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PUBLIC HEALTH 

PAPERS AND REPORTS 



VOLUME XVI 



PKESEMTED AT THE EIORTEENTH ANNUAL MEBTINO OP THE 



American |)nblk Qmltl) Association 



CHARLESTON, S. C, DECEMBER 16-19 



I 890 



WITH AN ABSTRACT OP THE RECORD OF PROCEEDINGS 



CONCORD, N. H. 

Railroad Sqjl7Arb 
1891 



Copyright, 1891, 
Bt Irving A. Watson, Sec American Pubuc Health Association 



All Rights Reserved 



NOTE BY THE SECRETARY. 



The papers published in this volume do not necessarily carry with 
them the endorsement of the Association. The authors alone should be 
held responsible for all statements made and opinions expressed. A few 
of the papers will be new to all the members, having been read by title 
only and referred to the Publication Committee. 

It is a matter of regret, that by reason of an incompetent stenographer 
we are unable to present the interesting discussions that followed the 
readings of papers, with a few exceptions, in which cases the manuscript 
was furnished by those taking part in the debates. 

As the admission of the Republic of Mexico to representation in the 
Association at the Charleston meeting marks an era in sanitary progress, 
we have incorporated in this volume the report of the Mexican delegates 
to their government, in Spanish. 

The "List of Members," and the " Sanitary Authorities of the United 
States, Canada, and Mexico," have been revised to date. 



TABLE OF CONTENTS. 



EIGHTEENTH ANNUAL MEETING. 

Pagb. 
Thb President's Address — Sanitation in 1890. By Henry B. Baker, A. M., 

M. D., Lansing, Mich. I 

Address of Welcome. By H. B. Horlbeck, M. D., Charleston, S. C. . 18 

Address. By J. S. Buist, M. D., Charleston, S. C. 19 

Address. By J. P. K. Bryan, Esq., Charleston, S. C 23 

Address. By Rev. Dr. Charles S. Vedder, Charleston, S. C 27 

What Constitutes a Filth Disease. By Samuel W. Abbott, M. D., Boston, 

Mass. 30 

The Vaccinal Protection of Passengers from Europe. By F. Montizam- 

bert, M. D., F. R. S. C, D. C. L., Quebec, Canada. 50 

The Sanitary Improvement of Stagnant Lakes by the Sea-Shore, as 

Exemplified at Virginl/i Beach, Va. By Joseph H. Raymond, M. D., 

Brooklyn, N. Y 57 

The Prevention of Tuberculosis — A Century's Experience in Italy 

under the Influence of the Preventive Laws of the Kingdom of 

Naples, Enacted in 1782. By Lawrence F. Flick, M. D., Philadelphia, Pa. 60 
Ventilation and Impure Air as Prophylactic or Causative of Disease. 

By P. C. Remondino, M. D., San Diego, Cal 71 

On the Prevention of Phthisis. By B. F. Wyman, M. D., Aiken, S. C. . . 94 
Maritimb Sanitation at Ports of Arrival. By H. B. Horlbeck, M. D., 

Charleston, S. C no 

Some Notes on Chemical Disinfection. By F. P. Venable, Ph. D., F. C. S., 

University of North Carolina 126 

Treatment of Sewage by Chlorine, Precipitation, and Sedimentation. 

By Joseph H. Raymond, M. D., Brooklyn, N. Y 132 

Railroad Hygiene: Railroad Cars— Proper Ventilation as a Sanitary 

Measure to Prevent the Transmission of Disease and to Promote 

THE Comfort of Travellers. By J. Somers Buist, M. D., Charleston, S. C. 147 
The Relation of Land Monopoly to Population Health. By George 

HoMAN, M. D., St Louis, Mo 153 

The Federal District in the Republic of Mexico as a Suitable Residence 

for Persons Predisposed to Tuberculous Affections, and for Relief 

OF Pulmonary Consumption. By Domingo OrvaJJanos, M. D., Mexico . 160 
Swine Red-Disease in Mexico. By Josift L. G6mez, D. V. S., Mexico . 168 

Leprosy and its Management in Minnesota. By Charles N. Hewitt, M. D., 

Red Wing, Minn 172 

Local Boards of Health. By A. A. Moore, M. D., South Carolina. . .181 

The Hygienic Value of Rational Irregularities in Habits of Living. By 

JAS. F. Hibberd, M. D., LL. D., Richmond, Ind 183 

Records of Fifty Examples of Defective Plumbing in New York City 

AND Vicinity. By Albert L. Webster, C. E., New York . . .190 

Sulphuring or Bleaching Dried Fruit a Mistake, if not a Crime. By 

Joel W. Smith, M. D., Charles City, Iowa 199 



VIU CONTENTS, 

The Sanitary Advantages op the Turkish Bath to the Individual. By 
Charles H. Shepard, M. D., Brooklyn, N. Y 202 

Underground Waters as Sources of Public Water-Sxtfplies in Ontario. 

By Peter H. Bryce, M. A., M. D., Toronto, Ont. 209 

The Relation of the Mechanical Arts to Preventive Medicine, Particu- 
larly Illustrated by the Artesian Wells and Tidal Drains of 
Charleston, S. C. By A. N. Bell, A. M., M. D., Brooklyn, N. Y. . . 227 

Tidal Drain System of Charleston, S. C. By Lewis J. Barbot, C. E., 

Charleston, S. C 236 

The Microscopical, Spectroscopical, and Chemical Analysis of Black 
Vomit as an Aid to Health Officers in the Differential Diagnosis 
OF Yellow-Fever and Malarial Fevers. By George T. Kemp, M. D., 
Ph. D., Brooklyn, N. Y 246 

Experiments on Trap Siphonage. By Prof. J. E. Denton, Hoboken, N. J. . 253 

Proceedings and Discussions of the Eighteenth Annual Meeting . 307 



REPORTS OF COMMITTEES, ETC. 

Report of Committee on Sanitary and Medical Service on Emigrant 

Ships. By S. H. Durgin, M. D., Chairman 43 

Report of the Committee on the Cause and Prevention of Diphtheria. 

By G. C. Ashmun, M. D., Chairman 97 

Report of the Committee on Animal Diseases and Animal Foods. By 

D. E. Salmon, D. V. M., Chairman 151 

Report from the South Carolina State Board of Health. By J. R. Brat- 
ton, M. D., President of the Board 176 

Report of the Committee on Necrology 328 

Report of the Treasurer 331 

Report of the Mexican Delegates 332 

Report of the Advisory Council 326 

Constitution of the Association 343 

By-laws of the Executive Committeb •...•.... 347 

Officers and Committees 351 

List of Members Elected at Charleston 355 

Revised List OF Members 358 

Sanitary Authorities OF THE United States, Canada, AND Mexico . 370 

Index 377 



THE PRESroENT'S ADDRESS. 

Sanitation in 1890. 

By henry B. baker, A. M., M. D., 
Of Lansings Mich. 

Members of the Association, Ladies and Gentlemen: — In 
accordance with the custom in this Association, this address is now 
presented in order to supply a general view of the present status of pub- 
lic health work in this country, to bring briefly before us a review of 
some of the progress made, especially since the last meeting of this Asso- 
ciation, and to suggest directions in which effort seems to be needed in 
order that progress shall be most satisfactory and promising for the 
future. 

Many of you are as familiar as I am with these several topics, but as 
each member of our Association views them from a different stand-point, 
there is reason for a hope that what is presented in this address may not 
be tiresome, and I do not forget that there are some present to whom 
public health topics must be new. To such persons I may say, that 
although many of its members are physicians, this Association is not a 
medical association. Although many of its members are especially well 
informed on subjects relating to personal hygiene, yet personal hygiene 
is not the subject which is uppermost in the minds of members of this 
Association. If you ask, What, then, are the objects of this Association ? 
the reply is found in its name, " The American Public Health Asso- 
ciation," and in its constitution, wherein it is stated, ^^ The objects of 
this Association shall be the advancement of sanitary science, and the 
promotion of organizations and measures for the practical application of 
public hygiene." 

The founders of this Association recognized the fact that in civilized 
society the life and health of every person are more or less bound up with 
the life and health of every other person; that not only is man his 
" brother's keeper," but on each person there rests some responsibility 
for the welfare of all, some responsibility for the public health ; and 
each person has a vital interest in the public health, because of its bear- 
ing upon self-preservation. 

We have all heard that " self-preservation is the first law of nature ;" 
but I think we must admit that it is not the first, but more frequently the 
last, law of the law-maker. Laws for the preservation of human life and 
health, in accordance with sanitary science, are of slow growth, and an 



2 THE PRESIDENT'S ADDRESS 

important object of this Association is ^' the promotion of organizations'' 
'' for the practical application" of sanitary science for the public good ; 
and such organizations for the public good can, as a rule, best exist only 
through public law, and the ordinary governmental methods. 

Governmental methods differ somewhat in the different parts of Amer- 
ica, and we must remember that this Association includes representatives 
not only from the several states of this Union, but also from the Prov- 
inces and the Dominion of Canada ; and I am happy to say that this year 
marks a new epoch, for we have with us officially appointed representa- 
tives from the general government of Mexico, eminent members of its 
Superior Council of Health. 

If, then, this address is to deal with those objects for which this Asso- 
ciation was organized, it must deal with the advancement of sanitary 
science and the promotion of sanitary organizations ; and, in the United 
States, the most perfect '^ organizations" for the practical application of 
measures for the public good must conform to our form of government, 
" of the people, for the people, by the people." In my opinion, there 
should be such a sanitary organization for the United States and for each 
other general government, for each of the several states and provinces, 
and for each of the numerous local governments. 

Advancement of Science. The Causation of Diseases. — It 
seems evident that no great and substantial progress can be made 
toward the prevention or avoidance of a disease until we have knowledge 
of its causation. Therefore the work which it is most important shall be 
first accomplished is that which shall yield us knowledge of the causa- 
tion of each disease. Within recent years much progress has been made 
in this important fundamental knowledge, thanks especially to two 
enlightened governments, Germany and Great Britain. 

It should be clearly held in mind that there are seldom less than three 
important factors, neither of which can be neglected in studying the 
causation of a disease. For instance, there is (i) the '^specific" cause, 
(2) what (when dealing with atmospheric conditions) I have called the 
" controlling" cause, and (3) the '* predisposing" cause. 

Causation of Consumption. — By all means the most important 
addition to our knowledge in this field is that for which we are chiefly 
indebted to Dr. Robert Koch, of the Imperial Board of Health of Ger- 
many, — the definite knowledge of the tubercle bacillus — the " specific" 
cause of consumption, the disease which causes the greatest mortality in 
this country and throughout the world. 

Every year there is being rapidly added to our knowledge, details of 
the controlling conditions, predisposing causes, and modes of spread of 
that most important disease — knowledge which will enable us to explain 
the methods by which this most dread disease may be prevented. 

Causation of Pneumonia. — The necessity for further knowledge of 
the causation of a disease than is supplied by knowledge of its '^ specific" 
cause is exemplified in the case of pneumonia, which disease, it is be- 
lieved, can be artificially produced in lower animals by means of its 



THE PRESIDENT'S ADDRESS, 3 

specific cause,^ yet the causation of which in man and in animals is cer- 
tainly proved (by statistics and by direct experiments) to be controlled, 
in great part, by conditions of the atmosphere.* 

One attempt to harmonize the facts from these two very different 
sources is that by Dr. William B. Canfield, who says, — " In the light of 
recent studies made by MetschnikofT,* Baumgarten,* Osier,* and others, 
it is more than probable that the phagocytes in a healthy individual, hav* 
ing healthy movements, are able to seize and assimilate the invading 
organisms, and it is only when an individual not well when the phago- 
cytes lose the power to battle against the specific organism of pneumonia 
from prolonged exposure to cold, that pneumonia sets in.'' * 

But experiments more recent than those referred to by Dr. Canfield, 
by Nutall, Buchner, Nissen, Lubarsch, Prudden, and others, indicate 
that the blood serum, even more than the leucocytes, is concerned in the 
destruction of pathogenic microdrganisms.'^ 

Causation of Diphtheria. — Evidence has been accumulating, and 
it now seems to be established, that the bacillus discovered by LoefHer is 
a specific cause of diphtheria. Dr. Klein, F. R. S., London, has demon- 
strated that in the cow, inoculated with diphtheria, the bacillus passes 
into the milk. This may account fbr the spread of diphtheria in some 
cases, otherwise unaccountable. In the trachea of cats the bacillus is 
alleged to have caused pneumonia," which was, I suppose, diphtheritic. 
Some experiments with doves by Babes and Piscariu' seem to have been 
especially well planned, and to have yielded results especially important. 
They found that the bacillus — the specific "germ" — promptly caused 
diphtheria in doves whose throats were scarified before the application 
of the bacilli, but did not cause the disease in doves with perfectly healthy 
throats. That something analogous to this is ti'ue, as a rule, concerning 
diphtheria in man, was claimed to have been indicated by myself some 
years ago. especially in my paper on the " Causation of the Cold Weather 
diseases. "^^ The hypothesis which I then published I still believe to be 
the true explanation, as to the way in which the throat is irritated and 
made sore, and consequently susceptible to diphtheria and other diseases, 
by exposure to the inhalation of air unusually cold and dry. But Dr. 

1 Report of Sec. of the State Board of Health, Mich., 1886, p. 315 ; also II Morgagni, Oct, Nov., 
Dec, 1888 ; also Trans. Md. Med. andChirurg. Fac., April, 1889, P- '^^ > ^^ Bulletin G^n6ral de 
Th^peutique, Paris, Dec. 15, 1889, p. 520 ; also Boston Med. and Surg. Jour., Jan. 23, 1890 ; also 
Therapeutic Gazette, vol. xiv, No. 2, Feb. 15, 1890, p. 142. 

s " The Causation of Pneumonia," Report Mich. State Board of Health, 1886, pp. 246-324; also 
Reports and Papers, Amer. Public Health Assoc, 1887 i ^^ Bulletin G^^ral de Th^peutique, 
Paris, Dec 15, 1889, p. 520; also Boston Med. and Surg. Jour., Jan. 25, 1890; also Therapeutic 
Gazette, voL xiv., No. 2, Feb, 15, 1890, p. 142. 

» Virchow's Archiv., vols, xcvi and xcvii. 

* Zeitsdirift f. Kl. Median, Bd. xv., i and 2. 

N. Y. Medical Record, April 13, 1889. 

« Trans. Md. Med. and Chirurg. Fac, April, 1889, p. 112. 

T T. Mitchell Prudden, M. D., in Med. Record, N. Y., Jan. 25, 1890. 

« " Public Health," Minnesota State Board of Health, vol. vi, No. 4, June, 1890, p. 33. 

^ Zeit. fiir. Hygiene, vol. viii, part 3d ; The Sanitary Inspector, Maine, July, 1890, pp. 6, 7. 
10 Report Mich. State Board of Health, 1887, pp. 197-21 1. 



4 THE PRESIDENT'S ADDRESS. 

K. E. Wagner {Annales de r Institute Pasteur^ p. 570, No. 9, t. 4, 
Sept. 25, 1890) has repeated Pasteur's experiments, producing anthrax 
in fowls by lowering their temperature by cold water, and has found that 
it can be done if the lowering is by means of antip)rrin. His experi- 
ments indicate that when the temperature is lowered the rate of destruc- 
tion is less than the rate of reproduction of the anthrax bacilli, while at 
the normal temperature of fowls, and especially when raised by the 
injection of the bacilli, the rate of destruction of the bacilli is greater than 
their reproduction, in the bodies of fowls, especially in the blood. Out- 
side the body at such temperature (42® C. to 43** C.) the anthrax bacilli 
do not form spores, and are killed in nine days.^ 

Experiments are needed to prove whether what is true of anthrax is 
also true of the other diseases which I have shown to be most prevalent 
after the cold weather.* 

Whether or not my hypothesis shall be found to be the correct explana- 
tion relative to the entrance of diphtheria, experiments indicate that it is 
true, in part at least, relative to pneumonia,^ and the fact now seems to 
be established that diphtheria, small-pox, pneumonia, and some other 
diseases that usually enter the body by way of the throat or air passages, 
are increased in prevalence at such times as people are exposed to cold 
atmosphere. 

Quarantine. — It is significant of great progress, I think, that the dis- 
eases which it now seems most important to dwell upon are not the 
same as in former times. Comparatively little is now said of small-pox, 
cholera, or yellow-fever. In this country these diseases are not such 
important causes of death as consumption, diphtheria, or scarlet-fever. 
For this result, general progress in sanitary administration must receive 
much credit ; but I think that, in this country, much credit must also be 
due to the greatly increased efficiency of the quarantine service, notably 
at such important ports as New Orleans, Quebec, and New York. Here, 
in Charleston, the efficiency has been greatly increased. 

The United States government, also, has, in recent years, done very 
much more than ever before for the establishment, equipment, and main- 
tenance of quarantine stations. 

A continuance of this work is desirable ; but, for substantial progress, 
something more than merely continuing the present methods of quaran- 
tine is needed. Diphtheria and scarlet-fever should be excluded by quar- 
antines ; but the entire country is permeated with those diseases, and 
with the still more important one-f-consumption ; and a health depart- 
ment of the interior is needed to be established at Washington, even more 
than is a continuance of quarantine. 

1 Supplement to the British Med. Jour., Nov. 29, 1890, p. 72. 

> Report Midu State Board of Health, 1888, pp. 143-169 ; Jour. Amer. Med. Assoc., Jan. 18 and 
25, 1890, pp. 73-84, 116-129. 

s Dr. Vito Platania, in Italy-— Giomale intern, delle scienze mediche, fascicule v ; also Bulletin 
G^ndralde Th^rapeutique, Paris, Dec. 15, 1889, p. 520; also Boston Med. and Surg. Jour., Jan. 23, 
1890; also Therapeutic Gazette, vol. ziv, No. 2, Feb. 15, 1890, p. 142. 



THE PRESIDENT'S ADDRESS, 5 

Cholsra. — To be forewarned should be to be forearmed ; but our 
long continued immunity from cholera in this country has led to a gen- 
eral belief that there is no longer danger from cholera in the United 
States — ^a belief which may be true, but, in my opinion, is not fully sup- 
ported by facts. The constant presence, throughout the United States, 
of typhoid fever, — ^a disease which is believed to be spread in almost the 
same ways in which cholera is spread, — should, it seems to me, teach us 
more humility as to the assumed sanitary superiority of our people and 
their surroundings, and should lead us to urge the people to adopt those 
measures which are now known to be restrictive and preventive of both 
cholera and typhoid fever. 

It should not be forgotten that our greatly improved systems of quar- 
antine at our leading seaports do not yet ensure us against the introduc- 
tion of cholera in the same manner in which it was introduced in 1873, 
when three distinct outbreaks of cholera, in widely remote parts of the 
United States, were traced to the unpacking of personal effects of immi- 
grants — at Carthage, Ohio : Crow River, Minnesota ; and Yankton, 
Dakota. So long as conditions are permitted to remain which result in 
the annual spread of typhoid fever in every state of this Union, there is 
good reason to believe that cholera would spread, if introduced at a 
season of the year favorable thereto. 

It should be, but is not, generally understood that there is coming to 
be a thickly populated area in a portion of this country in which by 
reason of alkaline waters the inhabitants are probably especially liable to 
typhoid fever, cholera, or other diseases propagated by microorganisms 
which enter the body by way of the alimentary canal, and which micro- 
organisms are generally destroyed by the normal acid of the healthy 
human stomach.^ It is not probable, but it is possible, that if cholera 
should become once thoroughly established in the warmest portion of 
the region of alkaline waters in this country, it might possibly find there 
a permanent home, as it has in the brackish waters of the Ganges in 
India. 

The bare possibility of such a calamity as the permanent addition of 
cholera to the diseases constantly present in this country should prompt 
the United States government to a thorough investigation of the subject, 
lest, through careless disregard of such duties by the government, the 
lives of thousands, perhaps millions, of our people should be jeopard- 
ized. 

Typhoid Fever. — But, after all, is cholera a more fatal disease or 
one more to be dreaded than its twin destroyer, typhoid fever? The 
number of deaths from typhoid fever reported as having occurred in the 
United States during the census year 1880, was 22,854;^ and it is prob- 
able that not much more than half of the deaths were reported, because 
the method of collecting the statistics of death for the United States cen- 

* Eighteenth Annual Report of the Local Gov. Board, Eng., i888~'89. Supplement containing 
Med Officer's Report for 1888 ; pp. 517, 521, 524. 

* U. S. Census, Vital Statbtics, vol. xu, part xi, p. 366. 



O THE PRESIDENT'S ADDRESS, 

SU8 is known to be very defective. We are apt to look with contempt 
upon the East Indians for living under conditions which permit their 
destruction by cholera ; while at the same time our own people are per- 
mitted to be swept off by the thousands in every year by a disease which 
we believe to be propagated in almost precisely the same manner that 
cholera is, and our national government is doing absolutely nothing to 
prevent its continuance ; does not even grant to its National Board of 
Health a dollar to investigate and report on the best methods for the pre- 
vention of this great waste of life and treasure that continues to go on, 
notwithstanding the belief of leading sanitarians that in great part it is 
unnecessary, and might easily be prevented without the use of more 
money than is annually wasted through preventable sickness from this 
disease. 

I think it is important that the government should investigate the 
reason for the prevalence of typhoid fever, ^'mountain fever," etc., in 
the region of the Rocky Mountains, especially in the region of alkaline 
waters. Such an investigation might throw much light upon the subject 
of the causation and better means of prevention of fevers throughout the 
entire country. 

Causation of Ybllow-Fbvkr. — Are not all the facts known, rela- 
tive to yellow-fever, compatible with the belief that the disease is caused 
by the inhalation (or otherwise taking into the human body) of the 
products of the growth, reproduction, or life processes of some organism, 
probably microscopic in size, which organism may not be capable of 
reproduction within the human body, but is capable of reproduction in 
filth outside the body, at high temperatures, but which organism is 
destroyed by a freezing temperature ? 

If there is such compatibility in the facts, is it not desirable that the 
United States government should take such measures as shall ensure 
the thorough searching for such hypothetical microorganisms, not in the 
bodies of yellow-fever patients, but in localities known to be infected ? 
Is not the importance of this subject, either as affecting the lives of cit- 
izens of this country, or as affecting the money interests of our people, 
sufficient to warrant the employment of a number of investigators, and 
the expenditure of considerable sums of money for investigations in the 
directions indicated by the facts in the possession of physicians and sani- 
tarians? 

It has been found that without the presence of oxygen (as in the human 
body), the cholera bacteria produce their poison more energetically and 
more quickly than in the presence of air ; but when developed in the 
absence of oxygen, the cholera bacteria are much more sensitive, traces 
of acid being sufficient to destroy them. When they first leave the body 
they are, therefore, easily destroyed by the gastric juice in the healthy 
human stomach, and cannot reach their habitat in the intestine, but if 
developed outside the body, in the presence of air, the bacteria soon be- 
come aerobic and not so easily destroyed. This seems to explain why 
cholera (like t3rphoid fever and yellow-fever) is only seldom directly 



THE PRESIDENT'S ADDRESS. 7 

contagious, and why the disease is contracted in an infected locality.^ 
Something similar or analogous to this being true in typhoid fever, and 
a noticeable fact in yellow-fever, the facts respecting the cholera bacteria 
may aid in the search for the specific cause of yellow-fever. 

