. It may remain an open question 
 whether the poison ever rises into the air with 
 the products of evaporation, or whether it ever 
 passes into a dry state and takes the form of 
 impalpable dust. To make security as com- 
 plete as possible, it is well to regard these 
 latter modes of communication as at least not 
 improbable. 
 
 The precautions to be taken may be divided 
 into two classes special and general. 
 
 i. When cholera has once broken out in 
 a given locality, it is only natural that the in- 
 habitants of adjacent places should take steps 
 to prevent invasion. Human beings are the 
 carriers of the germs of the disease, and if the 
 affected spot or district could be completely cut 
 off from all communication with its neighbours, 
 the progress of the disease would doubtless 
 be arrested. Absolutely rigid quarantine is, 
 however, usually impossible, and events have
 
 IX.] PRECAUTIONS. 211 
 
 shown that it is not essentially necessary. 
 The strictest watch should, however, be exer- 
 cised over every possible channel of communi- 
 cation, and all persons coming from an infected 
 country should be carefully examined. Even 
 if they be found healthy, a short detention, 
 perhaps for three or four days, may often be 
 desirable. There is, however, much doubt 
 as to the length of the incubation period of 
 cholera, that is, the time which elapses between 
 infection and the appearance of the earliest 
 symptoms. Mr. Macnamara's cases show that 
 twenty-four hours may be sufficient ; but Dr. 
 Parkes states that this stage can certainly last 
 for ten or twelve days, and that there are some 
 good cases on record where it lasted for more 
 than twenty. Quarantine, therefore, unless 
 enforced for at least three weeks, might be 
 quite useless. 
 
 When cases of cholera already exist, every 
 endeavour should be made to destroy, by 
 means of disinfectants or by burning, the 
 poisonous properties of the dejecta from 
 patients. Corrosive sublimate is the best 
 destructive, and a solution containing one part 
 in 1,000 of water should be added freely to
 
 212 THE PREVENTION OF CHOLERA. [CAP. 
 
 the discharges. A solution of carbolic acid 
 (i to 20 water) is now recommended as more 
 efficacious. Another good plan is to mix the 
 discharges with dry sawdust and sulphur, and 
 to burn with a sufficiency of straw and wood. 
 The bedding, body linen, and other articles 
 tainted with the discharges should be either 
 burnt or soaked for some hours in the sub- 
 limate, or carbolic acid solution, and afterwards 
 exposed to the action of super-heated steam. 
 The attendants on the sick should observe 
 the most scrupulous cleanliness, and should be 
 careful to wash their hands with hot water, 
 soap, sand, and disinfectants immediately after 
 performing the necessary offices for the sick. 
 If it be impossible to burn the discharges, they 
 should, after disinfection, be buried deeply in 
 the soil, as far as possible from wells and other 
 sources of water supply. 
 
 The purity of the water used for drinking 
 is a matter of supreme importance. In country 
 places, where cesspools and wells are some- 
 times not many yards apart, the danger of 
 polluted water, is very great. Moreover, 
 shallow wells (i.e., less than fifty feet deep) 
 not passing through impermeable strata, as stiff
 
 IX.J IMPORTANCE OF PURE WATER. 2 13 
 
 clay or hard rock, are especially dangerous. 
 The drainage of the neighbouring land tends 
 towards them, and heavy rains will often wash 
 many substances into them. It has been 
 proved that cholera bacilli soon perish in 
 pure water ; but if organic matters be present, 
 rapid multiplication is the rule. In addition 
 to passing through a filter, all suspected water 
 should be previously boiled. There is good 
 reason for believing that domestic filters too 
 often fail to answer any good purpose ; indeed, 
 in some cases, their action is directly mis- 
 chievous. This result is due to the impure 
 state into which the filtering material is allowed 
 to get. It seems to be forgotten that filters 
 act by keeping back injurious particles, which 
 in the course of time accumulate in the 
 interstices and on the surface of the filtering 
 material. Unless the latter is from time to 
 time cleansed or renewed, fairly good water 
 may actually take up impurities from the filter. 
 If charcoal be used as a filtering agent, it 
 should be boiled from time to time, say once a 
 month, and then dried by exposure to the sun, 
 or in an oven. A charcoal ball should be well 
 scraped, and allowed to remain for some time
 
 214 THE PREVENTION OF CHOLERA. [CAP. 
 
 in hot water. The spongy iron filters are 
 perhaps the best for general use ; the material 
 is cheap, and can be easily renewed. The 
 Chamberland-Pasteur filters, as described in 
 the essay on the London Water Supply, are 
 said to be remarkably efficacious in preventing 
 the passage of micro-organisms. 
 
 It is almost needless to add that water 
 should never be allowed to remain in cisterns, 
 unless the latter are easily accessible and are 
 kept perfectly clean. No drinking water 
 should be drawn from a cistern which is in 
 direct communication with a^pipe employed 
 for flushing a closet. 
 
 In view of the fact that the cholera poison 
 is conveyed by water, the inhabitants of 
 London rfiay be congratulated on the with- 
 drawal of the proposal to provide a hospital 
 for cholera patients on the Thames at Black- 
 friars. Facility of access is the only recom- 
 mendation attaching to such a plan ; but this 
 is altogether outweighed by the terrible risk 
 necessarily involved. 
 
 2. The general rules for the prevention of 
 cholera are those of ordinary hygiene. The 
 cholera poison multiplies only under insanitary
 
 IX.] RULES FOR PREVENTION. 215 
 
 conditions ; it fails to obtain a footing wherever 
 the laws of health are observed. Filth in any 
 form, and especially earth sodden with animal 
 dejections and refuse, favour the development 
 of such diseases as cholera and typhoid, and 
 render individuals more liable to become 
 affected. Hence all drains, closets, etc., should 
 be kept in perfect order ; fresh air should be 
 admitted as freely as possible into every room ; 
 dampness of the surrounding soil should be 
 remedied, and the most scrupulous cleanliness 
 should be observed. Moderation and care in 
 such matters as eating, drinking, and exercise 
 decidedly tend to lessen the danger of con- 
 tagion. Excessive indulgence in alcoholic 
 liquors could only render the system more 
 liable to attack. It is sometimes, though 
 erroneously, supposed that the addition of 
 ardent spirits to water destroys or neutralises 
 impurities. Unripe fruit and indigestible food, 
 as tending to cause irritation of the abdominal 
 organs, should be scrupulously avoided. Chills 
 are likely to be mischievous ; an extra layer 
 of thin flannel or silk round the waist may be 
 worn with advantage. Medical advice should 
 be sought on the first appearance of diarrhoea.
 
 2l6 THE PREVENTION OF CHOLERA. [CAP. 
 
 A few words must be added on the method 
 of preventing attacks of cholera by inoculating 
 with an attenuated virus persons likely to be 
 exposed to contagion. The method, which has 
 been brought to a high degree of perfection by 
 M. Haffkine, is based on knowledge gained 
 from laboratory experience. The cholera 
 virus, capable of causing the severest form of 
 the disease, is gradually transformed into one 
 which, though almost or quite harmless, pro- 
 tects inoculated persons in a greater or less 
 degree. This anti-cholera vaccination, so- 
 called, has now been applied to thousands of 
 persons in India, and the accumulated evidence 
 is decidedly in its favour. There is, of course, 
 some difference of opinion as to its utility ; 
 but if the experiments be continued during 
 another year or two, and the results still prove 
 highly favourable, it is difficult to imagine that 
 any ground will remain for scepticism. 
 
 More than twenty-five years have elapsed 
 since any epidemic of cholera has raged in this 
 country. During that interval the disease has 
 reached our ports, but has failed to establish 
 a footing. We may fairly attribute this im- 
 munity to the improved sanitary conditions
 
 IX.] IMPROVED SANITARY CONDITIONS. 21 7 
 
 which now obtain in all our large towns. We 
 cannot be too thankful for this result, and we 
 ought not to neglect its obvious lessons. In 
 country places much remains to be done in 
 order to bring the sanitary conditions to a 
 level with our knowledge. We cannot plead 
 ignorance ; apathy and indifference are the 
 foes most to be dreaded.
 
 X. 
 
 INFECTION AND DISINFECTION. 
 
 THE enormous variety of subjects contained 
 in medical literature necessitates the use 
 of a corresponding number of terms, the 
 majority of which have a certain and well- 
 known meaning, but it would be difficult to 
 find two words more wanting in the element 
 of precision and more loosely used than those 
 placed at the head of this article. The general 
 public, indeed, solve all difficulties by con- 
 necting with the word "infection" the idea 
 of something "catching" i.e., something that 
 can be propagated from one person to another, 
 and disinfection is correspondingly regarded as 
 the means whereby such propagation can be 
 hindered. It must be admitted that this simple 
 view is quite correct so far as it goes. It of 
 course disregards all questions as to the nature 
 
 of infection, and the reason why some diseases 
 
 218
 
 CAP. X.] CONTAGION AND INFECTION. 
 
 spread from person to person and others do 
 not, and it included the belief that disinfection 
 is generally attainable, and by comparatively 
 simple means. In cases especially where the 
 use of some well-advertised material is found 
 to neutralise or mask an unpleasant odour, 
 the completeness of the disinfection is looked 
 upon as absolutely certain. 
 
 In medical writings the confusion has been 
 still further increased by the use of the words 
 " contagion " and " contagious " in describing 
 those diseases which were considered to spread 
 from one person to another by contact. 
 "Infection" and "infectious" were limited to 
 the cases in which the poison of the disease 
 was supposed to be conveyed by the atmo- 
 sphere from the sick person to those at a 
 greater or less distance from him. Accordingly, 
 we used to hear of a disease being contagious 
 but not infectious, and vice versa. The 
 distinction is, however, a purely artificial one, 
 and is not sustained by facts ; for many of the 
 contagious diseases can be propagated indi- 
 rectly, that is, without actual contact between 
 the person who yields the poison and the 
 person who receives it. Take, for example,
 
 22O INFECTION AND DISINFECTION. [CAP. 
 
 diphtheria ; it assuredly spreads by contact, and 
 is therefore contagious, and no less positively 
 is the poison capable of being disseminated 
 through the atmosphere and infecting those 
 who inhale it. So, too, with small-pox. If its 
 virus be introduced under the skin of a per- 
 son unprotected by vaccination or a previous 
 attack, he will almost certainly suffer from the 
 disease, and the same result would follow were 
 such a person to be in close attendance upon 
 a small-pox patient. In the latter case, the 
 poison floating about in the atmosphere would 
 get into the system through the lungs, and this 
 is practically just as much an example of 
 contact as if the poison were artificially intro- 
 duced through the skin. It is therefore better 
 to consider the terms "infection" and "con- 
 tagion " as practically synonymous, and they 
 will be so used in the remarks that follow. 
 
 To show what is implied by an infectious 
 disease, let me take a typical example and 
 contrast it with another disorder well known to 
 be non-infectious. A young adult, previously 
 in good health, is suddenly attacked by such 
 symptoms as chilliness, soreness of throat, and 
 evidences of derangement of the stomach.
 
 X.] NATURE OF INFECTION. 221 
 
 There is nothing characteristic about these 
 symptoms ; but let us suppose that on the 
 following day there is high fever, dryness of 
 skin, headache, giddiness, etc., and that in a 
 few hours a scarlet rash appears, first on the 
 chest, and then spreads over the body. All 
 the symptoms become worse, and for ten or 
 twelve days the patient is very ill. After this 
 period, in favourable cases, a change takes 
 place for the better, the rash dies away, and 
 all the other symptoms gradually subside. In 
 from three to six weeks, supposing that there 
 are no complications, the patient regards 
 himself as well. Such, in a few words, is the 
 course of a mild case of scarlet fever, which 
 may be considered as a typically infectious 
 disease. Now suppose that our patient is 
 treated in a house where there are several 
 other young people who have never suffered 
 from the disease. We know from experience 
 that unless the most minute precautions are 
 taken, the majority of these persons will 
 exhibit similar symptoms. It is also well 
 known that if any of these patients, supposed 
 to have partially recovered from the disease, 
 change their place of abode and go among
 
 222 INFECTION AND DISINFECTION. [CAP. 
 
 other friends, the latter will run great risk of 
 being attacked, and that the disease may thus 
 spread ad infinitum. This capacity of propa- 
 gation, the possession of which is as certain as 
 anything can possibly be, suggests the inquiry 
 as to the manner in which the original patient 
 of our series became infected. He in his turn 
 must have taken the disease from some one 
 else, but it is quite possible that he has never 
 been within a mile of a scarlet fever patient. 
 In many such instances it is impossible to get 
 any clue to the original case ; but it sometimes 
 happens that evidence is forthcoming to the 
 effect that days or weeks, or even months 
 before, a person convalescent from the disease 
 had occupied a room of which our patient 
 was afterwards a tenant, or that some article 
 of clothing which once belonged to patient 
 number one had been handled or worn by the 
 person whose case we are considering. It is 
 evident that there must often be great diffi- 
 culties in prosecuting such an inquiry. 
 
 Let us now take an example of a non- 
 infectious disease, and notice how it contrasts 
 with the one we have just described. A young 
 adult, previously in good health, becomes
 
 X.] NON-INFECTIOUS FEVERS. 223 
 
 sensible of a feeling of heat alternating with 
 chilliness and perhaps shivering, and slight 
 pains in the limbs. In a day or two there is 
 more or less fever and thirst, and some of the 
 larger joints are swollen and very painful, while 
 the skin covering them is much reddened. 
 The pain and fever are the principal symptoms ; 
 but there are often others, a description of 
 which is unnecessary for our present purpose. 
 The complaint lasts an indefinite time, but 
 even in the absence of treatment usually 
 subsides within six weeks. Such, in a very few 
 words, is the course of rheumatic fever or acute 
 rheumatism. 
 
 These two diseases scarlet fever and rheu- 
 matic fever have much in common, but there 
 are sharp points of difference between them. 
 In both fever is a prominent symptom, and 
 in addition to the display of local symptoms 
 the whole system is evidently affected. The 
 differences, however, are still more important. 
 Scarlet fever is eminently infectious. The air 
 which surrounds the patient becomes con- 
 taminated and highly charged with the poison, 
 and persons breathing it run great risk of 
 becoming affected. In a case of rheumatic
 
 224 INFECTION AND DISINFECTION. [CAP. 
 
 fever, although the secretion from the skin 
 is generally very copious and peculiar in 
 character, so that the sense of smell is strongly 
 appealed to, there is no such risk ; the disease 
 cannot be conveyed from the patient to those 
 around him, however close the attendance and 
 however defective the ventilation of the room. 
 Infection from a previous case is therefore 
 never thought of in connection with rheumatic 
 fever, though the actual nature of the poison 
 which causes the disease is as yet unknown. 
 The attack is often excited by exposure to cold 
 and wet, circumstances which play no part in 
 the causation of scarlet fever. There is at 
 least one more important difference between 
 the two diseases : scarlet fever very rarely 
 indeed occurs a second time in the same 
 patient, and the symptoms never become 
 chronic ; rheumatic fever, on the other hand, 
 is very prone to recur, and in not a few cases 
 the original attack merges into a chronic state 
 of suffering, which may continue for months 
 or even years. 
 
 I have taken scarlet fever as a representative 
 of the class of infectious diseases the cause 
 of which is the contamination of the system
 
 X.] INFECTION IN DIFFERENT CASES. 225 
 
 by some specific poison, and I have sketched 
 in a few words the main symptoms which 
 result. For our present purposes the im- 
 portant points are the contagious or infectious 
 character of the disease, and the proofs that 
 the contagious material multiplies within the 
 system which it has invaded, and from which 
 it sallies forth in quest of other victims. 
 There are, unfortunately, not a few diseases 
 belonging to the same category as scarlet 
 fever, the principal being small-pox, measles, 
 typhus, influenza, whooping-cough, diphtheria, 
 typhoid, and cholera. With regard to all 
 these it may be stated that they are quite 
 separate and distinct as regards causation. A 
 case of scarlet fever never gives rise to 
 small-pox in those exposed to infection, neither 
 does any one of the above diseases ever pass 
 into another. There are other subordinate 
 distinctions : the poison of scarlet fever, 
 contained presumably in detached particles of 
 skin, clings for months to articles of clothing, 
 especially woollen ones ; that of small-pox may 
 be collected from the eruption and preserved 
 for years between pieces of glass ; that of 
 typhus is easily rendered innocuous by free 
 
 15
 
 226 INFECTION AND DISINFECTION. [CAP. 
 
 ventilation. All these peculiarities and many 
 more might be cited point to important 
 differences in the nature of the infectious 
 materials. 
 
 What this infectious material really is has 
 often been keenly debated since medicine 
 became a science, and at the present time 
 is the question which most closely occupies 
 the minds of medical investigators. Merely 
 to enumerate the inquiries and to describe 
 the experiments and the theories based thereon 
 would fill many volumes ; but it is not to 
 be wondered at that this subject should 
 have excited so much attention when we 
 reflect upon the prevalence and fatality of the 
 diseases in question, and upon the compara- 
 tively slight influence which treatment exercises 
 upon their course. On the other hand, 
 experience clearly shows that their prevention 
 is not only possible, but in some cases easily 
 accomplished. The knowledge of the causes 
 of these diseases would indicate the proper 
 preventive measures, or at any rate the 
 direction which such measures should take, 
 and hence a discovery of the cause in any 
 given case at once yields practical results.
 
 CONTAGIOUS AGENCIES. 227 
 
 When we know what causes infection we 
 can apply disinfection with every prospect of 
 success. Without such knowledge, success if 
 attained must be accidental rather than other- 
 wise. The nature of the contagious agencies 
 and the medium through which they spread 
 are the most important points in connection 
 with the subject of infection. 
 
 There is strong evidence in support of 
 the view that these contagia are actual living 
 things. Formerly the opinion was universally 
 held that infectious diseases were caused by 
 foul air ; and the effluvia connected with putrid 
 decomposition were regarded as a sufficient 
 cause for the development of fever, small-pox, 
 etc. It cannot be denied that gaseous matters, 
 notably sulphuretted hydrogen, may act as 
 poisons and cause many serious symptoms, 
 but it has never been shown that infectious 
 diseases originate in this manner. It is 
 contrary to all that chemistry teaches us that 
 sulphuretted hydrogen or ammoniacal vapours 
 inhaled by the lungs should increase within 
 the body and cause it to become a centre 
 of infection ; and we know likewise that 
 ordinary poisons e.g., arsenic or morphia
 
 228 INFECTION AND DISINFECTION. [CAP. 
 
 fatal as their effects may be to one individual, 
 have no power of increase and propagation 
 after being once taken. It is therefore evident 
 that the poisons of infectious diseases must 
 be something of an entirely different nature. 
 We know that they multiply in the system 
 to an almost infinite extent, and that every 
 one of the myriads of atoms thus developed 
 is as potent for evil as the atom from which 
 it originated. The possession of this and 
 other properties clearly indicates that the 
 contagious agencies are independent living 
 organisms capable of growth and reproduction. 
 It has long been known that certain diseases 
 of the skin e.g., ringworm are caused by 
 the presence of parasites which very rapidly 
 increase, and can be easily recognised under 
 the microscrope. 
 
 In the case of some three or four of the 
 infectious diseases it would seem that the 
 poison has really been discovered. On ex- 
 amining vaccine matter, the contents of the 
 pocks in small-pox, and discharges in glanders, 
 the microscope shows a vast number of 
 infinitely minute particles, which appear as 
 glistening points. Some of these are even
 
 X.] BIOPLASM. 229 
 
 less than the fifty-thousandth of an inch in 
 diameter, and it therefore follows that very 
 high powers are necessary for their detection. 
 Such particles, obtained from vaccine lymph, 
 have been washed in water ; the water when 
 inoculated did not produce any effect, but 
 the washed particles were found to have 
 retained their potency. It seems fair to 
 infer that the contagious agents of the other 
 infective diseases would resemble in their 
 physical characters that of vaccine, and the 
 nature of such particles is the important 
 problem that offers itself for solution. They 
 are supposed by some, and notably by Dr. 
 Beale, to be of animal origin, and to consist 
 of elementary living matter, termed bioplasm. 
 Such particles may be easily transferred from 
 an infected to an uninfected organism, in which 
 they will manifest their own specific powers, 
 and grow and multiply almost indefinitely, 
 exciting in their new home a series of changes 
 resembling those which characterised their 
 presence in the one from which they were 
 derived. This account is certainly correct as 
 regards the virus of vaccine, but it does not 
 precisely define the nature of the particles
 
 230 INFECTION AND DISINFECTION. [CAP. 
 
 or tell us anything of their origin. Dr. Beale, 
 however, states that particles of contagious 
 bioplasm are not generated in the organism 
 of the infected animal, but are introduced 
 from without, and were originally derived by 
 direct descent from the bioplasm of the body 
 of man or animal. He regards them, in fact, 
 as particles of degraded bioplasm. This 
 theory is not in favour at the present time. 
 One objection to its validity is constituted by 
 the fact that particles of living animal matter 
 die very rapidly after they have escaped from 
 the body, whereas many contagious germs 
 preserve their vitality and capacity for evil 
 for a very long time. 
 
 Another theory which was promulgated 
 some twenty years ago was to the effect that 
 the contagious particles are of the nature of 
 those low vegetable organisms which are 
 termed fungi. This view gains support from 
 the manner in which these bodies increase 
 in number when planted in a suitable soil, and 
 the power which they possess of decomposing 
 many organic substances. The fact, already 
 referred to, that several diseases of the skin 
 and hair in men and animals are undoubtedly
 
 X.] THEORY OF BACTERIA. 231 
 
 due to fungi, also tends to recommend this 
 theory. Recent experiments, however, have 
 shown that these organisms, capable as some 
 of them are of growth and development on 
 the surface of the body, do not possess the 
 power of growth and reproduction within the 
 body, and it is therefore unlikely that they 
 should be the causes of disease in which 
 the system is charged with poisonous materials. 
 
 A third theory is one which is extremely 
 popular at the present day, advocated as it 
 is by investigators of the highest repute. It 
 is almost needless to say that I refer to the 
 view which credits certain minute organisms, 
 termed bacteria, with the power of causing 
 the infectious diseases that is, with being in 
 themselves the poisonous agents. So firm is 
 the hold that this view has obtained that 
 "disease-germs" and "bacteria" are used as 
 though they were synonymous terms. It is, 
 moreover, probable that more experiments have 
 been made with reference to bacteria than on 
 any other subject whatever. 
 
 The term "bacterium" signifies a rod, and 
 many of these organisms are minute rod-shaped 
 bodies. They or their germs are very widely
 
 232 INFECTION AND DISINFECTION. [CAP. 
 
 diffused throughout nature ; they swarm in 
 the air and in water, especially if containing 
 organic matter, and are likewise found in 
 great numbers within the bodies of men and 
 animals. Any one who possesses a microscope 
 with a magnifying power of five hundred 
 diameters can readily examine a very common 
 form of bacterium. It is only necessary to 
 take a glass of ordinary water from a spring 
 or river, and to leave it in a warm room 
 exposed for some days to the air. A thin 
 coating, looking like a deposit of fine dust, 
 is formed on the surface of the water ; this 
 dust consists of myriads of bacteria, which 
 are readily seen when a drop of the water is 
 examined. The bacteria are found to be in 
 several stages of transformation : some are 
 in long jointed rods, others represent one 
 or more detached portions of these rods, and 
 others appear as extremely minute rounded 
 particles. Some of the rods are capable of 
 movement, and are seen to wriggle through 
 the fluid like small eels or snakes. The 
 minute rounded particles are the spores, which 
 eventually become rod-shaped bodies. These 
 and other organisms are found in great abund-
 
 X.] DIFFICULTY OF INVESTIGATION. 233 
 
 ance in an infusion of hay, set aside for 
 some days till it has become turbid. They 
 are present in vast numbers wherever there 
 is putrefaction. 
 
