764 TENTH INTERNATIONAL CONGRESS OF HYGIENE AND DEMOGRAPHY.

to the Belvidere Hospital for infectious diseases. On the

morning of Sunday, the day following their removal to the i

hospital, Dr. Knight of the Sanitary Chambers called andinformed me that in the hospital a bubo had been discovered I

in the right groin of Mrs. Malloy and another in the axillaof Patrick. He said that the pbysicianswere inclined tothink that the disease was bubonic plague and he asked my 1

cooperation in detecting similar cases.I now wish it to be clearly and distinctly noted that during I

the past three years I have seen typhus fever and small-poxand now bubonic plague within a stone’s throw of each other.As for enteric fever, erysipelas, puerperal diphtheria, andespecially scarlet fever, measles, and whooping-cough, thedistrict is never free from one or other of these diseases.I speak of five years’ experience from morn till night, andsometimes from night till morn, in and ont narrow and oftenfilthy entrances, up and down dimly-lit stairs, and throughdark and tortuous lobbies into low-roofed, odoriferous, andoften pestiferous, single apartments, where you may find

six, or even eight, individuals of both sexes eating andsleeping and washing and dressing within the four walls of £one room. Why send missionaries and money out of thecountry when there is such need of it at home as is thusindicated ? I have only to add that I found no buboes inthese cases, qualifying that statement by saying that I didnot specially search for them, nor was my attention directedto them by the patients. It never occurred to my mind-as I am certain it would occur to the mind of no man underthe circumstances described and on his first examination-that I had to deal with three cases of bubonic’plague.

THE TENTH INTERNATIONAL CONGRESSOF HYGIENE AND DEMOGRAPHY.

(FROM OUR SPECIAL CORRESPONDENT.)

THE WORK OF THE SECTIONS.

The Dustbin Problem.

ON Monday, August 13th, the Third Section took into con-sideration M. Hudelo’s report on the removal and treatmentof household refuse. In Paris this matter is treated in a moreradical and prompt manner than in London. Large dust-bins are not allowed. A small portable galvanised metallicbox is placed in the yard of each house. The inhabitantsbring their refuse, put it into this receptacle, and at night itis placed in the street in front of the house. In the

early morning the scavengers come round and emptythe contents of these boxes into their carts, but thereis an interval during which the c%i’onoaiers or rag-pickersmay come and take out of these portable dustbins anythingwhich they are capable of utilising. As the street sweepingsmay also be injurious to health these are likewise removed inthe early morning and the streets are washed and swept.The washing is necessary so as to collect and conveyto the sewers the small particles of dust which wouldotherwise remain in the atmosphere. Numerous analysesof the refuse thus collected prove that it contains enoughpotash, phosphates, and nitrogenous substances to be ofvalue for agriculture, but if so utilised it must be veryrapidly removed. It has, therefore, been suggested that thetramway lines extending to distant suburbs might beavailable for this purpose at night when the ordinarytraffic has ceased. Whether tramways or railways are

employed the cost of such transit may be greaterthan the value of the manure. The amount ofrefuse produced by a large town is much greatertha11 can be utilised in the fields that are not too far off. At

present for Paris the three railway companies-the Ouest, theNord, and the Est-transport refuse to a distance of 100kilometres at rates which are not prohibitive, but thisis not the case with the Paris, Lyon, et MéditerranéeCompany and the Orleans Company. Ic the refuse couldbe sorted and packed in compressed bales then whatis useful for agriculture might be sent for the same costdouble the distance. It is the space taken, rather than thEweight of such refuse, that causes the expense of transitThis raises the question as to whether it is possible to sorland pack; uch refuse near large towns without creating : anuisance. There is such an establishment at 8aint.Oaen-lesDacks which treats some 300 tons of Paris refuse per day

Here the refuse is sorted in a trench which has a double-metallic lining (where is the dustyard in or about Londonwhich thus protects the subsoil from contamination?) and allcorruptible materials are removed by railway-trucks within24 hours of their arrival. Is this done with equal prompti-tude in the London dustyards ? The rags and paper whichthe rag-pickers have not carried away are burnt and the"hard core "-galley-pots, tins, &c.--is broken up by acrushing-machine. The weight of the matter which is

conveyed by train and used for agriculture is thusreduced 20 per cent. in proportion to its bulk. No nuisancehas been created and the health of the workpeople engagedin this industry is satisfactory. The town pays 3zd. per tonfor the matter removed and this is cheaper than when itdoes the work itself.

