541TENTH INTERNATIONAL CONGRESS OF HYGIENE AND DEMOGRAPHY.

THE TENTH INTERNATIONAL CONGRESSOF HYGIENE AND DEMOGRAPHY.

(FROM OUR SPECIAL CORRESPONDENT.)

THE OPENING CEREMONY.

By two o’clock in the afternoon of Friday, August 10th, thelargest amphitheatre of the Ecole de Medecine was nearlyfull with expectant members of the Tenth International

Congress of Hygiene. The platform was decorated with redvelvet and gilt braidings and flowers, and was soon

occupied by well-known sanitary reformers. A few minutes

after 2 o’clock, the Prime Minister, M. Waldeck-Rousseau,accompanied by Dr. Brouardel (the President of the Con-

gress), Dr. A. J. Martin (the general secretary), and manyothers entered. Indeed, the platform proved too small andseveral members who should have taken their places by theside of the presidential chair were obliged to hunt forseats in the already crowded amphitheatre. It appearedthat there had been a great increase in the number ofmembers within the last few days, but that it was toolate to obtain a larger hall. Professor BBOUARDEL wasthe first to speak and he expressed his thanks to M.Waldeck-Rousseau for presiding over the meeting, as his

presence would show that the Government sympathised withthe efforts of the Congress to improve the public health ofall countries. He then expressed his gratitude to the foreignmembers of the Congress and assured them that in the causeof hygiene they would find no frontier demarcations. Allnations would benefit from their labours, and indeed it wasonly necessary to visit the great exhibition to realise thatthey had done so already. If, for want of technical know-ledge, the visitor failed to appreciate all the improve-ments, he need only look at the statistical tables whichset forth how the mortality had decreased in propor-tion to the sanitary reforms achieved. This was more

particularly shown by the exhibits of the United Statesand of Germany. The latter country displayed a map ofEurope which at a glance indicated how the prevalenc9of small-pox had been reduced where vaccination was

rigorously practised. It had been said that a centuryhence the civilisation of a people would be judged by thenumber of cases of small-pox occurring in its population.The same remark might be made with regard to typhoidfever, and where disinfection was rigorously practised therethe prevalence of infectious fevers was much reduced. InParis that reduction was during the last 10 years equal to25 per cent. The century which commenced with Jennerand closed with Pasteur promised still greater progress for thefuture. With the use of antitoxin the deaths from diphtheriahad been reduced by four-fifths, and large wards in the Parishospitals which had been reserved for cases of this disease hadto be closed for want of patients. In England the prevalenceof tuberculosis had been lessened by one’half, and Englandpaid the lightest tribute to this disease of any country. To

Eagiand and to Germany the world stood indebted for agreat example-the one nation by its sanitary legislation andthe other by its economic legislation had very materiallyreduced their death-rates. The engineer and architect inEngland, and the compulsory insurance with its pensions andsick fund in Germany had made all Europe anxious to dosomething of the same sort. The work was great; it mustbe begun at school and continued by the press. The nationsmust be taught that if sanitation was at times expensive ithad never failed to keep its promises. Its laws, however,had not yet been sufficiently applied to the poorer classes.Of all social questions this was the most urgent. The newcentury would continue the good work, particularly as theymight now rely on a more active support from the Govern-ments.

THE GOOD DONE BY HYGIENIC CONGRESSES.The General Secretary (Dr. A. J. MARTIN) reported that

no sooner had the Congress at Madrid decided that it wouldmeet next time in Paris than the French committee set towork. Through the Minister of Foreign Affairs applicationwas made to foreign Governments to form local com-mittees, and these committees had materially assisted ingiving the Congress its present representative character.Some 1500 members had been enrolled and three-quarters of

them were delegates representing Governments, universities,municipalities, and other organised bodies. For the dis-cussions of the Congress 56 reports had been submitted tothe sections and most of them were now in print and dis-tributed. They comprised the whole evolution of the centuryIf many of the facts adduced were not new they in any caseconstituted useful evidence. Thanks to the generosity of thetown of Paris it had been possible to print these reports.Dr. Martin then went on to review the practical resultsachieved by the various international congresses of hygiene.The first was held in Brussels in 1876, with the result thatthe Brussels Bureau of Hygiene then created had become amodel institution for all Europe. Two years later a similar

impulse was given in France by the presence of the secondCongress held in Paris during the Universal Exhibition of1878. The third Congress met in Turin, and since that daythere had been a great improvement in sanitary legislationand in the death-rate of Italy. In 1882 they met in Switzer-land, and in 1884 in Holland. At these Congresses Pasteurand Koch spoke and the prophylactic measures based ontheir discoveries were widely adopted. In 1885 they wereat Vienna and the sewerage works of that capital were takenin hand. In 1889 they came to Paris more especially to seethe results of Pasteur’s work. After their meetingin London in 1891 notable efforts had been made in