A Possibility of the Prevention of Cancer. — A study of the 
locations of 7,881 primary carcinomata,* as illustrating the probability 
of a cancerous microbe, has led Dr. Edmund Andrews, of Chicago, 111., 
to believe that the facts he has collected and presented make it probable 
that a microbe exists, and prove the importance of searching out the 
microbe ; also that much can probably now be done towards preventing 
this disease by measures looking to the prevention of access of microbes 
to those parts of the body most susceptible to primary cancer, especially 
the lower lip, its liability to primary cancer being " 8,448 times greater 
than a similar area of the intestine. "* 

In this connection may be held in mind an epidemic or outbreak of 
cancer attributed to the use of cider, in the making of which water from 
an impure source was used.* 

Inflammation — A proposed general advance " all along the line.*' 
It is coming to be the general belief of physicians, and especially of sur- 
geons, that nearly all inflammations are caused by the presence of micro- 
organisms. (Some of the most common of these pus generators are the 
round ones — the micrococci, sometimes grouped by twos, and in chains, 
etc., — staphylococci y and streptococci pyogenes .^ three varieties of each : 
the alhus^ aureus^ and citreous.) 

Some of these microorganisms are now very widely and generally dis- 
tributed in thickly inhabited places, while in sparsely inhabited regions, 
especially in mountainous regions, they are not so generally found. I 
think we should put with this fact another one — that most new states and 
localities are, apparently, good health resorts. I remember well, that 
many years ago certain states in this Union were considered exception- 
ally healthful as regards diseases of the lungs, while now the mortality 
statistics in those states show the greatest proportion of the deaths to be 
from diseases of the lungs. Part of this ch ange may be due to a change 

1 Amer. Jour. Med. Sci., July, 1890, p. 77. * 

* " I. Other things being equal, primary carcinoma b most frequent on those surfaces which, by 
their position, would be most accessible to free^wimming microbes or spores derived from without 
the body. 

<* 2. The liability to cancer is increased if the epithelial surface is so situated that the spores can 
remain upon it for at least some hours without being swept away, as on the lower lip ; but the lia- 
Inlity is greatly diminished if the parts are frequently swept off, as the globe of the eye by winking, 
or the oesophagus by swallowing food and drink. 

" 3. The liability to cancer is great if the membrane has vast numbers of deep glandular follicles, 
into which tlie spores can penetrate and lie free from disturbance, and have direct access to the more 
delicate epithelial cells, as at the pyloric end of the stomach and the follicles of the mammary glands. 

"4. Those portions of the skin which are usually uncovered are oftener attacked than those cov- 
ered with clothing and constantly brushed by its friction. The skin of the face, for instance, produces 
more cancers than all the covered portions of the integument combined." — ^Jour. of the Amer. Med 
Assoc., November 23, 18S9, P* 739* 

* Jour, of the Amer. Med. Assoc, November 23, 1889, p. 742. 
« Science, vol. xiv, No. 342, August 23, 1889, p. 129. 



8 THE PRESIDENTS ADDRESS. 

in the average age of the inhabitants, but I think a part of it is due to 
the fact that the microscopic causes of inflammation have constantly been 
increasing, so that now the carpets and upholstered furniture in most 
residences, the floors of most public assembly rooms, the clothing, hair, 
beard, and hands of most of the inhabitants, are infected With these 
microscopic causes of inflammation. 

The surgeons have been acting upon this comparatively recent addition 
to our knowledge, and to those of us who practised surgery only as long 
ago as during the late war, the successes in recent surgery are marvellous. 
Not long since, I listened to the recital of the details of fifly-two succes- 
sive surgical operations, each involving the opening into the abdominal 
cavity, and each was successful.^ 

My belief is, that much of such wonderful success as is now achieved 
by the leaders in surgery is due to the advance of our knowledge upon 
what was formerly known as " the germ theory of disease," which 
gave rise to what was known as " antiseptic surgery," which is now 
giving place to what is known as " aseptic surgery." The septic 
microorganisms are now kept out of wounds, pus does not form, inflam- 
mation does not occur, the wounds heal, and the patient recovers. 

What I am about to propose may seem to some of you at first as 
Utopian, but I hope to be able to enlist your enlightened sympathies in 
the direction of a movement designed to do away with all inflammatory 
diseases of man, in a manner analogous to what has been done by the 
leading surgeons in doing away with inflammations following surgical 
operations. Let us glance at the stupendous character of the suggestion, 
gradually but eventually to do away with all inflammatory diseases ! No 
more consumption, pneumonia, bronchitis, pharyngitis, laryngitis, tonsil- 
litis, rheumatism, etc., including nearly all the dangerous communicable 
diseases. 

So far as relates to the dangerous communicable diseases, such as 
small-pox, scarlet-fever, and diphtheria, sanitarians now know how to 
restrict and perhaps to stamp out most of them, and they are doing this as 
fast as they are supported in doing it by governments ; but the measures I 
have to suggest would, I think, tend to aid greatly in that work, and, in 
addition, would aim to place at once dll inflammatory diseases on the 
list of preventable diseases— ^ise&ses which we think we know how to 
prevent just as soon as the people generally shall come to understand the 
methods proposed, and shall generally co5perate in the employment of 
those methods. 

Without elaboration,^ my proposition may be put in the form of pre- 
amble and questions, thus : 

Since nearly all suppurative inflammations are breeding-places for 
microorganisms, which, when they gain entrance into another living body 

^ Trans. Mich. Med. Soc, 1890, p. 349. 

* I hold dearly in mind methods which, if adopted, would, I think, probably be effective, but the 
statement of them cannot be attempted here. Among the most important measures would be the 
disinfection of all sputa, pocket handkerchiefs, etc. 



THE PRESIDENT'S ADDRESS, 9 

(or into another weak or injured spot in the same body), are capable of 
again starting the inflammatory process, — therefore. 

Should not all purulent discharges^ and all f us which is accessible^ 
be destroyed or disinfected? Should not the aim be thus to restrict the 
spread of, and eventually to stamp out, all inflammations ? 

Immunity through Inoculation of Attenuated Virus, Albu- 
mens, AND Ptomaines. — It has long been known that all animals con- 
stantly give off poisons, which, if accumulated, are fatal to their own 
existence. 

Certain vegetable ferments, which produce alcohol, are said to be ren- 
dered inactive by the presence of no more than 2 per cent, of alcohol.* 

Pasteur says, — " Many microbes seem to give rise in their cultures to 
substances which have the property of being harmful to their own devel- 
opment."^ 

There seems to be a universal law, that all living organisms form 
poisons to themselves ; and there is good foundation for the hope that 
there may be found methods of using those poisons for the destruction of 
those microdrganisms which cause diseases of man, or otherwise for the 
prevention of those diseases. 

Immunity against Rabies. — Prof. Welch says, — " There can be no 
doubt whatever that it is possible to render animals immune against 
rabies both before and after inoculations which would otherwise cause 
the disease. The independent and careful experiments of Ernst in this 
country are free from all partisan bias, and have fully confirmed the 
statements of Pasteur and others upon this point." • 

Prof. Henry Sewall, of the Michigan University, demonstrated the 
possibility, through injection of snake poison, of rendering the organism 
immune to the bite of the rattlesnake.* 

The experiments and practices of Pasteur and others, for the purpose 
of securing for mankind immunity from dangerous communicable dis- 
eases, through the inoculation of the body with the attenuated virus of 
such diseases, have for several years kept this subject before the people, 
and there has seemed ground for the hope that eventually success would 
crown the efforts being made in this direction ; and if once the principle 
is learned with reference to one disease, then there is hope with reference 
to the other diseases. But nearly all such efforts have been made by 

1 " Immunity throagh Leucomaines/' by EaseUo Giiell BacigalupL Translated from the second 
French edition by R. F. Rafad, M. D. J. H. Vail & Co., New York, 1889. 

» Comptes Rendus, Stance du 26 October, 1885, p. 771. M. Pasteur said, — 

'* As far back as the year 1880, 1 had instituted research in order to establish the fact that the 
microbe of chicken cholera produced a sort of poison of this microbe. 

^ One would say, that immediately there springs into existence a product which arrests the devel- 
opment of the microbe, whether cultivated in contact with the air or in a vacuum. 

" Mr. Raulin, my former assistant, ttnlay Professor to the Faculty of Lyons, has shown, in the 
remarkable thesis which he sustained at Paris, March 22, 1870, that the vegetation of the Aspergil- 
lus niger develops a substance which arrests, in part, the production of thb mould when the nutri- 
tive medium does not contain salts of iron.^' 

> William H. Welch, M. D., Trans. Maryland Med. and Chirurg. Faculty, April, 1889, pp. 170, 171. 

4 Mentioned in British Med. Jour., November 29, 1890, p. 1264. Trans. Am. Assoc, for Adv. of Sd. 



lO THE PRESIDENT'S ADDRESS. 

individual workers, at their own expense, and at such irregular times as 
they are able to take from their regular avocations by which they main- 
tain themselves. A few workers have been employed by governments, 
but there is no such governmental support of such investigations as the 
immense importance of the subject demands, and especially not in our 
own country. The United States government can be commended for 
what it does in this direction relative to the health of domestic animals^ 
but what can one say, by way of apology, for a government that appro- 
priates hundreds of thousands of dollars to study the causes of diseases of 
domestic animals, and then fails to appropriate as much to do a similar 
work for the lives of the people ? I wish, however, to commend what 
has already been done by the United States government.^ I have 
already mentioned what it has done for quarantine ; but I believe there 
is promise of great good to the human species as a result of the govern- 
mental researches into the causation of diseases of animals. The work 
of Drs. Salmon, Smith, and Schweinitz, of the United States Depart- 
ment of Agriculture, looking to the production of immunity in animals 
exposed to hog cholera, has added greatly to our knowledge of the 
underlying principle in the production of immunity to dangerous com- 
municable diseases of animals and of man. 

Dr. Welch has said, '^That immunity against infectious diseases may 
be secured by the injection of chemical substances produced by the 
growth of specific bacteria, was demonstrated first by Salmon and Smith 
in the case of hog cholera, and has since been demonstrated by Roux 
and Chamberland for malignant oedema, and by Wooldridge for an- 
thrax,"* both dangerous diseases of man as well as animals. 

Published accounts of experiments by Dr. Schweinitz,' and also by 
Frederick G. Novy, Sc. D., at the Michigan State Laboratory of Hygiene, 
indicate that by the inoculation of an animal with the albumens and 
ptomaines formed in culture liquids by the life-processes of the germs of 
hog cholera, the animal becomes insusceptible to hog cholera, whether 
exposed to the disease by inoculation, or by direct contact and association 
with animals sick with the disease. Dr. Schweinitz was even able to 
produce immunity in an animal by inoculation with a pure chemical pre- 
pared synthetically in the laboratory. The results of these experiments 
are in harmony with facts already known.* Perhaps the term " atten- 
uated virus*' may still be used, if we consider that the "attenuation" 
consists in the destruction of the germ, and in the saving of its products 
for use in the production of immunity. Of course much remains to be 
done before this knowledge can be made directly available in the preven- 
tion or restriction of dangerous communicable diseases of man, and the 
sooner that work is done the sooner the thousands of human lives now 

^ Jour, of the Amer. Med. Assoc., July 5, 1890, p. i. 

* William H. Welch, M. D., Trans. Maryland Med. and Chuiirg. Fac, 1889, p. 172. 
^ Med. News, Philadelphia, September 6, 1890, pp. 231-339, and October 4, 1890, pp. 332-335. 
« The substance used by Dr. Koch for the eradication of consumption is not yet known, but it 
may be expected to be in line with those facts. 



THE PRESIDENT'S ADDRESS, II 

lost through those diseases may be saved. Such work is for the general 
g^d, and should be done by the general government. It should be done 
with reference to diseases of man, and not confined to diseases of ani- 
mals, nor even to diseases which, like rabies, affect man and animals. 

Is it not time that human life should be recognized as a proper object, 
and the most important object, of solicitude on the part of the national 
government of the United States ? 

It will be a great gain, however, if it can be brought about that the 
government shall do such work, even if only for the saving in money 
values to the people, which, undoubtedly, would be immense. 

Antidotes to Diseases already Acquired. — At the recent Inter- 
national Medical Congress in Berlin, Dr. Koch, of the Imperial Board of 
Health, referring to his now famous consumption cure, said, — "My 
researches on this substance, therefore, although they have already occu- 
pied me for nearly a year, are not yet completed : and I can only say this 
much about them, that guinea pigs, which, as is well known, are extraor- 
dinarily susceptible to tuberculosis, if exposed to the influence of this 
substance cease to react to the inoculation of tuberculous virus, and that 
in guinea pigs suffering from general tuberculosis, even to a high degree, 
the morbid process can be brought completely to a standstill without 
the body being in any way injuriously affected. . . . This opens 
up an oft promised field of work, with problems which are worthy to be 
the subject of an international competition of the noblest kind. . . . 
Allow me, therefore, the expression of a wish that the nations may 
measure their strength on this field of labor and in war against the small- 
est, but the most deadly, foes of the human race ; and that in this strug- 
gle for the weal of all mankind, one nation may always strive to surpass 
the other in the success which it achieves."^ 

Certainly we can all join with Dr. Koch in such wishes for national 
effort for life-saving work ; but I think that, among all the countries 
represented at the international congress, there are few governments 
which occupy such an enlightened position on the subject of sanitary 
researches as does the German Empire. If our own national govern- 
ment would even do as much as to publish and thoroughly disseminate 
among our people the important results of the researches made by the 
German Imperial Board of Health, our people would have cause to 
rejoice, and probably thousands of human lives would be saved through 
the knowledge thus obtained. Something in the direction of such publi- 
cation has recently been done by the United States Marine Hospital Ser- 
vice. But much more than has yet been attempted should certainly be 
done in that line. And if our government were to wake up to the 
importance of doing what the highest interests of its constituents de- 
mand — cause researches to be made for the creation of such knowledge — 
it can find as bright intellects and as faithful workers among our own 
scientific men as there are in any country ; and in a short time the world 
might be as much indebted to the United States Board of Health for life- 

^ Jour, of the Amer. Med. Assodation, toL xv, No. io, Sept. 6, 1890, p. 370. 



12 THE PRESIDENT'S ADDRESS, 

saving knowledge as it now is to the Imperial Board of Health of Ger- 
many. 

While we accord great honor to Dr. Koch, who discovered the specific 
cause of consumption, and who now thinks he has discovered its anti- 
dote, let us not forget that it was an honored member of our own Asso- 
ciation, our president in 1887, Dr. Sternberg, of the United States 
Army, who first discovered the specific cause of pneumonia, a disease 
which, as a cause of mortality in this country, ranks only a little lower 
than consumption ; and, if the subject were followed up, it should yet 
yield results somewhat comparable with those reached by Dr. Koch with 
reference to the somewhat similar disease which he seems to have con- 
quered. 

Let. us consider for a moment the prospective importance of such a dis- 
covery as that suggested by Dr. Koch : It is not claimed that all deaths 
are reported in this country, but the reported deaths in the United States 
from that one disease, consumption, in the single census year 1880, were 
91,270: without doubt more than 100,000 such deaths occur in the 
United States in each year. If, as stated by Dr. Koch, '^ in guinea-pigs 
suffering from general tuberculosis even to a high degree, the morbid 
process can be brought completely to a standstill without the body being 
in any way injuriously affected,'* there is certainly ground for the hope that 
something approaching that can be done for the human being, and that, 
if sufficient intelligent effort be put into the research, the substance which 
will do this can be found, even if it has not already been found by Dr. 
Koch. Let us suppose that our own national government were to pay 
for such researches, and that annually the lives of one half, or even of 
one fourth, of the 100,000 of our people, who otherwise would have pre- 
maturely died, were to be saved: how would that compare with the 
work of the agricultural department of our government for the distribu- 
tion of garden seeds ? how would provision for such work by congress 
compare with its work for the protection of our infant industries? how 
would it compare with any work that has been done by congress during 
the past twenty years .^ I admit that in 1879 ^^ established a National 
Board of Health ; but the government failed to sustain the board long 
enough to permit of many such researches as those I suggest, although, 
as long as it was sustained, it did excellent work. 

In comparing public health work with the work of the United States 
Agricultural Department, I do not forget that " That art on which a 
thousand millions of men are dependent for their sustenance, and two 
hundred millions of men expend their daily toil, must be the most im- 
portant of all, — the parent and precursor of all other arts." * 

But all must concede that agricultural art has now made such wonder- 
ful progress that there is no longer need for more, fully to sustain not 
only the necessities of man, but to supply many luxuries. Superfluous 
effort, therefore, might well be diverted from agriculture to supply those 
provisions for public health work for the want of which hundreds of 

^ James F. W. Johnston. 



THE PRESIDENTS ADDRESS, 13 

thousands of our people actually prematurely perish, and hundreds of 
thousands more drag out a miserable existence. 

So many of our people are now raising farm products, that that is 
claimed to be a comparatively unprofitable occupation. 

Apparently, then, this country needs fewer farmers, more sanitarians. 

We welcome to our ranks, however, not only farmers, but all good 
people. 

They have departed, but their works continue. — Custom 
and humanity dictate that there shall be public recognition of the ser- 
vices of those who have publicly labored with us, and who have ceased 
their labors, but whose good work will go on down through the ages. 
Considering our numbers, and the average age of our members, it is to be 
expected that in every year death will overtake some of us. Before the 
time for our next meeting, some of us will have passed over to the '' great 
majority." Since the last meeting, so far as I know, only three of our 
members have died, — ^Dr. Charles Linnaeus Allen, secretary of the State 
Board of Health of Vermont, who was elected a member of this Associa- 
tion in 1888; Dr. J. H. Baxter, surgeon-general of the U. S. Army, a 
member of this Association since 1876 ; and Dr. William Brodie, president 
of the Board of Health of Detroit, Michigan, a member of this Associa- 
tion since 1873. Dr. Brodie had long been a prominent member of the 
medical profession. He had been president of the State Medical Society 
of Michigan, and president of the American Medical Association. It 
was largely through his work that this Association held its successful 
meeting in Detroit in 1883. Dr. Brodie was president of the first San- 
itary Convention held under the auspices of the Michigan State Board of 
Health. 

I trust that a committee, or the secretary of this Association, will make 
fitting records of the services of our deceased brothers, and of tributes to 
their memory. 

Death of Sir Edwin Chadwick. Since our last meeting, sanitary 
reform has lost an able advocate in the death of Sir Edwin Chadwick in 
England. In recording his death, the British Medical Journal said, — 

Few men have deserved better of their country than the veteran sanitarian whose 
death, at the advanced age of 91, we have to record. His investigations of the sanitary 
condition of London, dating back to 1847, ^^^^ ^^ official starting-point of a reorganiza- 
tion of the Health Department, and laid the public legislative basis of the first of a series 
of sanitary reforms which have been of inestimable value during the last half century in 
the saving of life and the diminution of sickness and disablement. His subsequent services 
to the cause of army health reform, and his continuous devotion to great and small 
questions of public and personal sanitation, placed him quite in the first rank of non- 
medical sanitary reformers. ... It has been aptly observed, that had he, as a mili- 
tary man, succeeded in destroying one hundredth part of the lives which he was promi- 
nent in assisting to save, his statue would have been erected long since in more than one 
of the great cities of the empire, and he would have been loaded with honors and titles. 
As it is, it was not until he attained the age of 90 that he received the honor of knight- 
hood.* 

^British Med. Jour., No. 1541, July la, 1890, p. 96. 



14 THE PRESIDENT'S ADDRESS. 

Practical Application of Sanitary Science. — I have already 
touched that subject which was declared the second object of this Asso- 
ciation, but mainly to show that the most rapid advancement of sanitary 
science is made, and is to be expected, where governmental aid is most 
complete and abundant, — in other words, where the people as a whole 
contribute according to their means. Having left the subject of advance- 
ment of science, I will briefly consider such " organizations and meas- 
ures for the practical application of public hygiene." 

State Boards of Health. — There is reason for a high degree of 
pride in the wonderful development in this country of the state boards 
of health. Although none of them have anything approaching the 
resources which are placed at the disposal of the Imperial Board of 
Health of Germany, or of the Government Board of England, and, it 
must be confessed, that the debt which humanity owes to Dr. Robert 
Koch, of the German Board, is perhaps greater than to any man in this 
country, in any field of human effort, still I think it can fairly be claimed 
that some of the state boards in the United States rival the boards of 
health in the general governments of the most enlightened countries in 
the world — rival them in the amount of useful services which they are 
continually performing for their own people and for the general sanitary 
enlightenment of the world ; especially do they rival them in the imme- 
diate practical results of their work. 

For instance : Statistics, which appear to be trustworthy, seem to prove 
that in one state, and apparently through measures inaugurated and 
maintained by the state board of health, the deaths from small-pox have 
been so reduced that more than one thousand five hundred persons have 
continued to live who would have died from that disease if its mortality 
rate had continued as it was before the establishment of the state board 
of health. A thousand five hundred lives saved from small-pox means 
a saving also of at least six thousand cases of sickness from that loath- 
some disease.^ 

In that same state, also, the vital statistics seem to prove that through 
similar, though not identical, work, there has already been a saving of 
life from scarlet-fever equal at least to five thousand persons, and (if the 
death-rate was ten per cent.) a probable saving of fifty thousand cases of 
sickness from that disease.^ 

Nor is this all. Statistics indicate that at least one life a day is being- 
saved in that state by measures started and maintained by its state board 
of health for the restriction of diphtheria.' As the death-rate is about 
twenty-four per cent., at least fifteen hundred cases of sickness from 
diphtheria are prevented annually. 

At least one other state (Massachusetts) has undertaken statistical 
effort to learn the effect of such work, and similar saving has been made 
apparent. 

1 Proceedings of Sanitary Convention at Vicksburgh, Michigan, 1889, p. 56. 
> Proceedings of Sanitary Convention at Vicksburgh, Michigan, 1889, p. 58. 
* Proceedings of Sanitary Convention at Vicksburgh, Michigan, 1889, p. 62. 



THE PRESIDENTS ADDRESS, 1$ 

It seems desirable that other states^ in which similar work has been 
done, should collect and publish evidence of the results of their work. 

The Value and Importance of Statistics. — On many questions 
of public policy, no useful conclusion can be reached without a thorough 
knowledge of the facts involved. And frequently it is important to have 
accurate knowledge respecting several classes of facts. For instance : In 
order to know what disease it is most important that we shall strive to 
prevent, it is necessary to know what disease causes the most deaths, or 
the most suffering among the people. Mortality statistics supply this 
knowledge. Again : In order to know whether a disease which is an 
important cause of death is itself caused by climatic or meteorological 
conditions, it is necessary to have, and to compare with the statistics of 
deaths and of sickness, other statistics relating to the various meteoro- 
logical conditions. 

For several years we had at Washington a United States Commis- 
sioner of Labor, and he collected valuable statistics on the various 
branches of the subject of human labor. We ought to have at Washing- 
ton an officer charged with the duty of collecting statistics relating to 
those subjects which bear directly upon human life and health. 

