1 
 

THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 
 MRS. PRUDENCE W. KOFOID 
 
'k 
 
THE MILROY LECTURES 
 
 1899 
 
By the same Author, 
 
 SECOND EDITION. With 13 Illustrations. 
 Crown 8vo. 6s. %d. 
 
 ESSAYS ON RURAL HYGIENE. 
 
 Lancet.— 'Well wortliy of the serious coasideration of those into whose 
 hands is committed the control of the public health.' 
 
 British Medical Journal.— ' Well worth reading. Dr. Poore attacks 
 the local authority with much spirit, and with unanswerable logic on some 
 points.' 
 
 Glasgow Herald.—' A highly important book. The whole book is an 
 education in itself. It is a volume to be read and re-read equally by house- 
 holders and by professional sanitarians. Our only regret is that amid the 
 flood of hygienic literature which is, year by year, turned loose upon the 
 world, there are so few books of this type— fearless, honest, and scientific 
 criticisms of existing errors, and full, likewise, of recommendations whereby 
 these errors may be rectified.' 
 
 SECOND THOUSAND. With 36 Illustrations. 
 Crown 8vo. 3s. Qd. 
 
 THE dwelling-house. 
 
 Times.—* Dr. Poore does good service in hammering away at the folly of 
 taking town sanitation as a model for more happily situated communities- 
 . . . When it comes to applying model by-laws, intended for large towns, to 
 niral districts, and when rich men build country houses on the base model 
 of the London " mansion," then he is justified in protesting. As a counter- 
 blast to the worship of such false gods his book is useful and welcome.' 
 
 Engineer. — • Lack of space prevents our quoting freely from the section 
 headed " Eemedies for Overcrowding," which is admirable, and should be 
 read and re-read by sanitary authorities until they have thoroughly digested 
 it.' 
 
 LONGMANS, GREEN, & CO., 89 Paternoster Row, London, 
 New York and Bombay. 
 
THE EAETH 
 
 IN RELATION TO 
 
 THE PRESERVATION AND DESTRUCTION OF 
 
 CONTAGIA 
 
 BEING THE MILROY LECTURES DELIVERED AT THE 
 ROYAL COLLEGE OF PHYSICIANS IN 1899 
 
 TOGETHER WITH 
 
 OTHEB PAPERS ON SANITATION 
 
 BY 
 
 GEORGE VIVIAN POORE, M.D.(Lond.), F.R.C.P. 
 
 PBOFESSOB OF THE PBINCIPLES AND PBACTICE OF MEDICINE 
 
 UNrV'EBSITY COLLEGE, LONDON 
 
 PHYSICIAN TO UNIVEBSITY COLLEGE HOSPITAL 
 
 BTC. 
 
 LONGMANS, GREEN, AND CO 
 
 89 PATERNOSTER ROW, LONDON 
 NEW YORK AND BOMBAY 
 
 1902 
 
 All rights reaerred 
 
 k^» 
 
Digitized by the Internet Archive 
 
 in 2007 with funding from 
 
 IVIicrosoft Corporation 
 
 http://www.archive.org/details/earthinrelationtOOpoorrich 
 

 TO 
 
 SIR WILLIAM SELBY CHUKCH, Bart. 
 
 PBESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS 
 
 THIS BOOK IS DEDICATED 
 
 WITH GREAT RESPECT 
 BY 
 
 THE JUNIOR CENSOR (1902) 
 
 i^S565Sl 
 
PEEFAOE 
 
 The Author feels that no excuse is needed for the 
 republication of the lectures and papers included in 
 this volume, which deal with subjects of national 
 importance. 
 
 To Mr. George Fernet, M.E.C.S., &c., his warmest 
 thanks are due for much invaluable help in passing the 
 volume through the press. 
 
 May 1902. 
 
CONTENTS 
 
 MILKOY LECTUEES 
 
 CHAPTER PAGE 
 
 I. Earth — Pathogenic Saprophytes — Tetanus . . 1 
 
 II. Anthrax 9 
 
 III. Diarrhoea — Dysentery — Cholera . . . .22 
 
 IV. Malta Fever — Plague — Diphtheria . . . . 29 
 V. Malaria — Blackwatbr Fever — Tsetse Fly Disease 
 
 — LoupiNG III— Texas Fever— Horse-sickness 38 
 
 VI. Enteric Fever 46 
 
 VII. The Maidstone Epidemic 58 
 
 VIII. Immunity — Danger of Wounds 69 
 
 IX. Practical Considerations 78 
 
 X. Agriculture 87 
 
 XI. The Maintenance of the Fertility of the Soil . 96 
 XII. Sanitation in Holland 104 
 
 XIII. Carrington Moss 116 
 
 XIV. Conclusions 125 
 
 ADDKESS TO THE ROYAL MEDICAL AND 
 CHIRURGICAL SOCIETY 
 
 XV. Enteric Fever caused by Pollution of Public 
 
 Water-supplies 135 
 
 XVI. Recommendations as to Water-supply — What 
 
 TO DO WITH Infected Material, &c. . . 151 
 
CONTENTS 
 
 CHAPTER PAQB 
 
 XVII. Application of Excreta to well-tilled Humus 165 
 XVIII. Enteric and Overcrowding . . . . . 177 
 
 VARIOUS PAPERS 
 
 XIX. The Sanitation of Camps — Flies and the Science 
 
 OF Scavenging 189 
 
 XX. An Experiment in Sanitation— Collection of 
 
 Rain-water — Disposal of Slop- water . . . 201 
 
 XXI. Milk in its Relation to Health and Disease . 216 
 
 XXII. Some Dietetic Problems 281 
 
 Index . . 251 
 
ILLUSTRATIONS 
 
 FIGURE PAGE 
 
 1,2. TUTSHAM-IN-FlELD 61 
 
 8. Tutsham-in-Orchard 62 
 
 4. EwBLL 62 
 
 5. 'Spot' Plan of Surroundings of Maidstone Bar- 
 
 racks AND Prison 68 
 
 6. View of Cottage To face 203 
 
 7. Plan of Cottage 203 
 
 8. Slop Gutter : Longitudinal Section .... 209 
 
 9. Duplicated Tank-filter 210 
 
 10. Filtration Gutter 211 
 
 11. Slop Gutter : Cross-section 211 
 
 12. Earth Closet: Ground Plan 214 
 
 13. Earth Closet: Vertical Section 214 
 
THE EAETH 
 
 IN 
 
 EELATION TO THE PRESERVATION AND 
 DESTRUCTION OF CONTAGIA* 
 
 CHAPTER I 
 
 EARTH— PATHOGENIC SAPROPHYTES-TETANUS 
 
 That which we commonly speak of as earth, soil, or 
 humus, is largely composed of excreta and the dead 
 remains of animals and vegetables, which, as the 
 result of fresh biological processes, are either returned 
 to the bodies of living vegetable organisms, or, after 
 becoming mineralised and soluble, are washed down- 
 wards by the rain and ultimately find an exit in 
 the sea. It is obvious that not only does ' earth ' 
 vary in composition with the varying conditions of 
 subsoil, climate, flora and fauna, but that * earth ' must 
 undergo seasonal variations necessitated by the vigorous 
 upgrowth in the spring or the decay of the fall — the 
 heat and drought of summer or the flood and frost 
 of winter. The interstices between the particles of 
 
 * Being the Milroy Lectures delivered before the Boyal College of 
 Physicians, London, in 1899 (Chapters I. to XIV. inclusive). 
 
 B 
 
2 EARTH 
 
 * earth ' are filled at one time with air, at another 
 time witli water, and the line of demarcation between 
 earth and air on the one hand and earth and water 
 on the other is often not very definite. Again, the 
 dust which is suspended in the air and which settles 
 on everything is liable to contain infective particles, 
 harmless to breathe but dangerous if they fall upon a 
 wound. It is obvious that such particles may be 
 regarded as belonging to the earth or the air. Some of 
 them doubtless emanate from the earth, having been 
 raised as dust ; but we must admit that there may be 
 organisms which grow in the air, live in the air, and 
 die in the air without ever touching earth or water and 
 which elude all attempts at identification or artificial 
 cultivation. While there are organisms which may live 
 indifferently in air or watqr, others are probably more 
 exclusive in their obligatory conditions. The mutual 
 interaction of earth, air, and water must never be lost 
 sight of. It is the life in the earth, both vegetable 
 and animal, which helps by its influence on vegetation 
 to maintain the quality of the atmosphere. Again, it is 
 the earth which gives the quality to spring and river 
 water. Pure water is a body of definite chemical com- 
 position, and pure air is a tolerably definite mixture of 
 gases, and it is not difficult approximately to measure 
 the degree of pollution of either. The chemical comr 
 position of earth, on the other hand, is complex and 
 constantly changing, and it is not possible for the 
 chemist to fix any standard of quality. The practical 
 agriculturist by the aid of touch, smell, and vision will 
 say at once whether any given sample of earth is foul 
 or pure, sour or sweet, rich or poor, fertile or sterile, 
 and we must perforce content ourselves with the terms 
 used by the practical man. The word * earth ' in the 
 
PATHOGENIC ORGANISMS 3 
 
 ensuing lectures will usually be regarded as meaning 
 humus in a healthy condition. 
 
 There are certain pathogenic organisms which are 
 constantly found in the earth and which appear to be 
 ubiquitous. They adhere to our skin and clothing, get 
 under the nails, and lodge in the hair. They produce 
 various diseases of wounds and wounded persons, and 
 we now recognise that in the absence of those precautions 
 which we call * antiseptic ' it is never safe to inflict even 
 the smallest wound. The modern surgeon not only 
 renders his hands and instruments aseptic, but he 
 operates in spotless garments and endeavours to have 
 an operating-room as clean and free from dust as 
 possible. The organisms which produce the various 
 wound infections are saprophytes which flourish exter- 
 nally to the body. They are ubiquitous and (probably) 
 necessary, and so long as we have a whole skin and 
 uninjured mucous membrane they do us no harm. As 
 all organic matter is constantly circulating, passing 
 through death to other forms of life and necessarily 
 undergoing humification as it does so, it follows that the 
 agents of these changes, the microbes which are to this 
 end propagated in the soil, vary with the circumstances. 
 Houston ^ gives the estimated number of microbes per 
 gramme found in twenty-one samples of soil. These 
 vary from 8,326 in a virgin sand and 475,282 in a 
 virgin peat to 115,014,492 in the soil from the trench 
 of a sewage farm. Broadly speaking, the microbes 
 bear a proportion to the amount of dung. Warington 
 estimated that a gramme of dung from a cow fed on 
 hay contained 165,000,000. They all, presumably, have 
 their optimum conditions — chemical and physical quali- 
 ties of the nutritive medium, access of air or other gases, 
 
 ' Local Oovemment Board Eeport, 1897-98. 
 
 b2 
 
4 EARTH 
 
 lightness or darkness and temperature — and when the 
 optimum conditions concur, growth and multiplication 
 go forward at a pace which we can hardly appreciate. 
 The fact that for the growth of some the access of air 
 is necessary, while others obtain their oxygen from the 
 medium in which they grow, and others, again, are able 
 to take in oxygen from either source, has formed the 
 basis of a classification which has assisted our under- 
 standing. Saprophytes, including those which produce 
 wound infection, are presumably of service in bringing 
 about the decomposition of complex organic bodies. 
 Whether we are able to check the growth and multiplica- 
 tion of these facultative parasites outside the body is 
 doubtful, and whether or no we should be gainers or 
 losers by so doing is still more doubtful. Bacterio- 
 logists have experienced no little difficulty in discovering 
 the exact conditions which are necessary for the growth 
 and development of many of the micro-organisms which 
 have been studied. Some are more exacting than others, 
 and those which are best able to accommodate them- 
 selves to varying circumstances naturally obtain the 
 mastery when several are attempting to grow simul- 
 taneously in the same medium. Some of the larger 
 saprophytes, such, for instance, as the common mush- 
 room, require no little skill for their artificial production. 
 Their cultivation requires far more attention to exact 
 details than is necessary with ordinary green-leaved 
 garden plants. We know that for a few weeks in the 
 autumn they may appear in great numbers in dry pastures 
 where horses have been fed, provided the conditions of 
 the air as to temperature, light, and moisture be favour- 
 able, and we also know that directly the necessary 
 conditions fail the mushroom harvest is at an end. 
 We also know how strange is the predilection of certain 
 
TETANUS 5 
 
 fungi for the dung of particular animals, and I would 
 allude to a list furnished to me by Mr. George Murray, 
 F.K.S., which shows that the optimum conditions for 
 the growth and development of these short-lived and 
 delicate organisms must be marvellously subtle and pro- 
 bably quite beyond the ken of the chemist. 
 
 Tetanus 
 
 I will now proceed to deal seriatim with some of the 
 contagia which are best understood, and will begin with 
 tetanus. Among the ubiquitous organisms which are 
 habitually found in earth is the bacillus of tetanus. It 
 is said to be present in almost all rich garden soils and 
 that the presence of horse-dung favours its occurrence. 
 It is strictly anaerobic and has been artificially cultivated 
 by Kitasato in an atmosphere of hydrogen. It forms 
 spores and grows best at a blood heat. Marchesi has 
 found it at a depth of two metres but no lower. The 
 pure cultivation of the bacillus, which has a disagreeable 
 aromatic odour, is often not very virulent. It is fatal to 
 animals as well as man, and among animals the horse 
 appears to be most liable to be attacked. Infection 
 always takes place by inoculation through the wounded 
 skin or mucous membrane — never, it is believed, through 
 the healthy alimentary or respiratory tracts. Cases of 
 * idiopathic ' tetanus are reported, but it has fallen to the 
 lot of few of us to see a case, and professional opinion 
 seems to lean to the idea that in such cases the inoculat- 
 ing wound has been overlooked. The toxin which the 
 bacillus brews locally in the wound is toxic to the central 
 nervous system, and the antitoxin to be effectual must, 
 it is said, be injected subdurally into the central nervous 
 system. The exhaustion of the nervous system seems 
 to increase its vulnerability, which is, perhaps, the reason 
 
6 EARTH 
 
 why tetanus has been relatively common in the domain 
 of military surgery. There seems to be no doubt as to 
 the ubiquity of the tetanus germ. Every child who falls 
 on the ground and gets an abrasion of the skin, all 
 tillers of the soil who get accidental wounds in the course 
 of duty, and every horse which * breaks its knees ' by 
 falling in the London streets, runs, potentially, a risk 
 of inoculation with tetanus. In the face of the ubiquity 
 of the cause the rarity of the disease is remarkable. I 
 have made inquiry of many practitioners in the Thames 
 valley, where market gardening is the chief industry and 
 where countless tons of London horse-dung are spread 
 upon the land, and learn from them that tetanus is in 
 their experience the rarest of diseases. Seeing that the 
 bacillus is so strictly anaerobic one is justified in sup- 
 posing that the tillage of the soil, which brings it in 
 contact with air and sunshine, must be unfavourable for 
 its growth and virulence. The bacilli must die out 
 under such conditions and the inoculation of the spores 
 alone is said by Vaillard, Kouget and Vincent to be 
 incapable of setting up tetanus. If the bacillus or the 
 spore be carried in dust, or if they be washed into the 
 water and drunk, we have no evidence that any harm 
 results therefrom. In common with some other mi- 
 crobial diseases tetanus is more virulent in the tropics 
 than in temperate climates. Friedberger and Frohner 
 state that it is so common among horses in St. Domingo, 
 especially after the operation of castration, that geldings 
 are worth twice as much as stallions. 
 
 The statement made by Le Dantec and H. M. Stanley 
 that the natives of the New Hebrides and Central Africa 
 are in the habit of poisoning their arrows by smearing 
 them with mud (obtained in the New Hebrides from a 
 mangrove swamp) gives emphasis to the importance of 
 
TETANUS 7 
 
 a tropical temperature and the absence of tillage as 
 factors which make for increase of virulence of the 
 tetanus bacillus and other organisms found in earth. 
 Pus from the wound of an animal suffering from tetanus 
 is capable of conveying the disease, and perhaps it is 
 due to this fact that certain stables and pastures have at 
 times acquired an evil reputation in respect of tetanus. 
 Captain Hayes, F.E.C.V.S., is of opinion that wounds in 
 the hoof as the result of careless shoeing are a great 
 cause of what may look like idiopathic tetanus in horses. 
 In an article by Mr. Sidney Villar in the * Journal of 
 Comparative Pathology and Therapeutics ' for December, 
 1897, an observation by Mr. Joseph Woodger is quoted 
 to the effect that tetanus is particularly common among 
 horses used in dust-carts, and Mr. Villar continues : " In 
 my own practice in Middlesex there are two farms where 
 the disease is specially prevalent. One of these, at 
 Alfreton, is occupied by a farmer who habitually spreads 
 on his fields large quantities of London refuse ; at the 
 second farm, five miles away, the bailiff brought two 
 large loads of the sweepings of London roads in 1893 
 and dressed his home meadows with it. On these 
 meadows his colts and young stock were pastured and 
 for two and a half years tetanus was endemic on his 
 farm ; during this period six colts became affected and 
 I believe only one entirely escaped the disease." 
 
 This experience of Mr. Villar seems to point to the 
 danger of placing upon grazing land material which is 
 probably mixed with broken glass or crockery. On 
 clay lands, such as are common in the north of London, 
 manurial matters placed on a pasture would be long in 
 getting incorporated with the soil, and to allow horses 
 to browse amongst the crude impurities of a great city 
 cannot be without danger to the horses. Municipal 
 
8 EARTH 
 
 authorities who wish to find a ready market for street 
 refuse must clearly take care that it is not mixed with 
 dangerous materials of no manurial value likely to 
 wound the feet of animals. Inorganic refuse, such as old 
 metal, crockery and glass, should be placed two feet 
 beneath the surface, while organic matter should be 
 kept near the surface where it is accessible to tillage. 
 In connection with Marchesi's observation that the 
 tetanus organism has not been found at a greater 
 depth than two metres, I would allude to a fact to 
 which I shall return later, that this approaches the 
 maximum depth to which the earthworm burrows. 
 It is obvious that if a spore were carried downwards 
 by a worm, it would there meet with anaerobic conditions 
 favourable for its preservation. A review of the main 
 facts connected with tetanus cannot but rouse in us 
 some surprise that in the face of the ubiquity of the 
 cause the disease in man should be so rare. This is 
 probably in part due to the fact that we wear boots. 
 
ANTHRAX 
 
 CHAPTEE II 
 
 A-NTRBAX 
 
 Anthrax is a disease which undoubtedly is connected 
 with the soil. The bacillus was discovered by PoUender 
 in 1849, a discovery which is just fifty years old and 
 which marks the dawn of pathological bacteriology. 
 The identification of the bacillus in the laboratory, and 
 the diagnosis of the disease in animals from quarter- 
 evil and septicaemia, is not without difficulty. These 
 difficulties are now understood, but they are sufficient 
 to throw a shade of doubt over some of the earlier 
 observations. It may be well in the first place to give 
 some of the facts collected by Pasteur without comment. 
 M. Chamberland, the able assistant of M. Pasteur, 
 in his work ^ gives a resume of what one may call the 
 modern history of charbon. In 1842 a Government 
 report showed that in France the disease raged among 
 the flocks of half-bred merino sheep belonging to 
 farmers in la Beauce. It especially attacked lambs, and 
 the losses in this district of la Beauce amounted to as 
 much as 20 per cent, (out of a total of some 1,300,000 
 sheep) " et souvent dans les localites dont le sol est 
 sec et calcaire la mortalite va jusqu'au quart, au tiers et 
 depasse parfois la moitie du troupeau." In the depart- 
 ment of Seine-et-Marne and in the districts of Provins, 
 1 Ijq Charbon, Paris, 1883. 
 
lo ANTHRAX 
 
 Fontainebleau, and Meaux are certain farms known as 
 fermes d charhon — " les meilleurs cultivateurs ne les 
 louent qu'en tremblant." Also in le Cantal charbon is 
 known as * mal de montargnes ' and certain hills are 
 known as 'montagnes maudites' because of their evil 
 reputation in relation to charbon. The animals stricken 
 with charbon show foi' a few days some excitability and 
 passing dyspnoea, and they become distended after 
 feeding. Next the urine becomes bloody, and it is a 
 sign of bad omen to see fleeces spotted with blood. The 
 dung also is noticed to be soft and slimy, of a whitish 
 colour stained with blood. They die at last somewhat 
 suddenly, and in doing so usually void some blood- 
 stained dung and urine, and expel bloody froth from the 
 nostrils. Post-mortem decomposition is rapid, and the 
 animal swells up and blood is expelled from the nostrils. 
 Haemorrhages are found in the skin and cellular tissue, 
 as also in the viscera, which are engorged with blood. 
 
 The discovery of Bacilli anthracis in the blood 
 clinches the diagnosis. It was in 1850 that Bayer and 
 Davaine described the bacilli, and in 1877 Pasteur com- 
 municated to the Academy of Sciences the important 
 fact of sporulation observed in these bacilli by Koch 
 and himself, and further pointed out that the Bacillus 
 anthracis was essentially aerobic and was quickly 
 destroyed in the blood of the dead animal after the 
 onset of putrefaction. It is important to take notice of 
 the extent to which the ground is soiled by the dung, 
 discharges, urine, and bloody wool of an animal ill with 
 anthrax. 
 
 In August 1878, M. Pasteur fed sheep on lucerne 
 previously watered with a pure cultivation of B^-cillus 
 anthracis. He says that " in spite of the immense 
 number of spores taken in with the food many of the 
 
PASTEURS EXPERIMENTS ii 
 
 sheep escaped death. . . . The communication of the 
 disease in this way is still more difficult in the case of 
 guinea-pigs." ** Nous n'en avons pas obtenu d'exemple 
 dans d'assez nombreuses experiences. Les spores, dans 
 ce cas, se retrouvent dans les excrements. On les 
 retrouve egalement intactes dans les excrements des 
 moutons." The mortality is much increased when the 
 infected food is mixed with prickly material such as 
 the leaves of thistles and the chopped beards or husks 
 of barley, and the post-mortem examination of sheep 
 rendered * charbonneux ' by fodder of this kind gave 
 reason to suspect that they were in fact really 
 * inoculated ' by definite injury by the prickly food to 
 the back of the throat. Of nineteen sheep fed on 
 lucerne polluted with spores, three died after four, 
 seven, and nine days ; of eleven sheep, fed on polluted 
 lucerne and thistles, three died after three, four, and 
 six days. 
 
 It is recognised by professional * knackers ' that they 
 run little risk of contracting * charbon ' by manipulating 
 dead animals far advanced in putrefaction, and both 
 Pasteur and Koch have shown that putrefaction soon 
 destroys the bacilli in the blood and tissues of an 
 animal, and that the Bacillus anthracis being aerobic, 
 sporulation does not take place inside the putrefying 
 body, but is very liable to occur in the blood which 
 escapes from it, whether the blood flow upon the earth 
 or upon a dung-heap. 
 
 In August 1878, Pasteur made a necropsy on the 
 body of a sheep, and then buried the carcass in 
 M. Maunoury's garden. Ten months afterwards Pasteur 
 found spores of anthrax in the earth of this animal's 
 grave, and established the fact by the inoculation of 
 guinea-pigs. The spores were found in the surface soil 
 
12 ANTHRAX 
 
 over the grave, although since the burial the ground 
 had not been moved. Similarly spores were found 
 in the soil over the grave of a cow buried two years 
 previously, and at a depth of two metres. These 
 spores were found over the graves of dead animals 
 after all the operations of cultivation and harvest. 
 Earth taken at a distance from these graves did not 
 give charbon. 
 
 In announcing these facts to the Academy of 
 Sciences in July 1880, Pasteur says : ** I shall not be 
 surprised if doubts arise in the minds of the Academy 
 as to the correctness of these facts. It will be asked, 
 * Does the earth, which is so potent as a filter, allow 
 these microscopic spores to rise to the surface ? ' 
 These doubts seem to be supported by facts already 
 published by M. Joubert and myself. We have an- 
 nounced that water from even superficial springs is 
 sterile. . . . These, in spite of conditions above which 
 make for pollution, keep perfectly pure, which shows 
 that a certain thickness of earth arrests all solid 
 particles." Pasteur attributes the uprising of spores to 
 the action of earthworms, and he claims to have actu- 
 ally recovered spores from the bodies of earthworms 
 living in soil polluted with anthrax. 
 
 *' May not * earthworms,' " asks Pasteur, '* bring 
 other noxious germs to the surface ? They are always 
 filled with a mixture, and the spores of charbon are in 
 them mingled with germs of putrefaction and septic- 
 aemia." Pasteur at this time regarded the earthworm 
 as the great cause of the dissemination of anthrax. 
 In a footnote Pasteur calls attention to the fact that 
 in le Cantal there are pastures which from time im- 
 memorial have escaped {sont epargnees)^ and others in 
 which from time to time the cattle were decimated and 
 
EXPERIMENTAL 13 
 
 which are known as 'montagnes dangereuses,' which 
 are abandoned without deriving the least profit from 
 them, " at least during several years," says M. Baillet.^ 
 *' This last circumstance deserves great attention. It 
 proves that the cause, whatever it may be, which pro- 
 duces charbon in a locality disappears with time." In la 
 Beauce, Pasteur saw certain fields in which the folding 
 of sheep had been interdicted for several years — 
 i.e., since the last death thereupon from charbon. 
 " Now we placed flocks of sheep on five of these fields, 
 and the mortality was nil except in one flock where it 
 amounted to 1 per cent." 
 
 M. Colin, of Alfort, a professor at the Veterinary 
 School, not being satisfied with some of Pasteur's ex- 
 periments, a further report was made on May 17, 1881, 
 by a commission composed of M. Bouley, M. Davaine, 
 M. Alphonse Guerin, and M. Villemin. Earth from a 
 twelve-year grave, a three-year grave, and from virgin 
 soil was kept at a temperature of 90° C. for fifteen 
 minutes, and the fine sediment was injected into guinea- 
 pigs. Of five guinea-pigs inoculated with twelve -year 
 earth on March 19, four died on March 21 and 22 from 
 septicaemia, and one died on March 23 from charbon. 
 Of five guinea-pigs inoculated with three-year earth on 
 March 19, four died from March 21 to 23 from septic- 
 aemia, and one died on March 23 from charbon. Of 
 five guinea-pigs inoculated with virgin soil on March 19 
 none died. One had a small abscess at the seat of 
 puncture. Of six guinea-pigs inoculated with twelve- 
 year and three-year earth on March 30, five died from 
 septicaemia on April 3, and one died from charbon 
 (twelve-year earth) on April 3. Of three guinea-pigs 
 inoculated with excreta taken from the bodies of living 
 
 ' Mimoires du MmisUre de V Agriculture, 1870. 
 
14 ANTHRAX 
 
 earthworms, two died from septicaemia and one from 
 charbon on March 30. Of the nineteen animals killed 
 by the above experiments, fifteen died from septicaemia 
 and four from charbon. 
 
 Since 1879 M. Pasteur had asserted that most soils 
 when inoculated were capable of causing death from 
 septicaemia quite apart from any contamination by the 
 death of anthrax animals. Of three guinea-pigs inocu- 
 lated on March 28 with worm castings taken from above 
 the graves of some of the victims of the Commune 
 situated on waste land, one died from septicaemia on 
 April 1, and two were unharmed. 
 
 Pasteur had clearly demonstrated that the anthrax 
 bacillus is essentially aerobic, that it is soon destroyed 
 by putrefaction, and that for sporulation free exposure 
 to air and a temperature above 15° C. and under 45° C. 
 are necessary. These facts seem out of harmony with 
 the view that earthworms bring spores from a deeply 
 buried carcass to the surface. 
 
 The following case is quoted by Pasteur.^ On 
 August 21, 1796, a mare fell dead from anthrax on a 
 causeway {digue) at Houe (Eure-et-Loire). The animal 
 was skinned, and the carcass was dragged by two horses 
 all along this causeway (along which farm animals 
 passed to and fro), with the result that the ground was 
 soiled by the blood and other debris of the dead animal. 
 A large number of the sheep and cows which used this 
 soiled path died. These animals were skinned and 
 buried, with the result that the foci of contamination 
 spread, and ultimately 500 or 600 sheep succumbed to 
 anthrax. The skinning and transportation of an animal 
 dead from anthrax must necessarily be a most danger- 
 ous process. 
 
 • Annules de V Agriculture, l^re S6rie, tome xxx. p. 332. 
 
ANTHRAX LOCALITIES iS 
 
 All are agreed that anthrax is a disease liable to 
 haunt localities. Thus, in the report of the Board of 
 Agriculture for 1895, I find the following : 
 
 An undoubted fact in connection with anthrax is its 
 tendency to recur on certain farms. An examination 
 of the agricultural returns received shows that during 
 1895 the disease reappeared on twenty-three farms or 
 other premises in England and six in Scotland where 
 it had been reported in the previous year. From this 
 cause farms come to be regarded as dangerous, and 
 their value is very greatly depreciated. In a report 
 issued by the German Government,* allusion is made to 
 the farm of Parkisch, where anthrax was rife. " Numer- 
 ous outbreaks of the disease were especially remarked 
 when certain portions of the farm were used as pasture, 
 and when fodder from these portions was used in the 
 stalls. The former tenant of the farm is said to have 
 buried on different parts of the farm carcasses of animals 
 which had died of anthrax, and also to have put the 
 carcasses into the dung-heap to use them as manure." 
 
 Again, '*Dlouie is a large estate in Kroloen, dis- 
 trict Posen, and is known as a hot-bed of anthrax. . . . 
 It is stated that carcasses of animals which have died 
 from anthrax have been buried with great carelessness 
 on different parts of the fields, especially behind the 
 sheep sheds and in a small wood situated some hundred 
 paces from the farm, which also serves for pasturage, 
 and even in the dung-heaps which together with the 
 straw from under the diseased animals were used for 
 manure." 
 
 It is alleged by Friedberger and Frohner that the 
 spores may vegetate in the soil and surface water quite 
 independently of the animal body. The disease is said 
 ^ Eepori ojtlfia British Board of Agriculture, 1894. 
 
l6 ANTHRAX 
 
 to occur among horses, cattle, and buffaloes in Eastern 
 Bengal, Manipur, and Burma without the agency of 
 infection and to be in that part of the world a so-called 
 * miasmatic ' disease. As spore formation requires some- 
 thing like a blood heat, it is only what might be expected 
 to find the disease becoming endemic among cattle and 
 horses in tropical countries. Where infected animals 
 drop dung and other discharges on the soil it becomes 
 impossible to say whether the infective spore originates 
 in the soil or in the animal. The distinction which 
 separates soil from dung is somewhat subtle. These 
 authors assert that '* there exists a well-marked connec- 
 tion between the disease and the amount of moisture in 
 the soil. It appears most frequently in lowlands and 
 plains exposed to inundations and great heat." Copeman 
 also asserts that the disease is prevalent on damp soils 
 containing much humus, as, for instance, upon peat bogs 
 and near the borders of lakes and rivers which have 
 overflowed. On the other hand, we have Pasteur speak- 
 ing of montagnes maudites in connection with anthrax 
 and asserting that the mortality is great in soils which 
 are sees et calcaires. 
 
 Many of the outbreaks of anthrax in this country 
 have been in the neighbourhood of Bradford and have 
 been traced to the use of infected wool-refuse as manure. 
 A map published by the Board of Agriculture shows 
 that the outbreaks of anthrax are most frequent in those 
 counties of Great Britain where dry foreign wools, hairs, 
 hides, and skins are manufactured into goods. In 1892 
 there were forty-two outbreaks of anthrax in the West 
 Biding of Yorkshire, as against two in the North Riding 
 and one in the East Riding. Wool when used as a 
 manure must take a long time in becommg disintegrated 
 and humified. In this respect it is very different from 
 
IVOOL SORTERS' DISEASE 17 
 
 dung, and if wool be infected with anthrax spores it must 
 be a very dangerous manure for a pasture. The chief 
 sources of danger are said by Dr. Bell, of Bradford, to be 
 the dry wools of goats, alpacas, and llamas which are im- 
 ported very dry from hot countries. It is the anthrax 
 spore which is the danger, and if, as is the case, a high 
 temperature and free admission of air be necessary for 
 sporulations an excess of water would be unfavourable 
 for that process. There seems a concurrence of opinion 
 that the Bacillus anthracis is killed by putrefaction and 
 soon disappears in the unopened and unskinned body. 
 Schmidt-Miihlheim inoculated guinea-pigs with anthrax 
 and as soon as they were dead he skinned them and 
 placed the limbs in an incubator at 39° C. The surface 
 of the flesh was soon covered with a whitish film which 
 was found to consist exclusively of anthrax bacilli, in many 
 of which commencing spore formation was apparent. 
 There can be little doubt that the soil becomes infected 
 by the discharges from the living animal and the skinning 
 and other manipulations of the dead one. The advice 
 which is usually given in this country to bury anthrax 
 carcasses deeply and unopened and unskinned is doubt- 
 less sound, although it is open to question if the depth 
 of the grave adds materially to the anaerobism of the 
 surroundings. It is very doubtful if in an unopened 
 body spore formation be possible after a short period 
 of burial. It is clear that the animal should be buried 
 at the spot where it dies and that the spot should be 
 enclosed and planted with a few saplings of some 
 indigenous tree. The value of ' quicklime ' is doubtful. 
 Whether it be advisable to delay burial until quicklime 
 can be obtained is still more doubtful. 
 
 All Pasteur's experiments in relation to graves 
 appear to me to be vitiated by the fact that they took 
 
i8 ANTHRAX 
 
 place in an anthrax district, and it is very difficult to 
 say whether the spores were derived from the buried 
 animal, or from the dung of infected ones which had 
 been used as manure, or from the blood-stained wool 
 which, we are told, is of * bad omen ' in a flock. It is a 
 noteworthy fact that of the nineteen guinea-pigs inocu- 
 lated by the Alfort Commission four only died from 
 anthrax and fifteen from septicaemia, and that the earth 
 from the three-year-old grave and from the twelve-year- 
 old grave conveyed anthrax in the same proportion — i.e. 
 one in four inoculations. There seems no doubt that 
 spores may be found in earthworms or their castings, 
 and there is equally no doubt that if the worms have 
 brought the spores from the depths of the earth such 
 spores must have originally been formed on the surface. 
 It is, of course, quite impossible to say whether a worm 
 swallowed the spore on the surface or below it. It is 
 certain that recently-dead bodies have no attractions 
 for worms. Such carrion usually forms the food of 
 maggots hatched from the eggs of diptera deposited 
 before burial, and of beetles which live in the earth, and 
 are soon attracted to it. 
 
 There are some discrepancies amongst observers as 
 to the infectivity of food grown on anthrax ground. On 
 the one hand, Pasteur was unable to do much harm to 
 sheep fed on lucerne sprinkled with spores, and on the 
 other hand, we have a story quoted by Pasteur of an 
 old woman whose goat and cow died from anthrax when 
 fed with clover stolen from over a grave two years after 
 the burial of an anthrax animal. It is, of course, im- 
 possible to get away from the 2?os^ lioc fallacy in these 
 cases, especially in a country where animal hygiene was 
 utterly neglected, and where anthrax was, or diseases 
 resembling it were, rife. In this country we have had 
 
SHEEP AND ANTHRAX 19 
 
 no outbreaks of anthrax at all comparable to those which 
 have proved such a scourge in France and other parts 
 of the Continent. The loss of sheep from anthrax in 
 England is very slight, and the explanation is probably 
 to be found in the relative vulnerability and immunity ^ 
 of the flocks. Sheep in England are rarely housed, but 
 are allowed to breathe at all times the freshest of fresh 
 air. Their pastures are changed before the ground gets 
 foul, and when food is short they are either killed at 
 once or fed upon imported food. Such a condition of 
 things would be likely to breed immunity to disease 
 of all kinds ; and it is noteworthy that tubercle is 
 much less common among sheep than amongst ani- 
 mals which are housed. When flocks are kept partly 
 for dairy purposes, and when sheep are housed and 
 breathe a foul air, and lie upon filth mixed with earth, 
 it is no wonder that disease, especially such a disease 
 as anthrax, is liable to be rife and to be difficult to 
 eradicate. 
 
 Anthrax in the human subject is a rare disease. 
 Man is never infected through the alimentary tract as 
 appears to be the rule among animals. Dr. Bell, of 
 Bradford, says that ** no such case has been recorded in 
 this country." Cutaneous anthrax (malignant pustule) 
 is caused by direct inoculation. It occurs (1) in those 
 who come into contact with infected animals alive or 
 dead ; (2) in those who handle offal, skins, hoofs, horns, 
 hairs, wools or other derivatives from such diseased 
 animals ; and (3) in countries where the disease is 
 
 ^ Algerian sheep are immune to anthrax. See Chauveau, * Nature 
 de rimmunite des Moutons Alg^riens centre le Sang de Kate. Est-ce 
 une aptitude de race ? ' (C. B. Acad. Sc. xcl. 1880) cited by A. Billet in 
 'Contribution a I'Etude de la Morphologic et du D6veloppement des 
 Bacteriac6es,' Paris, 1890 (with other references). 
 
 c 2 
 
20 ANTHRAX 
 
 common among animals, women and children who do 
 not come into direct connection with infective material 
 are not infrequently attacked with the disease through 
 the medium of persons, animals, or insects. 
 
 Pulmonary anthrax or wool-sorter's disease was first 
 noticed in the Bradford worsted district after the intro- 
 duction of alpaca and mohair as textile materials in 
 1837. " This form of anthrax may attack any person 
 exposed to the inhalation of anthrax spores in dust 
 arising from the products of diseased animals." The 
 fact appears to be undoubted that anthrax may be a 
 dust disease and that the spores when perfectly dry may 
 be inhaled into the lungs. And yet I have hitherto 
 found no records of pulmonary anthrax from the in- 
 halation of dust from highly manured ground which 
 must, one would suppose, especially in the West Eiding 
 of Yorkshire, often contain anthrax spores. The lungs 
 of the agricultural labourer and the market gardener 
 appear to be immune to the infectivity of anthrax spores. 
 It seems to be of very great importance to bear in mind : 
 (1) that anthrax spores persist even in the finely pul- 
 verised soil of worm castings, which must be very easily 
 dried and converted into dust ; (2) that anthrax may 
 undoubtedly infect man by the inhalation of dust ; and 
 (3) that pulmonary anthrax among agriculturists has 
 not been recorded. In India it is believed by some that 
 dust is a common cause of enteric fever among Euro- 
 peans, a statement which is insusceptible of proof or of 
 disproof. Does pulmonary anthrax occur among the 
 rural population of the tropical countries where the 
 disease is endemic amongst cattle ? In this connection 
 we must bear in mind that anthrax bacilli may change 
 their virulence without undergoing any morphological 
 changes, and in this form when inoculated may confer 
 
VIRULENCE 21 
 
 immunity on susceptible animals without apparently 
 producing other effects. The virulence is diminished 
 by cultivation at high (from 108° to 120° F.) or low 
 (from 66° to 75°) temperatures, by cultivation under 
 pressure of three or four atmospheres, by exposure to 
 sunlight, or by admixture with other bacteria. The 
 modified organisms thus produced are not pathogenetic 
 but confer immunity on susceptible animals for nine or 
 twelve months. Morphologically they are indistinguish- 
 able from the most active and virulent forms of the 
 organism, and they will generally regain their virulence 
 when favourable conditions are restored, although the 
 degree of virulence varies in different species of animals. 
 The persistence of the anthrax spore in the earth does 
 not admit of a doubt, but there is no evidence that man 
 is ever infected directly from the earth. How far 
 anthrax in animals is due to inoculation rather than 
 to feeding requires further and very careful investiga- 
 tion.^ 
 
 * Pictet and Yung by a special process have subjected bacteria to a 
 temperature as low as - 130° Centigrade, without killing some of them, 
 for instance anthrax spores. (G. von Bunge, Physiologie des Menschen, 
 vol. i. 1901, p. 283.) 
 
22 DIARRHCEA 
 
 CHAPTEK III 
 
 DIABEHCEA-DYSENTEBY—CHOLEBA 
 
 DiARBHOEA is a diseasG which in its epidemic form has 
 been supposed to be engendered in the earth. 
 
 The third quarter of the year 1898 ^ was character- 
 ised by a very large infantile mortality, mainly attri- 
 butable to diarrhoea. The rainfall for the quarter 
 was unprecedentedly small, the temperature was above 
 the average, and the harvest was one of the best on 
 record. 
 
 Of the 141,540 deaths registered, 52,837 were those 
 of infants under one year of age. The mortality of 
 infants, measured by the proportion of deaths under 
 one year of age to registered births, was 225 per 1,000, 
 which is the highest proportion in any quarter for which 
 the figures are available, and is 55 per 1,000 above the 
 average in the ten preceding third quarters. In the 
 thirty-three great towns as a whole, infant mortality 
 was equal to 275 per 1,000 births, being higher than 
 the proportion in England and Wales by 50 per 1,000. 
 
 Excluding the towns, infant mortality in the re- 
 mainder of England and Wales was in the proportion 
 of 184 to 1,000 births. Diarrhoea caused 22,524 deaths, 
 equal to an annual rate of 2*85 per 1,000, or 1*21 above 
 the average rate of mortality in the third quarters of 
 the previous ten years. 
 
 The death-rate from this disease ranged from 0*7 in 
 
 * Quarterly Eeturn of the Begistrar-General. 
 
DIARRHCEA 
 
 23 
 
 Kutlandshire, 0*58 in Hertfordshire, 0*66 in Shropshire, 
 and 0*68 in Dorsetshire, to 3*63 in Leicestershire, 3-70 
 in Staffordshire, 3*94 in Lancashire, 4*23 in the East 
 Riding of Yorkshire, and 4*40 in Warwickshire. Among 
 the thirty- three great towns the diarrhoea rate averaged 
 3*85 per 1,000, the highest rates being 5*85 in Hull, 
 5-94 in Sunderland, 6*30 in Sheffield, 6*38 in Wolver- 
 hampton, 6-41 in Preston, and 6*47 in Salford. In the 
 sixty-seven other large towns the rate averaged 3*27 
 per 1,000. In the rest of England and Wales the 
 diarrhoea death-rate was equal to 2*07 per 1,000. 
 
 It will be observed that the mortality from diarrhoea 
 was mainly urban. Among counties it is the rural 
 counties which have least and the industrial counties 
 which have most diarrhoea, and if we turn to the mor- 
 tality returns for those counties where diarrhoea was 
 especially rife, we shall find the mortality greatest in 
 the urban districts. It is a point not without interest 
 to note that the diarrhoea death-rate and the fever 
 death-rate in this quarter bore no relation to each 
 other, and that, while the diarrhoeal death-rate was 
 1-21 above, the fever death-rate was 0*03 below the 
 average for the corresponding quarter of the last 10 years. 
 In the following table some figures are collected which 
 show this very strikingly : 
 
 Table showing the Death-rates per 1,000 frorn Fever 
 and Diarrhoea during the Third Quarter of 1898. 
 
 - 
 
 Fever 
 
 Diarrhoea 
 
 England and Wales . 
 
 London 
 
 Wolverhampton 
 
 Leicester 
 
 Manchester .... 
 Preston 
 
 016 
 Oil 
 0-18 
 013 
 0-09 
 0-28 
 
 2-85 
 3-19 
 6-38 
 5-34 
 5-38 
 6-41 
 
24 DIARRHCEA 
 
 Diarrhoea is a disease of hot weather, when there 
 is special liability to sour milk, rancid butter, stinking 
 fish, high meat, and rotten fruit. Ballard thought that 
 when the four-foot temperature of the earth reached 
 56° F. diarrhoea became common. Tomkins, of Leicester 
 (Leicester is a * diarrhoea town '), showed that the 
 disease became common when the one-foot thermo- 
 meter stood at 60°. Snow, of Buffalo, U.S.A., showed 
 that in 1886-88 diarrhoea mortality was highest when 
 the minimum atmospheric temperature attained its 
 highest average range. The London statistics for 1887 
 and 1888 collected by Dawson Williams show a similar 
 relationship between diarrhoea and a high average 
 minimum range of temperature. Copeman considers 
 it highly probable that the disease is due to * microphytic 
 processes ' going on in the upper layers of the soil. 
 This would afford an explanation of the fact that summer 
 diarrhoea is especially a disease of cities having a polluted 
 soil. Ballard's conclusions (as given by Copeman) were : 
 " That the essential cause of diarrhoea resides ordinarily 
 in the superficial layers of the earth, where it is intimately 
 associated with the life processes of some micro-organism 
 not yet detected, captured, or isolated. That the vital 
 manifestations of such organism are dependent, among 
 other things, perhaps principally upon conditions of 
 season and on the presence of dead organic matter which 
 is its pabulum. That on occasion such micro-organism, 
 capable of getting abroad from its primary habitat, the 
 earth, and having become air-borne, obtains opportunity 
 for fastening on non-living organic material and of using 
 such organic material both as nidus and pabulum in 
 undergoing various phases of its life-history. That in 
 food, inside of as well as outside of the human body, 
 such micro-organism finds, especially at certain seasons, 
 
BACILLUS ENTERITIDIS SPOROGENES 25 
 
 nidus and pabulum convenient for its development, 
 multiplication, or evolution. That from food, as also 
 from the contained organic matter of particular soils, 
 such micro-organisms can manufacture by the chemical 
 changes wrought therein through certain of their life- 
 processes a substance which is a virulent chemical 
 poison (probably ptomaine). That this chemical sub- 
 stance is in the human body the material cause of 
 epidemic diarrhoea." 
 
 It is most important to remember that these specula- 
 tive notions of Ballard's are not facts. 
 
 The Bacillus enteritidis sporogenes is believed by 
 Klein to be the cause of infantile diarrhoea.^ It is an 
 anaerobic bacillus which forms spores, and may be 
 easily cultivated in milk. It is fatal to rodents when 
 injected hypodermically, and produces a foul-smelling 
 bloody oedema of the cellular tissue and adjacent muscle 
 tissue. The spores were found in four out of ten cases 
 of infantile diarrhoea examined, and in six out of eight 
 cases of cholera nostras. It was found in eight out of 
 ten samples of milk purchased in London milkshops 
 between April and the end of June (when diarrhoea was 
 not epidemic?) including samples of so-called *pure 
 sterilised milk.' It has been found in large quantities 
 in sewage and in sewage effluents. It is found in horse- 
 dung, and in all matters polluted with it. It has not 
 been found in pig-dung or cow-dung, or in the dung of a 
 healthy human being. 
 
 In face of the wide distribution of the microbe, it is 
 evident that the vulnerability of the individual must be 
 an important factor in determining an attack of diarrhoea. 
 If we are to consider diarrhoea as a soil disease it is 
 evident that it exists only in the upper layers. It is 
 
 • Twenty-seventh Local Government Eeport, 1897-98. 
 
26 DYSENTERY 
 
 more common among city streets than in agricultural 
 districts. According to Klein, the probable cause is 
 largely to be found in horse-dung which is pulverised 
 and blown about generally. Temperature, as we all 
 know, is most potent as a cause of infantile diarrhoea in 
 cities. That it is a * soil ' disease in any true sense is 
 certainly not proven. 
 
 Dysentery 
 
 Andrew Davidson ^ says : — "In keeping with the 
 predilection of endemic dysentery for marshy localities, 
 accounts of its endemo-epidemic extensions in temperate 
 climates generally point to the temporary establishment 
 of paludal conditions." Thus in 1873 an outbreak arose 
 from the cleaning out of the lateral canal of the Loire 
 and the desiccation of the mud. A similar result 
 followed at Leymen (Haut-Rhin) from the clearing out 
 in August, 1850, of a vast slimy reservoir situated in 
 the middle of the village. In tropical countries dysentery 
 appears to be more independent of soil than in temperate 
 climates, but an imperfectly- drained or marshy soil is 
 everywhere favourable to its prevalence. The geological 
 nature and the mineralogical constituents of the soil are 
 secondary in importance to its physical conditions — its 
 dryness, humidity, and aeration. These again are of 
 less moment than its state of organic purity. That a 
 soil charged with dysenteric or perhaps even with faecal 
 (simple faecal) evacuations is capable of giving rise to 
 the disease is amply proved. The epidemics which 
 occurred in the Cumberland and Westmorland Asylum 
 in 1864-65 and in 1868 were shown by Dr. Clouston 
 to be in part due to the effluvia from a stiff clay field over 
 which the sewage of the asylum was allowed to flow. 
 
 • AlXbutV^ System of Medicinet vol. ii. p. 408. 
 
ASYLUMS, WAR AND FAMINE 27 
 
 The soil was quite unfit for irrigation purposes. Dysen- 
 tery is very common in asylums, a fact which is probably 
 due to the infectivity of the excreta and the dirty habits 
 of lunatics. Among the causes of the frightful dysentery 
 mortality which made Secunderabad a byword, none was 
 more effective than the saturation of the soil of the site 
 itself with organic impurities, the extreme pollution of the 
 vicinity with faecal matters, and the bad privy accommoda- 
 tion. The dysentery of war and famine shows little respect 
 for climate or season ; under the given conditions it appears 
 in countries most free from the endemic disease, and at 
 all seasons of the year. The dysentery of war and 
 famine is extremely fatal, and it has a greater tendency 
 than any other to become complicated with typhus, 
 typhoid, and malarious fevers. In the Irish workhouses 
 during the ten years ending June, 1851, no fewer than 
 50,019 persons perished from dysentery, and 20,507 from 
 diarrhoea. The dysentery of war and famine frequently 
 assumes a contagious character. The bacteriology is 
 rather uncertain owing to the numbers and variety of 
 the micro-organisms which are found. 
 
 Davidson concludes : (1) The healthy intestine is 
 capable of much resistance to the infective agents of 
 dysentery. (2) The healthy human being carries with 
 him organisms capable under certain conditions of 
 giving rise to inflammation of the intestinal tract, and 
 besides organisms of suppuration, putrefaction, and 
 sepsis are everywhere present which have the power of 
 determining dysenteric inflammation of the bowels when 
 their nutrition is impaired. (3) A simple catarrhal con- 
 dition of the bowel is sufficient in itself to produce true 
 dysentery. (4) When we observe a body of men seized 
 with an infectious form of dysentery immediately after 
 being subjected to hardship and depressing meteoro- 
 
28 CHOLERA 
 
 logical influences, while another body in the vicinity 
 having the same food- and water-supply but not sub- 
 jected to the like fatigue and hardships escape, we are 
 led to infer that the common exciters of inflammation 
 rather than any specific agent must have given rise to 
 the disease. 
 
 Cholera 
 
 Ernest Hart says : * Within certain areas in India 
 cholera is endemic, especially in the country of the 
 lower Ganges. There the air, the water, and the soil 
 are never cold, the ground is often damp, and when it 
 is dry the tanks are foul, so that there is always a fit 
 breeding-place for the contagion, &c.' Koch's vibrio 
 (Kanthack) grows in dilute peptone at from 30° to 
 35° C. It is commonly said to be destroyed by drying. 
 It is a facultative anaerobe and highly saprophytic. 
 Cultures retain their vitality on silk threads for eighty- 
 six days and dried on glass for 120 days. *' From flies 
 fed on choleraic material the vibrios could be separated 
 after fourteen days." The inoculation test practised on 
 the lower animals is inconclusive. According to Petten- 
 kofer (quoted by Copeman) cholera occurs when the 
 ground-water after having attained a higher level than 
 usual commences again to fall. 
 
MALTA FEVER 29 
 
 CHAPTER IV 
 
 MALTA FEVEB-PLAGUE-^DIPHTHEBIA 
 
 Malta fever ^ is caused by the Micrococcus melitensis 
 discovered by Bruce in 1887. It is common to the 
 shores of the Mediterranean and Red Seas. " It was 
 early apparent that its presence in Malta and Gibraltar 
 was connected with faecal and organic matter from 
 human sources. Sewers and sewage works where these 
 have been undertaken, as in Valetta and Naples, appear 
 to have little influence in diminishing the attacks. 
 Indeed, the channels are so frequently pervious and 
 allow the faecal matter to soak into the pores of the soil 
 that they virtually become elongated cesspools and 
 increase rather than diminish the dissemination of the 
 poison. Tomaselli notices the same fact in relation to 
 the prevalence of the fever and the introduction of 
 sewers into Catania. In his opinion the immense 
 quantity of sewage and sewer air which is developed 
 in these sewers and finds its way out of them is to be 
 placed in the first rank of its causation and is an argu- 
 ment in favour of the aerial dissemination of the 
 morbific agent. The micro-organism grows best in 
 nutrient material the alkalinity of which is slightly 
 less than human blood and at a temperature of from 
 37° C. to 39° C. It fulfils Koch's postulates at all 
 points. It lives for a long time in the dry state." 
 
 ' AllhutVs System of Medichie, vol. ii. p. 463, by Lane Notter. 
 
30 PLAGUE 
 
 Plague 
 
 Plague has been regarded as a soil disease, but recent 
 evidence must materially modify this opinion. 
 
 The alleged facts which support this view are, 
 according to J. F. Payne in his article on Plague in 
 * AUbutt's System of Medicine ' : (1) its limited geographi- 
 cal distribution ; (2) because ground animals such as 
 rats perish in large numbers — " they have buboes and 
 their organs contain immense numbers of the plague 
 bacilli ; it cannot therefore be doubted that the virus 
 exists underground before it affects human beings"; 
 (3) its recurrence at the same spot while places near 
 and in direct communication escape ; (4) the escape of 
 water populations such as in Canton and in London in 
 1665 ; (5) the fact that the ground floor is affected 
 more than the first floor — *' Plague does not go up- 
 stairs " (?) ; and (6) " the beneficial effect of local sani- 
 tary measures." 
 
 It would appear from the above reasons that the 
 endemic prevalence of plague is comparable to that of 
 cholera or typhoid fever and is governed by somewhat 
 similar laws, though in other respects it differs very 
 much from those diseases. In the double infection of 
 the soil and the organism it resembles anthrax. Along 
 with the infection of the soil there appears to be a 
 passage of the virus in some form into the air, so that 
 it has always been believed that the disease may be 
 acquired by inhalation like typhus fever. Scientific 
 explanation of this method of receivmg the virus is 
 still wanting. Epidemics have often been preceded by 
 drought ; epizootics, famine, and abundance of flies 
 have been noticed. Epidemics are usually checked by 
 cold and heat. It is pre-eminently a filth disease, 
 
VIENNA CASES 31 
 
 invading by preference the crowded, ill-ventilated 
 hovels of the miserable. " A soil contaminated with 
 faecal discharges and decaying animal matter of all 
 kinds appears to be an essential condition for the 
 vitality of the virus." Widely different opinions have 
 been held as to its * contagiousness.' " The infection is 
 doubtless generally conveyed by persons either infected 
 with the disease or in the state of incubation. Such 
 persons convert the house they occupy into a focus of 
 infection till possibly the virus passes into the soil and 
 a severe epidemic may result." The rate of extension 
 is variable but generally slow ; plague has taken weeks 
 or months to pass from one side of a city to another ; 
 it creeps along from point to point so as to be com- 
 pared by some to a drop of oil on paper. Such gradual 
 extension suggests the slow progress of a virus in the 
 soil itself, and probably that is in some places the 
 explanation, but obviously only transmission through 
 short distances can be thus accounted for. 
 
