1399FIFTEENTH INTERNATIONAL CONGRESS OF HYGIENE & DEMOGRAPHY. [

THE FIFTEENTH INTERNATIONAL CON-GRESS OF HYGIENE AND DEMO-

GRAPHY AT WASHINGTON.

(FROM OUR SPECIAL SANITARY COMMISSIONER.)(Continued from p. 1248.)

Washington, Oct. 7th.Town Planning.

IN the afternoon of Thursday, Oct. 3rd, Section VI. wasagain well attended, and Sir GEORGE McCRAE opened adebate on town planning. The great question was how tomake reforms pay. If the strain on municipalities was toogreat, the projects would fall through. Already, he thought,garden cities had spent too much on ornamentation. Town

planning schemes to be really effective must retrieve theblunders of the past, and this was by far the most expensiveand difficult side of the subject. Actually, while large sumswere spent on pulling down old and bad quarters, newdistricts were being built up which would in time prove justas insanitary as those demolished. Millions of money werethus wasted. It was far preferable to deal with virgin soilwhere no vested interests existed. On the continent of Europethey thought more of the beauty of the streets than ofdomestic hygiene. Splendid boulevards at Berlin and else-where merely masked the slums hidden behind Liverpoolwas the town where the most successful rehousing schemeshad been applied. The price of land and the cost of

procedure were a terrible impediment. The demarkationbetween town and country government had rendered jointefforts difficult. But the Town l’lanning Act now enabledone local authority to carry plans beyond its own boundary,and the Local Government Board could restrict the numberof houses built on any area. This would lower the price ofland but would extend the area of towns. Therefore, cheaptransit was essential, and at Berlin workmen could travelfor 4d. per week. Good progress had already been made,and in Scotland during two years no less than 23 townplanning schemes had been introduced.

Mr. ROBERT 11’. DE FOREST, of New York, explained thatwhat had been aforetime prescribed by the law was nowcondemned by the law. In 1867 the law said that allhouses must have privy vaults, which term presumably meantcesspools. But by the law of 1901 these abominations weredeclared illegal and were removed from 70,000 houses inNew York City. Before proper housing by law could beenforced the people must be educated to the point of demand-ing such conditions. The passing of resolutions and lawswas a much quicker process, but it was not possible to applywhat the people did not appreciate. On the other hand,much could be done without legislation where a real demandexisted. Thus, baths were now supplied on a large scale inprivate dwellings, but there was no law on the subject.

Sanitation on the American Farm.Dr. J. N. HupTY, of the State Board of Health,

Indianapolis. treated the section to a satirical and amusingpaper on Rural Hygiene. The farmhouse bedrooms inAmerica were so badly ventilated, he said, that even thefire burnt slowly for want of oxygen. The ignorance of thefarmer and his unwillingness to learn were phenomenal.There was a great deal of typhoid among them, and as thisdisease was due to communal sinning much missionaryexpenditure was needed at home.. As a rule the farm welland the farm privy were intimately associated. Dr. Hurtyknew a farmer who, having inherited a sanitary house, toreout the bath and destroyed the water-closet as complicatedand unnecessary paraphernalia. Good cooking was an art notgenerally known or practised on the farm. The pasty com-plexion and the sunken epigastrium of the eaters testified toits injuriousness. There was much overeating of tasty butindigestible food, and the too free use of condimentsencouraged this. The prevalence of dyspepsia, rheumatism,headaches, biliousness, so-called malaria, vertigo, andeczema could be easily traced to such habits. The frying-pan was overworked, and far too much smoked, pickled,and salted meats were eaten. He believed it was the vitiatedhouse air, the polluted drinking-water, the neglect of thebath, the poor bread, the fried embalmed meats, and over-eating that made the farmer fly so extensively to alcohol and

patent medicines, as the empty bottles all about the placetestified. This was a phase of American life which the visitorfrom Europe had little opportunity of seeing. No paper readat the Congress was more heartily appreciated, and theaccuracy of Dr. Hurty’s picture was not challenged.

Alcohol and Phthisis.At a joint meeting of the Division of Demography and

Section IV., Hygiene of Occupations, Dr. JACQUESBERTILLON, Chief of the Bureau of Municipal Statistics ofParis, insisted that innkeeping was an occupation which, byencouraging alcoholism, increased the mortality from

phthisis. He quoted some English statistics showing thatfrom the ages of 25 to 55 years the number of deaths fromphthisis was twice as high among innkeepers as amongshopkeepers. Though everyone knew that alcohol attackedthe liver, he thought it was much more fatal in its effect onthe lungs. Indeed, all diseases except cancer occurred morefrequently among English public-house keepers than amongshopkeepers. In English public-houses, however, spirits werelargely drunk. In France, it was clearly demonstrated thatspirits were a prolific cause of phthisis. South of the

Loire, where the grape-vine abounded, proportionately littlespirits were consumed, for wine was cheaper than the

glass or wooden vessels in which it was contained, and inthis region phthisis was of rare occurrence.