England to improve the housing of the poorer classes.At Budapest they gave a special welcome to Dr.Roux, who had just produced his anti-diphtheritic toxin ;while finally, at Madrid, they had infused new lifeand hope among the Spanish sanitary reformers. What theresults of the present Congress would be it was as yet toosoon to say ; but they might rest assured that wherever theCongress met there sanitary reforms would follow.

THE PROMISES OF THE PRIME MINISTER.

The President of the Council of Ministers, M. WALDECK-ROUSSEAU, now rose and read his speech. In the name ofthe French Government he welcomed the members of theCongress. They had already met twice in Paris and he wasglad of this opportunity of rendering homage to the praise-worthy and useful work they had accomplished. Hygienewas quite a modern science. It dated back barely morethan 50 years. Preventive medicine was most complex andthis might be explained by the fact that it could be con-sidered as the crown of all natural sciences. The dis-coveries of physicians, of chemists, and of engineers were thematerials out of which hygiene was constructed. But torealise the ingenious theories of the hygienists the helpof the State was needed. They had every right to

rely on such help. This declaration was greeted withloud applause. M. Waldeck-Rousseau continued: "Youare the most valuable and indispensable collaboratorsof all governments. You are the guardians of publichealth-that is to say, of the most precious gift a Statecan possess. For too long governmental and parliamentaryinitiative has neglected the elaboration of indispensablesanitary laws. For too long the incontestable right of theState to impose upon the individual necessary preventivemeasures which, while protecting his health preserve thepublic welfare, has been overlooked and misunderstood. Therights of the individual, badly interpreted, have prolongedthis delay. It is a matter of education and the democracieswill insist that such education shall be given." The presenceat the Congress of so many distinguished foreigners is a

guarantee that the work of the Congress would summarise! what the civilised world had done. " Our best reward," hesaid, "will be the confidence you will have of seeing yourtheories applied by those who are in power. You may restassured that so far as we are concerned and in the measureof our forces, your confidence will not be misplaced."

This handsome promise was loudly applauded; and it isall the more precious as it was not due to the enthusiasmor impulse of the moment, but bad been deliberately writtendown beforehand in the carefully elaborated set speechwhich M. Waldeck-Rousseau read out.

Dr. CALLEJA spoke on behalf of Spain, recalling that hehad been a student in that amphitheatre and had learnt tolook upon France as his second country.

Dr. EOHLEB, for Germany, said much had been done, butmuch more remained to be done. The fruit of their teachingwould ripen in the next century. The Tenth Congress ofHygiene stood between the two centuries, and he hoped itsdeliberations would help to render the twentieth century acentury of sanitary reform.

542 TENTH INTERNATIONAL CONGRESS OF HYGIENE AND DEMOGRAPHY.

Professor CORFIELD, on behalf of Great Britain, alsorecalled the fact that he had been a student in thatamphitheatre. He lamented the fact that at several ofthe previous Congresses the British Government had notbeen represented. Then at last the War Office had sent onedelegate. Now on this occasion there were no less than fiveofficial representatives of the British Government attending.This, he thought, was a big improvement, though he wasutterly unable to explain how it had been brought about.Perhaps the British Government had at last grasped the factthat there was something serious in these Congresses; or,perhaps it was because since the Congress had met inLondon many dwellings, he might almost say palaces, hadbeen built for the working-class. In any case, they werenow five Government representatives, and if they continuedto increase in the same ratio they would be 25 at the nextCongress.

Dr. VAN IVAMA-STERNNEGG of the Austrian StatisticalBureau, Dr. BARTOLETTE of the United States Army, and arepresentative of the Russian Government having said afew words, M. WALDECK-RouSSEAU expressed his gratifica-tion at haviog heard so many cordial remarks from theforeign delegates. He thought that the French Faculty ofMedicine should be proud of the fact, rendered manifest thatafternoon, that so many illustrious teachers of hygienecoming from different countries had been its forme pupils.The meeting now terminated and the members hurried off tothe fête and garden party to be given at the Elysee by thePresident of the Republic.

EXCURSION TO THE ACHÈRES SEWAGE FARM.