There is now a "Department of Labor" in the United States Govern- 
ment. Should there not be a Department of Life and Health ? 

Statesmanship. — This is an age of organizations among the people, 
for the general benefit of all. People generally are coming to have that 
degree of intelligence, education, and culture which fits them for self- 
government. The daily papers, the magazines, the excellent postal 
facilities, the telegraph, and the telephone have served greatly to equal- 
ize the intelligence of the people generally. They have served greatly 
to do away with famines, with continual warfare, and, I believe, with 
great wars ; and certainly they have done much to make the old-time 
plagues and pestilences horrors of the past. 

Yet, although the general governments of countries are making prog- 
ress toward conforming to the actual conditions among the people, old 
customs and precedents have a powerful influence in restraining progress ; 
and I think this is more noticeable to members of this Public Health 
Association than to any other class of people, for the reason that sani- 
tary science is a comparatively new science, and has not for so long a 
time been available for spreading its knowledge among the people. 
But already the leading minds in several of the most civilized countries 
have recognized the fact that the greatest good to the greatest number of 
citizens consists, first of all, in securing to them life and health. Thus, 
for instance, Disraeli said that action in this direction " is the wisest 
statesmanship." Gladstone has expressed himself similarly. And, 
through the lead of such statesmen, England has its useful general board 
of health — the "Local Government Board," with its corps of medical 
officers. Some of the important work of the German Imperial Board of 
Health is well known. 

In our own country, the framers of the Declaration of Independence 



l6 THE PRESIDENT'S ADDRESS. 

declared that "life, liberty, and the pursuit of happiness" are *' among 
the unalienable rights," to secure which "governments are instituted 
among men." 

In times past, the minds of men and of governments have been kept 
so occupied with protecting the lives of their citizens from the dangers 
caused by the battling of other men, hostile tribes, and foreign govern- 
ments, that little time or energy has been left to devote to the protection 
of life and health from ordinary preventable causes of death and sick- 
ness. Now that men and nations are coming to be less destructive of 
each other, it is rapidly coming to be seen that by organized effort and 
general cooperation a great proportion of the premature deaths, and of 
the sickness from the most common diseases, and the resulting pauper- 
ism, insanity, and crime, can easily be prevented, and this without any radi- 
cally new principle of government, but by an extension of the principle 
of protection of life and property into new systems of effort. The con- 
stitution gives congress the power to "provide for the common defence 
and general welfare of the United States." 

It is the same now as when the book of Rosea was written — our 
"people are destroyed for lack of knowledge ; "* and a government has 
only to collect, search out, and disseminate among its people "knowl- 
edge" of the causation of disease, its modes of spread, and how to avoid 
causes of deaths and the spreading of epidemic diseases, to make it pos- 
sible for its people to have safety to " life " and that " pursuit of happi- 
ness" which are only possible to persons in health. This implies, how- 
ever, that the government must constantly maintain statistical investiga- 
tions and scientific researches into the causation of diseases, and such a 
complete and thorough system of prompt notification of the outbreak of 
every dangerous communicable disease within its own country — and 
also in all parts of the world where it may readily spread to its own 
country — that the government shall be able to, and shall, in fact, promptly 
warn all its people endangered, and not only warn them, but shall at 
the same time place before them the best that is known or can be learned 
concerning the exact methods for avoiding the dangers to life and health 
from that particular disease which at the time is threatening. 

Only by some such modification of governmental methods is it pos- 
sible to do for a people that service which it is the highest function of a 
government to perform. 

We hear much about the wisest statesmanship as applied to such 
questions as relate to our commercial dealings with other nations— ques- 
tions whether it is wiser to have " free trade," or " protection" of home 
industries ; yet these are questions of small consequence to the people of 
any country when compared with questions which involve the protec- 
tion of the lives and the health of the people themselves, because the 
people can get sufficient food and other necessaries for subsistence under 
" free trade " or under " protection ;" but under neglect of proper gov- 
ernmental protection of life and health a large proportion of the people 

^ Hosea, chapter iv, ▼erse 6. 



THE PRESIDENT'S ADDRESS, 1 7 

prematurely die, and still larger proportions suffer sickness, life-long 
pain, and physical and mental degradations, from causes which under 
proper governmental protection are easily preventable. That this is 
true, there is no longer question ; incontrovertible facts are on record 
proving that it is strictly true. As soon as this knowledge comes to a 
majority of the people, they will surely demand that the government shall 
no longer neglect its highest functions ; and we may confidently look 
forward to a *'good time coming," when the safety of life to our peo- 
ple shall be the first and most important concern of the enlightened 
government of these United States ; when the most important officer 
in this country, whether he be called commissioner of health, secretary 
of the health department, or president of the United States, shall, at all 
events, be its wisest sanitarian, or, at least, its most competent public 
health administrator. And you, the members of this Association, are 
and should be laying the foundations, and fitting yourselves for the per- 
formance of such highest and most sacred duties ; for, in these days of 
rapid advances in the spreading and equalizing of knowledge, we know 
not how soon the clamor of our people for the protection of their lives 
may force upon our own national government the proper performance 
of its highest duties, which it has so long neglected. 



n. 

ADDRESS OF WELCOME. 
By H. B. HORLBECK, M. D., 

CHAIRMAN LOCAL COMMITTEE OF ARRANGEMENTS, 
Charleston^ S. C, 

Pellow-Mkmbers of the American Public Health Associa- 
tion — Ladies and Gentlemen: As chairman of the local committee, 
it is my privilege to bid you welcome. 

Recognizing the work of the American Public Health Association in 
benefiting humanity, we feel that in bidding you welcome we are fulfill- 
ing a kindly trust. We are honored by your presence, and we are here 
to-night to show you that the promotion of the welfare of humanity is in 
our eyes the highest of human aims. 

Your labors vouchsafe the relief of human suffering, and a prolonga- 
tion of human life. The teachings of your members indicate to the 
many millions of the American continent the story of the problem of ex- 
istence with the least harm from ever-present pernicious surroundings. 
Your results by direct examination tell us that here is peril and there is 
safety, and your daily labors elevate life into a recognition of proud re- 
sponsibility. 

From your published papers the people of this land may glean the 
lesson of how to live, of how to utilize the blessings of constantly recur- 
ring Almighty beneficence, and of how to put an estoppel upon fatal 
influences. 

Our pleasures beckon us on, our enjoyments are our incentives to con- 
stant labor for these privileges. 

The mission of the American Public Health Association is to speed, 
not lessen, these pleasures and enjoyments ; and to say, and to say with 
emphasis, that they must be in abeyance to laws which should hinder 
you from pursuing pathways beset with danger : they close such doors, 
but they disclose to you broad and bright roadways where existence is 
open and free and safe, and where buoyant lifts engendered by healthy 
methods make the gift a happiness and a treasure. 

With such a mission you have prospered, and your long roll of mem- 
bership shows the valuation of this country that it is better for the land 
that you are here. We wish you a hearty God-speed in your work. 



m. 

ADDRESS. 
By J. S. BUIST, M. D., of Charleston, S. C. 

Mr. Chairman, Gbntlembn of the American Public Health 
Association — Ladies and Gentlemen: The distinguished honor 
which has been conferred upon the city of Charleston, the metropolis 
of our beloved state, by the presence in our midst of a body of scientists 
composed of the intellectual strength, the educated wisdom, and the ma- 
tured experience of a long series of years of close culture and observation, 
is indeed a fortunate circumstance, and one that we may well be proud 
of; and in being the happy medium of extending to them in behalf of the 
medical profession, as well as the community in which we live, a hearty 
welcome to this old, time-honored city by the sea. I but reflect the 
general sentiment of a hospitable people as well as a united profession, 
when I say it is an honor which any city may well be proud of. 
Coming as the members of this Association do, in the cause of the pub- 
lic good, with a philanthropy that is unlimited, seeking no personal 
advancement, but with hearts free from bias, with the sole object of bet- 
tering the material as well as the temporal condition of their fellow- 
creatures, without the hope of reward or the fear of punishment, by con- 
ference and interchange of thought, they are in search of truth as de- 
veloped by scientific research, and to place practically the results of their 
labors before their admiring and appreciative fellow-men. Men and 
women of culture rule the world. Education and intelligence, properly 
directed, are the levers, the pivots, upon which in this day and generation 
turn the most important events of life. Science is progressing. Knowl- 
edge is becoming more diffused and general, the evil of ignorance is 
being lifted, the power of brute force is rapidly giving way to the influ- 
ences of reason, and the truth, however deeply hidden, either in the 
resources of nature or locked away in the impenetrable labyrinth of 
thought, is being drawn forth to pay tribute to man's perseverance and 
energy, and to protect him from evil and danger. The combination of 
thought, and the interchange of ideas by the co-mingling and union of 
patient research and investigation, elaborate truth, dispel error, and 
place upon a firm and practical basis that which must ultimately result 
for the mutual benefit of all. This Association, representing in its en- 
tirety the great principle of progress, looks forward to the day, not far 
distant, when it can point with pride to its record, and show by practi- 
cal results its vast achievements in the cause of sanitary science, in 
elevating the moral tone, improving the physical condition of the race, 



20 ADDRESS. 

in establishing method and intelligence in the place of ignorance and 
superstition, and teaching men to rely upon well digested methods and 
systems in combating the constant evils and dangers to which they are 
exposed. But one branch of that noble profession from w^ose massive 
trunk spring the varied and multifold influences that are at work to 
ameliorate the sufferings and trials of humanity, it works in complete 
harmony with it, the mutual dependence of the different parts being ab- 
solutely essential to the integrity and character of the whole. It draws 
its members not only from the ranks of the medical profession, but, en- 
tering a wider domain, it takes from the general field of science its most 
able and cultured votaries, and with the combined powers of enlighten- 
ment and potent analysis it endeavors upon a plane somewhat higher 
to grapple with first causes, tracing from effects backwards until it 
reaches the very germ itself, which it proposes with the help of that great 
physician completely to eradicate, or so to ameliorate or subdue as to ren- 
der it subservient to its will. Pause, for a moment, to note the change 
that has taken place in the last decade in the history and progress of sani- 
tary science on this North American continent, subject as they have been 
to the influences this organization has had in moulding and determin- 
ing the various measures that have been adopted to promote the health 
and well-being of its inhabitants, municipal, state, and national. Note 
that through its high standard of requirement men learned, skilled, and 
experienced in their calling have been placed in control and power, 
where before ignorance and indifference have been the rule. See how 
through its teachings and its dissemination of knowledge the masses 
have been educated, and taught the value and ^necessity of care, both of 
persons and all their surroundings, as of mutual and dependent benefit 
one upon the other. With fearless indifference as to the prince in his 
palace or the peasant in his hovel, it works with but one aim, the benefit 
of the whole human race, recognizing the fact that there is no exemption 
by reason of caste and condition. See how, by patient toil and research, 
the most hidden secrets of nature have been brought forth to light, to pro- 
mote the comfort and enjoyment of mankind. 

Confidence in methods has been established, security for property has 
been assured by reason of its never sleeping vigilance to detect the first 
evidences of its opponents to invade its closely guarded domain. Com- 
merce has been placed upon a certain and permanent basis, regulated by 
well defined and understood laws, so that in every way the minimum of 
evil shall result to the good of the whole. Animated by purely philan- 
thropic impulses, and firmly convinced that many diseases, whose origin 
had for many centuries baffled the researches of the most learned, could 
be prevented by due regard to the securing of pure air, pure water, pure 
food, due regard to proportionate labor and rest, more careful attention 
to sewerage and quick and effectual disposal of sewage, it has already 
commenced to solve the problem of acute infections, miasmas, robbed 
them of most of their terrors, checked their progress, mitigated their 
severity, and, by following them to the sources of origin, threatened them 



ADDRESS. 21 

with destruction, or else confined them within natural limits. Its active 
workers, not satisfied with the mere experimentalization of theories 
drawn from recorded facts, have not failed to risk personal safety and 
even life itself in their efforts to solve the great problems of the causes 
operating to the destruction of the human race. By a long series of years 
of patient toil, working against prejudice and the deep-rooted systems of 
long established customs, it has, by mere force of reason and the devel- 
opment of truth, gained the confidence of government, and made an 
enlightened law subservient to its behests. 

Preventive medicine has become the coequal of curative medicine ; — 
the one cannot succeed without the other ; they are both essentially de- 
pendent, one upon the other. It is a broad and great field that is open- 
ing up before the phlilanthropist, the scientist, and the humanitarian. 
Embraced in this noble work of sanitation are men and women of the 
highest standing, the most cultured minds, and the most refined tastes. 
Gathering from the professions of medicine, law, and divinity the best 
and ablest men, it is working for the single purpose of increasing the 
happiness of the human race. 

The department of sanitary science is full of promise at present ; — 
never before were there so many strong men in the ranks as now ; never 
before were there so many cultivated and brilliant minds entering it as 
to-day. From our great institutions of learning, fostered by our lasting 
peace and domestic concord, are issuing daily the best educated minds 
the world has ever seen, a large portion of whom are entering these in- 
viting fields of interest and research. With acute observation already 
trained in the severe schools of analysis and criticism, these are bringing 
to bear the results of past experiences, and learning to find the inmost 
causes and to apply the necessary remedies. When this great power is 
centralized, as it must be in the near future, its influence upon the social, 
domestic, business, and religious life of this country cannot be esti- 
mated. It is the proud privilege of this Association to mould the prin- 
ciples and formulate the facts upon which this case rests, and the day is 
rapidly approaching when an enlightened community will look upon it 
as a crime to tolerate aught that will jeopardize the public health. 

A grateful and appreciative world is looking with wonder and admi- 
ration to the results of this great work. More glorious than all the vic- 
tories achieved by famous warriors, more brilliant than the crowns worn 
by the most potent monarchs, will be the acclaim which will greet those 
who, with unselfishness, toil and reap in the cause of suffering humanity. 
Not more than one month since, there flashed to every point of the civil- 
ized world the news of a great discovery. The active wheels of busi- 
ness seemed for a moment checked; men and women paused in the 
duties of life to read, to admire, to praise. Thousands, nay tens of 
thousands, of the sorely afflicted and distressed raised a universal shout of 
joy, praise, and gratitude. Learned institutions, regardless of cost, sent 
to the seat of the discovery their most efficient and able leaders. Gov- 
ernments employed their agents and all their mighty powers to verify the 



22 ADDRESS, 

truth and permanency of the great fact. With one acclaim the united 
voice of the world paid tribute to genius and worth. Honors, titles, 
and wealth rapidly followed, but these were but a feather in weight 
compared with the everlasting gratitude of a mighty victory achieved, 
and the consciousness of one of the weapons of the fell destroyer being 
rendered powerless. And to-day, as well as in all generations to come, 
the name of Robert Koch will be as a household word, and millions yet un- 
born will learn to lisp his name in admiration and praise. Governments 
may perish, systems may dissolve, but gratitude to the humanitarian 
will always live. 

To this and kindred work the American Public Health Association is 
pledged. It is a proud day for us that you have honored us with your 
presence. But for the hygienic conditions, there would have assembled 
here to-night an audience filling every seat, composed of the culture and 
refinement of our city and state, to testify by their presence the deep ap- 
preciation of the compliment conferred upon them, and to bid you all 
take courage in the great work before you. This old city, filled with 
its historical reminiscences, throws its doors wide open to you, and bids 
you partake of its hospitality. You may not find the massive throngs of 
larger places, the stirring bustle of overstrained commerce, but that gen- 
uine hospitality which the Southland can extend to his neighbors and 
friends. 



IV. 

ADDRESS. 
By J. P. K. BRYAN, Esq., of Charleston, S. C. 

Mr. President and Gentlemen : I have listened with deep inter- 
est to the annual address of our eminent guest, Dr. Baker, and I esteem 
it a grateful privilege to share in this memorable occasion, and to add a 
word of welcome and congratulation to the distinguished members of 
this Association. 

We rejoice to greet in this old commercial city, so long famed for 
the vigor of its professional life, and for its intellectual, scientific, and 
literary power, this illustrious band of thinkers and workers in this new 
era. 

This city, once the home of Agassiz, Sims, Thomas, Ramsay, Bach- 
man, and Geddings, and the scene of the activity of this gifted and 
large-hearted profession now gathered about you, feels a near kinship in 
your aims and purposes, and wishes you God-speed in the noble work 
that is the mission of this Association. And however much in our own 
city we may have fallen short as yet in some of our works of modern 
sanitation, it is not because the higher ideals are not striving in our 
minds, but only because their perfect realization cannot just now come 
out of a somewhat empty pocket, depleted by the misfortunes of the 
recent past. Still, here in Charleston, we feel you may find two strik- 
ing object-lessons in study of the public health, — the one, a city now for 
a generation redeemed and preserved from the scourge of the dreaded 
pestilence of the South land, through the wisdom and courage of enlight- 
ened sanitation ; the other, a city guarded this day at our sea gates from 
the ravages of foreign disease by the very latest and most complete sci* 
entific system. 

We welcome you again, gentlemen, for the high theme you come to 
discuss in our midst — that supreme interest, the public health, upon 
which all our material life and prosperity depends, and which supports 
and must continue to support this vast and progressing modem civiliza- 
tion as its foundation stone. 

It touches deeply the power, the purity, and the energy of the individual 
life. It involves the sweetness, the wholesomeness, and the sunlight of 
our homes, that, in fulfilment of the gracious promise, ^^ no plague come 
nigh our dwelling." It means pure air, pure water, pure food, the 
warm sunshine of heaven, and all the conserving and renewing agencies 
of a higher and better life for our cities. It goes further, and gathers up 
the health of communities and states, guarding them from the ravages of 



24 ADDRESS. 

local disease and the invasion of foreign pestilence. In this theme, and 
its profound meaning to us of the South in our exposure to tropical inflii» 
ences, and especially at this time in our vastly growing life, we feel an 
abiding interest, and rejoice in the mind and conscience and experience 
here concentrated upon its problems in this Association. 

We welcome you again, gentlemen, for the cause in which you come — 
the cause of exact science in the modem world — the cause of man's 
intelligent dominion of nature, the growing knowledge of its laws, and 
the larger control of its forces to the blessing of humanity. In the physi- 
cal world man is solving the secrets of nature, and at his command, — the 
wave of the magic wand of the modern enchanter, — nature opens up her 
depths, and yields her treasure to his comfort and his happiness. In 
this cause a vast army of workers are moving with you on the yet 
unconquered strongholds of the material world, investing the very citadel 
of nature. That which you have done and they have done is but an 
earnest of what will be done. It has been a mighty work, if we look at 
it only in its results. ^' It has lengthened life ; it has mitigated pain ; it 
has extinguished diseases ; it has increased the fertility of the soil ; it has 
given new securities to the mariner ; it has furnished new arms to the 
warrior ; it has spanned great rivers with bridges of form unknown to 
our fathers ; it has guided the thunderbolt from heaven to earth ; it has 
lighted up the night with the splendor of the day ; it has extended the 
range of human vision ; it has multiplied the power of the human 
muscles ; it has accelerated motion ; it has annihilated distance ; it has 
facilitated intercourse, correspondence, all friendly offices, all dispatch 
of business ; it has enabled man to descend into the depths of the sea ; to 
soar into the air ; and to penetrate securely into the noxious recesses of the 
earth." It has tunnelled great mountains ; made the ocean a bed for the 
electric bond of continents ; turned the course of rivers ; reclaimed vast 
regions from nature's waste, and made them a habitation for man; 
made the storm and the whirlwind a matter of foreknowledge ; and the 
human voice to be heard in tone and accent in other lands, preserving it 
for other times. Aye, more, it has even stayed the black plague of 
despair and death ; it has hurled back from peaceful, smiling lands the 
destroying angel of cholera ; it has in almost divine pity come near to 
the hopelessly stricken outcasts of the ages, and even now in mercy 
bends over the consumptive and the leper, in the hope of a new miracle 
given and revealed of God to man in its ^* Be thou clean ! Go in 
peace." 

"These are but a part of its fhiits and its first fruits, for it is an activ- 
ity which never rests, which has never attained its end, which is never 
perfect. Its law is progress. A point which yesterday was invisible is 
its goal to-day, and will be its starting-post to-morrow." 

And more than all, it has revealed the grandeur and order and beauty 
of that wonderful creation, the material universe. It has dispelled the 
superstition and awe in which nature's forces and processes were held, 
and has revealed them as the beneficent outflowing of Divine goodness, 



ADDRESS. 25 

intended neither to baffle man in the sphere of conduct, or confound him 
in the region of belief, but capable of being made the benign instru- 
ments of intelligent will, the servants of enlightened conscience, and the 
ministers of tenderest mercy. This scientific knowledge and progress 
are the motive power and the glory of the material part of this civiliza- 
tion. It is a sceptre of dominion. Man has harnessed the steeds of 
thought to this chariot, which bears him in triumph through the mate- 
rial universe. And he who has the ideal of modem power within him 
will follow the shining pathway of that chariot, and make its triumph 
the triumph of his own people and country ; for its course is not only a 
path of material blessing to the modern world, but also ennobles the 
creature in his mastery of creation, and fulfils the promise to man of the 
dominion of the earth, and binds the soul of man in awe and gratitude 
to his loving Father. 

And finally, gentlemen, we welcome you in the spirit in which you 
gather here to-night. If I were to name the distinguishing feature of 
that spirit, it would be the exalted charity that crowns this great learn- 
ing, here consecrated to the good of fellow-man — the divinest principle, 
and, I love to believe, the most powerful motive working in this 
world to-day, touching all men with its tenderness, and making all men 
kin in its universal blessing. For even here about you in this good and 
great work gather your fellow-citizens, touched and kindled here by 
the knighthood of the golden rule. Here even front afar in gratitude 
are watching you eagerly the cities of this land to whom your wisdom 
and your warning often have been the flaming sword keeping the Eden 
of their public health ; and before you in homage bend even the maj- 
esty and sovereignty of this great republic, whose sea portals you have 
so often closed against ^' the pestilence that walketh in darkness and the 
destruction that wasteth in the noonday." And I behold a greater con- 
course still of all mankind, watching and waiting to learn from you and 
your coworkers throughout the world the fiirther prevention of disease 
and the larger protection of the public health. 

In the most renowned contests and rivalry known in human history, 
the Grecian games, the lists were free to all comers of pure blood. 
Long before the mighty contest the herald proclaimed throughout the 
land the reign of peace, and the Greek turned to the plains of Olympia, 
where, amid the throng of his assembled countrymen, the prize in 
severest contest was simply an olive wreath ; but the Greek was on 
these very plains being educated in arts and arms and literature and 
philosophy, and here indeed was the school of the civilization of that 
great people. 

And we to-day have our own greater and grander Olympia. Indeed, 
the whole modern world is the Olympia of the new and nobler contests. 
The lists are free to all the sons of genius, whether of song, or science, 
or art, or literature, or philosophy. The heralds have gone forth and 
proclaimed the reign of peace, and the mind of man, turning from strife, 
is turned in spirit to the vast gathering-places where all men may meet 



26 ADDRESS, 

as one. The prize is, as of old, the enduring fame of the victor, but, 
greater and grander far, the severe strife and struggle and effort are for 
the good, the advancement, the glory and honor of his fellow -man. 
The cloud of witnesses that attend are all peoples, races, nations, and 
tongues, and mighty is the victor and happy the man who triumphs in 
this universal and unceasing festival of humanity. 