 The peculiar interest connected with these 
 simple experiments is due to the fact that 
 minute organisms closely resembling those 
 just described are found in the bodies of 
 patients suffering from acute infectious diseases, 
 and the question naturally arises as to the 
 relation which exists between the organisms 
 and the symptoms. Are the former the cause 
 of the latter, or is their presence a mere 
 coincidence ? Another suggestion is that their 
 presence is the result of the disease. If the 
 symptoms are really caused by the presence 
 and action of the bacteria, it would follow 
 that differences must exist between the organ- 
 isms found in different diseases. Great and 
 manifold difficulties attend such investigations ; 
 it is sufficient here to notice the extreme 
 minuteness of the organisms, necessitating 
 the use of the highest powers of the micro- 
 scope for their detection. Moreover, as 
 already stated, bacteria are found in large 
 numbers in the bodies of persons apparently
 
 234 INFECTION AND DISINFECTION. [CAP. 
 
 healthy, and some of these organisms very 
 closely resemble, if indeed they are not 
 identical with, those that have been found in 
 connection with severe infectious diseases. It 
 is hardly conceivable that minute organisms 
 which abound, for example, in the mouth and 
 give rise to no changes, should be capable 
 in other parts of causing the most serious 
 symptoms. 
 
 In order to prove that a micro-organism is 
 the real cause of a disease, at least three 
 conditions must be fulfilled. In the first place, 
 the same species of micro-organism must be 
 invariably found in the blood, lymph, or diseased 
 tissue of man or animal suffering from or 
 dead of the disease. Secondly, the organism 
 must be cultivated apart from the body in 
 which it has been found, so as to make sure 
 that it has been separated from all other 
 morbid materials to the presence of which 
 the disease might possibly be due. Thirdly, 
 when the organisms thus cultivated have been 
 introduced into the body of an animal capable 
 of being attacked by the disease, similar 
 symptoms ought to be set up, and the same 
 micro-organisms should be found in the newly
 
 X.] PASTEUR AND DAVAINE. 235 
 
 affected animal. If, in testing any given 
 disease, these conditions are fulfilled, it is 
 scarcely possible to doubt that the micro- 
 organisms are the cause ; they certainly can- 
 not be the result. It is fair, also, to argue 
 from diseases in which the conditions are ful- 
 filled, that others in which, owing to circum- 
 stances, the tests cannot be properly carried 
 out are due to similar causes. 
 
 Very strong evidence is forthcoming in 
 support of the theory that micro-organisms 
 are the cause of infectious diseases. Horned 
 cattle and sheep are subject to a disease 
 termed anthrax, or splenic fever ; and so far 
 back as 1849, minute rod-shaped bodies were 
 found in the blood of animals which had died 
 from this disease, which is also communicable 
 to man. The significance of these rods was 
 suspected only after Pasteur's researches into 
 the part played by minute organisms in fer- 
 mentation. Guided by these discoveries, 
 Davaine inoculated healthy animals with blood 
 from those diseased, with the result of pro- 
 ducing similar symptoms, while myriads of 
 organisms were found in the bodies of those 
 animals which had been inoculated with a
 
 236 INFECTION AND DISINFECTION. [CAP. 
 
 very minute quantity of blood. The symptoms 
 are very characteristic, and the disease at one 
 time caused an enormous mortality among 
 cattle in France. By the opponents of the 
 bacterium hypothesis it might of course be 
 urged that in the inoculation experiments 
 other morbid materials were simultaneously 
 conveyed and that the transmission of the 
 disease was due to their presence. 
 
 To meet this objection, and to fulfil the 
 second condition laid down in the last para- 
 graph, experiments for cultivating the organisms 
 were set on foot in the following manner. A 
 drop of blood taken from an animal that 
 had died from anthrax was put into a glass 
 flask containing an infusion of yeast, which 
 had been carefully treated and proved to be 
 free from organisms. In twenty-four hours 
 the liquid, previously clear, was seen to be 
 full of very light flakes, which, when examined 
 under the microscope, were found to be 
 masses of organisms resembling those con- 
 tained in the blood. A drop taken from 
 this first flask was added to a second, and 
 produced the same effect, and a drop from 
 this was added to a third, and so on till
 
 X.] INFECTION IN ANIMALS. 237 
 
 a tenth flask was thus charged with organisms. 
 In this way the organisms were enormously 
 multiplied and completely freed from the 
 admixture of any other substance. Yet when 
 a drop was taken from the twentieth or even 
 the fiftieth flask of such a series, and inserted 
 under the skin of a sheep, it caused anthrax or 
 splenic fever, attended by the same symptoms 
 as those produced by the drop of blood taken 
 from the first animal. It is impossible to 
 conceive of any clearer proof that the organisms 
 are the sole cause of the disease. So crucial 
 a test, however, cannot be applied in every 
 case ; for many of the infectious diseases which 
 are the scourge of mankind do not affect the 
 lower animals, and it is therefore impossible to 
 make trial of the organisms found in connec- 
 tion therewith. Besides anthrax, there are 
 other infective diseases in animals which have 
 been proved to be due to bacteria, and these 
 facts strongly support the belief that the 
 infectious diseases of mankind are due to the 
 invasion of similar organisms. It is, however, 
 impossible as yet to dogmatise upon this 
 subject. There have already been too many 
 assertions and inferences drawn therefrom
 
 238 INFECTION AND DISINFECTION. [CAP. 
 
 which have turned out to be unwarranted. It 
 is comparatively easy for skilled observers to 
 detect the presence of micro-organisms, and 
 whenever uniformity of appearance is demon- 
 strable in connection with a given disease, a 
 decided addition has been made to our 
 knowledge. For reasons above given, the 
 next point viz., the determining whether 
 the organisms are the cause of the disease, 
 is surrounded with great difficulties. The 
 discoveries, however, with regard to splenic 
 fever strongly support the view that bacteria 
 are the efficient agents of contagious diseases. 
 
 Space will not permit me to do more than 
 allude to the various theories that have been 
 advanced with regard to the manner in which 
 these tiny organisms produce disease. It was 
 at first thought that they acted like parasites, 
 and exhausted the system during their devel- 
 opment. It is now, however, more commonly 
 believed that the organisms elaborate a special 
 ferment or poison, which, when produced in 
 sufficient amount, gives rise to the symptoms 
 of the disease. 
 
 One of the most valuable results of the study 
 of these organisms is the discovery that, by
 
 X.] INOCULATION. 239 
 
 cultivation, the virulence of some, at least, 
 can be so mitigated that when inoculated they 
 produce only slight and non-fatal symptoms, 
 the development of which in a given animal is 
 nevertheless protective against future attacks 
 of the original disease. By cultivating the 
 organisms of splenic fever at a temperature of 
 1 08 it is found that filaments are produced, but 
 not spores, and that by repeated cultivation 
 this growth becomes altered as regards its 
 properties of causing disease. When inocu- 
 lated, it sets up a mild form of splenic fever, 
 not dangerous to life, but perfectly protective 
 against subsequent inoculation with the other- 
 wise poisonous organisms. This discovery is 
 worthy of being classed with that of vaccination 
 as a protection against small-pox. 
 
 The immunity acquired by protective in- 
 oculation is a very interesting and important 
 subject. As a result of Pasteur's successful 
 experiments upon fowl-cholera and splenic 
 fever, the idea naturally arose that all infectious 
 diseases might be prevented by antecedent 
 inoculation with attenuated virus. This ex- 
 pectation, however, is not likely to be altogether 
 fulfilled ; for we know that in the case of some
 
 240 INFECTION AND DISINFECTION. [CAP. 
 
 infectious diseases small-pox, for example- 
 even a first attack does not always protect the 
 patient against a second. But such cases are 
 quite exceptional, and the conclusion to be 
 drawn from the results of Pasteur's method, 
 modified and adapted to various diseases by 
 other investigators, are such as to justify the 
 utmost confidence in "protective inoculation.'' 
 As a further development of experimental 
 researches, it has been found that the watery 
 portion (the serum) of the blood of animals 
 rendered immune is, as regards some diseases, 
 capable of conferring immunity upon other 
 animals. The infection of the poisonous pro- 
 ducts of bacteria leads to the development in 
 the blood of substances to which the term 
 "antitoxin" has been applied. These sub- 
 stances are found to be "protective"'; they 
 neutralise or destroy the injected poison, and 
 the fluid thus rendered " antitoxic " can be 
 used to protect other animals. As related 
 in the chapter on diphtheria, there is every 
 reason to hope that an " antitoxin " has been 
 discovered the use of which will greatly re- 
 duce the mortality caused by that widespread 
 disease.
 
 X.] PROPAGATING MEDIA. 24! 
 
 With regard to the channels through which 
 the contagious organisms are spread, a few 
 words will suffice to state what is known on 
 this point, which is intimately connected with 
 the subject of disinfection. Air and water are 
 the chief media for the propagation of in- 
 fectious disease. In the case of scarlet fever, 
 which has been taken as the type, the scales 
 detached from the skin, and similar tissues from 
 the throat, contain the germs of the disease, 
 and these find their way into the atmosphere 
 and are received into the lungs. They attach 
 themselves also to articles of clothing and 
 furniture, and are thus often carried to long 
 distances. The tenacity with which such 
 contagia adhere to woollen articles is very 
 remarkable. Sir Thomas Watson relates the 
 following instance : A house in which several 
 persons had been attacked by scarlet fever 
 was left empty for a year. When the family 
 returned, a drawer in one of the bedrooms 
 resisted for some time attempts to pull it open. 
 A strip of flannel had got between the drawer 
 and its frame, and had made the drawer stick. 
 This piece of flannel the housemaid put play- 
 fully round her neck. An old nurse who was 
 
 16
 
 242 INFECTION AND DISINFECTION. [CAP. 
 
 present, recognising it as having been used as 
 an application to the throat of one of the 
 subjects of scarlet fever, snatched it away and 
 burnt it. The girl, however, soon sickened 
 with the disease. In the cases of cholera and 
 typhoid fever, the discharges from the patient 
 find their way into water, which thus becomes 
 the channel by which the diseases are 
 propagated. Food, too, may become similarly 
 contaminated. Milk, for instance, has been 
 often known to convey the poisons of typhoid 
 fever, of scarlet fever, and of diphtheria. In 
 the case of the first, the contamination has 
 been probably due to adulterating the milk 
 with foul water containing the disease-germs, 
 but it may have arisen in some cases from the 
 typhoid emanations having been absorbed by 
 the milk. The poisons of scarlet fever and 
 diphtheria were probably transmitted to the 
 milk from the skins and throats of persons 
 employed in the dairy, and recently convales- 
 cent or scarcely recovered from attacks of these 
 diseases. The germs of certain other infectious 
 diseases find their way into the system through 
 abraded surfaces of the body. 
 
 The fatal character of many infectious
 
 X.] ANCIENT METHODS. 243 
 
 diseases, and the ease and rapidity with which 
 they spread and attack large masses of the 
 population, are sufficient to account for the 
 endeavours that have been made since very 
 early times to arrest their progress. As in 
 many other matters, practice has preceded 
 science, and centuries before the vaguest ideas 
 were entertained as to the nature of the 
 diseases which seemed destined to be the 
 scourges of mankind, efforts were made to 
 stamp them out. As might be expected, many 
 of these efforts were of the rudest description, 
 but the earliest of them aimed at the object 
 which the most modern science also seeks to 
 achieve viz., the destruction of the contagi- 
 ous material. The term "disinfection" first 
 occurred in literature towards the end of the 
 last century. A French writer, Morveau, in 
 1 80 1, published a work on " The Disin- 
 fection of the Air," but the word was used 
 somewhat earlier by a few English writers. 
 
 The most ancient method consisted in 
 destroying by fire everything that had been 
 in contact with the source of infection, the 
 idea, no doubt, being that as fire consumes 
 what is visible, it likewise destroys what is
 
 244 INFECTION AND DISINFECTION. [CAP. 
 
 invisible. It is possible that the practice of 
 burning the dead was in a measure based upon 
 the conviction that a source of danger to the 
 living was thus got rid of. The thirteenth 
 chapter of Leviticus contains the most minute 
 directions for disinfecting cases of leprosy ; 
 destruction of suspected articles by means of 
 fire, the copious use of water, and isolation 
 of the leper, are the means prescribed. 
 Inspection by the priest was to decide as 
 to the efficacy of these measures. Among the 
 Egyptians and certain Asiatic peoples, the 
 fumigations used by the priests in exorcising 
 disease were probably neither more nor less 
 efficacious than similar processes in vogue at 
 the present day in some European countries. 
 In the growth of ideas with regard to 
 the causes of infectious diseases, the theory 
 gradually took shape that the infecting matters 
 were formed as a result of the processes of 
 decomposition ; and as these processes are 
 generally attended with the development of 
 more or less unpleasant odours, it seemed only 
 natural to assume that the causes of the latter 
 were also the causes of disease. In addition 
 to regarding foul emanations as generally
 
 CHLORINE GAS. 245 
 
 mischievous, the idea was entertained that 
 there was something quite specific about them, 
 and accordingly we find that attempts to mask 
 or neutralise them were regarded as the best 
 methods of checking the spread of infectious 
 diseases. Deodorisation came to be considered 
 as equivalent to disinfection. The idea was 
 the more welcome inasmuch as it could 
 be carried into effect without destroying 
 property and without much difficulty. The 
 attempt was certainly in the right direction, 
 for the destruction of noxious agencies was 
 the object in view. Unfortunately the means 
 employed absolutely failed to effect their 
 purpose, and belief in their efficacy caused 
 very mischievous results viz., a sense of false 
 security and neglect of ventilation and cleanli- 
 ness as regards sick persons and surrounding 
 objects. In fact, the confident adoption of 
 deodorants as a means of checking the spread 
 of infectious diseases was a decidedly retro- 
 grade step as compared with the use of fire 
 for destruction and of water as a purifying 
 agent. 
 
 Chlorine gas was the deodorant which came 
 into very general use at the beginning of the
 
 246 INFECTION AND DISINFECTION. [CAP. 
 
 present century. It was freely employed in 
 hospitals, both civil and military, in prisons, 
 workhouses, etc., and was supposed to be 
 efficacious against fevers, cholera, and small- 
 pox. Whenever its characteristic odour could 
 be perceived, danger of infection was no longer 
 feared. Persons carried about with them small 
 flasks containing chemicals which generated 
 this gas, and inhaled a little when they con- 
 sidered themselves exposed to risk. It soon, 
 however, became evident that these precautions 
 were useless ; but even so recently as 1866, 
 during the war between Austria and Prussia, 
 it was thought sufficient to distribute saucers 
 containing chloride of lime throughout the 
 military hospitals, while only feeble efforts 
 were made to ensure cleanliness and other 
 important sanitary requirements. In order 
 to act as a real disinfectant, chlorine must 
 be employed in a very different manner. The 
 terrible mortality after surgical operations and 
 severe injuries a feature of which was that 
 a large majority of patients died with symp- 
 toms of blood-poisoning showed the futility 
 of such attempts at disinfection. 
 
 In spite, however, of many similar failures,
 
 X.] MODERN IMPROVEMENTS. 247 
 
 deodorisation has been almost universally re- 
 garded as the main object to be accomplished, 
 and other chemical agents have been used in 
 order to combat the gaseous products of 
 decomposition. This object could certainly 
 be attained if the sense of smell were to be 
 the sole judge of success ; and the practice 
 of deodorisation led also to the discovery and 
 use of many substances which have the power 
 to prevent or retard putrefaction, and were 
 therefore termed antiseptics, and regarded as 
 equivalent to disinfectants. The conclusion, 
 however, was soon forced upon the minds of 
 experimenters that the infective agencies of 
 fevers, small-pox, etc., were neither offensive 
 gases nor the products of putrefaction, but 
 something of an entirely different character. 
 When an infectious disease became associated 
 with the idea of a transportable material which 
 increases and multiplies in its new ground, the 
 discovery was not far off* that organisms 
 capable of reproduction are the real causes of 
 the disease. 
 
 Definite . ideas now prevail as to what is 
 meant by disinfection, and as to the methods 
 by which this object can be attained and the
 
 248 INFECTION AND DISINFECTION. [CAP. 
 
 tests whereby their efficacy may be proved. 
 Any substance may be regarded as a true 
 disinfectant which, when added to a quantity 
 of fluid swarming with bacteria, abolishes the 
 reproductive power of these organisms. If 
 the bacteria are capable of producing disease, 
 or the poison of disease, a successful experi- 
 ment has been made in the way of disinfection. 
 This fact explains the paucity of the real 
 experiences we possess of disinfection proper. 
 Heat, exposure to air and sunlight, removal 
 by mechanical processes, and the use of 
 chemical agencies, are the means at our 
 disposal ; it will be sufficient to point out a 
 few of the methods in which they may be 
 employed. 
 
 A very high temperature, say of 240 and 
 upwards, will, of course, destroy all such forms 
 of organised matter as we are now considering, 
 and if we could always isolate the germs 
 of disease, and expose them to great heat, 
 the task of disinfection would be thoroughly 
 accomplished. Such isolation is of course 
 impossible ; but we make use of heat for the 
 destruction of germs which have found a 
 resting-place in clothes, bedding, and textile
 
 X.] RULES FOR DISINFECTION. 249 
 
 articles of furniture. The application of heat 
 requires apparatus which cannot be extempor- 
 ised, and which are indeed beyond the capacity 
 of private resources. The infected articles 
 have to be placed in ovens or hot-air chambers, 
 the temperature of which can be raised many 
 degrees above the boiling-point of water. A 
 high temperature, however, has less effect upon 
 the spores than upon the mature organisms, 
 but successive heatings are found to effect the 
 desired result. During their development, 
 which is much promoted by the influence of 
 heat, the spores rapidly pass through several 
 stages, in which they become softened and far 
 more capable of final destruction. Exposure 
 to a current of steam at a temperature of 212 
 is a more potent, rapid, and satisfactory method 
 than the use of dry heat, and it has the further 
 advantage of causing less injury to the articles 
 to be disinfected. This question of injury to 
 infected articles is of much importance in 
 dealing with poor patients ; but under different 
 circumstances, or when the articles are of small 
 value, complete destruction by fire is the best 
 means of disposing of them. In the majority 
 of cases, and especially when the articles
 
 250 INFECTION AND DISINFECTION. [CAP. 
 
 consist of blankets and other woollen goods, 
 destruction has to be avoided, and the problem 
 to be solved is how to disinfect thoroughly 
 and at the same time do as little damage as 
 possible to the textures. Those materials 
 which are derived from the animal kingdom 
 are the most expensive and the most difficult 
 to deal with, and are at the same time the 
 favourite resting-places of the germs of disease, 
 which, when contained in woollen materials, 
 are protected from currents of air and thus 
 preserved. As Dr. Russell, the Medical Officer 
 of Health for Glasgow, points out, " The 
 value of the manufactured article depends 
 sometimes on form and elasticity, which may 
 be lost through heat ; or on colour, which may 
 be impaired. Every one knows that blankets 
 and other woollen articles cannot be boiled 
 without serious injury. Even the most cautious 
 washing changes gradually the white, fleecy, 
 new blanket into the yellow, dense, bare 
 comparatively comfortless old one. With 
 cottons and linens there is no trouble ; they 
 may be boiled with impunity. Wool, hair, 
 and feathers are most troublesome. They all 
 depend, for their value and utility, upon form
 
 X.] PRACTICAL RULES. 251 
 
 and elasticity, which again depend, not only 
 upon the hygrometric moisture, but upon the 
 presence of certain fats. When we begin to 
 deal with such articles, we find that we are 
 involved in all the technical knowledge of 
 several trade processes. . . . The practical 
 result is constant friction in carrying out 
 disinfection ; temptation to public officials to 
 scamp the work to avoid censure ; constant 
 private efforts to escape interference by con- 
 cealment, or appeals to fictitious domestic 
 processes ; or on the part of the wealthy to 
 resort to the general cleansing and renewing 
 operations of the upholsterer and hair and 
 feather cleaner." 
 
 If we wish to popularise disinfection, we 
 must simplify the process as much as possible, 
 having due regard to efficiency. It must 
 never be forgotten that exposure to sunlight 
 and fresh air constitutes one of the most 
 effective means of disinfection that we possess, 
 and it has the great advantages of involving 
 no expense and but little trouble. Accordingly 
 we find that in all regulations, intended to 
 be observed by the public in general, great 
 stress is laid upon the employment of those
 
 252 INFECTION AND DISINFECTION. [CAP. 
 
 great natural disinfectants, fresh air and sun- 
 light. Additional measures, easily carried out, 
 should either precede or follow the exposure 
 to air. Clothes, bedding, and all textile 
 fabrics should be thoroughly washed with 
 soap and hot water, left to soak for some 
 hours in clean water, and then dried and 
 exposed to air and sun for as many days as 
 possible. Such articles as cannot be washed 
 should be fumigated, in a manner presently 
 to be described, either with chlorine or 
 sulphurous acid, well shaken, beaten or 
 brushed, and exposed freely for several days 
 to sun and air. As a matter of course, all 
 pillows, beds, mattresses, stuffed furniture, etc., 
 should be cut open, the contents spread out 
 and thoroughly fumigated. " Carpets are best 
 fumigated on the floor, but should afterwards 
 be removed to the open air and thoroughly 
 beaten." 
 
 Dr. Russell states that, at Glasgow, simple 
 washing has for many years been the sole 
 method of disinfection applied by the sanitary 
 authorities to all washable articles, and that 
 the most careful investigation has failed to 
 discover a single case of disease propagated
 
 X.] DISINFECTION OF ROOMS. 253 
 
 by such materials. As a matter of course, 
 every care is taken that the work is thoroughly 
 done ; the washing-house is constructed for 
 the purpose, and provided with an ample 
 supply of water and steam, and various 
 mechanical appliances. All articles, with the 
 exception of woollen fabrics, are purified by 
 boiling or exposure to steam at a heat of 
 212. Owing to the extreme softness of the 
 water and the copiousness of the supply, 
 Glasgow doubtless has many facilities for 
 carrying out a system of disinfection which is, 
 to a great extent, mechanical in its operation. 
 Beating, shaking, and brushing are valuable 
 auxiliaries in dealing with articles which cannot 
 be properly washed. 
 
 For the disinfection of the air of rooms 
 many substances are recommended and 
 employed, but the way in which they are 
 generally used causes them to act merely as 
 deodorants. Even at the present day the 
 fact is very incompletely realised that venti- 
 lation that is, the continual admission of 
 fresh air, coupled with the escape of air that 
 has been contaminated is the only effectual 
 method of purifying the atmosphere of rooms
 
 254 INFECTION AND DISINFECTION. [CAP. 
 
 occupied by patients suffering from infectious 
 diseases. It is simply useless to place saucers 
 containing chloride of lime, carbolic acid, or 
 Condy's fluid in a contaminated atmosphere 
 with the expectation that the germs floating 
 about therein will be attracted, caught, and 
 killed, like mice in a trap. The chlorine, 
 doubtless, will readily diffuse itself throughout 
 a room, and remove some offensive odours ; 
 but to act as a true disinfectant it must be 
 so much concentrated, that the air thus charged 
 with it would be quite irrespirable by human 
 beings. It is, however, when used scien- 
 tifically, the best disinfectant we possess for 
 purifying the walls, etc., of an empty room. 
 All the openings and chinks of such an 
 apartment should be made as nearly air-tight 
 as possible, and the evaporation of a large 
 quantity of water in the room aids the action 
 of the chlorine, which is easily generated by 
 adding hydrochloric acid to bleaching powder. 
 