 It is encouraging to observe how the habit of calmly 
 observing and recording the phenomena of different 
 epidemics together with carefully devised experiment 
 has thrown light upon many of the obscure points 
 connected with plague. We now know that plague is 
 protean in its forms and that all forms are not conveyed 
 from individual to individual with equal readiness. The 
 unfortunate accident which occurred in 1898 in Vienna 
 ought to have, and doubtless has had, the effect of 
 dispelling many of the superstitions in regard to plague. 
 It has clearly demonstrated to the people at large 
 (1) that the poison is something tangible which may 
 be conveyed from one part of the world to another in 
 a test-tube ; (2) that the poison may infect the lower 
 animals ; (3) that the lower animals may infect man ; 
 
32 PLAGUE 
 
 (4) that the pulmonary form of the disease is terribly 
 infectious and communicable through the air ; and 
 
 (5) that measures of disinfection and isolation are 
 capable of cutting short an epidemic. Experiments 
 carried out in districts where a disease is epidemic or 
 endemic necessarily acquire a measure of uncertainty 
 from that fact alone. The occurrence at Vienna, much 
 as one may deplore it, was an object-lesson of the 
 greatest value and converted what many regarded as 
 mere theories into facts which all can read and under- 
 stand. In the recent epidemics in the East the theory 
 that plague grows * in the soil ' has received no support 
 whatever, and that it spreads in the soil like a drop of 
 oil permeating paper appears to be unlikely. In India 
 two facts have come to the front — viz. the danger in rela- 
 tion to plague of (a) rats and (b) abrasions on the skin. 
 The rat lives in burrows in the soil and swarms in our 
 sewers. He feeds largely at night and comes out of his 
 hole in search of food and prey. It has long been 
 recognised that the rat is susceptible of plague. In 
 Bombay, according to Simpson, as many as 100 affected 
 rats were counted in one small grain depot in one day. 
 Hindoo writings 800 years old warn the inhabitants to 
 leave a district when they observe a mortality among 
 rats. The infection of rats usually follows infection 
 of a distant locality by men. Nowhere has this been 
 more decidedly proved than during the epidemic in 
 India, where the infection of the rats has unfortunately 
 followed the introduction of the virus by man, from a 
 primary seat of infection situated at considerable dis- 
 tances from the secondary area of infection. Eats may 
 convey infection from infected burrows on their feet or 
 fur ; they also become infected by eating each other. 
 When dying they usually leave their holes and run 
 
RATS 33 
 
 about the rooms of a house and then die. Carelessness 
 in dealing with or handling them, especially in the 
 filthy surroundings and associated with the dirty habits 
 of the inhabitants of these houses, along with the pos- 
 sible convection by vermin, must all necessarily be in 
 favour of the infection being carried to man. The 
 amount of such infection spread by rats cannot be 
 gauged. The infection of the rat is no proof whatever 
 of infection of the soil except by filth deposited on the 
 surface. Lowson in his report to the Bombay Govern- 
 ment in 1897 says : " That the disease is primarily a 
 soil disease is certainly borne out neither by observa- 
 tion nor experiment. Takaki and I carried out bacterio- 
 logical experiments in Hong-Kong by which we were 
 able to prove that even in houses in which the earthen 
 floors had been severely infected no cases of plague 
 infection could be obtained, and later experiments on 
 the artificial infection of earth with a culture of the 
 plague bacillus have shown that the mixture of earth 
 and bacilli loses its infecting power, sometimes in a 
 couple of days." Indeed, there has been no proof forth- 
 coming so far that the plague bacillus has ever been 
 found below the surface of the earth. 
 
 In Hong-Kong the soldiers who were attacked by 
 plague were in the cleansing squads, and were well 
 booted, but worked with trousers open at the bottom. 
 In India the military parties who assisted in this work 
 were ordered to wear putties to prevent plague-infected 
 dust and animals from coming in contact with their 
 legs, with the result that none of those engaged in this 
 work became infected, and that, too, amongst probably 
 eight or ten times more soldiers than were doing the 
 work in Hong-Kong. To sum up, it may be said that 
 the following are the most important items in the spread 
 
 D 
 
34 DIPHTHERIA 
 
 of plague : (1) filthy habits of the people, such as spitting 
 over the floor and others mentioned above ; (2) filthy 
 houses ; (3) overcrowding and consequent rapid increase 
 of contagious disease when once imported ; (4) presence 
 of rats, insects, and other vermin ; (5) the naked con- 
 dition of the people going about, such people presenting 
 almost unlimited opportunities for the entrance into 
 their tissues of plague poison by inoculation and through 
 abrasions ; (6) pollution of soil and houses with the 
 excretions of man and animals ; and (7) filthy clothing 
 and absence of bodily hygiene. 
 
 Diphtheria 
 
 With regard to diphtheria, Arthur Newsholme in his 
 work on * Epidemic Diphtheria ' (1898), while admitting 
 that personal infection is the chief means by which 
 diphtheria is spread, contends that : The specific micro- 
 organism of this disease has a double cycle of existence, 
 as have the specific micro-organisms of enteric fever, 
 erysipelas, scarlet fever, rheumatic fever, &c. One 
 phase is passed in the soil, another in the human 
 organism. One is saprophytic, the other parasitic.^ It 
 is not strange, therefore, that the epidemic prevalence 
 of all the above diseases is favoured by deficient rainfall 
 if this is sufficiently long continued. This deficient 
 rainfall implies a low subsoil water and a subsoil above 
 the level of this water which is relatively dry and warm, 
 probably the optimum conditions of the saprophytic life 
 of the above pathogenic micro-organisms. The causes 
 of the transition of the diphtheria bacillus from the 
 saprophytic to the parasitic phase of life may be sur- 
 
 ' It is not contended that there is a regular alternation of sapro- 
 phytic and parasitic generations ; but that such alternations do occur. 
 
SEASON 35 
 
 mised both as regards {a) season and (6) years of 
 special epidemic prevalence. Diphtheria is most pre- 
 valent in the autumn and early winter months, when 
 the optimum temperature and the optimum degree of 
 humidity of the soil are rapidly disappearing or have 
 departed. It is also most prevalent after the wet 
 weather, occurring in, or immediately following, excep- 
 tionally dry years. Both these conditions tend to raise 
 the ground water and to drive out any pathogenic micro- 
 organisms from the soil. 
 
 Newsholme is of opinion that in order to account for 
 the epidemic and even pandemic waves of diphtheria, 
 the diphtheria bacillus under certain conditions becomes 
 more actively virulent and infective — more remote from 
 its saprophytic phase of life, and that thus persons who 
 can resist the ingress of the feebler fall victims to the 
 more powerful micro-organism. The latter is probably 
 the correct hypothesis, and the evidence already given 
 clearly points to the conclusion that of the external 
 cultural conditions leading to increased virulence of 
 the diphtheria bacillus and greater readiness for assum- 
 ing a parasitic life, exceptional deficiency of rainfall 
 and consequent exceptional deficiency of moisture in 
 and exceptional warmth of the subsoil form an essential 
 part. 
 
 The above is a very ingenious hypothesis, but it is 
 essential to point out that the diphtheria bacillus has 
 not been recovered from the soil and that the bacilli 
 of rheumatic fever and scarlet fever have not yet 
 been identified.^ Before Newsholme's hypothesis can be 
 accepted a great deal more evidence will be necessary. 
 
 ' Poynton and Paine have isolated a diplococcus in rheumatic fever, 
 which may turn out to be the specific micro-organism. {Path. Tra/ns. 
 vol. lii. 1901, p. 10, and other p^^pers.) 
 
 D 2 
 
36 DIPHTHERIA 
 
 Newsholme's figures and tables show clearly that the 
 amount of diphtheria is very great in the American 
 cities. He records death-rates (per 100,000) for diph- 
 theria of 109 in New York (average of 28 years, 1868- 
 95), 77 in Chicago (36 years, 1859-94), 100 in Boston 
 (35 years, 1861-95), 114 in Brooklyn (1875-95), and 
 129 in Pittsburg (1877-94.) The highest death-rate 
 from diphtheria ever recorded in London was 76 (per 
 100,000) in 1893. The average death-rate per 100,000 
 was in Salford 32 (1860-95), Manchester 18 (1871-96), 
 Liverpool 14 (1860-95), and Sheffield 15 (1859-96). 
 The figures were still lower in others of our great 
 industrial towns. In Holland we find death-rates per 
 100,000 from diphtheria alone of 7 in Eotterdam, 12 in 
 The Hague, and 31 in Amsterdam (all three for 1879- 
 95). Berlin gives 101 (1869-96), St. Petersburg 65 
 (1879-95), and Moscow 64 (1878-96). The death-rate 
 in Japan appears to be low. 
 
 Newsholme's figures generally seem to show that 
 diphtheria is now a disease more of the towns than of 
 the rural districts. It is not very easy to understand 
 how in a city where pavements and other impermeable 
 coverings to the soil are general, the bacillus is driven 
 by the rising subsoil water into the air. Of course, it 
 may be driven out of the sewers and sewer ventilators, 
 in which case it becomes a sewer disease rather than a 
 soil disease. Why is it not an air disease? Nobody 
 who has ever smelt the air of Bond Street in a hot July, 
 or who has watched the impurities descending from the 
 upper air when they are driven downwards by the first 
 showers after a drought, would refuse to allow to the air 
 of a city any amount of potential infectivity. Most of 
 the facts collected by Newsholme are explained as readily, 
 if not more readily, on the theory that diphtheria is an 
 
SOIL 37 
 
 air disease as upon the theory that it is a soil disease. 
 If we remember that a theory is not a fact these specu- 
 lations will do no harm. Unfortunately this is not 
 always remembered. Diphtheria (Copeman) has been 
 supposed to show a preference for houses on damp clayey 
 soils (Greenhow, Airy) and dampness of habitation 
 (Thursfield). *' Although," says Copeman, ** dampness of 
 site is undoubtedly a factor in the production of out- 
 breaks of diphtheria, particularly if such dampness be 
 due to persistent leakage from imperfect sewers or cess- 
 pools," it does not appear to bear any relation to the rise 
 and fall of the subsoil water. 
 
 That diphtheria is a soil disease is certainly not 
 proven. 
 
38 MALARIA 
 
 CHAPTER V 
 
 MALARIA— BLACKWATEB FEVER— TSETSE- LOUPING 
 ILL— TEXAS FEVER— HORSE SICKNESS 
 
 A FEW years ago I should have spoken of * malaria ' as 
 undoubtedly caused by something in the soil itself, and 
 I should have indulged in the stock phrases about 
 miasmata, mephitic vapours, and the like. The dis- 
 covery of hsematozoa in the blood of sufferers from 
 malaria has altered our point of view. The most widely 
 spread poison in the world has become something which 
 is visible and tangible and inoculable. No discovery 
 which has ever been made in the domain of medicine is 
 likely to have such far-reaching effects. Further, it 
 seems certain that the infection of human beings may 
 take place via the mosquito, and we are now concerned 
 to find out whether this is or is not the only medium 
 through which the blood of man receives the parasite. 
 Some who are well qualified to speak would answer in 
 one way and some in another. This is not the place for 
 weighing arguments pro and con, nor can I claim any 
 special knowledge which qualifies me to sit in judgment. 
 Let us assume that it may possibly be shown hereafter 
 that what we have hitherto regarded as ' malaria ' is a 
 parasitic disease wholly and solely inoculated in us by 
 insects of the mosquito class. While on the one hand 
 we may be able to show Europeans the importance of 
 
MALARIA AND CULTIVATION 39 
 
 protecting themselves against the attacks of insects, 
 we must still continue to make use of our accumulated 
 knowledge as to the conditions of soil which indirectly 
 cause remittent fevers to be endemic, and which favour 
 the increase or decrease of mosquitoes by facilitating 
 or otherwise the formation of breeding pools. Old and 
 well-established facts will now be re-examined by intel- 
 lects strengthened and widened by the discoveries of 
 Laveran and Boss, and our knowledge is sure to be 
 extended and increased. 
 
 Although the conditions of soil which give rise to 
 malaria are too well known to need any lengthy dis- 
 cussion here, it may be well to give some of the latest 
 utterances on the subject. 
 
 Sir Joseph Fayrer, writing on the * Climate and 
 Some of the Fevers in India,' in * Allbutt's System of 
 Medicine,' * says of malaria : " It often appears with 
 great virulence after excavation or turning up of soil, 
 and in land-that has recently been denuded of jungle." 
 ..." On the other hand, draining and cropping seem 
 after a time to diminish or destroy the poison. Maclean 
 calls attention to the fact that when excavations were 
 made in the island of Hong-Kong, which consists 
 entirely of weathered and decaying granite, and is 
 liable to be permeated with a peculiar fungus, violent 
 and fatal remittent fever appeared." 
 
 Osier says: '*An interesting feature in connection 
 with the disease is the gradual disappearance from 
 certain regions under the influence of drainage and 
 cultivation. In England, even in the fen country, it is 
 now almost unknown. In New England, too, it has 
 gradually disappeared. In parts of Canada bordering 
 Lake Ontario which were formerly hotbeds of the 
 
 > Vol. ii. p. 311. 
 
40 BLACKWATER FEVER 
 
 disease cases only exceptionally occur." It is well 
 called a soil disease. " Excavations of all sorts, 
 extensive cuttings for railways, and the breaking up 
 on a large scale of virgin soil have in many instances 
 been followed by outbreaks of malaria." ^ The greater 
 prevalence of fever in the Koyal Engineers in com- 
 parison with other troops is probably to be accounted 
 for by their more frequent employment in the excava- 
 tion of the soil. Manson,^ speaking of Eoss's work in 
 connection with the mosquito, says that although he 
 believes that malaria may be acquired by the bite of 
 the mosquito, he does not believe that this is the only 
 way. Eees,^ of the Seamen's Hospital, gives details 
 of an outbreak of intermittent fever (confirmed by 
 examination of the blood by himself and Manson) 
 which affected twenty-two of the crew of a ship nine 
 days out from Colombo and fourteen from Calcutta on 
 her homeward voyage. Air-borne infection or water- 
 borne infection cannot be lightly dismissed. 
 
 As to blackwater fever, Crosse, writing on the 
 subject,^ says : ** Some will ask, Why has blackwater 
 fever become so common recently ? The first case on 
 record in the Niger Territory was, so far as I know, 
 my own, ten years ago. The first case on the Niger 
 Delta is said by some old coasters to have occurred in 
 1882. It seems to me that since we have begun to 
 turn up virgin soil for coffee and other plantations the 
 disease has become common. ... It is significant that 
 our first three gardeners died of blackwater fever, and 
 
 * I recently discussed this subject with two gentlemen who were 
 intimately connected with Indian railways, and who professed ignorance 
 of any danger arising from recent cuttings. 
 
 2 Brit. Med. Jour. Sept. 24, 1898. 
 
 « Ibid. Sept. 24, 1898. * Ibid. Oct. 8, 1898. 
 
SOIL AND MOSQUITOES 41 
 
 that for some considerable time cases only occurred 
 near the plantations, and as plantations became common 
 so the disease spread to the other stations in the 
 territories. Castellote notes a case in which a white 
 man personally superintended the digging of a grave 
 and stood about in the sun for two or three hours ; 
 next day he had severe fever which developed into 
 blackwater fever." According to Batter sby, " many 
 virulent attacks after the turning up of virgin soil 
 have been recorded." Almost equally remarkable, 
 according to this observer, is the diminution of the 
 disease which has been brought about in certain 
 localities by drainage and cultivation of the soil. 
 
 It is generally conceded that the turning up of 
 virgin soil is one of the most fruitful causes of malig- 
 nant malarial fevers, and numberless examples of this 
 are given in text-books on the subject. Surgeon 
 Bowden, E.N., D.S.O., informs me that the turning up 
 of fresh soil is often followed by an influx of mosquitoes. 
 On the other hand, the cultivation of the soil seems 
 ultimately to lead to the decrease and disappearance of 
 malaria. The broad facts of Nature must convince us 
 that this must be so, for if man in his attempts to 
 grow food merely increased the deadliness of his 
 surroundings, the human race would soon become 
 extinct. 
 
 There is a group of diseases which (like malaria) 
 seem to be dependent upon the bites or stings of insects, 
 and which, although they affect animals rather than 
 man, throw much light upon the pathology of infection, 
 and teach us that so-called ' climatic diseases ' may 
 be due to something very gross and palpable. 
 
42 TRYPANOSOMA 
 
 Tsetse Fly Disease 
 
 Kanthack, Durham, and Blandford ^ have shown 
 that Ngana or tsetse fly disease is due to a hasmatozoon 
 (trypanosoma) in the blood inoculated by a fly. Cats, 
 dogs, mice, rabbits, rats, hedgehogs, donkeys, horses, 
 and their hybrids seem susceptible. The disease appears 
 to be communicable only by some form of inoculation 
 and is not probably conveyed by feeding on infective 
 material in the absence of superficial lesions. Material 
 taken from the dead body twenty-four hours after 
 death is not infective. The nearest lymphatic glands 
 to the inoculated spot are the first to suffer. The 
 haematozoon gets through the lymphatics to the blood. 
 In the late stages of the disease the animals (especially 
 dogs) may become infected by pyococci, i.e, a spon- 
 taneous infection to which the animal is rendered prone 
 by its marasmus. The blood may contain 3,000,000 
 haematozoa per millimetre, or may prove infective 
 though none be visible. The trypanosoma sanguinis 
 which is found in a certain proportion of rats has no 
 apparent relation to tsetse fly disease. A similar 
 parasite is said to cause * surra ' in India and an allied 
 disease among horses in Algeria. Surra is probably 
 conveyed by flies. Lingard thinks the fodder soiled 
 with rat-dung may give the disease, but that is doubtful. 
 The tsetse fly is a dipterous insect somewhat resembling 
 the common house fly. It has a long thin proboscis, 
 chestnut thorax marked longitudinally by four black 
 lines, and a yellowish-white abdomen of five rings. It 
 inhabits principally the low-lying and swampy valleys 
 of the Zambesi and Chobe. 
 
 ' Proceedings of the Royal Society, vol. Ixiv. p. 100. 
 
TICKS 43 
 
 LoupiNG III 
 
 * Louping ill,' which is common in the North of 
 England and Scotland, and which has been noticed as 
 fatal to sheep frequenting certain pastures, has now 
 been shown by Williams, Meek, and Greig Smith ^ 
 to be caused presumably by a special kind of sheep 
 ' tick ' found on these pastures, which tick is supposed 
 to be hatched in the upper layer of the soil, and to 
 inoculate the sheep with micro-organisms which cause 
 the disease — a disease which is characterised by 
 staggering and lameness, due to congestion of the brain 
 and spinal cord, which have been found post mortem. 
 
 Texas Fever 
 
 Texas fever of cattle appears to be caused by a 
 hsematozoon with which the animal is inoculated by a 
 tick (Ixodes or boophilus bovis) which is parasitic. The 
 Australian tick fever and the ixodic anaemia of Jamaica 
 appear also to be produced by allied if not identical 
 parasitic animals. Principal Williams, F.K.C.V.S., of 
 the New Veterinary College, Edinburgh, in writing on 
 ixodic anaemia or Texas fever ^ (which he studied in 
 Jamaica), which is due to the infection of cattle with a 
 blood parasite by the agency of a tick (ixodes bovis), 
 insists that every attempt should be made to get rid of 
 the ticks, which breed especially in the vegetable rubbish 
 left upon the pastures. ** Every effort should be made," 
 he says, "to conserve and increase tick destroyers 
 such as the black tick birds. ... I have had much 
 amusement in watching these birds, as there seems to be 
 
 ^ YeUrinarian, 1896-97. 
 
 2 'Pryyici'piQs and Practice of Veterinary Medicine^ p. 416 et seq. 
 
44 AFRICAN HORSE DISEASE 
 
 an understanding between them and the cattle whereby 
 they are assisted and encouraged to destroy the ticks. 
 Domestic fowls should be encouraged, and starlings and 
 song- thrushes might be imported. To a stranger visit- 
 ing the island (Jamaica) the scarcity of birds is a 
 striking feature. I have been told that it is due to 
 the mongoose, which has not only diminished the 
 number of wild birds and domestic fowls, but other 
 tick-destroying creatures such as the ground lizard. 
 Now this destruction of the natural tick destroyers 
 should, as far as possible, be prevented, firstly by legal 
 protection, secondly by encouraging the slaughter of 
 the mongoose." (For further remarks see Veterinary 
 Journal, 1896.) 
 
 African Horse Disease 
 
 South African horse disease has no apparent con- 
 nection with insects or surface wounds, but appears to 
 depend, not upon conditions of the surface soil, but on 
 temporary conditions of the vegetation which forms the 
 pastures. 
 
 South African horse disease (oedema mycosis) is 
 described by Captain Hayes, F.E.C.V.S., in his trans- 
 lation of Friedberger and Frohner's * Veterinary Patho- 
 logy,' and is supposed by Edington to be caused by a 
 mould (penicillium) which grows in the vessels, caus- 
 ing thrombosis and exudation of serum, with fatal results. 
 It appears to occur chiefly among animals which are 
 allowed to graze while the dew is on the grass, and the 
 growth of the microbe is supposed to be connected with 
 the dampness of the grass. The disease, once contracted, 
 is almost always fatal, but the prophylactic appears to 
 be dry fodder and the folding of horses until the sun 
 has dissipated the moisture of the dews. 
 
TRAMPS AND SMALL-POX 45 
 
 The history of those diseases which appear to depend 
 on inoculations points with no uncertainty to the 
 advisability of keeping a whole skin. The * verminous 
 person ' has assumed an importance in relation to the 
 public health which the Legislature has already recog- 
 nised, while the ' tramp,' with his special liability to 
 small-pox, is one to whom the anti-vaccinationist is 
 likely to discover a * conscientious objection.' The 
 special liability of the * tramp ' to suffer from small- 
 pox—if such is really the case — seems to offer a field 
 of investigation well worthy of being methodically 
 explored. 
 
 There are other diseases more or less suspected of 
 being soil diseases, but the facts are at present too few 
 to make any discussion profitable. These are yellow 
 fever, beri-beri, swine fever (undoubtedly propagated 
 by fouling of the surface soil), cancer (?), threadworms, 
 hydatids, and ankylostomum duodenale. Malignant 
 oedema is an infective disease of wounds undoubtedly 
 caused by a ubiquitous anaerobic saprophyte, which 
 occasionally manages to grow in the cellular tissue and 
 to generate gas (COg, H, HgS, CH^) therein. 
 
46 ENTERIC FEVER 
 
 CHAPTEE VI 
 
 ENTERIC FEVER 
 
 Enteric fever has of late years much occupied the 
 attention of epidemiologists and bacteriologists, and 
 our knowledge of its definite relationship to filth, 
 milk, and water has undergone considerable increase. 
 The laboratory experiments connected with enteric 
 fever are of great interest and value, but it would be, 
 to say the least, hazardous to build upon them any 
 measures intended for practical sanitation. It must 
 never be forgotten that the typhoid bacillus does not 
 fulfil one of Koch's postulates. The disease produced 
 by the inoculation of guinea-pigs with pure cultivation 
 of typhoid bacillus has but a remote resemblance to 
 the disease which we clinically know as enteric fever, 
 a disease which seems limited to the human species. 
 Sidney Martin ^ found that *' none of the ordinary 
 cultures of the typhoid bacillus obtainable in the 
 laboratories will kill an animal,^ but that it may be 
 rendered virulent by inoculation and transference 
 through a succession of peritoneal cavities, and also by 
 
 ' Croonian Lectures, 1898. 
 
 ^ When therefore Sir Richard Thome in commenting upon Martin's 
 pure cultivations of Bacillus typhosus in sterilised soil says that they 
 yielded the bacillus ' presumably in virulent phase ' {Local Government 
 Board Reports, 1897-98, p. 23), his presumption is scarcely warranted 
 by the facts. 
 
SOIL 47 
 
 injecting simultaneously the products of other micro- 
 organisms, such as streptococcus or Bacillus coli com- 
 munis." It is noteworthy that the Bacillus coli com- 
 munis and Gaertner's bacillus when subjected to similar 
 manipulations are as toxic to rabbits as is the typhoid 
 bacillus. It must be remembered that * pure cultiva- 
 tions ' of the Bacillus typhosus cannot be said to exist 
 in nature. We recognise, and it may be taken as 
 proven, that the main cause of the endemicity and 
 epidemicity of enteric fever in this country is to be 
 found in the faeces of the patient, and yet Martin tells 
 us that while the bacillus is invariably found in the 
 spleen and mesenteric glands and in intestinal lesions, 
 "it is found in some cases in the motions of typhoid 
 fever and also in the urine." Dr. J. R. Carver, working 
 under Delepine at Manchester, found the typhoid bacillus 
 twice in twenty samples of typhoid faeces and once in 
 sixteen samples of typhoid urine.* Osier records sixteen 
 instances of bacilluria in fifty-one cases (1900-1901) 
 and states that " bacilli may be present in the urine for 
 years after the attack." 
 
 Martin, working with sterilised soils, has shown 
 that in soils which are more or less * polluted' with 
 organic matter the Bacillus typhosus will continue to 
 live and spread at ordinary temperatures, but that in 
 virgin soils (both sandy and peaty) the pure cultiva- 
 tions of the bacillus die out from some unexplained 
 cause. Martin gives one experiment ^ to show that in 
 unsterilised soil containing much organic matter the 
 bacillus may continue to live, but as yet there has been 
 no evidence of spreading. The results recorded in the 
 same observer's more recent paper are that typhoid 
 bacilli will grow and live for a long time in sterilised 
 * Tlie- Lancet, August 20, 1898. ^ Local Government Bej^ort, 1897-98. 
 
48 ENTERIC FEVER 
 
 soils, but rapidly die out in unsterilised soils, being 
 overpowered by the bacilli present in the soil. {See 
 27th (1897-98), 28th (1898-99), and 29th (1899-1900) 
 Annual Eeports of the Medical Ofi&cer to the Local 
 Government Board.) John Eobertson and Maitland 
 Gibson ^ collected thirty samples of soil from areas 
 which they considered likely to be infected. *' In not 
 one single instance was the Bacillus typhosus found." 
 
 These gentlemen carried out experiments in a field 
 (soil, eight inches of clayey loam on ten inches of sand 
 and clay on stiff yellow boulder clay) ; each experimental 
 patch had the turf removed and nothing was allowed to 
 grow upon it. The patches were eighteen inches square. 
 Three patches were inoculated with 200 cubic centi- 
 metres of a pure cultivation of the Bacillus typhosus 
 mixed with one and a half gallon of tap water — No. 1 
 on the surface. No. 2 nine inches deep, and No. 3 
 eighteen inches deep, the top soil being removed and 
 replaced. This was done on May 30, 1896, and on 
 August 26 the Bacillus typhosus was found three inches 
 below the surface of each, and at nine inches below the 
 surface of No. 2 and No. 3, and also at eighteen inches 
 below the surface of No. 3. On October 20 there were 
 practically the same results. On November 27 the 
 Bacillus typhosus could not be found in either patch. 
 Towards the end of August, 1896, three other patches 
 (Nos. 4, 5, and 6) were inoculated in the same way, and 
 on November 27 no Bacillus typhosus could be found. 
 These patches were three feet square. On January 17, 
 1897, patches No. 4, 5, and 6 received two gallons of 
 very weak beef tea, which was repeated at fortnightly 
 intervals till June 3, 1897, when on examination the 
 organism was easily found. No organism was found at 
 this date in patches Nos. 1, 2, and 3, which had not 
 
 ' Brit, Med. Jour. January 8, 1898. 
 
EXPERIMENTAL 49 
 
 been fed with bouillon. Practically the same result was 
 obtained on July 11. The persistence of the Bacillus 
 typhosus appears to depend on feeding it with fluid 
 nourishment. A sewer leaking into the soil would do 
 this, or liquid filth in a privy. It was shown that the 
 organism would grow three inches downwards or 
 upwards from a depth of eighteen inches. The slight 
 downward growth might be due to mechanical conditions. 
 The effect of sunlight does not penetrate far. 
 
 Laboratory experiments went to show that vegetation 
 (grass) prevented the growth of the organism. This 
 may go to explain * why typhoid fever is so much more 
 prevalent in towns than in rural districts.' Attempts 
 to prove the aerial conveyance of the organism from 
 liquid filth failed. 
 
 Further allusions by Dr. J. Kobertson to these 
 experiments were made later in the year,^ in the course 
 of which he said : '* During the winter months organisms 
 disappeared from the surface soil, and from these 
 experiments I was led to believe that the deeper layers 
 acted as a sort of shelter during the winter months, 
 from which the organisms sallied forth to the surface 
 during the warmer months." He had not noticed any 
 relation between typhoid fever and the rise and fall of 
 the ground water, but he thought it was most common in 
 places where the ground water is near the surface. The 
 Bacillus typhosus quickly dies out in grass-covered areas. 
 
 Let us now turn from these experiments, which, after 
 all, are very artificial, to the practical experiences of 
 sanitarians in the matter. It may be premised that 
 Martin's experiments show that the Bacillus typhosus 
 will grow in any soil rich in organic matter, and that 
 although aerobic it can be cultivated as an anaerobe 
 » Brit. Med. Jour. August 13, 1898. 
 
50 ENTERIC FEVER 
 
 even in an atmosphere of carbonic acid,^ and the 
 bacillus seems to be definitely destroyed by sandy or 
 peaty * virgin ' soils. Robertson and Gibson cultivated 
 the bacillus on a soil in which clay predominated. 
 Sir Charles Cameron is of opinion that it flourishes in 
 gravel. At Dublin on August 23, 1898, he said, speak- 
 ing of enteric fever : " That there is a connection 
 between enteric fever and the soil is shown by the 
 results of observations of the distribution of more than 
 4,000 cases of the disease in Dublin. Where gravel 
 forms the site of streets there is far more typhoid fever 
 than in districts which rest upon the stiff boulder clay. 
 This is clearly owing to the fact that the Bacillus 
 typhosus, which is aerobian — that is, requires oxygen — 
 can get it more freely in the loose gravels than in the 
 stiff clays. In the gravel, too, there is a much greater 
 space for the development and movement of the bacilli." 
 
 Dr. Scurfield, of Sunderland, said that ** the greater 
 part of the county of Durham in which typhoid fever 
 had been prevalent during the last few years was 
 covered with stiff boulder clay, and in the urban district 
 of Sunderland typhoid fever had been just as prevalent 
 in the boulder clay as in the houses built on sand or 
 gravel.' The late Professor Pettenkofer, of Munich, is 
 mainly answerable for the theory that enteric fever is 
 due to a soil organism which grows with maximum 
 vigour when the level of the ground water falls. 
 
 Dr. Christopher Childs, in a valuable paper which 
 appeared in The Lancet,^ has placed us in possession 
 of important facts. Munich lies on a bed of gravel 
 1,700 feet above sea-level. Between 1851 and 1896 the 
 population had increased from 124,000 to 412,000, so 
 
 ' Local Oovernment Board Report, 1867. 
 2 The Lancet, February 5 1898. 
 
MUNICH 51 
 
 that modern Munich is largely a new city. Up to 1865 
 Munich was a city of soak-away cesspools and filthy 
 surface wells, and it was not till 1858 that the cesspool 
 system began to be remedied, and not till 1865 that the 
 water-supply began to be improved. Pettenkofer's early 
 investigations, Dr. Childs says, led him to the conviction 
 that in Munich there was not the slightest connection 
 between the drinking-water and the typhoid,^ and this 
 in spite of the fact that the water was shown on analysis 
 to be organically polluted. The analyses and general 
 investigations of the earlier date have been very imper- 
 fectly recorded, but there is evidence, says Dr. Childs, 
 that the water was much worse in the earlier periods 
 than latterly. Of Pettenkofer's personal investigations 
 Dr. Childs says : " I have not succeeded in finding 
 recorded details, but they derive their weight from the 
 high authority of Pettenkofer himself." The enteric 
 death-rate, which (per 100,000) was 202*4 for the decade 
 1851-59, fell to 147*8 in 1860-69 ; to 116*7 in 1870-79. 
 In 1880 it was 72 ; in 1881 it had fallen to 18 and has 
 not risen since. 
 
 The water in Munich is derived from the mountains, 
 and when these are covered with snow the subsoil water 
 falls. It is a most interesting fact to note that Petten- 
 kofer's Munich typhoid fever was a disease of winter. 
 The incidence of the Munich typhoid fever between the 
 years 1851-67 was, according to Pettenkofer, in monthly 
 averages as follows : 
 
 February. 
 
 . 36-8 
 
 April 
 
 . 231 
 
 September 
 
 . 161 
 
 January . 
 
 . 33-5 
 
 November 
 
 . 19-0 
 
 July 
 
 . 15-8 
 
 March . 
 
 . 31-8 
 
 May 
 
 . 17-6 
 
 June 
 
 . 15-2 
 
 December 
 
 . 28-5 
 
 August . 
 
 . 16-7 
 
 October 
 
 . 150 
 
 > This may have been due to the fact that the wells were all equally 
 bad. 
 
 E 2 
 
52 ENTERIC FEVER 
 
 The average English sanitarian reading this account 
 of Munich with its soak-away cesspools and foul drinking- 
 water would not need any new theories to account for 
 the prevalence of typhoid fever. If we accept Petten- 
 kofer's theory that the fever was due to organisms in 
 the subsoil, it is interesting to observe that the Munich 
 fever, unlike typhoid fever in other places, reached its 
 maximum in February, and was most rife in the coldest 
 weather when the surface of the ground must have been 
 often frozen. During the winter months, when the big 
 houses were closed and the stoves were lighted, the 
 interior of the houses must have been filled with cess- 
 pool air. An organism permeating the soil might be 
 expected to die out gradually. The sudden fall of the 
 death-rate from 72 in 1880 to 18 in 1881 seems to imply 
 that the organisms suddenly died over the whole area 
 of the city. Munich is a city in which the general 
 sanitary condition has undergone gradual amelioration. 
 Sewers on modern lines were begun in 1878, and 800 
 private slaughter-houses were destroyed in the same 
 year. There is now a highland water-supply and typhoid 
 fever has gone. But it is needless to say that the sub- 
 soil water rises and falls precisely as it did half a century 
 ago. The connection of typhoid fever in Munich with 
 organisms growing in the soil is to my mind not proven.^ 
 
 In 1896 there were 111 cases of enteric fever at 
 Chichester, of which the majority occurred in July and 
 
 1 Ziegler (in 10th ed., 1901, of his Allgemeine Pathologic, vol. i. 
 p. 39) refers to Pettenkofer's view that the soil influences the virulence 
 of the micro-organism by communicating a something to the latter 
 under certain conditions, but adds that recent research on the etiology 
 and spread of typhoid fever, cholera, and plague has not lent any support 
 to such an hypothesis. 
 
CHICHESTER EPIDEMIC 53 
 
 August, and of which only two died (one committing 
 suicide while delirious). Seventy- six houses were 
 attacked in localities which had been repeatedly invaded 
 in former years. Of these houses thirty-nine had well- 
 water (quality doubtful), and thirty-six had company's 
 water. In sixty-two of the cases the patients were 
 males and in forty-nine they were females. There had 
 been recent works of drainage, and it was found that the 
 percentage of incidence of fever on the whole of the 
 undrained houses of the town was slightly in excess of 
 that of the drained houses. There was no evidence that 
 the disturbance of the soil in this ancient walled city 
 for works of drainage had inlfluenced the incidence of 
 fever. Many of the houses attacked had old privies, &c., 
 and the back yards were soaked with organic matter. 
 Enteric fever, as usual, showed a preference for filthy 
 surroundings. This outbreak has been spoken of as 
 due to the growth of the Bacillus typhosus in the soil 
 round the houses attacked, but the evidence is certainly 
 not conclusive, and the fact that the women who mind 
 the house suffered less than the men is rather opposed to 
 such a theory. The epidemic, which departs somewhat 
 from ordinary epidemics in the time of its maximum 
 virulence and its very low mortality, remains un- 
 accounted for. Chichester is built on a bed of gravel. 
 (The facts as to this epidemic are culled from Dr. Bul- 
 strode's report to the Local Government Board.) In 
 1898, seventy-six houses in Chichester were again in- 
 fected with enteric fever. Of these fifty-eight were 
 * drained ' and eighteen * not drained ' ; forty-four con- 
 sumed town water, while thirty-two had well-water. 
 Mr. Jones, the medical officer of health, points out 
 that the percentage of incidence was markedly in excess 
 
54 ENTERIC FEVER 
 
 in the ' well-water ' houses and slightly in excess in the 
 * undrained ' houses. 
 
 Enteric fever has long been regarded as a filth 
 disease, and there is abundant evidence that filthy sur- 
 roundings in some way or other predispose to it. 
 Waterlogged privies soil-sodden with the leakage of 
 sewers, the air of cesspools and traps, proximity of 
 water-closets to the kitchen, and other conditions of 
 filth are all bad. While we agree as to the fact we may 
 differ as to the explanation. Some would assert that 
 the Bacillus typhosus is actually growing and spreading 
 in the filth, and indeed that is possible, but direct evi- 
 dence of it is wanting. Some would even say that the 
 soil being inoculated the specific organism may con- 
 tinue to grow and spread in it far away from the point 
 of inoculation, and so (by growth, not irruption) may 
 poison the local water at a distance. Of this there is 
 positively no evidence whatever. If for the sake of 
 argument we allow that the Bacillus typhosus may grow 
 in the soil we have to ask how it emerges from the soil 
 to do us harm. We are here confronted with con- 
 tradictions. Eobertson and Gibson showed that the 
 bacillus disappeared in the winter to reappear in the 
 summer, while at Munich the increase of enteric fever 
 was a phenomenon of midwinter. In Budapest it is 
 associated with a rising ground-water, and at Munich 
 with the opposite condition. In this country it is a 
 disease of autumn and the period of floods, while others 
 assert that it may be conveyed by dust, which ought to 
 produce a prevalence in March. The opinions held by 
 sanitarians and bacteriologists on this question differ 
 widely, but there seems to be a consensus of opinion 
 that a waterlogged soil rich in organic matter is the 
 one in which the Bacillus typhosus is most likely to 
 
FLIES 55 
 
 flourish. If this should be true the official position 
 that in sewage treatment filtration through earth is a 
 sine qua non becomes untenable. 
 
 In the discussion which followed a paper which I 
 had the honour of reading before the Eoyal Medical and 
 Chirurgical Society in November, 1898, on the Preven- 
 tion of Enteric Fever, and which has been published in 
 vol. Ixxxi. of the Transactions of that Society,^ many 
 eminent sanitarians and bacteriologists made most valu- 
 able statements. Sir Kichard Thorne said, p. ^Q: "I 
 do not think Nature made any provision for the disposal 
 of specific excreta. Nature provides an easy means of 
 dealing with the ordinary healthy excreta of healthy 
 people living on the land, but dangers arising from 
 specifically contaminated excreta are, I fear, much more 
 difficult to be thus got rid of." ^ 
 
 The danger from flies is, in Director -General Jame- 
 son's opinion, a very real one in tropical countries. By 
 their agency faecal poisons are probably carried to the 
 food or milk. Dr. Sims Woodhead said : " We stand in 
 need of further information in respect of the continu- 
 ance of the typhoid bacillus in soil. I agree . . . that 
 the typhoid bacillus has a much greater chance of per- 
 sistence in a waterlogged soil containing a moderate 
 amount of organic matter than in a dry, well-aerated 
 soil, however large an amount of organic matter it 
 may contain. In this, however, my actual experience 
 is limited, though I hold a strong opinion on the sub- 
 ject." When we consider that the bacillus of typhoid 
 fever may remain in the intestine for some time after 
 
 ' This paper will be found on p. 135 of this volume. 
 
 2 This opinion is not quite in harmony with Sidney Martin's repeated 
 demonstrations that the Bacillus typhosus is killed by virgin sand or 
 peat, and the death of it in Eobertson and Gibson's soil which had not 
 been watered with beef tea, and its extermination by growing grass. 
 
56 ENTERIC FEVER 
 
 recovery as well as in the urine and gall-bladder, and 
 when we also remember what Metchnikoff pointed out in 
 relation to cholera, viz. that the vibrio may be present 
 in the intestine a long time before an attack of cholera 
 occurs, it would seem that we can have typhoid bacilli 
 under very similar conditions present in the intestine in 
 practically healthy individuals, and that this bacillus 
 may remain in the intestine a considerable time before 
 the intestinal tract becomes so altered that the bacillus 
 has a chance of doing its special work. Then it is that 
 bad, though not actually infected water, may help the 
 typhoid bacillus to do its work. 
 
 Dr. Corfield insisted on the importance of sewer air 
 and cesspool air as factors in producing the endemicity 
 of enteric fever. He instances Lyons as a city in which 
 cholera has never spread, but in which typhoid fever is 
 endemic. Lyons is a city of cesspools. 
 
 Loesener, in a paper ^ on the * Viability of Pathogenic 
 Bacteria in Interred Corpses,' states that he injected into 
 the vessels and cavities of dead pigs a great quantity of 
 pathogenic bacteria so that their number should exceed 
 that of the saprophytes. In the first experiments the 
 animals were not interred, and under these conditions 
 the viability of the bacilli of typhoid fever and cholera 
 did not exceed four or five days. When the animals 
 were treated in this way and buried in a porous soil the 
 pathogenic bacteria manifested a maximum viability as 
 follows : Typhoid fever (one instance only) ninety- six 
 days, cholera twenty-eight days, tubercle ninety -five days. 
 Bacillus pyocyaneus thirty-three days, pneumo-bacillus 
 of Friedlander twenty-eight days. Micrococcus tetragonus 
 twenty-eight days, and tetanus 361 days (showed com- 
 
 ' Arbeiten aus dem kaiserlichen Oeswidheitsamte, vol. xii. f. 11, 
 p. 448. 
 
CEMETERIES 57 
 
 plete virulence after 234 days). The Bacillus anthracis 
 preserved its complete virulence during the whole year 
 of the experiment, and the bacillus of rouget du pore ^ 
 and septicaemia of mice 234 days. As for the typhoid 
 bacillus, it was possible to isolate it from the buried 
 corpses only once. * I believe,' he says, * with Koch that 
 the value of Pfeiffer's reaction of immunity is relative, 
 and that outside the human body it is not in our power 
 to identify the typhoid bacillus.' 
 
 Lcesener's conclusion is that cemeteries are not 
 harmful (even when graves made in a permeable soil 
 are liable to inundation either temporarily or perma- 
 nently) provided the graves be surrounded by a layer of 
 earth sufficient to filter the liquids traversing them.^ 
 
 ' Kobin, in Nouveau Diet. Abr4gi de Medecine, dc. 1886, states that 
 rouget du pore is, according to some observers, anthrax in the pig, to 
 others typhoid fever of pig (Pasteur). In Hayes's translation (1898) of 
 Friedberger and Frohner's Veterinary Pathology, vol. i. p. 75, swine 
 erysipelas is given as the equivalent of rouget du pore. 
 
 2 From Annales d'Hygi^ne Puhlique et de Medecine Legale, troi- 
 si^me s6rie, tome xxxvii Janvier 1897. 
 
58 
 
 MAIDSTONE EPIDEMIC 
 
 CHAPTER VII 
 
 TRE MAIDSTONE EPIDEMIC 
 
 The epidemic of enteric fever in Maidstone in 1897 is 
 of great importance in relation to the influence of the 
 earth on contagion, and the report to the Local Govern- 
 ment Board by Mr. J. S. Davy, Dr. T. Thomson, and 
 Mr. G. W. Willcocks has put us in possession of most 
 of the essential facts. 
 
 The date of the attacks (the notifications were later) 
 in the town and in the County Lunatic Asylum as given 
 in Table I. of the report were as under : 
 
 Table I. 
 
 Week Ending 
 
 Borough 
 
 Asylum 
 
 September 4, 1897 . 
 
 29 
 
 
 
 11 „ 
 
 
 
 
 165 
 
 1 
 
 18 „ 
 
 
 
 
 434 
 
 18 
 
 25 „ 
 
 
 
 
 432 
 
 48 
 
 October 2 „ 
 
 
 
 
 274 
 
 12 
 
 » 9 » 
 
 
 
 
 134 
 
 15 
 
 16 „ 
 
 
 
 
 64 
 
 4 
 
 23 „ 
 
 
 
 
 45 
 
 2 
 
 30 „ 
 
 
 
 
 33 
 
 4 
 
 November 6 „ 
 
 
 
 
 25 
 
 2 
 
 13 „ 
 
 
 
 
 23 
 
 1 
 
 20 „ 
 
 
 
 
 19 
 
 — 
 
 27 „ 
 
 
 
 
 13 
 
 — 
 
 December 4 „ 
 
 
 
 
 4 
 
 — 
 
 11 » . 
 
 
 
 
 5 
 
 — 
 
 18 „ . 
 
 
 
 
 3 
 
 — 
 
 25 „ 
 
 
 
 
 2 
 
 
 
 January 1, 1898 . 
 
 
 
 
 3 
 
 — 
 
FARLEIGH SPRINGS 59 
 
 It was conclusively shown that the outbreak was due 
 to the pollution of a spring or springs belonging to the 
 Farleigh water-system. Of persons drinking this water 
 nearly 8 per cent, were attacked, while of those drinking 
 water belonging to other systems of supply less than 
 1 per cent, were attacked. The Farleigh springs, which 
 are fifteen or sixteen in number, crop out on both banks 
 of the Medway (mainly on the left bank) where the 
 overlying and permeable green sand (locally known as 
 
 * ragstone ') rests upon the impermeable clay beneath. 
 The water of these springs is for the most part pumped 
 to the Barming reservoir, whence it is distributed mainly 
 to the higher parts of the town. The Farleigh springs 
 yield collectively over 3,000,000 gallons a week, and they 
 were treated collectively, and their waters were all mixed 
 in one reservoir, holding 500,000 gallons, before distri- 
 bution. That this reservoir and the pipes connected 
 with it became polluted with enteric poison was beyond 
 doubt, but it was not quite so clear which of the con- 
 tributing springs was at fault. When, however, the 
 springs were examined on September 19, one and one 
 only was found to be dirty, viz. the spring known as 
 
 * Tutsham-in-Field.' In order to condemn this spring, 
 which yielded only 35,000 gallons per week, both chemical 
 and bacteriological analyses were wholly superfluous, 
 and accordingly it was cut off from the supply on the 
 following morning, September 20. This spring was 
 reported as still dirty a month later, and when I saw it 
 on November 5 it was still turbid, and manifestly unfit 
 for drinking purposes. 
 
 * Kagstone ' is often fissured, and there had been 
 experiences in the Borough of Maidstone of the pollution 
 of an old municipal supply known as ' the Conduit,' and 
 of a well known as * Hill's Well,' by leakage of sewage 
 
6o MAIDSTONE EPIDEMIC 
 
 from broken pipes and similar well-understood causes. 
 Bacteriological investigations were made by Dr. Wash- 
 bourn and Dr. Durham on behalf of the corporation, by 
 Dr. Sims Woodhead and Dr. Cartwright Wood on behalf 
 of the water company, and by Dr. Tew and Mr. Foulerton 
 on behalf of the rural authority. The first four were all 
 agreed that Tutsham-in-Field water afforded evidence of 
 animal pollution on September 19 and 20, and the last 
 two found similar evidence in the mixed Farleigh waters 
 taken at Barming on September 22. It is noteworthy, 
 and of very great importance, that diligent search was 
 made for the Bacillus typhosus by the six eminent 
 bacteriologists engaged, but without success. The situa- 
 tion of the Farleigh springs was such as to render them 
 liable to pollution, and on chemical grounds they were 
 open to suspicion, but only one of them (Tutsham-in- 
 Field) was really convicted of animal contamination and 
 was obviously dirty and unfit to drink. The facts of the 
 epidemic are, I think, quite consistent with the theory 
 that it was caused by pollution of the spring at Tutsham- 
 in-Field. 
 
 The Tutsham-in-Field spring derived its immediate 
 supply from the under draining of a hop garden, and a 
 reference to the diagram will show that its natural flow 
 was assisted by some 20 feet of earthenware pipes, with 
 open joints, which lay immediately on the Atherfield 
 clay, and at a depth below the surface which varied from 
 2 feet near the catch-pit to 4 feet at the end which 
 was farthest in the hop garden {see fig. 1). Immediately 
 above the spot where the open pipes are nearest to the 
 surface was a fence made of stakes driven into the 
 ground, which may have served as direct conducting 
 channels down to the open-jointed pipes. (Parentheti- 
 cally, I would remark that the danger of a dead fence in 
 
TUTSHAM-IN-FIELD 
 
 6i 
 
 such a connection ia much greater than a hedge with 
 living roots.) Close to this fence were deposits of faeces. 
 The line of the spring occupies a slight depression in the 
 
 JL_V 
 
 TUTSHAM 'N FIELD 
 
 Fig. 1. 
 
 ground, and the natural surface drainage must have 
 been to a spot very close to that at which the collecting 
 pipes were shallowest. This spot was only a few yards 
 from a path which crosses the hop-garden fence by 
 means of a stile, and in short the circumstances were 
 
 TUTSHAM "N FlCLD 
 Fm. 2. 
 
 such that the risk of befoulment of the ground close to 
 the collection pipes was very great ^ {see fig. 2). 
 
 If the diagrams at Tutsham- in-Field be compared 
 
 ' In his report to the Local Government Board Mr. P. Adams speaks 
 of this fence as a 'hedge,' but both the photograph and the plan show 
 that it was a ' fence.' The point is not unimportant when the tendency 
 of fences to rot at the foot is considered. 
 
62 
 
 MAIDSTONE EPIDEMIC 
 
 with those of Tutsham -in- Orchard and Ewell (figs. 3 
 and 4) it will be observed that earthenware pipes with 
 open joints are used in all of them, but while in the 
 
 I a 3 4 8 
 
 "^Stoitii 
 
 TUTSHAM 'N ORCHARD 
 
 Fig. 3. 
 
 first-named these open joints came to within 2 feet of 
 the surface, they did not come nearer than 5 feet at 
 Tutsham-in-Orchard and 14 feet at Ewell. The surface 
 
 
 Fig. 4. 
 
 of the ground above the pipes was formed of turf at 
 Tutsham-in-Orchard and Ewell. The Tutsham-in- 
 Orchard spring was bright and apparently wholesome, 
 
RAINFALL 63 
 
 and the Ewell spring appeared to be the purest water 
 of the whole of the Farleigh group. 
 
 It must be remembered that the 3 feet of hop 
 ground which covered the open-jointed pipes at Tutsham- 
 in-Field was of a sticky, clayey nature, liable to crack 
 and fissure in times of drought, and there can be little 
 doubt but that the rain which washed this spot ran with 
 its washings almost direct to the reservoirs. Under the 
 circumstances which existed it is very important to study 
 the rainfall and the exact times of its incidence. It is 
 obvious that without rain no infective material could be 
 washed into the * spring,' and it is also obvious that a 
 short sharp shower might do infinite mischief at Tutsham- 
 in-Field and yet be insufficient to affect the level of the 
 subsoil water in Maidstone. Let us look at the facts of 
 the epidemic from this point of view. 
 
 The incubative period of enteric fever is stated by 
 the Clinical Society of London to vary between five and 
 twenty-three days. I am justified, therefore, in assum- 
 ing that the majority of those who might receive a dose 
 of poison to-day would be attacked between the seventh 
 and twenty-first day following. Between June 28 and 
 August 7 there had fallen only 0*21 inch of rain. At 
 the end of a dry period the delay in the distribution of 
 water would not be great, but it is obvious that a house 
 cistern might be charged with infective material, and 
 considerable delay might occur before the attacks, if the 
 bulk of the household were away. After forty days of 
 drought rain fell to the extent of 0*44 inch on August 7 
 and 8, and 0-13 inch fell on August 15. On August 17 
 and 18 there was a fall of 0*53 inch, and if this rain 
 washed infective material to the reservoir it should 
 cause attacks between August 24 and September 9. The 
 first attack of the epidemic is stated to have occurred on 
 
64 MAIDSTONE EPIDEMIC 
 
 August 28, and between that and September 8 there 
 were 101 attacks. On August 26 hop-picking commenced, 
 and the population round the Tutsham spring was neces- 
 sarily increased. On that day there fell 0*35 inch of 
 rain, the heaviest fall in any one day since May 80. The 
 effect of this shower should become manifest between 
 September 2 and September 16. The attacks down to 
 August 8 have been previously given, but between the 
 8th and 16th there were 385 attacks. On September 1 
 there was 0-31 inch of rain ; again on September 5, in 
 the very middle of the hop-picking, there fell 0*44 inch, 
 the heaviest fall since March 2. The effect of this 
 should become manifest between September 12 and 26. 
 Omitting the cases down to and including the 16th, 
 we find that between the 17th and 26th inclusive there 
 were 625 attacks. There was 0*27 inch on September 8, 
 hop-picking being still in progress. This would carry 
 us on to September 27, 28, and 29, in which days there 
 were 122 cases. On September 18 and 19 (hop-picking 
 having come to an end on the 13th) there fell 0*51 
 inch. This would take us down to October 9, and we 
 find that from September 30 to October 9 there were 
 237 attacks. On September 20 the Tutsham springs 
 were cut off, the effect of which would not be fully 
 manifest for three weeks. On October 12 the daily 
 attacks suddenly dropped from eighteen to seven. 
 