Mr. EDWARD BUNNELL PHELPS, editor of The AmericanUnderwriter, gave figures collected by life insurance com-panies showing that alcohol might be considered as a factorin 5-1 per cent. of the total deaths, or 7-7 per cent. of thedeaths occurring after the age of 20 years. These figures arebased on a total estimated population, in America, of

86,874,990. Other estimates, though different in detail,corresponded generally with these figures.

Dr. W. F. Boos, from Boston, quoted German statisticsshowing that 7 per cent. of the accidents to workmenwere dependent on the use of alcoholic drinks, and costthe German sick benefit societies close upon 5,000,000 marksper annum. On the Lockawanna Railway last July 39 liveswere lost because the engine-driver was the worse for drink.At Berlin railway servants were examined before they wereallowed to go on duty; this was, he thought, essential,especially in regard to engine-drivers and pointsmen.

The Treatment of Inebriates.Dr. IRWIN H. NEFF, of the Massachusetts State Hospital

for Inebriates, said that all legal and punitive measuresagainst drunkenness had completely failed. Whatever couldbe done, he urged, could be successfully done only by theState. Private institutions, and even municipal institutions,could not grapple with the evil. There was in any case abetter prospect that the State would apply modern andhumane methods. They must act not as fanatics but asreasonable beings, and therefore recognise that a com-

paratively small percentage of users of alcoholic drinks wereconfirmed drunkards. Both curative treatment and custodialcare of cases susceptible of benefit were needed. Therecidivist who constantly appeared in the courts should beplaced under restraint.

Mr. ROBERT A. WOODS, of the South End Settlement,Boston, thought that with better sanitation generally, betterfood for mothers, and better milk for children there wouldbe less drunkenness, for public baths, gymnasiums, play-grounds, healthier and more joyous lives would strengthenthe power of resistance, moral as well as physical, of thecity dweller, since inebriety was an accentuated expressionof an underlying nervous disorder.

It seemed to me that in this discussion there was

too great a tendency to regard the drunkard as an

offender, if not actually a criminal, against whom severemeasures should be adopted, while not enough attentionwas paid to the poisonous concoctions sold as alcoholicdrinks, which are in part responsible for the number of

persons who have become drunkards.

Ventilation.Mr. D. D. KIMBALL, member of the American Society of

Heating and Ventilating Engineers, opened, in Section VI.,a debate on ventilation. The speaker protested againstthe modern cult of the open window, saying thatartificial ventilation was sought precisely because the open-ing of windows for ventilating purposes did not work.

They had to deal, he said, with the chemical composition

1400 IRELAND.

of air, its contained organic matter from body exhalationsand excretions, and with its dust, humidity, and tempera-ture. The air volume must differ according to the numberand the occupations of the persons concerned. Much

painstaking study, investigation, and experimentation wereneeded. The cooperation of experimenters was necessary.There were physiological, medical, and engineering problemswhich must be solved simultaneously, and they were not tobe answered by merely throwing open a window to the

general discomfort.Professor C. E. A. WINSLOW, Curator of Public Health at

the American Museum of Safety, New York, complained ofthe lack of a proper theoretical basis. No distinctionexisted between competent and incompetent ventilatingengineers. Even when a good system of ventilation wasintroduced its regulation was entrusted to incompetentjanitors. Mechanical fans had become unpopular from thiscause. Systems of ventilation proved failures also becauseno provision was made for the removal of excess heat.

Cooling as well as ventilating was required. Dr. HowardEvans, at Chicago, had done some remarkable work on theselines. The first thing was to guard against overheatingand excessive moisture. This was best done by constantlysupplying air of lower temperature than that of the room.Inside the temperature should never exceed 680 to 700 F. Ifthe temperature was 600 each person required 2000 cubic feetof fresh air per hour to prevent the temperature rising in con-sequence of the heat the average adult produced. If intro-duced air was at a lower temperature it should enter by thefloor, but it should be tempered in cold weather so as not tocause discomfort. Downward ventilation failed when theroom temperature equalled that of the incoming air. Windowventilation might be satisfactory in hospitals, but it was

wholly impracticable in factories and assembly rooms, and itwas doubtful whether it would ever be generally adopted inschools. Finally, it was essential that the cool, temperedair should be evenly distributed from properly designedducts through openings sufficiently numerous to avoid

draughts.TAe Food-supply.