Destr1lctors.With regard to the use of destructors the results are not

always satisfactory. At Copenhagen, at Berlin, and else-where it has been necessary to adj. fuel as otherwise therefuse would not burn. In England the destructors workbetter because the dustbins contain a large proportion ofcinders. In Paris it is estimated that the household refuseamounts to a quarter of a ton per inhabitant per annum andif this could be properly burnt and the heat utilised it wouldgive 2017 horse-power per hour. A lengthy account wasgiven of the various methods of destruction by fire employedin different countries and of the drying process adopted bysome towns in America by which the grease is extractedand used for making soap and for other industries. AtSt. Louis 100 tons of refuse yield J?32 worth of manure andJ?6 8s. worth of grease, but this does not cover the workingexpenses. Altogether the report concluded by recommend-ing the utilisation of refuse for agriculture, where it is

possible to convey it immediately to the fields. Otherwise

some process of destruction by fire should be employed.In the discussion which followed it was pointed out thatwhat was thrown away as ashes in England would be lookedupon as coal in Holland and that what the Dutch threwaway the Germans would still find means of utilising. Adestructor that would be workable at Amsterdam would bequite useless at Berlin, for not only were the ashes in thelatter town absolutely devoid of any cinders, but there wasa great deal of fluff from the cloth industries which wouldnot burn. In the same manner the value of refuse as

manure differed greatly according to the occupations andcustoms of the people from whom it was collected. It was,therefore, impossible to lay down any hard-and-fast principle.Finally, the section resolved to adjourn the whole questionto a future Congress.

1 ie Protection of Water Within the .Drvclling.The next report was by M. Lacan, Vice-President of the

French Society of Sanitary Architects and Engineers, and byM. Louis Masson, engineer and inspector of the Parissewers and dwellings. It dealt with domestic sanitation andthe connexion of houses with the sewers. Plenty of pure airand pure water were agreed to be the first of necessities. Butthough at first the water might be pure if the pipes wereoccasionally empty the air might oxidise the lead and thuspoison the water. In the country districts it was wenknown how easily wells were contaminated. Nevertheless itwas easier to protect the water than the atmosphere. Thewater must not be allowed to come into contact with the air.Even if perfectly pure in the main the connexions with thehouse were often dangerously defective. The pipe might beeither too small or too large for the amount of water it hadto deliver, there might be too many bends or angles, or theplumbing of the joints might be carelessly done. All thisrequired careful calculation so that the pipes within the

dwelling might deliver the amount of water required withoutcausing a vacuum in the delivery pipe. The size of the tapsmust be in proportion with their number and the size of theprincipal pipe within the house, so that the opening of twotaps at the same time should not empty the main house pipeand cause air to enter. Of course the water for flushing thoclosets should not be taken direct from the main but from adisconnecting flushing tank, or "waste preventer," as it iscalled in England. Naturally the employment of cisterns tostore the supply of drinking-water, which are so largely usedin London, was absolutely and emphatically condemned. Itwas impossible to prevent dust and emanations in gaseous

, form reaching and contaminating such cisterns. As for the, use of domestic filters these required so much care and were

at best of such doubtful utility that a warning against th. dangers they occasion was very neeeksa y.

765

The Ventilation of Private Divellings.In respact to the unsolved problem of the ventilation of

private dwellings, the report treated of a phase of the subjectwhich in England is singularly neglected, namely, the

porosity of the walls. A house covered with impermeablepaint or other similar substance required far more ventilationthan was the case where the natural porosity of the walls waspreserved. As in winter it was difficult to keep windows open,ventilating shafts should be brought behind the fireplacesso that the outside air might be partially warmed before itwas discharged into the room. The only absolutely certainmethod of ventilation was when mechanical power wasemployed, and the reporters seemed to think that this couldonly be applied to large buildings or assembly rooms. Butwith a little jet of water or a weak electric current the veryslight amount of power necessary to move a small fan couldbe secured and for no very large cost; and such methodscould be and are utilised in private dwellings.

Public Sewers.With regard to house refuse the ideal would be its

destruction by fire as rapidly as it is produced. But itwas not every house that possessed a sufficiently good cven andfire to burn up at once the dust collected in sweeping andthe vegetable and animal refuse from the kitchen. In regardto drainage the report first stated that where cesspools hadibeen abolished and houses placed in connexion with sewersthere the death-rate had been greatly reduced. This was

quite true, but the reporters were too sweeping in their con-demnation of the separate system, of mechanical and