 It must be borne in mind that the Tutsham spring 
 had presumably sent a considerable dose of muddy 
 water to the Barming reservoir on September 18 and 
 19, the very day before it was cut off, when there fell 
 0*51 inch of rain, and the influence of this would be 
 felt up to October 11 at least. On October 11 and 12 
 the daily attacks fell from eighteen to seven and never 
 rose again above nine. We must remember that after 
 
TUTSHAMJN-FIELD 65 
 
 the Tutsham springs had been cut off there was the 
 possibility of poison lurking in the foul Barming reser- 
 voir, the water pipes, and the house cisterns. On Sep- 
 tember 29 there fell 0-83 inch of rain, a shower of 
 tropical severity, and it is exceedingly likely that in the 
 stirring up of the town sewers there may have been 
 some leakage into the water service. There is no evi- 
 dence on the point, but such things do happen ai; such 
 times. In any case the effect of the wholesale poison- 
 ing of part of the water system which had taken place 
 would be likely to endure for some time. It was not 
 till October 18 that the implicated water system was in 
 great part (but not wholly) disinfected, and this process 
 was not completed entirely until November 4. The full 
 benefit of this would show itself three weeks later 
 (November 25). In the weekly returns of attacks (see 
 Table I.) there were only four for the week ending 
 December 4, as against thirteen for the week ending 
 November 27. Subsequent to November 27 there were 
 only seventeen attacks. 
 
 The epidemiological facts of this outbreak are quite 
 compatible with the theory that the dirty water sup- 
 plied from Tutsham-in-Field was the main cause of the 
 outbreak, and I do not think that the effects of the 
 contamination could be expected finally to disappear 
 until three weeks after the completion of the disinfec- 
 tion of the water service on November 4. The inspectors 
 in their report fix October 18 as the day when the 
 influence of the Farleigh water ceased to be felt in 
 Maidstone, and they say (p. 32) : ** Nearly all the cases 
 notified after October 18 (some 280 in number) are to 
 be regarded as having had a cause other than the 
 consumption of Farleigh water." This opinion seems to 
 imply that in the estimation of the inspectors the dis- 
 
66 MAIDSTONE EPIDEMIC 
 
 infection of the Farleigh water system which began on 
 October 16 and continued until November 4 was super- 
 fluous and useless. 
 
 Speaking of the 280 cases they continue : *' By Mr. 
 M. A. Adams they were referred to direct infection from 
 previous cases and to insanitary conditions of water- 
 closets, drains, and sewers. This explanation appears 
 to us to be the probable one if the insanitary conditions 
 referred to be taken in the wide sense of including the 
 fouling of the soil by leakage from these defective drains 
 and sewers. Kecent researches into the life-history of 
 the bacillus of typhoid fever go to show that this organ- 
 ism finds in a soil contaminated with foul matters from 
 leaky sewers, drains, and cesspools conditions especially 
 favourable to its vitality and multiplication. That the 
 soil on which Maidstone stands is thus contaminated 
 was set beyond doubt by the evidence put before us. 
 To the existence of these conditions is mainly, we con- 
 sider, to be attributed the remarkable persistence of 
 fever in Maidstone after the primary cause of the out- 
 break had been removed by cutting off the Farleigh 
 water-supply." 
 
 Do the facts of the case really establish the con- 
 clusion which the inspectors say is ' set beyond doubt ' ? 
 I do not find a single word in the report or a single 
 experiment to prove that the Bacillus typhosus was 
 growing in the soil of Maidstone. The epidemic is re- 
 markable not only for its severity but from the fact 
 that six gentlemen, all eminent for their skill in bacteri- 
 ology, failed to discover a single typhoid bacillus. 
 The bacteriological investigations were upon a scale 
 which was quite unprecedented and in so far as the 
 Bacillus typhosus was concerned were entirely and 
 absolutely negative. It may be, as the inspectors 
 
PRISON AND BARRACKS 67 
 
 hint was the case, that the Bacillus typhosus was 
 permeating the soil of Maidstone in November, De- 
 cember, and January very much as a blue mould 
 permeates a cheese, but no examination of the soil is 
 recorded in the report. There are facts, however, which 
 make strongly against any such contention. These were 
 the total escape of the barracks and prison. 
 
 On page 26 of the report is the following paragraph : 
 " The barracks and the Maidstone prison are both within 
 the borough and both are connected with the town 
 sewers. The population of the barracks was 300, this 
 total including 166 men, 44 women, and 88 children. 
 The water supplied to the barracks is that of the 
 Boarley system of the water company's supply. No 
 case of typhoid fever occurred in the barracks during 
 the year. At the prison the average population through- 
 out the year was 171, the total number of prisoners 
 received being 1,925. The water used on weekdays is 
 from a well 34 feet deep sunk in the Hythe beds of the 
 lower greensand. On Sundays water is turned on to 
 the prison from the Boarley mains. There have been 
 no cases of typhoid fever or diarrhoea among the 
 prisoners or staff during the whole of 1897." During 
 the five months (August to December) there were 
 probably 800 persons who drank water from the 34-feet 
 well sunk in the ' contaminated ' soil of Maidstone. A 
 reference to the map (fig. 5) will show that the area of 
 the prison is closely hemmed in on the north and east 
 by fever- stricken houses, and the escape of the prison 
 and barrack populations is most remarkable. Neither 
 rise nor fall of subsoil water brought tj^phoid fever or 
 diarrhoea to the prison. 
 
 The investigations connected with the Maidstone epi- 
 demic are of great interest as pointing to the wonderful 
 
 F 2 
 
68 
 
 MAIDSTONE EPIDEMIC 
 
 protection which the humus affords to the underlying 
 water against pollution from above. The whole of the 
 Farleigh springs were of the same character, the catch- 
 pits of many of them w'ere liable to invasion in time of 
 flood, and the gathering-ground of most of them was 
 highly cultivated and manured land. And yet none 
 of them (always excepting Tutsham-in-Field) afforded 
 
 Fig. 6. 
 
 ' Spot ' plan of surroundings of Maidstone barracks and prison. The big numerals 
 sliow the height above sea-level. The black dots are fever-stricken houses. 
 
 evidence of serious bacterial impurities. It may be added 
 that in the third quarter of 1898 there was one death 
 from enteric fever in Maidstone and another death from 
 the same cause in the fourth quarter, so that the * con- 
 taminated ' soil of Maidstone was not able to contami- 
 nate the inhabitants during the drought of July, August, 
 and September or the rains of October, November, and 
 December of 1898. 
 
IMMUNITY 69 
 
 CHAPTEK VIII 
 
 IMMUNITY— DANGER OF WOUNDS 
 
 Bacteriologists have abundantly proved that the germs 
 of disease are ubiquitous. They are found in earth, air, 
 water ; in the dust and on the walls of our dwellings ; 
 in clothing, in meat, milk, bread, and even occasionally, 
 as Andrewes has shown, in hot baked rice-pudding. 
 With regard to most of the necessities of life we hear 
 the cry of * unclean,' * unclean,' until the wonder is that 
 we are any of us left alive to warn our neighbours. The 
 fact that many of us manage to live to a respectable 
 age and to die from something which is non-infective 
 cannot but make us consider whether, after all, the 
 immunity of the individual is not the fact which tends 
 more than any other to the improvement of the public 
 health. It is wholesome for us to remember that the 
 greatest sanitary achievement of our time has been the 
 practical disappearance of typhus fever. Of the causa 
 causans of this disease we know nothing. Its absolute 
 disappearance has not been produced by successful germ 
 hunting. Its disappearance is probably due to the im- 
 proved conditions under which the masses of the popu- 
 lation live as regards food and cleanliness. Few of us 
 doubt that if this country should become involved in 
 war, and food should become dear and scarce in conse- 
 quence, the relative immunity of the population would 
 
yo IMMUNITY 
 
 be lessened and typhus fever would re-assert its sway. 
 Whether we succumb to an infective disease or not 
 probably depends in great measure upon the dose of the 
 poison which we receive. When an endemic disease 
 such as enteric fever becomes epidemic it is due to the 
 sudden dissemination of a poison in relatively large or 
 virulent doses. Even in the most severe epidemics it 
 is rare for more than 10 per cent, of those who have 
 run obvious risks of receiving the poison to be attacked. 
 The questions of virulence and vulnerability are most 
 important. It seems to be well established that the 
 virulence of some of the pathogenic microbes varies 
 immensely with the conditions of soil, temperature, air, 
 sunlight, &c., under which they are grown, and it is a 
 fact that must be remembered that it is not always the 
 pure cultivation which manifests most virulence. Many 
 infective diseases assume a virulence in the tropics which 
 is rarely met with in temperate countries. This appears 
 to be true of tropical malaria, enteric fever, cholera, 
 yellow fever, anthrax, and tetanus. In hot countries 
 where a temperature equal to the optimum for the 
 growth of many pathogenic microbes is often continu- 
 ously maintained for weeks in succession, the risks of 
 contagion and the danger of uncleanliness must often 
 have become apparent in a manner more convincing 
 than is the case among us. The repeated injunctions 
 as to uncleanliness in the Mosaic law, and the rigid 
 rules laid down as to the conditions which made a man 
 unclean and which necessitated his subsequent purifica- 
 tion, must have been the outcome of experience. To eat 
 with unwashed hands in a tropical country and without 
 knives and forks would clearly be to run considerable 
 risks. The regulations in force among the Hindus were 
 even more stringent, and although some of the regula- 
 
HINDU MANNERS 71 
 
 tions may appear to us to be extravagant and nonsensi- 
 cal, it is impossible not to admit that most of them have 
 for their aim the protection of the individual and his 
 fellow man from the risks of infection.^ 
 
 • In the Abbe Dubois's book on Hindu Manners, Customs, and 
 Ceremonies, translated by Beauchamp (Clarendon Press, 1897), will be 
 found a chapter (vol. i. p. 238), largely culled from the great book of 
 Brahmin ritual called Nittia-Earma, on hygienic rules, and among 
 them a section on ' Eules to be observed by Brahmins when answering 
 the Calls of Nature.' 1. Taking in his hand a big c7iem&t^ (brass vessel) 
 he will proceed to the place set apart for this purpose, which should 
 be at least a bowshot from his domicile. 2. Arrived at the place he will 
 begin by taking off his slippers, which he deposits some distance away, 
 and will then choose a clean spot on level ground. 3. The places to be 
 avoided for such a purpose are the enclosure of a temple, the edge of a 
 river, pond, or well, a public thoroughfare or a place frequented by the 
 public, a light-coloured soil, a ploughed field, and any spot close to a 
 banyan or any other sacred tree. 4. A Brahmin must not at the time 
 wear a new or newly-washed cloth. 5. He will take care to hang his 
 triple cord over his left ear and to cover his head with his loincloth. 
 6. He will stoop down as low as possible. It would be a great offence 
 to relieve oneself standing upright or only half stooping ; it would be a 
 still greater offence to do so sitting upon the branch of a tree or upon a 
 wall. 7. While in this posture he should take care to avoid the great 
 offence of looking at the sun or the moon, the stars, fire, a Brahmin, a 
 temple, an image, or one of the sacred trees. 8. He will keep perfect 
 silence. 9. He must chew nothing, having nothing in his mouth, and 
 hold nothing on his head. 10. He must do what he has to do as 
 quickly as possible, and rise immediately. 11. After rising he will 
 commit a great offence if he looks behind his heels. 12. If he neglects 
 none of these precautions his act will be a virtuous one, and not without 
 merit ; but if he neglects any of them the offence will not go without 
 punishment. 13. He will wash his feet and hands on the very spot 
 with the water contained in the chembu which he brought. Then taking 
 the vessel in his right hand and holding his private parts in his left, he 
 will go to the stream to purify himself from the great defilement which 
 he has contracted. 14. Arrived at the edge of the river or pond where 
 he purposes to wash himself he will first choose a suitable spot and will 
 then provide himself with some earth to be used along with the water in 
 cleansing himself. 15. He must be careful to provide himself with the 
 proper kind of earth and must remember that there are several kindg 
 
72 IMMUNITY 
 
 There can be no doubt that the health and vigour of 
 the individual are all-important in relation to infective 
 disease. The enervating influence of a tropical climate 
 upon Europeans is recognised as a potent predisposing 
 cause of infective disease, and if to the effects of climate 
 be added those of inordinate fatigue and insufficient 
 
 which cannot be used without committing an offence under these cir- 
 cumstances. Such are the earth of white ant nests, potter's earth, road 
 dust, bleaching earth, earth taken from under trees, from temple enclo- 
 sures, from cemeteries, from cattle pastures, earth that is almost white 
 like ashes, earth thrown up from rat-holes, and such like. 16. Provided 
 with the proper kind of earth he will approach the water, but will not 
 go into it. He will take some in his dtemhu. He will then go a little 
 distance away and wash his feet and hands again. If he has not a 
 brass vessel he will dig a little hole in the ground with his hands near 
 the river side and will fill it with water which he will use in the same 
 way, taking great care that this water shall not leak back into the river. 
 17. Taking a handful of earth in his left hand he will pour water upon 
 it and rub it well on the dirty part of his body. He will repeat the 
 operation, using only half the amount of earth, and so on three times 
 more, the amount of earth being lessened each time. 18. After cleansing 
 himself he will wash each of his hands five times with earth and water, 
 beginning with the left hand. 19. He will wash his private parts once 
 with water and potter's earth mixed. 20. The same performance for 
 his two feet, repeated five times for each foot, beginning, under the 
 penalty of eternal damnation, with the right foot. 21. Having thus 
 scoured the different parts of his body with earth and water he will wash 
 them a second time in water only. 22. After that he will wash his face 
 and rinse his mouth out eight times. When he is doing this last act 
 he must take very great care to spit out the water on his left side, for if 
 by carelessness or otherwise he unfortunately spits it out on the other 
 side he will assuredly go to hell. 23. He will think three times on 
 Vishnu and will swallow a little water three times in doing so. 
 
 In the course of some remarks on Ankylostoma duodenale in dogs, 
 Mr. Arthur Powell (late of Kalain, Cachar, and now of Bombay) {Brit. 
 Med. Journ. vol. i. 1900, p. 1,452) says : " It is a fact, not generally 
 known outside India, that a Hindu considers it a grave insult to address 
 anyone without washing the mouth after defacation. Anyone who has 
 travelled on the rivers of Assam is familiar with the sight of the banks 
 in the early morning. Every riparian native defsecates at the water's 
 edge, completes the * toilet of the perineum ' in the river, and then 
 
ENTERIC FEVER 73 
 
 food, the risks of infection getting a hold of the organ- 
 ism are greatly increased. Director-General Jameson 
 told us in the debate on enteric fever already 
 alluded to that "in almost all the posts occupied by 
 European troops co-operating with the various columns 
 in Afghanistan, extending from the British territory up 
 to Kabul and Kandahar, cases of enteric fever appeared, 
 some of which posts were occupied probably for the 
 first time since the world began." In the Nile expedi- 
 tion in 1889 those troops suffered most which had 
 undergone most exposure and fatigue, " and it becomes 
 difficult to resist evidence tending to show that in the 
 causation of this disease there may be more factors 
 than are generally acknowledged." Dr. Maclean, R.N. 
 (in a letter to Sir J. Fayrer), alludes to the occurrence of 
 enteric fever in the Island of Ascension, under circum- 
 stances of close observation where no connection could 
 be traced with defective sanitary arrangements, though 
 it is probable that malarial influences did occur. " There 
 is no such thing as a drain or a cesspool in the island, 
 all the sewage and other filth being removed daily and 
 thrown into the sea to leeward of all dwelling-houses. 
 The water, partly collected from the roofs of buildings 
 
 rinses out his mouth from the same water, though he sees the whole 
 bank studded with his fellows engaged in one or other stage of this 
 operation." 
 
 Mr. Charles Bentley, M.B., CM. {Brit. Med. Joum. January 25, 1902, 
 p. 190), contends that 'ground itch,' a skin disease of the feet affecting 
 coolies working in the tea gardens of Assam during the wet season, is 
 caused by the larvae of the Ankylostoma duodenale, which are hatched 
 out from the fseces deposited at random by the coolies near their ' lines.' 
 Mr. Bentley's experiments appear to bear out his contention. The larvae 
 are killed by desiccation, so that they disappear in the dry season. 
 [The deposition of faeces at random is indefensible. They should be 
 deposited methodically on a well- tilled humus, which should be planted 
 forthwith.— G.V.P.l 
 
74 IMMUNITY 
 
 during rain and partly condensed, is stored in iron and 
 cemented stone tanks and removed from all possible 
 sources of contamination." It is of course possible 
 that in a case such as this the Bacillus typhosus may 
 be lying dormant in the body ready to assert itself when 
 bodily enfeeblement reaches a certain pitch. It has 
 been asserted (and the assertion received the support of 
 the late Professor Kanthack) that the Bacillus typhosus 
 may be found in an abscess years after the attack, and 
 the same thing holds good in a less degree with regard 
 to the microbes of diphtheria and cholera. 
 
 Nothing is better established with regard to tubercle 
 than its relation to overcrowding and unwholesome 
 occupations. Three times as much tuberculous disease 
 occurs in the centre of London as at the outskirts, and 
 an hotel servant in London runs a risk of dying from 
 tubercle nearly ten times as great as that of the farm 
 labourer. In our combat with this disease we must by 
 no means confine our efforts to microbe hunting. So 
 again with * filth diseases,' we must remember that 
 almost all infective diseases are especially fatal to those 
 who live in the midst of filthy surroundings. It is not, 
 I think, at all necessary to assume, although it is 
 possibly the case, that specific organisms are growing 
 in the filth. In the cramped dwelling of the artisan, 
 where the privy is often barely six feet from the back 
 door, the risks of faecal befoulment of the food or person 
 are very great, and when in such places large pails of 
 faeces are left to putrefy for a week or more, it is not to 
 be wondered at that the inhabitants should show an 
 undue predisposition to the infection of enteric fever, as 
 has been pointed out by Boobbyer and others. But it 
 must be remembered that wherever putrefaction is 
 going on and wherever anaerobic organisms are grow- 
 
ODOURS 75 
 
 ing in a filth-sodden soil unwholesome gases, such as 
 CO2, H2S, CH4, and H, are being given off, and it is 
 impossible not to admit that the breathing of these 
 gases from week end to week end in the crowded courts 
 of a great city may so lower the vitality of the body 
 as to increase its vulnerability to infection of all kinds. 
 But these gases which are naturally given off from 
 sewers and sewer traps, from cesspools, from privies 
 and from waterlogged and filth-sodden soil are accom- 
 panied by ' odours ' which are often too subtle for the 
 chemist to analyse but which, nevertheless, are suffi- 
 ciently potent to make a strong man sick and faint and 
 to reassert themselves in the excreta twenty-four hours 
 after being inhaled. The odour given off by a tropical 
 arum at Kew some few years since during the time it 
 was in flower and just ripe for fertilisation was of a 
 kind which could only be described as appalling and 
 which made it impossible to enter the house where it 
 was growing without putting a clip on the nose and 
 holding the breath. I merely want to emphasise the 
 fact that odours may have a power which neither the 
 chemist nor the bacteriologist can gauge, and that we 
 must be ready to admit that to live in stinks and filth 
 must depress the health and increase the susceptibility 
 to infection by microbes some of which have perhaps 
 a greater measure of ubiquity than we are definitely 
 aware of. 
 
 Professor Stewart Stockman ^ reports an investiga- 
 tion which he carried out on a septic organism which 
 proved fatal to 380 fowls out of 400 on a poultry farm. 
 He says : " The most important thing about this bacillus 
 seems to me to be its fatal effect on tuberculous birds 
 while it appears to be non-pathogenic, or nearly so, 
 * Yeterinarian^ September, 1898. 
 
76 IMMUNITY 
 
 for healthy birds. It is also interesting to note that 
 it killed a rabbit affected with the coccidium oviforme 
 although the healthy ones were little affected by it. 
 This observation, I think, affords fresh evidence in 
 favour of what is taught about certain other microbes — 
 namely, that they are only pathogenic to the enfeebled 
 organism." 
 
 It is an established fact and is now universally 
 accepted that infective organisms may gain access to 
 the body through the smallest conceivable wound 
 whether of the skin or the mucous membrane. The 
 various forms of septicaemia as well as erysipelas and 
 malignant oedema are due to this cause. Tetanus, as 
 we have seen, is always due to the inoculation of a 
 wound, and it is a question whether anthrax of cattle is 
 not more often caused by inoculation of a skin abrasion 
 than hitherto has been suspected. Whether any of our 
 common infective fevers are communicable by accidental 
 inoculation is a moot point and one which is certain to 
 receive a full share of attention in the immediate future. 
 It is certain that in the transmission of plague a broken 
 skin bears a most important part, and it may be that 
 other infections may be conveyed in the same way. A 
 distinguished pathologist is credited with having in- 
 fected himself with enteric fever by a post-mortem 
 wound. The infections brought about by flies, ticks, and 
 mosquitoes are at present attracting much attention 
 from pathologists, and it seems probable that the danger 
 of certain ' soils ' and climates may be shown to be due 
 in an increasing degree to the insects which find in the 
 localities the various conditions necessary for their 
 existence. It may be that in some instances an abrasion 
 of the skin made by an insect may merely serve as a 
 point of entrance for infective organisms abounding 
 
FLIES 77 
 
 in the surface of the soil or in the immediate surround- 
 ings of the individual and having no necessary con- 
 nection with the insect itself. It seems certain, however, 
 that in the majority of instances which have been 
 worked out a particular species of insect serves as an 
 intermediary host for a specific organism which affects 
 a specific animal. We hear a good deal in a loose and 
 speculative way about flies conveying fever. This may 
 be true, but we must always bear in mind what I feel 
 inclined to call the excessive specialism of nature. 
 Insects which feed on dung and carrion are seldom 
 attracted by the food of human beings, and I confess to 
 being somewhat sceptical as to the accidental conveyance 
 of infection by * flies ' which heedlessly buzz first into 
 the faeces and then into the milk. The pathologist of 
 the future will clearly have to call in the help of the 
 entomologist. 
 
78 PRACTICAL CONSIDERATIONS 
 
 CHAPTEK IX 
 
 PRACTICAL CONSIDERATIONS 
 
 The Maidstone epidemic has been very useful in 
 directing attention to some of the common conditions 
 which endanger water-supplies. Pasteur and all sub- 
 sequent bacteriologists have directed attention to the 
 value of the earth as a filter, and it is a matter of 
 common knowledge that a very shallow layer of compact 
 earth will remove the bacteria and much of the organic 
 matter from water percolating through it. 
 
 The greatest danger to shallow wells is to be found 
 in subterranean collections of filthy fluids which leak 
 through fissures in the earth, and with a gradually 
 increasing hydraulic pressure. If there be no such 
 dangers in the immediate neighbourhood, then a 
 properly constructed shallow well is safe. The lined 
 well five feet deep which I have in the middle of my 
 garden has given water of exceptional purity for years, 
 notwithstanding that the ground is cultivated with 
 human excreta to within six or seven feet of the well. 
 Dr. Macmartin Cameron, medical ofiicer of health for 
 Kirkcudbright and Wigtown,^ shares my opinion that a 
 * surface well ' properly constructed and in a selected 
 situation is a safe source for water. Dr. Cameron's 
 paper embodies much experience obtained in his official 
 
 ' Brit. Med. Jour. August 13, 1898. 
 
SHALLOW WELLS 79 
 
 capacity, and many of his observations are worthy of 
 quotation as showing some of the limits of danger 
 and safety in relation to shallow wells. 
 
 " The construction of new village wells. — When the 
 wells of a village are shown to be contaminated, and 
 a new water supply becomes imperative, it is not, as 
 a rule, necessary — not, at least, in the province of 
 Galloway, for which I have the honour to be medical 
 officer of health— to press on a gravitation scheme 
 as the only way of meeting the difficulty. A simple 
 and inexpe -sive well scheme will often suffice. All 
 that is requisite is to sink new wells outside the 
 precincts of the village on higher ground if practicable. 
 Commonly enough, the selfsame water that feeds the old 
 wells may be tapped at a point before it has entered 
 the polluted ground of the village. All that is then 
 required to secure perpetual immunity from pollution 
 is to obtain possession of a sufficiency of ground around 
 each well to be devoted for all time to purposes of 
 filtration. With a sufficient reserve (anything, say, 
 from half to one acre, according to circumstances) 
 little or no danger will accrue from ordinary agricultural 
 operations beyond, but it would be better that as much 
 as possible of the outlying ground should be left under 
 grass. There is no safer or better water than that 
 which a surface well in an old grass park can be got 
 to yield. This is an ideal site. I should have no 
 fear even of a top dressing of manure, provided the 
 ground in the immediate vicinity of the well were not 
 profaned. 
 
 " Professor Hunter Stewart (Edinburgh) remarked 
 that Dr. Vivian Poore's experiment with a six-feet 
 well carefully cemented at the sides gave water which 
 contained seven micro-organisms to the cubic centi- 
 
8o PRACTICAL CONSIDERATIONS 
 
 metre and the Bacillus coli was conspicuous by its 
 absence. A part of the supply of the city (Edinburgh) 
 was from wells near the Pentland Hills, not more 
 than eight feet deep, situated in highly manured land, 
 and exposed to pollution from neighbouring middens. 
 From the water of these particular wells of a maximum 
 of eight feet in depth, he found a maximum of micro- 
 organisms of eleven to the cubic centimetre, and a 
 minimum in three out of eight wells of absolute sterility. 
 These observations abundantly supported the observa- 
 tions of Dr. Poore." ^ 
 
 Keverting to the conditions which obtained at 
 Maidstone, I will mention a few considerations which, 
 though obvious enough, are often neglected. During 
 a drought, such as occurred in June, July, and August, 
 not only would the stiff hop land be liable to crack, 
 but the earthworms would retire to the lowest point in 
 search of moisture. At such times they go deeper and 
 deeper into the soil, and lie coiled up in oval knots 
 at the bottom of their burrows. I have upon the 
 table a piece of a worm -burrow removed from my 
 garden in September last at a depth of more than 
 two feet. It is more than a quarter of an inch in 
 diameter, and would act as a drain from the surface 
 to the deeper parts. This question of worm-burrows 
 is one of great practical importance to sanitarians, 
 because, especially after a drought, they may serve 
 to conduct surface water to considerable depths without 
 its really being influenced by that biological filter, 
 the humus. Darwin ^ says that although worms gene- 
 rally live near the surface they may burrow to a 
 considerable depth during long-continued dry weather 
 and severe cold ; the depth varies with the soil. 
 
 ' See p. 126. "^ Vegetable Mould and Earthworms, p. Ill c^ seq. 
 
EARTHWORMS 81 
 
 " In a bed of fine sand overlying the chalk which 
 had never been disturbed, a worm was cut into two 
 at fifty-five inches, and another was found here at 
 Down in December at the bottom of its burrow at 
 sixty-one inches beneath the surface. Lastly, in earth 
 which had not been disturbed for many centuries a 
 worm was met with at a depth of sixty- six inches, and 
 this was in the middle of August. The burrows are 
 lined with viscid earth, voided by the worm, which 
 gives at once smoothness and a certain amount of 
 durability to the burrow." 
 
 Then, again, we must not forget the effect of harvest 
 on the soil. Before harvest the amount of moisture 
 retained upon the growing plant and absorbed by the 
 still active root would prevent anything except the 
 heaviest rain from penetrating, although even at such 
 a time one must admit that even half a pint of water, 
 if thrown on a suitable place, might travel via clay- 
 crack and worm-burrow to a depth of five feet or more. 
 When harvest begins not only is the earth deprived 
 of its green protecting mantle, but the upward drainage 
 of the root action ceases, and with the falling tempera- 
 ture of autumn and the lessened evaporation the 
 rain which falls has an ever-increasing power of 
 penetrating the soil. In a hop garden the first step 
 in harvesting is the removal of the pole, and the hole 
 thus left is capable of conducting rain water to a 
 depth in the soil of two feet or more. If, therefore, 
 there be open-jointed stoneware pipes in a hop garden 
 at a depth of two or three feet from the surface, it 
 is possible, nay, likely, that when the hop-poles are 
 removed a surface channel three or four inches in 
 diameter may communicate with these pipes and a 
 
 G 
 
82 PRACTICAL CONSIDERATIONS 
 
 heavy rain may wash solid matters into them from 
 the surface. 
 
 There are other practical matters which need con- 
 sideration in relation to liability of springs to suffer 
 from surface contaminations. If a plant or tree dies 
 — be it hop, beech, hazel, or what not— the roots, 
 instead of helping the upward drainage of the soil, 
 and preventing surface water from reaching the springs, 
 may serve as a direct guiding channel from the surface 
 to the spring. And if the spring be artificially main- 
 tained by under-draining it with open-jointed pipes 
 (an operation which involves a considerable disturbance 
 of the ground and its artificial re-making), this danger 
 is considerably increased. Burrowing animals are 
 necessarily a danger in this connection, and if rats 
 or rabbits establish themselves anywhere near the out- 
 crop of a spring, they must be exterminated. Eats 
 and rabbits sometimes burrow very deeply, but I have 
 not been able to get any authentic statement as to 
 the maximum depth in the soil to which they may 
 penetrate. Eats are animals which the sanitarian is 
 bound to regard with some suspicion. In relation to 
 the plague they seem to be a very definite danger, 
 and when they crawl from the sewers (their favourite 
 lurking place in towns) to our houses it is possible 
 that they may be at least as dangerous as sewer gas. 
 Eats occasionally make their homes in dung-heaps, 
 especially if such heaps be made in outlying places 
 and are long neglected. It is well known that they 
 invade cornricks, in spite of elaborate precautions, 
 but it is safe to regard the rat as a haunter of foul 
 places and a lover of filth, and its presence among us 
 is often due to our permitting accumulations of filth, 
 and our delay in putting filth to its proper use. 
 
SPRINGS 83 
 
 Although it is probable that a very few inches of 
 soil may, if properly tilled and cultivated, serve as an 
 efficient protection to the subsoil water, we must never- 
 theless be mindful of the accidents which may serve to 
 conduct filth from the surface to the springs. The 
 danger of having a catch-pit flooded from the surface is 
 one which can easily be guarded against by covering 
 with suitable structures. The ground above the outcrop 
 of a spring ought to be carefully turfed to a point which 
 is six or seven feet above the level of the spring. A 
 spring used as a water-supply must be very carefully 
 watched. If the water become turbid or if a worm find 
 an entrance to the catch-pit the use of such water should 
 be discontinued, or it must be boiled and filtered until 
 the cause of the turbidity be satisfactorily demon- 
 strated. Such springs should always be carefully 
 inspected during heavy rains, because it is at such 
 times especially that shallow springs establish surface 
 relations. 
 
 The question arises whether it is safe to allow the 
 gathering ground of a spring to be cultivated. This is 
 a national question of the very greatest importance. 
 No nation which is dependent upon its native soil for 
 food production could possibly afford to raise such a 
 question. What would a Chinese say if you told him 
 that the water of his well contained a trace of ammonia 
 and had a permanent hardness above the local standard, 
 and therefore his tea-gardens and rice-fields must remain 
 unmanured and be converted to permanent pastures ? 
 His answer to the * foreign devil ' who ventured to pro- 
 pound such a theory had better go unrecorded. But in 
 China they boil the water before drinking it and they do 
 not seek to fix the responsibility for the absolute purity 
 of the water of a district upon a single underpaid 
 
84 PRACTICAL CONSIDERATIONS 
 
 individual ; nor do they talk about ' manslaughter ' 
 when a break-down in the arrangements from some 
 cause, natural or artificial, brings about an outbreak of 
 disease. 
 
 Provided there be a fairly thick layer of earth above 
 the spring I am inclined to think that there is safety 
 rather than danger in the cultivation of the overlying soil. 
 Any spring which is covered by seven feet of soil — that 
 is, six inches more than the depth of the deepest 
 recorded earthworm — might be considered safe from the 
 risk of unchanged organic matter soaking into it from 
 above. ^ In the first place, the cultivation of the land 
 ensures that it is visited more or less frequently by 
 individuals more or less intelligent. A gathering ground 
 for water which is remote from the haunts of man has 
 dangers of its own. Eats or rabbits may burrow in it 
 and these as well as other animals and birds may pro- 
 vokingly die in the runnels which primarily collect the 
 rain-water, and I cannot understand how anybody who 
 has ever walked over a moor can maintain the thesis 
 that water running off a neglected waste is safer to drink 
 than that which has percolated through well-cultivated 
 land. 
 
 Last year I visited a spring which was being used 
 for public purposes and which was and had been sup- 
 plying water of excellent quality. The spring, which 
 rose in a little copse lying in a natural dell in a remote 
 and seldom visited spot, was enclosed and protected 
 against surface washings which the configuration of the 
 ground would certainly conduct towards it in times of 
 flood. Some of the trees were dead and their stumps 
 
 • For the same reason, although I agree with Dr. M. Cameron, I am 
 of opinion that the first eight feet of all ' shallow ' wells should have an 
 impermeable lining. 
 
ENTERIC FEVER 85 
 
 and roots were permeated with fungi and were rotten, 
 and one could not but regard it as possible that these 
 rotten roots might serve as conducting channels from 
 the surface to the water which was running beneath to 
 the neighbouring town. Possibly the workings of 
 rabbits or other burrowing beasts had hastened the 
 death of some of the trees. If so, the burrows might 
 run very close above the gathering water. Further, 
 there was evidence to show that this dell was visited by 
 an occasional tramp and had been made a playground 
 by the children from the nearest group of cottages. It 
 is clear that the non-cultivation of this particular spot 
 was a source of danger rather than of safety to the purity 
 of the spring. 
 
 Enteric fever is a disease especially liable to become 
 epidemic in the autumn. The autumn is the time of 
 year when after removal of the crops the parched 
 earth is soaked, and it is also the time of year when 
 there are large accumulations of manurial matters 
 waiting to be spread upon the land. In the summer 
 the yield of springs is seldom increased no matter how 
 heavy may be the rains. The water which falls upon 
 the earth is all absorbed by the roots of growing plants 
 and to a large extent mounts upwards in the plant to 
 help metabolism and to quicken growth. With the 
 ripening and harvesting of the crops root action ceases, 
 water which falls upon the earth tends more and more 
 to percolate, and when the early frosts have given their 
 death-blow to the greenery of summer then the springs 
 begin to rise and to yield more water. The nitrification 
 and final solution of organic matter in the soil goes 
 forward mainly, if not entirely, in the upper layer, and 
 it is doubtful if any appreciable amount of oxidation 
 takes place in the parts which are beyond the reach of 
 
86 PRACTICAL CONSIDERATIONS 
 
 tillage. A certain proportion of the mineralised organic 
 matter necessarily escapes absorption and percolates 
 with the water, and if there be much unused nitrates 
 remaining in the soil after harvest the amount which 
 percolates to the springs may be considerable. If 
 nitrates be placed upon the soil in the form of artificial 
 manures they are often dissolved and washed beyond 
 the reach of plant roots with the first heavy shower. 
 Not only nitrates but soluble salts of ammonia are 
 placed on the ground in large quantities, and the 
 presence of free ammonia in the drainage water of culti- 
 vated land which has been artificially manured need 
 not be an indication of pollution in the proper sense. 
 It must be very hazardous to draw just conclusions as 
 to the wholesomeness or otherwise of water from the 
 amount of nitrates in it. 
 
AGRICULTURE 87 
 
 CHAPTEE X 
 
 AGBIC ULTUBE 
 
 The facts with which we have been dealing in these 
 lectures show: — 1. That there are certain organisms 
 which are indigenous to the soil and ubiquitous. These 
 organisms, if they contaminate a surgical wound or are 
 inoculated, may cause septicaemia, erysipelas, malignant 
 oedema, or tetanus. They are very possibly necessary 
 saprophytes, and we recognise that it is useless to attempt 
 to * stamp out ' the germs of these surgical contagia, 
 although (thanks to Lord Lister) the surgeon is able to pro- 
 tect his patient from the evils which arise from them and 
 to prevent their cultivation in hospitals. Apart from acci- 
 dental inoculation these organisms are not dangerous. 
 We must often swallow them with our food and drink 
 and inhale them with our breath and no practical harm 
 results. These contagia are persistent in the soil and 
 are probably most common in soils which are richest in 
 organic matter. 2. The contagium of anthrax is appa- 
 rently difficult to eradicate from a soil which has once 
 been contaminated with it. This is probably due to the 
 fact of sporulation and to the spore being very resistant 
 to external influences of all kinds. The evidence, such 
 as it is, points to the fact that in temperate countries 
 at least the contagium dies out of the soil in time. 
 M. Pasteur's experiments were vitiated by the circum- 
 
88 AGRICULTURE 
 
 stance that they were made in districts where the 
 disease was and had been rife. More information is 
 needed as to how far the infection of animals depends 
 upon wounds of the skin or mucous membrane and on 
 the vulnerability of the animals by the mal -hygienic 
 conditions in which they live. It is possible that in 
 tropical countries the Bacillus anthracis is indigenous to 
 the soil. Man apparently does not acquire anthrax by 
 inhaling or swallowing pulverised earth. He is always 
 infected through the medium of infected animals or their 
 skins, flesh, or wool. 3. To what extent malaria is 
 directly a soil disease, apart from the mosquito as a 
 connecting link, is in the present state of our knowledge 
 doubtful. There is no doubt, however, that malaria 
 disappears before drainage and cultivation. 4. With 
 regard to enteric fever, diarrhoea, plague, and some 
 other diseases there can be no doubt that they are all 
 favoured by filth, although we are ignorant of the precise 
 way in which filth favours the occurrence of these 
 diseases. Some might say that a filth disease is a soil 
 disease and that there is no line of demarcation between 
 the two. This is true, but it is nevertheless very 
 necessary for practical purposes to distinguish the one 
 from the other. We are all agreed that it is dangerous 
 to allow the purlieus of a house to become sodden with 
 liquid filth, but it might be equally dangerous to the 
 public health to encourage the idea that it is dangerous 
 to dung the land for fear of inoculating it with infectious 
 disease. Happily from the laboratories we get comfort 
 in this matter. Sidney Martin has shown (as Dempster 
 had previously shown with regard to peat) that * virgin 
 soil,' whether sandy or peaty, is, even when sterilised, 
 fatal to the Bacillus typhosus, and one naturally asks. 
 What is virginity ? and whether cultivated soils by 
 
DUNG 89 
 
 excessive production do not tend, paradoxical as the 
 question may sound, to return to that condition of vir- 
 ginity in which they are able to grapple with infective 
 organisms ? The evidence goes to show that cultivation 
 and production are the enemies of dung infections. 
 Robertson and Gibson found that a growth of grass was 
 fatal to the Bacillus typhosus. That dung contagia 
 must be destroyed or their virulence be diminished by 
 tillage is self-evident. Were it otherwise our race must 
 long since have been extinguished. The race which has 
 shown the greatest persistence in this world (the 
 Chinese) is precisely that one which has systematically 
 inoculated its native soil with dung contagia for three 
 or four millennia. Politically they are said to be sick, 
 but physically and economically they are * going strong ' 
 and are likely to continue. 5. The fact that most of 
 the alleged soil diseases are more rife in the crowded 
 centres of population than in the rural districts is a fact 
 which must not be lost sight of. Whether this be due to 
 the greater vulnerability of town populations or to the 
 soakage of the purlieus of the house from leaking sewers 
 it is difficult to say. In any case it is incontestable 
 that soil diseases (so-called) are most rife precisely in 
 those spots where the ground is not cultivated. 
 
 Infective organisms contained in dung have to run 
 the gauntlet of many enemies, such as dogs, sparrows, 
 rats, flies, maggots, beetles, earthworms, moles, sunlight, 
 fresh air, innumerable saprophytes (both aerobic and 
 anaerobic), and the chemical action of the roots of 
 plants. Of course, there may be spores which emerge 
 from these ordeals unharmed and still virulent, but it is 
 evident that, being mortal as we are, they are likely to 
 succumb before the digestive and disintegrating processes 
 which they encounter. The bulk of the evidence goes 
 
90 AGRICULTURE 
 
 to show that contagia must be largely destroyed in the 
 soil and that agriculture is really the corner-stone of 
 preventive medicine. It becomes of great importance, 
 therefore, to devise means by which ^ the fertilising 
 material of our towns may be applied to the soil with 
 safety and despatch. 
 
 I may be pardoned for reverting to the method of 
 dealing with human excreta which I have practised now 
 for twelve years in my experimental garden at Andover : 
 (1) the excreta are moved every day so that there is no 
 accumulation of filth near the dwelling ; (2) they are 
 put just below the surface of freshly-dug ground so that 
 they are out of the reach of flies ; and (3) the ground is 
 planted with plants of the cabbage order as quickly as 
 may be, so that very soon there is no possibility of dust 
 being blown off the surface of the ground, and the mass 
 of living cabbage leaves freshens the air. I cannot 
 believe that dust from agricultural land is a danger in 
 this country, whatever it may be in the tropics. In my 
 garden the ground treated in the manner stated, apart 
 from the growth of cabbages, soon becomes coated with 
 a green growth of algae. Mr. A. Gepp, of the Natural 
 History Museum, who visited my garden in 1898, took 
 some of this growth away and very kindly examined 
 it and he pronounced it to consist of algae — " chiefly 
 Vaucheria sessilis (in good fruiting state) with a little 
 ulothrix, a gloeocystis, and an oscillatoria." Such a 
 growth effectually prevents the possibility of dust. 
 
 Dr. Samuel Hyde,^ speaking on the open-air 
 treatment of consumption, says : " Sparseness of vege- 
 tation, like thinness of population, is a climatic factor 
 favourable to the treatment of consumption. Where 
 vegetable life abounds there vegetable decomposition 
 • J3n^ Mod. Jour. October 8, 1898. 
 
VEGETATION 91 
 
 must also abound and vice versa. Wherever there is life 
 we have a corresponding amount of death accompanied 
 necessarily by the products of decomposition." This is 
 quite true and our experience teaches us that, provided 
 the supply of food be adequate, a high level of health 
 may be maintained in places where there is little or no 
 vegetation, as upon the sea and on alpine heights and 
 in arctic solitudes. " Wherever there is life," says Dr. 
 Hyde, " we have a corresponding amount of death." 
 That is true, but the converse is also true, and we may 
 say that wherever there is death we have the potentiality 
 of a corresponding amount of life. I believe that what 
 I have called the circulation of organic matter is a 
 beneficent fact from which there is no escape, and that 
 whether we derive good or ill from the inevitable 
 processes of death and decay depends very much upon 
 ourselves. We must never forget that vegetation 
 purifies the soil, freshens the air, rests the eye, and 
 prevents dust, and these facts must be recognised as to 
 a great extent counterbalancing the evils of dead leaves. 
 There are always pros and cons which have to be 
 weighed. Nothing makes entirely for good or entirely 
 for evil and we have always to balance our accounts and 
 to see whether the general effect be good or ill. The 
 British sanitarian is so circumstanced that he need 
 not trouble himself at all about the most important of 
 all sanitary considerations — viz. food-supply. He is 
 busy in burning or washing into the sea every kind of 
 fertilising matter, and if a general coal strike or a war 
 were suddenly to bring famine with its attendant 
 diseases to our doors he would protest that that was no 
 concern of his. With our steadily diminishing birth- 
 rate and the daily increase of institutions for the recep- 
 tion of those whose moral, mental, or physical diseases 
 
92 
 
 AGRICULTURE 
 
 prevent them from earning their own living, it is difficult 
 to believe that the stamina of our highly civilised urban 
 populations is increasing. Apart from the question of 
 food-supply, it is, I believe, absolutely necessary to 
 encourage agriculture in order that our race may be 
 maintained in vigour. The strong contrast which exists 
 between the agriculturist and the town worker in the 
 matter of health is well known. 
 
 Table {deduced from Table IV. of the Supplement to 
 the Fifty-fifth Beport of the Registrar-General) 
 showing the mortality from certain specified causes 
 in each of three sections of occupied males^ as com- 
 pared with that among all occupied males, the mor- 
 tality of the latter being taken as 100 in each case. 
 
 All causes 
 
 Influenza 
 
 Alcoholism 
 
 Eheumatic fever .... 
 
 Gout 
 
 Cancer 
 
 Phthisis 
 
 Diabetes 
 
 Diseases of the nervous system . 
 Diseases of the circulatory system 
 Diseases of the respiratory system 
 Diseases of the liver . 
 Other diseases of the digestive) 
 system . . . . i 
 Diseases of the urinary system . 
 
 Accident 
 
 Suicide 
 
 Other causes .... 
 
 h 
 
 III 
 
 upied 
 briots 
 
 llll 
 
 a 
 
 |!^3 
 
 ^^|5 
 
 i^U 
 
 < 
 
 
 
 < 
 
 100 
 
 120 
 
 131 
 
 72 
 
 100 
 
 100 
 
 100 
 
 100 
 
 100 
 
 138 
 
 146 
 
 54 
 
 100 
 
 100 
 
 114 
 
 86 
 
 100 
 
 300 
 
 100 
 
 100 
 
 100 
 
 134 
 
 109 
 
 91 
 
 100 
 
 150 
 
 121 
 
 73 
 
 100 
 
 114 
 
 100 
 
 100 
 
 100 
 
 107 
 
 132 
 
 77 
 
 100 
 
 107 
 
 122 
 
 75 
 
 100 
 
 124 
 
 166 
 
 51 
 
 100 
 
 111 
 
 119 
 
 89 
 
 100 
 
 100 
 
 129 
 
 82 
 
 100 
 
 137 
 
 122 
 
 78 
 
 100 
 
 86 
 
 105 
 
 79 
 
 100 
 
 129 
 
 114 
 
 86 
 
 100 
 
 91 
 
 130 
 
 76 
 
 Dr. Tatham's letter to the Kegistrar- General on the 
 mortality of males engaged in certain occupations in 
 
COMPARATIVE MORTALITY 
 
 93 
 
 the three years 1890-92, which constitutes Part II. of 
 the Supplement to the Fifty-fifth Annual Keport to 
 the Eegistrar-General, shows clearly enough that the 
 agricultural classes in this country enjoy a large 
 measure of health. Dr. Tatham's statistics refer to 
 occupied males between the ages of twenty-five and 
 sixty-five years, and the tendency to disease and death 
 is indicated by a mortality figure, the mortality for all 
 males between twenty-five and sixty-five years of age 
 being taken as 100. The preceding table (p. 92) taken 
 from p. 18 of this report shows the mortality of three 
 great classes of the community with perfect clearness. 
 
 — 
 
 1 
 
 ll 
 
 ?.2 
 
 1 
 
 -1 
 
 Is 
 
 1 
 
 if 
 
 ii 
 
 j 
 
 Ii 
 ^1 
 
 1 
 
 
 i 
 
 
 < 
 
 1 
 
 l^ 
 
 
 •c 
 
 bo 
 
 < 
 
 1 
 
 All causes 
 
 100 
 
 72 
 
 63 
 
 64 
 
 59 
 
 53 
 
 66 
 
 70 
 
 58 
 
 Influenza 
 
 100 
 
 100 
 
 109 
 
 112 
 
 115 
 
 112 
 
 112 
 
 118 
 
 82 
 
 Alcoholism . 
 
 100 
 
 54 
 
 31 
 
 31 
 
 46 
 
 31 
 
 31 
 
 31 
 
 31 
 
 Eheumatic fever . 
 
 100 
 
 86 
 
 86 
 
 71 
 
 86 
 
 71 
 
 71 
 
 57 
 
 100 
 
 Gout .... 
 
 100 
 
 100 
 
 50 
 
 50 
 
 50 
 
 100 
 
 50 
 
 50 
 
 50 
 
 Cancer .... 
 
 100 
 
 91 
 
 82 
 
 84 
 
 82 
 
 77 
 
 82 
 
 86 
 
 82 
 
 Phthisis 
 
 100 
 
 73 
 
 57 
 
 63 
 
 43 
 
 44 
 
 62 
 
 70 
 
 61 
 
 Diabetes 
 
 100 
 
 100 
 
 86 
 
 86 
 
 143 
 
 167 
 
 71 
 
 71 
 
 57 
 
 Diseases of nervous sys- 
 
 
 
 
 
 
 
 
 
 
 tem .... 
 
 100 
 
 77 
 
 62 
 
 63 
 
 62 
 
 50 
 
 65 
 
 71 
 
 57 
 
 Diseases of circulatory 
 
 
 
 
 
 
 
 
 
 
 system 
 
 100 
 
 75 
 
 66 
 
 68 
 
 61 
 
 52 
 
 71 
 
 75 
 
 61 
 
 Diseases of respiratory 
 
 
 
 
 
 
 
 
 
 
 system 
 
 100 
 
 51 
 
 52 
 
 49 
 
 41 
 
 29 
 
 58 
 
 57 
 
 48 
 
 Diseases of the liver 
 
 100 
 
 89 
 
 63 
 
 59 
 
 96 
 
 81 
 
 48 
 
 56 
 
 63 
 
 Other diseases of diges- 
 
 
 
 
 
 
 
 
 
 
 tive system 
 
 100 
 
 82 
 
 82 
 
 75 
 
 96 
 
 75 
 
 79 
 
 75 
 
 64 
 
 Diseases of urinary sys- 
 
 
 
 
 
 
 
 
 
 
 tem .... 
 
 ilOO 
 
 78 
 
 59 
 
 59 
 
 71 
 
 68 
 
 51 
 
 56 
 
 63 
 
 Accident 
 
 100 
 
 79 
 
 63 
 
 68 
 
 53 
 
 54 
 
 74 
 
 77 
 
 39 
 
 Suicide .... 
 
 ■100 
 
 86 
 
 71 
 
 71 
 
 100 
 
 129 
 
 57 
 
 50 
 
 71 
 
 All other causes . 
 
 100 
 
 76 
 
 73 
 
 76 
 
 65 
 
 61 
 
 79 
 
 86 
 
 61 
 
94 AGRICULTURE 
 
 The preceding table (p. 93) which is deduced from 
 Table IV. shows the mortality from certain specified 
 causes in the agricultural class as a whole and in its 
 several divisions as compared with the standard mor- 
 tality among all occupied males, the latter being taken 
 as 100. 
 
 Out of the sixteen causes specified in this table, 
 there is only one in which the mortality of agriculturists 
 as a class exceeds that of occupied males generally. 
 The exception is influenza, the mortality from which 
 disease shows an excess equal to 9 per cent. The chief 
 excess under this heading probably occurred in the first 
 quarter of the year 1892, which was marked by a severe 
 outbreak of influenza specially affecting the country 
 districts. The mortality among agricultm'ists from 
 phthisis does not exceed 57 per cent., and that from 
 diseases of the respiratory system does not exceed 
 52 per cent, of the standard mortality among occupied 
 males, and their mortality from all other diseases of 
 the local class is considerably below the same standard. 
 
 These tables show conclusively that agriculturists 
 are among the healthiest class in the community and 
 that even the farm labourer in the matter of health is 
 83 per cent, better than the average. This is a matter of 
 great interest and importance. He is often represented as 
 half-starved, miserably housed, a martyr to rheumatism 
 and poisoned by filthy water. As a matter of fact as 
 regards sobriety and health he might be taken as a 
 model by the rest of the industrial classes. There is 
 another point of view from which agriculture is of 
 great importance. We are beginning to find out that a 
 factory hand who has to keep pace with steam machinery 
 becomes * too old for his work ' at a comparatively 
 early age. Defects of eyesight or hearing or a lessening 
 
OLD-AGE PENSIONS v. A GARDEN 95 
 
 of acuteness and nimbleness soon unfit a man for 
 employments where dexterity is of more importance 
 than experience. There has been much talk of late of 
 * old-age pensions,' but it must be admitted that even if 
 the financial difficulties of the question could be over- 
 come the prospect of being without employment and 
 existing on a pittance without any true interest in life 
 after the age of fifty-five years is not cheerful. I believe 
 that the practice of agriculture is the only remedy for 
 this, and that the best old-age pension will be found in 
 the possession of an acre or so of land. Not only are 
 the ordinary horticultural operations all possible for a 
 man long after he is capable of attending to machinery, 
 but such a possession would give him an interest in 
 life and he would find that the productiveness of his 
 land would certainly increase with time and in direct 
 proportion to the amount of skill and labour expended 
 in tillage and cultivation and the quantity of organic 
 manure placed upon the soil. 
 
 The greatest need of our country at the present day 
 I believe to be an increase in the facilities for the 
 transfer of land. Many of the above facts appear to 
 show that the practice of agriculture is absolutely 
 essential, apart from the question of food, for the 
 maintenance of the vigour of our race. Anything 
 which discourages or increases the difficulties of 
 agriculturists can hardly be in the interests of the 
 public health. 
 
96 
 
 FERTILITY OF THE SOIL 
 
 CHAPTER XI 
 
 THE MAINTENANCE OF THE FERTILITY OF THE SOIL 
 
 There is much evidence to show that dung is absolutely 
 necessary to maintain the fertility of the soil. In a 
 paper by Sir John Lawes and Sir Henry Gilbert on 
 the valuation of unexhausted manures * the difference 
 between organic manures and mineral manures is well 
 brought out. The lasting effects produced by farmyard 
 manure (14 tons to the acre) are shown in the annexed 
 table : 
 
 Table I. — Experiments with Farmyard Manure on 
 Permanent Grass Land, 
 
 
 every 
 Year 
 
 Manured 
 
 1866-63, 
 
 Uumanured 
 
 since 
 
 Excess of 
 
 Mauuitjd 
 
 over 
 
 TJnmanured 
 
 8 years 1856-63 \ 1st crops J 
 
 12 years 1864-75 | only i 
 
 20 years 1876-96 (1st and 2nd 
 
 crops) .... 
 
 Cwt. 
 
 ill 
 
 25i 
 
 Owt. 
 
 m 
 
 291 
 
 Cwt 
 4 
 
 In only one year — 1893, a year of drought — did 
 the manured plot give less produce than the unmanured. 
 The authors say : * It is true that the application of 
 14 tons of farmyard manm'e per acre per annum for 
 eight years in succession is an unusually heavy dress- 
 ' Journal of the Royal Agricultural Society, vol. viii. 1897, p. 674. 
 
BARLEY 
 
 97 
 
 ing ; but it is of interest to know that the residue was 
 very materially effective for some years, and that it 
 was more or less so for THIETY-TWO YEAKS after 
 the application " (the capital letters are my own). The 
 following table giving experiments with barley tells the 
 same tale. 
 
 Table II. — Experiments with Barley, 1852-96. 
 
 
 Un- 
 
 manured 
 
 every 
 
 Year 
 
 Mixed 
 Minerals 
 every Year 
 (no nitro- 
 gen) 
 
 Farmyard Manure 
 
 Every 
 Year 
 
 20 Years 
 
 1852-71 ; 
 
 TJnmanured 
 
 since 
 
 20 years 1852-71 . 
 25 years 1872-96 . 
 
 Bushels 
 20 
 12| 
 
 Bushels 
 27i 
 161 
 
 Bushels 
 48i 
 49i 
 
 Bushels 
 48i 
 29 
 
 The above table shows that the effect of the farm- 
 yard manure is very appreciable for at least a quarter 
 of a century. It also shows that when farmyard 
 manure was used every year the yield for the final 
 twenty-five years was greater than in the first twenty 
 years. And also that the increase by using mineral 
 manures without nitrogen is appreciable but slight. 
 The use of rape-cake as an organic manure for barley 
 gave interesting results which are set forth in Table III. 
 