 If, however, large quantities are required, 
 these are most readily and economically 
 obtained by pouring two parts of sulphuric 
 acid, of a specific gravity i'535, over one 
 part of bleaching powder, just enough water
 
 X.] DEODORISING. 255 
 
 being then added to cause the latter to be 
 covered. The gas may also be prepared in 
 another way viz., by mixing together common 
 salt four parts, oxide of manganese three 
 parts, sulphuric acid nine parts, and five parts 
 of water. This process involves more expense 
 and trouble than the method with bleaching 
 powder. When chlorine is used for fumigating 
 and disinfecting purposes, the vessels contain- 
 ing the mixture which evolves it should always 
 be placed in the higher parts of the room, 
 as it then descends on account of its density, 
 and soon becomes mixed with the surrounding 
 air. It must be remembered that chlorine, 
 when combined with moisture, removes many 
 vegetable colours from fabrics ; it has little, 
 if any, bleaching power when moisture is 
 absent." 
 
 For deodorising purposes in sick-rooms and 
 passages, a gas called " euchlorine " will be 
 found very serviceable. It is produced when 
 a few crystals of chlorate of potassium are 
 dropped into a little hydrochloric acid. The 
 mixture can be conveniently made in a small 
 wide-mouthed bottle, which should be placed 
 as near the ceiling as possible, so that the
 
 256 INFECTION AND DISINFECTION. [CAP. 
 
 gas may descend into the room. Half an 
 ounce of the strong acid will be found sufficient 
 for several days ; a few crystals of the chlorate, 
 as many as can be taken between the finger 
 and thumb, should be dropped in night and 
 morning. 
 
 Bromine is even more powerful as a dis- 
 infectant than chlorine, but is not so convenient 
 for use ; both these agents are superior to 
 sulphurous acid, which, however, possesses a 
 considerable degree of efficacy, and is easily 
 employed for disinfecting empty rooms. All 
 openings and chinks should be closed as 
 before, and a pound or more of sulphur should 
 then be burnt in a brazier or other suitable 
 vessel. The space to be disinfected should 
 be kept saturated with the gas for a couple 
 of hours or more. It must be remembered 
 that sulphurous acid tarnishes and damages 
 metals, and bleaches vegetable colours. 
 
 For the disinfection of walls and ceilings 
 Professor Esmarch recommends that they 
 should be rubbed down with bread, the pieces 
 of which must be carefully collected and burnt. 
 Experimenting in this way in the Berlin 
 Hygienic Institute, he found that all germs
 
 X.] PURIFYING ROOMS. 257 
 
 were completely removed, and the rooms were 
 rendered immediately habitable without danger. 
 The rubbing is easily effected, and can be 
 done at very little expense by untrained 
 persons ; it may also be used as a preliminary 
 to disinfection by chlorine or sulphurous acid, 
 both of which will penetrate into chinks and 
 corners which cannot be reached by the hand. 
 
 Washing the surfaces by means of a spray 
 containing disinfectants in solution is another 
 efficacious method of purifying walls and 
 ceilings, and the most potent substance which 
 can be used in this manner is the perchloride 
 of mercury or corrosive sublimate. The 
 solution, which' is highly poisonous to all 
 forms of life, contains one part of the mineral 
 in one thousand parts of water. A similar 
 solution may be employed for the immersion 
 of infected linen or clothing before washing ; 
 the articles should be allowed to remain in 
 it for four hours at least. 
 
 Carbolic acid has been variously estimated 
 as a disinfectant. For some years after it was 
 first employed as a germicide it was consid- 
 ered to be the most efficacious substance of its 
 class. Later on the preference was given to 
 
 17
 
 258 INFECTION AND DISINFECTION. [CAP. 
 
 solutions of the perchloride of mercury ; but 
 since 1892, as the result of many experiments 
 by Dr. Crookshank and others, the superiority 
 of carbolic acid has again been demonstrated, 
 and in surgical practice it is now regarded 
 as the most powerful germicide. The question, 
 however, may well be asked whether the 
 highly diluted carbolic vapour used for purposes 
 of aerial disinfection is not powerless to deal 
 with an atmosphere saturated with the germs 
 of infectious diseases. For the disinfection 
 of liquids, a large amount of carbolic acid is 
 required ; the mixture should contain at least 
 two per cent, by weight of the pure agent. 
 Carbolic vapour will preserve for some months 
 the freshness of a piece of meat suspended 
 therein, and a very small quantity mixed with 
 animal fluids keeps them fresh, and prevents 
 all tendency to decomposition for an almost 
 indefinite period. Milk can be thus preserved 
 by the addition of one-fifth per cent. Carbolic 
 acid will stop the progress of putrefactive 
 changes, and, as Dr. J. A. Russell points out, 
 " small quantities of this disinfectant, instead 
 of destroying contagion, may actually preserve 
 its activity, when otherwise it would have
 
 x.] CONDY'S FLUID. 259 
 
 succumbed to the action of natural agencies. 
 This danger may accompany the limited use 
 of any disinfectant that has a ' pickling ' or pre- 
 servative action in small quantity." There is 
 also another drawback connected with its use. 
 Volatility is one of its properties, and " the 
 acid may, for a time, deprive the contagion 
 of its infective power, without permanently 
 abolishing it, and the virulent properties may 
 be regained whenever the acid has evaporated." 
 Condy's fluid a solution of the permanganate 
 of potassium is much employed for general 
 purposes of disinfection and deodorisation. It 
 is a very efficacious deodorant of fluid matters, 
 and has the advantage of being non-poisonous ; 
 but to act as a real disinfectant that is, to 
 destroy contagious germs or abolish their power 
 of reproduction it must be used in very large 
 quantities, and is therefore expensive. It is 
 admirably adapted for deodorising offensive 
 matters in the sick-room, and to these it should 
 be added until its colour remains. It is like- 
 wise well adapted for pouring down drains and 
 sinks, and a supply of it should be kept in 
 every house. Ozone may be prepared from 
 it by adding three parts of strong sulphuric
 
 260 INFECTION AND DISINFECTION. [CAP. 
 
 acid to two parts of the salt dissolved in water ; 
 and this, like the permanganate itself, oxidises 
 organic matter and thus destroys offensive 
 emanations, and, moreover, being gaseous, 
 will diffuse itself through the air, whereas 
 the permanganate is non-volatile. Ozone is 
 also evolved from terebene, which is a very 
 effective and pleasant deodorant when used 
 with a spray apparatus. 
 
 For the disinfection of sinks, drains, etc., 
 the permanganate has already been advised ; 
 carbolic acid and the chloride of zinc (Burnett's 
 solution) are also efficacious. A perchloride 
 of mercury solution, eight grains to a gallon, 
 is an extremely powerful disinfectant ; but the 
 mercury is precipitated when brought into 
 contact with copper, lead, and tin, and it 
 renders leaden pipes very brittle. The 
 stronger acids are liable to objections of the 
 same character. 
 
 Some of the statements made in preceding 
 paragraphs will now be summarised, so as to 
 indicate the methods of carrying out disinfec- 
 tion under the various circumstances in which 
 it is required. 
 
 A patient suffering from a contagious disease
 
 X.] ISOLATION OF CASES. 26 1 
 
 must be prevented from becoming a source 
 of danger to the healthy. Infective matters 
 are being constantly given off from his body, 
 and every care must be taken to prevent these 
 from being conveyed to others by attendants, 
 by clothes, bed-linen, etc., or through discharges 
 of all kinds. Free ventilation into the open 
 air, through windows, provides for the escape 
 of noxious emanations, which are rendered 
 harmless by dilution. After recovery, the 
 patient, nurses, all clothes, the sick-room and 
 its furniture must be thoroughly disinfected. 
 
 The measures best calculated to ensure these 
 objects are as follows : 
 
 i. The patient must be isolated in a separate 
 room, at the top of the house, if possible. 
 All unnecessary articles of furniture, woollen 
 materials especially, must be removed from 
 the room before the patient is placed in it. 
 Carpets and woollen curtains are favourite 
 resting-places of morbid germs, and are dis- 
 infected and cleansed with difficulty. All 
 drawers, cupboards, etc., should be emptied. 
 Staircase windows should be kept open night 
 and day, so as thoroughly to ventilate the 
 house. The door of the patient's room must
 
 262 INFECTION AND DISINFECTION. [CAP. 
 
 be kept closed as much as possible, and 
 outside should be suspended a cloth saturated 
 with a solution of carbolic acid, chloride of 
 zinc, or with dilute Condy's fluid. This should 
 never be allowed to become dry. The windows 
 in the room must be kept open whenever 
 circumstances will permit, and except in hot 
 weather a fire should be kept burning. The 
 destruction of unpleasant odours is best effected 
 by euchlorine (see pages 254 et sqq.}. The 
 patient's attendants should not visit other parts 
 of the house, and it will be an advantage in 
 most cases to select persons who have already 
 had the disease. The medical attendant will 
 adopt all necessary precautions to prevent 
 himself from becoming a carrier of contagion. 
 With regard to the residents in the house, there 
 is no risk in allowing them to continue their 
 ordinary avocations, and to leave the premises 
 as usual, provided that the patient is kept 
 properly isolated, and plenty of fresh air is 
 allowed to circulate in the house. Vessels, 
 cups, and plates used for feeding the patient 
 should be kept upstairs, and articles of 
 food or drink left by the patient should be 
 destroyed.
 
 X.] USEFUL DISINFECTANTS. 263 
 
 2. All the discharges from the patient should 
 be disinfected before being carried downstairs. 
 If they are to be thrown into the drains, the 
 best disinfectants are carbolic acid, chloride 
 of zinc, and permanganate of potassium. 
 These should be freely employed ; small 
 quantities are utterly useless. Whenever the 
 discharges can be buried deep in earth (an 
 excellent method of disposing of them) quick- 
 lime should be added in excess, or a strong 
 solution of perchloride of mercury (four grains 
 to a pint of water) should be mixed with 
 them. In country places where fuel is readily 
 procurable, burning the discharges in the open 
 air is an excellent way of destroying contagious 
 germs. 
 
 3. For disinfecting the sheets and body- 
 linen used by the patient, the methods already 
 described must be carefully employed (see 
 page 252). As soon as the clothes are removed 
 from the patient or his bed, they should be 
 placed in a wooden tub containing a solution 
 of perchloride of mercury (two grains to a 
 pint). After remaining for twelve hours, they 
 may be removed, rinsed in clean water, and 
 sent to be washed.
 
 264 INFECTION AND DISINFECTION. [CAP. 
 
 4. When the patient is convalescent, he 
 should be carefully washed with hot water 
 and carbolic or thymol soap ; and, as soon as 
 he is able to bear them, a few warm baths 
 will have a very beneficial effect. His hair 
 should be thoroughly cleansed, and he should 
 be dressed in clothes which have not been 
 in his room, and taken into another apart- 
 ment. The attendants should adopt similar 
 precautions with regard to washing, change 
 of clothes, etc. 
 
 5. The room, when vacated by the patient, 
 should be thoroughly cleansed and disinfected. 
 All movable articles should be taken away, 
 washed, exposed to heat, and then to air and 
 sunlight. Especial care is necessary in dealing 
 with bedding, wool, and feathers. Leather 
 and other articles which would be destroyed 
 or greatly damaged by heat should be sponged 
 with carbolic acid diluted with forty parts of 
 water. With regard to the room itself, the 
 best means of disinfecting it have been already 
 described (see pages 251 et sqq.}. Chlorine 
 and sulphurous acid are the best gaseous dis- 
 infectants, and are easily generated. The 
 floor should be thoroughly scrubbed, the ceiling
 
 X.] DRINKING WATER. 265 
 
 scraped and whitewashed, the walls repapered 
 or rubbed over with bread, and the paint 
 washed with carbolic soap. It is impossible 
 to take too much pains in carrying out these 
 measures of disinfection. After they are com- 
 pleted, the windows and door of the room 
 should be left open night and day for a 
 fortnight at least before the room is again 
 occupied. 
 
 It is quite certain that the germs of some 
 infectious diseases, notably cholera and typhoid 
 fever, are conveyed into the human body 
 through the medium of drinking-water. When 
 compelled to make use of water of a suspicious 
 class, nitration and boiling constitute the most 
 reliable methods of purification. Spongy iron 
 is, upon the whole, the most efficacious filtering 
 material. The water, especially if passed 
 through sand afterwards, comes out quite clear 
 and pure, and may be kept for a long time 
 without showing any signs of the production 
 of living organisms. The Chamberland- Pasteur 
 filter effectually strains off all organisms and 
 their spores ; but it has little or no effect 
 upon dissolved constituents. Charcoal filters, 
 on the other hand, certainly sometimes allow
 
 266 INFECTION AND DISINFECTION. [CAP. 
 
 spores or germs to pass through unchanged, 
 and when they are employed, boiling should 
 always be superadded. It is not sufficient 
 to bring the water once to the boiling-point ; 
 in order to be efficacious, repeated boilings are 
 necessary, for the reasons given in a preceding 
 paragraph. Milk of a suspicious character 
 should always be thus thoroughly boiled. 
 Travellers on the Continent do well to provide 
 themselves with small portable niters, now 
 easily procurable, for in many places the 
 drinking-water is highly charged with im- 
 purities. It is satisfactory to know that the 
 tannin contained in tea is a purifying agent 
 of some value as regards organic matter present 
 in water. 
 
 In order to complete this sketch of the 
 present state of our knowledge with regard to 
 infection, and of the best methods of prevent- 
 ing the spread of infectious diseases, it seems 
 desirable to give a short account of the public 
 arrangements having the latter object for their 
 aim. In the metropolis every vestry and 
 district board must appoint one or more legally 
 qualified medical practitioners of skill and 
 experience as officers of health. The duties
 
 X.] POWERS OF PUBLIC BODIES. 267 
 
 of such officers are, among others, to ascertain 
 the existence of diseases, more especially epi- 
 demics, and to point out the best means of 
 checking or preventing their spread. Under 
 the Public Health Act, 1875, tne whole of 
 England, with the exception of the metropolis, 
 is divided into sanitary districts, placed under 
 the charge of certain authorities, who must 
 appoint, from time to time, a medical officer 
 of health, whose duties have been clearly 
 defined by the Local Government Board. We 
 have, therefore, at the present time, in every 
 part of the country, highly-trained medical 
 officers of health, performing duties of a mani- 
 fold character, having for their objects the 
 prevention of the breaking-out and spread of 
 disease, and the improvement of the general 
 health of the public at large. It is not too 
 much to say that the efficient performance of 
 these duties, aided by the co-operation of those 
 most nearly concerned, cannot fail to lessen 
 the number of cases of infectious disease, and 
 might, indeed, in time, cause some of these 
 affections to disappear from the Registrar- 
 General's returns. One of these duties is 
 described in the following regulation : " On
 
 268 INFECTION AND DISINFECTION. [CAP. 
 
 receiving information of the outbreak of a 
 contagious, infectious, or epidemic disease, the 
 medical officer shall visit the spot, inquire 
 into the causes and circumstances of the out- 
 break, advise as to measures for preventing 
 the extension of the disease, and assist in 
 executing the same." 
 
 Up to 1889 Parliament had dealt with the 
 subject of the notification of infectious diseases 
 in a very imperfect and unsatisfactory manner. 
 It had promulgated no general law applicable 
 to all communities ; but had simply permitted 
 regulations on the subject to be inserted in 
 a few local Bills. In most places it was no 
 one's business to report the existence of cases 
 of infectious disease to the sanitary authorities ; 
 in a few localities, only the medical attendant 
 was charged with this duty ; and in others the 
 householder was likewise bound to make a 
 report. The differences have to a large extent 
 been abolished by the Act passed in 1889, 
 which charges both the medical attendant and 
 the head of the family to which the patient 
 belongs (or some other person connected with 
 him), as soon as they become aware that the 
 case is one to which the Act applies, to send a
 
 SANITARY AUTHORITIES. 269 
 
 certificate, giving certain necessary particulars, 
 to the medical officer of health. Failure to 
 give such notice renders the persons liable 
 to a fine not exceeding forty shillings ; and 
 the diseases to which the Act applies are, in 
 all places, small-pox, cholera, diphtheria, mem- 
 branous croup, erysipelas, scarlatina (scarlet 
 fever), and the fevers known by any of the 
 following names : typhus, typhoid, enteric, 
 relapsing, continued or puerperal. 
 
 The sanitary authority of any district may, 
 with the consent of the Local Government 
 Board, add any other infectious disease to the 
 above category ; but the adoption of the Act 
 is nowhere compulsory, though in June of last 
 year it was in force among twenty-seven out 
 of twenty-nine millions of people in England 
 and Wales. It would seem that the time has 
 come when the Act should be enforced by 
 statute in every district of the country : those 
 districts which neglect to do all in their power 
 to check the spread of disease should not be 
 allowed to endanger neighbouring districts. 
 
 I must not bring this essay to a conclusion 
 without stating that there are many disin- 
 fectants now offered to the public, but which
 
 270 INFECTION AND DISINFECTION. [CAP. 
 
 regard to space and the purpose I had in view 
 have prevented me from describing. I have 
 thought it best to confine my remarks to such 
 disinfectants as are really efficacious, and to 
 point out the advantages and drawbacks 
 connected with their use. With respect to 
 many so-called " disinfectants," it is sufficient 
 to say that their power has been absurdly 
 over-estimated. It cannot be too strongly 
 insisted upon that deodorisation is by no 
 means equivalent to disinfection. My object 
 has been to indicate in the first place what 
 in the present state of our knowledge seems 
 to be the true theory as to the causation of 
 infectious diseases, and to show how obstacles 
 are presented to more rapid scientific progress 
 by the extreme minuteness of the organisms 
 with which we have to deal. With regard 
 to disinfection, I have striven to prove how 
 entirely it must depend for its success on the 
 specific action exercised upon the disease-germs 
 by the means employed. The realisation of 
 this necessary relation cannot fail to dispel 
 many a fond belief with regard to disinfectants ; 
 but it will leave us with a more intelligent and 
 useful appreciation of their true properties,
 
 X.] KNOWLEDGE IS POWER. 27! 
 
 and, by revealing how far we still are from 
 the goal of complete knowledge, may even 
 stimulate the investigator to explore paths of 
 science which are yet unknown. Virgil says, 
 <J Felix qui potuit rerum cognoscere causas," 
 and to nothing is this aphorism more applicable 
 than to a knowledge of those agencies which 
 produce infectious diseases.
 
 XL 
 THE LONDON WATER SUPPLY. 
 
 THE importance of a sufficient supply of 
 wholesome water for domestic purposes 
 is at the present day admitted by all who have 
 paid any attention to the subject. Water is a 
 necessity of life, second only to the air we 
 breathe. It or its elements form about four- 
 fifths of the human body, and without its 
 assistance no function can be discharged. It 
 is a necessary constituent of all food, and is 
 of itself the most valuable of the many articles 
 which come under this denomination. Life 
 can be supported for days and even for weeks 
 upon water alone, and its admixture with so- 
 called solid foods is a necessary condition of 
 their being utilised by the animal system. 
 Although some substances resist its action as 
 a solvent, its power in this respect is much 
 
 more extensive than that of any other fluid. 
 
 272
 
 CAP. XL] CONTAMINATION OF SOURCES. 273 
 
 Water has other valuable properties. It is 
 the most effective and convenient agent for 
 cleansing the surface of our bodies, our clothes, 
 furniture, and dwellings, and the soil itself; and 
 when it descends in the form of rain, it cleanses 
 the air by washing the impurities out of it. 
 Its physical properties and the ease with which 
 it can be set in motion render it the most 
 convenient channel for the removal of many 
 waste and effete materials, and for their con- 
 veyance to places suitable for their disposal, 
 and it is especially this use of water which 
 has led to so many difficulties and dangers in 
 connection with its supply to large communi- 
 ties. Abundance of wholesome water is almost 
 everywhere obtainable, but unfortunately its 
 sources and the streams in which it flows are 
 too often contaminated by the admixture of 
 filthy and noxious matters. Such contamina- 
 tion is not only repulsive to all ideas of 
 cleanliness, but it includes many great dangers, 
 for not a few epidemics of fatal diseases have 
 been caused by the germs of such disorders 
 having gained access to the water. It is now 
 pretty generally known that any sudden out- 
 break of disease in an epidemic form is almost 
 
 18
 
 274 THE LONDON WATER SUPPLY. [CAP. 
 
 certainly attributable to the water supply, that 
 is, to something which has passed into the 
 water, and has been swallowed by the sufferers. 
 
 In primitive communities and in sparsely 
 scattered populations there is seldom much 
 difficulty in obtaining a supply of water. 
 Wells are sunk ; and if these are properly 
 protected from contamination, the supply, as 
 a general rule, is abundant and wholesome. 
 In Eastern countries, such as India, in which 
 water is the only fluid drunk by the natives, 
 the popular taste becomes so far educated as 
 to be able to distinguish good water from bad ; 
 it is generally safe to use water from those 
 wells that are the most frequented. Palatable 
 water is, however, not necessarily pure water, 
 and well water is peculiarly liable to contamina- 
 tion, not only from matters thrown or falling 
 into it, but from noxious substances which soak 
 through the surrounding soil. 
 
 When, however, extensive communities in- 
 habiting large cities have to be supplied with 
 water, the problem is one of a very different 
 character. To obtain sufficient water of any 
 kind must often be difficult ; to obtain whole- 
 some water may be almost, if not quite,
 
 XL] RIVERS AND SEWAGE. 275 
 
 impossible. A supply cannot be obtained on 
 the spot ; if thousands of wells were sunk in 
 a large city, some would yield bad water, all 
 would be liable to contamination, and the 
 supply would eventually prove insufficient. 
 Water must therefore be brought from a 
 distance, and whenever large towns are in the 
 vicinity of rivers, the most natural course to 
 pursue is to take the water thus brought within 
 reach by natural agencies. River water, free 
 from admixture with extraneous matters, is 
 generally of excellent quality. Many rivers 
 begin in clear mountain streams of pure water, 
 and receive accessions to their volume, not 
 only from tributary streams, but from the 
 ground water which, having fallen as rain on 
 higher ground, has sunk in, to reappear in 
 sandy or gravelly regions at lower levels in 
 the form of springs. If rivers were simply 
 channels for the passage of water, if no effete 
 and waste materials were allowed to pass into 
 them, we should hear very little about the 
 difficulties of supplying water to the majority 
 of large cities. Up to quite recent times, 
 rivers have been regarded as the most con- 
 venient receptacles for sewage and waste
 
 276 THE LONDON WATER SUPPLY. [CAP. 
 
 matters of all kinds, and even modern legis- 
 lation against such pollution has not achieved 
 the desired object, though considerable im- 
 provement has been effected. It may be laid 
 down as a general rule that no stream ought 
 to be used both as a source of supply and 
 as a carrier of waste and excrementitious 
 materials. 
 