pneumatic apparatus, &c. They forgot that where there wasno fall some sort of mechanical apparatus must be and wasemployed to raise the sewage or propel it forward andthat where the separate system had been applied therehad likewise been a great decrease in the death-rate. In Paris itself immense engines are employedto raise the sewage so that it may flow on to theirrigation plains of Acheres, &0. This is achinery, andvery costly machinery; and in some towns it has beenfound more expedient to use a larger number of smallermachines, distributed in different directions. In Berlinthere are six such centres ; and where pneumatic apparatusis employed, as at Bombay, Rangoon, Southampton, &c., a stillgreater number are employed and still greater economy isrealised. That water carriage, as the reporters nrgued, is thesimplest of methods is undeniable; but where there is nofall the water will not carry, and a fall below a flat surfacecannot be artificially created for any considerable distance.Consequently the sewers of Paris, of London, and of manyother towns are apt to be clogged with deposits. They are notself-cleansing; scavengers armed with all manner of ingeniousapparatus have to be sent down to clear these sewers. It isnot drainage by water carriage, but by human labour. If

any machinery can effectively replace human labour of sucha description it merits careful consideration from all sanitaryxeformers. As the report deals with domestic drainage andnot with public sewers the reporters would have been betteradvised had they left this latter subject alone instead of

going out of their way to condemn systems, theories, andmethods which were not under discussion.

Soil-pipes as Sen’er rentilat07’s.Dealing with the internal arrangements of the house, the

principles proclaimed will find very general acceptance.Every tenement should have its own water-closet, for thoseused in common by several families can never be clean. A

vigorous, and as far as possible an instantaneous, flush shouldbe provided. A water-sealed syphon should be placed underevery closet-pan, sink, bath waste pipe, &c. The seal ofthese traps should be two inches deep. The rain as well asthe slop-water should drain into the main soil-pipe of thehouse and the diameter of this pipe should be small. InFrance it is generally much too large. The soil-pipe shouldcontinue to the roof of the house and be left open and, ofcourse, should be absolutely watertight. It should be occa-sionally tested with smoke or water to see that there is noleakage. The water test is the most reliable.

So far everyone was agreed, but as soon as the reportersapproached the subject of the public sewers divergencesof opinion became manifest. Indeed, the discussionwhich followed was in the main devoted to the questionnow raised - namely, should there be a trap at thebottom of the house soil-pipe so as to disconnect itfrom the public or street sewer? The reporters were

opposed to the use of these disconnecting traps, whichwere first employed when the sewers were badly built andthe sewer airs really dangerous; "but now it is recognisedthat the hypothesis that the diffusion of epidemical diseasessuch as typhoid fever, cholera, and diphtheria, by sewer-gasis incompatible with our actual knowledge of the principlesthat govern the propagation of these maladies." Then,again, we were told that the disconnecting trap preventedthe utilisation of the soil-pipes for the ventilation ofthe sewers and the circulation of air in the soil-

pipes. This latter assertion shows a confusion in theauthors’ minds between what in England is meant by adisconnecting trap or chamber and a mere syphon. The

disconnecting trap or chamber should be provided with anair inlet for the ventilation of the soil-pipe of the heme.It is best that this inlet should be carried to the top ofthe house, as then it does not matter whether it acts as aninlet or outlet. In any case the soil-pipe must have twoapertures, one consisting of the continuation of the pipeitself to the top of the house and the other communicatingwith the soil-pipe just before it reaches the syphon that

separates it from the sewer. Then there. can be no pressureon the traps, even if the pipe should be blocked in any partof its course. Of course it is eay to condemn the dis-connecting trap when improperly constructed and this is

precisely what was done and what should be done ; but noaccount was taken of cases in which the system was properlyand sati-factorily applied. In justice, however, it must besaid that the term "disconnecting trap" was only occasion-ally employed and that the section had but vague ideasas to what this sort of trap might be. The terms more

generally used were siphon termin1ls or siphon de pied.Of course, a simple syphon at the end or foot of :the soil-

pipe may very justly be condemned unless and apart fromthe ordinary outlet an air inlet is added to such a syphon.Then it is that it becomes not a simple syphon or trap but adisconnectinq trap. A syphon which is affixed to an un-ventilated pipe does not disconnect, because the water-sealis constantly broken by the pressure or suction frequentlyoccurring in the pipe. Had the report made this distinctionclear a great deal of unnecessary discussion would have beenavoided.The experiments made by the British Sanitary Institute

were quoted to show that with the ordinary two-gallonflush soil remained in the trap which separated the soil-pipefrom the sewer. This, then, was against the principle thatall such putrescent matter should be immediately carriedaway. To flush such traps properly it would be necessarygreatly to increase the water-supply. The report thereforeurges that these traps should be done away with and that everydomestic soil-pipe should become a ventilator of the sewer.The plentiful supply of oxygen thus secured would ’- burnup the injurious microbes as fast as they are produced."This latter sentence is in flat contradiction with the assertionpreviously made that sewer air did not propagate epidemicaldiseases.Mr. ROECHLIN (Leicester) while agreeing in many