 Table III. — Bape-cake as a Manure for Barley 1852-91. 
 
 - 
 
 Rape-cake alone 
 
 Rape-cake with mixed 
 
 Mineral Manures and 
 
 Nitrate of Soda 
 
 20 years 1852-71 
 „ ,, 1872-91 
 
 Bushels per acre 
 
 Bushels per acre 
 49f 
 41^ 
 
 It is to be noticed that the reduction in produce in 
 the second twenty years as compared with the first 
 amounted to more than eight bushels per acre. The 
 
98 
 
 MAINTENANCE OF FERTILITY 
 
 reduction in the second twenty years was, in the opinion 
 of the authors, mainly due to less favourable seasons, 
 but nevertheless it is shown that the yield with farm- 
 yard manure for the twenty-five years 1872-96 was 
 49 bushels as against 48J for the twenty years 1852-71. 
 The experiments made in growing clover on rich garden 
 soil are of great interest. This has been done for forty 
 years in a part of the Kothamsted kitchen garden which 
 has been in cultivation for two or three centuries. The 
 average yield for the forty years was 59^ cwt., or nearly 
 three tons of hay, which *' would be a very good yield for 
 the crop grown only occasionally in the ordinary course 
 of agriculture." The average yield in the first ten years 
 was much greater than in the subsequent thirty years, 
 and averaged 95^ cwt., and the maximum yield appears 
 to have been about 148 cwt., or nearly seven and a half 
 tons to the acre. In 1857, after the removal of the 
 crops of the fourth year of the experiment, the surface 
 soil nine inches deep contained four times as much 
 nitrogen as the average of the Eothamsted arable soils 
 to the same depth, and nearly five times as much as 
 the exhausted arable land where red clover had failed. 
 The experiments on wheat with artificial manures are 
 equally instructive. 
 
 Table 1Y.— Showing the Yield of Wheat in Bushels 
 per Acre, 
 
 
 
 Mixed Mineral Manure — 
 
 
 
 y\^ 
 
 
 " 
 
 
 
 And 
 
 Period 
 
 
 
 
 NH, 172 lb. N 
 
 
 Alone 
 
 AndNH, 
 
 AndNH, 
 
 for first 13 years 
 
 
 86 lb. N. 
 
 129 lb. N. 
 
 (1862-64) ; un- 
 
 
 
 
 
 manured for 
 
 
 
 
 
 last 19 years 
 
 
 Plots 
 
 Plot: 
 
 Plots 
 
 Plot 16 
 
 13 years 1852-64 . 
 
 18f 
 
 37| 
 
 39 
 
 39^ 
 
 19 years 1865-83 . 
 
 l^ 
 
 291 
 
 m 
 
 14| 
 
WHEAT 99 
 
 In the above experiments we find, no dung being 
 used, that the yield is less in the second period than in 
 the first, and that when the large amounts of artificial 
 manure were withdrawn in Plot 16 the yield dropped 
 almost at once. The authors say : " There is, in fact, 
 abundant evidence to show that there is but little effective 
 manure residue after the growth of a grain crop by the 
 application of ammonium salts ; and there is little doubt 
 that the produce of one and a half bushels of grain and 
 its straw per acre per annum more over the nineteen years 
 after the cessation of the application of ammonium salts 
 than on Plot 5 with the mineral manure alone is, so far as 
 it is to be attributed to residue, mainly due to the increased 
 crop residue — stubble and roots accumulated during the 
 thirteen years of the application ; and much the same 
 may be said of the after-effects when grain crops have 
 been grown with nitrate of soda." Again : " When 
 organic matter, animal or vegetable, is applied to the 
 soil as manure, its complete decay and the complete 
 liberation of its fertilising constituents extend over a 
 considerable period of time. Poor land cannot be 
 suddenly brought into condition by the consumption on 
 the farm of purchased foods. Nor can condition — that 
 is, accumulated fertility — be at once withdrawn by 
 suddenly stopping the use of foods." 
 
 Food-supply. — Sir William Crookes, the President 
 of the British Association, in his address (Bristol, 1898) 
 drew attention to the fact that if population continued 
 to increase we might expect to be short of wheat. Our 
 remedy was to increase the fertility of the wheat-growing 
 area of the world, and taking, as was perhaps but 
 natural, a purely chemical view of fertility, he put 
 forward the proposition that the productiveness of the 
 
loo MAINTENANCE OF FERTILITY 
 
 soil might be expected to bear a direct ratio to the 
 amount of fixed nitrogen which is applied to it, and he 
 found comfort in the fact that after the exhaustion of 
 the nitre beds of Chili and the guano beds of Peru, the 
 chemist of the future would be able, by the aid of 
 electricity generated by Niagara and other natural 
 forces, to fix the atmospheric nitrogen for the benefit of 
 the farmer. In the course of his address Sir William 
 Crookes made allusion to the sewage question in the 
 following words : 
 
 " There is still another and invaluable source of fixed 
 nitrogen. I mean the treasure locked up in the sewage 
 and drainage of our towns. Individually the amount so 
 lost is triflmg, but multiply the loss by the number of 
 inhabitants, and we have the startling fact that in the 
 United Kingdom we are content to hurry down our 
 drains and watercourses into the sea fixed nitrogen to 
 the amount of no less than 16,000,000^. per annum. 
 This unspeakable waste continues, and no effective and 
 universal method is yet contrived of converting sewage 
 into corn. Of this barbaric waste of manurial con- 
 stituents Liebig nearly half a century ago wrote in 
 these prophetic words : * Nothing will more certainly 
 consummate the ruin of England than a scarcity of 
 fertilisers — it means a scarcity of food. It is impossible 
 that such a sinful violation of the divine laws of Nature 
 should for ever remain unpunished, and the time will 
 probably come for England sooner than any other 
 country when, with all her wealth in gold, iron, and 
 coal, she will be unable to buy one-thousandth part of 
 the food which she has during hmidreds of years thrown 
 recklessly away.' The more widely this wasteful system 
 is extended, recklessly returning to the sea what we have 
 
TILLAGE loi 
 
 r 
 taken from the land, the more surely and quickly will 
 the finite stocks of nitrogen locked up in the soils of the 
 world become exhausted. Let us remember that the 
 plant creates nothing ; there is nothing in bread which 
 is not absorbed from the soil, and unless the abstracted 
 nitrogen is returned to the soil its fertility must 
 ultimately be exhausted." 
 
 Sir John Lawes and Sir Henry Gilbert, in a com- 
 munication addressed to the Times on December 2, 1898, 
 point out that even supposing that atmospheric nitrogen 
 could be fixed at a remunerative price, the addition of 
 nitrates without the addition of the other mineral con- 
 stituents necessary for wheat growing would be of no 
 permanent use ; but they express the opinion that the 
 stores of nitrogen and other fertilising salts existing in 
 our own soils and the soils of foreign countries can be 
 made available by thorough tillage and proper rotation 
 of crops. The land wants labour, and the production of 
 wheat is likely to be proportionate to its market value. 
 They point out that the average wheat production of the 
 ujimanured plot at Kothamsted (over thirteen bushels) 
 is greater than the average of the whole of the United 
 States, a fact mainly due to proper tillage and thorough 
 weeding. 
 
 It is tolerably evident that fertility is not merely a 
 chemical question. The year 1898 was remarkable for 
 a fine wheat crop in this country. The yield is said to 
 have averaged thirty-five bushels instead of twenty-eight 
 or twenty-nine bushels per acre. Sir John Lawes, in 
 his annual letter to the Times (October 22, 1898) on 
 * The Wheat Crop of 1898,' states that at Kothamsted 
 the yield on the experimental plots was as under 
 (p. 102). 
 
I02 
 
 MAINTENANCE OF FERTILITY 
 
 Table 1.— Wheat Crop in 1898. 
 
 
 Bushels per 
 
 Cwt. of 
 
 
 acre 
 
 straw 
 
 Plot 3, unmanured 
 
 12 
 
 12^ 
 
 Plot 9, nitrates 
 
 23f 
 
 33| 
 
 Plot 7, ammonia salts .... 
 
 28| 
 
 44f 
 
 Plots, „ „ . . . . 
 
 29f 
 
 54f 
 
 Plot 2, farmyard manm-e 
 
 38 
 
 55f 
 
 In 1898 at Kothamsted the plot dressed with nitrate 
 of soda yielded twenty-three bushels, as against thirty- 
 eight bushels on the farmyard plot, and in explanation 
 Sir John Lawes says : " For only the second time during 
 a period of more than forty years the wheat plant was 
 much injured where we have used the heaviest dressing 
 of nitrate of soda for want of enough rain to form and 
 distribute a sufficiently dilute solution of it; and a 
 similar result occurred in the year of drought of 1893 ; 
 whilst in this year, 1898, the barley plant was much 
 injured with only half the amount of nitrate applied." 
 Sir John Lawes also gives the average yield of these five 
 plots for periods extending over forty-six years. 
 
 Table \l,— Wheat Crop, 1852-97. 
 
 - 
 
 Un- 
 manured 
 
 Farm- 
 yard 
 
 Ammonia 
 salt 
 
 Ammonia 
 salt 
 
 Nitrate 
 of soda 
 
 36 years 1852-87 . 
 10 years 1888-97 . 
 46 years 1852-97 . 
 
 13 
 
 12J 
 
 12| 
 
 33f 
 40f 
 35J 
 
 32| 
 33| 
 
 36i 
 
 37| 
 36| 
 
 36f 
 33| 
 36i 
 
 From the above table it will be observed that not 
 only has farmyard manure proved to be practically the 
 equal of artificial manures for nearly half a century, but 
 that during the last ten years the yield from it has been 
 considerably more than that of any of the artificially 
 manured plots. It is interesting to observe, also, that 
 
VALUE OF PLANT-ROOTS 103 
 
 had the wheat-growing area of this country in the year 
 1898 been sprinkled with nitrate of soda after the 
 manner of Plot 9 at Eothamsted, the yield might have 
 averaged only twenty-three bushels instead of thirty-five 
 bushels. On 2,000,000 acres, which is approximately the 
 wheat area of the United Kingdom for 1898, this means 
 a deficit of 24,000,000 bushels or 3,000,000 quarters. 
 The chemical analysis of a soil often fails to give the 
 clue to its fertility or sterility. Mr. Kobert Elliot, in a 
 paper on * The Value of Plant-roots as Tillers of the 
 Soil,' ^ quotes Sir John Lawes to the effect that " All 
 our experiments tend to show that it is the physical con- 
 dition of the soil — its capacity for absorbing and retain- 
 ing water, its permeability to roots, and its capacity for 
 absorbing and radiating heat — that is of more importance 
 than its, strictly speaking, chemical composition." It is, 
 in fact, abundantly evident that the biological side of 
 fertility is quite as important as the chemical, and that 
 organic manures are absolutely necessary to maintain 
 the fertility of the soil, and that of all organic manure 
 there is nothing to be compared with dung. If all that 
 comes from the land be returned to it there can be no 
 reason why the agriculturist should trouble himself 
 with chemical theories. He has only by labour to 
 maintain the soil in a good physical condition and he 
 may rest assured that its fertility will increase. 
 
 ' Journal of the Boyal Agricultural Society, vol. viii. p. 469. 
 
I04 SANITATION IN HOLLAND 
 
 CHAPTER XII 
 
 SANITATION IN HOLLAND 
 
 In Holland the connection of sanitation with agriculture 
 is far closer than with us, and it is possible that we may 
 derive some useful hints from our neighbours. In 
 Holland the sanitary problems are of a formidable kind. 
 The level of the country varies from a few feet above to 
 a few feet below the mean level of the German Ocean, 
 and it is needless here to recount how the Dutch people, 
 marvellous for their shrewdness and untiring industry, 
 have maintained a successful warfare against the forces 
 of Nature. With the exception of two or three incon- 
 siderable areas the whole of the Kingdom of the Nether- 
 lands is a flat plain intersected at very frequent intervals 
 by canals and rivers. These watercourses are all sluggish 
 and in some of them the slow current is maintained 
 artificially by pumping. It may be said that every 
 Dutchman lives within a few yards of a watercourse of 
 some kind, be it ditch or canal. These canals form a 
 very cheap and admirable means of internal communi- 
 cation, and in consequence the barge population is very 
 large indeed. The population of Holland tends steadily 
 to increase, such increase being most marked in the 
 big towns. 
 
 In no country in Europe, probably, has the state 
 of public health improved more remarkably than in 
 
DEATH-RATE 
 
 los 
 
 Holland. This is well shown by the following table 
 which is taken from the 'Annuaire Statistique de la 
 Ville d' Amsterdam,' 1896. The decline of the death- 
 rate has been uniform and continuous since 1884, but 
 for the sake of conciseness the years 1877, 1880, and 
 every fourth year thereafter alone have been given. 
 
 Nomhre des decbs {mort-nes exclus) par 100,000 habi- 
 tants de la population moyenne dans les cinq 
 grandes villes des Pays-BaSy amiees 1877-96. 
 
 
 Amster- 
 
 Eotter- 
 
 s'Graven- 
 
 
 Gronin- 
 
 Les 5 
 
 Annies 
 
 dam 
 
 (iam 
 
 hage 
 
 Utrecht 
 
 gen 
 
 villes 
 
 1877 
 
 25,00 
 
 25,32 
 
 21,66 
 
 23,91 
 
 29,51 
 
 24,70 
 
 1880 
 
 27,00 
 
 24,65 
 
 23,38 
 
 27,10 
 
 24,39 
 
 25,74 
 
 1884 
 
 27,87 
 
 27,01 
 
 24,87 
 
 26,38 
 
 22,00 
 
 26,67 
 
 1888 
 
 21,82 
 
 21,26 
 
 20,11 
 
 22,56 
 
 20,04 
 
 21,38 
 
 1892 
 
 19,78 
 
 23,26 
 
 20,32 
 
 23,84 
 
 17,27 
 
 20,89 
 
 1896 
 
 17,77 
 
 18,27 
 
 16,27 
 
 19,04 
 
 16,01 
 
 17,65 
 
 The causes of this improvement in the death-rate are 
 probably the same as have operated throughout Western 
 Europe generally. These causes are : (1) the improve- 
 ment in the physical and moral condition of the lower 
 strata of society ; (2) sanitation in its widest sense ; 
 (3) the rapid increase of population, especially in the 
 towns, causing a dilution of the high death-rates in the 
 old crowded portions by the lower death-rates of new 
 settlers in the outskirts ; and (4) the decrease in the 
 birth-rates. In Holland, as in England, the importance 
 of pure water, especially for town populations, is 
 abundantly recognised, and public supplies have, within 
 recent years, been carefully protected from pollution and 
 filtered before being distributed. The risk of drinking 
 canal water must have been very great indeed. The 
 mode of dealing with faecal matter is necessarily different 
 from ours. In Holland water-closets are the exception 
 
io6 
 
 SANITATION IN HOLLAND 
 
 and not the rule, and while the slop water of the houses 
 is allowed to flow into the canals, the fasces are collected 
 and used for agricultural purposes. During a visit to 
 Holland in September, 1898, I was able to obtain the 
 Dutch death-returns for 1885-89 and for 1889-94, a 
 period of ten years in all. For this I have to thank 
 Mr. Verryn Stuart, the secretary of the Statistical Com- 
 mission at The Hague, who most courteously procured 
 for me the volumes containing the returns in question. 
 
 The Netherlands, 
 
 
 
 1885-1890 
 
 1890-94 
 
 Provinces 
 
 31 
 ^1 
 
 III 
 
 Hi. 
 
 
 pi 
 
 
 North Brabant 
 Guelderland 
 South Holland 
 North Holland 
 Zealand . 
 Utrecht . 
 Friesland . 
 Overyssel . 
 Groningen 
 Drenthe . 
 Limburg . 
 Kingdom . 
 1885-94 
 Kingdom . 
 
 
 60,436 
 53,706 
 
 110,964 
 90,959 
 20,456 
 25,837 
 31,851 
 33,765 
 25,594 
 13,653 
 26,352 
 
 493,573 
 
 994,506 
 
 245 
 
 313 
 
 563 
 
 621 
 
 93 
 
 166 
 
 263 
 
 280 
 
 253 
 
 90 
 
 100 
 
 2,987 
 
 5,970 
 
 1 in 247 
 1 „ 171 
 1 „ 197 
 1 „ 146 
 1 „ 220 
 1 „ 156 
 1 „ 121 
 1 „ 120 
 1 „ 101 
 1 „ 152 
 1 „ 263 
 1 „ 165 
 
 1 „ 166 
 
 62,808 
 55,713 
 
 112,139 
 89,494 
 20,390 
 26,098 
 30,893 
 34,145 
 25,988 
 14,564 
 28,701 
 
 500,933 
 
 257 
 308 
 462 
 713 
 125 
 184 
 227 
 238 
 237 
 107 
 125 
 2,983 
 
 1 in 244 
 1 „ 181 
 1 „ 243 
 1 „ 125 
 1 „ 163 
 1 „ 142 
 1 „ 137 
 1 „ 143 
 1 „ 110 
 1 „ 136 
 1 „ 229 
 1 „ 168 
 
 Taking the population for 1885-94 at 4,500,000, the 
 average annual death-rate is 18*26, and the typhoid fever 
 and typhus fever death-rate is 0*13 per 1,000. 
 
 It will be observed that in Holland, generally, the 
 death-rate from enteric fever compares favourably with 
 our own. Knowing as we do the great risk of drinking 
 sluggish water liable to faecal contamination (which has 
 
ENTERIC FEVER 107 
 
 been exemplified in the Tees valley), the low enteric 
 death-rate in Holland is not a little remarkable. Enteric 
 being a fever of slow and insidious onset, it is impossible 
 in sporadic cases to say where or how the patient may 
 have been infected, and in cities with an ever-shifting 
 population this difficulty is accentuated. That being 
 the case it will not be without interest if I give a few 
 particulars concerning the provinces of Groningen and 
 Friesland, which I visited in the vacation of 1898. 
 These two provinces are almost entirely devoted to 
 dairy farming, the breeding of horses and cattle, and 
 agriculture. The shifting and travelling population is a 
 small one, and it is here, if anywhere, that we may learn 
 the effect of local habits and customs on the public 
 health. 
 
 The town of Groningen with 63,863 inhabitants is 
 in point of population the fifth town in Holland, and a 
 reference to the table will show that the improvement 
 in its death-rate in the past twenty years has been as 
 remarkable as that observed in the other Dutch cities 
 or in any town or city in this country. In this town as 
 also in Leeuwarden, the capital of Friesland, and in 
 the great majority of Dutch towns, the faecal matter is 
 collected in pails, and it is probable that in the whole 
 extent of the two northern provinces of Groningen 
 and Friesland there is not a water-closet to be found. 
 The whole of the faecal matter is scrupulously and 
 religiously collected and returned to the soil. Dutch 
 cleanliness is proverbial, and certainly I have never 
 been in a town so exquisitely clean as is the town of 
 Groningen. The accumulation of ordure in the streets 
 and backyards is simply not tolerated, and the inhabi- 
 tants co-operate with the scavengers in clearing away 
 all refuse as quickly as possible. The collection of 
 
io8 SANITATION IN HOLLAND 
 
 faecal matter is very simple. The closet-pails are much 
 smaller than those which are commonly used in this 
 country, and they are emptied twice or thrice a week or 
 daily if the householder is ready to pay a small fee. 
 The collecting cart is really a tank upon wheels with a 
 sort of hood projecting behind like the hood of a carriage 
 facing the wrong way. The pails are brought out, and 
 the man and pail are hidden by the hood as the con- 
 tents are simply tipped into the tank. The pails even 
 when full being such as one man can lift easily, the 
 collection is probably ten times as rapid as is the case 
 in those English towns which make use of huge two- 
 man pails which weigh 50 lb. and more when empty. 
 Again it is obvious that the Groningen authorities do 
 not make the mistake of hauling about an immense 
 weight of pails, which adds enormously to the expense. 
 The depot where the material is collected is on the 
 outskirts of the town, where a wharf has been con- 
 structed with a view to its removal by barge for the 
 purposes of the farmer. Here, again, the arrange- 
 ments are very simple. The stuff is simply stacked 
 beneath rough sheds covered with corrugated iron. 
 The men employed have found out exactly how to do it, 
 and by arranging a layer of street sweepings and 
 rubbish (dung, straw, paper, rags, &c.) with peat ashes 
 (the fuel used in this district is almost exclusively peat) 
 alternately with a layer of pail contents, the whole mass 
 drains and consolidates into a very rich black manure 
 which the farmer highly appreciates. The floor of the 
 depot is concreted and provided with channels so that 
 the urine drains away into a large tank whence it is 
 pumped into barges for the use of the agriculturist. 
 Considering the work which went on in it, this depot 
 was wonderfully neat, the stacks were as evenly made 
 
DISPOSAL OF EXCRETA 109 
 
 as the best hay stacks, and the paths between them 
 were quite free from befoulments. The smell from the 
 putrid draining was, to say the least, powerful, but the 
 solid stuff soon ceases to be very offensive. There were 
 large numbers of flies in this depot, but I frequently 
 remarked that the flies in the town of Groningen were 
 not nearly so troublesome as is the case in cities less 
 carefully scavenged. 
 
 In the town of Leeuwarden the pails are taken to 
 and from the depot, but the pails are much smaller 
 and lighter than those in use in England, so that fifty- 
 four of them (three tiers of eighteen each) can be 
 carried on a one-horse lorry. In the ten years 1885-94 
 there were in each of the provinces of Groningen and 
 Friesland 490 deaths from enteric fever and typhus 
 fever, 980 deaths in all or an average of 98 per annum 
 in a population of some 600,000, giving a rate for typhus 
 fever and enteric fever of 0*1 6 per 1,000. During the 
 same period there were 97 deaths from the same cause 
 in the town of Groningen and twenty-seven in the town 
 of Leeuwarden, or 124, giving a yearly average of 12*4. 
 These figures are not large, but they show that as 
 regards these diseases the condition of Groningen was 
 slightly worse than the town of Leeuwarden. As in 
 England so in Holland, the death-rate from enteric 
 fever has been falling steadily, and the returns for the 
 last available year (1897) are very instructive. From 
 these returns I find that in the province of Groningen 
 with 296,521 inhabitants there were 23 deaths from 
 enteric fever in eighteen parishes, giving a death-rate 
 of 0-08, and in the province of Friesland, with 389,425 
 inhabitants, there were 19 deaths from enteric fever in 
 twelve different parishes, giving a death-rate of 0*056 
 per 1,000. It is a remarkable and most interesting 
 
no SANITATION IN HOLLAND 
 
 fact that in 1897 there was no death from enteric 
 fever in either of the capital towns of Groningen or 
 Leeuwarden, containing over 95,000 inhabitants (Gron- 
 ingen 63,863 and Leeuwarden 31,598). 
 
 The figures given above must be taken to show that 
 in these two provinces there is no serious endemicity 
 of enteric fever. When we consider that dairy farming 
 is the staple industry of these provinces, that milk, 
 which is most sensitive to typhoid fever infection, is 
 everywhere abundant, and that human excreta contain- 
 ing a certain proportion of typhoid fever excreta are 
 used, and have been used for ages, to manure this 
 fertile district, which lies almost in the water, the com- 
 parative freedom from enteric fever seems remarkable 
 and very full of instruction. 
 
 These facts seem to me to afford a very large measure 
 of proof that there is no inherent danger in the methods 
 of sanitation pursued in Groningen and Friesland and, 
 in fact, in Holland generally. Dutchmen are eminently 
 shrewd, thrifty, industrious, and methodical. The in- 
 teriors of their dwelling-houses and cattle-houses are, 
 as a rule, exquisitely clean and neat, and on the farm 
 one is constantly confronted with the same character- 
 istics. In the agricultural districts nothing is ever 
 thrown into the ditches or watercourses. On the 
 contrary, everything is taken out of them that can be 
 turned to profit. These ditches must be kept clean 
 and the banks of them need constant attention. The 
 banks are kept in repair largely by the mud which is 
 removed from the ditch, and whatever the ditch will 
 grow in the shape of rush or weed or willow is all 
 carefully harvested and turned to account for thatching 
 or for litter or for basket work. The Dutch farmer 
 never feels the effect of drought and this is one secret 
 
AGRICULTURE in 
 
 of his success. His endless watercourses serve for 
 fences and afford a cheap and ready means of transport. 
 They are a source of small profit in various ways, and 
 most certainly they are never allowed to carry away 
 from the farm anything which possesses manurial 
 value. The methods of the Dutch agriculturist are 
 slow and sure and steady. He has had to contend with 
 the forces of Nature and has got the upper hand, and is 
 now ahead of the whole world in exacting labour and 
 profit from wind and water. 
 
 It is very difficult to appraise the fertility of a 
 district. The area of Friesland is given as 331,030 
 hectares, of which 206,718 are pasture and 47,317 are 
 arable. These 254,035 hectares of land under cultiva- 
 tion are farmed by 14,049 farmers, of whom 5,374 are 
 freeholders. The average holding would thus appear 
 to be 18 hectares or about 43 acres, and as one travels 
 through the province the substantial farmhouses appear 
 to be dotted over the country with something like 
 mathematical precision, and the cattle (of which there 
 were 233,582 in the province in 1897) appear to be 
 innumerable. 
 
 Groningen contains a considerable amount of waste 
 land. The pastures are less extensive than in Friesland 
 and there is a greater area under the plough. In 1897 
 I find that in Groningen 7,351 hectares of wheat pro- 
 duced 35 hectolitres per hectare; 4,702 hectares of 
 barley produced 41 hectolitres per hectare ; and 33,135 
 hectares of oats produced 57 hectolitres per hectare. 
 These returns are large and are the equivalents of 
 40 bushels of wheat to the acre, 46 bushels of barley 
 to the acre, and 65 bushels of oats to the acre. 
 Agricultural returns for a single year are not, perhaps, 
 of great value, but these figures show at least that the 
 
112 SANITATION IN HOLLAND 
 
 land is capable of an enormous yield. The yield of 
 oats especially appears to be very large. 
 
 The returns issued by the Board of Agriculture show 
 that in 1896 we imported from Holland 923 horses, 
 663,196 cwt. of dead meat, over 500,000 cwt. of butter 
 and cheese, 861,887 cwt. of margarine, 217,891 cwt. of 
 milk and condensed milk, 375,116 bushels of fresh 
 fruit (apples, pears, cherries, plums, &c.), and 1,581,386 
 bushels of onions. In addition we imported from 
 Holland 609,710 cwt. of grain and 40,127 tons of hay, 
 and no mention is made of the horticultural products 
 in the form of * Dutch bulbs,' &c., which we import in 
 enormous quantities. 
 
 In the United Kingdom of Great Britain and Ireland 
 there are, including waste lands, 77,672,000 acres sup- 
 porting a population of 40,000,000, and in Holland 
 there are (excluding lakes and rivers) 7,786,000 acres 
 supporting 4,894,000, so that Holland supports a bigger 
 population per acre than the United Kingdom. In the 
 United Kingdom the area under cultivation (crops and 
 grass) amounted to 47,868,553 acres in 1897, and this 
 figure appears to be slightly decreasing. In Holland 
 in 1895 the total area under crops and grass was 
 5,149,817 acres, showing an increase of 95,000 acres on 
 the preceding three years. In the United Kingdom 
 there are 1*2 acre of cultivated land per head of the 
 population and in Holland there are 1*05 acre of 
 cultivated land per head of the population. Statistics 
 prove that Holland is a most fertile and productive 
 country, but one requires to travel through it in order 
 to be fully impressed with the extraordinary amount of 
 produce which the Dutchman exacts from the soil. In 
 Groningen and Friesland one cannot but be struck 
 with the well-to-do look of the population. If there 
 
DUTCH PERSEVERANCE 113 
 
 be wretchedness and squalor it is not visible to the 
 traveller, and must be, in any case, relatively small in 
 amount. The people are well nourished and well 
 clothed, the towns are handsome and clean, and the 
 shops are excellent. Perhaps no better evidence of the 
 high level of comfort which pertains in this purely 
 agricultural country can be given than the fact (which 
 I take from 'Baedeker's Guide') that the town of 
 Leeuwarden with 31,000 inhabitants supports twenty- 
 five firms of jewellers and silversmiths who are mainly 
 engaged in making personal and household ornaments 
 for the farmers and their families. Let it not be 
 supposed that the Dutchman owes his position of 
 agricultural supremacy to the * natural ' fertility of the 
 soil of his country. Doubtless he has found a large 
 amount of well-watered pasture land ready to hand, 
 but it is undeniable that some of the very best of his 
 land has been won from the sea, the desert moorland, 
 and the bog, by indomitable pluck and perseverance. 
 Above all, the Dutchman is fully impressed with the 
 necessity of returning to the soil everything that comes 
 out of it. Nobody knows better how to facilitate that 
 circulation of organic matter which is a law of Nature, 
 and he sees that his profit depends upon the complete- 
 ness and rapidity of that circulation and that in 
 farming as in other businesses a rapid turnover of 
 capital is to be aimed at. In Holland everything which 
 has manurial value is religiously returned to the land, 
 and we find that the population is increasing as fast 
 as ours and that the land under cultivation is increas- 
 ing, although the area of land is less per head in Holland 
 than in the United Kingdom. The level of public 
 health is as high in Holland as in the United Kingdom, 
 and an enormous amount of farm, garden, and dairy 
 
 I 
 
114 
 
 SANITATION IN HOLLAND 
 
 produce is exported to this country where (albeit that 
 many a tract of bog and waste moorland is waiting for 
 the subjugation of civilisation) the land under cultiva- 
 tion is tending to decrease, where manurial wealth is 
 being recklessly burnt or turned into the sea, and where 
 one-half of the population is absolutely ignorant of 
 the uses and value of dung and the other half is, if not 
 ignorant, too squeamish to use it. 
 
 The municipal accounts of the city of Groningen for 
 the year 1897 show that the total cost of keeping the 
 city clean was 94,596 florins (12 florins = 1Q. The 
 chief items of this expenditure were : 
 
 
 Florins 
 
 Salaries and wages . 
 
 . 50,615 
 
 Horse hire 
 
 . 21,441 
 
 Eepairs to carts 
 
 . 4,507 
 
 Boat hire 
 
 . 1,500 
 
 Brooms . 
 
 812 
 
 Disinfectants . 
 Sundries . 
 Clearing snow 
 
 Total . 
 
 Florins 
 
 263 
 
 . 4,177 
 
 . 11,281 
 
 . 94,596 
 
 As a set-off against this expenditure the accounts 
 show that the compost resulting from the stacking of 
 ordure and refuse, which amounted to 1,315 barge-loads, 
 was sold for 58,075 florins, and the liquid manure which 
 drained from the stacks, and which is much valued 
 by agriculturists, was sold for 5,339 florins. The total 
 receipts from the sale of manure amounted, therefore, 
 to 63,414 florins, which, deducted from 94,596, gives 
 31,182 florins (say 2,600/.) as the net cost of cleaning 
 Groningen. Taking the population of Groningen at 
 63,863, the cost of scavenging works out at something 
 less than half a florin or l^d. per head of the popula- 
 tion. It will be noticed that of the total expenditure 
 (exclusive of clearing snow) very nearly two- thirds go 
 in wages, a great part of which is paid to the poorest 
 class and must in some degree lessen the poor-rate. It 
 appears that the permanent staff consists of 102 persons, 
 
GRONINGEN 115 
 
 of whom fifty-six with twenty-eight horses and carts are 
 engaged mainly in collecting ordure, and twenty people 
 with ten horses and carts in collecting ashes and refuse. 
 For cleaning sewers, canals, gutters, and gratings nine- 
 teen men are employed. The collection of ordure is 
 done in the early morning before 10 o'clock. 
 
 I 2 
 
ii6 CARRINGTON MOSS 
 
 CHAPTER XIII 
 
 CABBINQTON MOSS 
 
 This seems to be the place in which to allude to the 
 spirited action of the city of Manchester, which has 
 reclaimed Carrington Moss and which is reclaiming 
 Chat Moss by fertilising the ground with the organic 
 refuse of the city. The ground is a virgin peat which is 
 admitted to be deadly to one at least of the supposed 
 earth organisms. The experiment is a splendid one, 
 and will certainly be the precursor of similar action 
 elsewhere. I have gathered some figures which may 
 give an idea of the gigantic task with which the Cleans- 
 ing Committee of the city have to grapple. From the 
 report of the Cleansing Department of the city of Man- 
 chester for 1897 I find that 354,364 tons of refuse — 
 very nearly 1,000 tons a day — were disposed of. Stated 
 in cartloads there were of street sweepings, 61,248 ; of 
 * Bell dust,' 9,823 ; of rubbish, 97,658 ; and of night- 
 soil, 240,781 ; total, 409,510. Of the material collected 
 nearly one-third of the weight is lost by evaporation (in 
 the preparation of concentrated manure), leakage, and 
 drainage, and nearly 100,000 tons find their way to the 
 rubbish tip, so that about 140,000 tons remain to be 
 accounted for. Of this 49,342 tons were sent to Car- 
 rington Moss, and over 57,000 tons were disposed of 
 to farmers direct. Over 6,000 tons of concentrated 
 manure (made from 108,000 tons of * day-soil ' or pail- 
 
CITY OF MANCHESTER 117 
 
 closet contents) sold for more than 17,000^. Nearly 
 19,000 tons were converted to mortar, and were sold for 
 4,500Z., and some 9,000 tons of clinkers were used for 
 road-making. The net expenditure of the Cleansing 
 Committee in 1897 amounted to 131,793Z., so that the 
 354,364 tons of refuse were dealt with at a cost of Is. ^d, 
 per ton. The total cost for the year of the Carrington 
 estate (including rent and interest of capital) was 2,482^.^ 
 The material sent to Carrington in 1897 consisted of 
 37,082 tons of nightsoil, 587 tons of sweepings and gar- 
 bage, and 11,673 tons of cinders. The Carrington Moss 
 estate, therefore, regarded merely as a dumping ground 
 for garbage and refuse, must be a source of satisfaction 
 to the Cleansing Department of the city of Manchester. 
 On August 11, 1897, I visited Carrington Moss, and 
 had the advantage of being shown over it by Mr. 
 McConnell, the bailiff. Carrington Moss was bought by 
 the Manchester Corporation in 1886. It is ten miles 
 from the city, in close proximity to the famous Chat 
 Moss, from which it is separated by the Manchester Ship 
 Canal, which serves for the transit of material from 
 Manchester. The estate, for which the Corporation gave 
 38,000^., has an extent of 1,100 acres, of which 600 were 
 wild moss commanding a rental of a shilling an acre 
 for sporting rights. The Corporation has spent 56,000^. 
 on light railways, roads, drainage, rolling-stock, build- 
 ings, &c., making the cost 94,000Z. (The outlay on the 
 estate is given as 82,946Z. in the City Treasurer's Ab- 
 stracts, 1897.) In the nine years 1889-97, 491,686 tons 
 of refuse material have been placed upon Carrington 
 Moss, or very nearly fifty tons per acre per annum. ^ 
 
 ' In the year ended March 31, 1901, the net cost was 861Z. 15s. 
 ^ In the thirteen years ended March 1901, the total is given as 
 639,779 tons. 
 
ii8 CARRINGTON MOSS 
 
 The moss has been drained by a series of deep trenches 
 with nearly vertical sides cut at regular intervals. The 
 refuse as it arrives from Manchester is transmitted by 
 means of a light railway to various parts of the estate, 
 where for the most part it is placed in heaps and allowed 
 to * ripen ' before being placed upon the ground. These 
 heaps soon cease to be in the least offensive. Nightsoil 
 is frequently applied directly to the fields. At the time 
 of my visit two barges, estimated to contain eighty tons 
 of refuse, were unloading at the little wharf which has 
 been especially constructed. The hay harvest was just 
 over, and the corn harvest was soon to commence. The 
 crops one and all were in splendid condition. Oats, 
 potatoes, carrots, wheat, and all the other usual farm 
 crops appeared to be first-rate, quality excellent, quantity 
 enormous. The roads were hard and firm, having been 
 brought to this condition by the application of clinker 
 and other forms of hard material from the city. The 
 farm is not quite a dead level, but the inequalities of 
 the surface are very slight, so that from every point the 
 spectator is able to survey an area of very considerable 
 extent. Without previous knowledge there was nothing 
 in the appearance of the farm (except the deep trenches) 
 to indicate the character of the subsoil. All indications 
 of bog had completely vanished. On reaching Mr. 
 McConnell's house we walked out upon a pretty lawn 
 surrounded by a flower-border brilliant with carnations 
 and the ordinary garden plants. The lawn was firm 
 and perfectly dry, and I was not prepared for the de- 
 monstration which I was to have of the character of the 
 subsoil. Taking an iron rod having a length of 11^ feet 
 and a diameter of about half an inch, Mr. McConnell 
 with one hand drove it through the turf of his lawn 
 completely up to the handle. I then did the same thing. 
 
THE SOIL 119 
 
 As the rod passed through the first foot or so there was 
 some resistance and a sense of grittiness was imparted 
 to the hand, but, this first obstruction passed, the descent 
 of the rod was progressively easier until it was finally 
 stopped by the handle resting on the lawn. On with- 
 drawing the rod the lower half was found to be wet 
 while the upper part was dry. To the upper half clung 
 a little grit and peaty earth, the lower half was clean 
 but wet. It was then only that one recognised that this 
 fertile paradise was literally floating. 
 
 Mr. McConnell informs me that Carrington Moss is 
 everywhere about twelve feet in depth and that the 
 variations in depth are very slight ; whereas Chat Moss, 
 although distant only a few miles, has a depth which 
 varies from four to over thirty feet. On Chat Moss, 
 where the digging of drainage trenches was in progress, 
 I examined the peat which had been removed. These 
 trenches are dug to a depth of about four feet to begin 
 with. The peat near the surface had the ordinary 
 fibrous character, whereas that from the bottom appeared 
 to the naked eye to be smooth and structureless and 
 saturated with moisture. It looked like brown jelly. 
 The moss resembles a huge sponge. Mr. McConnell 
 states that the surface of Carrington Moss is gradually 
 sinking ; that whereas when first he came to live on the 
 estate he could from a certain point see the spire only 
 of a neighbouring church, he can now see the slates 
 upon the roof. The sponge is being squeezed and 
 drained, and rendered more compact. The half million 
 tons of garbage which has been placed upon the surface 
 must exercise considerable pressure and must serve to 
 squeeze moisture into the deep trenches. Then, again, 
 the upward drainage of the abundant crops is obviously 
 very large indeed. The amount of moisture retained 
 
I20 CARRINGTON MOSS 
 
 and evaporated by an acre of oats or mangold must be 
 very great. 
 
 There are, as yet, not many trees upon the estate, 
 but part of it — about forty-three acres — is used as a 
 nursery for the shrubs required for the parks and 
 cemeteries of Manchester. These nurseries appeared 
 to be most flourishing and contained a large variety 
 of shrubs. The rhododendrons were extremely vigo- 
 rous. Mr. McConnell assured me that the farm as a 
 place of residence is by no means damp, and that the 
 rain which falls upon his lawn quickly drains away to 
 the reservoir beneath and leaves the surface dry. He 
 and his family and the employes on the farm have 
 always enjoyed excellent health. There has been one 
 case of enteric fever in nine years, the cause of which 
 is doubtful. 
 
 Of the 1,100 acres of land occupied, 1,011 acres are 
 let to tenants, and the rest is occupied by roads, wharves, 
 plantations, &c. On July 30, 1900, I paid a second visit 
 to Carrington Moss and I embodied the impressions 
 made upon me in a letter to the Times ^ from which the 
 following extracts are taken : 
 
 " Let me say emphatically that Carrington is not a 
 ' sewage farm.' The muck is dry, and is spread on the 
 surface of the land and ploughed in in the ordinary way. 
 There is no excess of water. Sewage farming in which 
 the living humus is drowned by tons of water leads 
 surely to agricultural bankruptcy. 
 
 *' At my visit in 1898, and again in July of this year, 
 I had ocular proof of the fertility of this reclaimed 
 land. The hay harvest was just over, and had been a 
 good one, and the standing crops of wheat and oats, 
 potatoes and carrots, would be hard to beat in any part 
 of England. The wheat was especially good, and one 
 
LAND SETTLING DOWN 121 
 
 field of 17 acres, which Mr. McConnell, the manager, 
 estimated would yield over forty bushels to the acre, 
 was certainly the finest I have ever seen. Much of the 
 land is now passing into the hands of nurserymen 
 and market gardeners. The ornamental shrubs (except 
 conifers, which have no appetite for manure) were in 
 splendid condition, and I am told that these nursery 
 gardens are exceptionally brilliant when the rhodo- 
 dendrons are in bloom. The physical change which has 
 taken place in this bog as the result of the agricultural 
 and other operations which have been carried out upon 
 it is very interesting. The downward drainage by the 
 deep trenches, and the upward drainage by the heavy 
 crops, which to a large extent prevent the rain from 
 percolating, have resulted in the sinking of the surface 
 and the general compression of the bog so that the land 
 tends steadily to get firmer. Formerly, when plough- 
 ing, it was necessary to put ' pattens ' upon the horses' 
 feet in order to prevent them from getting 'bogged,' 
 but this necessity, I was informed, now seldom arises. 
 
 " The farmhouse at Carrington stands on solid and 
 deep foundations, but that the land around it is gradu- 
 ally sinking is well shown by the fact that it is found 
 necessary to provide an additional step for the door 
 at recurring intervals. Between 1898 and my late 
 visit a new step had been placed. At my visit in 1898 
 Mr. McConnell, who then occupied the farm at Carring- 
 ton, gave an interesting demonstration of the character 
 of the soil by driving an iron rod, 11^ feet long and 
 half an inch in diameter, vertically through the turf 
 of his lawn up to the handle. I easily did the same 
 thing, for the rod having passed the first foot or so met 
 with little resistance, and when withdrawn was found 
 to be streaming with moisture. Mr. Carter, the present 
 
122 CARRINGTON MOSS 
 
 occupier of Carrington, kindly allowed me to repeat the 
 experiment at my late visit. I managed with some 
 difficulty to drive the rod into the soil for about 8 feet, 
 but the increasing resistance prevented one from driving 
 it completely *home.' When withdrawn, the rod was 
 not wet, but was coated with moderately moist soil. 
 The rapid desiccation and consolidation of the moss was 
 thus made evident. 
 
 *' I would respectfully suggest to the Corporation of 
 Manchester that this great experiment merits systematic 
 observation by men of science. A few ' surface ' wells 
 for the periodic examination of the water by chemists 
 and bacteriologists are much to be desired, and the 
 changes of earth temperatures, the progressive altera- 
 tions in the physical condition and the flora and fauna 
 of the soil ought to be systematically recorded. 
 
 *' The success attained at Carrington Moss has induced 
 the Corporation to purchase some 2,500 acres of Chat 
 Moss, which is now being subdued under the experi- 
 enced guidance of Mr. McConnell, so that, eventually, 
 the Corporation will be in possession of a fertile estate 
 of 3,600 acres. Allowing 10 per cent, for roads and 
 other works, they will have about 3,240 acres under 
 cultivation, or land capable of producing annually 
 13,000 quarters of wheat and 8,000 tons of straw where 
 none grew before. Assuming that the land is capable 
 of receiving twenty tons of refuse per acre in perpetuo, 
 the city will be in possession of a * destructor ' capable 
 of consuming about 65,000 tons of organic refuse per 
 annum, and each ton of refuse will ultimately return 
 about a bushel and a half of wheat and 2^ cwt. of straw 
 (the chief ingredients for 100 lb. of bread and perhaps 
 1,000 straw hats). 
 
 " This, surely, is better than burning or fouling rivers. 
 
OUTLAY AND RETURN 123 
 
 This Manchester experiment should set us all thinking. 
 Is there no possibility of bringing about a profitable 
 interchange of produce between the great cities and 
 the unreclaimed bogland of Ireland ? Is there not here 
 a lesson for the consideration of every village council 
 throughout the kingdom — a lesson which has been 
 taught, not by the Utopian dreamer, but by hard- 
 headed men of business ? " 
 
 The accounts of the Cleansing Department of the 
 city of Manchester for the year ending March 31, 1900, 
 show that the Garrington estate yielded 777^. 55. Id, 
 in excess of expenditure and that Chat Moss yielded 
 an excess of revenue over expenditure amounting to 
 2,591^. 135. \d. The interest on loans (capital account) 
 was for Carrington 2,036Z. and for Chat Moss 4,896Z., 
 so that the net cost of these two estates amounted to 
 3,563^. \s, ^d. The amount of material sent to these 
 estates in the year was 88,300 tons. 
 
 I am well aware that in farming, where results de- 
 pend so largely upon the weather, it is hazardous to 
 calculate returns on the yield of a single year, and that 
 anything under a ten years' average is likely to mislead. 
 On the other hand, 10^. worth of produce from an acre 
 of land is no excessive return. My visit to Carrington 
 Moss left upon me the impression that much of the 
 land is ready to pass, as some has already done, from 
 the hands of the farmer to those of the market gardener. 
 In that case, when oats, grass, and carrots and mangels 
 give place to fruit and high-class vegetables, it is cer- 
 tain that, with a market like Manchester at its door, 
 the money value of the crops in Carrington Moss may 
 be doubled or quadrupled. There is probably no city 
 in the world where excreta are dealt with by methods 
 other than water-carriage on so large a scale as they 
 
124 CARRINGTON MOSS 
 
 are dealt with in Manchester. In 1897 the city had an 
 area of 12,911 acres ; it contained 534,299 inhabitants 
 living in 105,728 dwelling-houses, or rather over five 
 persons to a house. There were 76,913 pail-closets, 
 presumably used by some 384,565 persons, who provided 
 189,585 tons (nearly 425,000,000 lb.) of ' pail contents.' 
 It would appear from the Cleansing Committee's ac- 
 counts (p. 36) that at the Holt Town Works 108,394 
 tons of *day soil' were converted into 6,304 tons of 
 concentrated manure, and that for the production of 
 this manure were used 4,897 tons of coal and coke and 
 1,674 tons of chemicals. Adding the weight of the 
 chemicals to the weight of the ' day soil ' we arrive at 
 the fact that 110,068 tons of raw material and chemi- 
 cals were reduced to 6,304 tons by the aid of 4,897 tons 
 of coal. Or we may say that 6,571 tons of fuel and 
 chemicals produced 6,304 tons of manure from 108,394 
 tons of raw material. The amount of water and other 
 volatile matter driven off amounted to 103,764 tons. 
 The price paid for chemicals (5,098?.) and fuel (675Z.) 
 amounted to 5,773Z., while the net profit on the sale of 
 manure amounted to 2,081?. (p. 15). 
 
 It is instructive to compare the Holt Town Works 
 concentrated manure accounts (pp. 14-15) with the Car- 
 rington Moss Farm accounts (pp. 28-31). At the former 
 a turnover of 30,533?. resulted in a profit of 2,081Z., or 
 rather more than 6J per cent., while at the latter a 
 turnover of 6,202?. resulted in a profit of 1,041?., or 
 very nearly 17 per cent. Turning to the City Trea- 
 surer's Abstracts we find that whereas the Holt Town 
 Works (p. 50), upon which the outlay has been 111,318?., 
 are now valued at 71,429?., the Carrington Moss estate, 
 upon which the outlay has been 82,946?., is now valued 
 at 118,617?., so that while 39,889?. of capital have been 
 lost at Holt Town, 35,671?. have been made at Carrington. 
 
CLEANLINESS OF GRONINGEN 125 
 
 CHAPTER XIV 
 
 CONCLUSIONS 
 
 I HAVE brought forward a considerable number of facts 
 to prove that the dangers of applying dung to the soil 
 are as nothing in comparison with the advantages— ad- 
 vantages which have been acknowledged from the dawn 
 of historic time till now. It remains to say a few words 
 on the financial side of the question. The great experi- 
 ment at Manchester seems to prove conclusively that 
 even in a huge city and with the heavy outlay which 
 seems to be inseparable from all modern municipal 
 undertakings a well-considered scheme of application 
 of offal and ordure m a dry state to the soil is the most 
 economic way of getting rid of it. I have shown how 
 in Holland great cities may be kept spotlessly clean and 
 in spite of obvious difficulties the public health be main- 
 tained by a well-devised system of scavenging. The 
 cleanliness of Groningen is a thing which is scarcely 
 realisable by one whose ideas of street sanitation are 
 acquired in the West End of London, and the economy 
 with which the scavenging is accomplished seems 
 astounding to the London ratepayer. I have further 
 shown that Holland, with a smaller area of cultivated 
 land in proportion to population than England, is able 
 to export to this country enormous quantities of farm 
 and dairy produce, and that while the English farmer 
 
126 CONCLUSIONS 
 
 can scarcely exist the Dutch agriculturist thrives and 
 grows rich. 
 
 It will not be uninteresting, perhaps, if I give some 
 of the results of my small experiment at Andover, 
 which is now in its fourteenth year of trial. In this 
 experiment the ordure and house refuse of about 
 100 persons have been removed and applied daily for 
 gardening purposes. The amount under the spade is 
 now exactly one acre, one rood, and seven poles, and I 
 should like to say that the quantity of faecal matter at 
 the disposal of ^my gardener by no means satisfies him. 
 I am also convinced that the garden might take with 
 advantage at least double the quantity if not more. 
 There is no evidence, after a long experience, that the 
 soil is overdone. On the contrary, its * condition ' has 
 steadily improved. 
 
 As to the financial results, the produce of my garden 
 has been sold on the principle of profit-sharing, so that 
 the gardener is interested in extracting the greatest 
 amount of produce from the soil. During the past 
 year (1889) careful accounts have been kept, and I find 
 that the produce fetched l\l. 195. 6cZ., which works out 
 to 56L per acre. Of this sum 41?. 125. Id, were received 
 for fruit, and 30^ 65. \\d, for vegetables. Some of 
 the chief items were as follow : Apples and pears, 
 18Z. 05. 6cZ. ; summer fruit, Yll, Is, Wd, ; peaches 
 (outdoor), 3Z. 195. 2d5. ; potatoes, 6?. 35. 4cZ. ; cabbage and 
 cauliflower, 5Z. I85. 3(i. ; tomatoes (outdoor), 2?. 35. ; 
 asparagus, 2Z. I5. \d. ; and flowers, 2Z. 25. 5^. The 
 method of agriculture which I pursue is well known, 
 but this has caused no prejudice against the garden 
 produce, which finds a very ready market. 
 
 In the middle of my garden is a well, which affords 
 evidence that no fgecal matters are washed downwards 
 
SHALLOW WELL 127 
 
 to the subsoil water. This well, which was made 
 mainly for experimental purposes, is very shallow, little 
 more than a dip-hole. The bottom is five and a half 
 feet from the surface of the ground ; the sides are lined 
 with concrete pipes to the very bottom, and around 
 these four inches of concrete have been run in in order 
 to give additional protection. There is a good parapet 
 and a movable cover. The well was made in 1891, and 
 the bottom and sides look as clean to-day as when 
 they were made. No water can possibly enter this well 
 except through the bottom, and I drink the water with- 
 out any hesitation or misgiving because I know there 
 are no leaking sewers or cesspools in the immediate 
 vicinity. The only pollution this well gets is from 
 insects, which creep under the cover. I value the 
 movable cover because it gives me the power of inspec- 
 tion, but I have not been able to keep the insects out. 
 These are chiefly wood-lice and spiders. When it is 
 remembered that the depth of water in the well is only 
 three and a half feet (the water rises to within two feet 
 of the surface of the ground), and the diameter two 
 and a quarter feet, and that the quantity of water 
 standing in the well is not more than some ninety 
 gallons, it is obvious that a colony of wood-lice might 
 easily affect an analysis. 
 
 One day while removing the cover of the well, my 
 gardener, before I could stop him, squashed some of 
 the wood-lice which he found, between his thumb-nail 
 and the inside of the cover. When the cover of this 
 well is taken off on an autumn morning one finds much 
 condensation on the inside of the lid. The water is 
 vaporised by the heat of the day, and is condensed on 
 the inside of the lid in the cold morning, and when the 
 lid is taken off these condensed drops flow back into 
 
128 CONCLUSIONS 
 
 the well. The dead wood-lice on the lid became per- 
 meated with fungi, and it cannot be but that the con- 
 densed drippings took back the washings from the 
 mouldy wood-lice. 
 
 This interested me as showing how a well may, if 
 left to itself, be in a sense self-polluting. 
 
 Dead insects are of course capable of providing 
 nourishment for countless bacteria, and the retrogres- 
 sion of my well in bacterial purity finds, I think, a 
 sufficient explanation from this cause. 
 
 Last summer (1901) I kept a light cover of * scrim ' 
 stretched on a hoop over the well. This kept out 
 insects, but doubtless many minor impurities were 
 washed through by rain. 
 
 Then again the pump stands in the open, and of 
 course affords a free passage to the well for many small 
 things of the insect class. 
 
 It is clear that no ground water can enter the well 
 except through the bottom, but it has become equally 
 clear to me that, having regard to the small capacity of 
 the well, it is inadequately protected from minor pol- 
 lutions of the class which I have described. 
 
 These facts must be taken into consideration when 
 reading the analyses. 
 
 I wonder if bacteria of the coli group are found in 
 wood-lice, spiders, and water-fleas ? 
 
 I wonder what is the life history of a water-flea ? 
 
 In the autumn of 1901 a sample of water from this 
 well was analysed on behalf of the Eoyal Commission 
 on Sewage Disposal, some members of the Commission 
 having previously honoured my garden with an official 
 visit. I have been favoured with a copy of this analysis, 
 and it becomes of interest to compare analyses made at 
 different dates. 
 
ANALYSES OF WELL WATER 129 
 
 The first analysis was made by the late Sir Edward 
 Frankland in April 1892, who found (in 100,000 parts) : 
 
 Organic nitrogen 
 
 . 0-008 
 
 Nitrogen as nitrates and 
 
 Ammonia . 
 
 . none 
 
 nitrites .... 0542 
 Chlorine . . . .1-9 
 
 The analysis for the Eoyal Commission on Sewage 
 Disposal was made in November 1901. This analysis 
 gives (parts per 100,000 by weight) : 
 
 Ammoniacal nitrogen 
 
 . 0-0002 
 
 Nitrate . 
 
 . 0-68 
 
 Albuminoid nitrogen 
 Nitrite . 
 