As might be expected cold storage and the supply andhandling of food were extensively discussed at the Congress.In this respect it is gratifying to learn that there is a hotelat Indianopolis where all the servants concerned with the

handling of food or laundry work are periodically medicallyexamined. State rather than municipal action seems

effective at Indianopolis. Five inspectors are appointedby the State to visit and check the work of localauthorities, and it is now insisted that local officers shall

pass technical examinations.Dr. MARY E. PENNINGTON, of the Food Research

Laboratory, Bureau of Chemistry, U.S. Department of

Agriculture, Philadelphia, who thus represents the CentralFederal Authority, added many explanations to the papershe contributed to the proceedings. The shortage of food-stuffs (felt even in the States) had compelled the Governmentto deal, not only with their adulteration, but also with theirpreservation. By checking deterioration the supply wasincreased, and the rise in prices controlled. The law mightprevent rotten goods reaching the market, but it did notteach carriers, warehousemen, and middlemen generally tohandle these things properly. Some knowledge of chemistryand bacteriology was required. The whole commercialroutine must rest on the fundamental facts concerning theorigin and results of decay. Therefore industries must

coöperate with the scientific investigator. Only thus hadthe citrus fruits of California become so stable a commoditythat it had almost been forgotten that they were perishable.The orchards of Oregon provided the Atlantic seaboard withfruit, and the Atlantic supplied Colorado with excellentoysters. On the other hand, ignorance and carelessness

played cruel havoc with the poultry trade. The unhappybirds were sent alive to large cities, arriving wounded,thin, fevered, and altogether undesirable for food. Withscientific care eggs previously cooled were more appetisingand ’fresher after a week’s transit in a refrigeratingcar than eggs from a farm close at hand, where themethods of handling were antiquated and careless. Eventhe frozen and dried eggs used by bakers, she said, could be,and were being, prepared with a degree of care and skillthat approximated to the routine of the bacteriological labora-tory ; and the cold storage industry was working with the

authorities, represented by the Department of Agriculture, to.establish a satisfactory system of food preservation. The

speaker had visited many farrns and had given instruction inbacteriology till the farmers began to understand that afteropening a bad egg it was necessary to sterilise everythingthat had come into contact with it. The women-originallythe roughest among underpaid foreign immigrants-em-ployed to open eggs were now , taught to observe

scrupulous cleanliness, and were rewarded incidentally bythe increased beauty of their hands. These big, active,quick girls were now working with earnestness and

energy because they had realised the importance of whatthey were doing, with the result that they were no longerunskilled labourers, but part of a vast scientific organisationdestined to save the food of the nation. Photographs wereshown illustrating the contrast between the old insanitaryand the modern scientific methods of dealing with eggs.

(To be continued.)

IRELAND.(FROM OUR OWN CORRESPONDENTS.)

Ireland and Medical Benefits under the National, Insurance Act.I MEDICAL men in Ireland were much astonished at a recent

communication to the Standard purporting to be the accountof negotiations between Mr. Thomas J. Kelly, of Enniscorthy,described as "President of the Irish Medical Association,"’ and certain prominent Members of Parliament, relating to.the extension of medical benefits under the Insurance Act toIreland. It was stated that terms had been agreed upon,and were to be referred to a Select Committee of the Houseof Commons. The terms, of which some were mutuallycontradictory, were given in detail. They bore no rela-

tion, however, to any demands put forward hitherto.on behalf of the medical profession here. Moreover,Mr. Kelly is not President of the Irish Medical Associa-tion, and it is well known that the conduct of aU

negotiations on behalf of the Irish profession has beencommitted to the Conjoint Committee of the Associations.Under these circumstances, readers were at a loss to under-stand the meaning of the statement in the Standard. Mr.

Kelly lost no time in disclaiming any share in the allegednegotiations. He wrote stating that he had never met orwritten to any of the Members of Parliament mentioned,that he has not and never had been President of the IrishMedical Association, that he had not been authorised to.conduct negotiations on behalf of that or any other body,and that he had conducted no such negotiations. The whole

story appears to have been an invention, but its publicationmay have done harm. There is a certain amount of agita-tion among the public in favour of the extension of medicalbenefits to Ireland. The Lord Mayor of Dublin took theopportunity last week of speaking in public in favourof such extension, and it is probable that he representsthe opinion of most of the city and town populations.The rural communities, on the other hand, are, forthe greater part, against the extension. One thing,however, is clear, those becoming members of the.

Approved Societies and all the friendly organisations wishmedical benefit to be extended to all parts of the UnitedKingdom. The great difficulty at present is to find any wayto provide sanatorium benefit. For instance, the Tyronecounty council on Nov. llth decided unanimously torescind a resolution passed at their previous meeting to takebeds at Peamount Sanatorium, and they agreed to appoint acommittee to go into the whole question and to confer withDr. E. C. Thompson, chairman of the Tyrone Medical Officers’Association, who was asked to place a scheme-which hehad at a previous stage of the proceedings put before themembers-in the hands of the secretary of the countycouncil for further consideration. Dr. Thompson objectsto Peamount Sanatorium, and thinks the best solution wouldbe for the County Tyrone council to erect a sanatorium toaccommodate 25-30 beds, and to retain the grant coming tothem in the county. At a meeting of the Belfast LocalMedical Committee held on Nov. llth a resolution was passedto the effect that, in addition to what is paid to any hospitalfor the upkeep of an insured person for sanatorium treat-ment, a sum of at least 5s. per week be paid the medical staff,