In such a contest the younger Herschel resolved, even in his youth, to 
enter, compacting with a faithful young student band that he would 
leave the world better than he found it — the noblest resolve of the strug- 
gler in the new Olympia. He said " light was his first love," and with 
the unconquerable genius of his father, under whose telescope he was 
reared, he went into the realm of the heavens that his fellow-men had 
searched for ages and thought they knew all things. And yet it was 
he who lived to accomplish that which is named as an almost impos- 
sible task in the book of Job, not only to know the '^ familiar regions of 
the North," but in those mysterious heavens ''to search out the secret 
chambers of the South." It was his unspeakable joy to behold and 
with his telescope to fathom the then unknown heavens, and first to 
tell to his fellow-man of their beauty and glory and grandeur in the 
number and magnificence of its stars, and of the Southern Cross^ con- 
stellations which David and Job, and even Galileo and Newton and 
LaPlace, the great masters of astronomy, never saw, and which were 
first searched out by this '* lover of light" in the new world. 

Around us, above us., within us, in nature, in the body and mind and 
heart of man, are unknown heights and depths awaiting the coming and 
the searching out by the " lovers of light " and the lovers of men for the 
blessing of humanity. 



V. 

ADDRESS. 

By Rev. Dr. CHARLES S. VEDDER, of Charleston, S. C. 

Gentlemen of the American Public Health Association : The 
ofEcials who have you in custody have resolved that the capital sentence 
which has been passed upon you should not be executed without ^^ bene- 
fit of clergy," You may not have expected this grace, nor have been 
conscious of needing it, but men are not always the best judges of the 
gravity of their own offences, nor of the consideration which deals with 
them leniently. 

My friend. Dr. Buist, an acknowledged expert, after a full diagnosis, 
to which you have just listened, pronounces unqualifiedly as to your 
sanity. Nay, he avers that you are not only sane in organization, but 
even sanitary. The learned solicitor, Mr. Bryan, has presented, with 
characteristic cogency, an argument which has brought conviction. 
You are found here, if not with arms in your hands, at least with 
hands on your arms, and if we have not already seized these evidences of 
the spirit with which you come amongst us, we will do so speedily. 

Our community, sitting as a court of winter if not of last resort, has 
arraigned you for sentence in this building, so full of tragic memories, 
and from its decree you can expect no mercy. Charleston is remorse- 
less in circumstances like these. There is no appellate court which can 
set aside or stay its judgment. There is but one high tribunal — St. 
Michael's steeple — ^from which a peal is ever heard in this jurisdiction, 
and if that shall sound now, it will only be to drown your cries at the 
hardships to which you will be subjected, or add to them by triple bob 
majors of exultation, from a musical repertoire which our recent Gala 
Week proved to include the torturing strains that bewail the fate of one 
luckless McGinty, — the idyl, so full of bathos, of a young maiden called 
Rooney, and even the public pillorying of a predatory Welshman, yclept 
Taffy. Let it be remembered, however, that this is the only taffy 
which our city tolerates. It has no place for, nor patience with, even 
that common and natural sample of the commodity— epitaphy. 

You need not be reminded, gentlemen — and the fact is not recalled to 
harrow up your feelings, but solely to explain and justify the summary 
methods which have been adopted — that it is always a suspicious cir- 
cumstance when a physician inquires as to the health of any of us lay- 
men. There is a suggestion of interested motives — a conviction that he 
wiU take it ill, if he does not find us so ; that he will be consoled for 
knowing that we are feeble, by the prospect of sending a fee bill to us. 



28 ADDRESS, 

The shrewdest physicians are chary about making such queries : our 
Charleston doctors never do. And we have a great many doctors, all of 
the very best, and of our best beloved. But we do not treat them well, 
because we remain so unreasonably and unconscionably well ourselves. 

Yes, we have many and very dear doctors, more than can have ade- 
quate scope for their powers and powders in a place so shamefully 
salubrious as Charleston. Yet they will not leave us, preferring a crust 
here to pound cake elsewhere. It must, therefore, needs be that some 
of them will lose their patience, from sheer lack of patients to lose. But 
we prize them all. Our physicians are the very pill-ars of our social 
structure. They make more calls — my own calling, perhaps, excepted 
— than any other in our community. And we do not deal with them as 
some, in some communities, are said to do ; when they call, we do not 
return their call, and then call it square. When they leave little hiero- 
glyphic notes which a druggist must be summoned to decipher, we do 
not reciprocate with notes of thanks, the commercial value of which it 
requires no arithmetic to cipher out. Nor do I believe that any one 
among us has met a physician, only to become a meta-physician by 
sweeping away subtle distinctions, as did the man whose medical 
adviser said to him, — 

'' The trouble with you, sir, is, that you do not take exercise enough. 
Take more !" 

'* Thanks, doctor. How much do I owe you?" 

" Two dollars." 

" Much obliged. There's your change." 

*' Ah, but I do n't feel well myself. What can be the matter with me ?" 

'* Why, doctor, it is easy to tell what is the matter with you. You 
take too much exercise. Take less ! Two dollars, if you please." 

No, none of us are as sharp as this, but we are so careftil about over 
or under exercising as to reach a happy mean that bars many of our 
medical men from abundant means of living. And now, here you come, 
gentlemen, not only inquiring after our health, but resolving yourselves 
into an enormous interrogation-point as to the health of the whole 
American people. You seek to find and eradicate the seeds of human 
maladies ; you propose to take the bread out of the mouths of our physi- 
cians, by restricting their opportunities of putting bread pills into the 
mouths of others. And, with characteristic unselfishness, they give you 
welcome. They do now, what they do always — ^try to make and keep 
men well, knowing that if they succeed it will be ill for themselves. 
They are not only content, but glad, to have your advice and aid in their 
play at cross purposes with their bread and butter. 

But, gentlemen, although our doctors thus assist at their own over- 
throw, our community will not witness their immolation without a terri- 
ble resistance and retaliation. Look for no respite from our revenge. 
Whatever we can do to pester you may be safely counted upon. 

The decree is, that you be taken from this place, and, to-morrow 
morning, be immured in a building near at hand, where you have 



ADDRESS, 29 

already been confined to-day, and that you be shut up there, for the 
most of each day, and much of every night, and there be compelled to 
wrestle with bacteria, bacilli, mephitic vapors, miasmatic conditions, 
and like savory matters, whilst the community looks on, uninterfering 
and unpitying. 

To aggravate your woes, by contrast, you will be sometimes released, 
and be visited and persecuted with public and social courtesies. You 
will be taken around and about our ancient city, to bemoan the fate 
which compels you to live elsewhere — save, of course, in the favored 
locality, so much like Charleston, where you do reside ; you will be 
admitted to our homes, and see the dearest matrons — except your own 
wives and mothers — in the world ; you will be permitted to look, from a 
becoming distance, into the eyes of the fairest maidens— except your 
own daughters, sweethearts, and sisters — that the sun shines on, and 
with the certainty that you cannot carry a single one of them away with 
you — unless she be willing. 

And you will be sentenced to examine our city drainage, — though here, 
again, mercy will interpose. Your scrutiny of this fragrant theme will 
be by relation, not inhalation ; by prelection, not inspection. Care will 
be taken to exempt you from the experience of a certain United States 
senator, serving ^^ befo' de war," in the national councils, at the same 
time with a famous senator from New York. The senator aforesaid, 
passing out of Willard's hotel, at night, fell Into an open sewer. A 
passer-by, hearing his groans, stepped to the edge of the pit, and asked 
who was there. " Well," was the reply, " when I fell in, I was Sena- 
tor Mc Dougal, but now I think I must be Senator Seward." 

As part of your penalty, gentlemen, you will see how far we are 
from throwing dust in your eyes, by being permitted to ride in a railway 
coach from which dust is excluded. It is a Charleston invention, and 
he who devised it hopes that the country, as a recompense, will come 
^' down with the dust" that shall gladden his eyes, because he has put 
down the dust that has blinded theirs. Some of our citizens, possibly, 
will injure their own health in drinking yours. And, although we are 
a reasonably temperate people, we intend to get you, if not " half-seas 
over," yet " over the bay," by taking you down to the bar. You will 
be subjected to the possibility of one malady for which there is no spe- 
cific in the whole Materia Medica — the mal de mer. 

And when we have followed you unceasingly and unmercifully with 
these, and like afflictions and inflictions, and you shall ask to be let off, 
promising never to do so again, we shall accept no such promise ; and 
we shall have so little commiseration, compulsion, or compunction, as 
to wish an encore of the whole programme, and as you depart will give 
you the honest, earnest, enthusiastic send-off, '^ Come again, gentle- 
men, — come again, as soon, as often, and in as great force as possible. 
The jury of the community is polled, and to this verdict of their self- 
constituted but no less confident foreman, they cry, '' And so say we 
all 1" 



VI. 

WHAT CONSTITUTES A FILTH DISEASE? 
By SAMUEL W. ABBOTT, M. D., 

SECRETARY STATS BOARD OF HEALTH, BOSTON, MASS. 

The doctrine that filth plays an important part in the causation of dis- 
ease lies at the foundation of very much of the sanitary administration of 
cities and towns throughout all civilized countries. The popular 
impression, however, and undoubtedly the belief among a very large 
part of the medical profession, as well as among many of the officials 
who have the charge of sanitary administration, is, that filth in the ordi- 
nary sense of the word is itself the active cause of disease, and that little 
else is essential to the production of certain infectious diseases than to 
deposit a certain amount of filth, or to allow such filth to accumulate 
within the premises occupied by a given population, in order to generate 
a pestilence. Hence the activity of sanitary bureaus in sweeping out 
filthy in cleansing foul spots, in removing garbage, in depositing tons of 
disinfectants in cesspools, catch-basins, and sewers. This activity in the 
cleansing of towns, the removal of filth, the sanitation of houses, cellars, 
and yards, is commendable, so long as the true r61e of filth in the causa- 
tion of disease is not lost sight of, and the entire energy of sanitary 
organizations is not expended in this one direction. 

The statements which I have to offer in this paper are partly the 
result of observation, in twenty years of a busy country practice, followed 
by several years of official sanitary work. 

One of the striking peculiarities of medical science, sanitary as well as 
otherwise, is its freedom from the trammels of mathematical laws. The 
human body is not a machine, but a complex and highly organized 
structure, and each individual of the species differs in many points from 
other individuals. One cannot expose a score of human beings to the 
contagion of small-pox, or that of scarlet-fever, and predict with cer- 
tainty just how many out the number will take the disease ; and if a cer- 
tain number become infected, no one can say how many will die ; and of 
those who survive, no one can foretell how many will suffer for years 
with the serious results of the sequelae of disease. No ! the human 
body cannot be put into a mathematical machine, with the certainty of 
securing certain definite results by simply turning a crank. 

What is the usual course of action in investigating the causes of an 
outbreak of any one of the diseases which are commonly termed filth- 
diseases ? Let us suppose that a case of diphtheria has occurred in the 
family of John Smith, and this case has been followed within 48 hours 



WHAT CONSTITUTES A FILTH DISEASE ? 31 

or more by another. A physician is called in by Mr. Smith. Usually, 
after the first or second visit the physician determines tlie case to be one 
of diphtheria, and, if the local statutes require it, and he is cognizant of 
the welfare of the community, he notifies the sanitary authority of the 
district or city, and the sanitary authority in the majority of instances 
contents himself with lying on his oars until the patient has either died or 
recovered, and then sets his agents at work to disinfect the apartment 
which the patient occupied, possibly one or more rooms, and possibly 
the whole house. If the case has been a serious one, or if several per- 
sons have been attacked, the inquiry usually arises, — What can be the 
matter with that house ? and what is the condition of its drainage and 
plumbing? The sanitary authority sets his agent at work again to 
examine the plumbing, and he usually finds a defect, since the majority of 
such houses have some such defect, — a leak is found in the soil-pipe, an 
overflowing privy-vault, a foul cesspool, an untrapped sink-drain, or a 
filthy cellar. The defects are soon remedied, and the agent reports every- 
thing in a satisfactory condition. Does it occur to him to make further 
inquiry as to the cause ? In therapeutic medicine, he who expects suc- 
cess in the treatment of disease must be a close observer of his patients, 
must study not only the present condition of his patient — as the tempo- 
rary objective and subjective symptoms may present themselves upon a 
single visit — but must learn, if possible, his entire physical history, his 
heredity, and the effect which race, condition in life, occupation, age, 
and climate may have had upon him ; — ^so in the broader field of preven- 
tive medicine, the successful sanitarian will not content himself with 
merely spying out and removing filth, but will leave no stone unturned 
until he has ascertained all the conditions which have contributed to the 
production of a case of infectious disease, or to the spread of an epi- 
demic. 

The opinion that filth is not a direct cause of disease, but is merely 
one of the conditions essential to the propagation of certain diseases of 
the infectious class, is by no means a new one. In his introductory to 
the report to the Privy Council of England, published in 1873, Mr. John 
Simon used the following language in which the notions of the present 
day, relative to the part which filth plays in the production of certain dis- 
eases, appear to have been foreshadowed : 

The exacter studies of modern times have further shown, that by various channels of 
indirect and clandestine influence filth can operate far more subtly, and also far more wide- 
ly and more destructively, than our forefathers conjectured. The later almost equally with 
the former knowledge, the finer almost equally with the general, is indispensable for sani- 
tary administration in modem times ; and filth is little likely to be guarded against with 
that thoroughness of detail, which present science shows to be necessary, unless the de- 
tail follow some intelligent appreciation of the ways in which filth becomes destructive. 

And still further in the same report he says, — 

. While the excessive production of fatal disease in filthy neighborhoods is a fact as to 
which there can be no doubt, and of which the immediate significance is deplorable, the 
ulterior suggestion is this, — ^That so far as filth in any instance produces anew such a dis- 



32 WHAT CONSTITUTES A FILTH DISEASE f 

ease as erysipelas or puerperal fever on the one hand, or phthisis or other tubercular 
disease on the other, the mischief first done is of a sort which entails certain possibilities 
of extension ; — such, namely, that in the one instance by accidental contagion, as in the 
other instance by hereditary transmission, it may, for aught we know, indefinitely extend 
beyond the sphere in which filth first produced it. 

As a comment upon the foregoing paragraph, there can be but little 
doubt that puerperal fever is a true filth-disease, transmitted from the 
sick to the well in many instances in consequence of neglect of such 
antiseptic precautions as are now known to be absolutely essential to the 
safety of the lying-in mother. It is for this reason that the suggestive 
term "Finger-nail Fever" has very properly been given to it in some 
parts of England. It is an essentially preventable disease, and as such 
is as amenable to sanitary rules and regulations as any other infectious 
disease. 

With reference to the prevention of filth-diseases Mr. Simon makes 
the following statement, — 

In order to the prevention of filth-diseases, the prevention of filth is indispensable. 
Truism though this may seem I think it needs to be expressly insisted on, as against any 
belief that districts, allowed to become filthy, can off-hand be made wholesome by disin- 
fectants. To chemically disinfect (in the true sense of that word) the filth of any 
neglected district, to follow the body and branchings of the filth with really effective 
treatment, to thoroughly destroy or counteract it in muck-heaps and cesspools and ash- 
pits and sewers and drains, and where soaking into wells, and where exhaling into 
houses, cannot, I apprehend, be proposed as physically possible. * * * This opinion 
as to the very limited degree in which chemistry can prevail against arrears of uncleanli- 
ness does not at all discredit the appeals which are constantly and very properly made 
to chemistry for help in a quite different sphere of operation ; with regard namely, to the 
management of individual cases of infectious disease, and to the immediate disinfection 
of everything which comes from them. In this latter use of disinfectants, everything 
turns on the accuracy and completeness with which each prescribed performance is done ; 
but such accuracy and completeness are, of course, only to be insured where operations 
are within well defined and narrow limits, and in proportion as disinfection pretends to 
work on indefinite quantities or in indefinite spaces, it ceases to have that practical 
meaning. 

A due regard to the principles laid down by Mr. Simon in this para- 
graph would undoubtedly have saved the cost of an experiment once 
performed in one of our large cities, namely, the disinfection, or rather 
the attempt at disinfection, of some 200 miles of a public system of sewer- 
age. Surely, if there is any place where disinfection may be said to 
have been applied to indefinite quantities and to indefinite spaces, such 
quantity and such space existed in the constantly running stream of 
liquid filth coursing through the cavity of a public sewerage system. 
No matter how large the dose of disinfectant deposited in such a stream, 
it was sure to be immediately washed away, with the added possibility 
of re-infection from one or more of its 10,000 connections, at the very 
next moment. The only possible mode of disinfecting such a stream is, 
to prevent its infection by preventing the introduction of infectious 
material into it. 

Undoubtedly each and all of the so called filth-diseases may find their 
victims in houses that are absolutely faultless, provided that conditions 



WHAT CONSTITUTES A FILTH DISEASE f 33 

Otherwise favorable exist in such houses, the prime condition being the 
presence of human beings. A child sick with diphtheria in any house 
whatever constitutes a menace to the health of every one who lives in 
the house, and especially to the younger portion of the household. This, 
again, is but one of the essential conditions to the propagation of infec- 
tious disease. 

The science of horticulture and the study of infectious diseases have 
certain points in common. The fruit culturist well knows that his trees 
need many conditions as essential to success. The fruit-tree, be it apple, 
pear, cherry, or peach, needs a good soil, sunlight, moisture, or rain, 
and a temperature neither too hot nor too cold in order to secure a good 
crop. Substitute in place of either of these conditions, some opposite 
condition, and the crop will be sure to fail. In place of sunlight substi- 
tute darkness, in place of a good soil substitute sand, in place of moisture 
substitute dryness, or salt water in place of fresh, and the result will 
be the same. Now in the study of the causes of disease, if there is any- 
thing clearly taught us by the wonderful discoveries of the present day, 
it is that infectious diseases find their parallel in the field of animate and 
inanimate nature. 

In the case of many of the infectious diseases, we find that while hu- 
man beings constitute the proper soil for their propagation and cultiva- 
tion, some of them are susceptible of cultivation in other animals, and 
some may be cultivated upon favorable soil outside the bodies of living 
animals. The results of the experimental researches of recent years in 
regard to the natural history of infectious diseases appear to show that 
what the older observers were wont to call causes were conditions only, 
and that dryness or moisture of the air or of the soil, high or low water 
in wells, high temperature and low temperature, over-crowding or den- 
sity of population, faulty ventilation and the presence of filth, are simply 
the favorable or unfavorable conditions in the propagation of disease, and 
not in the strict sense its causes. 

Analogy would also teach us that the actual cause of an infectious dis- 
ease is the disease itself — ^that is to say, a previous case ; and the more we 
learn of the origin of epidemics, as well as of so called sporadic cases, or, 
to use a term more applicable to the meaning which was originally ap- 
plied to them, '* autochthonous" cases, the more we are inclined to look 
for previous cases as the true cause or origin. Nor does the fact that we 
do not find the previous case, prove its nonexistence. 

How often is the theory of spontaneous development brought forward, 
not only by the house-holder but also by the practising physician, and by 
the term '* practising physician," I do not mean the bright, wide-awake, 
well rounded practitioner, who combines with the best knowledge of 
therapeutic measures, freed from all dogmatic trammels, a careful appli- 
cation of the principles of preventive medicine, but the old-time practi- 
tioner, the easy-going family doctor, whose entire stock in trade, like 
that of Dr. Holmes's Rip Van Winkle, lay in the contents of his ponder- 
ous saddle-bags. 



34 WffAT CONSTITUTES A FILTH DISEASE? 

The latter is called to a case of scarlet-fever which has occurred in the 
person of a young girl of seven years, who lives in a secluded house with 
her family, in the forest or upon the prairie, a mile from any other hab- 
itation. Hence the old-time practitioner infers, Here is a sporadic case : 
it must have originated sua sponte: it is surely autochthonous. Such 
an argument is not only fallacious, but lamentably defective. As well 
might the farmer say that the potato which springs up in a neglected cor- 
ner of his field originated sua sponte^ because he did not himself happen 
to see or to plant the seed or tuber which produced it. Or, to go a step 
further into the region of vegetable life, and question those forms whose 
seeds or spores are less tangible, a crop of mushrooms comes up upon 
my lawn. Regardless of the application of fertilizers which have been 
applied from my neighbor's stable, I might say these mushrooms have 
appeared sua sponte^ but the keen observer of the habits of the mush- 
room knows very well that such a theory has no foundation : each variety 
reproduces itself, and I find that a patch of these mushrooms, trans- 
ferred to another part of my garden, will continue to appear there year 
after year, so long as favorable conditions promote their growth and 
reproduction. Now let us apply this reasoning to the case of scarlet- 
fever in the forest. The theory of spontaneous origin is simply a con- 
fession of ignorance, and the keen observer cannot admit it until such 
questions as the following have been satisfactorily answered : 

Has this girl had any communication with other human beings out- 
side of the family, within the ordinary and acknowledged period of 
incubation, and especially with persons living in infected districts, or 
have any other inmates of the house had such communication? 

Have any human beings, either relatives or otherwise, visited the 
house — the grocer, the butcher, the milkman, the postman — within such 
period.^ Each of these sources opens up further avenues of infection. 

Have letters or other mail-matter, or currency of any sort, especially 
from infected districts, been received at this house ? 

Have the domestic animals been interrogated ? The transmission of 
infectious diseases from the domestic animals to man has become too well 
established to admit of doubt.^ 

I have indicated only a few of the possible avenues of infection. Un- 
doubtedly there are many others ; and not until every avenue has been 
searched and found to be closed can the theory of spontaneous origin be 
entitled to any credence, and even then it cannot be regarded as estab- 
lished, since the absence of a cause, to the discernment of the ordinary 
senses of sight and taste and smell and touch, does not prove its non- 
existence. 

Let us now pass from the general subject, and consider briefly some of 
the so called filth-diseases separately. 

By some authorities, small-pox is called a filth-disease. In several 
instances I have been called upon to appear before legislative committees 

^Bridsh Local GovemmeQt Board Reports, iS86, 1888. 



WHAT CONSTITUTES A FILTH DISEASE? 35 

to testify upon the subject of vaccination. The opponents of this practice 
almost uniformly state their belief in the theory that small-pox is a filth- 
disease, that it originates in filth, and that all that is essential to its pre- 
vention is the removal of filth and the practice of '' local sanitation " in 
the limited sense of the term. Actual observation and experience of the 
health ofiicers of infected districts showr that such an opinion cannot be 
sustained, and that small-pox may occur in houses that are perfectly 
clean, but that the liability to its occurrence is increased by the presence 
of filth. In this instance the filth undoubtedly becomes the vehicle or 
transmitter of the infectious principle, the contagium vivum^ from the 
sick to the well. About one half of the local outbreaks in Massachusetts 
in the last ten years have occurred in paper-mill towns, and in the fam- 
ilies of persons who worked in the rooms in which rags were being 
sorted and cut. These rooms are usually very dusty, and in nearly every 
instance it has been found that the rags were collected in some large city 
of the United States in which small-pox had recently prevailed. In two 
instances the man whose duty it was to feed and tend the dusting-machine 
was the first to be attacked with the disease. In this case the presump- 
tion is very strong that the filth or dust of the rags was simply the 
medium of contagion, the bales having probably contained rags which 
had had direct connection with patients sufiering with small-pox. 