 . 0-005 
 . none 
 
 Combined chlorine . 
 
 . 1-88 
 
 " This sample was clear and colourless, with a minute 
 quantity of whitish sediment and one water-flea ; no 
 smell ; alkaline." 
 
 A " small duplicate, mercury -join ted and incubated 
 at 80° F. on November 14, and analysed December 3," 
 gave: 
 
 Nitrite none 
 
 Nitrate 0-69 
 
 The above analyses seem to me to show that the 
 samples of 1892 and 1901 were for all practical pur- 
 poses identical in quality. The slight increase of 
 nitrates is probably due to the fact that the 1901 
 sample was taken in November, and the 1892 sample 
 in April. 
 
 The analysis of the Eoyal Commission gives certain 
 other facts which the analysis of Sir E. Frankland did 
 not give, viz. : 
 
 Oxygen absorbed from permanganate at 80° F. — at once . . 0-01 
 Oxygen absorbed from permanganate at SO** F. — after four hours . 0-06 
 Oxygen absorbed from permanganate at 80° F. after incubation 
 
 for five days— at once 0-02 
 
 Oxygen absorbed from permanganate at 80° F. after incubation 
 
 for five days — after four hours 0*14 
 
 Dissolved oxygen (parts per 1,000 by volume) . . . .3-9 
 
 K 
 
I30 CONCLUSIONS 
 
 Although we cannot compare the ' oxygen absorbed ' 
 in 1901 and 1892, it may be advisable to quote from 
 the reports on the quality of the London waters as 
 given in the ' weekly returns of the Eegistrar-General.' 
 
 Thus, in November 1901, Dr. Thorpe gives the 
 * oxygen consumed ' in four hours at 80° F. (mean) by 
 the water of the West Middlesex Company, which I 
 have drunk for over thirty years, as -068, which 
 exceeds the figure given by the Andover well. 
 
 In January 1902 the average of the mean results 
 for the West Middlesex water was -112. The other 
 figures in the analysis of the West Middlesex water, so 
 far as they are comparable with those of the Andover 
 water, are : 
 
 Nov. 1901 Jan. 1902 
 
 Organic nitrogen -017 -023 
 
 Nitrogen as nitrates and nitrites . . '167 -302 
 
 Chlorine 1-85 2-0 
 
 The water of the Kent Company, taken from a deep 
 chalk well, is used as a standard of purity by the pre- 
 sent official analyst (Dr. Thorpe), as it was by his pre- 
 decessor (Sir E. Frankland). It becomes of interest 
 therefore to state the facts (in so far as they are com- 
 parable with the Andover water) of recent analyses. 
 
 Det']^ Well of the Kent Company 
 
 Nov. 1901 Jan. 1902 
 
 Organic nitrogen -009 '006 
 
 Nitrogen as nitrates and nitrites . . -439 -664 
 
 Chlorine 2-2 3-8 
 
 Oxygen consumed after four hours at 
 
 80° F.— mean -004 -003 
 
 The interesting facts in these last analyses are the 
 fluctuations in the nitrates and nitrites and the 
 chlorine. 
 
BACTERIOSCOPIC ANALYSIS 131 
 
 The analyses 1892 and 1901 of my well show not 
 only that the water is one of fair quality, but they 
 further show : 
 
 1. That the quality has not deteriorated in ten 
 years. 
 
 2. That the faecal matter which has been freely 
 placed upon the humus surrounding the well is all 
 oxydised before it reaches the * ground water ' whence 
 the well is supplied. 
 
 The bacterioscopic analysis of this water, carried out 
 by Dr. Houston for the Eoyal Commission, showed that 
 one cubic centimetre of the water gave 1,400 bacteria 
 on gelatine at 20° C, and 280 on agar at 37° G. 
 Evidence of Bacillus coli (or closely allied forms) was 
 obtainable from 1 c.c. but not from -1 c.c. The indol re- 
 action was obtained from 1 c.c, but not from -1 c.c. 
 
 The tests for Bacillus enteritidis sporogenes gave 
 negative results. 
 
 Dr. Houston adds a note to his analysis to the effect 
 that " These samples were examined by the ordinary 
 methods used in the bacteriological examination of 
 sewage and sewage effluents. But in the bacterio- 
 scopic examination of potable waters special measures 
 should be adopted (for example the * Pasteur filtration 
 method'). This procedure was not carried out in the 
 present case. The negative results must therefore be 
 interpreted as only implying relative, not absolute 
 safety for drinking purposes. The presence of Bacillus 
 coli in 1 c.c. points to animal pollution. Its absence 
 from 0-1 c.c. shows that the contamination was not gross 
 in amount." 
 
 There has been an increase of bacteria in the water 
 of this well since it was examined by Dr. Cartwright 
 Wood in 1895. How far is this due to the circum- 
 
 K 2 
 
132 CONCLUSIONS 
 
 stances alluded to above? Will spiders, wood-lice, 
 earwigs, and water-fleas furnish bacteria of the coli 
 group? This seems to me a question which must be 
 answered. 
 
 Except in the vacation I certainly do not visit 
 Andover more than once a month. My experience 
 leads me to say that it is to me almost inconceivable 
 that the daily scavenging of our towns should not 
 yield enough profit to pay the wages. It is especially 
 to be noticed that the yield of this garden has under- 
 gone steady increase, and I have every hope that such 
 increase will continue. But it would be a great mis- 
 take to suppose that an acre of ground, cultivated and 
 manured as my garden is, is going to yield 50^. worth 
 of produce per annum at once. The test of true garden- 
 ing is increase. With the lapse of years, and without 
 appreciable cost, the increase of fruit trees is automatic, 
 and the yield of seeds is equally automatic and pro- 
 digious. My garden has gradually become fully fur- 
 nished, and to a large extent with its own offspring ; 
 and in that fact lies part of the secret of its increasing 
 yield. What we see in the London parks in the sum- 
 mer is not * gardening ' but a beautiful display, after 
 the manner of the houquetiere, of the results of garden- 
 ing elsewhere. In the same way the filling of flower 
 beds with a crowd of named and fashionable plants 
 bought for the season is not gardening but a mere 
 evidence of wealth. The real gardener in these cases 
 is the nurseryman. 
 
 The gradual increase in the yield of a plot of land, 
 at least for a very long series of years, is limited 
 only by the amount of skill and tillage which it receives 
 and the amount of dung which is available for it. 
 All evidence goes to show that organic manure in the 
 
BIOLOGY 133 
 
 form of dung is absolutely necessary for the main- 
 tenance of the fertility of the soil. We are gradually 
 becoming alive to the fact that fertility is a biological 
 question rather than a chemical question. To imagine 
 that chemicals can ever replace dung is a pure delusion 
 from which we shall some day be aroused. The success 
 or failure of agriculture is very largely a question 
 of dung, and it must be admitted that the dung pro- 
 spects in this country are very bad indeed. Imported 
 animal food yields very little dung for the land because 
 it is mostly washed (ultimately) into the sea, while 
 steam-engines and motor cars and bicycles must mean 
 a diminution of horse-dung. The sanitary pioneers of 
 half a century ago thought that the huge expenses of 
 modern sanitation would be compensated by the yield 
 from sewage farms. That has proved to be a delusion. 
 Sewage has proved to be merely the happy hunting 
 ground of sanitary tradesmen who have fattened on the 
 ratepayer. The nineteenth century closed with the 
 spectacle of a Koyal Commission still discussing the best 
 way of destroying the potentialities of life and prosperity. 
 In these lectures I have brought forward many facts 
 to show that there is no proof of any danger arising 
 from the use of dung for agricultural purposes, while 
 it is undeniable that the practice of agriculture is 
 pre-eminently healthy and invigorating. I have been 
 unable to find any evidence that contagia spread in 
 the soil. To live in filth and to inhale the products 
 of putrefaction given off from privies, or pails of faeces, 
 or sodden ground, results in disease, but there is no 
 evidence whatever that disease thus generated is able 
 to spread through the soil and infect a neighbouring 
 house or street. Looked at in another way we must 
 admit that filth disease, like many other forms of 
 
134 CONCLUSIONS 
 
 disease, is proportionate to overcrowding. We may 
 pave the backyard and provide it with a trapped gully 
 (not always sweet) and we may wash the faeces into 
 a ventilated sewer, which then delivers part of its 
 vapours near our bedroom windows. It is a difficult 
 problem, and there are pros and cons. 
 
 While we exult (not always reasonably) in our 
 diminished death-rate, let us not forget the diminished 
 birth-rate, the multiplication of asylums of various 
 kinds, and the steady increase in the amount of help 
 from public funds which is necessary to maintain the 
 health and decency of the masses. The year 1899 
 has been unsurpassed in the volume of trade and in 
 the bounty of the harvest, but the infant mortality in 
 our towns for the Michaelmas quarter was the highest 
 on record. Yes ; there are pros and cons. At present 
 he who advocates any attempt to entice a fair proportion 
 of the people * back to the land ' is regarded as a Utopian 
 dreamer. I feel convinced that the only chance of 
 getting a living from agriculture lies in the due enrich- 
 ment of the soil. There is no chance of this so long 
 as the only form of sanitation which receives any 
 official encouragement is one which involves a systematic 
 starvation of the soil. One sometimes comes across 
 statements which would lead one to suppose that 
 cultivated land is a public danger — statements which 
 are mere assertions. Some of our sanitarians, careless 
 of food supply, are liable to be dominated by stereotyped 
 ideas, and to fix their attention unduly upon one side of 
 a question and upon one disease. The more enthusiastic 
 of them, if they can secure a trifling diminution in the 
 mortality of one disease, seem quite ready to * make a 
 solitude and call it peace.' 
 
POLLUTION OF WATER SUPPLIES 135 
 
 , CHAPTER XV 
 
 Entebic Feveb^ 
 
 POLLUTION OF PUBLIC WATER-SUPPLIES : AT THE 
 SOURCE, IN THE COURSE, AND AT THE PERIPHERY 
 
 The Registrar-General's returns show that the death- 
 rate from enteric fever, which was '322 in 1871-80, had 
 fallen to -200 in 1881-90. 
 
 Our satisfaction at this decline is seriously qualified 
 by the fact that the tendency of towns to suffer from 
 epidemics of the disease seems to be as great, if not 
 greater than ever. At present (1898) there are three 
 towns (Maidstone, King's Lynn, and Ligoniel, a suburb 
 of Belfast) in which enteric exists in epidemic form as 
 a result of the pollution of the public water-supply. 
 Maidstone has had an amount of enteric fever in the 
 last three months which, under ordinary circumstances, 
 should have been spread over twenty-five or thirty 
 years, and it is evident that this is a calamity of a 
 kind which is not compensated by a decline in the 
 endemic death-rate. I have collected for the purpose 
 of this discussion short records of forty-six instances 
 in which pollution of public water-supplies has taken 
 place, resulting in outbreaks of enteric fever, more or 
 
 * Being the opening address of a discussion on the subject of the 
 Prevention of Enteric Fever, delivered before the Koyal Medical and 
 Chirurgical Society, London, on November 23, 1898 (see also chapters 
 xvi. to xviii.). 
 
136 
 
 ENTERIC FEVER 
 
 less severe. In thirty of these outbreaks the number 
 of persons who suffered is given, and I find they amount 
 to 16,576. I am, therefore, well within the mark 
 when I say that for the last thirty years considerably 
 more than 500 persons per annum have suffered from 
 enteric fever as a result of the pollution of public water- 
 supplies-. 
 
 I am mainly indebted for my information to the 
 reports made to the chief medical officer by the 
 inspectors of the Local Government Board. These 
 reports are among the chefs-d'oeuvre of English medical 
 literature, and one hopes that they may be at some 
 time re-edited and made more available, than at present 
 is the case, to the great bulk of the profession. For 
 six of the cases which I have tabulated I am indebted 
 to the * Tabular Analysis of Water-borne Typhoid,' 
 lately published by Mr. Ernest Hart. 
 
 The contagion of enteric fever is contained in the 
 excreta of the patient, and it is conveyed to the healthy 
 person in his drink or in his food, and probably in the 
 air he breathes. When enteric fever has occurred in 
 epidemic form, the poison has usually been conveyed 
 by water, often directly, and only less often indirectly, 
 through milk or other beverages. In order to keep my 
 remarks within bounds I shall not further allude to 
 milk epidemics. 
 
 The following is a brief tabular statement of the 
 Contamination of Public Water-supplies, 1867-97 : 
 
 Date 
 
 Name of Town 
 
 Source of 
 Supply 
 
 Where Polluted 
 
 No. of 
 Persons 
 Attacked 
 
 1867 
 
 1870 
 1873 
 
 Guildford 
 
 Warwick 
 
 Sherborne 
 
 Chalk well 
 
 ? 
 
 Wells 
 
 Source and 
 course 
 ? 
 Periphery 
 
 250 
 243 
 
WATER-SUPPLY CONTAMINATION 
 
 137 
 
 Date 
 
 Name of Town 
 
 Source of 
 Supply 
 
 Where Polluted 
 
 No. of 
 
 Persons 
 
 Attacked 
 
 1874 
 
 Lewes 
 
 Wells 
 
 Course 
 
 486 
 
 ,j 
 
 Hull 
 
 ? 
 
 ,, 
 
 526 
 
 M 
 
 Over Darwen 
 
 )> 
 
 ,, 
 
 2,035 
 
 1876 
 
 Tideswell 
 
 M 
 
 ♦» 
 
 — 
 
 1878 
 
 Dewsbury 
 
 l> 
 
 Source and 
 course 
 
 600 
 
 1879 
 
 Okehampton 
 
 f) 
 
 Periphery 
 
 — 
 
 M 
 
 Swansea 
 
 Upland 
 
 Source 
 
 640 
 
 >> 
 
 Caterham, &c. 
 
 Chalk wells 
 
 »> 
 
 352 
 
 1880 
 
 Enfield 
 
 ? 
 
 Periphery 
 
 — 
 
 >> 
 
 Haverfordwest 
 
 )) 
 
 Course and 
 Periphery 
 
 — 
 
 ,, 
 
 Sandown 
 
 Stream 
 
 Source 
 
 — 
 
 >) 
 
 Ventnor 
 
 ? 
 
 Course 
 
 
 
 » 
 
 Llanelly 
 
 Stream 
 
 Source 
 
 — 
 
 
 Perth 
 
 River 
 
 Course 
 
 162 
 
 >) 
 
 Newlyn 
 
 Well 
 
 Source 
 
 — 
 
 1881 
 
 Blackburn 
 
 
 
 Course 
 
 238 
 
 „ 
 
 Bodmin 
 
 — 
 
 Periphery 
 
 — 
 
 1882 
 
 Bangor 
 
 — 
 
 Course 
 
 548 
 
 1883 
 
 Hitchin 
 
 Well 
 
 Source 
 
 — 
 
 1884 
 
 Sheerness 
 
 — 
 
 Course 
 
 — 
 
 *) 
 
 Kidderminster 
 
 Well 
 
 Course 
 
 1,200 
 
 »» 
 
 Beverley 
 
 Chalk well 
 
 Source 
 
 231 
 
 1885 
 
 Faldingworth 
 
 Well 
 
 ,, 
 
 — 
 
 i> 
 
 Fareham 
 
 — 
 
 Course and 
 periphery 
 
 150 
 
 M 
 
 Swansea 
 
 Upland 
 
 Source 
 
 549 
 
 1887 
 
 Margate 
 
 Well 
 
 '> 
 
 — 
 
 1887-8 
 
 Mountain Ash 
 
 — 
 
 Course and 
 periphery 
 
 518 
 
 1888 
 
 Buckingham 
 
 — 
 
 Course 
 
 — 
 
 1889 
 
 Longton 
 
 — 
 
 ? 
 
 155 
 
 >) 
 
 Eochester 
 
 — 
 
 Periphery 
 
 — 
 
 > 
 
 Houghton -le- Spring 
 
 Well 
 
 Source 
 
 258 
 
 1890-93 
 
 Newark 
 
 River 
 
 jj 
 
 297 
 
 1890-91 
 
 Tees Valley 
 
 >> 
 
 )) 
 
 1,463 
 
 1891 
 
 Eotherham 
 
 Strea.ms 
 
 M 
 
 211 
 
 1891-2 
 
 King's Lynn 
 
 M 
 
 >> 
 
 226 
 
 1892-3 
 
 Chester-le- Street 
 
 
 )) 
 
 58 
 
 1893 
 
 Atherstone 
 
 '? 
 
 Course 
 
 112 
 
 M 
 
 Paisley 
 
 Upland 
 
 Source 
 
 672 
 
 >» 
 
 Worthing, &c. 
 
 Wells 
 
 Source and 
 course 
 
 1,411 
 
 1894 
 
 Newport 
 
 » 
 
 Source 
 
 516 
 
 1895 
 
 Raunds 
 
 )> 
 
 )) 
 
 129 
 
 1897 
 
 Maidstone 
 
 Springs 
 
 »> 
 
 1,890 
 
 )) 
 
 King's Lynn 
 
 Rivers 
 
 >> 
 
 450 
 
138 ENTERIC FEVER 
 
 Of these forty-six instances of pollution of a public 
 water-supply it will be noted that in three cases the 
 water was polluted both at its source and in its course, 
 and in three cases in its course and at the periphery. In 
 twenty-one cases it was polluted at its source alone ; in 
 twelve cases it was polluted in its course alone ; in six 
 cases it was polluted at its periphery alone ; in four 
 cases the fact is not stated. 
 
 Of the twenty-one instances in which pollution 
 occurred at the source it was shown that of such pol- 
 luted sources eleven were wells, seven were streams and 
 rivers, and three were upland sources. 
 
 These streams and rivers had been polluted by the 
 water-carried excrement flowing into them through the 
 drains and sewers of places higher up, and in some few 
 instances by the falling in of excremental matters from 
 the banks or from boats and barges. Every river and 
 stream in the country is more or less polluted in one 
 or other of these fashions. This fact is too familiar to 
 need further comment. 
 
 The mode of pollution of the wells is of more im- 
 portance. 
 
 Three of these polluted wells are of a common type, 
 e.g. at Newlyn, Faldingworth, and Eaunds, where the 
 wells were polluted quite in the ordinary domestic way 
 by the leakage into them, ftom neighbouring drains, of 
 foul liquid, either from closets or washhouses where 
 linen fouled by enteric had been washed. In the cases 
 of Guildford, Caterham, Beverley, Hitchin, Margate, 
 Worthing, and Newport, we have instances of the foul- 
 ing of deep wells in the chalk. A deep chalk well is 
 generally considered a safe source for water, and some 
 appear to think that safety is proportionate to depth. 
 It seems necessary to say that depth is no protection 
 against the effects of leakage at any point, for leakings 
 
DEEP WELLS 139 
 
 must fall to the bottom. It is necessary also to say that 
 the difficulties of inspection are very largely propor- 
 tionate to the depth. Again, as leakage may occur at 
 any point in the walls, the area of the walls is in some 
 sense a measure of the vulnerability of the well. The 
 chemist and bacteriologist may report with regard to a 
 particular sample taken at a particular time that the 
 water is * of excellent dietetic quality, well suited for the 
 supply of a town,' but the merest tyro in well-sinking 
 might point out the dangerous position and formation 
 of the well. 
 
 With regard to these wells the following particulars 
 may be given : 
 
 1. At Guildford the pollution of a new chalk well 
 was caused by the leakage into it of quantities of sewage 
 from an old ill-constructed sewer. 
 
 2. At Gaterham an adit over 400 feet below the 
 surface was definitely fouled by a workman suffering 
 from enteric, who deposited his evacuations in the 
 tunnel. The investigation of this classic case was 
 carried out with remarkable acumen by Sir Eichard 
 Thorne. The following are the facts : 
 
 1879. Bed Hill and Gaterham (Dr. Thorne Thorne). — 
 352 cases caused by a labourer who was working in the 
 adit of the water company, and who was suffering from 
 enteric at the time, actually depositing his evacuations 
 in the tunnel. The evidence shows that he began to be 
 ill on January 5, and that he continued to work in the 
 adit until the evening of January 20, when he was too 
 ill to continue. The adit was therefore possibly fouled 
 with enteric evacuations for sixteen days, and possibly in 
 increasing amounts. The epidemic began on January 19, 
 and, reaching its climax on February 1, came to an end 
 about a month later. 
 
I40 ENTERIC FEVER 
 
 Although I think that Sir Eichard Thorne clearly 
 demonstrated the true source of the enteric contamina- 
 tion, it was nevertheless shown that the Caterham wells 
 (three in number, sunk for some 400 or 500 feet through 
 clayey gravel and chalk, and with borings going to a 
 greater depth) were seriously liable to contamination 
 through fissures. Thus on one occasion " waste water 
 was pumped into a hollow spot about 170 feet to the 
 east of the wells ; here it disappeared, but it was soon 
 ascertained to be returning into the wells at a depth of 
 420 feet." The formation in which the wells were sunk 
 was, indeed, dangerously fissured in all directions, and 
 there were cesspools at various spots round the works. 
 
 3. At Beverley the well (333 feet deep) was alongside 
 a sewage farm belonging to the East Riding Asylum, 
 and from an irrigated field sewage is supposed to have 
 trickled down the well shaft. Here we have an instance 
 of sanitary works carried out for the benefit of one 
 community causing serious trouble to their neighbours ; 
 and other instances of this have occurred. 
 
 4. At Hitchin we are told that defects in the water- 
 works permitted occasional back-flow of sewage-polluted 
 river water into the pumping well. 
 
 5. At Margate the well was exposed to contamination 
 by soakage from sea water and from cesspools. 
 
 6. At Worthing we have a leakage of a sewer into a 
 heading run from the bottom of a deep chalk well. 
 
 7. At Newport (Isle of Wight) the chalk wells were 
 fouled by an adjacent pond, and probably by more 
 distant leaking cesspools, of which there were many. 
 This water contained the Bacillus coli, and I trust we 
 may learn in this discussion what is the true value of 
 that fact. 
 
 The eighth case of the fouling of a deep well occurred 
 
POLLUTION OF WELLS 141 
 
 at Herrington, near Hough ton-le- Spring, and the follow- 
 ing are the facts : 
 
 1889. Houghton-U'Spring (Dr. David Page).— 258 
 cases occurring in a population of 4,400 situated within 
 the area of the Herrington water-supply. 
 
 The supply was from a well 330 feet deep, through 
 * clay with sand partings in seams ' (72 feet) ; limestone 
 marl (15 feet) ; and for the rest through sandstone and 
 shale. The sides were lined with bricks set in mortar, 
 and it was believed to be impervious. 
 
 On examination the sides of the well were defective, 
 and a * feeder ' was found discharging into the well 
 45 feet below the surface. 
 
 Microscopic examination of this water afforded 
 evidence of contamination with household refuse, and 
 the source of contamination proved to be a farmhouse 
 containing a water-closet, situated three-quarters of a 
 mile off, and draining into the well through a fissure in 
 the magnesian limestone caused by the subsidence of a 
 colliery beneath. 
 
 On examination the pipes of the Herrington service 
 were found excellently jointed, but the sewer pipes were 
 leaking. 
 
 This case is one of very great importance. The 
 water company here was free from blame ; the pollution 
 was due to what may be called a pure accident. 
 
 It is well to call attention to this case, because the 
 deep tunnelling which is going on, and which is being 
 proposed, in London may not be without its effects upon 
 the network of pipes above. 
 
 These facts lead one to make a few remarks as 
 to sources of water. Enteric fever being essentially a 
 human disease, the chances of getting water impregnated 
 with enteric at its source must bear direct ratio to the 
 
142 ENTERIC FEVER 
 
 density of population round that source. On that account 
 there is just now a rush for gathering grounds which are 
 uninhabited. Some of these moorland waters are not 
 without their disadvantages, and we know very little as 
 to the comparative receptivity for poison in hard or soft 
 waters in the presence of enteric excreta. In the above 
 list there are three instances (Swansea [2] and Paisley) 
 of contamination of upland waters. 
 
 I find in Glasgow, which enjoys an unlimited supply 
 of the purest water in the world, that in the ten years 
 1881-90 the enteric fever death-rate was -25 per 1,000 
 living. The enteric death-rate for 1881-90 for England 
 and Wales was -20, and for London -19. The figures 
 seem to show that Glasgow, in spite of its pure water, 
 enjoys no immunity from enteric fever. 
 
 With regard to the relative advantages of wells and 
 springs (captured and enclosed) as against rivers, there 
 are certain obvious facts which must not be forgotten. 
 If a well or spring be fouled, the whole of the fouling is 
 mixed with the water and supplied to the houses. There 
 is, so to say, no escape for accidental pollution except 
 into the water-pipes. Given the fact of fouling, wells 
 and springs are likely to deliver a dangerous dose. A 
 well, in this respect, is analogous to the ' dead end ' of a 
 water main, which is always a dangerous spot in case of 
 fouling. If a river be fouled, more or less floats away 
 or passes by the intake. I need hardly allude to the 
 obvious fact that the water in a river is exposed to fresh 
 air and sunlight, while the water in a well enjoys no 
 such advantage. 
 
 There were eighteen cases in which a public water- 
 supply was polluted in its course, that is, in its transit 
 between the source and the houses, viz. at Guildford, 
 Tideswell, Dewsbury, Haverfordwest, Ventnor, Black- 
 
LEAKING SEWER-PIPES 143 
 
 burn, Bangor, Sheerness, Kidderminster, Mountain Ash, 
 Lewes, Hull, Over Darwen, Perth, Fareham, Bucking- 
 ham, Atherstone, and Worthing. Of these eighteen 
 cases, one (Bangor) was caused by fouling of the filter- 
 beds, and two (Haverfordwest and Ventnor) were due to 
 fouling of the reservoirs. The other fifteen were practi- 
 cally due to the same cause, viz. tlie in-suction of 
 foul air or liquids by leaking water-pipes during inter- 
 missions in the supply. It is not necessary to go into 
 details of these cases, but it may be stated that at 
 Guildford a sewer was actually traversed by a water- 
 pipe, and at Sheerness * water mains were often laid in 
 the same trench as tributary sewers.' At Perth river 
 water from near the sewer outflow got into the water 
 main which runs under the Tay. 
 
 We must remember that sewer-pipes and water-pipes, 
 however well laid and made, are like ourselves mortal, 
 and liable to accidents and the inevitable results of age. 
 They are perfectly sure to leak sooner or later from 
 some cause or another. If they leak we must reckon 
 upon an interchange of their contents. These pipes are 
 always placed in proximity to each other and out of 
 sight, so that if the sewers leak into the water-pipes our 
 first indication of it is an outbreak of disease. 
 
 I have a cottage in the Thames valley where the 
 Local Council, by the help of some 130,000/. borrowed 
 with the consent and implied approval of the Local 
 Government Board, is and has been busy, by dint of 
 sewering and paving all the country roads, in making 
 the way smooth for the speculative builder and site 
 owner, who fill their pockets by building houses with the 
 minimum curtilage allowed by the Local Government 
 Board. The houses are springing up at a rate of twenty- 
 five or thirty to the acre, and at a rent of about eight 
 
144 ENTERIC FEVER 
 
 shillings a week. I see the water-pipes and sewer-pipes 
 being laid for this mushroom crop of brick and stucco, 
 and in the mornings I hear the traction engine and 
 steam roller rumbling about only a few feet above these 
 pipes, as though their only thought was to make quite 
 sure of cracking them. 
 
 I may recall the fact that a few years ago in London 
 the local authorities, by removing every particle of snow 
 and throwing down salt, succeeded in surrounding our 
 water-pipes with a freezing mixture, with the result that 
 no small proportion of them burst ; and I may also 
 recall the fact that a deep tunnel caused a dangerous 
 subsidence of the earth above it only a few weeks ago in 
 the City. The only way of minimising the very obvious 
 danger of thus laying water-pipes and sewer-pipes would 
 be to insist that where they go together they shall do so 
 only in subways, where they are open at all times to 
 ready inspection. An alternative would be to insist on 
 maintaining narrow roadways between the backs of new 
 houses, and to keep the sewers at the back and the 
 water-pipes in the front. Whatever plan be adopted, it 
 is evident that these two sets of pipes — afferent and 
 efferent— must come into close proximity somewhere. 
 Nevertheless what I have suggested would lessen this 
 danger. 
 
 Next I have to say a few words on the very important 
 subject of the pollution of water at the periphery, i.e. 
 through the taps. 
 
 This mode of pollution has been, I think, most con- 
 clusively established. 
 
 One of the first persons to call attention to this 
 danger was Dr. Blaxall, in a report on an outbreak of 
 enteric fever at Sherborne. This was followed in a few 
 months by the late Sir George Buchanan's report on 
 
MOUNTAIN ASH EPIDEMIC 145 
 
 Caius College, which must remain for all time one of the 
 classics in the literature of preventive medicine. Mr. Spear 
 in his report on Mountain Ash, Glamorgan, deals with 
 the same point. I will quote from these three reports, 
 but I think we shall derive most instruction by reversing 
 the order and taking Mr. Spear's first. 
 
 1888. Mountain Ash (Mr. John Spear).— The 518 
 cases of this epidemic were chiefly due to the in-suction 
 of foul air (and liquids and solids ?) into water-pipes 
 during intermissions of supply. Leakages in the pipes 
 were numerous. 
 
 There was some evidence to show that streets supplied 
 with water-pipes having ' dead ends ' suffered somewhat 
 more than others. Concerning one of these terminal 
 * dead end ' branches Mr. Spear says, " It would take its 
 full share of the first rush of water (after an inter- 
 mission), and all impurities would have to be withdrawn 
 through the house taps." 
 
 In another place he says, ** Given a fever poison 
 present in a water system, it is quite possible that in 
 the dead ends of pipes or at other places where stagna- 
 tion occurs, or at any given point where escape may 
 take place into the soil, further development of the 
 poison leading to new or more intense infection of the 
 water may occur." 
 
 Allusion is made to a dead-end pipe, fifty-three yards 
 long, gradually ascending from a larger main to supply 
 a school, including two closets which were supplied by 
 pipes direct from the main, " When the water was 
 turned off at the main, and the tap of one of these 
 closets opened for a moment, suction of air up the pipe 
 was immediately heard." Mr. Spear further adds in a 
 footnote, '' Suction into this main was very strong during 
 intermission of service. At such times the house taps 
 
146 ENTERIC FEVER 
 
 greedily sucked up water placed at their open mouths." 
 It wants only a moment's consideration to see that 
 ascending * dead ends,' whether in houses or in streets, 
 are converted into powerful aspirators directly pressure 
 within them fails. 
 
 In the school above mentioned there were two cases 
 of enteric, and it is possible that specifically infected 
 matter had been aspirated into the mains. 
 
 In another part of his report Mr. Spear has this im- 
 portant paragraph : — *' Intermission of water-current, 
 however, is not by any means essential to the introduc- 
 tion of foreign matters into water-pipes. Under various 
 physical conditions very powerful in-suction of external 
 matters into a full-flowing water-pipe can take place . . . 
 But the fact of this lateral in-suction into water-pipes 
 * running full ' is not known, as it ought to be, to many 
 of the engineers who undertake the responsible business 
 of laying water mains and other water-pipes." 
 
 1873. Gaius College (Dr. Buchanan). — 15 cases, 
 of which 12 occurred in * Tree Court,' which had been 
 built only a few years and contained all the latest 
 'sanitary improvements.' Out of 63 residents in 
 Tree Court, 12 (or 19 per cent.) were stricken with 
 fever in the month of November. Tree Court had a 
 water-supply through a branch from the main in the 
 street, which, to use a pathological expression, was 
 an * end artery,' and, although it supplied a branch to 
 each of the nine staircases of Tree Court, formed no 
 anastomoses with any other water-pipes in the college. 
 This water got fouled by one of two private closets in 
 Tree Court. The manner of the fouling was in this way. 
 The closet which was on the first floor of staircase P 
 was provided with a * safe,' i.e. a big metal tray sur- 
 rounding the base of the closet to catch accidental 
 
CAWS COLLEGE EPIDEMIC 147 
 
 splashings and drippings. This * safe ' drained into the 
 soil-pipe just beyond the closet- trap, through a small 
 pipe with a trap of its own. The subsidiary trap was 
 fed by what is technically known as a weeping-pipe, a 
 branch of the pipe supplying the closet. This closet 
 supply was direct from the Tree Court main without the 
 intervention of any cistern. 
 
 The water-supply to Caius College is * continuous,' 
 but it is liable to intermissions, and such intermissions 
 are known to have occurred on October 25 and Novem- 
 ber 1, and probably at other times. 
 
 When, with the water turned off, the closet on stair- 
 case P was used, the trap of the safe would be emptied 
 and the trap of the closet be left filled more or less with 
 faeces. The weeping-pipe was therefore open to the 
 sewer air coming up the soil-pipe and to the filth in the 
 closet trap. With the pipes of Tree Court empty of 
 water they would be liable to be filled with sewer air. 
 It was further proved that the end of the weeping-pipe 
 was covered with filth, and it is probable that the water 
 system of Tree Court was definitely inoculated with 
 Bacillus typhosus in addition to being impregnated with 
 sewer air. 
 
 1873. Sherborne (Dr. Blaxall).— 243 cases. * Board 
 of Health ' water derived from two deep wells. Water- 
 closets supplied direct from the mains. Between De- 
 cember, 1872, and May, 1873, there were 243 cases. 
 " During December, 1872, and January, 1873, the water 
 was frequently shut off from the town at a point near to 
 the reservoir, and the same thing was done every night 
 in February. It is known that when the water was thus 
 shut off there were certain delivery pipes up which there 
 was a rush of air immediately the tap was unscrewed. 
 Now many of the openings of the pipes, as before 
 
 L 2 
 
148 ENTERIC FEVER 
 
 described, are situated in the pans of the water-closets. 
 At night, after the closet had been used, the tap would 
 be turned on for the admission of water ; none flowing, 
 the tap in many instances would not be turned off again, 
 and thus a direct passage into the water mains would be 
 left open. . . . Thus the system of pipes for the water- 
 supply became the means of ventilating the closet pans ; 
 if a trap happened to be broken or out of order it 
 became a means of ventilating the sewers, and if a pan 
 happened to be full of excrement that excrement would 
 be sucked into the water-pipe." 
 
 This mode of water pollution is well understood, and 
 we know the importance of maintaining constant pres- 
 sure in our water service. It seems clear that many of 
 the critics of Maidstone have not been aware of the 
 danger of lessening water pressure at a time when the 
 sewer-pipes must have been highly charged with enteric 
 poison. 
 
 How far is the maintenance of constant pressure 
 attainable? It is evident that there must arise occa- 
 sions when the water-pipes must be empty. To main- 
 tain constant pressure is a counsel of perfection which 
 is unattainable. 
 
 The dangers of peripheral pollution, by the in- 
 suction or diffusion of foul gas or liquid, is so well 
 recognised that all w.c.'s are now supplied through 
 independent cisterns. 
 
 There is yet another way in which peripheral pollu- 
 tion of a public water-supply may take place. 
 
 The outbreak at Worthing in 1893 was accompanied 
 by an outbreak in the adjoining districts of West Tarring 
 and West Worthing having a different water-supply, and 
 the explanation of this is that Worthing water entered 
 the pipes of the adjoining districts through the ball 
 
STORM EFFECTS ON SEWERS 149 
 
 hydrants in the street at a time when the pressure in 
 the pipes intermitted. 
 
 A few weeks before the close of the last holidays I 
 was staying at Andover, which has a mmiicipal water- 
 supply obtained from a deep chalk well. During one of 
 the last days of September there was a very heavy 
 thunderstorm with torrents of rain. I went out in this 
 storm to one of the lowest points in the town, and there 
 I found what I had found before under similar circum- 
 stances, viz. the water bursting up through the street 
 sewer, with the result that the street was flooded with 
 foul water and faecal matter. A few inches below this 
 mess were the water-pipes supplying the district, and I 
 hope they were not cracked, and that the pressure in 
 them was fully maintained until after this impregnating 
 flood had subsided. 
 
 I stood at the lowest point to which storm water 
 must gravitate, and here Nature had provided an over- 
 flow into a ditch. Some years ago the storm water was 
 taken into the sewer, and a storm overflow from the 
 sewer was taken into the ditch. Nature meant that the 
 sudden storm should cleanse the surface of the ground 
 and also cleanse the ditch, and thus do nothing but 
 good. Man interfered, with the result that, instead of 
 being cleansed, both the street and the ditch were filled 
 with the poisonous purgings of a sewer. I give this as 
 a type of what is common. The craze for taking rain 
 water underground instead of allowing it to run on the 
 surface is as dangerous as it is costly. 
 
 The experiences at Sherborne, Mountain Ash, and 
 Caius College seem to point to the conclusion that every 
 public water-supply should protect its own purity, by 
 compelling every house to have a cistern of its own as a 
 * cut-off ' between the impurities of the house and the 
 
I50 ENTERIC FEVER 
 
 water in the mains. This necessity is implied by the 
 compulsion which we are now under of having a separate 
 cistern for the water-closets. But water-closets are not 
 the only filthy places. There are water-taps which are 
 theoretically capable of tainting the water-pipes under 
 certain given conditions almost everywhere. Most 
 * noxious trades ' require water. Kitchen sinks are not 
 always sweet ; the post-mortem room sink is an uncom- 
 fortable thing to think of in connection with peripheral 
 pollution, and bacteriological laboratories fill us with 
 'horrible imaginings.' Sewer air is everywhere, over 
 street gratings, and at the eaves, and although diluted 
 almost to vanishing point, it makes up by quantity what 
 it may lack in intensity. 
 
 In Dr. Thresh's valuable book on * Water-supplies,' 
 p. 211, I find an allusion to an observation by Sir G. 
 Buchanan at Croydon in 1875, of an instance in which 
 bloody water was drawn from a tap at a house next door 
 to a slaughter-house. This is a fact which is very 
 eloquent in connection with automatic peripheral pollu- 
 tion. 
 
 Under existing conditions it appears certain that 
 every common water-supply is to a greater or less 
 extent automatically self-polluting, and it will be 
 interesting to hear what the sanitary officials may 
 have to say on this question of the house-cistern as 
 a 'protection to tine general supply. 
 
 A dirty house-cistern is doubtless very undesirable 
 for the people in the house. If it is dirty, that is their 
 fault, and it seems unreasonable that the purity of the 
 general supply should be endangered by the filthiness 
 or carelessness of the householder. 
 
 That the filthy should * stew in their own gravy ' is 
 reasonable enough, but that the cleanly should be 
 called upon to stew in it is unreasonable. 
 
WATER SUPPLY 151 
 
 CHAPTEE XVI 
 
 RECOMMENDATIONS AS TO WATER-SUPPLY— WHAT TO 
 DO WITH INFECTED MATERIAL— TREATMENT OF 
 INFECTED LINEN -DISPOSAL OF EXCRETA— HIS- 
 TORICAL, 
 
 « 
 
 The remarks which I have made on public water- 
 supplies seem to show that when we accept a water- 
 supply from a public body, our health to a considerable 
 extent passes out of our own keeping. That is obvious ; 
 and it is also obvious that when the order is given to 
 close a private well, and to accept a public supply, the 
 sanitary authority incurs a very grave responsibility 
 indeed. 
 
 The instances I have quoted seem to compel the 
 conclusion that public water-supplies are a cause of the 
 epidemicity of enteric fever. These water-supplies 
 diffuse the poison with a completeness which is almost 
 inconceivable, and further insure that the poison is 
 laid on, as it were, to our very mouths. 
 
 The condition of a city with its water-supply 
 polluted by enteric is fearful to contemplate. Not only 
 is the water being drunk, but the inhabitants are 
 washing in it, the dairies and milk cans are being 
 swilled with it, the very pats of * margarine ' are being 
 made up with its help, the oysters are lying in it, the 
 salads and flowers are being sprinkled with it, and the 
 streets are being watered with it. Then when the need 
 
152 ENTERIC FEVER 
 
 of closet-flushing is at its maximum, and the street 
 sewers are full of enteric poison, comes the order to 
 cut off the water, and it certainly requires great skill to 
 minimise the danger of so doing. 
 
 These epidemics show the danger of * putting too 
 many eggs in one basket,' and they force upon us the 
 necessity of arranging water-supplies with as many 
 independent sub-divisions as may be feasible. They 
 also serve to show the necessity of not permitting the 
 mixing of water derived from different sources. Dairy 
 companies have learnt, by bitter experience, the neces- 
 sity of keeping the milk supply from different farms 
 absolutely distinct. Water companies must do the 
 same thing. 
 
 The great milk companies have voluntarily adopted 
 a system of milk supervision which approaches perfec- 
 tion. The milk is submitted to a daily, almost hourly, 
 examination by skilled experts. 
 
 The water companies must do the same thing. 
 Every water company ought to have a laboratory for 
 the chemical and bacteriological examination of the 
 water which it distributes, and there ought to be a 
 proper staff of skilled experts constantly at work 
 examining samples taken daily, or even hourly, not 
 only at the source, but at various points in the area of 
 distribution. 
 
 Under existing conditions the purity of our water- 
 supplies can only be maintained by vigilance and 
 publicity. The notification of disease is undoubtedly a 
 great protection, but it is clear that every notification 
 should he forwarded instantly to the water authority 
 and the sewer authority ^ whose respective inspectors 
 should examine the implicated premises without delay. 
 
 It is evident that repeated chemical and bacterio- 
 
SHALLOW WELLS 153 
 
 logical examinations of water are of great value, but it 
 is not probable that they are much protection against 
 sudden pollutions occurring after heavy downpours of 
 rain. The mischief is done suddenly, and both the 
 chemist and bacteriologist will possibly be able to 
 register the catastrophe, but not prevent it. It is 
 most important that the public should not be led to 
 expect the impossible, and to imagine that analyses can 
 make a public water-supply secure. The interpretation 
 of analyses is not always easy, but any sudden change 
 in the quality of a water would arouse suspicions. 
 
 Of what import is the presence of Bacillus coli in a 
 water ? This bacillus is known to occur in rabbits and 
 birds. Does it occur in the dung or dead bodies of 
 insects, such as spiders, centipedes, slugs, snails, &c., 
 which are very apt to gain an entrance into wells ? 
 Does it occur in fish? This question ought to be 
 answered. 
 
 All sources of water not only need to be guarded by 
 chemists and bacteriologists, but they need constant 
 watching by a shrewd practical man. It is not too 
 much to say that all sources of water have their purity 
 endangered by sudden flood and downpours, and water- 
 collection should be as far as possible stopped during 
 such occurrences. A clear water which suddenly 
 becomes turbid must always be dangerous. My shallow 
 well at Andover, which is only five feet deep, and which 
 is absolutely protected from surface or lateral con- 
 tamination, has once or twice become turbid after 
 exceptionally heavy rains. The reason for this appears, 
 to be that so soon as the soil above the ground water 
 gets saturated, the deposit on the bottom of the well is 
 driven upwards by the suddenly increased pressure 
 under which the water rises in the well. 
 
IS4 ENTERIC FEVER 
 
 There is very definite safety in having the water 
 sources near at hand and capable of being inspected. 
 By means of the electric light a well of moderate depth 
 can easily be inspected, but it is difficult to know what 
 may have happened in a bore-hole at a depth of 400 or 
 500 feet. 
 
 There are some who are of opinion that the public 
 safety would be enhanced by placing our water-supplies 
 in the hands of public authorities ; I am not of this 
 opinion, for the following reasons : 
 
 1. Because private authorities can control their 
 servants and get rid of incompetent officers more easily 
 and promptly than public bodies, who are elected to 
 their offices by their servants and the friends of their 
 servants. 
 
 2. Because water companies equally with railway 
 companies should be made liable to ' damages ' in case 
 of accidents. A successful action for damages against 
 a sanitary authority by, let us say, 10 per cent, of the 
 ratepayers of a town would result in the payment by 
 the plaintiffs of 10 per cent, of the damages awarded 
 them, while the bulk of the remainder would be paid by 
 persons who are blameless and helpless. This is a 
 reductio ad absurdum, 
 
 3. Because no person should be allowed to control 
 a water company without incurring some degree of 
 personal responsibility. It is the power of borrowing 
 and spending money without personal responsibility 
 that constitutes the dangerous element in our modern 
 local government. 
 
 I am very strongly of opinion that water companies 
 should be placed exactly on the same footing as other 
 trading companies, and that every householder should 
 have the right of paying for water by meter if he so 
 
WASTE OF WATER 155 
 
 desires. In houses not supplied by meter no waste- 
 pipe should be allowed beneath any supply tap so as 
 to insure that, if the tap be left carelessly turned on, 
 the house must be flooded. This would effectually 
 check waste. 
 
 It seems very necessary to check waste of water. 
 Many local authorities are at their wits' end for 
 water, and are calling in the help of wizards. But 
 we have had the comforting assurance that this, at 
 least, is a form of sanitary quackery which the public 
 auditors do not allow to be paid for out of the rates. 
 
 Wilful or careless waste of water (as by leaving a 
 tap turned on) should be punished by fine when water 
 is not paid for by meter. 
 
 Waste of water often necessitates the severe pumping 
 of wells and other sources, which increases the danger 
 of pollution. Waste must be checked. 
 
 There are others who seem to think that we shall 
 attain greater safety by the registration of plumbers. 
 These sanitary scapegoats are, I think, more sinned 
 against than sinning, and are often blamed most unde- 
 servedly for the inherent shortcomings of our modern 
 sanitary methods. If, however, plumbers are to be 
 registered, it does seem desirable that they should be 
 divided into two classes, and that we should run no 
 risk of allowing a man to attend to the water service 
 who perhaps carries about him infective matter acci- 
 dentally picked up in the * drains.' 
 
 The Disinfection of Linen 
 
 At University College Hospital some years ago this 
 question was submitted to a small committee, of which 
 I was a member, and we advised as follows : 
 
 1. That the linen should not be treated with 
 
156 ENTERIC FEVER 
 
 carbolic acid or corrosive sublimate, because of the fear 
 of coagulating albuminous soilings, and for the same 
 reason that it should not be put at once into boiling 
 water. 
 
 2. We advised that a special tank should be provided, 
 and should be filled every day with cold water to which 
 washing soda is added (about two pounds to a hundred 
 gallons) ; into this tank the soiled linen is taken 
 directly from the wards, and is allowed to soak till the 
 following morning, when the water in the tank is 
 thoroughly boiled for one and a half hours, and after 
 boiling is run off into the sewer. In this way the first 
 stage of the laundry work is accomplished. The 
 efiiuent water is sterilised, as is also the linen. 
 
 The same process can easily be carried out in private 
 on a smaller scale. 
 
 Disinfection of Stools 
 
 We now come to the important question as to what 
 ought to be done with the stools of enteric patients. I 
 have no hesitation in saying that in towns at least they 
 should be hurnt or boiled, and in all fever hospitals 
 intended for the reception of this class of patients a 
 proper destructor should be provided. 
 
 I have very little doubt that if this be accepted as 
 a principle, human ingenuity will soon provide the 
 means. 
 
 It is most desirable that, in the interest of the 
 nurses and friends, there should be a minimum of 
 manipulation of enteric faeces. I have my own ideas as 
 to how this end may be accomplished, but I must limit 
 myself to the discussion of principles rather than 
 details. I have very little faith in chemical disinfec- 
 tion. Badly done, this is more likely to preserve than 
 
ENTERIC EXCRETA AND WATER 157 
 
 destroy the poison, and the amount of manipulation 
 which thorough chemical disinfection necessitates is 
 most undesirable. 
 
 Of one thing I am convinced, and it is this, that 
 under no circumstances whatever should enteric excreta 
 he mixed with water. We know how insidious this 
 mixture is, and that the danger of it practically 
 increases when dilution has been carried to the extent 
 that the mixture has, to our unaided senses, the 
 characters of potable water. Enteric fever is pre- 
 eminently a water-borne disease. Enteric stools, there- 
 fore, must not be mixed with water, because it is the 
 property of water to return to its source. 
 
 * All things that are of the earth turn to the earth again, 
 And aU things that are of the waters return into the sea.' 
 
 Ecclus. xl. 11. 
 
 Let me illustrate this by some examples. A stool 
 mixed with water flows to the sewer, and so directly to 
 the sea. One would suppose that a stool so treated 
 was safely disposed of. Not at all ; the enteric poison 
 returns to us upon the oyster, and it must be admitted 
 that our habit of mixing enteric stools with water is in 
 a fair way to destroy our oyster industries —the fame of 
 which extends to the extreme limits of our historic 
 record. A very eminent agriculturist has said that our 
 sewage is good for our fisheries. At present we have 
 very conclusive evidence of evil, and no evidence of good 
 of any kind. 
 
 Again, an enteric stool mixed with water flows to the 
 sewer, and from the sewer leaks into a deep chalk well, 
 as at Guildford and Worthing, or runs off the surface of 
 a sewage farm into a deep w^ll, as at Beverley, whence 
 it is pumped in a state of extreme subdivision to poison 
 
158 ENTERIC FEVER 
 
 others. Or the mixture runs to the sewer, and so to the 
 river, passing en route through the watercress beds. 
 From the river it is pumped to the consumer of water, 
 and the watercress is sent far and wide, mainly to our 
 operatives in the big towns. The watercress industry, 
 like the oyster industry, is endangered, and we may soon 
 be deprived of this most agreeable vegetable. Or the 
 mixture runs to the sewer or cesspool, and leaking, under 
 pressure, worms its way sooner or later to a well or 
 spring, and possibly finds its way to the milk. Or the 
 water leaking from the sewer flows into the leaking 
 water-pipe, and so back to the consumer. Lastly, as at 
 Caius College, the mixture may be sucked directly from 
 the water-closet into the pipe supplying the drinking- 
 water. 
 
 Water returns to its source, whether the circuit be 
 long or short. 
 
 If any underground receptacle for water or sewage 
 begins to leak, and if the water in such receptacle be 
 constantly renewed, there is no limit to the distance 
 whether laterally or vertically which it may not travel. 
 The danger of a constant drip of water on one spot is 
 proverbial. It is a very serious danger in relation to 
 our water-supply. The deeper it goes, the further it is 
 likely to go. The pressure of a column of water is, 
 roughly speaking, nearly equal to half a pound for each 
 foot of vertical height. The force with which the water 
 returned from the surface into the Caterham well was, 
 at its maximum, about 185 lb. to the square inch. 
 
 What has just been said is founded on facts which 
 are familiar to everybody, and which are of almost daily 
 occurrence, and in this discussion it is most essential 
 to keep fact and theory quite distinct. The familiar 
 accidents to which I have just alluded are due entirely 
 
SIR WILLIAM /ENNER 159 
 
 to the fact that enteric stools have been mixed with 
 water. 
 
 There can be no doubt but that enteric fever must 
 have existed from all time, and that stools must often 
 have accidentally found their way to a spring or other 
 water source, but I think there is small room to doubt that 
 the great cause of the increase and wide epidemicity of 
 enteric fever in modern times has been the water-closet. 
 
 It is now half a century ago (in 1849) that my 
 great master. Sir William Jenner, contributed to this 
 Society a paper which closed the controversy which had 
 been raging for some ten years previously on the iden- 
 tity or non-identity of typhus and typhoid fevers. The 
 distinction between them is so clear that we of to-day 
 can hardly understand the controversy. It has been like 
 a dissolving view ; the clearly focussed typhus of 1830 
 became obscured by new elements, which have gradually 
 entirely occupied the screen, till now we have nothing 
 but the distinct features of enteric, and typhus has 
 vanished. 
 
 It seems probable that the main cause of the vanish- 
 ing of typhus was the repeal of the Corn Laws in 1846, 
 and the better wages and cheaper food which our 
 industrial population has enjoyed in increasing degree. 
 
 On the other hand, the rise of enteric was probably 
 due to the invention of the water-closet and the gradual 
 introduction of water-carried sewage. It must be re- 
 membered that the year 1849, in which the non-identity 
 of typhus and enteric was settled, was the year in which 
 cholera was raging, the year in which the great fact of 
 water-borne disease was established. 
 
 The conditions which gave us the great outburst of 
 cholera in 1849, when the Thames between the bridges 
 was at once our cesspool and our source of water, were 
 
i6o ENTERIC FEVER 
 
 eminently calculated to furnish sufficient enteric fever for 
 the establishment of its identity. If the same conditions 
 had obtained in the days of Heberden or Mead, Syden- 
 ham or Morton, the identity of these fevers would have 
 been established one or two centuries before. So glaring 
 a fact could not have escaped these most acute observers. 
 
 The sanitary methods of our ancestors were simpler 
 than ours. Water was pumped from a well on the 
 premises, excrement was deposited in a dry privy and 
 removed once a year by the nightman, while the slops — 
 trivial in amount as compared with the present day, and 
 containing no specific poisons — ran to a dead well or 
 sump, or flowed in an open channel to the nearest stream. 
 The old-fashioned privy, if kept scrupulously dry and if 
 the vault was ventilated, was by no means so offensive 
 as is the cesspool. The smell was sui generis. The privy 
 was generally well removed from the house ; sometimes 
 was big enough to accommodate three people at once ; was 
 furnished with a special seat for children (a most excel- 
 lent arrangement), and sometimes had a courtyard of 
 its own. There was no sloppiness or putrefaction and 
 not much or any soakage, especially if the vault was 
 ventilated so as to allow of evaporation. When this 
 arrangement was carried out with a fair amount of 
 common sense and with sufficient space the surface-well 
 ran little risk of infection by specific poisons. 
 
 Water being unobtainable without the labour of pump- 
 ing, there was no waste, and allowance being made for 
 evaporation, the volume of slop -water must always have 
 been less than the volume pumped from the subsoil. 
 This appears to me to be a not unimportant fact, and it 
 is evident that the soil round the dwelling ran less risk 
 of getting waterlogged and sour than is the case where 
 unlimited water is poured into the premises of thriftless 
 
WATER-CLOSETS i6i 
 
 and careless people, who are incessantly pouring slops 
 into a subsoil from which they are forbidden to pump. 
 
 When the water-closet was introduced, and its 
 contents were shot into the previously dry privy, putre- 
 faction resulted. * Sewer gas ' was invented, and the 
 privy began to leak under pressure, to the imminent 
 danger of the well. The privy was, by the use of the 
 water-closet, converted into a cesspool. 
 
 As late (I quote Mr. Lewis Angell) as 1815 it was 
 penal to discharge house drainage into sewers. Chief 
 Justice Holt laid it down " that every man should keep 
 his dirt to himself." 
 
 The water-closets and the resulting cesspools necessi- 
 tated first the admission of the overflow from cesspools 
 into the sewers, and then about 1848 some 30,000 cess- 
 pools were abolished in London, and the houses drained 
 directly into the sewers and so to the Thames. We 
 have had cholera in 1832, 1849, 1854, and 1866 ; the 
 death-rate from diarrhoea, which in London was -215 in 
 1838, rose to 1*705 in 1849. 
 