On August 13th some 300 members of the Congresswere conveyed by special train to the plains of Acheressituated on the banks of the Seine close to the forest ofSt. Germain. This municipal estate measures 10 kilometres inlength and one kilometre in width. It is irrigated throughoutwith the crude sewage of Paris. The train did not stop atthe station but at the extreme western end of the estate.Here three narrow-gauge trains conveyed the membersto various points of interest. In 1895 a visitor toAcheres would have seen the sewage from Paris justbeginning to arrive. The greater part of the plain seemedlike a vast desert. The small brushwood which formerlyserved to conceal the game-for the Emperor Napoleon III.,and after him Baron Hirsch, used to shoot over these

grounds-had been cleared away and nothing had yetgrown in its stead. The contrast to-day is most remarkable.The barren plain is now verdant with luxurious vegetation.Beetroot is growing over a large part of the ground,but there are also many fields rich with golden grain.The avenues are planted with trees, mostly walnut. Ofcourse they are still young and small, but they are healthyand flourishing. The greater part of land is let out tocultivators, but the municipality has kept a portion in itsown hands for experimental purposes and to lay out afew ornamental parks and to plant orchards. It was atthese spots that the members of the Congress stopped so as tostroll among the flower-beds, admire the peaches and otherfruits ripening on the trees, and above all to visit theornamental waters; these were as clear as crystal. Fishdarted rapidly about, and as the water came out of theearth in little jets glasses were filled and the waterwas eagerly drunk by nearly all the visitors. Yetthis was neither rain-water nor spring-water: it was thewater of the Paris sewers. What this meant was evidentto all, for close by on the surface of the soil in countlesslittle drains the black foul sewage was exposed to view. But

having fed the plants and having passed through more thansix feet of sandy soil the water collected at the lower levels ’’,is found to be quite free from the sewage. The sewage,whichcontained 11,750,000 bacteria per cubic centimetre, retainedbut 2350 bacteria in one part of the estate and only 188 inanother part-that is, of course, after it had filtered throughthe soil. The purified sewage water at Achères is more freefrom bacteria than is usually the case with good springwater. In regard to organic matter, where the amountextracted from the sewage weighed 34-9 grammes, after

passing through the soil this water only retained 1-8grammes. The object, however, is not to produce drink-ing-water out of sewage but to prevent the pollution ofthe Seine by the crude sewage. For this purpose the town ofParis now possesses 900 hectares at Gennevilliers, 1000 hectaresat Acheres, 2150 hectares at Méry-Pierrelaye, and 950hectares at Carrières-Triel—a total of 5000 hectares. As it is

calculated that 40,000 cubic metres of sewage can be treatedper hectare per annum, 200,000,000 cubic metres of sewagecan be turned in the course of the year on to these estates;and as yet the sewage of the town of Paris does not exceed180,000,000 cubic metres per annum, so that it is only thestorm overflow that now goes direct into the river ; and theSeine, which had been contaminated by the Paris sewage asfar down as Rouen, is at last free from this great source of

pollution. On the other hand, the sewage is no longerentirely wasted ; it produces luxuriant crops, and at Acheresthere is a large distillery where the beetroot is converted intoalcohol. All this was explained and shown to the membersof the Congress, who were not only greatly edified by thepractical success of this gigantic enterprise but were

also charmed by the artistic taste shown in the laying-out of the gardens, by the beauty of the flowers, by theartificial rockery around the ornamental waters, and by thegeneral prosperity, fertility, verdure, and brightness ofthe scene. After some light refreshments served at thedistillery, and having travelled over the entire estate in thenarrow gauge trains, the members reached the station ofAcheres, where the special main-line train was waiting toconduct them back to Paris. The entire cost of this agree-able and instructive expedition was defrayed by the Parismunicipality. M. Beckman, M. Launey, and M. LouisMusson, the principal municipal engineers, accompanied theparty and were busily engaged all the time in givingexplanations to the members.

THE PRIME MINISTER’S ENTERTAINMENT.The third official reception of the members of the Medical