In this category may be placed anthrax^ which in most parts of the Uni- 
ted States is a disease of rare occurrence. The whole number of registered 
deaths in Massachusetts from this cause in the past forty-eight years was 
ninety-eight, or an average of about two per annum. The greatest number 
in any one year was nine. At least fourteen of these deaths occurred in 
one small town among the operatives in a single industry ; and when this 
factory was removed to an adjoining town, the occasional outbreaks fol- 
lowed its removal to that town. Of the other cases, the greater number 
occurred in towns where the business of tanning hides was conducted. Of 
four cases which have come within my notice while in practice, two were 
in men and two in women : two were fatal, — the two women ; in these the 
lesion was on the head. In one of the others, the lesion was upon the 
angle of the lower jaw, and in the other upon the hand. No connection 
could be traced with any infection in either of the women, one of whom 
had been engaged in the handling of rattan from Singapore. One of the 
men lived in a town where foreign hides were tanned, but did not work 
in a tannery, and the other man who was infected upon the cheek was 
employed in the unloading of South American hides in Boston. The 
exact relation of these cases to the presence of filth may not at first seem 
clear. In those cases which occurred at Walpole, as reported in the 
Transactions of the Massachusetts Medical Society, and in the second 
report of the State Board of Health of Massachusetts, the persons 
attacked were operatives in a factory in which hair from Siberian^ or 

s In four years (i867-'7o) 56,000 horses, cows, and sheep, and 528 human beings died of this dis- 
ease in one district of Russia. (Virchow's Archiv., B. 54, p. 262.) 



36 WHAT CONSTITUTES A FILTH DISEASE? 

South American horses^ was received in bales, opened, sorted, and 
curled for use in the manufacture of mattresses. In the room in which 
the hair was sorted, occupied mostly by women, the air was charged 
with dust, and no special means for ventilation were provided for their 
protection. Is it strange, therefore, that this dry filth floating in the air 
should at times receive a dose of infectious matter, the materies morhi 
of anthrax, since it is known that such hair is not only shorn from the 
manes and tails of living animals, but also occasionally from those which 
have died of anthrax ? 

Anthrax pustules, according to Virchow, occupy chiefly the exposed or 
uncovered parts of the body (in the ratio of 84%). In this factory, how- 
ever, cases of internal infection were found to be of common occurrence. 
Such a mode of infection appears reasonable since it was known that the 
operatives had for several years been accustomed to partake of their 
luncheons in the dust-infected atmosphere of the sorting-room, the dust 
undoubtedly in this case being the vehicle or medium of contagion. 

Another disease which recent inquiries show quite conclusively to be 
propagated through the medium of a dust-laden atmosphere is that most 
destructive of all diseases, phthisis. The danger which -exists in the 
distribution of the dried sputa of phthisical subjects cannot be over- 
estimated. 

Dr. Marfan, chief of the medical clinic of the Faculty of Medicine of 
Paris, gives the details of a localized epidemic of phthisis, which is at 
least very significant as bearing upon this question of infection through 
the medium of dust. 

In an important business house in the centre of Paris twenty-two per- 
sons were employed about eight hours a day. One of them, aged forty, 
employed at this place for twenty-four years, had been phthisical for 
three years, when he died on the 6th of January, 1878. He coughed 
and spat upon the floor for three years, and did not leave his work till 
three months before his death. From that time, out of twenty-two per- 
sons employed, fifteen have died : one only died of cancer ; the remain- 
ing fourteen died of pulmonary tuberculosis. One year before the death of 
the first person, who appears to have been the starting-point of the epi- 
demic, two employes, who had been connected with the same business 
for more than ten years, began to cough and spit upon the floor. They 
died in 1885. Beginning with the end of 1884, the deaths followed each 
other at closer intervals. 

Dr. Marfan states the conditions of the apartment in which these per- 
sons were employed. It was small, and the cubic air-space was less 
than ten cubic metres (350 feet) to each person. It was badly ventilated, 
badly lighted, and the gas was burned a part of each day, especially in 

^ It is not strange that the infectious principle of anthrax should survive long voyages across the 
sea, since observation has shown that it is one of the most resistant of all germs to the action of 
destructive agencies. This permanence of the anthrax germ was well known as long ago as 1769. 
Foumier states that the poison retains its virulence for many years. KObstrvations et $xptrUnc$s 
sur U char ban maUn, 1769.) 



WHAT CONSTITUTES A FILTH DISEASE? 37 

ivinter. The floor was of wood, uneven, cracked, and very dirty. The first 
victim of phthisis, and those who followed, spat directly on the ground, 
and the sputa, becoming dry, were converted in this already unhealthy 
apartment into a poisonous dust The room was swept each morning, 
and sometimes the employes arrived before sweeping was finished, and 
while the dust was still floating in the air. It was difficult to sweep the 
room thoroughly, since the tables were fixed to the floor. It appears 
very probable that the swallowing and inhaling of this tuberculous dust 
was an essential factor in the propagation of the disease. 

The proprietor of the place where the deaths occurred removed and 
burned the floor, and so rapidly was the work done that the reporter had 
no time to collect a sample of the dust from the cracks in the floor for 
the purpose of experiments upon animals. A new floor was laid, which 
was waxed and treated from time to time with spirits of turpentine ; all 
painted surfaces were repainted, and Dr. Marfan recommended that the 
floor should be swept in the evening after the departure of the employes, 
and that the windows should be lefl open all night. 

Dr. Vallin recommends, in place of these measures, a mixture of equal 
parts of coal-tar and spirits of turpentine, or of parafline dissolved in 
warm petroleum ; and in place of the sweeping, the removal of the dust 
by sponges, or by cloths moistened with an antiseptic solution. 

These dried sputa, mingling with the dust of apartments, cars, factories, 
and schools, are inhaled by others, and thus the disease is transmitted from 
the sick to the well. Undoubtedly, there are other modes of infection 
in this disease. In 1866 I saw a flock of twenty fowls which were allowed 
to devour the sputa of a consumptive. All of them had cough, — wasted, 
sickened, and finally died with marked symptoms of phthisis. 

Recently, several prominent observers have taken the position that in- 
heritance has no influence in the production of phthisis. This appears to 
be a narrow view, and one which is not borne out by observation. I can 
certainly see no reason why the parents may not transmit to their offspring 
a greater or less susceptibility to infection by the bacillus tuberculosis. 

The liability to infection by scarlet-fever is undoubtedly increased by 
the presence of dust, since the contagious principle of this disease, so far 
as can be learned, exists largely in the particles of dried epithelial scales, 
which, falling from the body, mingle with the dust of apartments and 
thus spread the infection from the sick to the well. 

Typhoid fever may properly be styled the chief of filth-diseases, not 
however in consequence of its fatality or its prevalence, but on account of 
its peculiar modes of propagation and spread. It would be a work of 
supererogation to enumerate in detail before this Association, all the evi- 
dence in support of the spread of this disease through the contamination of 
water-supplies, milk-supplies, and other media, by the excreta of those 
who are sick with typhoid fever. Nor is it pertinent to urge that many 
cases occur in which such contamination is not disclosed by careful in- 
vestigation. It is sufficient to say that in many great epidemics, like 
those of Caterham and Plymouth, and also in multitudes of smaller epi- 



38 WHAT CONSTITUTES A FILTH DISEASE? 

demies which have occurred in connection with private water-supplies 
and milk-supplies, the chain of evidence — although rarely completed by 
the finding of the typhoid bacillus en route as one might, from the ileum 
of the sick to the oesophagus of the well, whether by the medium of a 
glass of water, a cup of milk, or a cup of tea, coffee, or any other drink 
in which either milk or water is used — is such as would rarely fail to 
produce conviction in the minds of a jury of experts. The experiments 
of Dr. Cory, of the Local Government Board of England, proved that 
infinitesimally small quantities of filth — ^that is to say, specific filth, the 
excreta of typhoid patients — while sufficiently abundant to endanger a 
water-supply were not within the range of chemical analysis to detect. 

Recent experiments in filtration would also cast some doubts on the power 
of typoid excreta to infect wells where a considerable stratum of gravel or 
sand intervened between the polluted source and the well. Where such 
infection has been known to exist, it would appear probable that there was 
either some direct contamination by surface fiow, or by means of under- 
ground connection with the water-table. One of the early observed epi- 
demics, that of Lausen in Switzerland, has occasionally been misquoted 
by saying that the polluted water passed through a mile of soil. Exper- 
iments with salt and with meal showed that there was an underground 
current or passage through which the dissolved salt readily flowed, but 
there was a sufficient barrier to obstruct the particles of starch in the 
meal. The observer, Dr. Hagler, suggested that smaller micro-organisms 
possibly might have found their way through the slight barriers which 
existed.^ 

Liebermeister says of this disease, — 

DaUy observation is sufficient to show that the decomposition of organic substances 
and of ezcrementitious substances is not of itself sufficient to produce typhoid fever. 
There are multitudes of houses in which the effluvia of the privies can be smelt 
through all the rooms, and in which the inhabitants are constantly inhaling sewer 
gases, and neither the temporary nor permanent residents are attacked with typhoid 
fever. Cities with defective sewerage are not by any means always visited with 
typhoid. It can readily be seen that there is no relative proportion between the fre- 
quency of typhoid fever and the want of cleanliness in different cities : the dirtiest 
cities may be exempt, and the cleanest attacked. There are villages, and there are cer- 
tain quarters in cities, where, both within and without the dwellings, decomposition of 
organic and excrementitious substances is constantly going on; but only in some of 
these situations does typhoid fever occur, while in others it has never been observed 
within the memory of man. But in such places the introduction of a single case of 
typhoid will often give rise to a severe epidemic . . . We are therefore forced to the 
conclusion, that, besides external conditions favorable to the development of the typhoid 
poison, something else is necessary. Numerous facts render it more than probable that 
this something necessary is the specific poison itself. In other words, the poison of 
typhoid fever does not originate in (filth or) decomposing substances, but finds in them 
a favorable ground for its growth and multiplication. The most convincing experiences 
show that typhoid fever never originates in any unusual amount of decomposing matter, 
nor from any circumstances favorable to decomposition, but is always preceded by the 
introduction of a case of the same disease. 

1 Und das Erd-filter, das fein genug ist, Stsirkemehlkomchen zuriickzuhalten, hat die Typhus- 
kdme durchgelassen. 



WHAT CONSTITUTES A FILTH DISEASE f 39 ' 

The evidence that cholera is propagated by sewage-polluted water- 
supplies is very strong, and that it should be endemic in India, where 
the defilement of public water-supplies is a matter of habitual occur- 
rence, is only what might be expected. Even in India improvement has 
already taken place in this direction, in cities where water-supplies 
have been obtained from new localities, hitherto unpolluted by sewage, 
as at Madras. 

Similar observations were made in London in 1849 and in 1854, 
where the case of the Broad street pump offered convincing proof of 
sewage pollution. 

In Breslau, in 1832, the closing of a polluted well was soon followed 
by rapid decline of the disease. 

In support of the same view, the mortality from cholera in Boston, in 
1832 and in 1849, was severe. In the former year the city had no pub- 
lic water-supply, and obtained its water almost exclusively from wells 
sunk in a soil polluted with the filth of two centuries. In the latter year 
(1849), when six hundred and eleven deaths from this cause occurred 
in Boston, a public water-supply had been introduced only eight months 
before the appearance of the disease, and its general use was then con- 
fined to the better portion of the city, in which the disease did not 
appear. In the epidemic of 1854, ^^^ deaths in a larger population 
(from the same cause) were but two hundred and sixty-one, and in that 
of 1866 there were but eleven. 

Undoubtedly a more efficient quarantine has accomplished much 
toward preventing the introduction of cholera into the United States, 
since, while it has frequently occurred in trans- Atlantic countries, we 
have been entirely exempt since 1873. 

The method by which the choleraic poison finds access to the human 
body appears to be not unlike that which is characteristic of typhoid 
fever, and so far it is a filth-disease, in that filth and filthy water form 
an essential soil for its propagation. In this statement we cannot ignore 
the possibility of its transmission by means of the air, by clothing, or 
by other media. 

In the case of yellow-fever ^^ there appears to be evidence that the 
accumulation of filth or excreta about dwellings, over-crowding, and 
water-pollution are conditions favorable to its propagation, and in this 
sense it is also a filth-disease. Undoubtedly the excreta, and possibly 
also the vomitus of the sick, constitute important factors in its produc- 
tion. Here also the introduction of the disease into any locality from 
without appears to be essential to its propagation, and the arrival of a 
ship from an infected port is usually the signal of its introduction. 
Hence the importance of an efficient quarantine against infected ports. 

The relation of diphtheria to filth is not so clear as in some of the 
other infectious diseases. It is often claimed that it originates in filthy 
drains, in cesspools, and in sewers, and that the so called sewer-gas is a 
common cause of the disease. That such filth may be a proper soil for 
the cultivation of the disease, when once introduced, I think there can be 



40 WHAT CONSTITUTES A FILTH DISEASE f 

but little doubt, but the claim that the disease originates in them is open 
to question. Of its infectious and directly contagious nature I have no 
doubt. A long experience in several serious epidemics convinced me of 
this. Another characteristic appears to be the permanence of the infec- 
tious principle in houses and apartments once infected. 
Upon this point Oertels makes the following statement : 

Epidemics of diphtheria are characterized by the slow extension of the disease, which 
may often remain confined to a sleeping apartment, to one floor, or to one house. Again : 
The diphtheritic contagion shows itself in the tenacity with which it clings to certain 
places, rooms, and houses, and in the fact that it can occasion sporadic cases in those 
places after the lapse of months. 

With reference to its origin in sewer-gas and defective plumbing, the 
following inquiry was ordered to be made last winter : In a city of Mas- 
sachusetts, in which diphtheria was epidemic, one hundred houses were 
selected for examination and inspection. A recent and quite severe epi- 
demic had prevailed, in which there had been one hundred and sixty- 
eight deaths from diphtheria in the course of the year (1889). Fifty 
houses were selected, in which cases of diphtheria were known to have 
occurred within twelve months prior to the time of inspection. Fifty 
other houses were selected, in which it was known that no cases of diph- 
theria had occurred during the previous five years. In general terms, 
the houses of the latter class were as nearly identical with the former, in 
their location, construction, and the social condition of their inmates, as 
possible. On inspection, the actual sanitary condition of these houses 
was found to differ but little in the two classes. Defects of plumbing, 
want of proper traps, leaks in drain pipes, and other similar defects were 
found about equally in the two classes. Not one of the one hundred 
houses had special provision for ventilation. In one point only did there 
appear to be a marked difference in the two classes, and that was in the 
ratio of damp cellars. In the houses in which diphtheria had existed, 
the ratio of damp cellars was as five to two when compared with the 
houses of the other class. I believe this is in accord with the observa- 
tions of others, to the effect that where diphtheria has once been intro- 
duced from without, it finds in dampness a congenial soil for its propa- 
gation. 

If it is desired to trace the course of an epidemic of diphtheria amid 
the mazes of a densely crowded city, there can be no more difficult task 
imagined. The daily influx and efiflux of population to and from the sub- 
urbs, the thronging of people in shops, markets, factories, steam-cars, 
horse-cars, and electric cars, the crowding together at lectures, churches, 
entertainments, theatres, and, finally, in the public and private schools, 
give the best facilities for the spread of epidemic disease. 

On the other hand, isolated communities occasionally present excellent 
opportunities for the careful study of the method of the spread of such an 
epidemic disease as diphtheria. Such a case presented itself to my no- 
tice during the past year. A quiet old town in Berkshire county, near 
the source of the Farmington river, has comparatively little connection 



WHAT CONSTITUTES A FILTH DISEASE? 4I 

with the outside world. It is eighteen miles from the nearest railroad, 
has no hotel, and has but little regular traffic with neighboring towns. 
In the spring of 1888, a school teacher, a native of this town, was 
employed as teacher of a school twenty-five miles distant. At the close 
of her term of teaching in June, 1888, she went home ill, her illness prov- 
ing on her arrival home to be diphtheria. Within the next six months, 
eleven cases occurred in the immediate family of this young woman and 
those of her relatives, no quarantine having been enforced. It spread 
across the street to the house of the family physician. Several deaths 
occurred in these two families. The family of the physician was shat- 
tered and he left the town, his house being abandoned and vacant for 
several months. The post-master of the village was also the village 
grocer. People went to and from the post-office and the first infect- 
ed house, and the grocer also made frequent visits to the house with his 
groceries. His family was next attacked, and so severely as to be 
broken up and scattered. After the house of the village physician had 
remained vacant several months, and some inefficient attempts at disin- 
fection had been practised, a new physician moved into and occupied 
the vacant house. Soon after moving in, his children were attacked. A 
lying-in woman whom he attended, together with her seven-year-old boy, 
were both attacked. A neighbor who called upon this woman during 
her illness was next attacked, and so the history of this epidemic could 
be traced from house to house, and from one individual to another, for a 
period of eighteen months or more. The houses of these people, which 
were visited, did not appear to be especially filthy, but in two or three 
instances excessive dampness of the neighboring soil was noticed. In 
the case of the physician whose family was attacked, after moving into 
the house which was formerly infected, the permanence of the diphthe- 
ritic germ appears to be illustrated. 

This history of successive outbreaks occurring in one house after the 
lapse of long intervals is not uncommon. Dr. Thursfield, at a confer- 
ence of Medical Officers of Health in England in August last, gives spe- 
cial prominence to this fact, as well as to that of the probable connection 
of structural dampness of habitations with diphtheria.^ He also calls 
attention to the investigation of Messrs. Roux and Yersin, who found 
that the diphtheritic germ, if protected from the air and light, might be 
kept an almost indefinite period and still produce characteristic symp- 
toms in animals inoculated with it. 

The history of the disease, in the small town to which I have referred, 
was that of introduction from without, and then of continuous infection 
from one person to another, through the public schools, the unwise vis- 
its of inquiring friends, the usual household visits of the grocer, the want 
of care on the part of the attending physician, and many other similar 
avenues of communicability. Undoubtedly the isolation of the first case, 
with careful disinfection, would have arrested the disease and prevented 

^Pub. Health, Sept., 1890. 



42 WHAT CONSTITUTES A FILTH DISEASE f 

this sojourn for many months with its train of suffering and death. This 
is by no means a solitary case : it is simply the history of hundreds of 
others which are of constant occurrence. 

The following statement of the Board of Health of the city of Boston, 
in its report for the year 1889, is pertinent as to the causes and preven- 
tion of this disease : 

It is an interesting fact that the disease has not been particularly prevalent in the 
crowded and imperfectly drained portions of the city, but has been fully as prevalent 
where the sanitary conditions are comparatively good. This would seem to prove that 
crowded tenements, imperfect drainage, and poor hygienic surroundings, although impor- 
tant factors in causing the prevalence of the disease, are not the whole cause, but that 
contagion, not only from mild and unrecognized forms, is the most important factor. 

In summing up the foregoing observations, and in attempting to 
answer the inquiry, "What constitutes a filth-disease?" we may reason- 
ably conclude that a filth-disease is one in relation to which filth, in some 
form or other, either wet or dry, plays the part of an important factor 
only, in its causation, but is not itself the direct cause ; that it acts either 
as a favorable soil for the propagation of disease-germs (other favorable 
conditions also existing) , or that it acts as a suitable medium or vehicle 
for the transmission of the particulate contagium from the sick to the well, 
as is probably the case in the inhalation of the bacillus tuberculosis in 
and with the dust of filthy or ill-ventilated apartments. 

We may also conclude that the filth which promotes the spread of 
infectious diseases is specific filth, and hence the necessity of removing 
all filth is, that thereby we are sure to remove the specific filth, or that 
which contains the germs of infectious disease. 

The point which I desire to emphasize in the foregoing paper is, not 
that the removal of filth should in the least degree be discouraged, but 
that, when done, it should be done intelligently and with this principle 
in view, that filth is a condition rather than a cause ; that it is the soil for 
the culture and transmission of infection, and not the infection itself; and 
just so far as the principle of infection is deprived of its proper soil, so 
far is one of the most important conditions of its growth and propagation 
removed. 

In the field of sanitation, the careful watching for and providing against 
the introduction of infectious disease, the isolation of the sick, the disin- 
fection of houses, clothing, and other associated material, are as essen- 
tial as the removal of that other condition to which your attention has 
especially been directed. 



vn. 

REPORT OF COMMITTEE ON SANITARY AND MEDI- 
CAL SERVICE ON EMIGRANT SHIPS. 

By S. H. DURGIN, M. D., Chairman of the Committee, 
Boston^ Mass, 

The immigration of people from foreign countries to the United States 
during the last ten years has been much larger than for any similar 
period in the history of our country, — the number landed for the ten years 
ending June 30th, 1889, exclusive of those from the British North Amer- 
ican possessions and Mexico, being 5,248,568 as against 2,742,137 for 
the previous ten years. The effect of this rapid increase of our foreign 
population upon the industrial and sanitary interests of our country is a 
problem which has already excited discussion in the halls of congress ; 
while the importation of physical and mental ailments^ frequently aggra- 
vated or induced by unnatural and unsanitary conditions on shipboard, 
has been recognized and deplored by medical and sanitary organizations. 
In considering this question, we are led to inquire, first, What proportion 
or number of these people are landed in this country in an unsound men- 
tal or physical condition, more or less dangerous to the communities in 
which they move, or who fall, sooner or later, upon the support of our 
charitable and correctional institutions.^ There are no statistical data, 
to our knowledge, by which we could make definite statements upon 
these points, but the observations of medical officers long in the service of 
immigrant inspection at our ports of entry, and those doing medical ser- 
vice in our departments for public charity and correction, warrant us in say- 
ing that the numbers are sufficiently large to attract serious attention, and 
that they point to a very disproportionate number of diseased and depend- 
ent persons among the foreign as compared with the native population. 
According to the statements of trustworthy dermatologists, supported by 
sufficient data, many of the skin diseases, particularly scabies, tinea favosa, 
leprosy, prurigo, lupus, and melanosis are rarely found in this country 
except as direct or indirect importations from foreign countries, and 
their increase among us is mainly if not wholly due to this cause. Dr. 
James C. White, of Boston, says, — " Unless some more stringent laws 
are made to keep out of our country the pauper and dirty populations of 
Europe, the direct importation of the diseases we have been considering 
(referred to above) , and those which may arise as well from the filthy 
habits they bring with them and transmit to their children, must follow 
with increasing magnitude." 

In 1880 our native-bom population numbered 43,475,840, and our for- 
eign-bom 6,679,943. The native-born paupers numbered 44,106, and 



44 MEDICAL SERVICE ON EMIGRANT SHIPS, 

the foreign-bom paupers numbered 22,991, or one pauper in 985 of the 
native-bom and one in 290 of the foreign-born — a proportion 3J<^ times 
as large in the latter as in the former ; and yet it will be found, when the 
census data for 1890 are completed, that the large proportion of paupers 
in our foreign population of 1880 will be considerably increased on ac- 
count of the poorer quality of immigrants which we have received from 
the poorest parts of Europe in the last ten years. This large influx of 
foreign people, the importation and increase of infectious and exotic dis- 
eases, and the consequent vast increase of our dependent class, lead us to 
the second and principal part of our inquiry. 