 As a direct consequence of the legislation of 1848, 
 every river and every source of water in the country 
 became polluted or in danger of pollution. We then 
 passed a law forbidding the pollution of rivers. 
 
 Dr. William Farr fully recognised that the cholera 
 of 1849 and 1854, and the increase of diarrhoea, were 
 due to the water-closet, but he still hoped that the con- 
 tents of a machine which rids our houses of filth need 
 not necessarily poison our rivers and other sources of 
 water. 
 
 I confess I am very pessimistic on this head, as will 
 be gathered from my remarks on the property of water 
 to return to its source ; and I feel convinced that unless 
 we are guided by sound principles, all expenditure with 
 
 M 
 
1 62 ENTERIC FEVER 
 
 a view to the prevention of enteric fever will be 
 wasted. 
 
 In the account of almost every outburst of enteric fever 
 one comes to the inevitable mixture (generally deliberate 
 and intentional, but sometimes accidental) of faeces and 
 water, and in a large majority of such cases we find the 
 water-closet. There are some who seem to think that 
 the abolition of middens and cesspools and their re- 
 placement by the underground sewer will abolish enteric. 
 I cannot share any such belief, because it has been 
 shown again and again that the leaking sewer or drain 
 is quite as much a danger as the leaking cesspool, and 
 water leaking from the same spot may (as I have 
 shown) trickle any distance. A drain made of so-called 
 sanitary pipes has a potentiality for leaking at some 
 1,760 joints in every mile of length. 
 
 Every town or village which has underground 
 sewers will certainly, sooner or later, poison its local 
 wells and other sources of water. 
 
 Whether or no we are able to obtain pure water 
 depends entirely upon our treatment of putrescible 
 refuse. If this be put beneath the surface of the ground 
 instead of upon it, the danger to every source of water 
 is immense. 
 
 APPENDIX 
 
 With reference to the Bacterial Treatment of London Sewage, the 
 reader is referred to the summaries of the Eeports by Dr. Clowes 
 and Dr. Houston to the London County Council in the ' British 
 Medical Journal ' of January 12, 1901, p. 104, and of February 2, 
 1901, p. 287. Briefly Dr. Clowes, dealing with the general and 
 chemical aspects of the matter, concluded : 
 
 (1) That the effluents from the great mass of London 
 
BACTERIA IN SEWAGE 163 
 
 sewage, clarified by screening, precipitation, and sedimentation, 
 may still lead to serious foulness of the river, containing as they 
 do a large amount of putrescible matter. 
 
 (2) That in summer-time, when the flush of water from the 
 upper river is diminished by drought and by the abstraction of 
 larger volumes of the water by the water companies, the condition 
 of portions of the lower river frequently closely approaches that 
 necessary to cause offence. 
 
 Fortunately the results of the long experiments carried on so 
 systematically since 1893 indicate that the London sewage may be 
 so far purified by means of contact beds, that a clear, non-putrescible 
 effluent may be obtained far purer than the effluent at present 
 obtained by precipitation and sedimentation. The introduction of 
 such a sewage effluent, clarified and freed from most of the organic 
 matter, into the muddy and brackish waters of the lower Thames 
 may be effected without giving rise to any offence. 
 
 On the other hand Dr. Houston, working at the bacteriological 
 aspect, found as the result of a very large number of experiments that 
 the total number of bacteria, the number of spores of aerobic bacteria, 
 the number of liquefying microbes, the numbers of Bacillus coli and 
 of spores of Bacillus enteritidis sporogenes were not remarkably less 
 in the efifluents from the coke beds than in the corresponding samples 
 of crude sewage. For instance, whilst a large number of samples 
 of crude sewage contained on the average 7,357,692 bacteria per 
 c.cm. the average of the corresponding effluents per c.cm. was 
 4,966,666 (a reduction of 32 per cent.). The average number of 
 the bacteria of the coli type in the crude sewage (600,000 per c.cm.) 
 was reduced in the effluents to 400,000 per c.cm. The number of 
 spores of Bacillus enteritidis sporogenes, varying from 10 to 1,000 or 
 more per c.cm. in the crude sewage, was found to have undergone 
 very little reduction in the effluents. 
 
 Both these bacteria are of special interest, being of excremental 
 origin : the Bacillus coli also because of its close association with and 
 resemblance to the Bacillus typhosus ; the Bacillus enteritidis 
 sporogenes because of its virulent character and apparent causal 
 relations to acute diarrhoea. It is argued that if the B. coli passes 
 so readily through the contact beds there is nothing to show thab 
 the B. typhosus will not do the same. Moreover Dr. Houston found 
 that various other species of bacteria, such as the sewage proteus 
 and the B. pyocyaneus, passed freely through the beds. Even 
 streptococci, which are generally known to us as highly virulent 
 
 M 2 
 
1 64 ENTERIC FEVER 
 
 but anything but hardy microbes, he constantly found in the 
 effluents. 
 
 In view of these results, it is difficult to diflfer from Houston's 
 conclusion that " however satisfactory the process may be from the 
 chemical and practical point of view, the effluents from the 
 bacterial beds cannot be reasonably assumed to be more safe in 
 their possible relation to disease than raw sewage slightly diluted, 
 but otherwise unaltered in its bacterial composition." 
 
 The far-reaching importance of the above discrepancies between 
 the chemistry and bacteriology of so vital a matter need not be 
 insisted upon. Yet, in many instances, public authorities and 
 private individuals are quite satisfied with the ordinary chemical 
 analysis, the biology of the subject being completely neglected. 
 
EXCRETA 165 
 
 CHAPTEE XVII 
 
 APPLICATION OF STOOLS TO WELL-TILLED HUMUS— 
 WATEB—DEEP BUBIAL— WELLS 
 
 In country places I believe that enteric stools may with 
 reasonable safety be applied to the surface of well-tilled 
 soil. They must not be mixed with antiseptics, and 
 they must on no account be buried deeply. They must 
 be placed only a few inches below the surface, and be 
 lightly covered. There is no evidence, so far as I am 
 aware, that fences {enteric or otherwise) treated in this 
 way have ever been productive of harm. The sooner 
 the ground is planted with cabbage plants the better, 
 and it must be borne in mind that, if the soil is to 
 remain sweet, tillage and cropping are a sine qua non, 
 and it is probable that pathogenic microbes succumb in 
 the process. There is no evidence to the contrary. 
 Tillage admits air, and in turning over the ground we 
 have the beneficent effect of sunlight. I have studied 
 somewhat closely for the past eighteen years the result 
 of applying human faeces to a well-tilled humus, and I 
 feel convinced that many who write upon the subject 
 have taken but little pains to inform themselves as to 
 the real facts. The rapidity with which faecal matter 
 disappears in the earth depends upon circumstances, 
 viz. the state of the soil as to tillage, the mass of faeces 
 to be dealt with, and the weather. If the weather be 
 
i66 ENTERIC FEVER 
 
 warm with occasional showers, we find at the end of 
 about three weeks that the whole of the faeces and 
 paper has become humified, and is no longer recognis- 
 able by eye or nose. The smell under all circum- 
 stances seems to disappear in a few hours. If there 
 be drought or frost the humification is delayed, but, 
 strangely enough, the humification is delayed longest if 
 the weather be continuously wet. Under these circum- 
 stances the pores of the soil are closed, and the humus 
 gets sticky and pasty, but the faeces are not and cannot 
 be washed out of the soil. On the top of the soil, water 
 can exert no continuous pressure = What harm are faeces 
 capable of doing when thus applied to the soil ? They 
 are not likely to be eaten or inhaled, they cannot be 
 drunk, and nothing short of absolute proof would make 
 me believe that the bacilli can pass downward to the 
 subsoil water, because, in well-tilled soil, the harder it 
 rains the tighter are the faeces locked up, and with them 
 one must suppose the bacilli, so long as they continue 
 to exist. I have never studied microscopically what one 
 may call the progressive fungology of faeces on their 
 road to humification, but I can say this, that on the 
 surface of the ground in the course of a month or so 
 there appears a green algoid growth, looking somewhat 
 like a covering of moss, and then on digging and taking 
 up a handful of earth one may detect little particles 
 riddled with fungi, often reddish and ultimately black. 
 The end is what the gardener calls ' good rich black 
 mould.' Its fertility is unequalled. I must repeat 
 what I have said, that the place of deposit must be loell- 
 tilled humus. If masses of faeces are dumped down on 
 clay banks sloping to a river they may be washed into 
 the river, and have been washed in many a time. Or 
 they may be driven by torrential rain into deep cracks 
 
TILLAGE 167 
 
 in the clay, and this has possibly happened in India 
 and perhaps here also. Again I feel tempted to put 
 forward a hypothetical case. It is this : as long as 
 plants are alive their roots absorb moisture from the 
 soil, but when they die the dead root of a tree or strong- 
 rooted plant like the hop may possibly serve as a drain 
 for the direct conduction of moisture to the subsoil. This 
 is purely hypothetical, and I have no knowledge of any 
 such occurrence. In a properly tilled humus there are 
 no cracks or fissures, and any cracks must inevitably 
 be filled up by the crumbly earth. The power of a 
 well-tilled humus to absorb, transform, and humify 
 organic matter is astounding ; and, provided it be tilled 
 and cropped, its power in this way seems steadily to 
 increase, as if * increase of appetite did grow by what it 
 fed on.' 
 
 In my published works (* Essays on Eural Hygiene * 
 and *The Dwelling-house') will be found details of 
 experiments which show conclusively how great is the 
 purifying power of humus on urine which is slowly 
 filtered through it; and, in short, there is abundant 
 evidence that a well-tilled and well-nourished humus is 
 an absolute protection to our subterranean water- 
 supplies. Further, I believe that, so long as the humus 
 keeps healthy and in a highly productive state, the 
 protection to our water-supplies is proportionate to the 
 thickness and richness of the humus, or, in other words, 
 to the amount of dung applied to it. 
 
 Further, I believe, and have supported the statement 
 by arguments in the works referred to, that the best 
 return agriculturally is got by the immediate and daily 
 application of faeces to the land, and that while the faecal 
 matter is, in agricultural phrase, * ripening,' one may 
 get a crop of cabbages, and after the cabbages anything 
 
1 68 ENTERIC FEVER 
 
 and everything. These statements are founded on an 
 experiment now in its eighteenth year, in which the 
 faeces of about one hundred people have been utilised in 
 the manner indicated on an acre and a quarter of land. 
 Now that the garden is in full bearing it returns me 
 over fifty pounds per acre per annum. 
 
 Is it not time that the people of this country were 
 taught that faeces properly used are a source of health, 
 wealth, and beauty ? This most important matter holds 
 no place in our National Educational System. There 
 are no municipal gardens for showing how faeces may 
 increase the attractiveness and prosperity of a town, and 
 to demonstrate that the man who resolutely applies faecal 
 matter to its proper use gets an immediate and great 
 reward. The people are silently taught that the only 
 * decent ' (!) way of dealing with faeces is to mix them 
 with water. This filthy mixture, by its putrefaction, fills 
 our courts and alleys with sewer gas ; it trickles to our 
 water sources, and the expensive works necessary for 
 attempting to sweeten it and purify it are of such a 
 horrible kind that they are always surrounded by walls 
 which reach higher than the nose and eyes of an or- 
 dinary man. I have always contended that there is 
 too much of Hercules and too little of Minerva in our 
 sanitary arrangements. We see the pipes, the engines, 
 the ventilators, the hospitals, and the smoke of the 
 destructor ; we hear the incessant thud of steam 
 machinery, and feel the rate collector's hand for ever in 
 our pockets ; but we never get a glimpse of the bright 
 side of the matter, the return which Nature inevitably 
 makes to nourish our bodies, gladden our senses, and 
 freshen the air. 
 
 In the reports of the Local Government Board 
 inspectors we constantly come across allusions to *a 
 
TYPHOID BACILLUS 169 
 
 polluted soil.' The water-closet has polluted our rivers 
 and the air we breathe ; we now begin to hear of pol- 
 luted soil. The outlook is not pleasant. Sir Eichard 
 Thorne, in a recent most interesting address, alludes to 
 experiments carried out by my friend and colleague, 
 Dr. Sidney Martin, which show that the typhoid bacillus 
 will thrive and multiply in a rich soil previously steril- 
 ised. This is an interesting fact, and I find no difficulty 
 in believing that in the untilled soils, sodden with faecal 
 and other filth, which are found in the close courts of 
 our modern manufacturing towns and in the old quar- 
 ters of towns which in former ages were walled fortresses, 
 the enteric poison may lurk. There is no more diffi- 
 culty in believing that the enteric poison will live in 
 sterilised earth than in believing that it will live in 
 gelatine, which has proved a valuable cultivating 
 ground for so many microbes. Acting upon this know- 
 ledge. Dr. Ballard showed that cold gelatinous food 
 stored in an unwholesome place might become a culti- 
 vating ground for pathogenic organisms, and he pub- 
 lished many facts in support of his contention. But it 
 would be quite as unreasonable to condemn jelly as 
 necessarily a dangerous food as it would be to condemn 
 the soil as the natural lurking-place of enteric because 
 under conditions which cannot exist in Nature the en- 
 teric microbe may exist in it. 
 
 It is necessary to state this because a careless reader 
 of some of the Local Government Board Eeports might 
 come to the conclusion that the manuring of the land 
 was a serious danger to the public health. A moment's 
 reflection will convince us that the balance of effects 
 resulting from the dunging of land must be in favour 
 of health, and there is no evidence of evil resulting 
 from farming or gardening operations. Agriculturists 
 
I70 ENTERIC FEVER 
 
 of all grades are the healthiest section of our popula- 
 tion. The great cities would be in a most pitiable state 
 if the gardener were not ready to cart away the dung 
 and bring back fresh fruit and vegetables. As the dung 
 of the modern horse bids fair to be cinders, one hopes 
 that a demand will spring up for human faeces, and that 
 the necessary machinery for their decent daily removal 
 will be accomplished. 
 
 The soils of cities become polluted because there is a 
 deficiency of air and sunlight and an excess of water. 
 The careless inhabitants can get water by turning a 
 tap. They throw it down the middens, they cast it on 
 the ash heaps, they spill it on the surface. The sub- 
 soil is never relieved of water by pumping, and foul 
 liquids are sure to be soaking into it from cracked 
 drain-pipes. Nothing can purify a filth-sodden soil 
 except tillage, and I much doubt whether an imperme- 
 able paving will do any good if there be a chance of 
 drain-pipes leaking beneath it. In some of our filthy 
 industrial styes no sanitary measures short of destruc- 
 tion can possibly do much good, and I fail to see the use 
 of herculean and endless labour in order to secure the 
 survival of the unfittest, unless we give the possibility 
 of wholesome life, which cannot be attained without 
 adequate space. 
 
 In these places the soil has become polluted because 
 faecal matter has been allowed to escape the action of 
 the humus, and being mixed with water has been de- 
 liberately taken through to the subsoil, out of the reach 
 of natural forces which make for purity, and beyond the 
 possibility of tillage which assists Nature to accomplish 
 her beneficent work in the interest of man. 
 
 It is only a well -tilled humus that can satisfactorily 
 deal with excreta. If there be an excess of water — i,e. 
 
-I- 
 
 EPIDEMICS 171 
 
 if the humus is drowned, as in a sewage farm — then 
 any protective action is very problematical. 
 
 The following is of interest in this connection : 
 
 1894. High Wycombe (Dr. S. W. Wheaton).— Town 
 in a long valley between chalk hills. Eapidly increasing 
 population 15,000 (?). Lies on gravel bed, water mainly 
 from shallow wells, partly from waterworks (private 
 company). Town was sewered in 1882. The sewage 
 runs to a twelve-acre sewage farm about a mile from 
 the town, and * after mixing with a preparation of 
 alumino-ferric oxide ' in a sludge pit, its liquid effluent 
 flows directly on to the land. The water-closets of the 
 town bad, and seldom adequately flushed. 
 
 Enteric fever had occurred every year since 1886. *^ 
 
 In one house the admission of a girl with enteric was 
 followed by eight cases, and it was found that {inter alia) 
 the soil-pipe of the closet passed over the well and 
 dripped into it. 
 
 Again in December, 1894, after a heavy downpour, 
 excreta were washed out of the sewers and into the 
 wells. 
 
 1895. Wycombe Marsh (Dr. G. S. Buchanan).— Two 
 miles below High Wycombe, and having the sewage 
 farm of High Wycombe at its upper end. Population 
 700 in 140 houses. 
 
 Excreta disposed of partly in privies and pails (the 
 contents beings used for gardens), and partly collected 
 by hopper closets, inadequately flushed and run into 
 soak-away cesspools. 
 
 In autumn of 1895 twenty-four cases of enteric in 
 nineteen houses situated between two streams — the 
 
 * Back-water,' 195 feet above Ordnance datum, and the 
 
 * Wye,' 185 feet above Ordnance datum, running parallel 
 to the Back-water and a quarter of a mile from it. 
 
172 ENTERIC FEVER 
 
 The direction of the flow of ground water was from 
 the Back-water to the Wye and beneath the majority of 
 the implicated houses. 
 
 The Back-water runs through the High Wycombe 
 sewage farm of twelve acres and in fact drains it. 
 Owing to the fact that the sewers of High Wycombe are 
 laid in the waterlogged gravel, and that the pipes 
 necessarily leak, an enormous quantity of ' sewage,' 
 estimated at 2,000,000 gallons per diem, is poured on 
 to the farm. The volume of the ' back-water ' is about 
 doubled after passing through the * farm.' 
 
 In September, 1895, a mill below the village which 
 had been long untenanted was let, and a dam previously 
 partly opened was closed. This stopped the flow in the 
 streams of Wycombe Marsh, with the result that the 
 subsoil water became impregnated with the sewage of 
 High Wycombe, and the wells of the village were more 
 or less affected. 
 
 Sir K. Thorne Thorne, in commenting upon this 
 case, says that it is interesting, since '* it illustrates a 
 danger which may devolve on one community as the 
 result of works carried out solely in the interests of 
 another community." (See also Beverley, pp. 140 and 
 185.) 
 
 The river Wye flows into the Thames at Bourne End. 
 
 N.B. — Two million gallons of water per diem is the 
 equivalent of seven inches of rain per. diem on twelve 
 acres of land, or 2,555 inches or 212 feet per annum. 
 
 Again, the deep burial of faeces will preserve them, 
 and not help their destruction, which is what we want. 
 Deep burial in a porous soil may not be without 
 danger. 
 
 For illustrations of this danger arising from bury- 
 ing infected faeces deeply, I would allude to a valuable 
 
MILK EPIDEMIC 173 
 
 report made to the Local Government Board in 1877 by 
 Dr. Ballard, on a prolonged outbreak of enteric at Ascot 
 in 1873-4 5-6. The epidemic was a milk epidemic, 
 but the main difficulty was to account for the specific 
 infection of the dairyman's well. 
 
 Dr. Ballard points out that the water-supply of this 
 district is (or was) from wells sunk into a * running 
 sand ' saturated with water, lying immediately below 
 the denser superficial sand. 
 
 The excreta of the first case which was imported 
 into the district were buried * in a hole in the sand ' 
 (depth not stated), and further there was a leakage of 
 the water-closet drains into the sand, and Dr. Ballard 
 suggests that the infected material may have reached 
 the dairyman's well by the * running sand.' He puts 
 this view forward as an hypothesis, and not as a proved 
 fact, but the calmly considered notions of so careful and 
 contemplative an observer are not to be neglected. 
 
 This Ascot outbreak of enteric, affecting sixty-nine 
 persons, mainly of the upper and middle classes, appears 
 to have been started by the importation in 1873 of a 
 case belonging to the well-known Marylebone milk epi- 
 demic of that year. This latter epidemic was due to a 
 case in Buckinghamshire. Thus we see, in these days 
 of rapid transit, how far infections may travel. 
 
 The Marylebone milk epidemic is a good instance of 
 the wrong disposal of infected faeces, and the danger of 
 mixing them with water. 
 
 1873. Marylebone milk epidemic (Mr. N. Eadcliffe). — 
 The cause of this epidemic was traced to a farm in 
 Buckinghamshire. The dairy well had become polluted 
 by long-continued soakage from a piggery, the soakage 
 creeping along the foundations of a wall. Against this 
 wall was the farm * ash heap,' in which the evacuations 
 
174 ENTERIC FEVER 
 
 of the farmer (who died of enteric) had been buried, and 
 upon which were cast all the chamber slops of the sick 
 man's room. This filthy mixture drained with the 
 soakage from the piggery into the well. 
 
 It is necessary to repeat that if faeces are placed on 
 to humus no antiseptics must be used. Such addition 
 merely prevents the humus from doing its work. The 
 unpopularity of town refuse with farmers is largely due 
 to the antiseptics which have been mixed with it, and 
 which, to borrow a phrase used by an agriculturist, 
 effectually * Mil the dung.' 
 
 I believe that a well, by draining the soil, helps to 
 maintain the purity of the soil ; and it is most im- 
 portant to remember that when water for household 
 purposes is pumped from the soil, the slop water re- 
 turned (allowance being made for evaporation) must 
 alwa}/s be less than the water pumped. There is, there- 
 fore, not much danger of getting the soil round the 
 dwelling waterlogged and unwholesome. 
 
 When, on the other hand, an artificial supply is 
 brought into a low-lying district already sodden with 
 filth, and when we give up pumping and proceed to soak 
 the land with our new supply, the purification of such 
 soil becomes a matter of increasing difficulty. 
 
 Purification of the soil is attained by tillage, and 
 by allowing the humus to breathe, and not by drown- 
 ing it. 
 
 At my cottage at Isleworth, where I have a quarter 
 of an acre of land, I have my own well, and I feel 
 certain it is a much safer supply than the public supply 
 of the district. 
 
 The instances of pollution of private wells by leaking 
 sewers and cesspools are innumerable, but these have 
 been mostly small family epidemics, and there can be 
 
SHALLOW WELLS i75 
 
 little doubt that on the whole there is safety in private 
 wells — absolute safety if the owner have common sense 
 and will take a little trouble. Private wells in crowded 
 cities must always be dangerous, because of the inevitable 
 leaking sewer. 
 
 I ventured to express the opinion in 1892 that a 
 shallow well properly made, and in the midst of whole- 
 some surroundings, is a perfectly safe source of water, 
 and it is gratifying to find that this opinion is shared 
 by so eminent an authority as Professor K. Koch. Koch 
 (' Bacteriological Diagnosis of Cholera,' 1894) advocates 
 the raising of water from the subsoil by means of tube 
 wells, which he maintains is a perfectly safe method. 
 He says, " People are now everywhere endeavouring to 
 perfect the supplying of water on a large scale to the 
 highest possible degree, but they should direct their 
 attention to the procuring of water on a small scale 
 also, and seek to limit the spread of cholera to a mini- 
 mum, so far as it depends on water, by improving wells 
 in the manner I have indicated. Just in this respect 
 a great deal still remains to be done." 
 
 In a report made to the Local Government Board 
 in 1893, by Dr. Bruce Low, will be found a table which 
 shows conclusively how large a measure of protection 
 against enteric fever is afforded by the use of wells for 
 the supply of water, even though those wells may be (as 
 in many instances was the case) badly constructed and 
 negligently kept. In the Gainsborough Kural Sanitary 
 District it was found that in forty-one villages, with a 
 population of 13,063, in which the inhabitants drank 
 well-water, there were in four and a half years twenty- 
 five notifications of enteric ; whereas in ten neighbour- 
 ing villages, with a population of 5,693, the inhabitants 
 of which drank Trent water or canal-water, the number 
 
176 ENTERIC FEVER 
 
 of cases of enteric was 167. In the first group the 
 incidence of enteric was 1*92 per 1,000 ; in the second 
 group it was 29*3. 
 
 It will be gathered that my sanitary faith consists 
 in a firm belief (I do not know a single fact to the 
 contrary) in the protection afforded to our water-supplies 
 by a well-tilled humus. I believe that organic filth of 
 all kinds should be kept upon the surface to nourish 
 the humus, and not be placed beneath it to endanger 
 the wells ; and I believe that the great cause of the 
 modern increase of enteric fever has been the water- 
 closet, which has fouled and is still fouling our sources 
 of water. In proportion as we have given up foul 
 water-supplies and have gone further afield the 
 mortality from enteric has lessened ; but the sudden 
 outbursts of late years have shown that we have 
 * scotched the snake, not killed it,' and it is impossible 
 to see any finality or real safety in our sanitary arrange- 
 ments so long as they are dominated by the idea of 
 putting our filth out of sight below the humus instead 
 of on it. 
 
OVERCROWDING 177 
 
 CHAPTER XVIII 
 
 ENTEBIC AND OVERCROWDING 
 
 The late Dr. Murchison was of opinion that over- 
 crowding was not an important factor in the causation 
 of enteric fever, and it is quite true that in comparison 
 with typhus or small-pox, or other mainly air-borne 
 contagion, overcrowding plays an insignificant part 
 among the predisposing causes of the disease we are 
 considering. 
 
 Nevertheless a reference to the Registrar-General's 
 last Decennial Supplement (supplement to the Fifty-fifth 
 Annual Report, 1895) will show (Table VI., p. 115) that 
 enteric fever was most rife in the more crowded counties. 
 Thus the average death-rate from enteric fever for the 
 whole of England and Wales during the ten years 1881- 
 90 was -20 per 1,000 persons living. 
 
 Eleven counties had an enteric death-rate higher 
 than the average, viz. Lancashire, Durham, and Notting- 
 ham, -27 ; North Riding and South Wales, -26 ; East 
 Riding, -24 ; Northumberland, -23 ; West Riding, -22 ; 
 Cheshire, Monmouth, and Hampshire, -21. 
 
 On the other hand, the thirteen counties having 
 the lowest death-rate from enteric were Hereford, '06 ; 
 Rutland, -08 ; Bedford, -09 ; Wilts and Dorset, -10 ; 
 Somerset, Surrey, and Oxford, -11 ; Suffolk and 
 Berkshire, '12 ; Sussex, Huntingdon, and Cumberland, 
 •13. 
 
178 ENTERIC FEVER 
 
 Broadly speaking, one may say that the enteric 
 death-rate was highest in the manufacturing counties 
 and lowest in the agricultural counties. 
 
 Hampshire is the only county which apparently 
 contradicts this statement, so that it may be well to 
 say that the relatively high enteric death-rate in this 
 county is largely due to the big seaport towns, with 
 hospitals (civil, naval, and military) and asylums. 
 
 The reason for the relative excess of enteric in the 
 more crowded districts is not far to seek. Not only is 
 the pollution of rivers at its maximum in these counties, 
 but the space round the dwellings is often so restricted 
 that it is impossible to prevent the pollution of the air 
 and soil by excremental matter. 
 
 The rural counties are constantly being threatened 
 with various expensive so-called sanitary works. It is 
 important, therefore, to bear in mind that these counties 
 suffer less from enteric than the wealthy urban dis- 
 tricts. 
 
 In overcrowded places, where people live night and 
 day in what one may call excremental surroundings, 
 there is no escape from contamination. It must be 
 in air, soil, and water ; in their food ; on their cooking 
 utensils and clothing ; in short, everywhere. The only 
 real remedy for this state of things is space round the 
 dwelling. Great schemes of sewerage and water-supply 
 have hitherto merely increased overcrowding. Our 
 224 millions of local debt has not abolished enteric, 
 while in some places it appears to have increased 
 tuberculosis and diphtheria. 
 
 As an instance of enteric in crowded areas, I cull the 
 following from a report by Dr. Bruce Low (1896) on a 
 northern town (Middlesbrough) where enteric is endemic 
 and at times epidemic. 
 
MIDDLESBROUGH 179 
 
 The population of this town has grown in little 
 more than half a century from 5,000 to over 85,000. It 
 lies on a flat near the sea, and is mainly occupied with 
 the coal and iron trades. The area is (excluding fore- 
 shore and tidal water) some 2,700 acres, and in the 
 most crowded parts 10,000 people are congregated on 
 fifty-five acres of land. Dr. Bruce Low says, '' The 
 older parts of the town are very closely built ; . . . the 
 backs of some of the houses are often shut in by out- 
 buildings, privies, and the like — some [houses] in the 
 old parts of the town are very bad ... in a dilapidated 
 condition. Houses of this class let for as little as one 
 shilling per week, and afford shelter for a very low class 
 of the population. . . . The employment at the works 
 attracts numbers of persons of a shifting class from a 
 distance. Many of these people are improvident, in- 
 temperate, and uncleanly in their habits. . . . 
 
 " When a high tide coincides with heavy rainfall, 
 the sewers are unable to contain the accumulated sewage 
 and storm-water. As a consequence there is backing- 
 up and ultimate escape of diluted sewage from street 
 and yard gullies, flooding some streets and the basements 
 of houses." 
 
 The middens are bricked and not cemented, and 
 " the ground below is often saturated with black and 
 filthy fluid. . . . Occasionally a single midden receives 
 the discharge from as many as six privies. These 
 privies are often a short distance from back doors and 
 back windows, and in numerous instances face the 
 pantry window and are within a few feet of it." In one 
 case the people complained that their windows could not 
 be opened ** owing to the abominable odours emitted 
 by the midden. ... In some cases between the backs 
 of dwellings in parallel streets there is a double row of 
 
 N 2 
 
i8o ENTERIC FEVER 
 
 midden privies divided by a narrow back passage only 
 four feet wide. . . . The contents of the privy middens 
 are said to be emptied once a fortnight. The wet filth 
 and ashes are mixed and thrown out of the midden 
 into a wheelbarrow, which is emptied out upon the 
 macadamised surface of the front street, and . . . the 
 contents lie in the street for a time while the fluid filth 
 soaks away." 
 
 Ash closets provided with pans are also in use. 
 They are emptied on an average twice a week, but the 
 system is greatly misused by the householder. We 
 read that the pans are sometimes dusted inside with 
 carbolic powder. " The pan contents . . . are taken to 
 the depot, and after rough articles such as tin cans, 
 matting, and the like have been removed, most of the 
 residue is put into trucks for removal to the rural 
 districts. . . . There is a growing difliculty in getting 
 rid of pan contents. 
 
 " The dirty habits of the lower classes [in Middles- 
 brough] also increase the dangers above indicated. In- 
 deed, it was found that the largest number of enteric 
 fever cases occurred in those parts of the wards occupied 
 by the roughest class of the population, people who 
 took no care of their houses or their persons, and paid 
 very little attention to the state of their food. Some 
 of these persons sleep in unwholesome * box-bed places,' 
 which resemble cupboards partitioned off from the 
 living-room, and ventilated only by a small aperture, 
 which, when opened, often overlooks the midden a few 
 feet away." 
 
 Dr. Bruce Low is inclined to think, as well he may, 
 that the fever in this town is " indigenous fever fostered 
 by unwholesome conditions pertaining to the town 
 itself." 
 
BICESTER i8i 
 
 Quite different are the circumstances of the town 
 of Bicester (Dr. Theodore Thomson, 1896), with some 
 8,000 inhabitants on as many acres of ground, a 
 stragghng and old-fashioned town with a stationary 
 population. Most of the houses have good gardens or 
 yards, and there are vault privies, pan-closets, and a 
 few water-closets. 
 
 Of the twenty-eight persons first attacked with 
 enteric, twenty- six obtained their water from Crockwell 
 Spring, situated at a point where the town sewer 
 describes a semicircle round it, having the spring in 
 the middle at a distance of some eight feet. This 
 encircling sewer was found to be broken and leaking. 
 
 I have brought the closely packed manufacturing 
 town into juxtaposition with a country town for the 
 sake of contrast. In a place like Middlesbrough, where 
 people live surrounded by faecal befoulment, there is 
 no possibility of their condition being made better or 
 worse by water-closets. Nothing can remedy such a 
 state of things short of total destruction and recon- 
 struction. Pending that, however, I think the daily 
 removal of excreta should be aimed at, and the local 
 authority should endeavour to acquire a tract of land 
 to give an object lesson in the advantage of a really 
 scientific treatment of excreta. 
 
 Dr. Murchison was of opinion that the danger of 
 infection from enteric stools was increased by putre- 
 faction. The permitting of faeces to remain about the 
 house for a week or fortnight, just long enough for 
 putrefaction to attain its maximum, must be terribly 
 hazardous. The model by-laws of the Local Govern- 
 ment Board permit privies within six feet of the back- 
 door ! 
 
 Is no correction for dangerous sanitary negligence 
 
i82 ENTERIC FEVER 
 
 ever to be tried with the individual ? A gentleman is 
 placed in the dock for not having his bicycle lamp 
 lighted; is nothing to be done to the man who 
 endangers his neighbour's health by swinish apathy? 
 Many towns correct filthy language by fine ; can nothing 
 be tried against filthy acts, which are infinitely more 
 dangerous ? 
 
 In a small town like Bicester, or in a village, the 
 problem is very different. If the inhabitants would 
 abolish their water-closets, and with them all under- 
 ground sewers and cesspools, and allow their slop-water 
 and storm-water to run in open channels or filtration 
 gutters, all risk of epidemics of enteric would end. In 
 such a place the great need is properly organised and 
 daily scavenging. Every receptacle for filth — dry closet, 
 ash-bin, slop-gutters — all should be cleaned and swept 
 out ex}ery day^ and the stuff put to its proper use on a 
 spot of public ground where the people may receive 
 an object lesson which should show how much it is 
 to their own interest to be cleanly. 
 
 I have been at some pains to lay down what I 
 consider to be the true lines for disposing of enteric 
 excreta, and incidentally for disposing of putrescible 
 filth generally. I am well aware that in big cities, 
 where houses have no curtilage, the convenience of 
 the water-closet will certainly override all other con- 
 siderations. If any improvement is to take place on 
 the lines I have indicated, such improvement must 
 begin at the outskirts of towns and not in the centre. 
 But the water-closet is practically established by law, 
 and no encouragement is given, even in country places, 
 to the householder who may think as I do, and who 
 may wish, for his own health and profit, to work out 
 his sanitary salvation on his own premises, and 
 
RESPONSIBILITY 183 
 
 independently of the sanitary authority. No man, 
 of course, must be allowed to endanger the health of 
 his fellow-man; but we all do this when we poke 
 excrement into a sewer without any certain knowledge 
 that it will not leak to our neighbour's water. Indi- 
 vidual responsibility in sanitation no longer exists, and 
 it is impossible to fix any responsibility on public 
 bodies. 
 
 The long list of epidemics caused by public works 
 must make us think that this system is not working 
 quite satisfactorily. In my published writings I deal with 
 these questions at some length, and I also try to work 
 out some of the details for the attainment of a profit- 
 able and safe sanitary independence. Great ' sewage- 
 schemes,' involving large expenditure, are always 
 supported (naturally enough) by the small shopkeepers 
 and the wage-earning classes, who generally control 
 our municipal government. 
 
 APPENDIX OF EPIDEMICS 
 
 1867. Guildford (Dr. George Buchanan). — 250 cases due to 
 pollution of a new chalk well supplying part of the town, by 
 quantities of sewage leaking from an old ill- constructed sewer. 
 
 Dr. Buchanan alludes to the fact that the conversion of privies 
 into water-closets was a danger, especially in the chalky soil of 
 Guildford. 
 
 Sir J. Simon, commenting on the case, says, ' The new well, 
 no one could doubt, was most dangerously situated ; in the porous 
 and fissured chalk stratum it was within ten feet of various 
 sewers, one of which indeed was traversed by the iron delivery 
 pipe of the high service,' &c. 
 
 1870. Warwick (Dr. Buchanan). — ' The public water-supply of 
 the town scandalously filthy.' 
 
 1873. Sherhorne (see p. 147). 
 
i84 ENTERIC FEVER 
 
 1870-73.— Mr. Simon gives a list of 147 places infected in 
 these years. In almost all of these reports the words ' polluted 
 water' or their equivalents appear, but the details are seldom 
 given, and no further analysis would prove profitable. 
 
 1874. Lewes (Dr. Thome Thorne). — 450 cases, due to pollution 
 in the course of and at the periphery of water service caused by 
 intermissions in the supply. 
 
 The water main at one spot passed through the centre of one 
 of the public sewers. ' This sewer was in consequence opened up, 
 and when the arch of the culvert was removed at the point where 
 the water main passed through it, a jet of water suddenly shot up 
 into the air. There was a hole in that portion of the water main 
 which was inside the sewer.' 
 
 1876. Tideswell, Derbyshire (Dr. Thorne). — Outbreak of enteric. 
 ' Spread of disease favoured by conditions in an intermitting water 
 service allowing of suction of foul air into water-pipes.' 
 
 1878. Dewshury District (Dr. Thome).— Population 124,286. 
 Excessive mortality, especially enteric. 
 
 ' Water-supply for some districts liable to pollution at its 
 sources, and periodically fouled in the delivery mains during 
 intermissions in the service.' 
 
 1879. OJcehampton (Dr. Blaxall). — ' Water-supply exposed to 
 pollution by direct communication between water mains and 
 closets.' 
 
 1879. Bedhill and Caterham (see p. 139). 
 
 1880. Enfield (Dr. Parsons). — Occasional occurrence of enteric. 
 Causes multiple. ' Probable local contamination of intermittent 
 water service by reflux of foul matters from water-closet.' 
 
 1880. Haverfordwest (Dr. Parsons). — Epidemic of enteric. 
 ' Public water-supply insufficient and liable to contamination both 
 at reservoirs and in course of delivery, by sewer air sucked in 
 during intermissions through leaky flush-valves.' 
 
 1880. West Cowes (Dr. Ballard). — Enteric fever prevalent. 
 ' Intermittent water-supply liable to pollution in the mains.' 
 
 1880. Sandown (Dr. Ballard). — * Water-supply from water- 
 works taken from a stream much polluted in its course by sewage 
 and excrement.' 
 
 1880. Ventnor (Dr. Ballard). — ' Water-supply from waterworks 
 intermittent, and polluted dangerously by free admission of sewer 
 air into reservoir by means of overflow pipe.' 
 
 1880. Llanelly (Dr. Parsons). — ' Water-supply constant and 
 
APPENDIX OF EPIDEMICS 185 
 
 plentiful, but liable to contamination by filth of population living 
 above intake.' 
 
 1880. Newlyn East, Cornwall (Dr. Ballard). — 'Very scanty 
 supply of water, and mainly from a well with which the village 
 drain freely communicated near its outlet.' 
 
 1880. Totnes (Dr. Parsons). — 'Outbreak apparently due to 
 failure of town water-supply in the exceptionally dry summer, 
 and consequent want of flushing of sewers, drains, and w.c.'s.' 
 
 1881. BlacJchum (Dr. Airy). — 238 cases due to fouling of a 
 culvert belonging to the water company by soakage from privies 
 and surface drainage of adjacent cottages at the village of Guide, 
 in which there had been cases of enteric fever. 
 
 1881. Bodmin (Dr. Parsons).— Severe epidemic. Cause? 
 Water-supply liable to contamination. 'Possibility of reflux of 
 foul matters into public water-supply from closets flushed direct 
 from an intermittent service.' 
 
 1882. Bojigor (Dr. Barry). — 548 cases caused by the filter 
 beds being flooded with raw river-water containing excremental 
 matter. 
 
 1884. Sheemess (Mr. John Spear). — ' Water service inter- 
 mittent, water mains often laid in same trench with tributary 
 sewers, and interchange of contents between house drains and 
 house service-pipes several times discovered.' 
 
 1885. Kidderminster (Dr. Parsons). — 1,200 cases at least. 
 Probably due to in-suctions of impurity during intermissions. 
 The fouling of a deep well by percolation of subsoil water and 
 sewage during a drought also not by any means excluded. 
 
 1883. Hitchin (Mr. W. H. Power).— ' Outbreak of enteric 
 associated with defects of the public waterworks, permitting 
 occasional back-flow of sewage-polluted river-water into the 
 pmnping-well.' 
 
 1884. Beverley (Dr. David Page). — 231 cases due to con- 
 taminated supply of Beverley Waterworks Company, derived firom 
 deep chalk wells (333 feet in all). Company's well and reservoir 
 close to sewage-irrigated field belonging to East Kiding County 
 Lunatic Asylum. Sewage firom asylum is supposed to have 
 trickled alongside the well shaft. 
 
 1885. Faldingworth (Dr. Gress well).— Small outbreak trace- 
 able to pump-water polluted by washings from a fever case 
 imported fi:om Newark. 
 
 1887. Margate (Dr. Page). — Increase of mortaHty from enteric. 
 
i86 ENTERIC FEVER 
 
 ' Water-supply pumped from a well in the chalk, on the outskirts 
 of the borough beside a populous and growing neighbourhood. 
 Water of bad quality and exposed to contamination by soakage of 
 sea-water and from cesspools.' 
 
 1888. Mountain Ash (see p. 145). 
 
 1888. BucJcingham (Dr. Parsons). — Sudden outbreak of enteric, 
 confined at first to a poor suburb of the town, and specially 
 affecting persons drinking water from a particular ' spout.' The 
 water conduit to this spout exposed to pollution from a leaky 
 drain which had received specifically infected excreta from a 
 previous case of enteric fever. 
 
 1889. Longton, Staffordshire (Mr. Spear). — 155 cases. * Special 
 incidences of primary invasion in part of the town getting a supply 
 from a particular section of the public water service.' 
 
 1889. Bochester (Mr. Spear). — Public water-supply from wells 
 in the chalk. ' In very many cases at Strood, and in a few in 
 Eochester, I found water-closets supplied direct from the mains, 
 i.e. without the intervention of any cistern or tank. The danger 
 of in-suction of air, and even of solid matter, into the water-pipes 
 from closet-pans, during temporary discontinuance of water- 
 pressure, is well known to attend this objectionable arrange- 
 ment.' 
 
 1889. Houghton-le- Spring (see p. 141). 
 
 1890-91. Tees Valley (Dv. Barry).— 1,463 cases due to public 
 water-supplies taken from the Tees, which was more than ordi- 
 narily polluted after a flood. 
 
 The water-supplies were owned by the Darlington Corporation 
 and the Middlesbrough Water Board. ' The river is found to be 
 at all times subject to conditions of the gravest fouling, by reason 
 of the fact that human excreta and other filth are knowingly and 
 deliberately conveyed to it.' 
 
 1891. Rotherham, Bawmarsh, and Masborough (Dr. Theodore 
 Thomson). — 211 cases. Caused by the pollution of the High 
 Level Water- Supply of the Eotherham Corporation. 
 
 Pollution caused by the washings of manure inclusive of human 
 excrement into the streams contributing to the public supply. 
 
 1891-2. King's Lynn (Dr. Bruce Low). — 226 cases, mainly in 
 February and March 1892, due to fouling of public water-supply 
 by the direct inflow of manurial filth, inclusive of human excreta 
 and typhoid excreta after a sudden thaw and flood. 
 
 1890-93. Newark (Dr. Bruce Low).—' Out of a total of 297 
 
APPENDIX OF EPIDEMICS 187 
 
 cases of enteric fever, 78-5 per cent, occurred among that half of 
 the population which habitually consumed water from the public 
 service.' 
 
 This water consisted in part of raw unfiltered water from the 
 Trent. 
 
 1892-93. Chester -le- Street (Dr. Maclean Wilson).— 58 cases, 
 mainly occurring in the area of the Consett Water Company, 
 which obtained its water from the Stanley Burn. The burn 
 was more or less fouled with excrement, but three miles above 
 intake was a cottage, draining into the burn, which, in October 
 1892, contained four cases of enteric. 
 
 The Consett water, before distribution, was subjected to sand 
 filtration, but it is pointed out that the sand was obtained from 
 the banks of the polluted Eiver Wear. 
 
 1893. Atherstone WarwicTc (Dr. Wheaton). — Outbreak of 
 enteric due to the introduction into the town water mains of 
 polluted water (particulars not given). 
 
 1893. Worthing (Dr. Theodore Thomson). — 1,411 cases in 
 Worthing, West Worthing, and West Tarring. The epidemic in 
 Worthing caused by leakage of a sewer into a heading run from 
 the bottom of a deep chalk well. The epidemic in West Tarring 
 and West Worthing presumably due to infection of the water 
 mains by the entrance of filth firom the surface through ball 
 hydrants. 
 
 Speaking of the Worthing epidemic. Sir E. Thome Thome 
 says, ' Chemistry had all along failed to detect in the water any 
 definite impurity, and it was only in the later stages of the 
 epidemic that the results of bacterioscopic examinations went to 
 finrnish conclusive evidence, not only of its being fouled by faecal 
 matter, but of its contamination by the specific material of enteric 
 fever.' 
 
 Both waterworks and sewers the property of the Worthing 
 Corporation. 
 
 1880. Newport, Isle of Wight (Dr. Ballard).— 'Water-supply 
 from water- works good and abundant ' {vide 1894). 
 
 1894. Newport, Isle of Wight, with ParWiurst Barracks Prison 
 (Dr. Theodore Thomson). — 516 cases (population over 10,000). 
 4*2 per cent, of those drinking ' Newport water ' were attacked ; 
 1*7 per cent, of those di'inking from private wells. 
 
 The water was from chalk wells imperfectly lined, polluted by 
 an adjacent pond, and probably by more distant leaking cesspools. 
 
i88 ENTERIC FEVER 
 
 of which there were many. Water found to contain Bacillus 
 coli. 
 
 1895. Baunds, NortJiants (Dr. Bruce Low). — 129 cases, mainly 
 traceable to two public wells which had been distinctly infected by 
 the rinsings and washings of utensils and linen and stools of 
 enteric patients. 
 
SANITATION OF CAMPS 189 
 
 CHAPTER XIX 
 
 TRE SANITATION OF CAMPS^FLIES AND THE 
 SCIENCE OF SCAVENGING' 
 
 In the recent debate ^ at the Clinical Society of London 
 on Dr. H. H. Tooth's paper ^ on enteric fever in South 
 Africa it was established : (1) that the number of flies 
 in our camps was prodigious ; and (2) that these flies 
 were largely a result of the military occupation. There 
 seems also to have been a very general consensus of 
 opinion (3) that flies may convey infection. It becomes 
 therefore of great importance to consider the genesis of 
 flies ; and I trust that one who has no claims to be 
 considered a dipterologist may be pardoned for recalling 
 a few common facts. 
 
 Flies multiply at a prodigious rate. Given a tempe- 
 rature sufficiently high to hatch the eggs, their numbers 
 are only limited by the amount of food available for 
 them. Linnaeus is credited with the saying that three 
 meat-flies, by reason of their rapid multiplication, would 
 consume a dead horse quicker than would a lion, and 
 the fact that certain diptera having some outward re- 
 semblance to the honey-bee lay their eggs in the dead 
 carcasses of animals probably led Samson and Virgil to 
 
 ' Eeprinted from the Lancet, May 18, 1901. 
 
 2 Ibid. March 16, p. 786, and 30, 1901, p. 932. 
 
 3 Ibid. March 16, 1901, p. 769. 
 
I90 SANITATION OF CAMPS 
 
 make erroneous statements with regard to the genesis 
 of honey and the manufacture of bees. The breeding 
 of ' gentles ' for ground-bait is an industry the practisers 
 of which could probably give much information as to 
 the nicety of choice exercised by flies in selecting 
 material for feeding and egg-laying. According to 
 Packard the house-fly makes selection of horse-dung 
 by preference for ovipositing, and as each female lays 
 about 120 eggs and the cycle of changes from egg to 
 fly is completed in less than three weeks it seems 
 probable that a female fly might have some 25,000,000 
 descendants in the course of a hot summer. Other 
 varieties of flies multiply, I believe, still more rapidly. 
 
 As flies multiply upon, and in, organic refuse of 
 every kind it is obvious that the sooner such refuse is 
 placed where it cannot serve for the feeding and hatch- 
 ing of flies the more likely is the plague of flies to be 
 lessened. The most commonly available method for 
 the bestowal of organic refuse is burial. The egg-laying 
 of flies in dead carcasses commences at the very instant 
 of death, or even before death in the case of enfeebled 
 animals. This fact has been insisted upon by Megnin 
 in * La Faune des Cadavres,' and appears to be true of 
 human beings dying from fever. It is obvious, there- 
 fore, that there must be no delay in the burial of 
 organic refuse, and that the burial of animals and 
 excreta is quite as important as the burial of human 
 beings. After a great battle it may not be possible to 
 follow this advice, but nevertheless there can be no 
 harm in insisting that the instant burial of all organic 
 refuse must be the aim of those who are called upon 
 to guard the public health, whether military or civil. 
 
 It is impossible to lay down any line of action which 
 shall be the best under all circumstances, and those 
 
SALISBURY PLAIN 191 
 
 who, like myself, have not been through the South 
 African campaign are incompetent to deal with the 
 special circumstances of that campaign. Nevertheless, 
 I am of opinion that much that I have witnessed on 
 Salisbury Plain in connection with camp-scavenging is 
 bad and is not calculated to teach the soldier the right 
 principles of dealing with organic refuse, which is 
 always his most dangerous enemy. The science of 
 scavenging requires to be taught. If the duty of sca- 
 venging be left to the ignorant and be controlled by 
 persons who think that necessary details are beneath 
 their notice, then annoyance and disease are the only 
 results possible. 
 
 If the scavengings of a camp are to be satisfactorily 
 dealt with the question of their ultimate disposal must 
 be ever present in the mind of the scavenger. The 
 materials collected have to be burnt, to be buried, or to 
 be otherwise dealt with. The mere dumping of refuse 
 in mixed heaps ought certainly to be abandoned, and the 
 contents of the latrines ought to undergo immediate 
 superj&cial burial at the nearest available spot in order 
 to avoid cartage and spilling. In many cases it should 
 be possible to bury the excreta in the immediate vicinity 
 of the spot where they are dropped. We hear of excreta 
 being buried in trenches ten feet deep, but such a course 
 must mean that they are left exposed to give off odours 
 and to breed flies for many hours before they are under 
 ground and covered up. I have consulted a gravedigger 
 on this question and asked him, * If you were ordered 
 to dig a grave ten feet deep what breadth and length 
 would be necessary, and what time would you require ? ' 
 His reply was that (in chalk) the grave would have to 
 be six and a half feet long and three and a half feet 
 wide, and that he would rgquire a day and a half to 
 
192 SANITATION OF CAMPS 
 
 complete the work. It is certain that thirty-six or forty- 
 eight hours' delay in the disposal of faeces is most 
 undesirable. I have always advocated the burial of 
 faeces in shallow furrows rather than in deep trenches, 
 and, in this country at least, where alone I have had 
 experience, I am convinced that this is the only reason- 
 able course to pursue. If properly done all o£fence to 
 eyes or nose is thus ended and the faeces cease to 
 attract either flies or rats. The faeces can be covered 
 continuously as soon as they are dropped, and there is 
 no need of having malodorous open trenches partially 
 filled which are waiting to be completely filled before 
 being covered up. 
 
 This burial of faeces must be done methodically and 
 carefully and with every attention to detail. The pro- 
 ceedings must be precisely those of a gardener who is 
 intent upon raising crops. The fact that in war the 
 crops may never be harvested is quite beside the mark 
 and affords no excuse for slovenly procedures which are 
 a danger to health. Nitrification in the soil is the aim 
 equally of the sanitarian and the agriculturist. If a 
 plot of ground fifty yards long and fifty yards wide — 
 slightly more than half an acre — be allotted for the 
 disposal of faeces this should be marked off into, say, 
 sixteen strips, each about eight feet wide and fifty yards 
 long, with a narrow path of about eighteen inches 
 between each strip to allow for watering and cultiva- 
 tion. The line of the furrows must be accurately marked 
 by a cord and reel in the ordinary way, and the digger 
 must move continuously backwards in order to avoid 
 trampling on the freshly dug ground. The making of 
 the furrows should commence at the point furthest 
 from the latrines and it should gradually come nearer 
 to them. The earth removed from the first furrow 
 
TRENCHES 193 
 
 should be wheeled down near the latrines, where it will 
 be ultimately wanted to cover the last furrow which is 
 dug. The capacity of the furrow or little trench will 
 depend upon the size of the spade. I find that, working 
 in ordinary garden soil with a spade having a blade 
 nine inches long and seven inches wide (the furrow 
 being consequently nine inches deep and seven inches 
 wide), eight stable-bucketfuls of soil each holding two 
 and a half gallons, or about twenty-two pounds weight 
 of earth, were removed. This amounts to two and a 
 half bushels of soil, weighing 176 pounds, as the 
 measure of the capacity of a trenchlet eight feet long. 
 This trench must be filled with excreta, and great care 
 must be taken that nothing except faeces and paper and 
 the accompanying urine is placed in it. If broken 
 crockery or old tins are accidentally mixed with the 
 excreta they must be removed. The trench being filled 
 with faeces, mark out a digging line at a distance equal 
 to the width of the spade (seven inches) behind the 
 edge of the first trench and then cover the faeces in the 
 first trench by the earth removed in making the second. 
 Owing to the draining away of urine and moisture and 
 their great compressibility it will be found that the 
 excreta undergo a considerable diminution of bulk when 
 tipped into the trench. When the earth of the second 
 trench has been removed and shovelled on to the top of 
 the first trench it will be found that there is a raising 
 of the general level of the ground, and the second trench 
 will be found to have a cross section which is rather 
 triangular than rectangular, owing to the oblique direc- 
 tion of its front wall, which is composed of a sloping 
 bank of friable earth. The surface of the ground must 
 be left crumbly, smooth, and perfectly neat, like a well- 
 prepared garden bed. No particle of faeces or paper 
 
 o 
 
194 SANITATION OF CAMPS 
 
 must be left uncovered. There will be no offence to 
 eye or nose, no putrefaction is possible, and the faeces 
 are beyond the reach of dipterous insects, and if there 
 has been no delay in the collection and burial of the 
 faeces they cannot have been used for oviposition to any 
 great extent, so that the soil will not become infested 
 with * grubs.' 
 