Congresses took place on Monday evening, August 13th,and was given by M. Waldeck-Rousseau, who, as PrimeMinister, elected to take over the portfolio of the Ministryof the Interior. He entertained at dinner 80 of the officialGovernment representatives who are members of the TenthInternational Congress of Hygiene, and later in the eveningthrew his official residence at the Place Beauveau opento all the members of the Congresses. Hardly anymembers, however, of the International Congress ofMedicine remained in Paris and nearly all the guestswere members of the Congress of Hygiene, consequentlyI do not think that there were at any time more than1500 persons present. The result was a thoroughly enjoy.able evening. To begin with-and this is always a goodsymptom—I was on entering at once able to dispose of my over.coat. At the Palace of the Luxembourg this simple operationhad necessitated a fierce struggle in the midst of a dense anddisorderly crowd that lasted for more than half an hour.Once within the beautifully furnished saloons of the MinistryI was able to stroll about freely, for there was no crowding.Even the buffet was not besieged, and refreshments could beobtained without delay or struggle, or the risk of havingwine spilt over one’s clothes or an ice dropped down one’sback, all of which mishaps had become usual incidents onthese festive occasions. But, more wonderful still, in the

spacious long room which had a stage at its farthest ex-

tremity I was actually able to obtain a seat and thus saw incomfort the whole performance. First there were some

Andalusian dances, and then a pot-pourri of the most popularsongs from Offenbach’s operettas. These were admirablyrendered and loudly applauded. The gardens were illumi.nated and offered a cool strolling ground for the guests tosmoke and chat, and it was not till after midnight that themembers resigned themselves to quit these luxurious andpleasant Ministerial reception rooms.

THE RECEPTION AT THE H6TEL DE VILLE.On the afternoon of Tuesday, August 14tb, the Congress

was received at the Hôtel de Ville by M. GRÉBAUVAL,the President of the Paris Municipal Council. All thereception-rooms were thrown open and for some time themembers strolled about looking at the gigantic andsomewhat sensational pictures that illustrated dramaticepisodes in the history of the town. Ultimately an

usher announced the arrival of the President of theMunicipal Council, who took his stand in front of a

buffet and the members gathered in a half-circle around.Professor BROUARDEL introduced the Congress, observingthat it constituted a remarkable gathering of people from allparts of the world who discussed together in perfectharmony, there being no party divisions among them. Theresolutions adopted by the Congress in the main coincidedwith the policy of the Paris Municipal Council in so far assanitary questions were concerned. This opinion would be

543THE WAR IN SOUTI-I AFRICA.

more particularly confirmed by those members of the

Congress who had visited the Exhibition where they couldsee what had been done to improve the public health ofParis. The Municipal Council had always been popularwith hygienists, for it had shown considerable readiness to

adopt the suggestions of sanitary reformers, it had spent aconsiderable amount of money on improvements, and it wasever ready to welcome both French and foreign hygienists.M. GRÉBAUVAL expressed his thanks for the laudatory wordsuttered by the Dean of the Paris Faculty of Medicine. Theconcord to which allusion had been made was the happyresult of the study of science. Hygiene represented thebeneficent goddess who in teaching preventive medicinealso helped to prevent moral corruption. As hygienists themembers of the Congress had examined the minutest detailsof every-day life, thus showing a truly scientific spirit.It was to be hoped that in time the mass of the people wouldlearn to be equally minute and careful. Formerly the con-stituted authorities were at the service of intolerance and

superstition ; now they were at the service of science. Thecrowd would not forget this Congress, for it had helped tobuild a wall-not a Chinese wall, but a European wall-against disease. He invited the Congress to accept a glass ofchampagne and he asked leave to drink to the prosperity oftheir good work. Some members of the Congress were thenpresented to the President of the Municipal Council, andafter a little conversation the Congress dispersed so as toprepare for the great banquet to be held at night.To-morrow there will be no sitting. The day will be left

free so that the French members of the managing committeemay conduct parties to the Exhibition to show and explainthose exhibits that are of technical interest to hygienists.The work of the sections will be resumed on Thursday,August 16th.Paris, August 14th.

THE WAR IN SOUTH AFRICA.

THERE is but little to be chronicled from a military pointof view during the past week. What there is, on the whole,is good. The Boers are being hard pressed. We have newsabout Lord Kitchener and De Wet which would lead to thebelief that the force commanded by the skilful Boer generalwas at last in grave danger of being surrounded, but this

has been so often an unfulfilled belief before, owing to theclever way in which he has eluded capture, that we may wellhesitate to express any definite opinion until it is an

accomplished fact and there is no longer any room for doubt.Until this has been done we may expect a repetition ofharassing raids and surprises. In war the boldest strategy isso frequently the best that to our unmilitary mind we failto understand why, following the plan adopted by Shermanin his celebrated march during the American war, no

attempt has been made to provision a strong force andmarch it for the purpose of seizing the railway and cuttingoff the source of the Boer supplies and line of communica-tion with Lorenzo Marcques. The more we learn of thewar in South Africa the more clearly does it appear thattransport has throughout been the main source of all ourdifficulties. The railways in South Africa are of narrow

gauge, there is a great deficiency of rolling-stock, thereare steep gradients and a want of sufficient motive power;the consequence of all which is that trains take a very longtime in making their journeys and have to carry relativelylight freights. The hospital service has greatly sufferedon this account and the straits to which General Rundle’sforce has been reduced are apparently attributable to thesame cause.