respects with the opinions expressed in the report submittedto the section, spoke strongly in favour of the disconnectingtrap. Where in the experiments of the British SanitaryInstitute the flush had not sufficed to clear the trap it camefrom a closet in the cellar, that is to say, on nearly thesame level. In Paris, where the houses were so lofty,the flush would acquire sufficient velocity to clear out every-thing from the trap. He had examined houses where anobstruction occurred and this happened not necessarily inthe disconnecting trap but in various parts of the systems.M. EMILE TEHLAT thought that it was a matter of detailof application rather than a question of a general principle.Dr. Vaillant was in favour of suppressing the siphon depied. Pasteur had explained that there were two sorts offermentation, and that the fermentation which took placein contact with the air was not dangerous. M. Dow-KowsKi from Russia argued that if a trap was placedat the bottom of the soil-pipe people would concludethat all that was necessary had been done, and wouldnot take trouble to put traps under the closet-pans andwaste-water pipes. If the latter syphons were properlyinspected there was no need of a disconnecting trap. Mr.ADOLPHE SMITH protested against the assertion that recentbacteriological discoveries justified the belief that sewerair was not injurious. Even if such emanations from thesewers did not contain pathological bacteria it was quitecertain that they predisposed persons to disease. Practically

766

the result was the same. It had been said, however, thatscavengers who worked in the sewers enjoyed good health.Doubtless this was the case, but they were poor men who hadfor the most part been reared in unhealthy homes, andhaving survived they might be considered immune. Then

they were in the prime of life, they did not workin sewers at a susceptible age, and when in the sewerstheir bodies were in full activity. The greatest dangerwas when vitality was at its lowest ebb-namely, duringsleep. Now, if the soil-pipes of private houses were tobe converted into ventilating shafts for the public sewers,would not sewer air be discharged into bedroom windows ‘?This danger would be especially great where the groundwas not absolutely level and houses overlooked eachother. The speaker illustrated this by describing how atMaidstone typhoid fever had followed the level of a sewerventilator. Sewers should be amply ventilated, but in suit-able places and not haphazard on the roof of every house,without regard to windows that might be close by and athigher levels. No general rule could be laid down. Hereand there a soil-pipe could be utilised as a sewer ventilator,but this could not be applied on all sides whatever thecharacter of the houses and of the ground. Dr. RICHAUDagreed that it was not possible to dogmatise, and Dr.REYNAULD said that if in the small towns of Austriaa syphon was placed at the bottom of the soil-pipe therewould not be enough air in the sewers and people wouldneglect to put traps in their houses. The soil-pipe air couldbe as dangerous as that of the sewer. M. BECHMANNbrought the discussion to a conclusion by insisting thatthe section should strive to indicate what were the resultsthat were to be attained rather than the means to be

employed. Thus the use of disconnecting traps might wellbe left to be decided according to local circumstances.The section might be content with insisting that domesticdrains should be so constructed as to be free from odour andto ensure the immediate evacuation of the soil. A resolutionto that effect was thereupon carried. It further stipulatedthat all apertures leading to the soil-pipe should be trappedin such a manner as to prevent the entry (,f air from the pipeor the sewer into the dwelling. Further, the soil-pipe shouldbe permanently ventilated throughout. Another resolutionwas carried insisting that special care should be given toimprove all plumbing work and that all water-pipes, traps,and soil-pipes should be so placed and built as to be freefrom the effects of frost. The section then adjourned.

(To be continued.)

ASYLUM REPORTS.

Royal Lnnatia -4sy7ii7n,, Montrose (Ann2al Report for I1899).-Overcrowding had been felt for some time at thisasylum and it was decided to build a detached block or villato relieve the congestion. This has been so far carried outthat it was expected that the villa would be ready for occupa-tion by September. The cost of erection was estimated at.&7000. As, however, this would provide only for one-half,or the male portion, of the overcrowding at the asylum, thecommittee are now considering plans for the erection ofanother house to accommodate the female surplus. The

average number of patients resident during the year at theasylum was 659. 75 males and 89 females were admittedduring the year, making a total of 164 patients admitted. Ofthese 138 were new cases and 26 were re-admissions. 126 ofthe admissions were rate-supported, while 38 were privatepatients. Dr. John G. Havelock, the medical superintendent,states in his report that intemperance in drink was the causeof insanity in 13 per cent. of the admissions. Hereditarypredisposition was the cause in 11 per cent., old age in 10per cent., and moral causes accounted for another 10 percent. In 25 per cent. of the admissions no cause