 How many men will provide the quantity of faeces 
 which can be placed in a trench eight feet long from 
 which 176 pounds weight of earth have been removed ? 
 The answer to this question is governed by bulk rather 
 than by weight. If faeces and earth were equal in bulk 
 for equal weights and if we allow a quarter of a pound 
 of fasces for each man — for the urine soaks away and 
 qua bulk may be neglected — then the answer would be 
 176 X 4 = 704. If the faeces are weight for weight 
 four times as bulky as the earth, the answer is 176. In 
 any case it seems safe to say that a trench eight feet 
 long, nine inches deep, and seven inches wide will suffice 
 to take the faeces of 100 men. This estimate entirely 
 accords with my experience gained in my garden at 
 Andover, where the faecal accumulations of twenty 
 cottages have been disposed of daily in the manner 
 indicated for eighteen years, and where it takes at least 
 five years to cover an acre of ground in this way. Those 
 who have not had experience of this method of dealing 
 with faeces are apt to have exaggerated views as to the 
 amount of land required. If a trench eight feet long 
 and seven inches wide is sufficient for the disposal of 
 the daily quota of excreta from 100 men, then ten such 
 trenches occupying an area of eight feet by seventy 
 inches — say six feet— is enough for 1,000 men, and one 
 strip of ground fifty yards long and eight feet wide 
 would serve for a regiment of 1,000 men for twenty-five 
 
VEGETATION 195 
 
 days, and the sixteen strips would serve for 400 days — 
 let us say half an acre per annum per 1,000 men. The 
 actual area necessary will depend to some extent upon 
 the nature of the soil and the care and skill of the 
 scavenger, but in no case can the area required be 
 regarded as a bar to the process— certainly not on the 
 veldt or on Salisbury Plain. It need not be insisted 
 on that a scavenger must be incessantly at work. The 
 excreta should be taken up as soon as dropped and be 
 placed in a covered pail, and the pail when full should 
 be emptied into the furrow and covered up. In this 
 way effluvia are stopped and ovipositing by diptera is 
 rendered impossible. Further, this method of disposing 
 of faeces necessitates no increase of the impedimenta of 
 an army ; no lime or chemicals are needed, and no 
 apparatus beyond a spade and a set of garden tools. 
 
 The ground beneath which the faeces are deposited 
 should when the work is done have the appearance of a 
 well-prepared garden bed and it will need little atten- 
 tion until it is covered with herbage of some kind. 
 The only question remaining to be decided is as to 
 what that herbage should be. There can be no camp 
 without water-supply, and in every camp one of the 
 sanitary problems is the disposal of waste water. Some 
 of this waste water should be used in time of drought 
 for laying dust and encouraging fertility in that small 
 area of ground beneath the well- tilled surface of which 
 the faeces are safely bestowed. Then, the higher the 
 temperature the quicker will the ground bring forth 
 green leaves to freshen the air. Whether the crop be 
 grass, cabbage, cereals, onions, mustard and cress, 
 lettuces, spinach, or what not must depend upon cir- 
 cumstances. I think the seeds sown in such ground 
 should always be those of culinary vegetables, which 
 
 o 2 
 
196 SANITATION OF CAMPS 
 
 may prove a real blessing if the camp be long occupied. 
 With a little care in a hot climate one may have a 
 green covering of grass or mustard and cress in a 
 week, which at least will give off oxygen to the air 
 even if it do not serve as an antiscorbutic diet for 
 man and beast — a diet which may just supply that 
 something which is lacking in tinned and salted pro- 
 visions. 
 
 In a temporary camp these methods of excrement 
 disposal are the best on the grounds of immediate 
 hygiene. In places like Salisbury Plain, which are to 
 be used as camping-grounds year after year, latrine 
 gardens are essential, and, if properly managed, should 
 furnish a good many acceptable extras for the canteens. 
 Last year (1900) at Perham, on Salisbury Plain, there 
 was a field of many acres occupied by the scavenging 
 contractor and placed a few hundred yards from the 
 camping-ground. On this were piled heaps of camp 
 refuse, old tins, meat bones, broken victuals, packing 
 materials, and faeces which had been * dumped ' with a 
 view to burning when dry enough. In their recent 
 state these heaps (in which flies were swarming) could 
 be smelt for a quarter of a mile down wind, and when 
 they began to burn the offensive smoke drifted still 
 further and not seldom over the camps themselves. 
 This haphazard method of * dumping ' refuse in pesti- 
 ferous heaps is not economical, not even from the point 
 of view of the area of ground required, and would be 
 rendered unnecessary by a little care in collection and 
 the judicious use of the spade by men who knew how to 
 turn these despised materials to profitable account. 
 Horsedung in the same way should be neatly stacked 
 in heaps like hotbeds, protected at the sides and covered 
 with earth. In this way the flies would be prevented 
 
KITCHEN REFUSE 197 
 
 from feeding and egg-laying on the dung, large quanti- 
 ties of saladings might be produced, and when the camp 
 was moved this well-rotted material should be applied 
 to the camping-ground with a view to the renovation 
 of the turf. On Salisbury Plain the growth of summer 
 is trodden under foot and there is no systematic reno- 
 vation in the winter. On turf downs the actual camp- 
 ing-ground should be changed every year and the 
 ground * top dressed ' as soon as the camp breaks up 
 in the autumn. Without careful management and good 
 husbandry these downs will soon be trampled and 
 scuffled into a dusty wilderness. In the same way all 
 the kitchen refuse should (after utilisation to a maxi- 
 mum extent in the stock-pot, &c.) be neatly stacked, 
 protected at the sides, and covered with earth. All 
 organic refuse should be completely protected by soil 
 from the attacks of diptera, and its fertilising properties 
 should be utilised forthwith. 
 
 It is sometimes said that we ought to be ready to 
 forgive the house-flies for the annoyance which they 
 cause to us because of their great services as sca- 
 vengers ; but I am rather inclined to take the view 
 that the presence of flies is a reproach to us for not 
 putting organic refuse to its proper use, and that the 
 fly is a robber which has been bred in material which 
 we have deliberately allowed to lie above ground instead 
 of covering it with soil. The scrupulous sweeping up 
 of crumbs and food particles immediately after meals 
 and the instant removal of the remains of food to fly- 
 proof larders need not be insisted upon. I believe that 
 a great advance in domestic hygiene will have been 
 made when the custom is more general of removing 
 dung every day from our stables, piggeries, cattle-sheds, 
 and poultry-runs, and stacking it carefully so as to 
 
198 SANITATION OF CAMPS 
 
 prevent the access of diptera, or burying it immediately 
 beneath the surface of well-tilled soil with a view to 
 the production of crops. We pity the horse * turned 
 out ' in a paddock when we see it tormented with * flies.' 
 Few of us pause to think that if the horsedung had 
 been collected daily and put to more profitable use 
 instead of being allowed to lie about and generate a 
 plague of flies the animal might have been happier 
 and the dung might have been more valuable for fer- 
 tilising purposes. When flies breed in dung-heaps the 
 larvae eat the dung and leave the straw. If each fly 
 needs one grain only of sustenance then the 25,000,000 
 which I have stated as the possible season's progeny 
 of a female house-fly will be capable of robbing a farmer 
 of 25,000,000 grains of fertilising material, which at 
 7,000 grains to the pound works out at 3,571 pounds, 
 or considerably more than one and a half tons. It is 
 bad economy to have your scavenging done by flies and 
 sad to see your potential wealth make to itself wings 
 and fly away. In my garden at Andover where human 
 excreta have undergone daily superficial burial for about 
 eighteen years there is no excess of flies, and I have 
 come to the conclusion that an essential part of garden 
 management is the daily collection of all garden offal, 
 such as dead leaves, fallen and rotten fruit, &c., and 
 either superficially burying or stacking it so that it 
 shall not serve as a breeding-ground for insects which 
 often prey upon the plums and peaches in the autumn. 
 
 In the management of refuse I am no advocate for 
 the use of chemical disinfectants. These are expensive, 
 generally evil- smelling, often poisonous, and lead to an 
 increase of material to be transported. The soil is quite 
 capable, with proper management, of turning all organic 
 refuse into * soil ' — a fact which the experiments of Sir 
 
NEATNESS 199 
 
 Seymour Haden and myself have abundantly proved. 
 Our experiments have also shown that from the point of 
 view of the innocuous transformation of organic refuse 
 into * soil ' deep burial is a mistake. This is true alike 
 of dead animals and of excreta. We are happily hearing 
 less of the pollution of the earth and of the growth of 
 microbes and toxins in the soil, and even from the 
 laboratories of bacteriologists we are learning that the 
 soil is our best friend. The use of quicklime in the 
 treatment of excreta is, I believe, quite unnecessary. 
 My experiments in burying small animals tend to show 
 that the quicklime preserves the body and mischievously 
 prevents the beneficent action of the soil. In the manage- 
 ment of refuse, there must be no slovenly * dumping.' 
 What is wanted is proper sorting at the time of collec- 
 tion, great attention to detail, absolute neatness, and an 
 appreciation of the ends to be attained. 
 
 In recommending the immediate collection of all 
 organic refuse and its instant covering with earth, I 
 am making no new recommendation. Moses had had 
 experience of a * plague of flies ' in Africa and was no 
 novice in the matter of camp-management. He found 
 it necessary to be most explicit in his directions for the 
 treatment of excreta. These directions are given in 
 Deuteronomy xxiii. 12-14, and I find that in the Eevised 
 Version of the English Bible there is an interesting 
 change in the passage. The old version runs thus : 
 
 * Thou shalt have a place also without the camp, 
 whither thou shalt go forth abroad : 
 
 ' And thou shalt have a paddle upon thy weapon ; and 
 it shall be, when thou wilt ease thyself [sittest down] 
 abroad, thou shalt dig therewith, and shalt turn back 
 and cover that which cometh from thee : 
 
 * For the Lord thy God walketh in the midst of thy 
 
200 SANITATION OF CAMPS 
 
 camp, to deliver thee, and to give up thine enemies 
 before thee ; therefore shall thy camp be holy : that he 
 see no unclean thing in thee [nakedness of anything], 
 and turn away from thee.' 
 
 The new version says (verse 13) : * Thou shalt have 
 a paddle among thy weapons,' and as a variant for 
 paddle gives * shovel ' in the margin. The passage, 
 therefore, means that a shovel for burying excreta 
 immediately is a necessary implement in every camp. 
 
AN EXPERIMENT IN SANITATION 201 
 
 CHAPTEK XX 
 
 AB EXPERIMENT IN SANITATION— COLLECTION OF 
 BAIN-WATEB— DISPOSAL OF SLOP-WATEB' 
 
 This cottage is represented {see fig. 6) not because of 
 any architectural beauty, but because it presents points 
 of interest. It forms the lodge of Gallagher's Copse, 
 which is a mile from Andover Junction, just outside the 
 borough boundary. The borough having recently adopted 
 the Model By-laws of the Local Government Board, it 
 became necessary to trek over the border in order to 
 escape from possible hindrances and prohibitions — an 
 important matter, because the owner is, in the matter 
 of house-building, an experimentalist. The soil is chalk. 
 The foundations were laid out by the aid of a compass, 
 in order to ensure that one angle of the cottage should 
 point due north. This arrangement ensures that there 
 is a possibility of some sunshine upon every wall of the 
 house at every season of the year. The accommodation 
 consists (see fig. 7) of a living-room (l), three bed- 
 rooms (b, b, b), scullery and wash-house (s), glazed 
 verandah (v, v), earth closet (c), wood-house (w), and 
 rain-water tank (t). * 
 
 In the house it will be noticed that there is a door 
 front and back, so that the passage can be swept by a 
 thorough draught ; that no room communicates directly 
 
 > Eeprinted from Country Life of July 6, 1901. 
 
202 AN EXPERIMENT IN SANITATION 
 
 with any other room ; and that every room has a fire- 
 place, which, from the point of view of ventilation, is 
 most important. No fireplace is placed against an out- 
 side wall. The chimneys do not get chilled, and * draw ' 
 admirably. 
 
 This cottage contains what ought to be the minimum 
 accommodation, viz. a living-room, and a bedroom each 
 for parents, boys, and girls. The scullery and wash- 
 house is so placed that, although it can be reached under 
 cover, the smell of cooking and the steam of washing 
 need not invade the dwelling-house. The earth closet 
 is well removed from the rooms, but, nevertheless, can 
 be reached under cover, via verandah and wash-house. 
 The walls are built of * mud,' with rough-cast on the 
 outside. Mud {i.e. chalk puddled up with a certain 
 proportion of straw), flints, and timber are the only 
 building materials found in the district. Most of the 
 clay-pits in the immediate vicinity have been long worked 
 out, and there is no stone. Mud is a non-conductor of 
 heat, and is consequently a very warm material. It is 
 said in the district that frozen water-pipes are very 
 uncommon in mud houses. It is very lasting, provided 
 it be kept dry. Mud walling should be begun in March, 
 and should not be carried on after the beginning of 
 September. It is not advisable to hurry your operations. 
 Foundations are necessary for mud walls, and these 
 should be of flint, concrete, brick, or stone. The mud is 
 15 inches thick, and with rough-cast on the outside and 
 a lining of match-boarding the thickness of the walls 
 is about 17 inches, and the fireplaces being all in the 
 centre and every side exposed to the sun, it is needless 
 to say that the cottage has proved a very snug winter 
 residence. The floors are of concrete, finished in granite 
 cement, and the skirtings are of the same material. 
 
PLAN OF COTTAGE 
 
 203 
 
 1 
 J 
 
 1 ^ , I °1 
 
 pq 
 
 PR 
 
 a^ 
 
 S3 
 
 
 R 
 
 J 
 
 \ 
 
204 AN EXPERIMENT IN SANITATION 
 
 Mud walls are inexpensive. The price paid for the 
 walls of the above cottage was 5s. per perch, i,e, a piece 
 of wall 1 foot high, 15 inches thick, and 16^ feet long. 
 
 The Model By-laws of the Local Government Board 
 say that the walls of a dwelling-house must be of hard 
 and incombustible material bonded together by good 
 mortar or cement. Now as mud is not hard, contains 
 straw, and is not bonded with anything, it is doubtfully 
 by-legal in districts which have adopted these Model 
 By-laws. In the late fire at Andover it was found 
 that while the thatched roofs blazed, the old mud walls 
 of the cottages withstood the fury of the flames. When 
 the tendency of by-laws is to boycott a local building 
 material and to extinguish a local industry, the 'pros and 
 cons ought to be very carefully considered. 
 
 An interesting feature of this cottage is the rain- 
 water tank. Although I have a deep well close at hand 
 which supplies an abundance of pure water, I was 
 anxious to ascertain how far rain-water falling on the 
 roof was capable of being utilised for household purposes, 
 notwithstanding that in some districts of England 
 cottages which are dependent upon rain-water only are 
 not permitted. With this end in view, I was careful to 
 provide a very plain, simple roof, without recesses for 
 the lodgment of dirt or nests, and it was this which led 
 me to use slates as a roofing material in preference to 
 the more picturesque tiles which grow moss. My rain- 
 water tank is constructed on the principle of the Venetian 
 cistern. In a city which reached the highest pinnacles 
 of commercial and artistic supremacy on ' rain-water,' 
 one is tolerably sure to get valuable ideas for the collec- 
 tion and storage of that commodity. The Venetian 
 cistern is of large capacity, and is so arranged that all 
 water drawn from the central well has previously passed 
 
RAIN-WATER TANK 205 
 
 through a sand j&lter. The tank is circular in form, 
 having an internal diameter of 7 feet and a depth of 
 10 feet. It is divided down the centre by a diaphragm, 
 which is perforated at the bottom by three agricultural 
 drain pipes. Each half of the tank contains 3 feet of 
 filtering material consisting of (from above, down) 1 foot 
 of coarse gravel, 1 foot of fine gravel, and 1 foot of 
 sand. The rain-water which falls from the roof passes 
 through two strainers contained in an ornamental vase, 
 and then, before being pumped, passes down through 
 1 foot of coarse gravel, 1 foot of fine gravel, and 1 foot of 
 sand, and up through a similar filter, before it can be 
 drawn from the pump. The tank is constructed entirely 
 of cement concrete, and the pump has a copper suction 
 pipe. It was important to avoid the use of lead, iron, 
 or galvanised iron for the storage of rain-water intended 
 for dietetic purposes. It will be noticed that all the 
 water has to be raised by a pump, so that none of it can 
 accidentally run to waste. The drips from the pump 
 are conducted back into the unfiltered half, and should a 
 boy play with the pump, he will merely ensure a double 
 filtration for the water, and will not be able to waste 
 any of it. I believe that half the water which we are 
 supposed to * use ' is merely wasted by carelessness and 
 bad taps. It will be noted that the water tank has been 
 brought to the front of the house, and that an ornamental 
 vase has been used for conducting the water from the 
 roof. Anything amiss with the water tank will be noticed 
 at once. This seems better than a dirty water-butt in an 
 obscure corner. Those who have more money and taste 
 will, I hope, soon outdo me in this direction. I commend 
 the rain-water tank to the attention of architects. 
 
 It may be well to dwell for a moment on the powers 
 of this roof as a rain collector. The area of the roof is 
 
2o6 AN EXPERIMENT IN SANITATION 
 
 (approximately) 1,100 square feet, and if the annual 
 rainfall fluctuate between 24 inches and 30 inches, then 
 the amount of rain falling upon the roof will vary from 
 2,200 cubic feet to 2,750 cubic feet. If we take a cubic 
 foot as the equivalent of 6| gallons, then we may say 
 that the amount of rain annually falling on the roof 
 will fluctuate between 13,750 gallons and 17,187 gallons. 
 If we put the average water-supply of the roof at 
 15,000 gallons a year, or rather more than forty gallons 
 a day, we shall not be far wrong. 
 
 Water experts say that in towns we want a supply of 
 forty gallons per head per diem. The dweller in the 
 clean country is content with much less than this, and 
 I feel convinced that ten gallons a day is an extravagant 
 estimate for the daily supply of a perfectly clean peasant 
 who does clothes-washing at home, but has not the 
 power of wasting water. 
 
 The storage capacity of the tank is about 1,600 
 gallons, or forty gallons a day for a drought of six 
 weeks. The water is excellent, odourless and colourless, 
 and altogether very unlike ordinary rain-water. 
 
 The water of this cistern was analysed both chemi- 
 cally and bacterioscopically for the Eoyal Commission 
 on Sewage Disposal on November 14, 1901, and with the 
 following results : 
 
 Parts per 100,000 by weight. 
 
 Ammoniacal nitrogen 0*064 
 
 Albuminoid „ 0-020 
 
 Nitrite 0-033 
 
 Nitrate 0-086 
 
 Oxygen absorbed from permanganate r at once . 0-23 
 
 at 80° F. 1 after 4 hours 0-48 
 
 After incubation at 80° F. for 6 days { ^l^^f^ * ^'^f 
 
 L after 4 hours 0-79 
 
 Combined chlorine 0-16 
 
 Dissolved oxygen (parts per 1,000 by volume) . 2-8 
 
WATER ANALYSIS 207 
 
 * Sample clear but yellow, no sediment, peculiar 
 faint smell rather like soot.' 
 
 The above is a typical analysis of rain-water. To 
 the eye and palate it is the best sample of rain-water I 
 have ever seen, and it has been used for all domestic 
 purposes. It should be said that the yellow colour is 
 very slight. Personally I cannot detect any smell, but 
 there is a faint taste of terra-cotta. 
 
 Dr. Houston found 25 bacteria per c.c. on gelatine at 
 20° C, and 7 per c.c. on agar at 37° C. The tests for 
 Bacillus coli and Bacillus enteritidis sporogenes gave 
 negative results. 
 
 These analyses, and those given on pp. 129-130 in 
 connection with my shallow garden well, are full of in- 
 struction and show how chemistry and bacteriology are 
 needed to check each other, and how both need to be 
 checked by a knowledge of source and circumstances. 
 
 The disposal of slop-water is always an important 
 consideration in cottage management. Usually this 
 means slop-water plus roof-water, but in this cottage 
 the roof water has been provided for. The amount of 
 slops, allowance being made for evaporation in cooking, 
 and washing and drinking, must always be considerably 
 less than the water consumed. Economy in the use of 
 water lessens the slop difficulty. 
 
 In this instance the slops are strained and filtered, 
 and allowed to flow away in a * filtration gutter,' to be 
 presently described. The arrangements are on the 
 south side of the. cottage, well exposed to the sun, so as 
 to favour evaporation. 
 
 The sink is just beneath the window of the scullery, 
 and the waste-pipe, without trap of any kind, passes 
 through the wall, and terminates in a free end about 
 18 inches from the wall and 2 feet 6 inches above the 
 
2o8 AN EXPERIMENT IN SANITATION 
 
 level of the ground. The waste-pipe empties itself into 
 a strainer and filter, which are placed about 15 inches 
 from the cottage wall, so as to avoid the risk of splash 
 or back soakings or accumulations of * dirt ' and insects 
 between the wall and the filter. The strainer is placed 
 on the top of the filter, and the filter discharges its water 
 on to a filtration gutter. This filter is shown in fig. 6 
 at the extreme right, and is marked with a cross. A 
 longitudinal section of the arrangement is shown in fig. 8. 
 The strainer consists of a basket with a wisp of 
 straw in it (b). This arrests all but the finest particles, 
 and is the best fat-trap I know — the only one, in fact, 
 which does its work efficiently and without offence. 
 The straw may be changed as often as necessary— every 
 day, once a week, once a month, according to the 
 amount of accumulations, which will largely depend 
 upon the thriftiness and knowledge of the cook. The 
 contents of the strainer may be given to the chickens, 
 put on the manure heap, or burnt. A new handful of 
 straw is then put in and the strainer replaced. The 
 changing of the straw has the advantage of giving a new 
 direction to the water. Any old basket of suitable size 
 which will hold the straw answers the purpose of a 
 strainer. After months of use it will get greasy and 
 rotten, and may then be burnt and be replaced by a 
 new one. From the strainer the slops flow into the 
 filter, which is simply a galvanised iron vessel, with an 
 outlet at the bottom and filled with broken clinker 
 varying in size from peas at the bottom to walnuts 
 at the top. This filter effects a further purification of 
 the slops, and acts partly mechanically and partly by 
 virtue of the growth of bacteria, on the surface of the 
 broken clinker. The filter shown has been specially 
 constructed, and is duplicated (see fig. 9), and the waste- 
 
2IO 
 
 AN EXPERIMENT IN SANITATION 
 
 pipe of the sink is provided with a reversible nozzle so 
 that either half of the filter can be used. For a cottage, 
 however, this is not necessary, and an old galvanised 
 iron bucket with a hole in the bottom will be found to 
 answer every purpose. 
 
 The filtration gutter consists of strong cast-iron 
 guttering, perforated with conical holes, having the small 
 ends upwards so that they cannot get jammed {see fig. 10). 
 This guttering, which is 9 inches wide and in lengths of 
 
 Fig. 9. — Duplicated Tank Filtek. 
 
 6 feet, is laid upon loose porous rubble or gravel placed 
 in a trench. 
 
 A trench 18 inches wide and 18 inches deep was first 
 dug from the filter due south, care being taken that the 
 bottom of the trench should slope away from the cottage, 
 in order that water should not flow back towards the 
 foundations of the building. The lengths of guttering 
 are then laid on a level with the top of the trench, the 
 level being maintained by means of bricks on edge, built 
 
FILTRATION GUTTER 
 
 211 
 
 up without mortar in little columns of four from the 
 bottom of the trench, each column, except the first and 
 last, serving to support the ends df adjacent lengths of 
 
 -h 
 
 
 
 ^So 
 
 tier 
 
 coo 
 
 t% 
 
 p 2 
 
212 AN EXPERIMENT IN SANITATION 
 
 guttering. It being ascertained that the level of the 
 guttering is true, with the slightest possible slope down- 
 ward from the filter, the trench is finally filled with 
 loose rubble of any kind — builders' rubbish, burnt clay, 
 lumps of chalk, gravel, clinker, coke, whatever may be 
 most readily obtained. This arrangement is shown in 
 longitudinal section (fig. 8) and in cross section (fig. 11). 
 Care should be taken that the packing be accurately 
 done at the junctions of the lengths of guttering, in 
 order to give support and firmness to the brick supports. 
 When finished, the filtration gutter looks as though it 
 had been simply laid upon the ground, there being, of 
 course, no indication of the rubble-filled trench beneath 
 it. The iron guttering is sufficiently strong to permit a 
 wheelbarrow or cart to pass over it, and there is no 
 objection to taking the gutter across a path. The sides 
 of the trench should be planted ; or the trench may be 
 dug in a shrubbery or plantation. At the cottage in 
 Gallagher's Copse the trench is taken across the garden, 
 and the sides are planted with raspberries and black 
 currants. 
 
 The arrangement shown has been in use since 
 September 1900. The straw in the basket has been 
 changed about once a fortnight. The filter has never 
 been changed ; we have never seen the slops run further 
 than the end of the first length of guttering, and when 
 the slops are not running the gutter and its neighbour- 
 hood looks perfectly dry. There is absolutely no smell, 
 no offence to eye or nose. The length of gutter provided 
 is 24 feet (four lengths), but the water has never been 
 seen to travel more than 6 feet. 
 
 Next, as to expense. The guttering has been made 
 for me by Messrs. Tasker, of the Waterloo Iron Works, 
 Andover, and costs Is. 6cZ. per foot run, and the special 
 
FILTRATION GUTTER 213 
 
 duplicated slop filter was supplied by the same firm at a 
 cost of 275. 6cZ. The total cost, therefore, of draining 
 this cottage was as under : 
 
 £ s. d. 
 Labour for digging trench, &c. . .026 
 
 Basket 9 
 
 Filter 17 6 
 
 Four lengths of filtration gutter (24 feet 
 
 in all) 1 16 
 
 Forty-eight old bricks, clinkers, &c., say 10 
 
 £3 7 9 
 
 But if an old basket and an old galvanised pail be em- 
 ployed, and if two lengths of guttering be used instead of 
 four, then the above bill will be reduced by 2L 6s. 3<i., 
 leaving 11. Is. 6d. as the total cost for providing drainage 
 for the cottage. Not only does the filtration gutter allow 
 the slop-water to flow away, but it stops back dead 
 leaves, which otherwise would soon choke the porous 
 rubble in the trench. 
 
 I may say that I advise that nothing but open 
 guttering be used for slop-water, be it perforated or 
 otherwise. Wherever this putrescible mixture flows in 
 the dark, the faint smell of drains is soon perceptible. 
 Where all is open, those little accidents which proverbially 
 will happen are seen at once. 
 
 Finally, the construction of the earth closet demands 
 a few words. Its precise situation and the reasons for 
 it have been previously alluded to. The closet is lighted 
 by a skylight, and air is freely admitted everywhere, 
 both in the closet and beneath the seat — a point of very 
 great importance. The receptacle is capacious, and is 
 in the form of a * dry catch,' as described in * Eural 
 Hygiene ' and ' The Dwelling-house.' The seat is only 
 14 inches high. The earth is contained in a bin fed 
 
214 
 
 AN EXPERIMENT IN S ANITA TION 
 
 ^^' 
 
 .■^ 
 
 CO cc 
 
 
THE EARTH CLOSET 215 
 
 from a large hopper-reservoir, which holds enough earth 
 for about 1,000 uses of the closet. The earth is added 
 by means of a hand scoop. The earth box is filled, and 
 the soil is removed, from the outside. In the illustration 
 (fig. 6) the lid of the hopper, through which the earth 
 is supplied, is plainly visible. Figs. 12 and 13 show a 
 plan and a vertical section. 
 
2i6 AN EXPERIMENT IN SANITATION 
 
 CHAPTEE XXI 
 
 MILK AND ITS RELATION TO HEALTH AND DISEASE^ 
 
 I SHALL begin by recalling to the recollections of you all 
 the great work that was done by Dr. Ballard, the medical 
 officer of health for Islington, when in the year 1870 he 
 demonstrated that an epidemic of enteric fever was 
 definitely due to milk. Ballard's work was so important 
 that I hope you will excuse me if I recall the main 
 actual facts with regard to it. They were these : — 
 During a moderate prevalence of enteric fever in Isling- 
 ton in the summer of 1870, Dr. Ballard noted that 
 within a circle of less than a quarter of a mile radius 
 there were 168 cases occurring in sixty-seven houses, 
 and of these twenty-six died. As there were only twenty 
 typhoid deaths registered in the whole of this large 
 parish outside the special area, there waij evidently some 
 special cause for the existence of the fever within the 
 special area. The house hygiene, which naturally first 
 of all attracted attention, I think we may dismiss by 
 saying that the houses attacked by the disease were no 
 worse than the others. Then the houses within the 
 limited area where the disease occurred had the same 
 water-supply as the rest of the parish and district. The 
 theory as to the fever which found most credence amongst 
 
 • An address delivered before the Wimbledon Medical Society, Novem- 
 ber 8, 1901. Keprinted from the Clinical Journal of January 8, 1902. 
 
MILK 217 
 
 the inhabitants, and amongst some of the doctors too, 
 was that it was in some way connected with the cutting 
 made for the North London Eailway. They talked of 
 * miasmatic influences,' and they said the soil was pol- 
 luted. Dr. Ballard was told that the mother of one 
 of the patients had an idea that the epidemic was due 
 to milk, and Ballard frankly admitted that when the 
 suggestion was made to him it appeared ridiculous. But 
 he was a man of singularly open mind, and he went to 
 work with very great patience, and followed up the 
 suggestion of the lady and made, with the willing assist- 
 ance of the medical practitioners of the district, a house- 
 to-house investigation. He found first of all that there 
 were no fewer than eight cases of enteric fever amongst 
 the family and employees of the dairy. Then he next 
 found that fifty-four of the sixty-two families attacked 
 (87 per cent.) were regular customers of the dairy, and 
 of the twenty-six fatal cases one had come from the 
 country, and the remaining twenty-five were customers 
 of the dairy. This particular dairy supplied 142 out of 
 2,000 families living in the area, and it was found that 
 seventy of these 142 families had been attacked, and 
 that out of fourteen fatal cases occurring outside the 
 special area five' were regular customers of the dairyman 
 in question, and others were chance customers ; so that 
 out of the total number of cases of enteric fever at that 
 time in Islington, Ballard undoubtedly showed that a 
 very undue proportion were customers of this dairy. He 
 also found that in 75 per cent, of the families attacked 
 the attacks were multiple — that is, that there were two 
 or three, or even more, patients in one house. And in 
 a particular house where several families lived, and who 
 all used the same foul privy, the only sufferers were an 
 old man and an old woman who drank the suspected 
 
2i8 MILK 
 
 milk. Then Ballard went to the premises of the dairy, 
 and an examination of the dairyman's premises showed 
 that rats had established a communication between the 
 sewers which received the faeces of the house first 
 attacked with enteric fever, and a wooden subterranean 
 water-tank, the water of which was used to swill the 
 milk cans. The conclusion was inevitable. 
 
 I am perfectly well aware that everybody in this 
 room is acquainted with this historic instance, but I have 
 chosen nevertheless to give you the details of the case. 
 It was the first time that milk as a serious cause of 
 disease had been really brought into court, and I wish to 
 recall to your recollection how patient was the work of 
 Ballard, how he left not a stone unturned to prove his 
 case. After Ballard's investigation of that Islington 
 epidemic the conveyance of enteric by milk was no 
 longer a * view ' held by this man or by that man, but 
 it was a fact, and you know very well that since Ballard 
 pointed out this fact milk epidemics of enteric fever 
 have been frequently reported. It is due, I think, to 
 the memory of the man who first really demonstrated 
 this fact, that the whole circumstance should be accu- 
 rately brought before you. It was indeed an epoch- 
 making investigation by a man with a scientific and 
 logical mind. He knew what care was necessary to 
 prove his case, and he definitely proved it. 
 
 I would here point out that that epidemic, and others 
 like it, were not due to anything wrong in the cow but 
 were evidently due to bad sanitary arrangements. And 
 I mention this because I am of opinion that there should 
 be no difficulty whatever in any dairy farm, even in the 
 wilds of the country, in obtaining an absolutely pure 
 water-supply. You cannot have a dairy farm unless 
 some part of it be moderately near a stream. There 
 
TABES MESENTERICA 219 
 
 are always meadows on the dairy farm, and to sink a 
 well, properly made, with securely lined sides, and to 
 dispose of the faeces by dry methods away from the well, 
 is a perfectly easy thing, and there ought not to be any 
 difficulty in getting such wholesome arrangements. It 
 is my opinion, and it is an opinion which may not be 
 shared by all, that on a dairy farm subterranean sewage 
 arrangements which are out of sight, and are liable to 
 be invaded by rats and to leak into wells, ought really, 
 if we are to have any control, not to be allowed. The 
 practice of swilling cowsheds and cow-houses with water 
 and leaving them damp cannot be regarded as whole- 
 some or sanitary in any way. You will find that the 
 best and sweetest smelling cowsheds are those without 
 water laid on, where no swilling is possible, where the 
 cleansing is carried out every day, and the place swept, 
 not swilled. 
 
 Now I wish to direct your attention to tubercular 
 disease, and I wish to bring to your notice certain facts 
 which have been brought forward as showing that there 
 is a very definite connection between milk consumption 
 and certain forms of tuberculosis. It is well known 
 that in recent years death from phthisis and death from 
 tuberculous disease have undergone a very notable de- 
 crease in this country. The only exception to this rule 
 has been found in deaths from tabes mesenterica among 
 children in the first year of life, and it was concluded 
 by the late Sir Eichard Thorne that as children pre- 
 sumably drink proportionately more milk in the first 
 year than in any subsequent year, it might be assumed 
 that the cause of the increased mortality from tabes 
 mesenterica in the first year of life was the bacillus 
 contained in the milk coming from cows with tubercu- 
 lous udders. This is a very large assumption. An 
 
220 MILK 
 
 assumption of that kind cannot be proved without an 
 immense deal of trouble, and I want to bring to your 
 notice the facts as I have read them. In the ten years 
 1881-1890 there were 8,890,238 children born in Eng- 
 land and Wales, and of these children the majority 
 we may suppose were milk drinkers. I wish you to 
 notice, please, that I am dealing with ten years and 
 not with one. Dividing these milk-consuming babies 
 into two classes, we find that whereas 39,194 died 
 of tabes mesenterica, 8,861,144 did not die of tabes 
 mesenterica, so that the odds against a new-born 
 child dying of tabes mesenterica during the period of 
 greatest milk-consuming appear to be 228 to 1. Of 
 the 8,890,238 children born, 1,259,860 died in their 
 first year. That is 142 to every 1,000, so that the odds 
 are 7 to 1 against a new-born child dying in its first 
 year, but if it does die, the odds are 32 to 1 against its 
 dying of tabes. If in a hundred milk-drinking children 
 dying in their first year only three die of tabes, that 
 does not give a high degree of probability that milk and 
 tabes are cause and effect. Although the mortality of 
 children in their first year slightly declined during the 
 decade 1881-1890 (from 149 to 142 per 1,000 births), it 
 is still too high. It may be advisable to consider the 
 chief causes of death of the 1,259,860 children who died 
 in their first year in the ten years with which I am 
 dealing. These were: — Whooping-cough and respira- 
 tory diseases, 294,203 ; nervous diseases (chiefly con- 
 vulsions), 215,665 ; diarrhoea, cholera, and digestive 
 disease, 180,201 ; measles, 25,366 ; and no fewer than 
 21,095 died of ' violence.' Tabes mesenterica, as I have 
 mentioned, killed 39,194, phthisis 7,246, and other tuber- 
 culous diseases 32,615, the total of the tubercular group 
 being 79,055, and other causes not classified killed 
 
TABES MESENTERICA 221 
 
 444,275. Thus it appears from these figures that tuber- 
 culous diseases caused at the outside about one in 
 sixteen of the deaths of these milk- drinking babies as 
 against about one in eight of the deaths of the entire 
 population at all ages. 
 
 Now, before it is possible to conclude that tabes 
 mesenterica is a form of tuberculosis produced by milk- 
 drinking, it would be necessary to demonstrate, by ^os^- 
 mortem examination, that so-called tabes is in all cases 
 tubercular. This does not seem in the least degree pro- 
 bable. We know very well that tabes is a loosely used 
 pathological term, and that there are certain things 
 which you cannot put on a death certificate unless you 
 want to fight the parents. To take two things, you can- 
 not put ' starvation,' and you cannot put * congenital 
 syphilis,' and I take it that tabes is often put down 
 euphemistically because a child has wasted away, so 
 that tabes, although a convenient term, is a term of low 
 pathological value. It is impossible to conclude without 
 a post-mortem examination that tabes is tubercular. 
 Tubercular tabes is not diagnosable during life with 
 anything like the certainty that enteric fever is diagnos- 
 able. Thus the question arises, out of the 39,149 deaths 
 from tabes mesenterica how many were tubercular? 
 The answer to that is not forthcoming. The next 
 question which would have to be determined is, Are the 
 tuberculous mesenteric glands, supposing them to exist, 
 due to a primary inoculation of the alimentary system ? 
 Most pathologists assert — German and English — that 
 primary disease of the alimentry tract is not at all com- 
 mon, and that it is the rule rather than the exception 
 to find caseous bronchial glands or other evidence of 
 tubercle in the body, and if you find caseous bronchial 
 glands or tuberculous lesions in the body, it is quite 
 
222 MILK 
 
 impossible to conclude that the condition of the mesen- 
 teric glands or the ulceration in the intestines is really- 
 primary . 
 
 Then supposing you satisfy yourself hj post-'morte7n 
 examination that the child had tuberculous disease of 
 the glands, and that that tuberculous disease of the 
 glands was primary, the next question you would have 
 to decide is, To what extent was the child artificially fed ? 
 How much cow's milk did it get per diem ? And did 
 the milk contain tubercle bacilli? These questions 
 would all have to be answered before you could give 
 probability to the view that tabes, tuberculosis, and milk 
 are related. Ballard found, as others have found, that 
 the existence of enteric fever was not amongst the 
 very poor, but amongst the people who had money 
 enough to buy lots of milk, and I do not think it would 
 be the experience of most of us here present that the 
 existence of tabes or the wasting of children was 
 amongst the well-to-do. We shall find it among the 
 very poor indeed. Having found the bacilli in the 
 milk, you would now have to determine whether or not 
 the bacilli were alive, and did the bacilli come from a 
 cow with a tuberculous udder, or from other sources ? 
 Those are all points which you have to decide, so that 
 the question is a very, very difficult one to answer, and 
 it cannot be done by merely holding * views.' The 
 probability is, as I think I have shown you by the 
 figures quoted, that milk-drinking as a cause of tuber- 
 cular diseases of the bowels is of no very great import- 
 ance. Without a complete chain of circumstances, 
 having a tuberculous udder at one end and tuberculous 
 mesenteric glands at the other, it is impossible to 
 establish even a low degree of probability that they are 
 related as cause and effect. In how many of the 39,194 
 
DEATH-RATES 223 
 
 children who died of tabes mesenterica was such a 
 chain established? And without such a chain being 
 established I think the * view ' is really nothing but a 
 * view,' and a very hazy view too. Even with such a 
 chain established is it possible to exclude other sources 
 of infection in a child born into a world of which one- 
 seventh part of the inhabitants are tubercular ? So that 
 you see one is surrounded with sources of fallacy on 
 every side. Then having traced back the tubercle in 
 the mesenteric gland of the dead child to the udder 
 in the cow, can you start from the tubercular udder and 
 say that round that tuberculous udder, or round the dairy, 
 there were scattered in undue numbers cases of tabes 
 mesenterica ? I think that is a piece of evidence you 
 cannot get, but it ought to be got. We are dealing with 
 a chronic disease, a disease concerning the incubative 
 period, of which we know nothing, a very insidious 
 disease, and a disease totally different from enteric fever. 
 Ballard showed that the cases of enteric fever could be 
 traced back to the dairy, and he then went to the dairy 
 and showed how the milk was infected, and how it spread 
 the disease. He explained the matter from both ends. 
 It is perhaps not possible to bring forward similar evi- 
 dence in the case of tabes mesenterica. We ought, 
 however, unless we can bring forward evidence of this 
 kind, to maintain a discreet reticence, because it is no 
 good * quarrelling with our bread and butter,' nor with 
 our milk unless we have some real solid grounds to go 
 upon. If, as seems probable, it be true that cow's milk 
 as a cause of tuberculosis holds an insignificant position, 
 I cannot think it is wise to adopt an alarmist attitude 
 on the question. 
 
 Now we will go to the death-rate from tabes mesen- 
 terica, and I find that the rate in 1881-90 for the whole 
 
224 MILK 
 
 population— I cannot get it for children under one year 
 of age — was -28 per thousand. Now certain counties 
 were above the average for England and Wales as a 
 whole, and these counties were Durham, Northumber- 
 land, Nottingham, London, Lancashire, the North Eiding 
 of Yorkshire, Staffordshire, and Worcestershire — all of 
 them, you will perceive, manufacturing counties. When 
 we come to the dairying counties we find that the rates 
 for tabes are lower, and lowest of all in Dorsetshire, where 
 the rate was only -11 per thousand, as against -46 in 
 Durham, where the rate was highest; that is to say, 
 there were more than four times as many deaths from 
 tabes in Durham as in Dorsetshire. If you go through 
 the agricultural and dairying counties you will find the 
 same low figures ; thus, Dorsetshire -11 per thousand, 
 Rutland -12, Westmoreland -13, Berkshire, Oxfordshire, 
 Herefordshire, and Huntingdonshire -14, Somersetshire 
 •15, Hertfordshire -15, Shropshire -15, Sussex and North 
 Wales -18, Northampton -18, Devonshire, Gloucester- 
 shire, and Bedfordshire -19. It is an interesting fact 
 that in the dairy counties the death-rate from tabes 
 mesenterica is low and in the towns it is high. In short, 
 proximity to the cow and possible facilities for obtaining 
 raw milk do not seem to have had any untoward effect 
 upon the tabes death-rate. 
 
 Next I will endeavour to show what is the incidence 
 of phthisis in the milk trades. Dr. Tatham gives in the 
 supplement to the 55th Report the death-rate of occupied 
 males, or, rather, the mortality figures of occupied 
 males between the ages of twenty-five and sixty-five 
 from certain causes. I have only taken out some causes ; 
 I do not want to weary you with unnecessary details. 
 The mortality figure from all causes in all males he takes 
 as a thousand, and the mortality figure of occupied males 
 
MORTALITY FIGURES 225 
 
 is rather less, because all males includes diseased males 
 as well as healthy ones, and the ones who are occupied 
 live longer, of course. Now, the mortality figure of all 
 occupied males from all causes, taking the mortality of 
 all males as 1,000, is calculated by Dr. Tatham as 953 ; 
 from alcoholism it is 13 ; from phthisis, 185 ; from 
 bronchitis, 88 ; from Bright's disease, 27. The group 
 of persons who have the highest mortality of any are 
 the inn and hotel servants in London. Their mortality 
 figure from all causes is 1,971, that is, more than 
 double the mortality figure of all occupied males ; from 
 alcoholism, 139, as against 13 ; from phthisis, 607, as 
 against 185 ; from bronchitis, 153, as against 88 ; from 
 Bright's disease, 60, as against 27. These figures bring 
 out very well what Professor Brouardel insisted on at 
 the late Congress on Tuberculosis in London, that 
 alcoholism is undoubtedly a great cause of death from 
 tuberculosis, and the high mortality figure of 607 
 amongst hotel servants from consumption is a very 
 interesting point. Now we come to the group that is 
 most important to us, that is to say, the milk-sellers. 
 The mortality figure of milk-sellers from all causes is 
 1,061, which is a little above that of all occupied males, 
 I may say that the mortality figure of all shopkeepers 
 is above that of all occupied males. In milk-sellers the 
 figure for alcoholism is 16, for phthisis 166, that is, below 
 the average for all occupied males. I think that is very 
 important, that these people who are always about with 
 milk have a mortality figure from phthisis less than 
 that of all occupied males. All occupied males give 185, 
 but the milk-sellers 166. Next I take the butcher. 
 His mortality figure is 1,096. From alcoholism, 35 ; 
 phthisis, 195 ; bronchitis, 79 ; and Bright's disease, 35. 
 Lastly comes the farm labourer. His mortality figure 
 
 Q 
 
226 MILK 
 
 is very low. It is 632, and the deaths from phthisis 
 only 115, and the farm -labourer is constantly engaged, 
 of course, in milking cows, possibly with tuberculous 
 udders, and probably manuring the land with the dung 
 that is voided from the tuberculous intestines of cows. 
 Taking the mortality figures for various trades from 
 phthisis, we have : Printers, 326 ; book-binders, 325 ; 
 hatters, 301 ; tobacconists, 280 ; tailors, 271 ; drapers, 
 260 ; shoemakers, 256 ; butchers, 195 ; milk-sellers and 
 dairymen, 166 ; fishmongers, 160 ; greengrocers, 154 ; 
 grocers, 131; gardeners, 106; physicians (who are always, 
 if I may say so, in touch with tuberculous sputum, but 
 they are driving in the open air and are well fed), 105 ; 
 clergymen, 67. It is to be noted that in the above list 
 those who are habitually brought presumably into close 
 contact with the Bacillus tuberculosis, such as the 
 physician who tends the patient, the clergyman who 
 visits him and buries him, the dairyman who sells tuber- 
 culous milk and butter, the butcher who deals in the 
 meat of tuberculous oxen, and the agriculturist who 
 tends the tuberculous cows and spreads their tuberculous 
 dung upon the soil, show no excessive tendency to 
 phthisis. I will remind you these are figures culled 
 from the tables of the Eegistrar-General in his supple- 
 ment, and I think they are not to be lost sight of in 
 examining this question. 
 
 Then, again, what has been our practice in this 
 matter ? Do we regard tabes in a child as due to milk 
 or due to want of milk ? It is a very great question 
 indeed. At University College, where we have not too 
 much money, we have a large Samaritan Fund, and we 
 used to spend a good deal of that Samaritan Fund in 
 giving away new milk to children that wanted it. We 
 gave the child with tabes cod-liver oil, of course, but an 
 
TABES MESENTERICA 227 
 
 order for a pint of new milk every day had remarkable 
 effects, and the way those children throve on it, and the 
 way they got well, was truly wonderful. My experience 
 at University College, and also at the Boyal Infirmary 
 for Women and Children, in the Waterloo Koad, was 
 exactly the same. It is a most important question. 
 Now, I do not think that this question can be settled 
 by laboratory experiments only, and I may say that, 
 whatever the answer may be to the question which 
 is to be tried again in the laboratories as to the exact 
 relationship between bovine tuberculosis and human 
 tuberculosis, we must not set aside the practical, the 
 clinical, and the epidemiological aspects of the ques- 
 tion. 
 
 I have asked again and again for epidemiological or 
 clinical facts which go to show that milk from a particu- 
 lar dairy has caused an undue amount of tuberculosis in 
 its milk consumers. Such evidence is wanting. Per- 
 haps that is due to the circumstances of the case and 
 the nature of the disease. Be that as it may, until such 
 evidence is forthcoming we ought to be very careful how 
 we move. We must have both science and practice 
 going hand in hand. In Ballard's case the discovery of 
 the Bacillus entericus merely strengthened the attitude 
 he had taken up. So with regard to Lister's great work ; 
 Lister took up what Pasteur had begun, and showed that 
 Pasteur's views were facts, and facts capable of practical 
 application. Now can you piece together milk and tabes 
 mesenterica, and show that they are cause and effect ? 
 
 It is too much the fashion at the present day to take 
 up a bacillus and multiply it (as these things do multiply 
 on cultivating media), and imagine all kinds of mischief. 
 That is not science. That has been done a good deal of 
 late years. For instance, people have said all bacilli 
 
 q2 
 
228 MILK 
 
 are so dangerous that the only rational thing to do is to 
 burn the dead body. Well, that is a matter that has 
 interested me, and I have looked about for evidence of 
 definite mischief having arisen from cemeteries. There 
 is not any. I do not say that some illness may not have 
 been caused occasionally, but on searching the Local 
 Government Board Reports I get no such evidence. 
 My own belief is that although cemeteries may be harm- 
 ful, yet they do a great deal more good than harm, 
 because they necessitate open spaces and growing of 
 trees, which freshen the air, and they keep the popu- 
 lation a little apart from each other. Our great object 
 nowadays is to prevent undue density of population, 
 and anything which prevents overcrowding and spreads 
 the people ought to be very welcome. Then again people 
 have said, and not very long ago either, that the typhoid 
 bacillus grew in the earth. Well, it seems very natural 
 that it should, but it does not, and there has never 
 been a case in which a definite typhoid epidemic has 
 been spread by the earth. They said this happened at 
 Maidstone, but of course it did not. You have only to 
 read the evidence carefully to find that such a statement 
 is a perfectly gratuitous assertion. Six bacteriologists 
 were at work at Maidstone, and they never discovered the 
 typhoid bacillus in the soil. (See p. 58.) 
 
 If I have not touched upon the burning question of 
 the relation of bovine tuberculosis to human tuber- 
 culosis, it is because I am not qualified to speak on the 
 subject ; I am not a bacteriologist, and it is purely a 
 bacteriological question. But even supposing that, by 
 dint of great ingenuity and perseverance, you can make 
 a bovine tubercle bacillus grow in a human subject, we 
 should still want to know the meaning of it, and we 
 must remember that just now people are very busy 
 
FOOD 229 
 
 taking a disease from calves and inoculating it into 
 human beings to do them good. Lord Lister said at 
 the Congress on Tuberculosis that it had been very 
 difficult to prove that vaccinia and variola were the same 
 disease. Even if the possibility of the transmission of 
 bovine tuberculosis to the human subject be admitted, 
 you have still got the other question to answer, whether 
 such transmission works mischief to the human race. 
 I feel that we must keep to the practical and clinical 
 side, and ask ourselves whether we in our daily experi- 
 ence have definitely seen harm from drinking good 
 milk — I am not speaking of sour milk or bad milk. I 
 think it is an important matter, because we must be 
 careful in this country not to get under the influence of 
 doctrinaires, of people who start a particular view, and 
 then run it for all it is worth and write it up. I have 
 brought figures forward which go to prove that the whole 
 thing needs a very careful consideration, and that evi- 
 dence is wanting from many sides. 
 
 The chemist can tell us very little indeed about 
 food. Whether it contains so much nitrogen or so much 
 carbon, &c. is not of much interest. There is a great 
 deal in food besides its chemical composition, and I 
 would remind you that we know nothing about the 
 chemical cause of scurvy. All chemical theories we are 
 inclined to set aside altogether, and we go back and say 
 it is the want of fresh food — fresh vegetables and fresh 
 meat. If we use these with really fresh milk from the 
 cow, or from the breast, scurvy tends to disappear. 
 When we are told that sterilised milk is as good as new 
 milk for the child, because animals maintain their 
 weight on it, I think that is a specimen of science run 
 mad. Children fed upon artificial food maintain their 
 weight, but though they may be fat, rosy, and plump, 
 
230 MILK 
 
 they may soon be down with rickets or with scurvy, so 
 that the mere fact that the child maintains its weight is 
 not enough. How about its vulnerability to disease of 
 various kinds? Eemember that to us, or to children 
 over nine mcjnths of age who are beginning to take a 
 mixed diet, the question of whether the milk is boiled or 
 fresh is not possibly of much importance. It does not 
 matter to me whether my milk is boiled or not ; I do not 
 consume many pints in a month, and I am getting a 
 mixed diet of many other things. But to the sucklings, 
 whether they get the right or the wrong thing is very 
 important, and we have to remember that we cannot 
 find that out in a few months or weeks. It may take 
 several generations, but nevertheless it is extremely 
 important, and all the more so because, with the increase 
 in population of our towns and cities, the inhabitants 
 are getting further and further removed from their milk- 
 supply and from their food-supply. We know now 
 practically nothing about our food- supplies, and we get to 
 know less and less about them, except that most of our 
 foods are wonderfully and curiously made. You must 
 remember that sterilised milk is all in favour of the 
 dairyman ; sterilised milk will keep for a month. He 
 bottles it, but is the bottled fluid the same as fresh milk ? 
 I doubt it very much indeed. The same remark applies 
 to meat, which nowadays is often killed at the Antipodes. 
 Is such meat the same as fresh-killed meat ? We get 
 more and more preserved foods, and we get further and 
 further away from the really fresh foods. There is a 
 great deal more tuberculosis in the cities than in the 
 country. I am inclined to think that the wasting chil- 
 dren of the cities will be improved by giving them as 
 much new milk as you can get them to take. 
 
SOME DIETETIC PROBLEMS 231 
 
 CHAPTER XXII 
 
 SOME DIETETIC PROBLEMS^ 
 
 Charles Lamb in one of the most charming of his essays 
 makes complaint of the man whose utterances are of too 
 positive a kind. The West Kent Medico-Chirurgical 
 Society will have no cause to pass a similar criticism on 
 the Purvis Orator of this evening. 
 
 It is mainly because the ' twilight of dubiety ' has 
 fallen upon me in regard to some dietetic problems, that 
 I have selected that subject for my discourse. Some of 
 the utterances on these questions which are found in 
 text-books, and which appeal to the wayfarer from the 
 hoardings in the streets, where the Fat Bulls of Bashan 
 compass us in upon every side, are to my thinking of too 
 positive a kind. 
 
 The change which has taken place in the dietary 
 of the British in the last two or three centuries is pro- 
 digious. The diet of our ancestors consisted mainly of 
 meat (including fish and poultry) and bread and beer 
 and wine and other fermented drinks made from honey. 
 Even in the dietaries of kings and nobles fresh vegetables 
 are seldom mentioned. Sugar and spices and dried 
 fruits were luxuries, brought from ' the Indies ' for the 
 tables of the rich, and except for occasional * pippins and 
 
 » Being the Purvis Oration, delivered to the West Kent Medico- 
 Chirurgical Society, December 7, 1900. 
 
232 SOME DIETETIC PROBLEMS 
 
 cheese,' fresh fruits were barely represented on the 
 dinner table. In the bills of fare of William of Orange, 
 I find mention of asparagus as an item served occasion- 
 ally for His Majesty's dessert. 
 
 It is difficult for us to conceive a dietary of which 
 tea, coffee, cocoa, sugar, and potatoes formed no part, 
 and into which fresh fruit and vegetables only occasion- 
 ally entered. How the poor, living on bacon and salt 
 meat, dried fish, bread and cheese, came through a 
 severe winter, we can scarcely understand ; nor can we 
 wonder if occasionally they were tempted to go ' in search 
 of conies,' or to cast covetous eyes on the fat deer in his 
 lordship's park. It is scarcely open to doubt that the 
 high mortality of these times and the frequent deaths 
 from * the purples,' the * bloody flux,' and allied diseases 
 which suggest a scorbutic habit of body, was due to the 
 comparative absence of fresh meat and vegetables from 
 the dietaries. 
 
 Fresh bread, good cheese, sound beer and honey 
 have each of them, probably, some antiscorbutic power ; 
 but if the bread be stale or sour, the beer ' turned,' and 
 the cheese rancid or mouldy, so that they create loath- 
 ing instead of appetite, the peasant's condition becomes 
 critical. 
 