 In applying this rule, however, to the case 
 of large cities, and especially to that of our 
 own metropolis, we are confronted with several 
 facts of a very remarkable character. Were 
 not the results of experience constantly before 
 us, to provide five millions of human beings 
 with a never-failing supply of water would 
 probably be regarded as an impossibility, and 
 it is still difficult to realise the magnitude of 
 the operations by which the supply is effected. 
 The simple fact is, that eight large water 
 companies supply one hundred and fifty-four 
 million gallons daily to a population amount- 
 ing in the aggregate to nearly five-and-a-half 
 millions, the consumption being at the rate of 
 twenty-eight gallons a head, and nearly half 
 of the total quantity supplied being taken from 
 the Thames. More than one-third comes from
 
 XL] THE WATER COMPANIES. 277 
 
 the Lea, while the remainder is supplied 
 from springs and wells. It follows, therefore, 
 that five-sixths of the total quantity of water 
 supplied to the metropolis is derived from 
 sources condemned by the rule laid down in 
 the previous paragraph. 
 
 The eight water companies are authorised 
 to obtain their supply from the following 
 sources : Five of them viz., the South wark 
 and Vauxhall, the West Middlesex, the Grand 
 Junction, the Lambeth and the Chelsea com- 
 panies take water from the Thames at 
 Hampton, Molesey, and Ditton, the maximum 
 quantity allowed in twenty-four hours being 
 one hundred and twenty millions of gallons. 
 The East London Company gets its supply 
 from the River Lea, at Chingford, and is also 
 allowed to take, when necessary, as much as 
 ten millions of gallons daily from the Thames 
 at Sunbury. The New River Company takes 
 water from the Lea, near Ware, the spring 
 at Chadwell, and from thirteen chalk wells in 
 the Lea valley. The Kent Waterworks Com- 
 pany obtains its supply from the chalk wells 
 between Deptford and Crayford. 
 
 All these companies contract to collect water
 
 278 THE LONDON WATER SUPPLY. [CAP. 
 
 from intakes, or certain defined spots where 
 it is obtainable, to store it in proper reservoirs, 
 filter it, bring it into the streets, maintain it 
 under a given pressure, and convey it into the 
 private service pipes provided at the expense 
 of the house owner or the consumer. The 
 companies' engagements are completed when 
 the water is brought, in a wholesome and pure 
 condition, to the premises of the consumer as 
 required by the "Metropolis Water Act, 1871," 
 and when provision is made for a regular 
 supply. They are not responsible for anything 
 which may happen to the water inside the 
 premises supplied. It may be kept in filthy 
 cisterns, it may absorb gases from drains or 
 cesspools, and may become absolutely poison- 
 ous ; but for such contamination, and for the 
 state of the pipes within the house, the builder 
 or householder is responsible. What is perhaps 
 still more important, because less generally 
 known, the water companies are not responsible 
 for much of the deterioration of quality at 
 the intakes, from the neglect of local public 
 authorities, such as river conservators and 
 others, who have allowed increasing quantities 
 of sewage or refuse matter to be discharged
 
 XL] THE METROPOLIS WATER ACT. 279 
 
 into the river above the points whence the 
 supplies are taken for public consumption. 
 
 Such, then, are the present arrangements 
 for supplying London and its five and-a-half 
 millions of inhabitants with water. They have 
 been completed at a cost of over fourteen 
 millions sterling, and since the passing of the 
 " Metropolis Water Act, 1871," the companies 
 have incurred and undertaken an expenditure 
 amounting to upwards of four millions for the 
 improvement of the water supply, both in 
 quantity and quality, for extending the capacity 
 of their reservoirs, and increasing the areas of 
 filtration, as well as for providing for the 
 requirements of a constant supply. In order 
 that the consumers' interests should be duly 
 protected, the " Metropolis Water Act " of 
 1 87 1 provided for the appointment of a water 
 examiner, being a competent and impartial 
 person, who should from time to time examine 
 the water supplied by the companies, to ascer- 
 tain whether they had complied with the 
 requirements of Section 4 of the " Metropolis 
 Water Act, 1852," which orders that every 
 company shall effectually filter all water sup- 
 plied by them within the metropolis for
 
 280 THE LONDON WATER SUPPLY. [CAP. 
 
 domestic use before the same shall pass into 
 the pipes for distribution. The filtration of 
 water taken from the Thames and Lea is 
 effected by the water companies in the following 
 manner. 
 
 The water is received into subsidiary reser- 
 voirs, and there stored for some days, during 
 which a large proportion of the suspended 
 matter gradually subsides, when the water is 
 drawn off into the filter-beds. These large 
 reservoirs have another advantage ; they enable 
 the companies to increase their storage during 
 fair weather, and to discontinue the collection 
 during temporary floods. In 1877 the total 
 storage of the seven companies was 1,041 
 millions of gallons; in 1888, 1,290 millions, 
 or about nine days' supply. The water sup- 
 plied by the Kent Company, being taken 
 from deep wells in the chalk, does not require 
 filtering. 
 
 The filtering-beds are composed of gravel 
 and sand, the depth of the materials thus 
 employed varying from three-and-a-half to 
 seven feet (see report by Water Examiner for 
 Nov. 1888). The upper layer of about two 
 feet is composed of sand, the remainder is
 
 XL] SAND FILTERS. 281 
 
 made up of gravel. Sometimes a layer of 
 shells is placed between the sand and gravel, 
 gradually increasing in coarseness. The pres- 
 sure of the water in these filters is not great, 
 the depth is never more than two feet, and 
 it is found that sixty gallons pass through each 
 square foot in twenty-four hours. The filtering- 
 beds are cleansed and replenished with fresh 
 sand from time to time. The action of the 
 sand is mainly of a mechanical nature ; it 
 certainly removes suspended matter, both or- 
 ganic and mineral, and it appears to retain 
 about 5 per cent, of the dissolved con- 
 stituents ; and the power of such a filter in 
 arresting organisms is considerable when the 
 sand is fresh, but it ceases after a time. Dr. 
 R. Koch, however, states that the reduction in 
 the number of organisms is due to the film 
 of mud which gradually forms on the surface 
 of sand-filters, and which mechanically retains 
 the organisms in the same manner as a Pasteur 
 filter, in which the water is forced through 
 unglazed biscuit ware. If this statement be 
 correct, it must be regarded as unfortunate that 
 the film has to be scraped off periodically, in 
 order to allow of the percolation of the water
 
 282 THE LONDON WATER SUPPLY. [CAP. 
 
 through the filter. The removal of the film 
 takes place about once a month ; and as Dr. 
 Koch states that a fortnight is required before 
 it acts as a good filtering medium, as against 
 organisms, it is clear that in our waterworks 
 there must always be several filter-beds which 
 offer but a slight obstacle to the passage of 
 microphytes, which may have gained access to 
 the water. Against this drawback, however, 
 is to be set the fact, already alluded to, that 
 fine white sand, well washed, arrests the passage 
 of a considerable proportion of organisms. It 
 does not afford complete protection, for it was 
 shown at Lausen, in Switzerland, that water 
 containing typhoid germs, after having been 
 subjected to sand-filtration, infected the 
 population of a village and destroyed many 
 lives. Ferruginous green-sand and spongy 
 iron are still more efficient in this respect (see 
 Dr. Frankland's Report on the use of spongy 
 iron in the filter-beds of the Antwerp water- 
 works). The duties of the water examiner are 
 of a multifarious character. He inspects the 
 filter-beds and reservoirs, and examines the 
 quality of the water at the intakes and after 
 filtration. He furnishes monthly and annual
 
 XI.] PRECAUTIONS. 28 
 
 O 
 
 reports, giving complete and exact information 
 with regard to the water supplied, including 
 such points as its source, total volume, 
 average daily supply, state of filtration, 
 condition of samples, etc. He furnishes 
 reports on the composition and quality of 
 daily samples of the water, based on analyses 
 made for the companies by analysts of their 
 own appointment, and by an analyst chosen 
 by the Government ; and lastly a report of 
 results of the bacteriological examination of 
 the metropolitan water supply made by Dr. 
 Percy Frankland. 
 
 From the foregoing account of the pre- 
 cautions taken to insure that the water when 
 delivered to the consumer shall be as pure as 
 circumstances will permit, it is obvious that no 
 charge of neglect can be sustained against 
 the companies or those who control their 
 operations. With regard to the companies, it 
 is universally admitted that they have always 
 been in advance of public opinion on improve- 
 ments in the water supply ; not only do they 
 fulfil their contracts, but they do not limit 
 themselves to a bare compliance with the 
 provisions of Acts ,of Parliament, they fre-
 
 284 THE LONDON WATER SUPPLY. [CAP. 
 
 quently adopt measures for the general 
 improvement of the supplies, and exhibit proofs 
 of their anxiety to discharge the duties of their 
 position towards the public. It cannot be said 
 that the inhabitants of London are dissatisfied 
 with the water supplied to them. Possibly 
 their satisfaction may be the result of ignorance 
 or indifference ; but there can be no doubt as 
 to its widespread existence. With regard, 
 however, to the source of supply and the 
 consequent quality of the water, very con- 
 flicting opinions are held by men who deserve 
 to be regarded as competent authorities. If 
 we are . to believe Dr. Frankland and those 
 who think with him, there may be water 
 everywhere in London, but there is not a drop 
 fit to drink, except that which is supplied from 
 the chalk wells in Kent. Other able chemists 
 agree with Dr. Tidy in declaring that the 
 London water is excellent, and that no better 
 sources of supply can be found for the metro- 
 polis, considering all the facts of the case, than 
 the rivers Thames and Lea. It will be well 
 to examine briefly the evidence adduced in 
 support of these two contradictory opinions. 
 There is, however, a preliminary question
 
 XL] RELATIVE PURITY OF WATER. 285 
 
 which must not be passed over : every one 
 wishes to secure pure water, but what is the 
 standard of purity ? Now pure water, using 
 the adjective in the strict sense, is not obtain- 
 able outside the chemist's laboratory, and much 
 care is required for its preparation. It is 
 obtained by distilling ordinary good water, and 
 the product has to be tested in various ways 
 in order to determine that it has received no 
 contamination from the vessels employed in 
 the process. If no mineral matters are dis- 
 coverable, and if on evaporation the water 
 leaves " scarcely a visible residue," it may 
 be regarded as pure. Next to distilled 
 water comes rain water, caught in clean 
 vessels, on mountains or large plains far from 
 human habitations and after some hours of 
 rain. It is almost needless to say that water 
 up to this standard of purity is not to be found 
 in the purest springs or rivers. These are 
 supplied by rain which falls on the earth, 
 charged with many impurities washed out of 
 the atmosphere, and capable of dissolving 
 many materials on and beneath the earth's 
 surface. Lime and magnesia are universally 
 present in the soil, and various organic matters
 
 THE LONDON WATER SUPPLY. [CAP. 
 
 offer themselves for solution. As water sinks 
 through the earth, new materials are taken up ; 
 others previously dissolved or suspended in the 
 fluid are often retained. Hence spring water 
 contains the results of solution modified by 
 filtration. River water, containing as it does 
 much rain water that has fallen on the earth, 
 is apt to vary greatly in composition, and 
 often contains much organic matter washed 
 off the surface by the rain. 
 
 Water, whether from river or spring, to be 
 regarded as wholesome, must be perfectly clear, 
 free from odour, tasteless, and cold. It must 
 also contain more or less air and carbonic acid 
 (otherwise it will taste flat) ; and it must be 
 soft, through the absence of undue amounts 
 of lime and magnesia. Its solid constituents 
 should not be much more than ten grains in a 
 gallon, except in the case of water from chalk 
 wells, where that proportion may be much 
 exceeded. With regard to the organic matter 
 an all-important question if water from the 
 chalk springs of the Kent Company be taken 
 as a standard, there should not be more than 
 one-tenth of a grain in a gallon. It is very 
 difficult to distinguish between dissolved
 
 XL] TESTS OF PURITY. 287 
 
 organic matter derived from vegetable sub- 
 stances and that of animal origin. Elaborate 
 chemical processes are required, and the 
 chances of error are considerable. Some 
 information may be obtained by examining 
 the sediment with the microscope, and from a 
 consideration of the source of the water and the 
 various matters dissolved therein. Bacteria of 
 all kinds, fungi, remains of animal structures, 
 eggs of parasites, etc., must be absent. In- 
 fusorial animalcules of various kinds and 
 diatoms are often seen in well waters, and do 
 not indicate any serious impurity. To make 
 an exhaustive examination of a given sample 
 of water requires considerable skill, but its 
 wholesomeness or otherwise can generally be 
 decided without much difficulty. It is perhaps 
 necessary to mention the fact that the taste 
 of water is a very uncertain indication of its 
 purity. If anything objectionable be detected 
 by the tongue, the water must be rejected ; 
 but dissolved organic matter is often tasteless, 
 and the sense of taste is of little use in dis- 
 covering many dissolved mineral substances. 
 Thus common salt is recognised by the tongue 
 only when a gallon of water contains as much
 
 288 THE LONDON WATER SUPPLY. [CAP. 
 
 as seventy grains. On the other hand, very 
 small quantities of iron communicate a peculiar 
 flavour to the water ; one-fifth of a grain per 
 gallon can be thus discovered. It is well to 
 warm water before tasting it ; cold is always 
 grateful to the tongue, and prevents many 
 unpleasant flavours from being noticed. 
 
 Having thus briefly alluded to the charac- 
 teristics of wholesome water, I proceed to 
 inquire whether the water supplied to the 
 metropolis can be included in this category. 
 It cannot be denied that a considerable amount 
 of sewage and refuse matter enters the 
 Thames above the spots at which the water 
 is taken by the various companies. It has, 
 indeed, been stated that the sewage from a 
 population estimated at more than half a 
 million is thus disposed of, and that therefore 
 the source of supply is contaminated to such 
 a degree as absolutely to condemn the water 
 even if filtered through sand in the best 
 possible way. It must be remembered that 
 the " Rivers Pollution Act " forbids the dis- 
 charge in their entirety of sewage matters 
 into rivers. The most common methods of 
 dealing with sewage are to allow the solid
 
 XL] POLLUTION OF RIVERS. 289 
 
 parts to subside or to precipitate the greater 
 portion by means of chemical substances, and 
 then to make provision for the liquid to pass 
 over or through land and thence into a stream. 
 The sewer water is to some extent purified, 
 but its standard of purity has not as yet been 
 fixed. Besides this source of contamination, 
 the result of floods must be taken into account. 
 The cultivated ground near the banks of the 
 upper Thames is often under water, and 
 much organic matter from manure, decaying 
 vegetables, etc., must be washed into the 
 river as the floods subside. Another source 
 of impurity viz., the refuse from house-boats 
 and from the floating population must also 
 be borne in mind. To express numerically 
 the condition of the Thames water, it may 
 be assumed that from four to five hundred 
 millions of gallons pass daily over Teddington 
 Lock, and that twenty million gallons of 
 dilute sewage have been mixed with it. The 
 potential impurity may be described as fluc- 
 tuating between 2 and 4 per cent. 
 
 It is all-important to determine as accurately 
 as possible whether this degree of impurity 
 represents a fixed quantity, or whether it is 
 
 19
 
 290 THE LONDON WATER SUPPLY. [CAP. 
 
 lessened as the water flows on. Much turns 
 upon the answer given to this question ; as 
 usual, very conflicting evidence is given by 
 experts, but an unbiassed examination would 
 appear to show that rivers with a flow of 
 a few miles possess considerable power of 
 transforming hurtful organic impurities into 
 harmless products. The change is effected by 
 three principal agencies, (i) The suspended 
 organic matters subside ; they are forcibly 
 carried to the bottom by the admixture of 
 the impure water with suspended mineral 
 matters. (2) Fish act as scavengers, and it 
 must be remembered that their presence in 
 water indicates a certain degree of purity. 
 (3) The most potent purifying agent is oxygen, 
 derived in part from the air and in part from 
 the plant life with which rivers abound. The 
 oxygen derived from the latter source being 
 set free in the water, is the more powerful 
 agent in producing the change. The weeds 
 of a river bed into which sewage passes 
 absorb a large amount of organic matter and 
 of chlorides, and are valuable purifiers of the 
 water. 
 
 Dr. Frankland admits that some purifying
 
 XL] OXIDATION. 2QI 
 
 action may occur in the course of the flow 
 of a river, but contends that it is so small as 
 to be practically useless. He considers that 
 if the water of a river be once contaminated 
 with ever so small a proportion of sewage 
 matters, no river in England is long enough 
 to bring about, by oxidation or otherwise, 
 such a removal of the organic impurities as 
 to render the water wholesome and fit for 
 domestic use. He cites the case of the river 
 Irwell, which, after passing Manchester, runs 
 eleven miles to its junction with the Mersey 
 without further material pollution, and falls 
 over six weirs ; yet the purification by oxida- 
 tion is trifling. Dr. Tidy, on the other hand, 
 asserts that if sewage be discharged into a 
 river and mixed with at least twenty times 
 its volume of pure water, after a moderately 
 rapid flow of a few miles, the whole of 
 the impurities will disappear as a result of 
 oxidation and other agencies, and the water 
 will be restored to its original state of purity. 
 The late Dr. Parkes an authority second 
 to none on such a subject was inclined to 
 attribute much influence to oxidation, and 
 several facts strongly support this view. The
 
 292 THE LONDON WATER SUPPLY. [CAP. 
 
 case of the river Tees deserves to be 
 mentioned ; this river receives the sewage 
 of Barnard Castle, containing four thousand 
 inhabitants, and of several villages, and like- 
 wise the refuse from dyeworks and fell- 
 mongers. It flows on for sixteen miles to 
 Darlington, where the water companies supply- 
 ing that town, Stockton, and Middlesbrough 
 obtain their water. It is somewhat remarkable 
 that Dr. Frankland has reported this water 
 to be " of unimpeachable quality, as clear 
 and bright (after filtration), and nearly as 
 palatable, as deep well or spring water." Here, 
 surely, there is no evidence of previous sewage 
 contamination. 
 
 Another remarkable instance of the purifica- 
 tion of water as a result of free exposure to 
 the air was furnished by Mr. A. le Grand, 
 in a communication to the Society of Arts. 
 He was well acquainted with the water of a 
 river known to be more or less polluted, and 
 of which samples were sent to analysts from 
 time to time. On one occasion the water as 
 drawn from the river was forced up into the 
 air in a jet, and the spray which fell was col- 
 lected and sent to the analyst. So great was
 
 XL] AIR AS A PURIFIER. 2Q3 
 
 the change in the direction of purity that the 
 analyst, until assured by competent authority, 
 was sceptical as to the real source of the water. 
 These instances seem to prove that exposure 
 to air purifies water contaminated with organic 
 matter. Such exposure must, however, be 
 complete and continuous. It is not contended 
 that well water conveyed in pipes can be thus 
 improved, though this admission is sometimes 
 cited by the opponents of the oxidation theory 
 in support of their view. About eighteen 
 years ago the chalk wells at Caterham became 
 polluted by a workman suffering from typhoid 
 fever, and the result was that many persons 
 in Redhill who drank the water were attacked 
 by the disease. Now, the distance between 
 these two places is about seven miles, and it 
 is not fair to assume that, because the typhoid 
 poison was capable of being conveyed that 
 distance in closed pipes, its effects would have 
 been the same had it passed into a river and 
 been swallowed after a flow of some miles. 
 
 If it were true that no improvement, whether 
 by oxidation or otherwise, takes place in river 
 water during its flow, and if sewage-matter, 
 even in very small amount, could not possibly
 
 294 THE LONDON WATER SUPPLY. [CAP. 
 
 be excluded, it would be absolutely necessary 
 to seek other sources of supply. Dr. Frank- 
 land's opinion is that we ought to have two 
 systems of water supply in London : the first 
 ought to give us good water fit for dietetic 
 purposes ; the second, water for manufacturing 
 and trading purposes, flushing sewers, watering 
 streets, and extinguishing fires. It would not, 
 however, be desirable to introduce two kinds 
 of water into houses, for most servants, not 
 to speak of other persons, would go to the 
 nearest tap, whatever the quality of the water. 
 Only the pure water should be introduced 
 in houses, and the use of meters should be 
 compulsory, so as to prevent waste. Dr. 
 Frankland thinks that it is quite unnecessary 
 to continue to supply some thirty gallons per 
 head, as is done in London, and that ten 
 gallons would be sufficient. He would obtain 
 this pure water from springs or deep wells, 
 and convey it to the consumer without pre- 
 vious admixture of sewage and other impurities. 
 Such wells can be found in the Thames Valley, 
 for it is a well-known fact that in times of 
 long drought the Thames is supplied exclu- 
 sively from springs almost all coming from
 
 XI.] DOMESTIC REQUIREMENTS 295 
 
 the chalk and the oolite. It certainly seems 
 unnecessary to take enormous pains to purify 
 water which is used only for watering streets 
 and other outdoor purposes. Even Thames 
 water taken at London Bridge, if a few days 
 were allowed for the subsidence of the coarser 
 impurities, would be sufficiently pure for such 
 uses. With regard to the average supply to 
 each individual, twenty-eight gallons daily is 
 probably excessive. There is doubtless much 
 waste from carelessness and bad taps, but it 
 is desirable that any error in the quantity 
 supplied should be on the side of excess. 
 Habits of cleanliness are not too common, and 
 nothing should be done that would tend to 
 make them less popular, or to furnish excuses 
 for negligence. Waste of water should, how- 
 ever, be checked in every possible way. Dr. 
 Parkes estimated that for personal and domestic 
 use, without baths, twelve gallons per head 
 daily should be given as a minimum supply, 
 and that with baths and perfect cleanliness 
 sixteen gallons should be allowed. Water for 
 necessary sanitary purposes is not included 
 in this estimate, and it must be remembered 
 that even a small general bath (4 feet long
 
 296 THE LONDON WATER SUPPLY. [CAP. 
 
 and i foot 9 inches wide) for an adult will 
 require from thirty to forty gallons. 
 
 If the Thames is to be superseded or sup- 
 plemented as a source of water supply in the 
 manner suggested by Dr. Frankland, it would 
 be necessary to inquire into the capacity of 
 springs and wells to afford the requisite quan- 
 tity of water. It is, perhaps, too readily 
 assumed that no grounds for fear would exist 
 with regard to the quality. Water from the 
 best chalk wells is clear, transparent, and 
 bright ; it is well aerated, and free from dead 
 organic matter, and contains comparatively 
 few organisms. Its hardness is its only draw- 
 back, and this depends upon the presence of 
 an excessive amount of chalk, held in solution 
 by carbonic acid gas. It may be softened by 
 adding lime, with which the carbonic acid 
 unites ; the chalk is then thrown down and 
 withdrawn from the water. It must never be 
 forgotten that well water may be, and often 
 is, highly impure, and this is notoriously the 
 case with shallow wells in porous soils. A 
 well drains an extent of ground around it 
 nearly in the shape of an inverted cone, and 
 the water which soaks in from the soil is often
 
 XI.] DEEP WELLS. 2Q7 
 
 very impure. The area drained must depend 
 upon the soil : Dr. Parkes states that the 
 distance ranges from fifteen to one hundred 
 and sixty times the depression of the water 
 in the well. The deepest (non-Artesian) well 
 will drain a cone, in a loose soil of chalk or 
 sand, of about half a mile in radius. All water 
 from deep wells must come from the surface, 
 and, as pointed out by Professor Bischof, the 
 question as to how far it is purified in passing 
 from the surface of the soil to the bottom of 
 a well is a very important one. It is often 
 assumed that the water has filtered through 
 hundreds of feet of solid rock, but it is certain 
 that much water often passes directly through 
 fissures, and does not gradually find its way 
 through minute interstices. Thus, even deep 
 wells have been known to contain seeds, stems, 
 and roots of certain marsh plants, and even 
 small fishes and shells. These deep wells are 
 often fed by leaky beds of rivers, and the 
 danger of contaminating them is increased 
 in proportion to the amount withdrawn by 
 the pumping and lowering of the ground water. 
 Well water often contains germs, and the 
 chemical purification may be only an increase
 
 298 THE LONDON WATER SUPPLY. [CAP. 
 
 of that performed by the ordinary sand-filter. 
 All these points require to be considered in 
 the examination of any projects for supplying 
 large communities with water from wells and 
 springs. 
 