We find that the medical inspection of emigrants at the foreign ports of 
departure, for the ostensible purpose of excluding unfit persons from emi- 
gration, with but two unimportant exceptions, is done by officers in the 
interest and employment of the country which is being abandoned by the 
emigrant, and not by an officer in the interest of the country where the 
emigrant seeks his new home. A single case, which occurred at Boston 
quarantine last summer, will serve to illustrate how this inspection ser- 
vice, as now performed in foreign ports, may fail to detect or arrest cases 
which we are unwilling to receive : It was a middle-aged woman who 
left her home in Sweden to join her family (who had preceded her) 
in their new home in America. She passed the medical inspection at 
Liverpool, and on reaching Boston quarantine placed herself in line 
with 6cx> others for inspection ; was easily apprehended as a leper, re- 
moved to the hospital, photographed, and afier a few days returned to 
Sweden under authority of Act of Congress, Aug. 3, 1882. The case 
was one of tubercular type, far advanced, with ulcerations on limbs and 
face, and with beginning necrosis of fingers and toes. I pass the photo- 
graph for your inspection. 

The occasional exposure of passengers to small-pox, shortly before 
embarking, renders early vaccination, at least before the expiration of the 
fourth day, extremely important. This act, however, is never performed 
until after embarkation, and generally too late to prevent an attack of 
small-pox among the passengers. 

The allowance of room for each passenger in the steerage must be 
regarded as inadequate for the healthful needs of the occupant, even 
when better means for ventilation are furnished than are now generally 
found, or which our laws demand. 

The means of ventilation as called for, and as generally found, are 
insufficient, ill-adapted, and for the most part inoperative. 

The small amount of fresh air now provided is delivered with a dan- 
gerous draft directly upon one or two persons, while the atmosphere of 
other parts of the same compartment, where ventilation is most needed, 
remains practically stagnant. An ample supply of fresh air could easily 
and safely be provided through larger shafts terminating near the floor 
in the open spaces in the centre of the ship between the compartment 
partitions. From this point the air would pass over the top of the parti- 
tions into the spaces occupied by the passengers, be well distributed, and 



MEDICAL SERVICE ON EMIGRANT SHIPS. 45 

then exhausted through the iron gutter in the floor at the side of the ship ; — 
the iron gutter to he connected with a shaft leading upward in the side 
of the ship to the floor ahove, and thence across to the centre of the ship 
terminating ahove the hurricane deck at a proper distance from the inlet 
shaft, and provided with an ample exhaust fan at the top to secure the 
current at all times in the right direction. 

The unclean personal habits of the average emigrant with the unclean 
and unaired bedding and clothing, added to the ills and confinement 
incident to a rough passage in these overcrowded and ill-ventilated quar- 
ters, are suflicient causes for the sickening odors which have often been 
described. 

The hospitals, when used for ordinary diseases, are fairly well located 
and arranged, except in the matter of ventilation, but when used for con- 
tagious diseases, with their present lack of any means for ventilation, the 
location is very bad. 

The means for ordinary bathing are inadequate, inconvenient, and but 
little used. 

The latrines are generally fllthy, and oftentimes extremely repulsive, 
for want of necessary care. 

The quarters in the forecastle for the crew are well arranged, but lack- 
ing in means for ventilation. 

One of the most noticeable features met with in the examination of 
emigrant ships is the general lack of information among the oflicers as 
to the location, use, care, or existence of any sanitary rules, means, or 
appliances, and the ready excuses given for their absence or poor condi- 
tion when found. 

All matters pertaining to the hygienic conditions of the ship are by 
law left in the hands of the master. This is wrong in principle, and a 
£iilure in practice. The master of the vessel is required to make, post, 
and enforce sanitary rules, but he has neither the training nor the adapta- 
bility for such duties. 

The laws concerning all points of sanitary construction and govern- 
ment on shipboard should be explicit, and should be enforced and supple- 
mented by an officer whose education and professional training have 
qualified him for the work. 

It is therefore our judgment that the sanitary care of the vessel belongs 
wholly to the ship's surgeon, who may reasonably be expected to possess 
the necessary qualifications. Experience and inquiry have shown that 
greater care should be used in the selection of the medical officers of the 
ship, and that such officers should be provided with better rank, pay, and 
assistance, to the end that all parts of the ship and every passenger may 
have intelligent daily inspections that the earliest symptoms of disease 
may be detected, and that a wholesome condition of the ship may be 
preserved at all times. 

The most recent laws for the regulation of emigration and emigrant 
ships were enacted in 1882, and such parts of these as pertain to the sub- 
ject under discussion are herewith given. 



46 MEDICAL SERVICE ON EMIGRANT SHIPS, 

In the opinion of your committee, the better protection of our country 
against the importation of contagious and infectious diseases, as well as 
the sanitary welfare of the emigrant while on shipboard, requires that 
these laws be revised and extended to meet the present standard views 
of the sanitarian. 

We therefore recommend, — 

That there should be allowed on all emigrant vessels such clear cubic 
space to each passenger, and that such means for ventilation be pro- 
vided in all parts of the vessel used by the passengers, including hospitals, 
as shall secure to each one at least 1 200 cubic feet of fresh air per hour 
continuously. 

That there should be provided and carried on every passenger ship 
bringing immigrants to this country, not less than one graduated and 
competent medical officer to each 600 passengers or part thereof; and it 
should be the duty of the principal medical officer of the ship to make 
and enforce regulations concerning the health of the passengers and the 
sanitary condition of the ship, and to post copies of said regulations and 
of the United States laws, pertaining to emigrant passengers, in accessi- 
ble parts of the ship ; that it should be the duty of the medical officer to 
make daily inspections of all passengers and their quarters and of all 
sanitary appliances, note their several conditions, and report the same to 
the master of the ship each day ; — and he should make such requisitions 
for material and aid upon the master of the vessel as he may deem nec- 
essary for the promotion of health among the passengers and the cleanli- 
ness of the vessel. 

That it should be the duty of the master of the vessel to provide all 
necessary aid to the medical officer in the performance of his duties. 

Be it enacted by the Senate and House of Representatives of the United States of America^ 
in Congi-ess assembled^ That it shall not be lawful for the master of a steamship or other 
vessel, whereon emigrant passengers, or passengers other than cabin passengers, have been 
taken at any port or place in a foreign country or dominion (ports and places in foreign 
territory contiguous to the United States excepted), to bring such vessel and passengers 
to any port or place in the United States unless the compartments, spaces, and accommo- 
dations hereinafter mentioned have been provided, allotted, maintained, and used for and 
by such passengers during the entire voyage ; that is to say, In a steamship, the compart- 
ments or spaces, unobstructed by cargo, stores, or goods, shall be of sufficient dimensions 
to allow for each and every passenger carried or brought therein one hundred cubic feet, 
if the compartment or space is located on the main deck or on the first deck next below the 
main deck of the vessel, and one hundred and twenty feet for each passenger carried or 
brought therein if the compartment or space is located on the second deck below the main 
deck of the vessel ; and it shall not be lawful to carry or bring passengers on any deck 
other than the decks above mentioned. And in sailing v^sels such passengers shall be 
carried or brought only on the deck (not being an orlop deck) that is next below the 
main deck of the vessel, or in a poop or deck-house constructed on the main deck ; and 
the compartment or space, unobstructed by cargo, stores, or goods, shall be of sufficient 
dimensions to allow one hundred and ten cubic feet for each and every passenger brought 
therein. And such passengers shall not be carried or brought in any between-decks, nor 
in any compartment, space, poop, or deck-house, the height of which from deck to deck 
is less than six feet. In computing the number of such passengers carried or brought in 
any vessel, children under one year of age shall not be included, and two children between 
one and eight years of age shall be counted as one passenger ; and any person brought in 



MEDICAL SERVICE OAT EMIGRANT SHIPS. 47 

such yessel who shall have been during the voyage taken from any other vessel wrecked 
or in distress on the high seas, or have been picked up at sea from any boat, raft, or 
otherwise, shall not be included in such computation. The master of a vessel coming to 
a port or place in the United States in violation of either of the provisions of this section 
shall be deemed guilty of a misdemeanor ; and if the number of passengers other than 
cabin passengers, carried or brought in the vessel or in any compartment, space, poop, or 
deck-house thereof, is greater than the number allowed to be carried or brought therein, 
respectively, as hereinbefore prescribed, the said master shall be fined fifty dollars for 
each and every passenger in excess of the proper number, and may also be imprisoned 
not exceeding six months. 

Sec 2. That in every such steamship or other vessel there shall be a sufficient number 
of berths for the proper accommodation, as hereinafter provided, of all such passengers. 
There shall not be on any deck nor in any compartment or space occupied by such pas- 
senger more than two tiers of berths. The berths shall be properly constructed, and be 
separated from each other by partitions, as berths ordinarily are separated, and each berth 
shall be at least two feet in width and six feet in length ; and the interval between the floor 
or lowest part of the lower tier of berths and the deck beneath them shall not be less than 
six inches, nor the interval between each tier of berths, and the interval between the up- 
permost tier and the deck above it, less than two feet six inches ; and each berth shall be 
occupied by not more than one passenger over eight years of age ; but double berths of 
twice the above mentioned width may be provided, each double berth to be occupied by 
no more and by none other than two women, or by one woman and two children under the 
age of eight years, or by husband and wife, or by a man and two of his own children under 
the age of eight years ; or by two men personally acquainted with each other. All the 
male passengers upwards of fourteen years of age, who do not occupy berths with their 
wives, shall be berthed in the fore part of the vessel, in a compartment divided off from 
the space or spaces appropriated to the other passengers by a substantial and well secured 
bulkhead ; and unmarried female passengers shall be berthed in a compartment separated 
from the spaces occupied by other passengers by a substantial and well constructed bulk- 
head, the opening or communication from which to an adjoining passenger space shall be 
so constructed that it can be closed and secured. Families, however, shall not be sepa- 
rated except with their consent. Each berth shall be numbered serially, on the outside 
berth-board, according to the number of passengers that may lawfully occupy the berth ; 
and the berths occupied by such passengers shall not be removed or taken down until the 
expiration of twelve hours from the time of entry, unless previously inspected within a 
shorter period. For any violation of either of the provisions of this section the master of 
the vessel shall be liable to a fine of five dollars for each passenger carried or brought on 
the vessel. 

Sec. 3. That every such steamship or other vessel shall have adequate provision for 
affording light and air to the passenger decks and to the compartments and spaces occu- 
pied by such passengers, and with adequate means and appliances for ventilating the said 
compartments and spaces. To compartments having sufficient space for fifty or more of 
such passengers, at least two ventilators, each not less than twelve inches in diameter, 
shall be provided, one of which ventilators shall be inserted in the forward part of the 
compartment and the other in the after part thereof, and shall be so constructed as to 
ventilate the compartment ; and additional ventilators shall be provided for each com- 
partment in the proportion of two ventilators for each additional fifty of such passengers 
carried or brought in the compartment. All ventilators shall be carried at least six feet 
above the uppermost deck of the vessel, and shall be of the most approved form and 
construction. In any steamship, the ventilating apparatus provided, or any method of 
ventilation adopted thereon, which has been approved by the proper emigration officers 
at the port or place from which said vessel was cleared, shall be deemed a compliance 
with the foregoing provisions, and in all vessels carrying or bringing such passengers there 
shall be properly constructed hatchways over the compartments or spaces occupied by 
such passengers, which hatchways shall be properly covered with houses or booby hatches, 
and the combings or sills of which shall rise at least six inches above the deck ; and there 
shall be proper companion-ways or ladders from each hatchway leading to the compart- 



48 MEDICAL SERVICE ON EMIGRANT SHIPS. 

ments or spaces occupied by such passengers ; and the said companion-ways or ladders 
shall be securely constructed, and be provided with hand-rails or strong rope, and, when 
the weather will permit, such passengers shall have the use of each hatchway situated 
over the compartments or spaces appropriated to their use ; and every vessel carrying or 
bringing such passengers shall have a properly located and constructed caboose and cook- 
ing range, or other cooking apparatus, the dimensions and capacity of which shall be suf- 
ficient to provide for properly cooking and preparing the food of all such passengers. In 
every vessel carrying or bringing such passengers there shall be at least two water-closets 
or privies, and an additional water-closet or privy for every one hundred male passengers 
on board for the exclusive use of such male passengers, and an additional water-closet 
or privy for every fifty female passengers on board, for the exclusive use of the female 
passengers and yo^ng children on board. The aforesaid water-closets and privies shall be 
properly enclosed and located on each side of the vessel, and shall be separated from pas- 
sengers' spaces by substantial and properly constructed bulkheads or partitions ; and the 
water-closets and privies shall be kept and maintained in a serviceable and cleanly condi- 
tion throughout the voyage. For any violation of either of the provisions of this section, 
or for any neglect to conform to the requirements thereof, the master of the vessel shall 
be liable to a penalty not exceeding two hundred and fifty dollars. 

Sec 4. An allowance of good, wholesome, and proper food with a reasonable quan- 
tity of fresh provisions, which food shall be equal in value to one and a half navy rations 
of the United States, and of fresh water not less than four quarts per day, shall be fur- 
nished each of such passengers. Three meals shall be served daily, at regular and stated 
hours, of which hours sufficient notice shall be given. If any such passengers shall at any 
time during the voyage be put on short allowance for food and water, the master of the 
vessel shall pay to each passenger three dollars for each and every day the passenger may 
have been put on short allowance, except in case of accidents, where the captain is obliged 
to put the passengers on short allowance. Mothers with infants and young children shall 
be furnished the necessary quantity of wholesome milk or condensed milk for the suste- 
nance of the latter. Tables and seats shall be provided for the use of the passengers at 
regular meals. And for every wilful violation of any of the provisions of this section the 
master of the vessel shall be deemed guilty of a misdemeanor, and shall be fined not more 
than five hundred dollars and be imprisoned for a term not exceeding six months. The 
enforcement of this penalty, however, shall not affect the civil responsibility of the master 
and owners of the vessel to such passengers as may have suffered from any negligence, 
breach of contract, or default on the part of such master and owners. 

Sec.«5. That in every such steamship or other vessel there shall be properly built and 
secured, or divided off from other spaces, two compartments or spaces, to be used exclu- 
sively as hospitals for such passengers, one for men and the other for women. The hos- 
pitals shall be located in a space not below the deck next below the main deck of the 
vessel. The hospital spaces shall in no case be less than in the proportion of eighteen 
clear superficial feet for every fifty such passengers who are carried or brought on the 
vessel, and such hospitals shall be supplied with proper beds, bedding, and utensils, and 
be kept so supplied throughout the voyage. And every steamship or other vessel canTing 
or bringing emigrant passengers, or passengers other than cabin passengers, exceeding 
fifty in number, shall carry a duly qualified and competent surgeon or medical practitioner, 
who shall be rated as such in the ship's articles, and who shall be provided with surgical 
instruments, medical comforts, and medicines proper and necessary for diseases and acci- 
dents incident to sea-voyages, and for the proper medical treatment of such passengers 
during the voyage, and with such articles of food and nourishment as may be proper and 
necessary for preserving the health of infants and young children ; and the services of 
such surgeon or medical practitioner shall be promptly given, in any case of sickness or 
disease, to any of the passengers, or to any infant or young child of any such passengers, 
who may need his services. For a violation of either of the provisions of this section the 
master of the vessel shall be liable to a penalty not exceeding two hundred and fifty dol- 
lars. 

Sec. 6. That the master of every such steamship or other vessel is authorized to main- 
tain good discipline and such habits of cleanliness among such passengers as will tend to 



MEDICAL SERVICE ON EMIGRANT SHIPS, 49 

the preservation and promotion of health, and to that end he shall cause such regulations 
as he may adopt for such purpose to be posted up on board the vessel, in a place or places 
accessible to such passengers, and shall keep the same so posted up during the voyage. 
The said master shall cause the compartments and spaces provided for, or occupied by, 
such passengers to be kept at all times in a clean and healthy condition, and to be, as 
often as may be necessary, disinfected with chloride of lime, or by some other equally effi- 
dent disinfectant. Whenever the state of the weather will permit, such passengers and 
their bedding shall be mustered on deck, and a clear and sufficient space on the main or 
any upper deck of the vessel shall be set apart, and so kept, for the use and exercise of 
such passengers during the voyage. For each neglect or violation of any of the provisions 
of this section, the master of the vessel shall be liable to a penalty not exceeding two hunr 
dred and fifty dollars. 

Sec II. That the collector of customs of the collection district within which, or the 
surveyor of the port at which, any such steamship or other vessel arrives, shall direct an 
inspector or other officer of the customs to make an examination of the vessel, and to 
admeasure the compartments or spaces occupied by the emigrant passengers, or passen- 
gers other than cabin passengers, during the voyage ; and such measurement shall be 
made in the manner provided by law for admeasuring vessels for tonnage ; and to com- 
pare the number of such passengers found on board with the list of such passengers 
furnished by the master to the customs officer ; and the said inspector or other officer shall 
make a report to the aforesaid collector or surveyor, stating the port of departure, the 
time of sailing, the length of the voyage, the ventilation, the number of such passengers 
on board the vessel and their native country, respectively ; the cubic quantity of each 
compartment or space, and the number of berths and passengers in each space ; the kind, 
and quality of the food furnished to such passengers on the voyage ; the number of deaths, 
and the age and sex of those who died during the voyage, and of what disease ; and in 
case there was any unusual sickness or mortality during the voyage, to report whether the 
same was caused by any neglect or violation of the provisions of this act, or by the want 
of proper care against disease by the master or owners of the vessel ; and the said reports 
shall be forwarded to the secretary of the treasury at such times and in such manner as 
he shall direct. 



vnn. 

THE VACCINAL PROTECTION OF PASSENGERS FROM 

EUROPE. 

By F. MONTIZAMBERT, M.D., Edin.; F.R.C.S.; D.C.L.; Medical Superin- 
tendent Canadian Quarantine Service. 

In considering the subject of the vaccinal protection of passengers 
from Europe to this continent, one of the first questions that naturally 
present themselves is, What is the principal object of the quarantine laws 
and regulations on this subject? 

There are no general compulsory vaccination or revaccination laws 
in America. Under all quarantine regulations the alternative of a quar- 
antine of observation may be chosen. It would seem evident, therefore, 
that the prevention of the introduction into America of vaccinally unpro- 
tected persons (who may contract small-pox after arrival), however de- 
sirable it may be in itself, is not the main object of the quarantine laws 
as to vaccination. 

The regulations requiring vaccination, or a quarantine of observation, 
have evidently for their main object the prevention of the entrance into 
this country of any vaccinally unprotected person who may have been 
exposed to the infection of small-pox shortly before sailing, or upon 
shipboard during the voyage, — in other words, who may have small-pox 
incubating in his system. They are, I presume, founded upon some 
such considerations as the following : 

(a) The period between the contracting of small-pox and the falling 
ill with the disease — the period of incubation — is, as a rule, about twelve 
to fourteen days. That is longer by some days than the average steam- 
ship voyage from Europe to this country. A passenger may, therefore, 
take the small-pox at his home, on the continent or in Great Britain, on 
his way to the port of departure, or whilst there waiting to embark, and 
yet remain apparently well during the voyage and when passing at quar- 
antine, and only fall ill with the developed disease after he has reached 
his inland destination on this side. 

(3) The period of incubation of the protective vaccination is less than 
that of small-pox. A vaccination usually '^ takes" on the third or fourth 
day. By the eighth day the vaccine vesicle is completely developed, 
with its areola, the " zone of safety." 

(^) When this stage of the vaccine vesicle is reached before the actual 
appearance of the eruption of small-pox, the attack of that disease, other- 
wise about to disclose itself, may be averted. 

{d) Even when this stage of the vaccine vesicle is only reached after 



VACCINAL PROTECTION, SI 

the actual appearance of the eruption of small-pox, the attack of that 
disease may be modified or aborted. 

It is evident, therefore, that the earlier we can secure the vaccination 
of passengers, the more complete will be the protection for them and for 
this country. Vaccination during the voyage cannot be depended upon 
to prevent the development of small-pox from reception of its infection 
shortly before embarkation, unless it can be performed the first day or two 
after sailing. If postponed by the ship's surgeon on account of other 
duties or to allow the passengers to get over their sea-sickness, if only 
done late in the voyage just to enable the ship's surgeon to make oath 
truthfully that it has been done, or, still worse, if only done at quaran- 
tine at the port of arrival, it may possibly modify the severity of the 
attack, but it cannot be counted upon to prevent its occurrence. 

My experience at the St. Lawrence quarantines has proved the well- 
nigh invariable usage of the ships' surgeons to be the postponement of 
the examination, and of such vaccination as they may do, until the vessel 
is in the comparatively quiet waters of the Gulf; that is to say, until a 
day or two before the vessel is due at the quarantine inspecting point. 
The excuse usually given is, that the recovery of the passengers from their 
sea-sickness had to be awaited. Personal observation has shown me that 
a very similar usage obtains on some, at least, of the principal steamships 
running to New York, and I am told by ships' surgeons generally that it 
is practically the rule for all vessels bringing passengers from Europe to 
all ports on this side. The experience of Dr. Smith, health officer at the 
port of New York, seems to be very similar to my own. Thus he writes 
in one of his reports : 

The success in securing the examination and vaccination of immigrants within the first 
twenty-four hours after leaving port has not been commensurate with the effort made. 
The sea-sickness, which very generally prostrates a great portion of the passengers soon 
after the voyage is commenced, continues several days, making it next to impossible for 
the surgeon in some cases to give the desired attention to this duty, and in others, and in 
many instances, affords a good excuse for neglecting it. 