 The gradual improvement in agriculture, especially 
 the .systematic use of * roots ' such as turnips and 
 mangolds for the winter sustenance of sheep and cattle, 
 has made the procuring of fresh meat in the winter an 
 easier matter. Concurrently the supply of human food 
 has been improved by the horticulturists, who have 
 made potatoes, carrots, turnips, ground artichokes, 
 celery, spinach, onions, leeks, beet, and the whole tribe 
 of cabbages available for our winter use. 
 
 More important still has been the effect of free trade 
 
IMPROVEMENT IN PUBLIC HEALTH 233 
 
 and rapid transit. The best of everything the world 
 supplies is to be had in our markets at a price against 
 which the home producer finds it difficult to compete. 
 Bananas are almost as cheap as turnips ; oranges may 
 sometimes be bought at little more than a farthing each ; 
 while grapes and pine-apples have long ceased to be the 
 exclusive luxuries of the wealthy. Imported animal food 
 is equally plentiful, and it is as true to-day as it was in 
 the days of Erasmus, that the masses of our population 
 fare equally as well as the monarch. 
 
 There is every reason to think that the improved 
 nutrition of the people has been the chief factor in that 
 improvement in the public health which has been 
 witnessed in the second half of the nineteenth century. 
 There is no excuse now for that taint of scurvy which 
 made the populations of the sixteenth and seventeenth 
 centuries so vulnerable to disease ; and the disappearance 
 from among us of spotted fever, typhus, and the purples 
 is probably due to this cause. That immunity to 
 zymotics is largely proportioned to the healthy nutrition 
 of the people is an assertion which may, I think, be 
 safely accepted. 
 
 There are one or two facts which tend rather to 
 check our optimism, and to suggest a questioning as to 
 whether the suppression of epidemic disease tends to 
 enhance the vigour of a race. 
 
 We are now confronted with the fact that the 
 diminution of our birth-rate is tending to rather more 
 than counterbalance the diminution of the death-rate, 
 and that an ever-increasing proportion of the population 
 has to be partially or wholly maintained at the public 
 expense. We may hesitate to call these assisted persons 
 * paupers,' but the fact remains. 
 
 The infants in our great cities are as delicate as 
 
234 SOME DIETETIC PROBLEMS 
 
 ever, and in hot seasons succumb to dietetic disease in 
 numbers which do not diminish. The pale and rickety 
 are apparently as plentiful as they were twenty years 
 ago. Our women, especially among the rich, are 
 neglecting the sacred privilege of suckling, and are 
 content to leave their offspring to the tender mercies of 
 advertising tradesmen, who compare badly with the 
 she-wolf that nurtured Komulus and Eemus. 
 
 We have long recognised rickets as a dietetic disease, 
 and in addition to rickets we have in recent years been 
 taught by Barlow and Cheadle that very definite scurvy 
 is not uncommon among infants who are artificially fed. 
 
 The increasing tendency to dental caries has been 
 attributed, and probably with justice, to deficiencies in 
 diet, and the ever-present dyspepsia, the scourge of all 
 ages and both sexes, betokens a want of vigour for which 
 dietetic errors are probably partly answerable. Again, 
 while I am ready to give every credit to our improved 
 powers of diagnosis, and to the greatly lessened dangers 
 which anaesthetics and antiseptics have brought to ab- 
 dominal operations, I cannot but feel that purulent collec- 
 tions within the abdomen are relatively more frequent 
 than they used to be, and it seems certain that the 
 human intestine is at least as vulnerable now to the in- 
 fection of enteric or dysentery as it was in former days. 
 These are questions which one cannot dissociate from 
 dietetics and nutrition. Nor must we refuse to consider 
 in like relation our increased and steadily increasing 
 susceptibility to malignant disease. 
 
 What we arbitrarily speak of as our advancing 
 civilisation has brought the important question of 
 the safe and effective * hand -feeding ' of infants very 
 much to the front, and very laudable efforts have been 
 made, first ^ to discover the proportions in milks of a 
 
FEEDING OF INFANTS 235 
 
 few complex ingredients which the chemist is able to 
 isolate and identify ; and secondly y by artificial means, 
 and often by the addition of materials which are not 
 found in natural milks, to make the milk of the lower 
 animals similar in composition to the milk of women. 
 
 But this is something more than a mere question 
 of chemistry. It is a question of biological action ; 
 and it seems to me certain that, in spite of infinite 
 pains and skill, milk in mamma must always be some- 
 thing very different from milk in vitro. 
 
 Milk in the breast is a part of the living mother, 
 just as the blood is, and like the blood it begins to 
 undergo physical changes the instant it is drawn. The 
 temperature falls, the fatty particles begin to separate, 
 and if it be whipped or churned there is formed, by 
 a process still imperfectly understood, that coagulum 
 which is conventionally known as butter. 
 
 In a very little time, proportionate to the tempera- 
 ture of the air and the purity of its surroundings, milk 
 turns sour or putrid and becomes unfit for human 
 food, and is often dangerously polluted by the filthy 
 ways, the carelessness, or the dishonesty of those 
 through whose hands it passes on the way to the con- 
 sumer. 
 
 To the suckling at its mother's breast, attached like 
 a bud to the parent stock, the milk flows from the living 
 cells of the mammary gland to the living stomach of 
 the child without risk of contamination, without loss 
 of temperature, without exposure to the air, without 
 any separation of its constituent parts, without, in 
 short, any of those physical changes which milk under- 
 goes in vitro y and which make it progressively less 
 digestible. It is probable that the composition of 
 human milk varies, in accordance with season and 
 
236 SOME DIETETIC PROBLEMS 
 
 diet, as much as does the milk of cows, but this is a 
 matter of small importance in comparison with the 
 physical difference between the milk which comes 
 direct from the mamma and the half-churned fluid 
 which is sucked from a bottle through a rancid bit of 
 indiarubber tubing. 
 
 I am inclined to the belief that milk becomes less 
 and less suited for the nutrition of an infant in direct 
 proportion to its remoteness in point of time from the 
 mammary gland. 
 
 It is difficult very often to form a judgment on the 
 effects produced by drugs or foods, because of the im- 
 possibility of getting away from the ^os if hoc fallacy. 
 
 I find, however, that there is an absolute consensus 
 of opinion among my obstetrical friends that children 
 which are nursed at the breast do better than those 
 which are hand-fed. My colleague, Dr. Herbert 
 Spencer, in particular speaks most positively on that 
 point. I am able to bring before you one case, which 
 seems very full of instruction. 
 
 A medical friend of mine has had three children, 
 and he has been good enough ta place in my hands 
 a record of the weights of these children for the first 
 eleven weeks following birth. 
 
 The interest of the record consists in the fact that 
 of these three children two were hand-fed, while the 
 third has been nursed by its mother. They are all 
 three boys, born in the same house, and in the midst 
 of comfort and good hygiene. One experiment is not 
 much, but the circumstances of this one seem to give 
 it a special value. The father says * all were splendid 
 chaps at birth,' a statement which, with regard to the 
 two first, I am able to corroborate. 
 
FEEDING OF INFANTS 
 
 237 
 
 
 1 
 
 2 
 
 3 
 
 
 Hand-fed 
 
 Hand-fed 
 
 Nursed 
 
 Weight at birth . 
 
 8 lbs. lOi oz. 
 
 9 lbs. loz. 
 
 9 lbs. 
 
 
 (138-5 oz.) 
 
 (146 oz.) 
 
 (144 oz.) 
 
 Weight at end of first 
 
 
 
 
 fortnight 
 
 127-5 oz. 
 
 151-5 oz. 
 
 164 oz. 
 
 Weight at end of second 
 
 
 
 
 fortnight 
 
 146-5 oz. 
 
 162-75 oz. 
 
 196-5 oz. 
 
 Weight at end of third 
 
 
 
 
 fortnight 
 
 153 oz. 
 
 170-5 oz. 
 
 221 oz. 
 
 Weight at end of fourth 
 
 
 
 
 fortnight 
 
 165-25 oz. 
 
 172-25 oz. 
 
 241 oz. 
 
 Weight at end of fifth 
 
 
 
 
 fortnight . 
 
 • 189-5 oz. 
 
 175 oz. 
 
 254-75 oz. 
 
 Weight at end of eleventh 
 
 
 
 
 week .... 
 
 193-25 oz. 
 
 180 oz. 
 
 265-75 oz. 
 
 Percentage of increase 
 
 33 per cent. 
 
 25 per cent. 
 
 84 per cent. 
 
 from birth . 
 
 nearly 
 
 nearly 
 
 
 These figures speak for themselves, and show that 
 the nursed child developed about three times as fast as 
 the two which were hand-fed. 
 
 Absolutely fresh milk, while it is still warm from 
 the animal, has always had a good repute for its 
 nourishing power, and in history there are instances 
 of aged people being kept alive by wet nurses. This 
 is recorded of Dr. Caius, one of the early Presidents 
 of the Eoyal College of Physicians and the founder of 
 Caius College, Cambridge. 
 
 In November 21, 1667, Pepys writes: "With 
 Creed to a Tavern. On this occasion. Dr. Whistler 
 (President of the Eoyal College of Physicians) told a 
 pretty story, related by Muffet, a good author, of Dr. 
 Caius that built Caius College ; that being very old, 
 and living only at that time upon woman's milk, he, 
 while he fed upon the milk of an angry fretful woman, 
 was so himself ; and then being advised to take it of a 
 good-natured, patient woman, he did become so beyond 
 the common temper of his age." 
 
238 SOME DIETETIC PROBLEMS 
 
 Most of the proved and acknowledged dangers of 
 milk, which are dangers inseparable from its manipu- 
 lation, are abolished by bringing the consumer into 
 direct contact with the producing animal and drinking 
 it * hot from the cow.' 
 
 There is still, I believe, a solitary cow in St. James's 
 Park, to remind Londoners that their ancestors were 
 believers in naturally warm milk; and if dairymen 
 persist in the dangerous practice of adding preserva- 
 tives and chemicals to the food of our infants, we may 
 live to see the re-establishment of the old custom, or 
 something like it. 
 
 It is greatly to be desired that our herds should 
 be composed of healthy animals — in that we are all 
 agreed — but to advise that, because of the dangers of 
 milk, all our infants are to be fed on sterilised milk or 
 boiled milk, instead of new milk, is to advise a rash 
 experiment, all the more dangerous, as it seems to me, 
 because the effects of such a practice will be difficult or 
 impossible to estimate. It would be a leap in the dark 
 —an arrogant rebuff to Nature, who in such matters is, 
 I believe, a tolerably safe guide. 
 
 And here I would take leave to remark that the 
 interests of consumer and producer are not identical 
 in this matter. If the dairyman be allowed to sterilise 
 all his milk, and still to call it * new milk,' he will be 
 relieved of the danger of losses from his produce * going 
 bad.' But he will sell us old milk for the price of new 
 milk. There is room here for liberty, and if sterilised 
 milk be labelled and sold as such, its market value 
 would soon be established. 
 
 So again the addition of antiseptics to milk or dairy 
 produce ought to be stated on the label. Why should 
 not milk and dairy produce to which chemicals are 
 
MEAT 239 
 
 added be allowed to find their market value ? Person- 
 ally I regard them as worse than worthless, but I am 
 aware that others hold a very different opinion. A 
 fair market will settle that question. That antiseptics 
 facilitate the trade of the vendor and increase his 
 profits there is no doubt. 
 
 Let us have fair labels, and let us adhere to the 
 motto ' Caveat emptor.'' 
 
 Having made out what seems to me a fairly strong 
 case in favour of new milk as against manipulated milk, 
 let us turn our attention to the question of meat. In 
 recent years we have had revealed to us the remarkable 
 effects produced in certain individuals by feeding on 
 the raw fresh thyroid gland of a sheep. The cretinous 
 dwarf has been seen to grow four or five inches in a 
 year, and to undergo an intellectual development on a 
 par with the physical change. The sufferer from obesity 
 sheds his fat while his pulse is quickened and the out- 
 put of urea is increased. The sufferer from myxcedema 
 regains her normal briskness and much of her natural 
 comeliness, while hair may, in some cases, be seen to 
 replace baldness, and the skin of the sufferer from 
 psoriasis become again as the skin of a little child. 
 
 We have learnt that this potent medicine must 
 be used with great caution, and we have further learnt 
 that the thyroid gland, in order to produce its full 
 effect, must be fresh and must not be cooked. The 
 chemist can tell us very little as to the difference 
 between cooked thyroid and raw thyroid, between fresh 
 thyroid and old thyroid, and yet dietetically there is an 
 enormous difference. 
 
 A fact of this kind seems to go far towards justifying 
 the popular prejudice in favour of ' underdone ' meat, 
 and the very general impression among doctors as to 
 
240 
 
 SOME DIETETIC PROBLEMS 
 
 the value of raw meat in certain conditions of impaired 
 nutrition. These dietetic problems are not susceptible 
 of rigid proof, but most of us are agreed that the 
 raw living oyster is a very digestible and stimulating 
 food, and that a new-laid egg beaten up with new 
 milk and taken raw is a food of great and acknowledged 
 value. We are not much given in this country to 
 the consumption of uncooked meat, but I would remind 
 you that in many parts of the world meat which has 
 been slightly salted and dried has a great reputation 
 for its nutritive and stimulating qualities. Beef may 
 be bought in London, under the name of hung beef 
 or Hamburg beef, which has been thus treated, and 
 which is enjoyed by many, and is easily digested. In 
 Germany hams and some forms of sausage are eaten 
 without being cooked, and the stimulating quality of 
 the food is said to outweigh the slight extra risk 
 of trichinosis. Among the advantages which the Boers 
 have had over us in South Africa must be reckoned 
 the very portable sun-dried food called ' biltong.' ^ 
 
 ^ In the British Medical Journal for April 12, 1902, Professor Halli- 
 burton, F.E.S., gives the following analysis of biltong made from a 
 sample at least two years old. 
 
 Composition of Biltong 
 Water ... 
 Solids . 
 
 Inorganic solids 
 
 Organic solids . 
 
 Proteids 
 
 Fat (ether extract 
 Glycogen . 
 Sugar 
 Extractives (by difference) 
 
 Professor Halliburton testifies to the ready digestibility of biltong, and 
 says that his experiments, both from the chemical and physiological 
 standpoints, testify to its valuable nutritive properties. 
 
 19-410 per 
 
 cent. 
 
 80-590 
 
 6-592 
 
 , 
 
 73-998 
 
 ) 
 
 65-866 
 
 5 
 
 5-140 
 
 > 
 
 0-133 
 
 , 
 
 0-090 
 
 5 
 
 2-769 
 
 > 
 
MEAT 241 
 
 This, I believe, should, correctly speaking, be made of 
 the loin muscles of a deer. Biltong made from the 
 ox appears to be equally valuable. With a piece of 
 biltong attached to the saddle, and a knife to cut it, 
 the commissariat department is at once simple and 
 effective. I have met English officers who were loud in 
 praise of biltong as a war ration. 
 
 In hot dry countries sun-dried uncooked meat is 
 much used by those who spend long hours in the 
 saddle. 
 
 In a moist climate like England the preservation 
 of dried meats is not to be done without great care. 
 
 It may be well to direct attention to the fact that 
 certain beasts which feed but seldom, such as snakes, 
 will not eat dead food, but only consume animals which 
 they kill themselves. It is interesting also to observe 
 how domestic carnivora, such as cats and dogs, when 
 burdened with the cares of a family, will often prowl 
 about in search of living prey. When I see my cat 
 incessantly stalking sparrows and making excursions 
 for mice to an inordinate extent, I know that she has 
 a litter of kittens, and I have also observed the same 
 propensity in a brooding bitch. 
 
 These facts have induced me to carry out some 
 experiments, or rather to ask my friend and former 
 pupil. Dr. Thiele, to carry out some experiments for me, 
 on the relative digestibility of meat under the three 
 conditions in which we know it, viz. : — {a) Immediately 
 after death, before rigor sets in ; (h) during rigor ; 
 and (c) after rigor, when the meat has become tender 
 again. 
 
 The result of these experiments so far has been 
 to show that m the usual mixture of HCl and pepsin 
 in one and a half hours the ante-rigor meat proves 
 
242 SOME DIETETIC PROBLEMS 
 
 25 per cent, more digestible than meat which has 
 entered into rigor. The post-rigor meat is not more 
 digestible than the meat in rigor. The ease with 
 which the muscle fibre undergoes peptonisation before 
 rigor seems to furnish a justification for the conduct of 
 carnivora which hunt their prej. Man very seldom 
 consumes meat before the advent of rigor, never, 
 probably, except when eating oysters. An officer just 
 returned from Africa, who takes a most intelligent 
 interest in these important dietetic questions, told me 
 that he was present on an occasion when some deer 
 got surrounded by a regiment of our men, and were 
 shot down, skinned, and eaten then and there before 
 the onset of rigor. He said they were very good eating, 
 and were much enjoyed as a change from tough draught- 
 ox and ' bully beef.' ^ 
 
 * In My Mission to Abyssinia, by Gerald Portal, I find the following 
 footnote (p. 188) : " Mansfield Parkyns {Life in Abyssinia, ch. xxvii. 
 vol. i.) gives the following description of ' brundo ' eating. The 
 slaughtering of animals in Abyssinia is attended with a regular 
 ceremony, as in Mohammedan countries. The animal is thrown down 
 with its head to the east, and the knife passed across its throat, while 
 the words ' In the name of the Father, Son, and Holy Ghost ' are 
 pronounced by the butcher. Almost before the death struggles are 
 over persons are ready to flay the carcass, and pieces of the raw meat 
 are cut off and served up before this operation is completed ; in fact, 
 as each part presents itself it is cut off and eaten while yet warm and 
 quivering. In this state it is considered, and justly so, to be very 
 superior in taste to what it is when cold. Eaw meat, if kept a little 
 time, gets tough ; whereas if eaten fresh and warm it is far tenderer 
 than the most tender joint that has been hung a week in England. 
 The taste is, perhaps from imagination, rather disagreeable at first, 
 but far otherwise when one gets accustomed to it." Portal says, "But 
 although we saw nothing of it, Bruce Mansfield Parkyns, Mr. Dufton, 
 and Mr. Kassam all speak of the fondness of the Abyssinians for what 
 they call brundo, i.e. a piece of raw meat cut from the carcass at the 
 very moment when the animal is killed, and eaten probably with the 
 inevitable red-pepper sauce before it has had time to grow cold." 
 
RIGOR MORTIS 243 
 
 The flesh of the coursed hare is said to be much 
 appreciated by epicures, and the reason given is that 
 rigor has passed off before the animal is eaten. On 
 the other hand, I am told that hunted stag is * horrid 
 to eat,' because *the fat gets all mixed up with the 
 meat in some way.' The contrast between the hunted 
 hare and the hunted stag is, if corroborated, interesting, 
 and seems worthy of attention. I have no personal 
 experience in the matter. The hare is an animal which 
 carries no fat. 
 
 The chemist can tell us very little as to the 
 difference between muscles in a condition of ante-rigor, 
 rigor, and post-rigor, and yet we find that their solu- 
 bility in digestive fluids differs considerably. We 
 practically never eat meat except in a condition of rigor 
 or post-rigor, when it is relatively indigestible. When a 
 joint of fresh meat is ' hung ' in a pure place, it ripens 
 and gets tender and delicious before putridity sets in. We 
 have no certain knowledge as to the cause of this * ripen- 
 ing,' and one naturally asks, * Is it microbial ? Has the 
 joint of meat served as a cultivating medium for a 
 vegetable growth of which the products are pleasing to 
 the palate?' The ripening of meat does not, if one 
 may judge by the palate, take place in the ice-chest, 
 nor is it possible when it comes out. Some of us are, 
 I think, too ready to judge of the nutritive qualities of 
 food by looking at the chemical analysis. We forget 
 that it is not that which we put into our mouths which 
 nourishes us, but that which we digest and absorb. 
 
 Digestion depends upon the condition of the diges- 
 tive organs, and these are stimulated to activity by the 
 sensory nerves of the mouth, tongue, palate, nose, and 
 eye. Our appreciations of different kinds of food vary 
 with the individual. In this, as in all other matters, 
 
 B 2 
 
244 SOME DIETETIC PROBLEMS 
 
 no two of us are alike. As digestion depends upon 
 the degree to which the flow of secretion from the 
 alimentary tract is stimulated by our sensory nerves, 
 we may fairly conclude that the food which is eaten 
 with appetite and liking is more useful than that which 
 we swallow as a duty, but with loathing, loathing so 
 great that sometimes the stomach instantly rejects its 
 contents. We cannot, happily, get away from that 
 inscrutable craving called appetite — a craving which 
 surely guides the sane man to a selection of food which 
 is suitable for him, and further prompts him to that 
 change of diet which appears to be essential for our 
 well-being. 
 
 Lind (' A Treatise on the Scurvy,' page 78) says : 
 " Our appetites, if they are not depraved, are upon this 
 and many other occasions the most faithful monitors, 
 and point out the quality of such food as is suited to 
 our digestive organs, and to the state and condition of 
 the body. For where there is a disposition to the 
 scurvy from a long continuance in the moist sea-air, 
 concurring with a glutinous and too solid diet, Nature 
 points out the remedy. In such a situation the ignorant 
 sailor and the learned physician will equally long with 
 the most craving anxiety for green vegetables and the 
 fresh fruits of the earth, from which only relief can be 
 had. Such people, in the height of the disease, not 
 only employ their thoughts all day long in satisfying 
 this importunate demand of Nature, but are apt to 
 have their deluded fancies tantalised in sleep with the 
 agreeable ideas of feasting upon them at {sic) land." 
 
 Lind, in addition to lemons, fresh vegetables, 
 oranges, pickles, sauerkraut, &c., advocates the use 
 of fresh fermented bread and fermented drinks, such 
 as cider, beer, spruce beer, and wine (such as Malaga 
 
SCURVY 245 
 
 and home-made wines). Spirits he considers bad for the 
 scurvy, and when used they must have some lemon juice 
 or a slice of lemon added. One of the best remedies is 
 to give lemon with Malaga. Sugar and molasses, added 
 to wine to start fermentation afresh, are advocated. 
 
 With the growth of our cities, it becomes increasingly 
 difficult to supply their populations with really fresh 
 food. In London we seldom eat fish in really fine 
 condition. The refrigerator enables us to get it free 
 from putrefactive changes, but few Londoners have 
 ever eaten fish in that crisp, curdy condition which it 
 is in when fresh caught. In the present year I have 
 twice visited Newcastle, and have been much struck 
 by the excellence of the fish, due, as I was informed, 
 to the fact that the fishing smacks unload in what 
 is almost the centre of the town. The fish are not 
 only fresh, but new-caught. There is the same kind 
 of difference between fish which have been for days 
 in a refrigerator and new-caught fish that there is 
 between new-laid eggs and * shop ' eggs. 
 
 The difference between fresh vegetables and those 
 which have been a day or so on a greengrocer's stall 
 is admitted by most of us. Few persons, however, 
 who have not a garden of their own know the flavour 
 of really new-gathered vegetables. Asparagus, peas, 
 beans, and even cabbages which are taken direct 
 from the garden to the pot have a flavour which can 
 and ought to be appreciated. 
 
 While on the subject of new-gathered food, allusion 
 may be made to the great and deserved popularity 
 of those vegetables which we habitually eat raw, such as 
 ripe fruits, lettuce, endive and other salads, watercress, 
 celery, and, among the poor especially, onions and garlic. 
 
 How much some of these vegetables lose by cooking 
 
246 SOME DIETETIC PROBLEMS 
 
 is best seen in the onion, which after cooking is but 
 a shadow of its former self. We must include butter 
 and cheese among the foods which are habitually taken 
 raw, and of whose highly nutritive qualities one can 
 have no doubt. It is obvious that modern cheap 
 substitutes for butter and cheese belong to an entirely 
 different class. 
 
 I have thus far offered you a good deal of evidence 
 that many foods are more valuable raw than cooked, 
 and more valuable new than old. The nutritive value 
 of a food is proportioned to its digestibility and its 
 power to stimulate appetite and digestive secretions. 
 Apart from such considerations mere chemical analysis 
 is worthless, and I must confess that personally I am 
 in no way converted to the belief that meat which 
 has been refrigerated is at all the equal of new meat 
 which has been hung. Kefrigerator meat is often sold 
 without warning ; and I am rather repelled by joints 
 which are deficient in fat ; in which the cellular tissue 
 shrinks upon the bones, like the jacket of a growing 
 schoolboy on his arms ; in which the first cut some- 
 times lets out a spirt of watery fluid ; in which the 
 fibres gape, and the meat is tasteless, stringy, and 
 flabby, and very often not done in the centre. Such a 
 joint is to a really fresh joint what a * shop egg ' is to 
 one which is new-laid. 
 
 I am quite ready to admit that refrigerated meat is 
 better than putrid meat; I am aware that there are 
 those who state that it is letter than fresh meat. 
 Nevertheless, I am of opinion that every carcass of meat 
 should bear upon it the date of slaughtering. 
 
 A week or two since I walked through a village street 
 near London on a Saturday night. 
 
 The grocers' shops were piled from floor to ceiling 
 
THE REFRIGERATOR 247 
 
 with tinned provisions ; most of the butchers' shops 
 were hung with joints shiny with moisture or absolutely 
 dripping, showing that they were fresh from the re- 
 frigerator ; and the vendors of fried fish were busy in 
 putting flabby blue sodden -looking stuff into boiling oil, 
 and making a fume which drifted for a quarter of a mile 
 down wind. It is needless to say that a refrigerator is 
 a famous invention for vendors, who are thereby enabled 
 to keep food for a good market, and are never compelled 
 to sell hurriedly at * an alarming sacrifice.' 
 
 The question whether this old food has the same 
 value as fresh food is one which it is diiBficult to answer, 
 but in the present state of our ignorance there ought to 
 be no risk of our mistaking the one for the other. In 
 the same way * tasteless antiseptics,' such as boric acid, 
 ought not to be added to food unless the fact be clearly 
 stated. It is surely as dangerous to keep a baby too 
 exclusively on pickled milk as it is to keep a sailor too 
 exclusively on pickled pork. 
 
 We are as yet quite ignorant of the vera causa of the 
 scurvy, which seems to make its appearance when per- 
 sons are deprived oi fresh food. No chemical theory as 
 yet put forward has afforded an adequate explanation. 
 With fresh vegetables, and to a less extent with fresh 
 recently killed meat, scurvy may be warded off, but 
 apparently it is not to be warded off by tinned pro- 
 visions, nor even by lime-juice which has been kept too 
 long.^ 
 
 ' In the account of the siege of Lucknow, in Recollections of my Life, 
 Sir Joseph Fayrer mentions the intolerable stench from the unburied 
 carcasses of horses, and the insufferable nuisance of flies, and'on page 191 
 he says : ' One of our greatest wants is that of vegetable food, and the 
 men risk their lives daily to gather the leaves of a wild cruciferous plant 
 growing amongst the ruins ; this is much prized as a green vegetable. 
 Scurvy is prevailing, and the want of this article of diet is severely felt.' 
 
248 SOME DIETETIC PROBLEMS 
 
 Lind's advocacy of fermented foods, such as beer 
 and bread, is interesting, and that leads me to say that 
 to speak of beer as an * alcoholic ' food, and to gauge its 
 value or the reverse by its percentage of contained 
 alcohol, is a mistake. Beer is the fresh product of a 
 cultivation of a species of saccharomyces in an infusion 
 of malt, just as bread is the production of an allied 
 fungus growing in dough. Alcohol and starch, 'per se, 
 have no antiscorbutic power, but beer and bread, which 
 result from fresh vegetable growths, are both of them 
 credited with the power of keeping off scurvy. 
 
 In the same way butter and cheese are both of them 
 the products of microbic growth upon certain milk pro- 
 ducts. Cheese is at its best when it is thoroughly ' ripe,' 
 but it must be regarded as fresh food to the end, because 
 it is the ever-growing microbe and its products which 
 really constitute the attractive features of cheese. 
 
 We have given conventional names to certain pro- 
 ducts without reference to chemistry. 
 
 Butter is a dairy product which takes some days to 
 make. Attempts have been made to hurry the process 
 by rapidly separating the cream by means of machinery. 
 * Separated ' cream will furnish a very edible grease of 
 uniform quality, but it has never fallen to my lot to eat 
 a really fine sample of butter (judged by flavour) which 
 has been made with * separated ' cream. 
 
 Nature refuses to be hurried, and it remains to be 
 seen whether the various * ripeners ' {i.e. pure cultivations 
 of microbes) will bestow the true flavour upon * sepa- 
 rated' butter. Margarine has no resemblance on the 
 palate to fresh butter, and is not in any sense a fresh 
 food. To my thinking it is inferior in flavour to good 
 dripping. 
 
BUTTER AND CHEESE 249 
 
 What is true of butter is true of cheese, and imita- 
 tions of cheese hurriedly made with the aid of fat and 
 chemicals ought to be marked. 
 
 The ripening of food such as hams, bacon, wine, and 
 even spirits is probably a biological process. 
 
 Attempts have been made to make * temperance ' 
 drinks without having recourse to fermentation, by arti- 
 ficially * charging ' mixtures of syrup and flavourings 
 with carbonic acid. It is very interesting to see how 
 singularly the attempt has failed, and how in the sum- 
 mer the demand is everywhere for ' stone-bottle ginger 
 beer ' {i.e. fermented) in preference to the imitation 
 article. I lately tasted an imitation ginger beer which 
 was a thin liquor, perfectly brilliant, very sweet, and 
 which made one sneeze. At a guess I thought it was a 
 mixture of water, saccharin, and formic aldehyde charged 
 with carbonic acid. 
 
 It is singular, but I think true, that liquids which 
 effervesce as the result of fermentation, and those which 
 are * charged ' with carbonic acid, taste quite differently, 
 and, moreover, the effervescence of fermentation is far- 
 more persistent. The practice of * charging ' the cheap 
 effervescent wines and bottled beers is one which ought 
 to be watched. In the same way aerated bread and fer- 
 mented bread cannot be mistaken for each other. From 
 my point of view the former is not * bread ' in the true 
 conventional sense. Baking powders produce an aeration 
 of farinaceous food very different from fermentation, 
 and not acceptable to all of us. 
 
 The chemist is showing very great ingenuity in 
 imitating Nature, and in furnishing * synthetic products,' 
 which are often made from manufacturers' * waste.' 
 We have a right to demand that these imitation foods 
 
250 SOME DIETETIC PROBLEMS 
 
 should be clearly labelled. We should then soon arrive 
 at their true market value ; and we must not allow old 
 food, whether refrigerated or pickled, to be sold for new 
 food, and the mixing of chemical products with natural 
 products should be absolutely forbidden unless it be fairly 
 stated on the label. 
 
INDEX 
 
 Abtssinians and meat, 242 
 Adams, Mr. P., 61 
 Agriculture, 87, 232 
 Agriculturists, healthiness of, 94, 
 
 170 
 Airy, Dr., 185 
 
 Algerian sheep and anthrax, 19 
 Analyses of well-water, 129 ; of 
 
 rain-water, 206 
 Anaemia, ixodic, of Jamaica, 43 
 Andover experiment, 126, 168 
 
 — garden, 90, 123 
 
 — shallow well, 127 
 
 — water-supply, 149 
 Andrewes, Dr., 69 
 Angell, Lewis, 161 
 Ankylostoma duodenale, 45, 72, 73 
 Anthrax, 10 ; cutaneous, 19 ; pul- 
 monary, 20 
 
 — and farms, 15 
 
 Antiseptics and stools, 166, 174, 
 
 198 
 Appetite, 244 
 Arrows, poisoned, 6 
 Arum, the Kew tropical, 75 
 Ascot enteric fever outbreak, 173 
 Ash-closets, 180 
 Atherstone enteric fever outbreak, 
 
 187 
 
 Bacilluria, enteric, 47 
 Bacillus anthracis, 10 
 
 — coli communis, 47, 80, 153, 163 
 
 — enteritides sporogenes, 25, 163 
 
 — pyocyaneus, 163 
 
 — typhosus, 47, 163, 169 
 
 Bacterial treatment of sewage, 162 
 
 Baillet, 13 
 
 Ballard, Dr., 24, 169, 173, 184, 185, 
 187, 216 
 
 Bangor enteric fever outbreak, 185 
 
 Barlow, Sir Thomas, 234 
 
 Barming reservoir, 59 
 
 Barry, Dr., 185, 186 
 
 Battersby, Dr., 41 
 
 Beef, 240 ; hung, 240 
 
 Beer, 248 
 
 Bell, Dr., of Bradford, 17, 19 
 
 Bentley, Charles, 73 
 
 Beri-beri, 45 
 
 Beverley enteric fever outbreak, 
 140, 185 
 
 Bicester enteric fever outbreak, 181 
 
 Biltong, 240 ; Professor Halli- 
 burton on, 240 
 
 Birth-rate, diminished, 134 
 
 Blackburn enteric fever outbreak, 
 185 
 
 Blandford, 42 
 
 Blaxall, Dr., 144, 147, 184 
 
 Boarley water system, 67 
 
 Bodmin enteric fever outbreak, 185 
 
 Boers and biltong, 240 
 
 Boobbyer, Dr., 74 
 
 Bouley, 13 
 
 Bovine tuberculosis, 228 
 
 Bowden, 41 
 
 Bruce, 29 
 
 Buchanan, Sir George, 146, 171, 
 183 
 
 Buckingham enteric fever out- 
 break, 186 
 
 Building, 201 
 
252 
 
 INDEX 
 
 Burial of faeces, 192 
 Burrows, 82 
 Butter, 248 
 
 Caius, Dr., 237 
 
 Caius College enteric fever out- 
 break, 146 
 
 Cameron, Sir Charles, 50 
 
 Cameron, Dr. Macmartin, 78 
 
 Camps, sanitation of, 189 
 
 Cancer, 45 
 
 Carnivora and living prey, 241 
 
 Carrington Moss, 116, 117 
 
 Carver, Dr. J. E., 47 
 
 Castellote, Dr., 41 
 
 Caterham enteric fever outbreak, 
 139 
 
 Cemeteries, 57, 228 
 
 Cesspools, 161 
 
 Chamberland, Dr., 9 
 
 Charbon, 9 
 
 Charging with carbonic acid, 249 
 
 Chat moss, 116 
 
 Chauveau, Dr., 19 
 
 Cheadle, Dr., 234 
 
 Cheese, 248 
 
 Chester-le- Street enteric fever out- 
 break, 187 
 
 Chichester enteric fever epidemic, 
 63 
 
 Childs, Dr., 50 
 
 Chinese, 83, 89 
 
 Cholera, 28, 161, 175 
 
 Cisterns, 150 
 
 Cities, 170 
 
 Cleanliness of Dutch, 110 ; of Gro- 
 ningen, 107; of West-end of Lon- 
 don, 125 
 
 Closet-pails, weight of, 108, 109 
 
 Clowes, Dr., 162 
 
 Colin, Dr., 13 
 
 Copeman, Dr., 24, 37 
 
 Corfield, Professor, 56 
 
 Corn laws and typhus, 159 
 
 Cottage, building a, 203 
 
 Cows, 238 ; and tuberculosis, 223 
 
 Crookes, Sir William, 99 
 
 Crosse, 40 
 
 Cutting off the water, 152 
 
 Daibies and enteric fever, 217 
 Darwin, 80 
 
 Davaine, 10, 13 ^ 
 
 Davidson, Professor Andrew, 26, 27 
 
 Davy, J. S., 58 
 
 Death-rate in Groningen and 
 Friesland, 109 ; in Holland, 105 ; 
 of tabes mesenterica, 224 
 
 Dempster, 88 
 
 Dental caries, 234 
 
 Dewsbury district enteric fever out- 
 break, 184 
 
 Diarrhoea, 21 ; mortality of, 22, 23, 
 161 
 
 Dietetic problems, 231 
 
 Digestion, 243 
 
 Diphtheria, 34 
 
 Dirty habits, 180, 182 
 
 Disinfection of linen, 155 ; of stools, 
 156 
 
 Dubois, Abb6, on Hindu manners, 
 71 
 
 Dung, 89, 96, 103, 133 
 
 Durham, Dr., 42, 60 
 
 Dutch, the, 104, 110 
 
 Dutch cleanliness, 110 
 
 Dysentery, 26 
 
 Eaeth, 1 
 
 Earth, the, as a filter, 78 
 
 Earth and anthrax, 13, 18 
 
 Earth-closet, 213 
 
 Earthworms, 12, 80, 81 
 
 Edington, Dr., 44 
 
 Elliott, Eobert, 103 
 
 Enfield enteric fever outbreak, 184 
 
 Enteric fever, 46, 85, 135 ; death 
 rates, 177 ; in Holland, 106, 109 
 110 ; and milk, 173 ; and over 
 crowding, 177 
 
 — — outbreaks : Ascot, 173 
 Ather stone, Warwick, 187 ; Ban 
 gor, 185 ; Beverley, 140, 185 
 Bicester, 181 ; Blackburn, 185 
 Bodmin, 185 ; Buckingham, 186 
 Caius College, 146 ; Caterham 
 139; Chester-le -Street, 187 
 Dewsbury, 184 ; Enfield, 184 
 Faldingworth, 185 ; Guildford 
 
 139, 183 ; Haverfordwest, 184 
 High Wycombe, 171 ; Hitchin 
 
 140, 185; Houghton-le- Spring, 
 141 ; Islington, 216 ; Kidder 
 
INDEX 
 
 253 
 
 minster, 185 ; King's Lynn, 186 ; 
 Lewes, 184 ; Llanelly, 184 ; Long- 
 ton, Staffs, 186 ; Maidstone, 58, 
 80; Margate, 140, 185; Mary- 
 lebone, 173 ; Masborough, 186 ; 
 Middlesbrough, 178 ; Mountain 
 Ash, 145; Newark, 186; Newlyn 
 East, 185 ; Newport, Isle of 
 Wight, 140, 187 ; Okehampton, 
 184 ; Parkhurst Barracks Prison, 
 187 ; Red Hill, 139 ; Eaunds, 
 Northants, 188 ; Eawmarsh, 186 ; 
 Rochester, 186 ; Rotherham, 186 ; 
 Sandown, 184 ; Sheerness, 185 : 
 Tees Valley, 186 ; Tideswell, 
 184 ; Totnes, 185 ; Warwick, 
 183 ; West Cowes, 184 ; Worthing, 
 140, 148, 187 ; Ventnor, 184 
 
 — stools and water, 157 
 
 Ewell, 62 
 
 Excreta, disposal of human, 90 
 (see also Groningen) 
 
 Experiments, agricultural, of Sir 
 John Bennett Lawes and Sir 
 Henry Gilbert, 96, 97, 98 
 
 Exports from Holland, 112, 113 
 
 F.ECAL matter, application of, to 
 land (see Andover, Carrington 
 Moss, Groningen, Manchester) 
 
 , how to deal with : Andover 
 
 garden, 126 ; Groningen method, 
 108 ; Manchester (see Carrington 
 Moss) 
 
 Falding worth enteric fever out- 
 break, 185 
 
 Farleigh springs, 59 
 
 Farms and anthrax, 15 
 
 Farmyard manure, 96 
 
 Farr, Dr. William, 161 
 
 Fauna of death, 190 
 
 Fayrer, Sir Joseph, 39, 247 
 
 Feeding of infants, 226, 236, 237 
 
 Fermented foods and drinks, 244 
 
 Fermes a charbon, 10 
 
 Fertility, maintenance of, of soil, 
 96 
 
 Filter, duplicated tank, 210 
 
 Filtration gutter, 210, 211, 212 
 
 Fish, 245 
 
 Flies, 77, 189, 247 
 
 Food and antiseptics, 239, 250 
 Food and chemical analysis, 243 
 Food-supply, 91, 99, 230 
 Foulerton, Mr., 60 
 Frieberger and Frohner, 6, 15, 44 
 Frohner (see Friedberger) 
 Fungi and dung, 5 
 
 Gaertner's bacillus, 47 
 Gainsborough and enteric fever, 
 
 175 
 Gallagher's Copse, 201 
 Gases, 75 
 
 Gelatinous foods and bacteria, 169 
 Gepp, Mr. A., 90 
 Gibson, Mr. Maitland, 48 
 Gilbert, Sir Henry, 96, 101 
 Glasgow enteric fever death-rate, 
 
 142 
 Graves and anthrax, 11, 13, 17 
 Gresswell, Dr., 185 
 Groningen, 107 ; collection of feecal 
 
 matter in, 107 
 Ground-itch, 73 
 Guerin, Alphonse, 13 
 Guildford enteric fever epidemic, 
 
 139, 183 
 
 Haden, Sir Seymour, 198 
 
 Heematozoa of malaria, 38 ; of 
 tsetse-fly disease, 42 
 
 Hamburg beef, 240 
 
 Hare, the flesh of coursed, 243 
 
 Hart, Mr. Ernest, 28 
 
 Harvest, influence of, on soil, 81 
 
 Haverfordwest enteric fever out- 
 break, 184 
 
 Hayes, Captain, 7, 44 
 
 High Wycombe enteric fever out- 
 break, 171 
 
 Hindu manners, 71 
 
 Hitchin enteric fever outbreak, 
 140, 185 
 
 Holland, mortality statistics of, 
 105, 106 
 
 — sanitation in, 104 
 
 Holt, Chief Justice, 161 
 
 Holt Town works, 124 
 
 Hong-Kong plague, 33 
 
 Hop gardens, 81 
 
254 
 
 INDEX 
 
 Horse disease, or African horse- 
 sickness, 44 
 
 Horses in St. Domingo and teta- 
 nus, 26 
 
 Horse-dung and diarrhoea, 26 
 
 Houghton-le- Spring enteric fever 
 outbreak, 141 
 
 House cisterns, 50 
 
 Houston, Dr., 3, 162, 207 
 
 Humification, 166 
 
 Humus, 1 
 
 Hung beef, 240 
 
 Hydatids, 45 
 
 Hyde, Dr. Samuel, 90 
 
 Immunity, 69 
 
 — of Algerian sheep to anthrax, 19 
 Imports from Holland, 112 
 Infant mortality, 134 
 
 Insects and wells, 127 
 
 Insuction by leaking water-pipes, 
 143 ; when direct connection 
 with main, 145 
 
 Intermission of water-supply and 
 enteric fever, 143 
 
 Isleworth cottage, 174 
 
 Islington milk enteric fever epi- 
 demic, 216 
 
 Ixodes bovis, 43 
 
 Jameson, Director-General, 73 
 Jenner, Sir William, 159 
 Jones, Dr., of Chichester, 53 
 Joubert, 12 
 
 Kanthack, 28, 42 
 
 Kidderminster enteric fever out- 
 break, 185 
 
 King's Lynn enteric fever outbreak, 
 186 
 
 Kitchen refuse, 197 
 
 — sinks, 150, 210 
 Kitasato, Professor, 5 
 Klein, Professor, 25, 26 
 
 Koch, Professor Eobert, 10, 11, 
 
 175 
 Koch's vibrio, 28 
 
 Lamb, Charles, 231 
 Laveran, 39 
 
 Lawes, Sir John Bennett, 96, 101, 
 102, 103 
 
 Le Dantec, 6 
 
 Leeu warden, 107, 109, 113 
 
 Lewes enteric fever outbreak, 184 
 
 Liebig, 100 
 
 Lind on scurvy, 244, 248 
 
 Linen, disinfection of, 155 
 
 Lingard, 42 
 
 Linnaeus, 189 
 
 Lister, Lord, 87, 229 
 
 Llanelly enteric fever outbreak, 
 184 
 
 Local Government Board, 143 
 
 Loesener, 56 
 
 Longton, Staffs, enteric fever epi- 
 demic, 186 
 
 Louping ill, 43 
 
 Low, Dr. Bruce, 175, 178, 186, 188 
 
 Lowson, 33 
 
 Maclean, 39, 73 
 
 Maidstone barracks and prison, 67 
 
 Maidstone enteric fever epidemic, 
 58, 80, 148, 228 
 
 Mai de montagnes, 10 
 
 Malaria, 38 
 
 Malignant pustule, 19 
 
 Malta fever, 29 
 
 Manchester cleansing, 116, 123 
 
 Manson, Dr. Patrick, 40 
 
 Marchesi, 8 
 
 Margarine, 248 
 
 Margate enteric fever outbreak, 
 140, 185 
 
 Martin, Dr. Sidney, 46, 47, 50, 88, 
 169 
 
 Marylebone milk enteric fever epi- 
 demic, 173 
 
 Masborough enteric fever outbreak, 
 186 
 
 McConnell, Mr., 117 
 
 Meat, 240 ; relative digestibility of, 
 241 ; Thiele's, Dr., experiments, 
 241 ; value of raw, 240, 242 
 
 Meek, 43 
 
 M6gnin, 190 
 
 Microbes, 3 
 
 Micrococcus melitensis, 29 
 
 Micro-organism of diphtheria, 34 
 
 Middens, 179 
 
INDEX 
 
 255 
 
 Middlesbrough and enteric fever, 
 178 
 
 Milk, 216, 235 ; and tabes mesen- 
 terica, 220 ; and tuberculosis, 
 219 ; and water supplies, 152 
 
 Milroy lectures, 1 
 
 Model by-laws, 181, 201, 204 
 
 Montagues dangerenses, 13 
 
 Moorland waters, 142 
 
 Mortality tables, 92, 93, 226 
 
 Moses, 199 
 
 Mountain Ash enteric fever out- 
 break, 145 
 
 Munich and enteric fever, 51 
 
 Murchison, Dr., 177, 181 
 
 Murray, Mr. George, 5 
 
 Mushrooms, common, 4 
 
 Newark enteric fever epidemic, 186 
 Newlyn East, Cornwall, enteric 
 
 fever outbreak, 185 
 Newport, Isle of Wight, enteric 
 
 fever outbreak, 140, 187 
 Newsholme, Dr. Arthur, 34 
 Nitrification, 85 
 
 Odours, 75 
 
 (Edema mycosis, 44 
 
 Okehampton enteric fever epi- 
 demic, 184 
 
 Old-age pensions, 95 
 
 Organisms, pathogenic, 3 
 
 Osier, Dr., 39, 47 
 
 Overcrowding and enteric fever, 
 177 
 
 Packard, 190 
 
 Page, Dr. Davis, 141, 185 
 
 Pails, closet, 108, 109 
 
 Parkhurst barracks prison enteric 
 
 fever outbreak, 187 
 Parsons, Dr., 184, 185, 186 
 Pasteur, 9, 10, 11, 12, 14, 18, 78 
 Pathogenic bacteria in interred 
 
 corpses, viability of, 56 
 Pathogenic organisms, 3 
 Paving, impermeable, 170 
 Payne, Dr. J. F., 30 
 Pepys, 237 
 
 Pettenkofer, 28, 50 
 
 Phthisis in milk trades, 224 
 
 Pictet and Yung, 21 
 
 Plague, 30, 76 
 
 Plant roots, as tillers of soil, 103 
 
 Plumbers, registration of, 155 
 
 Polluted soil, 169 
 
 Pollution of water, 161 ; of wells, 
 174 
 
 Portal, Mr. Gerald, 242 
 
 Post-mortem room sinks, 150 
 
 Power, Mr. W. H., 185 
 
 Poynton and Paine, Drs., 35 
 
 Practical considerations, 78 
 
 Privies, 160 
 
 Public authorities and water-sup- 
 plies, 154 
 
 Babbits, 82, 84 
 
 Eadcliffe, Mr. N., 173 
 
 Rainfall and Maidstone enteric 
 
 fever epidemic, 64 
 Rain-water tank, 204 
 Rats, 82, 84 
 Rats and plague, 32 
 Raunds, Northants, enteric fever 
 
 outbreak, 188 
 Rawmarsh enteric fever outbreak, 
 
 186 
 Rayer, 10 
 
 Redhill enteric fever outbreak, 139 
 Rees, 40 
 
 Refrigerated meat, 246 
 Refuse in Groningen, 107; on 
 
 Salisbury Plain, 196 
 Registration of plumbers, 155 
 Rickets, 234 
 Rigor mortis, 242 
 Rivers, 142 ; pollution of, 161 ; law 
 
 against pollution of, 161 
 Robertson, Dr. John, 48, 49, 54, 89 
 Rochester enteric fever outbreak, 
 
 186 
 Rothampstead experiments, 96, 97, 
 
 98, 101, 102, 103 
 Rotherham enteric fever outbreak, 
 
 186 
 Ross, 39 
 Rotiget, 6 
 Botiget du pore, 57 
 
256 
 
 INDEX 
 
 Salisbury Plain, 191 
 
 Sandown enteric fever outbreak, 
 184 
 
 Sanitary methods of our ancestors, 
 160 
 
 Sanitation, of camps, 189 ; an 
 experiment in, 201 ; in Holland, 
 104 
 
 Saprophytes, 3 ; classification of, 
 4 ; oxygen and, 4 
 
 Scavenging, of camps, 191 ; in 
 Groningen, 107, 114; of Man- 
 chester, 118 
 
 Schmidt-Muhlheim, 17 
 
 Scurfield of Sunderland, 50 
 
 Scurvy, 229, 244, 247 
 
 Sewage, bacterial treatment of, 
 162 
 
 Sewage farms, 171 
 
 Sewer gas, 161 
 
 Sewer pipes, leaking, 143, 162 
 
 Sewer pipes and water-pipes, 143, 
 144 
 
 Sewers and storm-water, 149 
 
 Sheerness enteric fever outbreak, 
 185 
 
 Sherborne enteric fever outbreak, 
 147 
 
 Simon, Sir John, 183, 184 
 
 Slaughtering of animals in Abys- 
 sinia, 242 
 
 Slop-water, 160, 161, 207 
 
 Smallpox and tramps, 45 
 
 Smith, Dr. Greig, 43 
 
 Snow, Dr., of Buffalo, 24 
 
 Soil, 1 
 
 Spear, Mr. John, 145, 185, 186 
 
 Spencer, Dr. Herbert, 236 
 
 Springs, 84, 142 
 
 Stag, flesh of hunted, 243 
 
 Stanley, Sir H. M., 6 
 
 Stewart, Professor Hunter, 79 
 
 Stings of insects, 41 
 
 Stinks, 75 
 
 Stockman, Professor Stewart, 75 
 
 Stools, disinfection of, 156 
 
 Stools, enteric, and water, 157 
 
 Stools and tillage, 165 
 
 Storm overflows, 149 
 
 Strainer for slop-water, 207, 208 
 
 Street refuse, 8 
 
 Street sweeping, 108 
 
 Streptococci, 163 
 
 Stuart, Mr. Verryn, 106 
 
 Surra, 42 
 
 Survival of the unfittest, 170 
 
 Swine erysipelas, 57 
 
 Swine fever, 45 
 
 Synthetic products, 249 
 
 Tabes mesenterica, 220 
 
 Takaki, Dr., 33 
 
 Tank, rain-water, 204 
 
 Tatham, Dr., 93, 224 
 
 Tees Valley enteric fever outbreak, 
 
 186 
 Temperance drinks, 249 
 Tetanus, 5 ; bacillus, 5 ; and 
 
 market gardeners, 6 ; pastures, 7 
 Tew, 60 
 
 Texas fever of cattle, 43 
 Thames and sewage, 159 
 Thiele, Dr., 241 
 
 Thomson, Dr. T., 58, 181, 186, 187 
 Thorne, Sir Bichard, 46, 55, 139, 
 
 169, 172, 184, 219 
 Threadworms, 45 
 Thresh, Dr., 150 
 Thyroid gland, 239 
 Tick-birds, black, of Jamaica, 43, 
 
 44 
 Tick fever, Australian, 43 
 Ticks, 43 
 Tideswell enteric fever outbreak, 
 
 184 
 Tillage, 165, 195 
 Tinned provisions, 247 
 Tomaselli, 29 
 Tomkins of Leicester, 24 
 Tooth, Dr. H. H., 189 
 Totnes enteric fever outbreak, 185 
 Tramps and enteric fever, 85 ; and 
 
 small-pox, 45 
 Trees, dead, 82 
 Trenches, 193 
 Trypanosoma, 42 
 Tsetse fly disease, 42 
 Tubercle, 74 
 Tuberculosis, 219 
 Tuberculous birds, 75 
 Tutsham-in-Field, 59, 60, 61 
 Tutsham-in-Orchard, 62 
 Typhoid and typhus, 159 
 
INDEX 
 
 257 
 
 Typhus, 69, 70 ; and corn laws, 
 159 ; and typhoid, 159 
 
 University College Hospital and 
 
 disinfection of linen, 155 
 Upland water, pollution of, 142 
 Urine and humus, 167 
 
 VAILIiARD, Dr., 6 
 
 Vegetables, 245 
 
 Venetian cistern, 204 
 
 Ventnor enteric fever outbreak, 184 
 
 Verminous, the, person, 45 
 
 Vienna plague cases, 31, 32 
 
 Villar, Mr. Sidney, 7 
 
 Villemin, 13 
 
 Vincent, Dr., 6 
 
 Warington, 3 
 
 Warwick enteric fever outbreak, 
 183 
 
 Washbourn, Dr., 60 
 
 Waste of manure, 100 ; of water, 
 155 
 
 Water, boiled, 83 
 
 Water-closets, 105, 107, 161, 169 
 
 Water companies, 154 ; and watei* 
 examination, 152 
 
 Watercress beds, 158 
 
 Water-pipes, burst, 144 ; and sewer- 
 pipes, 143, 144 
 
 Water-supplies, pollution of public, 
 
 136, 137 ; and milk, 152 ; and 
 
 public authorities, 154 
 Water-supply, 151 ; and dairies, 
 
 218 
 Wells, 154, 174 ; pollution of, 139, 
 
 140, 141, 158 
 
 — shallow, 78, 84, 127 ; and in- 
 sects, 127 
 
 — village, 79 
 
 Well water, analyses of, 129 
 
 West Cowes enteric fever outbreak, 
 184 
 
 Wheaton, Dr., 171, 286 
 
 Willcocks, Dr. G. W., 58 
 
 Williams, Principal, 43 
 
 Williams, Dr. Dawson, 24 
 
 Wilson, Dr. Maclean, 187 
 
 Wood, Dr. Cartwright, 60 
 
 Woodger, Mr. Joseph, 7 
 
 Woodhead, Dr. Sims, 55, 60 
 
 Woolsorter's disease, 16, 21 
 
 Worthing enteric fever outbreak, 
 140, 148, 187 
 
 Wounds, 76 
 
 Wycombe Marsh enteric fever out- 
 break, 171 
 
 Wye, the river, 172 
 
 Yellow fever, 45 
 
 ZiEGLER, Professor, 52 
 
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