 Admitting the comparative purity of deep 
 well water, it must not be forgotten that the 
 opinions of experts differ considerably as to 
 the quantity obtainable from these sources. If 
 we may judge from experience probably the 
 safest guide in the question before us not a 
 few deep wells would sooner or later become 
 exhausted if large supplies of water were drawn 
 from them. It must not be supposed that the 
 water passing into these wells is contained in 
 huge reservoirs which could be drawn upon 
 ad infinitum. Between the months of May 
 and November in ordinary years but little 
 water is received into the chalk area, and the 
 quantity becomes gradually diminished. The 
 replenishment depends on the winter rainfall, 
 the quantity of which influences the next year's 
 supply. When the first Artesian well was sunk 
 in the chalk under London the water rose 
 freely above the surface of the ground ; its 
 level is now 60 or 70 feet below it. When the
 
 XL] THE SUPPLY OF WELLS. 2Q9 
 
 Hanwell Asylum well was first bored, and for 
 some time afterwards, the water rose 1 8 feet ; 
 at the present day it has to be pumped up. 
 A similar and still more striking example is 
 afforded by the well at Richmond. When 
 this was first sunk, thirty years ago, water 
 rushed up and overflowed ; now it has sunk 
 1 20 feet. These instances prove that there is 
 no permanent storage of water, and that the 
 supply is likely to be exhausted. There is 
 another difficulty, though a less serious one, 
 connected with obtaining a large supply from 
 wells. Mr. Baldwin Latham has pointed out 
 that water cannot be taken from water-bearing 
 strata by means of a well without diminishing 
 the quantity which would otherwise flow out 
 by natural streams ; hence manufacturers with 
 works on the banks of streams might find 
 their industries crippled by withdrawal of the 
 water upon the supply of which they depend. 
 Apart from the natural objections against 
 drinking water in any way contaminated with 
 sewage matter, there is the risk of the pro- 
 pagation of serious diseases, the germs of 
 which passing with the discharges into water 
 are after\vards swallowed. The evidence that
 
 3OO THE LONDON WATER SUPPLY. [CAP. 
 
 typhoid fever and cholera may be thus spread 
 is quite convincing, and there is much pro- 
 bability that other disorders are disseminated 
 in a similar manner, though the connection 
 between them and impurity of water cannot 
 always be clearly demonstrated. Typhoid 
 fever has again and again been shown to be 
 propagated through the medium of water ; the 
 Caterham epidemic, already alluded to, is a 
 case in point. Ordinary sewage matter may 
 produce diarrhoea even of a serious character, 
 but for the production of typhoid the specific 
 germ must be present. The truth of this 
 statement is shown by those instances collected 
 by Dr. W. Budd and others, in which persons 
 had for years been drinking water contaminated 
 with ordinary sewage, but no cases of typhoid 
 had occurred until a sufferer from the disease 
 came into the place, and the discharges from 
 this patient were washed into the stream from 
 which the water supply was obtained. The 
 evidence that cholera may be propagated 
 through the medium of the water supply is 
 equally strong. Dr. Parkes has collected 
 many instances, and remarks that each succes- 
 sive example adds more and more weight to
 
 XL] ORGANIC MATTER IN WATER. 30! 
 
 those previously observed, until, from the mere 
 accumulation of cases, the cogency of the 
 argument becomes irresistible. It may be 
 added that in all probability the continuous 
 use of water containing much organic matter 
 lowers the resisting powers of the body, and 
 renders it a more favourable nidus for the 
 germs of specific disease. 
 
 The diseases just referred to are supposed to 
 be caused by the presence of living organisms 
 termed bacteria, microphytes, or more generally 
 disease-germs. The discovery and study of 
 these organisms date from a comparatively 
 recent period ; an enormous amount of attention 
 has been devoted to them, but so far with only 
 negative results as regards their differentiation, 
 with comparatively few exceptions. High 
 powers of the microscope are required for their 
 detection, and it is often impossible to say 
 whether those present in a given specimen of 
 water are similar to others taken from another 
 source. It would appear, moreover, that these 
 organisms or their germs may exist in water 
 and yet may be beyond detection by the 
 highest powers of the microscope. When their 
 presence is suspected, the test by " cultivation,"
 
 302 THE LONDON WATER SUPPLY. [CAP. 
 
 as it is termed, is now employed. A fluid 
 containing sugar, tartrate of ammonium, burnt 
 yeast ash and water is found to be an excellent 
 breeding-ground. A little of this fluid is boiled 
 in a test-tube, which has previously been ex- 
 posed to great heat, a few drops of the water 
 are added, and the mouth of the tube is closed 
 with cotton wool. If bacteria or their germs 
 exist in the water, in a few days the liquid 
 becomes milky from the presence of countless 
 organisms. Inasmuch, however, as bacteria 
 are to be found in the purest kinds of natural 
 water, this test is not a positive indication 
 of the quality of any given sample. It is, 
 however, useful when taken in connection 
 with other methods ; and if the water rapidly 
 becomes opalescent, the organisms may be 
 assumed to be comparatively abundant. 
 
 The bacteriological examination of the metro- 
 politan water supply is now regularly conducted 
 by Dr. Percy Frankland, and the results are 
 published in the monthly report. A small, 
 measured portion of the water is mixed with 
 gelatine and other nutritive media spread on 
 glass plates and set aside in a cultivating 
 apparatus. In a few days so-called " colonies "
 
 XI.] DEVELOPMENT OF BACTERIA. 303 
 
 of minute organisms will be discoverable. 
 These can be counted with the aid of the 
 microscope, and are described as so many in 
 a given cubic space. The significance of the 
 different forms has not yet been determined, 
 and there is no test which will distinguish 
 those which are the germs of disease from 
 those which are harmless. Dr. Bischof has 
 pointed out a curious fact in connection with 
 the development of bacteria. If samples of 
 unfiltered water be stored in flasks, the 
 organisms undergo no increase, but soon 
 diminish in numbers. If filtered water be 
 stored, the organisms increase enormously, 
 perhaps because the filtration has removed 
 some which would prevent the development of 
 others. Thus the Kent chalk water contains 
 but very few organisms ; if it be bottled and 
 kept in a warm place for a few days, millions 
 make their appearance. If unfiltered river 
 water were thus treated, the result would be of 
 an entirely opposite character. 
 
 It is obvious that myriads of bacteria are 
 constantly finding their way into the water of 
 the Thames ; they are known to possess great 
 vitality and to be capable of resisting the action
 
 304 THE LONDON WATER SUPPLY. [CAP. 
 
 of many chemical agents. They are, however, 
 destroyed by very slight differences of acidity 
 and by changes of composition in the fluid. 
 Fortunately, the composition of the Thames 
 water undergoes very frequent alterations, and 
 it varies in different places. Wholesale de- 
 struction of organisms is the probable result, 
 and their removal from water is certainly 
 effected by repeated and thorough filtration. 
 Dr. Percy Frankland stated that their average 
 reduction as a result of the treatment in the 
 reservoirs of the companies amounted in 1877 
 to 96*7 per cent. If this be correct it is 
 satisfactory to know that the removal of 
 organisms by filtration can be readily accom- 
 plished, and it follows that the propagation of 
 diseases through the medium of the Thames 
 water is, under present arrangements, ex- 
 tremely improbable. It might, indeed, be 
 rendered impossible, if ordinary care were 
 taken by householders still further to purify the 
 water supplied to them. Drinking-water should 
 never be taken from cisterns, and a filter should 
 find a place in every house, for there is no 
 difficulty in obtaining an efficient apparatus. 
 A preliminary caution is necessary : a filter
 
 XL] FILTERS. 305 
 
 which cannot be cleaned, and in which there 
 is no provision for renewing the materials, is 
 fraught with danger. So called " self-cleaning 
 filters requiring no attention " should be care- 
 fully shunned ; for if filters act effectually, they 
 must sooner or later contain a large quantity of 
 objectionable matters, some of which will be 
 communicated to the water intended to be 
 purified. Various materials are used in 
 domestic filters, the principal being animal 
 charcoal, spongy iron, and magnetic oxide of 
 iron. All these materials are more or less 
 efficient ; but the spongy iron appears to be 
 the most potent 'purifying agent at present 
 available. In the Sixth Report of the Rivers 
 Pollution Commission it is stated, on the 
 authority of Dr. Frankland, that under the 
 influence of this material (spongy, iron) Thames 
 water assumes the chemical characters of deep 
 well water. It has been tried on a large scale 
 at Antwerp, and proved to be remarkably 
 efficient. 
 
 The Chamberland- Pasteur filter, recently 
 introduced, would seem to be the best of all 
 domestic filters. In its simplest form it 
 consists of a tube of fine unglazed biscuit 
 
 20
 
 306 THE LONDON WATER SUPPLY. [CAP. 
 
 porcelain, which may be screwed on to the 
 service tap, when the pressure of the water 
 will force the fluid through the pores of the 
 porcelain, and a fairly rapid rate of filtration 
 results. It effectually strains off all organisms 
 and their spores, but it has little or no effect 
 on the chemical constituents in solution ; its 
 action is purely mechanical. The surface of 
 the porcelain tube in a short time becomes 
 covered with a slimy coating, even when an 
 apparently clean water is filtered. This coat- 
 ing is, however, readily and quickly removed 
 by taking out the tube and brushing it freely, 
 or by washing it with dilute hydrochloric acid. 
 
 Reference must be made to a paper recently 
 (January i8th, 1897) rea< ^ by Mr. W. J. Dibdin 
 on "The Character of the London Water 
 Supply." He submitted tables showing the 
 great bacteriological improvement which has 
 taken place in the quality of the water between 
 the years 1892 and 1895. The change had been 
 so great that even the bacteria in the river 
 itself at Sunbury had been reduced to one-tenth 
 of their former number. The amount of sewage 
 passing into the river above the Companies' 
 intake must therefore have been greatly
 
 XL] HEALTH OF LONDON. 307 
 
 lessened. Mr. Dibdin had also investigated 
 the effects of a well-known softening process 
 upon the dissolved and undissolved impurities 
 contained in Thames water. The process 
 (known as Clark's) consists in the addition of 
 lime, which, by combining with the carbonic 
 acid, causes all the carbonate of lime previ- 
 ously held in solution to be thrown down. At 
 the same time, the organic carbon and nitrogen 
 are considerably reduced in quantity, and 87 
 per cent, of the bacteria are removed from 
 the water, which, according to Mr. Dibdin, 
 in respect of its chemical quality and number 
 of bacteria, is thereby improved to a degree 
 comparable with that of the Welsh sources. 
 
 If we leave the theories of chemists and 
 turn to matters of fact, we find that the 
 inhabitants of the metropolis have been drink- 
 ing Thames water for many years, and that 
 London is the healthiest large city in the 
 civilised world. The germs of disease must 
 have found their way over and over again into 
 the water, and in such quantities as to have 
 produced serious outbreaks, had they not been 
 rendered harmless or destroyed. Attempts to 
 connect excessive rates of mortality with
 
 308 THE LONDON WATER SUPPLY. [CAP. 
 
 impurity of Thames water have altogether 
 failed ; in fact, when the latter condition has 
 existed, it has been noticed that the health 
 of London was excellent, and the deaths far 
 below the average. 
 
 If all the circumstances be dispassionately 
 considered, there would appear to be no 
 sufficient reason for rejecting the present 
 sources of water supply and for seeking others. 
 It is not, however, intended to imply that no 
 improvements are necessary. The further 
 development of the constant system of supply 
 (so as to do away with cisterns) cannot be too 
 strongly recommended ; and the same may be 
 said of a vigorous enforcement of the pro- 
 visions of the " Rivers Pollution Act." Those 
 who condemn Thames water have no doubt 
 done good service, inasmuch as they have 
 stimulated the companies to do their best with 
 the present sources of supply. It is not of 
 course denied that better water could be 
 got from the lake districts of Wales and 
 Cumberland, but the necessity for bringing 
 water from such distances has never been 
 demonstrated. There is one obvious way by 
 which great improvements could be effected,
 
 XL] LORD CROSS' BILL. 309 
 
 and that is the transference of the metropolitan 
 waterworks to a public authority. It is un- 
 fortunate that this plan, which was brought 
 forward some years ago by Lord Cross, has 
 not been carried into effect. The consolidation 
 of establishments, the increased vigilance in 
 collecting rates, with the consequent cheapness 
 of the water, and the unity of action in 
 effecting all necessary improvements, are a few 
 of the advantages which would accrue from 
 such a change. It is not too much to hope 
 that some similar measure may ere long engage 
 the earnest consideration of Parliament.
 
 XII. 
 
 HEALTH-RESORTS AND THEIR 
 USES. 
 
 THE idea that a remedy exists for every 
 disease to which human beings are 
 subject is one which must always be fascinating. 
 We naturally regard diseases as so many 
 enemies, and would fain persuade ourselves 
 that Providence has placed within our reach 
 certain agencies by which they may be 
 subdued. At the same time one is forced 
 to confess that every-day experience does not 
 encourage these sanguine views. We look 
 around us and see cases of chronic disease, 
 little if at all benefited by the treatment of 
 the most scientific character, carried out in the 
 best possible manner. Still, with some, the 
 idea survives that a remedy might be found 
 if only we knew where to look for it. This 
 
 notion was doubtless largely fostered by the 
 
 310
 
 CAP. XII.] THE SCIENCE OF HYGIENE. 311 
 
 implicit faith in drugs which prevailed not 
 many decades ago, and is yet far from extinct. 
 Such subjects as fresh pure air, diet, clothing, 
 exercise, etc., now justly considered as of 
 great moment, were for the most part either 
 totally neglected or passed over as quite 
 subordinate in value. The science of hygiene 
 that is, of the art of preserving health has 
 advanced with rapid strides since the beginning 
 of this century, and more particularly during 
 the last thirty years. While the treatment 
 of disease by drugs has lost much of its 
 popularity, an ever-increasing reliance is placed 
 on hygienic measures and dietetic regulations. 
 The first rank among the former must be 
 accorded to what is termed " change of air," 
 and to the various beneficial influences con- 
 nected with that large class of localities known 
 as " health-resorts." Such indeed is the 
 estimate in the public mind of the value of 
 health-resorts, and so boundless the promises 
 made on behalf of so many of these places, 
 that it would seem as though the idea not of 
 one, but of a score of unfailing remedies for 
 every disease, had been triumphantly realised. 
 I propose to discuss, firstly, the principal uses
 
 312 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 of health-resorts and the expectations which 
 may be formed in regard to them ; and, 
 secondly, to compare foreign health-resorts 
 with those which are to be found in the British 
 Islands. 
 
 The belief has prevailed from very early 
 times that health could be restored by a 
 sojourn in certain localities. It is probable 
 that, as at the present day, a change of tem- 
 perature constituted in most cases the principal 
 attraction. The dwellers in a hot, enervating 
 climate would find that improved health and 
 vigour attended even a short visit to a region 
 possessing climatic conditions of an opposite 
 character ; and on the other hand, sufferers 
 from various disorders e.g., of the rheumatic 
 class found relief in the heat from which the 
 former had been glad to escape. But besides 
 differences of temperature, several circum- 
 stances, peculiar to a locality, exercise a special 
 influence upon health. The pureness and 
 freshness of the air, the existence of springs, 
 the nature of the .vegetation and of the soil, 
 and the proximity to the sea, would be the 
 chief points. A place marked out from the 
 surrounding neighbourhood by the possession
 
 XII.] CHANGE OF AIR. 313 
 
 of any of these advantages, would in the course 
 of time be regarded as a sanatorium, at all 
 events for certain classes of diseases. The 
 benefits which so often result from change of 
 air, popularly so-called, are matters of daily 
 experience, and are never more clearly ex- 
 hibited than in cases of convalescence from 
 acute and severe disorders. Unmistakable 
 signs of improvement seldom fail to make 
 their appearance, in a very short time, when 
 convalescents for instance, from fevers are 
 removed from the scenes of their illnesses 
 into country air or to the seaside, which may 
 be cited as instances in point. Various chronic 
 conditions of ill-health are scarcely, if at all, 
 relieved by medicine alone, whereas a change 
 of air frequently brings about an improvement. 
 In a large number of cases, the physical 
 qualities of the atmosphere of certain districts 
 and localities have a peculiarly beneficial and 
 curative action, but different conditions are 
 required by different persons. Just as the 
 jaded dwellers in crowded cities are benefited 
 by country air, so, as has been said, it is found 
 that a temporary change of an opposite cha- 
 racter, and apparently for the worse as regards
 
 314 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 hygienic surroundings, often produces similar 
 results. When the mind is active and the 
 disposition social, the tranquillity of a country 
 life sometimes acts prejudicially upon the 
 nervous system, and causes deterioration of 
 health and strength. Under such circumstances 
 restoration is best effected by removal to a town, 
 where the mental faculties can find appropriate 
 opportunities for exercise. The benefit in 
 these cases is due really to the change of 
 environment, and not to the hygienic qualities 
 of the place. The same with regard to food. 
 Persons to whom delicate and highly nutritious 
 viands appear from long use to be absolutely 
 necessary, frequently discover that coarser 
 fare can be taken with relish, and that the 
 digestion is thereby improved. 
 
 That the benefits often result from the 
 change, and not necessarily from the place, 
 is proved by the fact that a permanent 
 residence in the locality does not always 
 perpetuate the advantage gained during the 
 earlier period of the sojourn. It is clear, 
 therefore, that change of air includes many 
 aids to health besides the physical properties 
 of the atmosphere. In cases of convalescence
 
 XII.] LITERATURE OF HEALTH-RESORTS. 315 
 
 from acute disease, it is true that much of 
 the benefit derivable from change of air is 
 due to minute differences in the physical 
 constitution of the atmosphere. Modern 
 chemical researches have shown that the air 
 of cities and towns and the air of country 
 places differ as regards the proportions of 
 oxygen and carbonic acid. But generally, 
 new scenes, agreeable society, recreation, rest, 
 or at least freedom from toil and ordinary 
 avocations, assist very considerably in the 
 restoration of shattered nerves and broken 
 health. 
 
 To estimate the popular opinion of the 
 value of change of air, it is only necessary 
 to cast a glance at the number of books 
 written for the purpose of instructing the sick 
 and their advisers in the choice of a locality, 
 or of proclaiming the special advantages of 
 particular places as regards climate, mineral 
 springs, or other features. No department of 
 hygiene has been so copiously treated as 
 this. Caution is, however, necessary in ac- 
 cepting statements with reference to localities 
 in which the authors have more or less 
 interest. Great kindness is usually displayed
 
 316 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 towards the virtues of the place so confi- 
 dently recommended, while its faults are 
 conveniently kept in the background, or not 
 allowed to exist. One of the handiest and 
 most trustworthy works is Dr. Macpherson's 
 " Baths and Wells of Europe." With this 
 work and " Our Baths and Wells," by the 
 same author, it is not difficult to form a 
 practical judgment as to the real character of 
 any given health-resort. Having come to 
 the conclusion that a change of air is de- 
 sirable or necessary, the important question 
 to decide is, What locality offers the best 
 chances of recovery or of prolongation of 
 life ? Various circumstances require consider- 
 ation ; the chief of these are, the ailment of 
 the patient, his own desires, his pecuniary 
 means, and his ability or otherwise to stand 
 the fatigue of a journey. In some cases 
 mere change of abode is sufficient ; in others, 
 a change from one part of England to 
 another, as to the seaside, appears to fulfil 
 all requirements ; while, in a third class, 
 certain advantages are connected with foreign 
 travel and residence. In addition to the good 
 results arising from change of air, there are
 
 XII.] CLIMATE. 317 
 
 those which are obtainable from drinking or 
 bathing in the waters of certain localities, such 
 waters either possessing a high temperature 
 or containing an unusual proportion of certain 
 saline matters in a state of solution, or ex- 
 hibiting both these peculiarities. 
 
 It is not easy to give in a few words a 
 proper definition of climate. The most 
 obvious circumstances which affect the climate 
 of a region or country are temperature, 
 humidity, purity of the atmosphere, wind, 
 atmospheric pressure, intensity of light, soil, 
 amount of vegetation, and nearness to the sea. 
 Many conditions, however, operate on the 
 human system besides those which come 
 under the cognisance of the meteorologist. 
 Pure air, abundance of sunshine without ex- 
 cessive heat, so that several hours can be 
 spent in the open air ; an equable temperature 
 and absence of, or shelter from, high winds, 
 whether hot or cold, are the main desiderata 
 for all classes of patients. For our present 
 purpose, the most convenient division of 
 climate is into that of (i) the seashore, (2) 
 the mountains, (3) inland wooded districts, 
 and (4) the open sea. The climate of the
 
 3l8 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 seashore presents several marked peculiarities. 
 Owing to the continuous evaporation going on 
 from the sea, the temperature during the 
 summer months is lower than that of the 
 neighbouring inland districts ; it is also much 
 more equable, because the sea water maintains 
 its temperature for some time, in spite of 
 changes of wind and other disturbing causes. 
 The air from the sea also contains abundant 
 moisture and particles of saline matter in 
 suspension ; it is more dense, and therefore 
 a given volume contains more oxygen than 
 ordinary air. Sea air also contains much 
 ozone and a minute quantity of iodine. The 
 effects of sea air are well known. It improves 
 the digestive powers and promotes changes 
 of the bodily tissues. It strengthens the 
 nervous system, and hence it materially assists 
 in the recovery from various forms of illness. 
 These effects are for the most part rapidly 
 produced. 
 