The members of the South African Royal Commissionare on their way to South Africa and the session ofParliament has closed, and we may consequently anticipatea brief lull in contentious criticism. We are not sorryfor it, for we think that the tone adopted in the lastdebate in the House of Commons on the Royal Com-mission was regrettable. We do not know, of course,whether Mr. Burdett-Coutts has an exasperating effect onMr. Balfour as has been alleged, but such certainly seems tobe the case, for a strained position has somehow been broughtabout. Mr. Balfour is usually extremely temperate andcourteous in his replies to Members and in his conduct of

Parliamentary business generally, butwhere Mr. Burdett-Coutts is concerned he almost always couches what he has tosay in a tone of asperity.Assuming that the statements from a special correspondent

of the Times of August 13th regarding the treatment ofenteric fever convalescents from South Africa are correct, wecan only say that they disclose a discreditable state of thingsand a want of practical organisation in looking after ourinvalid reservists. As regards the medical department andhospitals at the seat of war we continue to read the mostconflicting accounts in the public press as to their allegedshortcomings. It can scarcely be that any deficiency in thesupplies has arisen from these not having been present inthe country, for the Government and the public haveforwarded them in abundance. We can therefore onlyassume that, owing to transport difficulties, they have notbeen distributed. The medical officers should, in our

opinion, have full power to purchase hospital supplieswhenever necessary and where these are locally obtainable,notwithstanding the objections that might be urged againsthaving more than one spending depattment with an army inthe field.We can quite realise the disappointment of the medical

officers in South Africa at the change which has taken placein the state of affairs affecting their service and that theyare looking forward to the investigation by the RoyalCommission and some authoritative expression of opinion asto the alleged shortcomings and their causes with a keen senseof relief.

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THE IMPERIAL YEOMANRY HOSPITAL.BY ALFRED D. FRIPP, M.S., F.R.C.S.

The first detachment of the new branch of the ImperialYeomanry Hospital destined for Pretoria has arrived fromEngland, and pending the completion of the necessaryarrangements for their transport we are putting them uphere, to the number of 104 orderlies, two medical efficers, and12 nursing sisters. This brings op the number in our campto 1225. It is to be hoped that the difficulties—such, forinstance, as the inevitable irregularity of railway serviceas long as there are commandoes liable to swoop down

upon the line-which still make it necessary for the militaryauthorities to curtail railway travelling north of Bloem-fontein, even to the extent of forbidding the return ofprominent members of the mining industry to Johannes-burg, will shortly be removed, or that, at all events,means will be found for getting the staff and materialof this new branch up-country in order that they may getinto working order without undue delay. The personnelare full of enthusiasm and desire to get to work, whereas allthe excitement of working in the war and the novelty ofAfrican surroundings has worn itself out of our staff duringthe last five months, and much as many of our people wouldlike to see something of the "front" there are very few whowould voluntarily throw up their work in this hospitalfor the sake of any change of site, however tempting it

might be from some points of view. Everything runs likeclockwork here now and the feeling of romance has so

completely died out that we really almost at times forgetthat we have not been working under similar conditions allour lives, while at other times the feeling most prominentlyexpressed is one of home-sickness and a longing to be " backagain." Colonel Sloggett went down to Cape Town to meetthe new branch and brought them up here at once. It wasnot altogether an easy matter to find accommodation forthem, especially for the 12 sisters, for our own 48 sisterswere quite cramped enough already. However, by the help ofa few bell-tents their sleeping accommodation was arrangedfor, and with great good luck we got a fresh hut erectedjust in time to be used as a dining-room for the 60 nursingsisters who now have to be catered for. Only a tent had beenavailable for that purpose before and great inconvenience hasbeen caused from time to time by its being repeatedly blowndown. Now on the windiest and dustiest day they will atleast be freed from any anxiety as to whether they will findtheir meals in an edible condition. This but is 60 feet longby 16 feet 6 inches broad. One end of it is curtained offfrom the larger half as a sitting-room and there the diningtables are arranged, and we have placed it quite close to thesisters’ kitchen, but separated from it by an open-air space.The doors are placed in the middle of the long sides of thehut, so that the two ends should be as far as possibledefended from wind and dust. I think they will now bethoroughly comfortable.