The difficulty of examining and vaccinating a number of passengers 
suffering from sea-sickness with all its attendant disturbance of mind and 
body, needs only to be mentioned to be believed in ; but it can scarcely be 
even approximately realized without having been experienced. It may 
be assumed, then, that this cause of the tardy examination makes the car- 
rying out of the vaccinal protection during the first day or two of the 
voyage practically beyond the power of the ship's surgeon, and, as before 
stated, when postponed until later, the vaccination cannot be depended 
upon to prevent the development of small-pox contracted before embark- 
ation. When small-pox occurs during the voyage, and is reported or 
detected at quarantine, the danger to this country is not really great. 
The cases of sickness are strained out at quarantine : there is full oppor- 
tunity for the disinfection of the vessel, clothing, etc., and all persons on 
board are, at most ports, vaccinated. Under such circumstances the 
exposure is recent, and the vaccination, even at quarantine, will usually be 



52 VACCINAL PROTECTION, 

in time to prevent the spread of the disease. It is, therefore, not so often 
passengers from such vessels that communicate small-pox to interior 
communities. A greater source of danger is in those who have been 
infected at, or previous to departure from, the port on the other side, and 
who reach this country and pass the quarantine barriers prior to the 
development of the disease. And if there be a constant source of a grave 
danger to the interior communities of this country from the tardy revac- 
cination on shipboard where a time limit for such revaccination is 
enforced, as in the St. Lawrence, how much greater is the danger from 
some of the principal United States ports where practically any old vac- 
cination mark is taken as evidence of sufficient protection ! Thus of the 
port of New York Dr. Smith writes, — 

*' The law in relation to the vaccination of immigrants, which provides that ' those who 
are insufficiently protected from small-pox by vaccination shall be vaccinated/ leaves so 
much to the judgment of the surgeon of the steamer, that in some instances the vaccina- 
tions are so few that it is of little benefit in preventing the infection and development of 
the disease when passengers are exposed to the contagion during the voyage. The medi- 
cal officer not infrequently accepts the slightest evidence of vaccination as a sufficient pro- 
tection. The German surgeons revaccinate pretty thoroughly, but *the English sur- 
geons, as a rule, have vaccinated only those who have no evidence of previous protection, 
or in whom it is very obscure.' " 

The period during which a successful vaccination or an attack of small- 
pox ensures protection from small-pox varies to a certain extent under 
different circumstances, but no one who has had any experience with tha 
disease will maintain that infant vaccination is a certain protection 
throughout adult life. In some, it is possible that the regular phenomena 
of vaccination can be produced but once in a lifetime, but this is never to * 
be depended upon. There can be no doubt that the protective power of 
vaccination decreases in proportion to the length of time that has elapsed 
since its performance ; and that, too, without any necessary dependence 
upon the scar upon the arm, which may be carried unobliterated to the 
grave, — for it has been demonstrated over and over again that the condi- 
tion of the cicatrices does not fprnish reliable evidence as to whether the 
subject is or is not protected. 

In the armies of Europe, where revaccination is now general, the per- 
centage of successful revaccinations has varied from 50 to 75 per cent. 
In the report of the Committee to the American Medical Association, 
1885, i find the following amongst other conclusions : 

That out of any number of adult persons who have good marks of vac- 
cination, 40J4 per cent, are perfectly protected, while 59^^ per cent, are 
susceptible to varioloid. 

That out of any number of adult persons with imperfect marks of vac- 
cination, 23 per cent, only are protected, while 77 per cent, are liable to 
small-pox or varioloid. 

Regulations which only require steerage passengers to be vaccinated 
who are not ** sufficiently protected," are manifestly insufficient. Ships* 
surgeons are prone, as we have seen, to accept the slightest evidence of 



VACCINAL PROTECTION S3 

any vaccination mark as " sufficient protection," In any passenger vessel 
those without any marks are but as units compared to the hundreds with 
old marks, but almost equally unprotected. At the best, these few units 
may be vaccinated a day or two before the vessel reaches port on this 
side, and they, and all the unprotected or only partially protected hun- 
dreds, are given " Protected " cards. Of what practical use is such a 
law ? It might be comprehensible, if compulsory vaccination were a uni- 
versal law throughout America. It may tend to lessen the importation 
of unvaccinated persons'; it may serve to lull the public into a fancied 
state of security ; but it certainly cannot be expected or depended upon 
to protect interior communities from the introduction and development 
of small-pox contracted before sailing. And that, and that only, as we 
have seen, is the evident intention of and reason for the vaccination 
regulations that apply to vessels where no small-pox has occurred during 
the voyage. 

To secure the protection nominally sought by the vaccination regula- 
tions, every proposed passenger should be required to produce evidence 
of protection by vaccination, or revacci nation, within a fixed time-limit 
prior to admission to the vessel, or before it leaves the calm waters of the 
port of departure. 

For such a time-limit, seven years might well be adopted. That 
is the period in force in some of the great continental armies, and it 
recommends itself to the popular belief in a complete change of the 
body within each recurring interval. 

It may be difficult to secure this at the ports on the continent, but it 
would be a great deal gained if we could even secure it at the ports of 
departure in Great Britain. 

The government of England recognizes a duty to passengers leaving 
her shores, and to the countries for which they are so leaving her. In 
paragraphs 44 and 45 of the imperial ''Act to amend the law relating to 
the carriage of passengers by sea," it is enacted that 

No passenger ship, except as hereinafter provided [that is, where no medical man can 
be obtained], shall clear out or proceed to sea until some medical practitioner, to be 
appointed by the emigration officer, shall be satisfied that none of the passengers or 
crew appear, by reason of any bodily or mental disease, unfit to proceed, or likely to 
endanger the health or safety of the other persons about to proceed in such vessel. 
Such medical inspection of the passengers shall take place either on board the vessel, or, 
at the discretion of the said emigration officer, at such convenient place on shore before 
embarkation as he may appoint ; and the master, owner, or charterer of the ship shall 
pay to such emigration officer a sum at the rate of twenty shillings for every hundred 
persons so examined. 

If the emigration officer at any port shall be satisfied that any person on board, or 
about to proceed in any such passenger ship, is, for that or any other reason, likely to 
endanger the health or safety of the other persons on board, the said emigration officer 
shall prohibit the embarkation of such person, or, if embarked, shall require him to be 
relanded. 

A person in the stage of incubation of small-pox is certainly " likely 
to endanger the health or safety of the persons on board." Every vac- 
cinally unprotected person embarking may be in that stage from recent 



54 VACCINAL PROTECTION. 

exposure, consciously or unconsciously, to the infection, yet there being 
nothing in his appearance to betray his condition, it would not be dis- 
covered by this medical inspection. 

It may be urged that a similar statement would also apply to the other 
infectious diseases. So doubtless it would ; but we have in vaccination 
a ready means of protection against small-pox, which, unfortunately, we 
have not, as yet at least, against other diseases which likewise have a 
stage of incubation. 

The enlargement of this medical inspection to include the examina- 
tion as to the vaccinal protection of intended passengers, and the vaccina- 
tion at that time by the government medical officer, by medical men 
employed for the purpose, or by the ship's surgeon, of all passengers 
who may not demonstrate previous protection within the required limit, 
would be the best means — and indeed the only possible and effectual 
means that I can see— of protecting this country from the development, 
subsequent to landing here, of small-pox contracted before sailing. 

An occasional case might still occur on shipboard where the person 
only embarked at a late stage of the period of incubation, but even here, 
the vaccination, if performed before sailing, might modify or abort the 
attack. And from the protection of all others having been already 
secured, there would be no danger of the disease spreading on the vessel ; 
whilst, by thus making sure of the vaccinal protection of all persons 
before sailing, the great majority of the cases of small-pox now occurring 
on shipboard, and all those occurring on or just after arrival at this 
side, would be prevented. 

I have said, that, to secure the protection presumably sought by vaccina- 
tion regulations, every proposed passenger should be required to produce 
evidence of protection within a fixed time-limit. From the less general 
regard of the laws of health among the class from which steerage passen- 
gers as a rule are drawn, and from their greater danger of exposure to 
infection in the inferior class of lodging-house they occupy, as a rule, on 
their way to and at the port of departure, there is, to a certain extent, 
more risk from them than from passengers of a higher class. No class, 
however, is entirely free from the risk. And all of you who have paid 
any attention to this subject, must be familiar with cases of small-pox 
introduced into our sea-ports and interior communities by intermediate 
and cabin passengers. 

I am of the opinion that the difficulty of including cabin passengers in 
the vaccination regulations has been much over-estimated. People now 
crossing the Atlantic to this side understand, that, as a general thing, no 
questions are asked of cabin passengers, and so they take no special pre- 
cautions. In most instances no trouble ensues ; but every now and then 
a case of small-pox occurs on the voyage, perhaps among the numerous 
steerage passengers. Then the cabin passengers, ladies and all, may 
find themselves suddenly and unexpectedly confronted with the require- 
ment that they must show their arms to, and possibly submit to vaccina- 
tion by, a ship's surgeon or a quarantine officer, about whom they know 



VACCINAL PROTECTION, 55 

nothing, and in whom, and in the purity of whose vaccine, they may 
have no confidence. Hence, very naturally, a great deal of trouble, vexa- 
tion, and opposition. For this is unquestionably an intolerable annoy- 
nce to which to subject people of that class. But once it were generally 
known that all passengers, cabin as well as other, would be required 
to furnish evidence of recent vaccination, first-class passengers going 
from this side for a trip to Europe, and those coming from Europe here, 
would, before leaving their homes, send for their family physician, be 
vaccinated by him if need be, and in any case provide themselves with 
vaccination certificates. This they would do as regularly, and as much 
as a matter of course, as they would provide themselves with steamship 
tickets, or with passports if about to travel where they are exacted. 
And steamship ticket-agents would remind those purchasing tickets, or 
otherwise taking their passage, of the obligation. On the voyage the 
ship's surgeon could quietly satisfy himself that all the cabin passengers 
possessed satisfactory certificates, and would certify that fact under oath 
to the quarantine officer at the port of arrival. And so cabin passengers 
would be saved from annoyance, without the present risk to the public 
health, even if small-pox should occur on the vessel ; and the distressing 
scenes alluded to, instead of increasing in frequency, would altogether 
cease to recur. 

I am quite aware that during the late Montreal epidemic of small-pox 
the inland quarantine officers of Ontario, and of the United States Marine 
Hospital Service, found it necessary utterly to refuse to take written cer- 
tificates ; but the cases are not parallel. On the trains crossing the fron- 
tiers, hundreds of persons of all classes passed daily, and it was impossible 
to identify the holders of certificates. The certificates themselves might 
have borne the signatures of fictitious medical men, or, even if in every 
way correct, might be mailed back and used over and over again. But 
in steamships, during an ocean voyage, the surgeon could readily identify 
each passenger, if only by the names on the passenger-list. In the class 
of which cabin passengers are composed, it is indifference or carelessness 
as to re vaccination, rather than deliberate fraud, that needs to be pro- 
vided against. It is unlikely that any passenger of that class would pro- 
cure or manufacture a bogus signature, or that he would cross the Atlan- 
tic under a false name merely for the sake of availing himself of some one 
else's vaccination certificate. 

This Association has already, at a former meeting, passed a resolution 
recommending concerted and simultaneous action by the executive quar- 
antine authorities of American and Canadian ports as to regulations to be 
enforced on this side. 

In the hope of obtaining the approval and support of this Association 
towards the further effort to secure the vaccinal protection of passengers 
while it would be of real practical value, that is to say, before sailing, I 
beg now to submit the following resolution : 

Whereasy At the seaports, and in the interior communities of this con- 
tinent, an outbreak of small-pox is started from time to time by persons 



S6 VACCINAL PROTECTION, 

who have passed the quarantines of the American or Canadian ports 
apparently perfectly well, but in the stage of incubation of small-pox con- 
tracted before sailing, and who develop the disease subsequently to land- 
ing; and 

Whereasy Nothing can prevent this but vaccination or revaccination 
within a time-limit, before or within the first day or two after sailing ; 

Be it resolved^ That, in the opinion of this Association, it is desirable 
that every effort be made to secure the enforcement of such protection by 
the inspecting government medical officers at the ports of departure. 



IX. 

THE SANITARY IMPROVEMENT OF STAGNANT LAKES 

BY THE SEA-SHORE, AS EXEMPLIFIED AT 

VIRGINIA BEACH, VA. 

By JOSEPH H. RAYMOND, M. D., Professor of Physiology and Sanitary 
Science, Long Island College Hospital, Brooklyn, N. Y. 

It is my purpose in this brief paper to describe an ingenious, and I 
think unique, method of making a practical use of some of the powers 
of Nature — ^powers which are oftentimes employed by Nature herself 
rather to the detriment of man, than to his advantage and profit. 

One has but to visit the famous sea-side resort at Coney Island to un- 
derstand the destroying power of the waves of the ocean — a destructive 
force which has thus far bafHed the wit and skill of many an engineer, 
and in a night rendered desolate what twelve hours before was a charm- 
ing landscape. It is impossible to make even an approximate estimate 
of the money which has been expended at Coney Island in the repair of 
damages done by the ocean. The removal of the Hotel Brighton in 
1888, which was made necessary by the encroachment of the ocean, the 
repeated rebuilding of the Marine Railway, and the removal of prome- 
nades and flower gardens almost throughout the length of the island, have 
cost many thousands of dollars. 

From this picture of destruction let us turn to one more inviting, which 
reveals a method by which man may be benefited instead of damaged by 
this same force, provided the proper means are employed for its util- 
ization. 

At various points along the Atlantic sea-coast are fresh-water lakes, 
made by the drainage of the surrounding country. Such lakes formerly 
existed at the well known winter resort, Virginia Beach, Princess Anne 
county, Va., eighteen miles from Norfolk. Some years ago a channel 
was cut from one of these lakes. Lake Cypress, to Linkhorn Creek, a 
distance of two miles. This creek communicates with Lynn Haven 
Inlet through Broad Bay, and this in turn with Chesapeake Bay. The 
level of the lake was such that the water soon ran off and left the bottom 
exposed to the sun and air, and in a short time Lake Cypress ceased 
to exist. 

Within four hundred feet of the Princess Anne hotel was another lake. 
Lake Holly by name, vastly greater in extent than Lake Cypress, covering 
as it did eighty acres, its depth varying from one to four feet, and its sur- 
face-level being two feet higher than high-water mark. This lake, like 
the others, was but the accumulated rain-fall of the surrounding country. 



$8 SANITARY IMPROVEMENT OF LAKES, 

Between it and the ocean was a bluff ten feet high. Inland from it the 
land rose to the height of about fifteen feet, while the bottom was formed 
of clay which permitted none of the water which fell upon it to soak 
away, but held it as firmly as an earthen bowl. In times of drought the 
level of the water would be lowered by evaporation, and the banks of 
the lake, covered with muddy slime, would then be exposed. Such a 
body of water within sight of a popular sea-side hotel was, to say the 
least, an eye-sore, and rumor had it that at certain seasons of the year the 
shores of the lake were malarious. Such a reputation, whether founded 
on fact or on fiction, could but prove a detriment to the interests of the 
projectors of the hotel and its improved surroundings. But what could 
be done to mitigate the evil was the question. The first proposition was 
to drain off the water into the ocean, as had been done with Lake Cypress. 
This could be easily accomplished, and with but little expense ; but there 
were several objections to the plan. In the first place, a large surface of 
mucky material would be exposed, with the accompanying danger to 
health. To make this a permanent improvement it would be necessary 
to remove this muck, and then fill the excavation with clean earth. This 
would involve so enormous an expense that it was not feasible. But 
even if this plan were carried out, one of the most desirable features in 
the landscape would be obliterated, and a source of endless pleasure to 
the guests of the hotel would be destroyed. It was very desirable to do 
away with the unsanitary influences of the lake, but at the same time 
it was equally desirable not to be deprived of its advantages in so doing. 
If the stagnant fresh water could be replaced by a constantly circulating 
body of salt water, the problem would be solved. The first suggestion 
to effect this result was to connect the lake at its northern end by a cut 
with the canal which had been made to drain Lake Cypress. This cut 
would serve as an outlet. In order to supply the lake with salt water, 
it was proposed to provide steam pumps which would pump the water 
directly from the ocean. It was found, however, that this would require 
a plant costing about $20,000, and that the pumping would entail an 
additional expense of $20 per day. If the same result could be obtained 
in a cheaper way, it was a desirable thing to do. 

I now come to a description of the plan which was finally adopted, 
and which, as I have said, I believe to be a unique piece of engineering. 
It has up to the present time given perfect satisfaction to all concerned. 

The connection referred to between the northern end of Lake Holly 
and the old canal which drained Lake Cypress was made : thus an out- 
let was opened into Chesapeake bay. 

To serve as an inlet, a flume was constructed from the surface of the 
lake to the ocean, a distance of nine hundred feet, by cutting through the 
bluff, ten feet high, of which I have spoken. The bottom of the flume 
at the ocean end is two feet above high-water mark, and is perfectly level 
the entire distance to the lake. This flume was made by sinking, twelve 
or more feet into the clay, two rows of piles fifteen feet apart, each pile 
being about twenty feet in length ; these formed the sides of the flume. 




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SANITARY IMPROVEMENT OF LAKES, 59 

Similar, but shorter, piles were sunk into the ground between these 
rows to form the bottom of the flume. The piles were then capped 
with heavy timbers, and sheeted with 3x9 yellow pine firmly bolted to 
the piling. A flume was thus constructed nine hundred feet long and 
fifteen feet wide, with planked bottom and sides. 

The manner of sinking these piles is not without interest : In the spot 
where a pile is to be sunk^ a hole is bored in the sand or clay by means 
of a powerful jet of water projected from the end of a i J^ in. pipe, under 
a pressure of ninety pounds to the square inch, the pipe being lowered 
as the clay or sand is washed out. When the hole has reached a suffi- 
cient depth, the pipe is withdrawn and the pile quickly dropped into its 
place. The sand or clay settles around the pile, and holds it firmly in 
position. In the construction of the flume at Virginia Beach all the 
piles were sunk by this method. 

At the ocean end the flume flares out, for a distance of twelve feet, to 
a width of twenty feet at the extreme end, forming a bell-shaped mouth 
(Fig. I, Plan). The floor of this bell-shaped expansion is laid so as to 
form an inclined plane which starts two feet above the level of the floor 
of the flume, and descends to the ocean at low-water mark, falling five 
feet in this distance of twelve feet. The elevation of the starting-point 
of this inclined plane above the floor of the flume makes, at that point, 
what is designated " an apron." (Fig. i, cross section.) 

The practical working of this flume is as follows : When the incom- 
ing tide has risen sufficiently high, the ocean swell is such as to form 
waves, which have impetus enough to carry that part of them which 
comes within the bell-shaped mouth up the inclined plane to its top, 
where it drops over the apron into the flume, the apron preventing its 
return. Each succeeding wave adds its quota to that which preceded 
it, and soon there is a stream of water fifteen feet wide flowing through 
the length of the flume into the lake (Figs. 2, 3, 4). Careful observa- 
tion has shown that under ordinary circumstances sixteen waves pass into 
the flume each minute, filling it to the depth of one foot, and that this 
inflow continues during six hours each day, making in all 648,000 gal- 
lons of salt water directly from the ocean, which are carried into the lake 
daily. When the wind is on shore and the waves are high, this quan- 
tity is greatly exceeded, the water in the flume being, under these cir- 
cumstances, oflen three feet in depth. The total cost of this construction 
was but $8,000. 

The advantages of this change in the condition of Lake Holly are very 
apparent. Instead of a large accumulation of stagnant fresh water, 
there is now a beautiful body of circulating salt water flowing in from the 
ocean, and out through the channel which connects it with Chesapeake 
bay. In the lake, crabs and salt-water fish in considerable numbers can 
now be found. Boating, fishing, and still salt-water bathing can be 
enjoyed within a few minutes' walk of the hotel, while the banks of the 
lake can be utilized as building sites. 



X. 

THE PREVENTION OF TUBERCULOSIS— A CENTURY'S 

EXPERIENCE IN ITALY UNDER THE INFLU- 

ENCE OF THE PREVENTIVE LAWS OF 

THE KINGDOM OF NAPLES 

ENACTED IN 1782. 

By LAWRENCE F. FLICK, M.D., Philadelphia, Pa. 

On the 19th of July, 1782, the sovereign of the kingdom of Naples 
gave his sanction to a legal enactment for the prevention of tuberculosis, 
which, according to De Renzi, the medical historian of Italy, contained 
the following propositions : 

1. That the physician shall report the consumptive patient, when ulceration of the 
lungs has been established, under penalty, for the first offence, of 300 ducats, and, upon 
repetition, of banishment for ten years.' 

2. That an inventory shall be made by the authorities of the clothing in the patient's 
room, to be identified after his death, and if any opposition shall be made, the person 
doing so, if he belongs to the lower class, shall have three years in the galleys or in 
prison ; if to the nobility, three years in the castle and a penalty of 300 ducats. 

3. That household goods which are not susceptible shall be immediately cleansed, and 
those that are susceptible shall at once be burned and destroyed. 

4. That the authorities themselves shall tear out and replaster the house, alter it from 
cellar to garret, carry away and bum the doors and wooden windows, and put in new 
ones. 

5. That the poor sick shall at once be removed to a hospital. 

6. That newly built houses cannot be inhabited before one year from their completion, 
and six months after plastering has been finished and repairing has been done. 

7. That superintendents of hospitals must keep in separate places clothing and bed- 
ding for the use of consumptives. Other severe penalties are threatened to those who 
buy or sell objects which had been used by consumptives, to servants, members of the 
family, and to any transgressor whomsoever. 

1 1. Che medico deve rivelare Pifermo di tisi quando I'ulcera polmonale e stabilita, sotto pena la 
prima volta di 300 ducati, e nel caso di reddiva alia rilegazione di died anni ; 2. Nell' inventario 
da farsi dalla puUica Autorita delle robe contenute nella stanza dell' infermo da verificame I'esistenza 
dopo la morte di esso, e chi si opponeva, se era innoUle avea tre anni di galera o di presidio, se 
era nobile tre aii!Ai di castello e 300 ducati di pena ; 3. Che i mobili non suscettibili fossero subito 
purificati, ed i stiscettibili immediatamente boiidati e distrutti; 4. Che I'autorita stessa ^'facda 
stonacare la stanza ed intonacare di nuovo, mutare il pavimento e la soffita, togliere e brudare le 
porte e le finestre di legno, e porre le nuove." 5. GP infermi poveri mandarli subito all' ospedale ; 
6. Che le case di fresco fabbricate non posono essere abitate prima di un anno dd loro termine, e 
sd med dopo che si e eseguita I'intonacatura, e la mettitura de' pezzi d'opera ; 7. Che i Govema- 
tori degli ospidali debbano tenere in luogo seperato le vest! e le biancherie per uso de' tisicL Al 
tre pene severissime d minaccinao a chi compra o vende oggetti seroiti a' tisid, a' domestid, alle 
persone di famiglia ed a qualunque trasgressore. — Storia Delia Medidna in Italia. Salvatore De 
Renzi, vol ▼, pages 511-5x4. 



THE PREVENTION OF TUBERCULOSIS, 6l 

The kingdom of Naples, as it was then constituted, comprised all of 
the territory of the present kingdom of Italy, which constitutes the prov- 
inces of Abrozzo, Campania, Apulia, Basilicata, and Calabria,^ — an area 
of about 11,291 square miles. Its population at that time was about 
4,500,000,' and the population of the same territory at present is about 
89038,186.* Politically, it formed one government with Sicily, and 
through its rulers was closely associated with Spain, continuing so until 
i860, when all Italy was united under one government.* The probabil- 
ities are, therefore, that the laws for the prevention of tuberculosis 
extended to the kingdom of Sicily as well as to that of Naples ; and it is 
not at all unlikely that Spanish sentiment and Spanish influence had 
something to do with their enactment. 

How strictly the law was enforced it is now difficult to learn, but the 
probabilities are that it was well received and scrupulously carried out 
by the people, for they were thoroughly convinced of the contagiousness 
of tuberculosis, and recognized the necessity of some practical measures 
for its prevention, even before the law was enacted. De Renzi says 
that many hardships resulted from its enforcement, because of the inter- 
ference with the renting of property, inasmuch as the people would not 
go into a house which was known to have been infected.* I find no 
reference any^where to imposition of penalties, and I am inclined to 
believe that the law was more strictly enforced by the demands of the 
people than by the execution of the authorities. Efforts were soon made 
to have the law repealed, but it seems to have been allowed to remain 
on the statute books until the termination of the government in i86o. 
The medical profession was at first almost unanimous in its adherence 
to the theory of contagion and in its support of the law ; but as time 
rolled on, it became nearly as unanimous in its disbelief in contagion and 
its opposition to practical measures for the prevention of the disease.^ 
The masses, however, clung tenaciously,^ and cling to this day, to the 
belief that the disease is contagipus, and have never given up entirely 
the preventive practices which they acquired during the operation of the 
law." 