could be ascertained. There was a history of previousattacks in 27 per cent. of the cases admitted. Innine cases influenza, was the exciting cause of the attack.The number of patients discharged as recovered was 68-i.e.,30 males and 38 females, or 10-3 per cent. of the averagenumber resident. The deaths during the year amounted to59, or 30 males and 29 females-i.e., 8-9 per cent. of theaverage number resident. The causes of death were asfollows : three deaths were due to epilepsy, three to cerebralhaemorrhage, two to renal disease, five to malignantneoplasms, five to pneumonia, six to senile decay, six to

general paralysis of the insane, seven to phthisis and otherforms of tuberculosis, and 14 to cardiac disease. Post-mortem examinations were made in only 35 out ofthe 59 deaths. Several cases of influenza occurredin the institution during the winter months, but theepidemic was less virulent than in previous years.The Commissioners in Lunacy in their reports statethat the institution is well managed and that the booksand registers are correctly and regularly kept. The farmand garden account showed a surplus during the year ofover .B275. As authorised by the managers the committeehave negotiated a loan of .615,000 in order to meet thebalance of expenditure for Carnegie House and Lodge (theparts of the institution for the admission and accommodationof private patients) and for the new villas now in course oferection. Owing to increased annual outlay in recent yearsthe committee propose to raise the rate of board for al}

pauper patients to C32 per annum in future, which is the-minimum rate of board charged by any of the other charteredasylums in Scotland.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6832 births and 440deaths were registered during the week ending August 25th.The annual rate of mortality in these towns, which had de-clined from 20’5 to 19’5 per 1000 in the three preceding weeks,rose again to 19’8 in the week under notice. In London therate was 19’2 per 1000, while it averaged 20’1 in the 32 pro-vincial towns. The lowest death-rates in these towns were11-3 in Cardiff, 11-4 in Swansea, 13-2 in Bradford, and13’5 in Halifax and in Croydon; the highest rates were25-5 in Salford, 25-9 in Sheffield, 28-6 in Plymouth, 28’5 inWolverhampton, and 30’7 in Preston. The 4404 deaths inthese towns included 1180 which were referred to theprincipal zymotic diseases, against 1263 and 1061 in thetwo preceding weeks ; of these 883 resulted from diarrhcea,117 from whooping-cough, 62 from measles, 50 from

diphtheria, 44 from fever " (principally enteric), and 24from scarlet fever. The lowest death-rates from thesediseases were recorded in Bradford, Swansea, Cardiff, andHalifax ; and the highest rates in Preston, Wolverhampton,Plymouth, and Hull. The greatest mortality from measlesoccurred in Gateshead, Leeds, Brighton, and Oldham; fromwhooping. cough in Gateshead, Nottingham, and Derby;from "fever" " in Portsmouth; and from diarrhoea inLeicester, Sheffield, Preston, Wolverhampton, Plymouth, andHull. The mortality from scarlet fever showed no markedexcess in any of the towns. The 50 deaths from diphtheriaincluded 14 in London, seven in Leicester and in Leeds,and three in Sheffield and in Salford. No fatal case of

, small-pox was registered in the week in any of the 33I large towns and only one case was under treatment in

the Metropolitan Asylums Hospitals at the end of theI week. The number of scarlet fever patients in these

hospitals and in the London Fever Hospital on Saturday,, August 25th, was 1726, against 1827, 1838, and 1793 the

three preceding weeks ; 140 new cases were admitted during, the week, against 156, 155, and 177 in the three preceding, weeks. The deaths referred to diseases of the respiratory- organs in London, which had been 128 to 132 in the two pre-, ceding weeks, further rose in the week under notice to 149,, but were 12 below the corrected average. The causes of 47,i or 1’1 per cent., of the deaths in the 33 towns were not-

certified either by a registered medical practitioner or byi a coroner. All the causes of death were duly certified in, Cardiff, Nottingham, Salford, Bradford, and in nine otherI smaller towns; the largest proportions of uncertified deaths were registered in Portsmouth, Leicester, and Liverpool.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had declined from 19’0 to 16’9 in the five precedingweeks, rose again to 17 9 per 1000 during the week endingAugust 25th, and was 1-9 per 1000 less than the mean rateduring the same period in the 33 large English towns. Therates in the eight Scotch towns ranged from 11’8 in Perthand 16-6 in Leith to 23-3 in Paisley and 24-9 in Greenock.The 554 deaths in these towns included 52 which werereferred to diarrhcea, 23 to whooping-cough, nine to measles,