 Sea air is useful in almost all cases of 
 chronic disease, and especially in those of 
 tedious convalescence. When, however, the 
 digestive and assimilative functions are very 
 weak, the result is often not satisfactory,
 
 XII.] BATHING. 319 
 
 inasmuch as waste of the body is promoted, 
 while a corresponding amount of new material 
 fails to be assimilated. Under such circum- 
 stances a preliminary sojourn for a short period 
 in pure country air is advisable. No country 
 in the world can vie with England in the 
 number and variety of its seaside places, 
 many of them excellently situated, and offering 
 every advantage in the way of fresh air, 
 facilities for bathing, etc. These advantages 
 are, however, much neglected, and sometimes 
 turned into positive sources of mischief. It 
 is a serious error to suppose that bathing in 
 sea water is always innocuous and generally 
 beneficial, and that in these respects it has 
 the advantage over bathing in fresh water. 
 Bathing in the open air is potent either for 
 good or evil according to circumstances, yet 
 it too often happens that baths are taken 
 even by delicate persons without proper 
 advice. As Dr. Weber points out, even 
 warm sea-baths are generally indulged in more 
 on the prompting of the inclination than under 
 competent advice. He adds that, " infinite 
 advantages might be derived from them, either 
 alone or combined with the internal use of
 
 32O HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 waters. Many invalids would gain more 
 from such a plan properly carried out than 
 from a visit to a continental spa." It certainly 
 seems strange that whereas advice is always 
 sought before taking baths at continental 
 bathing-places, where perhaps the water con- 
 tains only a small proportion of saline matter 
 and differs but little from that of an ordinary 
 warm bath, courses of warm sea- water baths 
 in England are often taken by invalids of 
 all kinds without any advice, and with blind 
 confidence in the suitableness of the water 
 to all conditions. Sea air is especially bene- 
 ficial in scrofula, in bronchitis, in many cases 
 of rheumatism, in gout, and in most cases of 
 consumption. The increased temperature plays 
 an important part in the alleviation of many 
 of these diseases. The list of English summer 
 health-resorts by the seaside is a very long 
 one. Those on the eastern coast, from 
 Tynemouth to Dover, have a comparatively 
 dry and bracing climate. On the south-east, 
 as far as the Isle of Wight, there are a host 
 of well-known places with climates differing 
 according to their situation, aspect, exposure 
 to certain winds, etc. Further westward are
 
 XII THE SEASIDE. 
 
 3 2I 
 
 Bournemouth, so justly renowned as a winter- 
 residence, Torquay, Penzance, etc. On the 
 west coast are the Welsh watering-places, and 
 those of Lancashire, Westmoreland, and Cum- 
 berland. Many very desirable spots are to 
 be found on the coasts of Scotland North 
 Berwick, Dunoon, Nairn, Rothesay, and 
 Ardrossan being those that are best known. 
 Ireland is almost equally well provided with 
 similar places. The Channel Islands have 
 many qualities to recommend them, especially 
 during the winter season. Their temperature 
 is considerably higher and more equable 
 than that of most portions of our southern 
 coasts. 
 
 The diseases for which seaside stations are 
 generally resorted to are pulmonary complaints, 
 including consumption, bronchitis, and asthma. 
 England is not deficient in localities eminently 
 suitable for persons suffering from these affec- 
 tions. These localities are all characterised 
 by mildness and equability of temperature, 
 and purity and comparative calmness of the 
 atmosphere. In the advantages they offer to 
 patients suffering from pulmonary diseases they 
 are second to few, and they have the marked 
 
 21
 
 322 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 recommendation of being easily accessible, 
 near home, and within reach of friends. Of 
 course as regards temperature they cannot 
 compete with the Riviera, but temperature 
 is not everything, even in the treatment of 
 a consumptive patient. Indeed, from recent 
 experience, it would seem that hot climates 
 are not necessarily good for consumption, and 
 that cold and frost are by no means always 
 bad, but sometimes salutary for chest diseases. 
 Moreover, we are assured by Dr. Bennet that 
 the descriptions of the winter climate of Nice, 
 Cannes, and Hyeres, and of Italy in general, 
 as contained in most books of travel, works 
 on climate, and guide-books, are mere poetical 
 delusions. " The perpetual spring, the eternal 
 summer, the warm south, the balmy atmo- 
 sphere," described in such glowing terms, exist 
 only in the imagination of the writers. 
 
 Some of our English health-resorts have 
 other recommendations beyond their tempera- 
 ture as curative agencies for chest diseases. 
 Bournemouth, for example, combines several 
 favourable conditions, met with elsewhere only 
 at Arcachon. The natural purity of the air 
 is secured at Bournemouth by the general
 
 XII.] BOURNEMOUTH. 323 
 
 adoption of stipulations for a large space 
 round every house. The atmosphere of the 
 place is positively disinfected by the "oxidising 
 and antiseptic influences of the peroxide of 
 hydrogen and camphoraceous matters, due to the 
 chemical effect of moisture and sunshine upon 
 the terebinthinate emanations from the pine- 
 trees." Dr. Dobell has given figures showing 
 that upwards of three million pine-trees remain 
 in the different districts of Bournemouth and 
 its immediate surroundings. These trees give 
 off an immense quantity of camphoraceous 
 material, the antiseptic powers of which car 
 be conceived, if we reflect that a comparatively 
 weak solution " is sufficiently strong to preserve 
 animal matter almost indefinitely free from 
 decomposition." The atmosphere is soothing 
 to the respiratory organs, is mild and fairly 
 equable, and not relaxing by over moisture. 
 The night-temperature during winter is never 
 very low ; fogs are unknown ; and, according 
 to Dr. Dobell, the hotels, boarding-houses, 
 and lodging-houses are, almost without excep- 
 tion, excellently built and well-arranged for 
 invalids. When such advantages as these 
 can be obtained near home, it is surely a
 
 324 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 mistake to send patients several hundred 
 miles for the sake of a somewhat higher 
 temperature. No doubt, to bask in the 
 sunshine of the Riviera for several hours a 
 day is most enjoyable and exhilarating ; 
 but at sunset the temperature rapidly falls, 
 and a frosty night often succeeds a day on 
 which the majority of invalids required 
 sunshades to protect them from the heat. 
 Unless proper care be taken, such variations 
 of temperature are apt to lead to very un- 
 toward accidents. 
 
 Space will not permit me to dwell at greater 
 length upon this topic, and I now pass on 
 to consider another class of climates available 
 as health-resorts, namely, that of mountains. 
 The term "mountain-climate" is generally 
 applicable in Europe to heights of from 1,500 
 to 6,000 feet. The effect of mountain air 
 resembles in some respects that of sea air. 
 The differences are for the most part due 
 to lower density and temperature, and to the 
 more frequent variations in the latter respect. 
 The air also contains less moisture, and the 
 temperature often falls considerably at night. 
 The effect of mountain air is to improve the
 
 XII.] MOUNTAIN CLIMATES. 325 
 
 digestion and nutrition, and to strengthen 
 the nervous system. The improvement in 
 these respects is brought about less rapidly 
 than at the seaside. Owing to the rarefaction 
 of the air with the increase of elevation, more 
 frequent and deeper inspirations are required, 
 and more or less excitement of the organs 
 of circulation necessarily ensues. Mountain 
 climates are suitable for many cases of con- 
 valescence from acute diseases, and for condi- 
 tions of ill-health in which want of tone is 
 the prevailing characteristic. Where there is 
 great muscular debility, or any organic disease 
 of the heart, such climates are decidedly 
 unsuitable. Of late years several mountainous 
 localities have obtained a considerable reputa- 
 tion for the treatment of cases of consumption, 
 and of these Davos Platz is perhaps the most 
 celebrated. This place is 4,800 feet above 
 the sea-level, and six or seven hours by 
 diligence from Landquart Station, on the road 
 from Zurich to Coire. Its efficacy for the 
 cure of consumption in the case of natives 
 of the lowland stations has long been known. 
 Evidence of the value of mountain air in 
 consumption has also been derived from
 
 326 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 the experience of medical practitioners in the 
 large towns at the base of the Peruvian 
 Andes. Consumption appears to be a very 
 common disease in these places, and the 
 removal of the patients to stations at elevations 
 of several thousand feet is attended by the 
 happiest results. The winter climate at Davos 
 is preferable to that of the summer, as there is 
 far less wind, and the climate is more equable 
 and dry. Snow begins to fall in November, 
 and continues through December, generally 
 attaining a depth of three or four feet. " The 
 atmosphere," says Dr. Burney Yeo, " becomes 
 still and calm, the air intensely cold and dry, 
 and absolutely clear. The temperature at 
 night often falls very low, frequently some 
 degrees below zero. The days are cloudless, 
 with an intensely blue sky, and an amount 
 of heat from solar radiation which enables 
 invalids to pass hours sitting in the open 
 air ; and the brilliancy of the sunshine in 
 midwinter makes umbrellas and sunshades 
 essential for protection." 
 
 South Africa possesses many stations the 
 natural conditions of which render them very 
 suitable for the treatment of affections of the
 
 XII.] SOUTH AFRICA. 327 
 
 chest. One region, called the Karroo (signify- 
 ing the dryness of the climate), is pre-eminent 
 in this respect. It is divided into two portions, 
 termed the Great and the Northern Karroo. 
 The former consists of a vast plateau of 
 considerable elevation, averaging about 3,000 
 feet above the level of the sea, whilst the 
 average height of the mountain ranges is about 
 5,000 feet, some places rising to 7,000. Its 
 special character is its excessive dryness it 
 is said that a clean polished steel razor can 
 be left out all night in the open without fear 
 of its acquiring one single speck of rust. Rain 
 falls very irregularly, and at rare intervals 
 only, and in small local showers many months 
 may elapse without a drop of rain. The 
 atmosphere is pure and wonderfully exhilarat- 
 ing. The summer temperature, though high, 
 is easily tolerated ; the winter is cold, but 
 bright and bracing, with abundant sunshine. 
 Among the places best adapted for sanatoria 
 are Ceres (1,493 feet), Matjesfontein, Beaufort 
 West, and Cradock, all at an elevation of 
 nearly 3,000 feet. The Northern Karroo lies 
 at a much greater elevation than the Great 
 Karroo, averaging about 4,000 feet above the
 
 328 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 sea-level, while some of the mountain ranges 
 reach 7,800 feet. Its atmosphere is charac- 
 terised by peculiar dryness, which, in conjunc- 
 tion with the rarefaction, the constant sunlight, 
 and its generally uniform character, endows 
 the climate with properties obtainable in 
 Europe only at much higher altitudes. Chest 
 affections are rare, and consumption is almost 
 unknown among the inhabitants born and 
 bred in this region. The district can boast 
 of a long list of stations, all of which may 
 be strongly recommended as regards climate 
 and natural advantages. Among them may 
 be mentioned Frazerberg (4,500), Richmond, 
 Victoria (West), Hanover, Aliwal (North), and 
 Kimberley, all at an elevation of from 4,000 
 to 4,500 feet. 
 
 All these places and many others might be 
 added possess a climate which experience has 
 proved to be highly curative to consumptive 
 patients. It is likewise beneficial in cases of 
 debility and want of tone, many examples of 
 which are to be found in our own country, 
 especially that form of general tiredness with 
 insomnia resulting from the wear and tear of 
 modern life. But climate per se will not
 
 XII.] APPETITE AND DIGESTION. 329 
 
 suffice ; there are other factors which are 
 equally necessary. It is within the knowledge 
 of everybody that the diet of sufferers from 
 consumption and other wasting disorders, 
 should be as sustaining and nutritious as they 
 can take or bear. In the cases referred to, the 
 appetite is often capricious, and the amount 
 of food taken is -altogether insufficient to 
 counterbalance the daily losses. Hence one 
 important aim in treatment is to improve the 
 appetite and digestion, and this object may 
 often be attained by a sojourn in pure mountain 
 air. But it is useless and almost cruel to 
 stimulate the appetite, unless proper means of 
 satisfying it can at the same time be secured, 
 and in many of the places mentioned above 
 there is a great defect in this respect, as well 
 as in other matters of hygiene. In some 
 letters which appeared in the Standard news- 
 paper (1895), it was pointed out that in the 
 " parts of South Africa suitable, as regards 
 climate, for consumptive patients, comfortable 
 quarters, good, wholesome, well-cooked food, 
 and kindly attention are an unknown combina- 
 tion. Up-country hotels, even those advertis- 
 ing for invalids, are primarily bars and
 
 330 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 canteens, ill-adapted for delicate people. Small 
 ' Sanatoria ' have been started, but none have 
 yet arisen in which the invalid is the first con- 
 sideration, or with sufficient capital to place com- 
 fort and good food within reach of the invalid." 
 It is pleasant to be able to state that this 
 drawback will soon cease to exist. While in 
 South Africa, during the autumn of 1895, I had 
 opportunities of discussing the subject with 
 Mr. Cecil Rhodes, and later on, by his desire, 
 with Mr. Lawrence, of Kimberley ; and since 
 my return Mr. Lawrence has forwarded to 
 me, by Mr. Rhodes' request, gratifying reports 
 embodying the ideas which were discussed at 
 our interviews. The resolution, emanating 
 from Mr. Rhodes, was speedily adopted, of 
 establishing a sanatorium at Kimberley for the 
 treatment of persons suffering from pulmonary 
 complaints, especially in the incipient stages. 
 Mr. Rhodes promised a contribution of ,4,000 
 from some funds at his disposal, and "1,000 
 from his own purse. Another letter informs 
 me that Mr. Rhodes has promised an addi- 
 tional ,5,000. Such public-spirited generosity 
 is deserving of the highest praise ; the money 
 could not be devoted to a better purpose.
 
 XII.] KIMBERLEY SANATORIUM. 33! 
 
 Small institutions for the reception of 
 invalids already exist, but in few, if any, are 
 the arrangements of an altogether satisfactory 
 character. A model sanatorium of the kind 
 now proposed will not only be a source of 
 benefit to those who can avail themselves of it, 
 but will stimulate the foundation of similar 
 institutions in suitable localities, and will 
 indicate to all concerned the necessary con- 
 ditions for the attainment of favourable results. 
 Kimberley, the station chosen for the erection 
 of the buildings, presents many advantages. 
 Its climate is equal to that of any health-resort 
 in South Africa, and its surroundings are 
 generally better than can be found elsewhere. 
 Among its advantages may be enumerated 
 various clubs, the library, the theatre, and 
 other places of amusement ; also opportunities 
 for golf, tennis, cricket, coursing and shooting, 
 and the proximity of the river. The nuisance 
 due to the dust (of which I can speak by 
 personal experience), at Johannesburg and other 
 localities, has been greatly lessened at Kim- 
 berley since the present water supply was 
 obtained. The management of the Kimberley 
 Sanatorium will be vested in a Board, several
 
 332 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 members of which, well-known Kimberley 
 men, occupying the highest public and social 
 positions in the town, have been already 
 nominated. There will be a medical repre- 
 sentative at Cape Town from whom patients 
 arriving from Europe will be able to obtain all 
 requisite information and advice. The fees 
 for admission will be such as to secure a fair 
 remuneration to the resident custodians. Large 
 profits will not be aimed at, but the tariff will 
 probably be a little higher than at ordinary 
 hotels with which the institution will compare 
 favourably as regards comforts and necessaries 
 for invalids. Admission will be granted only 
 to those patients whose condition promises a 
 fair chance of recovery. A sum of ,8,000 has 
 been set aside for the building, and plans have 
 been invited by advertisement. I cannot but 
 express my sincere gratification at having been 
 associated in any degree with the inception of 
 so benevolent and desirable a project. 
 
 It must appear strange, and to some extent 
 inexplicable, that consumption should be cured, 
 or at all events its symptoms brought to a 
 standstill, and the general health vastly im- 
 proved, by such different climates as those of
 
 XII.] MOUNTAIN AIR. 333 
 
 Davos, the Karroo, Torquay, Bournemouth, 
 Mentone, Madeira, and other places. There 
 are, however, several circumstances which 
 serve as a tolerably adequate explanation, 
 though it must be confessed that our predic- 
 tions of the benefits likely to be derived in a 
 given case from any particular locality are often 
 falsified by the results. But the localities just 
 mentioned have several features in common. 
 The air is pure and free from admixture ot 
 organic particles. There is at these places 
 an unusual amount of sunshine, so that patients 
 can often spend several hours .of each day in 
 the open air, whereby the lungs are improved, 
 the appetite and powers of digestion are 
 increased, and the nervous system is strength- 
 ened. As to the special curative agencies at 
 work in mountainous health-resorts, in addition 
 to the dryness, purity, and stillness of the air, 
 the freedom from organic particles, which we 
 now know are active promoters of putrefaction, 
 is in all probability the condition most potent 
 for good in chest cases. There is also the 
 rarefaction of the air, which causes more 
 frequent and deeper inspirations, and thus 
 improves the condition of the breathing
 
 334 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 apparatus. The healthy portions of the lung 
 are called upon to display increased activity, 
 and their action compensates for the loss of 
 those portions invaded by disease. Besides 
 these advantages, patients take more care of 
 themselves in these elevated health-resorts 
 than at others where the conditions more 
 resemble those of ordinary life ; the place and 
 its peculiarities constitute a very important part 
 of the treatment, and the regulations with 
 regard to exposure, etc., are certain to be 
 carefully attended to. It is only necessary 
 to add that consumption is a disease of which 
 there are several varieties, each having certain 
 stages, and that the choice of the most suitable 
 locality can be arrived at only after a thorough 
 consideration of all the circumstances of the 
 case. 
 
 A few words will suffice for the description 
 of the climates of inland wooded districts and 
 of the benefits to be derived therefrom. All 
 large cities and towns are surrounded by more 
 or less salubrious country places, a sojourn in 
 which often serves to restore or improve the 
 health. The pureness of the atmosphere and 
 the comparative absence of organic particles
 
 XII.] COUNTRY AIR. 335 
 
 are the principal favourable agencies at work. 
 The air, too, is somewhat warmer and more 
 equable ; the humidity in wooded districts is 
 higher. Such conditions are especially suited 
 for convalescents from acute diseases, and for 
 the improvement of chronic ailments. A 
 change into country air, as has been hinted, 
 may often be advantageously adopted as a 
 preliminary to a lengthened sojourn by the 
 seaside or a journey to a mountainous health- 
 resort. But country air has a value of its own. 
 Dr. Beale says, "If patients could be induced 
 to retire to a pleasant part of the country, 
 where they would take moderate exercise, 
 and be free from mental anxiety, meet with 
 agreeable society, live regularly, take small 
 doses of alkalies, and bathe themselves for an 
 hour or two a day in warm water, in which 
 some carbonate of soda has been dissolved, 
 they would receive as great a benefit as by 
 travelling hundreds of miles away, and at much 
 less trouble and expense." All this is no doubt 
 true, but, as a general rule, persons like to 
 find things ready to their hand, and put less 
 trust in arrangements which could be made 
 almost anywhere than in those which are the
 
 336 HEALTH-RESORTS AND THEIR USES [CAP. 
 
 special characteristics of certain places. There 
 are many localities to be found in England, 
 Wales, and Scotland, specially adapted for 
 all the purposes of summer health-resorts ; but 
 generally there are no proper hotels or es- 
 tablishments for the reception of numerous 
 visitors ; and such establishments are mostly 
 discouraged by the landed proprietors, who 
 occupy the most eligible localities. " Such," 
 Dr. Weber points out, " is the case with the 
 moors of Scotland and Yorkshire, with their 
 wonderfully enlivening air. A small inn, a 
 few cottages and scattered houses, rarely 
 disengaged, are all that is to be had ; and 
 the social element is wanting, even if one be 
 fortunate enough to obtain accommodation." 
 Many localities close to London would afford 
 most excellent summer health-resorts ; in 
 Surrey, for instance, the hills near Leith Hill, 
 and the Ewhurst Windmill and Ranmore 
 Common, near Dorking, or the Hindhead or 
 the Blackdown, near Haslemere ; while further 
 away there are the South Downs, Dartmoor, 
 and Cannock Chase. Little or no accommo- 
 dation is, however, to be met with at any 
 of these places.
 
 XII.] SEA VOYAGES. 337 
 
 The last form of climate to which allusion 
 has been made is that of the open sea. Long 
 sea voyages are of great value in many cases 
 of consumption. The patients have the 
 advantages of the constant influences of the 
 sea air, combined with mental repose and 
 passive exercise. There are, of course, several 
 drawbacks, the most prominent being the 
 liability to sea-sickness and to bad weather 
 and the confinement which necessarily occurs ; 
 the monotony in occupations, the want of 
 variety of food and of articles sometimes 
 longed for by invalids, and the discomforts 
 arising from the machinery, in the case of 
 steam-vessels. If the patient be not liable to 
 suffer from sea-sickness, and if his appetite 
 and digestion be fair, he has a much better 
 chance of being benefited by a sea voyage 
 than under opposite conditions. Various 
 conditions of debility, especially those arising 
 from excessive mental strain, are almost certain 
 to be improved by a sea voyage. 
 
 An important class of health-resorts includes 
 those which have obtained their renown by 
 reason of the possession of springs of water, 
 valuable either on account of their temperature 
 
 22
 
 338 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 or because they contain an unusual amount 
 of certain gaseous or saline matters in a state 
 of solution. An enormous number of springs 
 are now in vogue, and if we could believe a 
 tithe of the statements confidently put forth 
 as to their efficacy, chronic disease would be 
 the fate only of those who either could not 
 or would not visit the health-giving springs. 
 Making allowances for an enormous amount 
 of exaggeration, let us see what can be claimed 
 for baths and waters. There is, however, a 
 difficulty at the outset, inasmuch as it is im- 
 possible to separate the influence of such 
 agencies as travelling, change of air, diet, and 
 social conditions, from that which may be due 
 to the external and internal use of any given 
 water. 
 
 It is not easy to classify mineral waters, but 
 for practical purposes they may be divided into 
 seven groups. The first includes the thermal 
 waters, which are characterised by considerable 
 elevation of temperature and poorness in saline 
 constituents ; heat and purity are, in fact, their 
 main peculiarities. By way of comparison, 
 it may be desirable to mention that water 
 artificially heated to from 85 to 92 constitutes
 
 XII.] MINERAL WATERS. 
 
 a tepid bath ; a warm bath has a temperature 
 of from 92 to 98 ; and a hot bath of from 98 
 to 104. The best known thermal springs are 
 those of Bath, Buxton, Teplitz, Gastein, Leuk, 
 and Wildbad ; the highest temperature of any 
 of them being about 1 20. When these slightly 
 mineralised thermal waters are taken internally, 
 the effect is neither more nor less than that 
 of an equal quantity of ordinary water heated 
 to the same temperature : tissue-change is 
 promoted, and the action of those organs 
 which remove waste products from the blood 
 is increased. Hot water taken slowly is 
 rapidly absorbed, and is useful for the purposes 
 just mentioned. It is, however, in the form 
 of baths that the simple thermal waters are 
 mostly used, the effects depending on the 
 temperature of the water and the time spent 
 in the bath. The beneficial results of a 
 course of warm baths are well known ; the 
 skin is softened and purified, more blood 
 circulates in it, and its functions are promoted ; 
 the nervous system is soothed, and certain 
 forms of swelling and exudation are lessened 
 or removed. All these good effects are often 
 witnessed in cases of rheumatism, gout,
 
 34O HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 neuralgia, and likewise after injuries, especially 
 of joints. It must be kept in mind that the 
 warmth and the moisture are the curative 
 agencies. In this class of waters there is 
 no claim that any saline matters are absorbed 
 by the skin ; indeed, the quantity dissolved 
 is too small to produce any effect, even were 
 we to admit the possibility of absorption. 
 
 In connection with baths of all kinds, the 
 capacity of the skin to absorb saline or other 
 substances dissolved in the water is a point 
 of considerable importance. All the tissues 
 of the body are more or less porous, and 
 therefore capable of soaking up water and 
 various other fluids brought into contact with 
 them. There is, it would appear, slight 
 increase of weight after a protracted warm 
 bath, and this is due to the imbibition of a 
 certain quantity of water. As a matter of 
 fact, however, the absorptive power of the 
 skin is not great, and for this reason the 
 integument constitutes a very effective barrier 
 to the admission of materials into the blood. 
 So long as the epidermis is intact, the hands 
 can be dipped into solutions of poisonous 
 substances without any risks of those evil
 
 XII.] MINERAL BATHS. 341 
 
 results which would certainly follow the intro 
 duction of a similar fluid into the stomach. 
 If it be true that only water is absorbed by 
 the skin, the utility of bathing in iron waters 
 or in alkaline waters, with the view of ob- 
 taining any special benefit from the substances 
 held in solution, is clearly very questionable. 
 Many experiments have been made for the 
 purpose of determining this question. Highly 
 soluble substances, such as iodide of potassium, 
 have been added to baths of warm water 
 and, after prolonged immersion, no trace of 
 the iodine could be detected in the saliva. 
 When, on the other hand, a few grains of 
 this drug are dissolved in water and swallowed, 
 the iodine can soon be discovered in the 
 saliva by a simple test. It is true that certain 
 medicines readily pass into the system when 
 rubbed into the skin, but this method of 
 application is different from simply keeping 
 the skin in contact with substances dissolved 
 in water. Curious properties have been 
 assigned to thermal springs, owing, as has 
 been thought, to some peculiarity of the heat. 
 There is, however, no foundation for this 
 view ; water artificially heated to a given
 
 34 2 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 temperature is just as efficacious as that 
 derived from springs destitute of any special 
 character. This fact is sometimes disputed 
 by those whose interest it is to advocate the 
 claims of certain springs, but those who know 
 most about such matters have little doubt 
 as to its truth. Some years ago the local 
 authorities at Wildbad (one of the best-known 
 baths of this kind) were proposing to enlarge 
 the bathing accommodation. One member of 
 the Board objected to the proposal, alleging 
 that any one could have a Wildbad bath in 
 his back kitchen. We have in England one 
 of the finest thermal springs to be found in 
 Europe. For all cases for which hot baths 
 are suggested, the waters of Bath are not to 
 be surpassed, while all the arrangements for 
 bathing fulfil every possible requirement. 
 They are now regaining their reputation, 
 having been undeservedly eclipsed by such 
 places as Teplitz, Gastein, and Wildbad. 
 
 The next important group of mineral waters 
 includes those which contain iron. These are 
 used both for drinking and bathing purposes, 
 but, as already mentioned, when taken as 
 baths, they have no special virtues, inasmuch
 
 XII.] SPAS AND WATERING PLACES. 343 
 
 as the iron is not absorbed by the skin. For 
 internal administration, however, they consti- 
 tute most valuable remedies for all cases in 
 which iron is indicated. In England we have 
 but few springs of this character which are 
 made any use of; that of Tunbridge Wells 
 is probably the best known. It is used 
 only for drinking purposes. One spring at 
 Harrogate contains iron. At Llandrindod, in 
 Radnorshire, there is a weak chalybeate 
 spring, whose waters are said to be very 
 decidedly tonic and hsmatinic, and easily 
 assimilated. A few springs in various parts 
 of England contain so much iron as to be 
 unfit for internal use. On the Continent, the 
 iron waters of Spa, Pyrmont, Schwalbach, 
 and St. Moritz are those most resorted to. 
 Many of these contain a large amount of 
 free carbonic acid, and are on that account 
 pleasant to take. 
 
 Sulphur waters form a third and distinct 
 group, and we have in England, at Harrogate, 
 one of the strongest of this class. In addition 
 to sulphur, the waters of Harrogate contain 
 a large amount of salts, the action of which 
 cannot be separated from that of the sulphur.
 
 344 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 Other sulphur springs are to be found at 
 Strathpeffer and Llandrindod. On the Con- 
 tinent the springs at Aix-la-Chapelle and 
 Aix-les- Bains are those that have the highest 
 reputation. The sulphur waters are supposed 
 to be useful in rheumatism, gout, neuralgia, 
 liver disorders, various affections of the skin, 
 and in sundry other diseases. Very divergent 
 opinions are held as to their real value in any 
 of these ailments. When taken as baths, their 
 effects are probably identical with those of 
 common water of an equal temperature, and 
 the same, in my opinion, may be said with 
 regard to their internal use. It is especially 
 worthy of notice that those local physicians 
 who are so enthusiastic over the virtues of 
 these waters almost invariably order power- 
 ful medicines to be taken during the course 
 of bathing and drinking. This custom is 
 universal in their treatment of one class of 
 patients who are sent in great numbers to 
 Aix-la-Chapelle. Experience teaches us that 
 the same medicines are wonderfully efficacious 
 at home, without the addition of malodorous 
 waters. 
 
 A fourth class of waters consists of those
 
 XII-] ENGLISH SPAS. 345 
 
 which contain common salt as their principal 
 constituent, and we have in England excellent 
 representatives of this class. At Droitwich, 
 Nantwich, and Middlewich, springs of brine 
 are abundantly found, and the preparation of 
 salt, by evaporating the liquor, forms the 
 staple industry of these places. Brine from 
 Droitwich has now been conveyed to Malvern, 
 where patients have the advantages of using 
 the strongest possible saline baths 'in a health- 
 resort celebrated for its dry air, perfectly pure 
 water, and exquisite scenery. The arrange- 
 ments at Malvern are excellent, and well 
 adapted for invalids. The water is too highly 
 saline for internal use, but in the form of baths 
 the salt acts as a powerful stimulant to the 
 skin, and promotes its nutrition. By its action 
 on the cutaneous nerves, it gives tone to the 
 system. Springs of water containing much 
 common salt are also to be found at Cheltenham, 
 Leamington, and Llandrindod ; at Kreuznach, 
 Rehme, and many other places on the Con- 
 tinent. Alkaline waters, which owe their 
 properties to the presence of carbonate of soda, 
 are not to be found in England. The most 
 celebrated are those of Vichy, Neuenahr, and
 
 34 6 HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 Mont Dore, which are hot, and those of Bilin, 
 Apollinaris, Vals, and Taunus, which are cold. 
 This class of waters enjoys a considerable 
 reputation in the treatment of indigestion and 
 of those conditions in which an undue amount 
 of acid is present in the system e.g., in 
 rheumatism and gout. They are used both 
 for bathing and drinking, though, as stated in 
 a previous paragraph, no appreciable amount 
 of the saline matters is absorbed by the skin. 
 Their internal use promotes tissue-change, 
 and if continued for some time produces 
 emaciation. It must be admitted that under 
 their use the symptoms of chronic gout and 
 rheumatism are often much relieved, but with 
 regard especially to the former affection, these 
 alkaline waters act merely as palliatives, the 
 symptoms sooner or later recurring when 
 their use is discontinued. On this account 
 they are far inferior to such waters as those of 
 Carlsbad, which belong to a class to be next 
 described. When taken by gouty persons, the 
 alkaline waters e.g., of Vichy neutralise the 
 materies morbi, but have little, if any, influence 
 in checking its formation. The Carlsbad 
 waters, on the other hand, while neutralising
 
 XII.] CLASSIFICATION OF SPAS. 347 
 
 the offending material, act likewise upon those 
 organs which are concerned in its production 
 in such a manner that its formation is decidedly 
 checked. 
 
 The next class of waters, those which 
 contain the sulphates of soda and magnesia, 
 is now represented in England chiefly by 
 the springs of Cheltenham and Leamington, 
 though there are many others which contain 
 these salts. Springs at Epsom, Streatham, 
 and Dulwich were very highly thought of in 
 the last century. Nowadays we import large 
 quantities of weaker waters, such as Ptillna, 
 Friedrichshall, Hunyadi Yanos, etc. These 
 are highly useful in many cases. The Carls- 
 bad waters, already referred to, contain, beside 
 sulphates, the carbonate of soda, and are 
 therefore more suitable for many cases than 
 those just mentioned. 
 
 The last class of waters which require notice 
 is not a numerous one. It contains those 
 springs of which the chief mineral constituents 
 are the carbonates and sulphates of lime and 
 magnesia. We have no representative of this 
 class in England ; abroad, the best known 
 springs are those of Bagneres de Bigorre,
 
 34$ HEALTH-RESORTS AND THEIR USES. [CAP. 
 
 Contrex^ville, and Wildungen. They are 
 useful in some forms of indigestion, especially 
 where acidity is a prominent symptom, and in 
 some skin diseases. As baths, their effects 
 are due simply to the heat and the water. 
 No absorption of the salts can be supposed 
 to take place. 
 
 This necessarily imperfect sketch of health- 
 resorts and their uses is sufficient to show 
 that we have in such places remedial agencies 
 of a very potent character. We must beware, 
 however, of expecting impossibilities and of 
 falling into the mistake of supposing that 
 the majority of ailments are curable by baths 
 and waters. It is unfortunately impossible 
 to obtain any statistics as to the results in 
 the thousands of patients who annually visit 
 baths and watering-places, either by the advice 
 of physicians or prompted by their own ideas 
 of what will be good for them. Favourable 
 cases are of course published in the local 
 handbooks ; we hear nothing of the majority 
 who fail to obtain relief. With regard to 
 baths, it would seem at least probable that 
 foreigners in general are more often benefited 
 than Englishmen, to whom daily ablution is
 
 XII CHOICE OF HEALTH-RESORTS. 349 
 
 not such a novelty as it must be as a general 
 rule to dwellers on the Continent. A glance 
 at the utensils provided for washing in most 
 continental hotels is sufficient to show the 
 slight attention ordinarily paid to this impor- 
 tant part of the toilet. Judging from the 
 writer's experience, it is necessary to add 
 that all patients hoping to derive real benefit 
 from a health-resort should seek proper advice 
 before resorting thither, and that, while there, 
 they should follow out to the letter the advice 
 of the local physician. Unless his directions, 
 trivial as they may seem, are attended to, 
 the place and its resources will not have 
 a fair trial. It must be borne in mind that 
 in not a few cases the improvement shows 
 itself only after the patient has returned 
 home. There is nothing surprising in this 
 delay, as most of the ailments, for the relief 
 of which recourse is had to bathing-places, 
 are of a chronic nature, and do not admit 
 of rapid cure. Lastly, when a health-resort 
 has to be selected, let it never be forgotten 
 that our country possesses many places of 
 this character, and in no respect second to 
 those to be found abroad.
 
 INDEX. 
 
 ABRAHAM, age at his death, 62. 
 
 Abstainers, total, longevity of, 
 133; compared with moderate 
 drinkers, 134; two classes of, 
 
 135- 
 
 Actuaries, Institute of, tables of 
 
 longevity, 64. 
 
 Addison, Dr., on diphtheria, 165. 
 
 Addison, J., on the valetudina- 
 rian, 87. 
 
 Africa, production of intoxicating 
 drinks, 114. 
 
 South, places suitable for 
 
 affections of the chest, 326- 
 328 ; defective arrangements 
 for invalids, 329. 
 
 Air, conductivity of, 104 ; a puri- 
 fier of water, 292 ; benefits 
 from change of, 312-315 ; sea, 
 318; bathing, 319; mountain, 
 324; country, 334; sea voyages, 
 
 337- 
 
 Aix-la-Chapelle, 344. 
 Aix-les-Bains, 344. 
 Alcohol, use of, 49, 85, 113; 
 
 manufacture, 114; general 
 
 action, 115 ; excitement, 115- 
 117; intoxication, 117; coma 
 or insensibility, 1 18 ; effects on 
 the body, 119; on the nervous 
 system, 119; sedative effects, 
 121 ; wine, spirits, and beer 
 compared, 123; absorption, 
 125 ; acts as a food, 126 ; com- 
 pared with opium, 1 27 ; reasons 
 for taking, 129 ; question of 
 necessity, 130; rate of mortal- 
 ity, 133 ; abstinence contrasted 
 with moderation, 133-136 ; 
 quantity, 136; tendency to 
 retard digestion, 139. 
 : Aldershot, result of the anti- 
 toxin treatment at, 186. 
 j Alivval, 328. 
 ', Alkaline waters, 345. 
 
 America, extension of diphtheria 
 to, 1 68. 
 
 American children, causes of ill- 
 health, 39. 
 
 Andes, Peruvian, 326. 
 
 Animals, fasting, experiments 
 on, 146 ; diphtheria in, 179. 
 
 351
 
 352 
 
 INDEX. 
 
 Anthrax or splenic fever, 235 ; 
 experiments on the organisms, 
 236. 
 
 Antitoxin, value of, 7 ; discovery, 
 183; method of preparation, 
 183 ; results of the treatment, 
 185. 
 
 Apollinaris, 346. 
 
 Arcachon, 322. 
 
 Ardrossan, 321. 
 
 Aretaeus, his description of diph- 
 theria, 167. 
 
 Arnold, Matthew, on the use of 
 alcohol, 122. 
 
 Artesian well, the first, 298. 
 
 Assurance offices, statistics on 
 total abstinence, 133. 
 
 Australia, effects of the anti- 
 toxin treatment in, 185- 
 
 Austria, effect of the antitoxin 
 treatment in, 185. 
 
 BACILLUS of cholera, 205, 207 ; 
 size, 205 ; mode of transport, 
 208 ; growth and development, 
 209. 
 
 of diphtheria, 175. 
 
 Bacon, Lord, on the pleasures of 
 gardening, 82. 
 
 Bacteria, nature and mode of 
 growth, 205 ; formation of 
 spores or seeds, 205 ; qualities, 
 206 ; forms of action, 207 ; 
 theory of, 231 ; meaning of the 
 term, 231 ; the common form, 
 232 ; existence of, in water, 
 301 ; test by cultivation, 302 ; 
 development in filtered or un- 
 filtered, 303 ; reduction of, 306. 
 
 Bagneres de Bigorre, 347. 
 
 Barnard Castle, 292. 
 
 Barrister, the daily work of a, 
 
 17-20. 
 
 Batavia, 201. 
 Bath, thermal springs at, 339, 
 
 342. 
 
 Bathing, 319. 
 
 Baths, results of warm, 339. 
 Battersea, mortality from cholera, 
 
 193, 195. 
 
 Beale, Dr., on particles of con- 
 tagious bioplasm, 229, 230 ; on 
 the value of country air, 335. 
 
 Beaufort West, 327. 
 
 Bedroom, temperature of, 90. 
 
 Beer, amount of alcohol in, 124. 
 
 Behring, 184. 
 
 Bengal, epidemic of cholera, in 
 1817, 188. 
 
 Bennet, Dr., on the climate of 
 Italy, 322. 
 
 Bermondsey, mortality from 
 cholera, 194. 
 
 Bertillon, Dr., on marriage affect- 
 ing longevity, 68. 
 
 Berwick, North, 321. 
 
 Bicycling, the exercise of, 82. 
 
 Bilin, 346. 
 
 Bioplasm, 229. 
 
 Birmingham, epidemic of diph- 
 theria, 168. 
 
 Bischof, Prof., on water from 
 wells, 297 ; the development 
 of bacteria in water, 303. 
 
 Blackdown, 336. 
 
 Black wall, 20 1. 
 
 Body, normal temperature, 95 ; 
 variations, 95 ; preservation of
 
 INDEX. 
 
 353 
 
 the general level, 96; loss of 
 heat, 97 ; use of clothing, 98. 
 
 Boulogne sore throat, epidemic 
 of, in 1855, 165, 169; number 
 of deaths from, 166. 
 
 Bournemouth, 321, 333; advan- 
 tages of, 322. 
 
 Brain, weakness of, 15. 
 
 Brandy, analysis of, 123. 
 
 Bretonneau, M., his use of the 
 term diphtheria, 166, 169. 
 
 Brighton, 54. 
 
 Bristol, the sewers of, 172. 
 
 British Medical Association, 
 report .of the Investigation 
 Committee, 85. 
 
 Bromine, 256. 
 
 Bromley, mortality from diph- 
 theria, 1 68. 
 
 Brunton, Dr., on the effects of 
 alcohol, 116, 117. 
 
 Bryson, Dr., on the outbreak of 
 cholera on board ship, 200. 
 
 Budd, Dr. W., 30x3. 
 
 Buffon on the normal duration 
 of human life, 61. 
 
 Bulwer on light reading, 52. 
 
 Burnett's solution of chloride of 
 zinc, 260. 
 
 Buxton, thermal springs, 339. 
 
 CABINET Minister, the work of 
 
 a, 25. 
 
 Cannes, 322. 
 Cannock Chase, 336. 
 Carbolic acid, 212, 257, 263. 
 Carlsbad waters, 346, 347. 
 Carpenter, Dr. W. B., 132, 142. 
 Caterham epidemic, 293, 300. 
 
 Cats, diphtheria in, 180. 
 
 Ceres, 327. 
 
 Chadwell, 277. 
 
 Chadwick, Sir Edwin, example 
 
 of transmitted longevity, 67. 
 Chamberland-Pasteur filters, 214, 
 
 265, 305. 
 Champagne, its intoxicating 
 
 power, 123. 
 
 Change of air, 311 : see Air. 
 Channel Islands, 321. 
 Charcoal filters, 265. 
 Chelsea, mortality from cholera, 
 
 193- 
 
 Chelsea Water Company, 277. 
 
 Cheltenham, 345, 347. 
 
 Chesham, Bucks, epidemic of 
 diphtheria, 168. 
 
 Chevreul, M., age at his death, 
 93 : note. 
 
 Chinese method of clothing, 105. 
 
 Chingford, 277. 
 
 Chloride of zinc, 260, 263. 
 
 Chlorine gas, use of, 245, 254^ 
 264. 
 
 Cholera, epidemics of, in India, 
 187-190 ; theories of its origin, 
 191 ; effect of impure water, 
 192; epidemics in London, 
 1849, 193; 1854, 194, 195; 
 1866, 195 ; theory of air-con- 
 duction, 199 ; outbreaks of, on 
 board ship, 200-202 ; contro- 
 versies on the subject, 203 ; 
 invisible animalcules, 204 ; the 
 bacilli, 204 ; special precau- 
 tions, 210-214; general rules 
 for the prevention of, 214 ; 
 method of inoculating, 216. 
 
 23
 
 354 
 
 INDEX. 
 
 Chossat, M., his experiments on 
 
 fasting animals, 146, 149. 
 Cleanliness, importance of, 90. 
 Clergy, average duration of life, 
 
 68. 
 
 Clergy Mutual Assurance, 135. 
 Climate, definition of, 317. 
 Clothing, use of, 98 ; wool, 98 ; 
 
 shoddy, 99 ; silk, 101 ; fur, 101 ; 
 
 felt, 101 ; cotton, 102 ; linen, 
 
 1 02 ; the best material, 102 ; 
 
 colour, 108 ; waterproof, 108 ; 
 
 general rules for, 1 10. 
 Coffee, the use of, 130. 
 Coire, 325. 
 
 Combermere, Lord, 73. 
 Companies, water, 277 : see 
 
 Water. 
 
 Competition, the strain of, 28. 
 Condy's fluid, 259. 
 Consumption, localities suitable 
 
 for, 321, 322, 325, 328, 332. 
 Contagion synonymous with in- 
 fection, 219. 
 Contrexeville, 348. 
 Cornwall, epidemic of diphtheria, 
 
 168. 
 
 Corrosive sublimate, 21 1, 257. 
 Cotton, an important article of 
 
 clothing, 102 ; its conducting 
 
 power, 103. 
 
 Country air, value of, 334. 
 Cows, diphtheria in, 179. 
 Cradock, 327. 
 Crayford, 277. 
 Crookshank, Dr., 258. 
 Cross, Lord, 309. 
 
 DALGETTY, CAPTAIN, 45. 
 
 Darlington, 292. 
 
 Dartmoor, 336. 
 
 Davaine, his experiments on 
 anthrax, 235. 
 
 Davos Platz, its efficacy for the 
 cure of consumption, 325, 333 ; 
 climate, 326. 
 
 De Quincey on the different 
 effects of opium and alcohol, 
 127. 
 
 Delirium tremens, 120. 
 
 Delta, outbreaks of cholera, 
 187. 
 
 Deodorisation, 245. 
 
 Deptford, 277. 
 
 Descartes, his plan of prolonging 
 life, 73. 
 
 Desmond, Lady, her reputed 
 longevity, 63. 
 
 Devonshire, epidemic of diph- 
 theria, 1 68. 
 
 Dibdin, Mr. W. J., his paper on 
 " The Character of the London 
 Water Supply," 306. 
 
 Diet suitable for aged persons, 
 84. 
 
 Digby, Sir Kenelm, 73. 
 
 Digestion, state of the, 45 ; pro- 
 cess, 46 ; diet, 49 ; effects of 
 alcohol, 138. 
 
 Dinner hour, 47. 
 
 Diphtheria, outbreak of, in 1856, 
 164 ; derivation of the word, 
 1 66 ; prevalence in early times, 
 167 ; in Spain, 167 ; in Eng- 
 land, 1 68; characteristics, 169; 
 average mortality, 170; sani- 
 tary measures, 171 ; variety of 
 causes for the development,
 
 INDEX. 
 
 355 
 
 172-174; liability of children, 
 174; the bacillus, 175; con- 
 tagious character, 175 ; propa- 
 gation by elementary schools, 
 176; milk, 178; animals, 179; 
 notification, 180; isolation, 
 181 ; treatment, 182 ; discovery 
 of antitoxin, 183 ; result of 
 the treatment, 185. 
 
 Disinfection, meaning of the 
 word, 218; ancient method, 
 243 ; adoption of deodorants, 
 245 ; modern rules, 247, 261- 
 265 ; high temperature, 248 ; 
 difficulties of the process, 249- 
 251 ; exposure to light and air, 
 251 ; washing, 252, 263 ; rooms, 
 253 ; various methods, 253- 
 260, 264 ; ventilation, 253 : 
 chlorine, 254; euchlorine, 255 ; 
 bromine, 256 ; bread, 256 ; 
 spray, 257 ; carbolic acid, 257 ; 
 Condy's fluid, 259 ; sinks, 
 drains, etc., 260. 
 
 Distilled water, 285. 
 
 Ditton, 277. 
 
 Dobell, Dr., on the advantages 
 of Bournemouth, 323. 
 
 Dor6, Mont, 346. 
 
 Dorttnda, outbreak of cholera 
 on board, 200. 
 
 Dover, 320. 
 
 Drains, disinfection of, 260. 
 
 Droitwich, 345. 
 
 Drugs, injurious use of, 30 ; faith 
 in, 311. 
 
 Dulwich, 347. 
 
 Dunoon, 321. 
 
 Dynamometer, 161. 
 
 EARLY rising, the practice of, 43- 
 
 45- 
 
 Eastbourne, 54. 
 Easton, extract from his work 
 
 on " Human Longevity," 61. 
 England, number of deaths from 
 
 diphtheria, 170. 
 England, outbreak of cholera on 
 
 board, 202. 
 Epsom, 347. 
 Esmarch, Prof., on the use of 
 
 bread in disinfection, 256. 
 Euchlorine, 255, 262. 
 Ewhurst windmill, 336. 
 Exercise of the mind, 77 ; of the 
 
 body, 79 ; need for discretion, 
 
 80; various forms of, 81. 
 
 FAKIRS, cases of suspended 
 animation, 1 56. 
 
 Fasting, 144 ; symptoms of, in 
 animals, 146; loss of weight, 
 147 ; cause of death, 148 ; cases 
 of voluntary abstinence, 149- 
 155 ; suspended animation, 
 155; symptoms of, in human 
 beings, 156-158 ; loss of weight, 
 159; fall of temperature, 160. 
 
 Felt, 101. 
 
 Fevers, example of infectious, 
 220 ; of non-infectious, 222. 
 
 Filters, 213, 265, 304. 
 
 Fire, its use in disinfection, 243. 
 
 Fish, increase in the use of, 49. 
 
 Foder6, his case of starvation, 
 154. 
 
 Food, improvement in the method 
 of preparing, 49 ; moderation 
 in, 83; two classes of, 112.
 
 356 
 
 INDEX. 
 
 Fothergill, Dr. J., 168. 
 
 France, effects of the antitoxin 
 treatment in, 185. 
 
 Frankland, Dr. Percy, his report 
 on the quality of water, 282, 
 283, 284, 302 ; on oxidation, 
 291 ; report on Tees river, 
 292 ; on two systems of water 
 supply, 294 ; average reduc- 
 tion of organisms, 304. 
 
 Frazerberg, 328. 
 
 Fresh air, importance of 50. 
 
 Friedrichshall, 347. 
 
 Fungi, 230. 
 
 Fur, use of, 101. 
 
 GARDENING, a form of exercise, 
 
 82. 
 
 Garottillo, 167. 
 Gastein, thermal springs, 339, 
 
 342. 
 Germany, effects of the antitoxin 
 
 treatment in, 185. 
 Gladstone, Mr., 33. 
 Golden Square, Soho, outbreak 
 
 of cholera, in 1854, 195. 
 Grand Junction Water Company, 
 
 277. 
 
 Grand, Mr. A. le, on the purifica- 
 tion of water exposed to air, 
 292. 
 
 Greeks, duration of life in the 
 time of, 63. 
 
 Greenwich, mortality from diph- 
 theria, 1 68. 
 
 Greg, Mr., 13; on a life without 
 leisure, 32. 
 
 HAFFKINE, M., his method of 
 anti-cholera vaccination, 216. 
 
 Halifax, 202. 
 
 Hamburg, epidemic of cholera, 
 209. 
 
 Hammersmith, mortality from 
 cholera, 193. 
 
 Hampton, 277. 
 
 Hanover, 328. 
 
 Hanwell Asylum well, 299. 
 
 Hardy, Sir J. Duffus, on the 
 longevity of man in the Middle 
 Ages, 63. 
 
 Harrogate, 343. 
 
 Health, undue solicitude for, 
 87. 
 
 Health resorts, value of, 311 ; 
 benefits from change of air, 
 312-315 ; character of localities, 
 316; effects of sea-air, 318; 
 bathing, 319; list of seaside 
 places, 320 ; equability of 
 temperature, in chest diseases, 
 321 ; advantages of Bourne- 
 mouth, 322 ; mbuntain air, 
 334 ; Davos Platz, 325 ; South 
 Africa, 326-328 ; Kimberley 
 Sanatorium, 331 ; effect on 
 consumption, 332 ; country 
 air, 334 ; localities, 336 ; sea 
 voyages, 337 ; mineral waters 
 and baths, 338-348. 
 
 Heat, loss of, 97 ; conducting 
 power of clothing materials, 
 103 ; of air, 104. 
 
 Hereditary longevity, 67. 
 
 High-pressure, evidences of, 27 ; 
 
 symptoms, 29 ; results, 33. 
 Hindhead, 336. 
 
 Hirsch, Dr., on diphtheria, 174. 
 Hogarth on the difference
 
 INDEX. 
 
 357 
 
 between topers and dram- 
 drinkers, 125. 
 
 Holidays, 53 ; mode of spending 
 the annual, 55. 
 
 Holland, Sir H., on the habit of 
 early rising, 72. 
 
 Holmes, Wendell, on the use of 
 alcohol, 122. 
 
 Hook, Dean, 44 ; on the practice 
 of reading, 52. 
 
 Horses, use of, for the antitoxin 
 serum, 183. 
 
 Howard, John, on the insanitary 
 condition of prisons, 3. 
 
 Hufeland on longevity, 67. 
 
 Humphry, Sir G. M., his 
 statistics on fifty-two cen- 
 tenarians, 64, 71 ; extract 
 from his " Report on Aged 
 Persons," 69, 83. 
 
 Hunyadi Yanos, 347. 
 
 Hurdwar, outbreaks of cholera, 
 187. 
 
 Hyeres, 322. 
 
 Hygiene, personal, 8 ; advance- 
 ment in the science of, 311. 
 
 " Hypochondriasis," 31, 87. 
 
 ICED water, injurious use of, 49. 
 
 India, epidemics of cholera, 187- 
 189; use of water, 274. 
 
 Indian Archipelago, production 
 of intoxicating drinks, 1 14. 
 
 Indigestion, 30 ; number of 
 remedies for, 46. 
 
 Infection, meaning of the word, 
 218 ; typical example of, 220 ; 
 of non-infection, 222 ; distinc- 
 tion as regards causation, 225 ; 
 
 differences in the nature of 
 contagious agencies, 227 ; 
 nature of particles, 228; bio- 
 plasm, 229 ; fungi, 230 ; bac- 
 teria, 231 ; relation between 
 the organisms and symptoms, 
 233 ; protective inoculation, 
 239 ; media for the propaga- 
 tion, 241 ; fatal character, 243. 
 
 Inoculation, protective, 7, 239. 
 
 Insanity, increase of, 31. 
 
 Intoxication, 117. 
 
 Iodide of potassium, 341. 
 
 Iron waters, 342. 
 
 Irwell river, 291. 
 
 JACKSON, DR. H., 32. 
 
 Jacobs, Sarah, her death from 
 starvation, 151. 
 
 Jameson, Dr., 192. 
 
 Japanese method of clothing, 
 105. 
 
 Jenkins, Henry, his reputed long- 
 evity, 63. 
 
 Jenner, Edward, the first to 
 practice vaccination in 1796, 
 5 ; his view of its protective 
 powers, 6. 
 
 Johannesburg, 331. 
 
 Johnson, Dr., on the advantages 
 of living in London, n. 
 
 Joshua, age at his death, 62. 
 
 Judge, the duties of a, 20. 
 
 KARROO, the Great, 327; the 
 
 Northern, 327. 
 Kent Waterworks Company, 277, 
 
 280, 286. 
 Kew, mortality from cholera, 193.
 
 358 
 
 INDEX. 
 
 Kimberley, 328 ; proposed sana- 
 torium at, 330; advantages, 
 
 33'- 
 
 Kingston, Mr. Beatty, his pam- 
 phlet on combating intemper- 
 ance, 141. 
 
 Klebs, his discovery of the 
 microbe of diphtheria, 184. 
 
 Klein, Dr., on diphtheria in cows, 
 179 ; in cats, 180. 
 
 Koch, Dr., his theory of the 
 bacilli of cholera, 204 ; on 
 sand-filters, 281. 
 
 LAMBETH WATER COMPANY, 194, 
 
 277- 
 
 Landquart Station, 325. 
 Latham, Mr. Baldwin, on the 
 
 supply of water from wells, 
 
 299. 
 
 Lausen, 282. 
 Lawrence, Mr., 330. 
 Lawyers, average duration of 
 
 life, 69. 
 Lea river, 193 ; amount of water 
 
 supplied from, 277. 
 Leamington, 345, 347. 
 Leith Hill, 336. 
 Leprosy, disinfecting cases of, 
 
 244. 
 
 Leuk thermal springs, 339. 
 Lewis, Sir G. C, on the limit of 
 
 human life, 60. 
 Lewson, Mrs., 73. 
 Life assurance companies, re- 
 cords of longevity, 64. 
 Life, the art of prolonging, 
 
 58 ; duration of, 59, 66 ; the 
 
 patriarchs, 62 ; Greeks and 
 
 Romans, 63 Middle Ages, 63 ; 
 assurance companies, 65 ; 
 three periods of, 75 ; necessity 
 of occupation, 76. 
 
 Linen, use of, 102 ; its conduct- 
 ing power of heat, 103. 
 
 Lister, Sir Joseph, his appeal 
 for funds for the preparation 
 of antitoxin, 163. 
 
 Liver, disease of the, 119. 
 
 Liverpool, 202. 
 
 Llandrindod, 343, 344, 345. 
 
 Loffler, his discovery of the 
 microbe of diphtheria, 175, 184. 
 
 London, advantages of living in, 
 ii ; disadvantages, 12; evi- 
 dences of " wear and tear," 12 ; 
 epidemics of diphtheria, 168 ; 
 number of deaths from, 170; 
 epidemics of cholera, in 1849, 
 193; in 1854, 194; in 1866, 
 195 ; health of, 307. 
 
 East, Water Company, 277. 
 
 Water Supply, 272 ; com- 
 panies, 277 ; measures, 283. 
 
 Longevity, 58 ; cases of, 63, 64 ; 
 conditions favourable to, 66, 
 74 ; hereditary, 67 ; sex, 67 ; 
 marriage, 68 ; occupations, 68 ; 
 moderation in eating and drink- 
 ing, 70 ; improbable causes of, 
 72-74 ; immoderate use of 
 sugar, 72 ; means adapted for 
 the attainment, 74; necessity 
 of occupation, 76 ; exercise of 
 the intellectual faculties, 77 ; 
 bodily exercise, 79 ; modera- 
 tion in food, 83 ; diet, 84 ; rules 
 for eating, 85 ; the use of
 
 INDEX. 
 
 359 
 
 alcoholic liquors, 85-87 ; sleep, 
 88 ; warmth, 89 ; exposure to 
 chills, 89; temperature of the 
 rooms, 90 ; cleanliness, 90 ; 
 question of desirability, 92 ; of 
 total abstinence, 133. 
 
 MACKENZIE, DR., 169. 
 
 Macnamara, Mr., on the com- 
 municability of cholera through 
 drinking water, 197 ; on badly 
 ventilated rooms, 199 ; the 
 length of the incubation period, 
 
 211. 
 
 Macpherson, Dr., his " Bath and 
 
 Wells of Europe," 316. 
 Madeira, 333. 
 Malvern, 345. 
 Manchester, 291. 
 Mansfield, Lord, 71. 
 Margate, 54. 
 Matjesfontein, 327. 
 Medical men, average duration 
 
 of life, 69. 
 Medical officer of health, 266 ; 
 
 duties of, 267. 
 Mental power, retention of, in j 
 
 old age, 77. 
 Mental work, result of, 14 ; j 
 
 various capacities for, 14 ; | 
 
 monotonous, 16; absence 
 
 of proper regulations, 17. 
 Mentone, 333. 
 Mercury, perchloride of, 257, 
 
 260, 263. 
 Mersey, the, 291. 
 Metropolis Water Act, 1871, 278, 
 
 279. 
 Micro-organisms of diphtheria, 
 
 175 ; of cholera, 205 ; the 
 causes of infectious diseases, 
 
 234- 
 
 Middle Ages, average duration 
 of life in the, 63. 
 
 Middlesbrough, 292. 
 
 Middlewich, 345. 
 
 Milk, a medium of propagating 
 diphtheria, 178, 242. 
 
 Mineral waters, 338 ; thermal, 
 338 ; iron, 342 ; sulphur, 343 ; 
 salt, 344 ; alkaline, 345 ; sul- 
 phates of soda and magnesia, 
 347 ; carbonates and sulphates 
 of lime and magnesia, 347. 
 
 Molesey, 277. 
 
 Moritz, St., 343. 
 
 Morveau, his work on " The Dis- 
 infection of the Air," 243. 
 
 Moses, his estimate of the life 
 of man, 62. 
 
 Mountain air, effect of, 324 ; in 
 consumption, 325. 
 
 Miiller, Dr., 192. 
 
 NAIRN, 321. 
 
 Nantwich, 345. 
 
 Naples, outbreak of diphtheria, 
 168. 
 
 Narcotics, effects of, 30, 88. 
 
 National Debt Office, cases of 
 longevity, 64. 
 
 Nervous system, effects of alco- 
 hol on the, 119. 
 
 Neuenahr, 345. 
 
 New River Water Company, 277. 
 
 Newsholme, Dr., on the rate of 
 mortality from intemperance, 
 133-
 
 360 
 
 INDEX. 
 
 Nice, 322. 
 
 North British Life Office, Edin- 
 burgh, 65. 
 
 OPIUM, effects of, compared with 
 alcohol, 127. 
 
 Organisms, minuteness of, 233 ; 
 cause of infectious diseases, 
 234; evidence in favour, 235; 
 experiments on anthrax, 236 ; 
 manner of producing disease, 
 238 ; mitigation by cultivation, 
 239; media for the propagation, 
 241 ; existence in water, 301 ; 
 test by cultivation, 302 ; re- 
 moval by filtration, 304. 
 
 Over work, diverse opinions on 
 the subject, 13 ; evidences of, 
 27. 
 
 Oxidation, 291. 
 
 Ozone, preparation of, 259. 
 
 PACINI, his theory of cholera, 
 204. 
 
 Palmer, William, his refusal of 
 food, 150. 
 
 Paris, Children's Hospital, effect 
 of the antitoxin treatment in, 
 185. 
 
 Parkes, Dr., on the exercise of 
 gardening, 82 ; on rice, 84 ; on 
 the use of alcohol, 131, 136, 137; 
 on the length of the incubating 
 period in cholera, 211; the 
 influence of oxidation on 
 water, 291 ; average daily 
 supply, 295 ; deep wells, 297 ; 
 the propagation of diseases. 
 300. 
 
 Parliament, the work of members 
 of, 24 ; disappointing results, 
 26. 
 
 Parr, Thomas, his reputed long- 
 evity, 63. 
 
 Pasteur, Dr., his researches into 
 organisms, 235, 239. 
 
 Paterson, Surgeon-Major Gen- 
 eral, on the antitoxin treat- 
 ment, 1 86. 
 
 Patriarchs, longevity of, 62. 
 
 Penzance, 321. 
 
 Perchloride of mercury, 257, 260, 
 263. 
 
 Permanganate of potassium, 259, 
 263. 
 
 Perspiration, amount of, 106. 
 
 Physician, the daily life of a 
 consulting, 22-24. 
 
 Plague, the Great, in 1665, lessons 
 from, 3. 
 
 Poore, Dr., 107 ; on animal heat, 
 
 102. 
 
 Potassium, iodide of, 341 ; per- 
 manganate of, 259, 263. 
 Priok, 201. 
 Prisons, insanitary condition of, 
 
 in 1774, 3- 
 Prussia, average mortality from 
 
 diphtheria, 170. 
 Public Health Act of 1848, 2; 
 
 amended, 7; of 1875, 267; of 
 
 1889, 268. 
 Pullna, 347. 
 Pyrmont, 343. 
 
 RAIN water, 285. 
 Ranmore Common, 336. 
 Ransome, Dr., on the rate of
 
 INDEX. 
 
 mortality from intemperance, 
 
 133- 
 Recreation, importance of, 51 ; 
 
 forms of, 51. 
 Redhill, 293. 
 Rehme, 345. 
 Rheumatic fever, symptoms of, 
 
 222 ; character of the disease, 
 
 224. 
 Rhodes, Mr. C, his contribution 
 
 to Kimberley Sanatorium, 330. 
 Richmond, 328 ; well, 299. 
 Riding, advantages of, 43, 81. 
 River water, quality of, 275, 286. 
 Rivers Pollution Act, 288, 305, 
 
 308. 
 
 Riviera, temperature of, 322, 324. 
 Roberts, Sir W., on the effects 
 
 of alcohol on digestion, 138, 
 
 139- 
 Romans, duration of life in the 
 
 time of, 63. 
 Rooms, disinfection of, 251, 264 : 
 
 see Disinfection. 
 Rothesay, 321. 
 Roux, M., 184. 
 Russell, Dr. J. A., on disinfecting 
 
 woollen articles, 250 ; washing, 
 
 252 ; carbolic acid, 258. 
 Rutland, Duchess of, on the 
 
 best methods of combating 
 
 intemperance, 141. 
 
 SALMON, MR. W., age at his death, 
 
 93 : note. 
 Salt waters, 344. 
 Sanitary legislation, 2 ; progress 
 
 of, since 1875, 7. 
 Scarlet fever, symptoms of, 220 ; 
 
 infectious character of the 
 
 disease, 223, 241. 
 Schwalbach, 343. 
 Sea air, effects of, 318 ; bathing, 
 
 319; on pulmonary diseases, 
 
 321 ; voyages, 337. 
 Seaford, 54. 
 Sewage, methods of dealing with, 
 
 288. 
 Ships, outbreak of cholera on 
 
 board, 200. 
 
 Shoddy, manufacture of, 99-101. 
 Sicily, outbreak of diphtheria, 
 
 168. 
 
 Silk, consistence of, 101. 
 Simon, Sir J., 195. 
 Sinks, disinfection of, 260. 
 Slare, Dr., on the use of sugar, 
 
 72. 
 Sleep, quantity of, 40 ; value, 40, 
 
 88 ; after-dinner, 41 ; exercise, 
 
 43 ; early rising, 43. 
 Sleeplessness, symptom of, 29 ; 
 
 effects of narcotics on, 30, 88 ; 
 
 causes of, 42. 
 Sloan, Dr., his case of starvation, 
 
 155- 
 Snow, Dr., his theory on the 
 
 transmission of cholera, 191 ; 
 
 on the outbreak in Soho, 197. 
 Society, its responsibility for the 
 
 " wear and tear " of life, 37 ; 
 
 demands of, 38. 
 South Downs, 336. 
 Southwark Water Company, 194, 
 
 277. 
 
 Spa, 343. 
 
 Spaniards, their term for diph- 
 theria, 167.
 
 362 
 
 INDEX. 
 
 Spirits, compared with wine, 123 ; 
 
 amount of alcohol contained 
 
 in, 124. 
 
 Spirometer, 160. 
 Splenic fever, 235 : see Anthrax. 
 Spongy iron, purifying influence 
 
 of, 265, 282, 305. 
 Spring water, quality of, 286. 
 Squire, Dr., on the contagious 
 
 character of diphtheria, 176. 
 Starvation, symptoms of, in ani- 
 mals, 146 ; in human beings, 
 
 156. 
 State, its responsibility for the 
 
 " wear and tear " of life, 36. 
 Stockton, 292. 
 Strathpeffer, 344. 
 Streatham, 347. 
 Succi, Signer, his fast, 158 ; loss 
 
 of weight, 159; temperature, 
 
 1 60. 
 Sugar, the use of, conducive to 
 
 longevity, 72. 
 Sulphur waters, 343. 
 Sunbury, 277, 306. 
 Sydehham, his cases of cholera, 
 
 188. 
 
 TANNER, DR., his prolonged fast, 
 152. 
 
 Tannus, 346. 
 
 Tea, the use of, 130. 
 
 Teddington, 194. 
 
 Tees river, 292. 
 
 Temperature of the bedroom, 90 ; 
 of the human body, 95 ; varia- 
 tions of, 96. 
 
 Teplitz thermal springs, 339, 342. 
 
 Terebene, 260. 
 
 Thames, 193, 194 ; amount of 
 water supplied from the, 276 ; 
 alterations, 304 ; influence of 
 spongy iron, 305. 
 
 Thermal waters, 338 ; baths, 339. 
 
 Thermometer, clinical, use of the, 
 
 95- 
 
 Thorns, Mr., 63 ; on the records 
 of the life assurance com- 
 panies, 64 ; investigations into 
 cases of longevity, 66. 
 
 Thorne, Dr., on the transmission 
 of diphtheria through the ele- 
 mentary schools, 177. 
 
 Throat, disease of the, 164. 
 
 Thymol soap, 264. 
 
 Tidy, Dr., on the quality of Lon- 
 don water, 284 ; the result of 
 oxidation, 291. 
 
 Tone, want of, 29, 35. 
 
 Torquay, 321, 333. 
 
 Total abstinence, 133: see Ab- 
 stinence. 
 
 Toulouse, murderer at, his ab- 
 stention from food, 149. 
 
 Tunbridge Wells, 343. 
 
 Tynemouth, 320. 
 
 UNITED KINGDOM TEMPERANCE 
 ASSOCIATION, 135. 
 
 United States, effect of the anti- 
 toxin treatment, 185. 
 
 VACCINATION, discovery of, 5. 
 
 Vals, 346. 
 
 Vegetables, increase in the use 
 
 of, 49. 
 Ventilation, problem of, 50 ; of 
 
 rooms, 253, 261.
 
 INDEX. 
 
 Ventilators, existence of surface, 
 172. 
 
 Vichy, 345. 
 
 Victoria, 328. 
 
 Viterbi commits suicide by star- 
 vation, 150. 
 
 WALES, number of deaths from 
 diphtheria, 170. 
 
 Walking, a form of exercise, 81. 
 
 Ware, 277. 
 
 Water, iced, injurious use of, 
 49; importance of pure, 212; 
 its use in disinfection, 244 ; 
 methods of purification, 265 ; 
 valuable properties, 272 ; diffi- 
 culties of supplying, 274; 
 quality of river, 275 ; amount 
 of consumption, 276 ; the com- 
 panies, 277 ; expenditure, 279 ; 
 Metropolis Water Act of 1871, 
 279 ; reservoirs, 280 ; filtering 
 beds, 280 ; duties of the ex- 
 aminer, 282 ; opinions on the 
 quality, 284; standard of purity, 
 285 ; distilled, 285 ; rain, 285 ; 
 river or spring, 286 ; tests, 
 287 ; sources of contamination, 
 288 ; sewage, 288, 300 ; floods, 
 289 ; purifiying agents, 290 ; 
 oxidation, 291 ; exposure to 
 air, 292 ; two systems of sup- 
 ply, 294 ; average daily supply, 
 295 ; quality of wells, 296 ; 
 quantity obtainable, 298 ; pro- 
 pagation of diseases, 299 ; ex- 
 istence of organisms or germs, 
 301 ; test by cultivation, 302 ; 
 development in filtered or 
 
 unfiltered, 303 ; filters, 304 ; 
 influence of spongy iron, 305 ; 
 improvement in the quality 
 between 1892 and 1895, 
 306. 
 
 Water Examiner, 280 ; duties of 
 the, 282. 
 
 Waterloo Bridge, 193. 
 
 Waterproof clothing, protection 
 of, 108. 
 
 Watson, Sir T., 165 ; on the 
 cause of cholera, 190 ; the 
 infection of scarlet fever, 
 241. 
 
 " Wear and tear," evidences of, 
 12 ; measures against, 36, 40, 
 50 ; causes of, 37. 
 
 Weber, Dr., on bathing, 319 ; on 
 the air of the moors, 336. 
 
 Wells, quality of the water, 296 ; 
 supply, 298. 
 
 West Middlesex Water Com- 
 pany, 277. 
 
 Wight, Isle of, 320. 
 
 Wildbad thermal springs, 339, 
 342. 
 
 Wildungen, 348. 
 
 Wilks, Dr., on the sedative effects 
 of alcohol, 121, 122; on the 
 beer-drinker, 131 ; the insur- 
 ance offices, 134, 135. 
 
 Willan, Dr., his case of starva- 
 tion, 155. 
 
 Wind, effect of, 105. 
 
 Windows, effect of double, 104. 
 
 Wine, moderation in the use of, 
 49; compared with spirits, 123; 
 amount of alcohol in, 124 ; in- 
 fluence on digestion, 138.
 
 364 
 
 INDEX. 
 
 Wood, Dr., on the increase of 
 
 insanity, 31. 
 Wool, an important article of 
 
 clothing, 98; properties of, 
 
 103; power of absorbing water, 
 
 106. 
 Woolwich, the sewers of, 172 
 
 YEO, DR. BURNEY, on the 
 temperature of Davos Platz, 
 326. 
 
 Yersin, 184. 
 
 ZINC, chloride of, 260, 263. 
 Zurich, 325. 
 
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