Whether or not any laws for the prevention of tuberculosis were ever 
enacted in any other part of Italy, I have been unable to ascertain. About 
the time that the laws of the kingdom of Naples were being enacted, quite 
a spirited controversy was carried on between some of the most learned 
medical men of the kingdom of Naples and some of the Solons in med- 
icine of the northern part of Italy, in which the latter opposed the theory 
of contagiousness of tuberculosis and the enactment of laws for its pre- 

X Annates D'Hygiene Publique et De Medicine Legale. Tome x6, p. 302. 

> Supra cito, page 300. 

*Statistica Delle Cause delle Morte &&, 1887, page xii. 

« Cyclopaedia Americanai vol. xv, pages 19-21. 

»Storia Delia Medidna in Italia. Salvatore De Renzi, vol. v, pages 511-5x4. 

aStoria Delia Medidna in Italia. Sahr. De Renzi, vol. v, pages 51 1-5 14. 

TBriefe Uber Italien, 1793, ^ WiUiehn Xaverius Jansen, pages 250, 251. 

< Historiqne De La Contagion De La Phthbie Pulmonaire, par. M. £. Boisseau, page 376. 



62 THE PREVENTION OF TUBERCULOSIS, 

vention, and the former defended them.^ But whether any such laws 
were passed or not, the people of the northern part of Italy largely held 
the same ideas about the contagiousness of tuberculosis as their southern 
neighbors, and undoubtedly instituted preventive measures against the 
disease, which they continue to practice to this day. 

The preventive measures inaugurated under the laws of the kingdom 
of Naples were based entirely upon empiricism, and for that reason 
were crude, harsh, and inefficient. It was known that tuberculosis was 
contagious, but it was not known wherein lay the medium of contagion. 
It was believed that the breath of the consumptive and the odor given 
off from his body were infectious, and that consequently it was not only 
dangerous to be near him, but that anything which had been near him 
was infectious. The fact that the contagion is confined to the sputa and 
tubercular pus was not known, and this, the only real source of danger, 
was in a measure overlooked. With the abstract idea that tuberculosis 
is contagious as the basis, the most heroic and sweeping preventive 
measures were haphazardly constructed, many of which could have but 
little influence in preventing the spread of the disease. The burning 
of the clothing and furniture used by a consumptive patient, after his 
death, and the cleansing of the house, which had been occupied by 
him, from cellar to garret, would afford some protection against the dis- 
ease ; but the patient during his lifetime was allowed to be a constant 
source of danger to his relatives, friends, and neighbors through the dis- 
semination of sputa and tubercular pus. The only real efficacious meas- 
ure practised was isolation. Nevertheless, in spite of the oppressive, 
superfluous practices instigated and fostered by the law, and its general 
defectiveness as a sanitary measure against the disease which it was 
intended to restrict, it contained some merit, and to some extent ful- 
filled the object for which it was enacted. Inasmuch, moreover, as the 
practices which it inaugurated, even though defective, have been pretty 
well carried out by the people for upwards of a hundred years, and some 
restrictive influence upon a disease must necessarily follow a general 
promulgation of the doctrine of its contagiousness, if it is contagious, it 
is but fair to accept the result of the operation of this law as a test of 
the practicability of preventing tuberculosis, and as an argument for, or 
against, the theory of its contagiousness. A comparison of the preva- 
lency of the disease in 1782 with that at the present time will show the 
practical results of the law. 

I have, unfortunately, not been able to find any mortality statistics for 
Italy as far back as 1782, and it is not probable that there are any in 
existence.* A good idea of the amount of tuberculosis in the kingdom 
of Naples and in all Italy can be obtained, however, from contemporary 
writers, native and foreign. Michele Sarcone, in recounting the dis- 
eases which occurred in the kingdom of Naples during the autumn of 
1764, ends up by saying, "Consumptives suffered in the largest num- 

1 Storia Delia Medidna in Italia. De Renzi, vol. ▼, pages 51 1-5 14. 
sBriefe iiber Italien, 1793, ^ Wilhelm Xaverius Jansen, page 250-251. 



THE PREVENTION OF TUBERCULOSIS. 63 

bcr, and as for these miserable creatures, they do not easily give up."^ 
Among the most frequent and fatal diseases which occurred that year, 
he puts down peripneumonia, pleurisy, diarrhoea, and rheumatism. 
From his description it looks as though many of these cases were acute 
malignant tuberculosis. The peripneumonias and pleurisies were so 
much alike that many took them as the same disease.^ In an autopsy of 
a soldier, who died of peripneumonia, he found that' "the lungs were 
adherent at the back to the pleura, with such strong adhesions that it 
was necessary to tear the parts to divide them. The right lobe was 
extremely swollen, hard, and covered with a yellow, sticky material ; 
the inside was saturated with black, curdled blood ; the bronchial sub- 
stance was choked up with a dense glutinous material, yellow in places, 
and ash-gray in others, and by a tenacious bloody scum. The left lobe, 
of a purple color, appeared less swollen than the right, and there was 
in the middle an obscure beginning of an abscess." The diarrhoeas he 
describes as sometimes accompanied by most rapid emaciation, and the 
rheumatism by ulceration. 

As among not the least of the ills to which human flesh is heir, he 
speaks of a skin disease which he claims is unjustly called the disease of 
Naples, and which, he says, ordinarily terminates in fatal consumption.^ 
In his account of the terrible disease which visited Naples that year in 
the form of a plague, he tells us that it was always accompanied by 
either a remittent or a continued fever, with a disposition to the break- 
ing down of tissue and the formation of pus, and often terminated in 
internal and external abscesses and tubercles.^ In those days tuber- 
culosis was not recognized unless it took the form of a slow, wasting 
disease. One cannot fail to recognize, however, in Sarcone's descrip- 
tions, tuberculosis of every form, — acute miliary tuberculosis of the lungs 
and pleura, tubercular peritonitis, tubercular meningitis, tubercular 
arthritis, tubercular adenitis, and lupus, all in the most malignant form. 
K many of the diseases, so ably portrayed by Sarcone, and which pre- 
vailed in his day to such a vast extent, were not tuberculosis, there is 
certainly no disease known to modern pathology with which his descrip- 
tions so well fit in. His appalling picture of the diseases of Naples is 
well sustained, and the suspicion that many of the acute forms were of 
a tuberculous character is entirely borne out by the writings of Dr. Ben- 

^ '^ I tabidi suffrirono moltissimo, e di quest! miseri se ne perderono failmente.'' Istoria ragionata 
De MaL &c. Michele Sarcone, part ii, page 658. 

» Supra dto., part i, pages 67, i^y 102, 166-167. 

• ^ Nel cavo del petto osservammo i polmoni aderenti per lo dorso alia pleura, con attacco tenace 
tanto, che bisognava lacerar le parti per dividerle. II lobo dritto estremente gonsio, duro, ricoperto 
di nn glntine giallastro : L'intemo era inondata di astro, e rappreso sangue : la sostenza bronchiale 
era affogata tra un denso glutine talora giallastro, talora cenerognolo, e da una teiuice spuma san- 
guinosa. — n lobo sinistro di un colore paonazzo : appariva men gonsio del dritto : e v'era nel mezzo 
nn oscuro prindpio di ascesso." 

Istoria ragionata de* mali osservati in Napoli nell' intero corso dell' anno 1764. Scritta da Michde 
Sarcone. P. 167 Parte Prima. 

^Ragionata De Mala, &c., Michde Sarcone, part i, pages 58, 59. 

B Supra^cito. part u, page 227 et seq. 



64 THE PREVENTION OF TUBERCULOSIS, 

jamin Pugh, an English physician, who visited Italy in 1783. Dr. Pugh 
says, — 

As this climate had been so long celebrated for its mildness, I was surprised at the 
obstinate continuance of the complaints of our own familyt stnd likewise at the numbers of 
diseased and miserable objects I met in every part of the city. I resolved to visit the 
hospitals, where I beheld misery in the extreme, fevers of every class (but scarcely one 
where the lungs had not been primarily concerned), rheumatism, dropsies, scrofulas, 
consumptions, ulcers of every kind, and venereal diseases without number. ... To 
what diseases, then, are the inhabitants of this country most subject ? They are troubled 
with fevers of various kinds, in most or all of which I found the lungs concerned, scrof- 
ulas, rheumatisms, ophthalmias, scorbutic putrid gums with ulcers, and eruptions of 
various sorts. The most prevailing distemper seemed to be a marasmus. I frequented 
their hospitals often, and found these to be the chief diseases, all which are familiar to 
those in the hospitals of Naples and other towns near the seacoast in Italy. But if the 
inhabitants themselves, whose very looks betray marks of ill-health, afforded not such 
numerous proofs of the unwholesomeness of this air, I am, alas, furnished with too many 
by my unhappy countrymen, who wintered there in 1783. There were twenty-four fam- 
ilies, besides several single English gentlemen, the whole of which amounted to one hun- 
dred and thirty-six persons ; and I believe very few of those who came there on account 
of the air, found expected benefit : I can except only two, one an elderly, gouty gentle- 
man, the other a tender, weakly, low-spirited gentleman, with a slow fever at times ; but 
both had sound lungs. The only consumptive cases which I saw at Nice were six young 
gentlemen, and a lady rather advanced in years, all of whom died in the course of the 
winter. Three of these young men were so active and cheerful at times, even a day 
before their deaths, that there was reason to hope for their recovery. Had they stayed in 
England, or some parts of the south of France, I firmly believe that four of the six, if 
not now alive, would at least have protracted their days. I attended a great many of the 
English, who came to Nice in health, in violent inflammatory fevers, in all of which the 
lungs were concerned.* 

Dr. Wilhelm Xaverius Jansen, a German physician, wrote from Italy 
in 1793, bearing testimony to the same condition of things. He says, — 

In the hospitals I still found quite a number of chest diseases accompanied by inflam- 
mation, seldom, too, as this occurs with us at this time of the year. Yet it is not always 
real inflammation. Mostly they are of a rheumatic character, and common people and 
soldiers, who expose themselves to wet and cold, are more frequently attacked than 
cleanly people. Besides these, one finds different kinds of consumption ; and these, as 
it appears, are either transmitted by the parents, or are conveyed by infection.' 

The terrible prevalency of tuberculosis in the kingdom of Naples and 
all Italy, at the time when the Neapolitan laws were introduced for its 
restriction, is borne testimony to, in possibly even stronger terms, by later 
writers than by contemporaries. De Renzi, the medical historian of Italy, 
who had access to all of the controversial writings of that day, says, — 

It has been asserted in this connection, and not through the instrumentality of the 
government (from which I do not take my information) that consumption had at that time 

1 Observations on the Climate of Naples, Rome, Nice, &c., by Benj. Pugh, M. D., 1784, page 7. 

s " In den Hospitaelem fand ich noch manche Brustkrankhdten mit Entzimdung gepaart, so selten 
diese auch in dieser Jahreszeit bd uns ist. Doch nicht immer ist es eigentiich Entzundung. 
Meist sind sie rheumatish und es werden davon gemeine Leute and Soldaten, die der Kalte und 
Nasse sich Uosstellen, weit mehr als die rdnliche Leute befallen. Ausser diesem findet man 
verschiedene Lungensuchten ; und diese wie es scheint, stammen theils von den Eltem her, oder 
werden durch Anstecken von andem mitgetheilt." 

Briefe iiber Italien, 1793, bei Wilhelm Xaverius Jansen, page 278. 



THE PREVENTION OF TUBERCULOSIS. 65 

become almost general, and that one could daily see death carry off many citizens, and 
the destruction of numerous families, because of the little precaution practised.^ 

J. B. Martinez, a Frenchman, wrote from Naples even as late as 1834, — 

I am free to say that consumption is not less frequent in this city than in Paris and 
London. I will add, moreover, that after having visited nearly all the important hos- 
pitals of France, Switzerland, England, Scotland, and Italy, I have nowhere seen fatal 
cases of phthisis in such large numbers as at Naples. It is true that the contagious 
nature which the Neapolitans ascribe to this unfortunate disease, is the cause of always 
confining to the same room the victims which it strikes down. But it is also true that 
the disease is much more frequent. Besides, this observation agrees with those of 
Messrs. Pequin, Terrel, Clarke, Renzi, etc., and is the same as that of travellers, strangers 
to the healing art, who have written about Italy.' 

In order fully to appreciate Martinez's statements, as taken in connec- 
tion with the contemporary writers I have quoted, one needs further to 
keep in mind the words of De Renzi, who, when comparing the preva- 
lency of consumption in 1848 with that of 1782, said, — 

Which state of things ought to be a source of comfort to us now living, as we find it 
no longer almost general, although the precautions used are less.* 

We are so accustomed to form our ideas of the prevalency of a disease 
upon the percentage of deaths to the number of living people, that it may 
be well to try to make an estimate of the mortality rate from tuberculo- 
sis in the kingdom of Naples in 1782. De Renzi tells us, in 1848,^ that 
tuberculosis was not nearly as prevalent then as it had been when the 
Neapolitan laws were made. Martinez tells us, in 1834, that consump- 
tion was at that time much more prevalent in Naples than it was in 
Paris or London. The mortality rate from consumption in London* and 
Paris • in 1834 ranged from 4 to 6 per 1000 living people. It is safe to 
conclude, therefore, that the mortality rate from consumption in Naples 
in 1834 could not well have been less than 4 per 1000 living people, 

i"Si afferma in quella relazione, e ne prowedimenti govemativi che ne derivano, che" il male 
della tisi polmonale allora erasi reso quais generale, e che tuttodi si vedeva cagionare la morte di 
tanti dttadini e la destruzione di numerose famiglie per la poca cautela che si usava. 

Storia della Medidna in Italia. De Renzi, vol. v, page 5x1. 

*<' Je dirais voluntiers que la phtlusie pulmonaire ne se montre pas moins frequentment dans cette 
ville qu'elle ne le fait \ Paris ou \ Londres. J'ajoutrai m€me qu'apr^ avoir visite presque tous les 
hdpiteaux importans de la France, de la Suisse, de PAngleterre, de PEcosse, et de PItalie, je n'ai 
jamais vu nuUe part les malheureux phthisiques en aussi grand nombre qu'a Naples. H est 
Trai que le nature contagieuse que les Napolitains attribut \ cette triste maladie est cause qu'ils 
font toujours coucher dans les m&nes salles les victims q'elle doit moissoner. Mais toujours est 
viai que ces malades sont tres nombreux. Du reste, cette observation est d'accord avec celles des 
MM. Pequin, Terrel, Clarke, Rend, etc, d m&ne avec celles des voyagers Strangers \ Part de 
guerir qui ont ^crit sur PItalie." 

Notice sur la Topographie Medicale de Naples. J. P. Martinez. 

» *' La qual cosa deve rinsdr di conf orto f er i present! che non veggono quasi generale, comunque 
minori sieno le cantde che si udno.'* Storia della Medicine in Italie. De Renzi, tome v, pages 
511-514. 

« Supra ctto. Tome v, pages 5 1 1-5 1 4. 

'Registrar-general's report, voL i. 

• Paris. Vaccher sur Mortalite en, 1865, p. 176. 



(i(> THE PREVENTION OF TUBERCULOSIS. 

and that it probably was more than 6 per looo. And as De Renzi, who 
is most excellent authority, informs us that there had already been a 
great reduction, it will not be overstepping tjie mark to place the mor- 
tality rate from tuberculosis, for the kingdom of Naples and for Italy, in 
1782, at 10 per 1000 living people. That this is, if anything out of 
the way, an underestimate is not only shown by the descriptions of con- 
temporary writers, but by some hospital statistics which De Renzi gives 
for the year 1828. Out of 5,285 admissions to one of the hospitals of 
the city of Naples during the year 1828, 1,108 were consumptives; and 
out of 1,366 deaths which occurred in the same institution during that 
year, 699 were due to that disease.^ Now, after making due allowance 
for the fact that the consumptive poor were being isolated in hospitals 
at this time, it must not be forgotten that these are the deaths and admis- 
sions to but a single hospital, and that Naples at that time had at least 
four large hospitals. 

If anything further is needed to complete the picture of the appalling^ 
prevalency of tuberculosis in Italy in 1782, it can be found in the reputa- 
tion which that country bore throughout northern Europe at that time. 
Medical men of other countries began to advise their people to remain 
away from those sunny skies which canopied eternal spring, as they 
believed them to overhang a climate specially adapted to the production 
of consumption. Pugh wrote, ^'And to some or all of these causes do I 
attribute that unbalmy quality of the air of Naples, so peculiarly unfa- 
vorable to consumptive lungs." The danger attendant upon a prolonged 
visit to Italy, and the fatality of the Italian climate to persons afflicted 
with consumption, found forcible expression in the proverb, " Vedi Na^ 
poll e poi muori^'^ See Naples and then die. 

As compared with then, what is the mortality from tuberculosis in 
Italy now? Let the official returns answer: In 1887 the mortality rate 
from consumption for all Italy was 1.29 per 1000 living people, and 
from tubercular affections, including, with phthisis, scrofula, tabes 
mesenterica, and tubercular meningitis, 1.95 per 1000. During the 
same year the mortality from consumption and general tuberculosis for 
the towns and cities of the territory which formerly constituted the king- 
dom of Naples was 1.16 per 1000 living people; and for the rest of 
Italy, for the same diseases and for like towns and cities, 2.20 per 1000.' 

The mortality rate for the city of Naples, during the same year, from 
consumption and general tuberculosis, was 1.92 per 1000. The mor- 
tality rate during the same year for other tubercular diseases, such as 
tubercular meningitis, scrofula, tabes mesenterica, and tubercular arthri- 
tis, was, for the territory which formerly constituted the kingdom of 

^De Renzi, Topografia Di Napoli, pages 131-132. 

s Briefe von Dr. Diruf, Deutche KJinik, Berlin, vol. xiii, x86x. 

* The compiler of the mortality statistics of Italy tries to explain the discrepancy in the mortality 
returns from phthisis between the north and south of Italy upon the ground of substitution in 
nomenclature, as the deaths from bronchitis in the south of Italy are more mmierous than in the 
north. This is not satisfactory, however, as the excess of deaths from bronchitis in the south of 
Italy over those in the north occurs in persons under 10 and over 50 years of age. 



THE PREVENTION OF TUBERCULOSIS, 6*J 

Naples, .89 per 1000 living people, and for the rest of Italy, .85 per 
1000. The mortality rate from the same diseases for the city of Naples 
during the same year was 1.26 per 1000.^ 

It will thus be seen from the figures given that there has been a very 
large reduction in the mortality from tuberculosis in the entire kingdom 
of Italy, and that the reduction has been particularly marked in the terri- 
tory which formerly constituted the kingdom of Naples. Italy has at 
present the lowest mortality rate from consumption of any country in 
Europe,^ with, possibly, the exception of Spain ; and that part of it which 
formerly constituted the kingdom of Naples is, in the country districts 
and small towns, practically free from the disease. Forty-five towns in 
this part of Italy, with an aggregate population of 742,068, had a mor- 
tality rate of .58 per 1000 from consumption and general tuberculosis dur- 
ing the year 1887. Ten selected towns, with an aggregate population of 
146,924, had a mortality rate of .28 per 1000 from the same diseases 
during the same year. Four selected towns, with an aggregate popula- 
tion of 36,460, had a mortality rate of .19 per 1000.^ It is fair to sup- 
pose that the country districts in this part of Italy have a still lower 
death-rate from these diseases. 

Expressed in figures, the reduction in the mortality from tuberculosis 
in Italy, since 1782, ranges from 50 per cent, to 90 per cent. The much 
greater reduction in that part which formerly constituted the kingdom 
of Naples is no doubt due to the immediate influence of the Neapolitan 
law. This is all the more noteworthy, since, at the time that the pre- 
ventive measures were begun, the disease seemed to be more prevalent 
in Naples than in any other part of the country. To fully appreciate 
the magnitude and to understand the entire meaning of this reduction, 
it must fiirther be borne in mind that Italy has again become, and has 
been for the last thirty or forty years, a famous resort for consumptive 
invalids. That the presence of such visitors contributes to keeping up 
the disease in Italy is evident from the mortality returns of the towns and 
cities frequented by them. Pallanza, for example, had a death-rate from 
consumption and general tuberculosis in 1887 of 4.21 P^^ 1000, Pisa, 3.25 
per 1000, San Remo, 2.44 per 1000, and Specia, 2.35 per 1000.* 

Now, what is the lesson to be learned from this vast reduction in the 
mortality from tuberculosis in Italy under the influence of the Neapol- 
itan law ? In the first place, it is a practical demonstration of the pre- 
ventability of the disease; and, secondly, it gives us some idea of what 
measures will bring about such a result. When, side by side with the 
reduction in the mortality from tuberculosis in the kingdom of Naples, 
under the operation of the Neapolitan law, is placed the reduction which 
has taken place in England during the last forty years from the same 
disease, as the result of isolation in special hospitals, it can certainly no 
longer be said that the prevention of this disease is a mere theory. In 
England there has been a reduction of 50 per cent, in the mortality from 
tuberculosis in forty years as the result of isolation, or from 3 to 18 per 
> Statistica deUe Cause deUe Morte, &c., 1887. 



68 THE PREVENTION OF TUBERCULOSIS, 

cent, of all cases a year.^ In the kingdom of Naples the disease has 
been nearly exterminated in one hundred years by a system of isolation 
and disinfection, or, rather, destruction of infected objects. Either of 
these facts, standing by themselves, might be looked upon as a mere 
coincidence ; but taken together, they must be accepted as the exponents 
of a fixed law. They show that tuberculosis is not only a preventable 
disease, but that it can be prevented by simple, easy methods. Now 
that we have real scientific knowledge of the etiology of tuberculosis, 
and know something of the biology of the little organism which pro- 
duces the disease, we can understand how the empirical practices in 
Italy, and the single preventive measure in England, can have produced 
such astonishing results. We see the law, that no new case of tubercu- 
losis can arise without having an old one to spring from, proved by the 
placing of old cases where they cannot produce new ones. 

In the light of the histoty of tuberculosis in Italy and in England, is 
the sanitarian of the day fully cognizant of his power over this disease, 
and fully aroused to his duty in the matter of its prevention ? If empiri- 
cal methods could produce such results in Italy, and isolation on a com- 
paratively small scale could produce such effects in England, what 
would be the result of well regelated scientific methods for its preven- 
tion ? It is my firm conviction, after careful study of the question, that^ 
with our present knowledge of the etiology of the disease, we have it in 
our power completely to wipe it out in a single generation. To do this 
would of course require well organized boards of health, an enlightened 
public, and the codperation of the entire medical profession. The pre- 
vention of disease is always nobler than its cure. Were half the energy 
which is being spent in the almost hopeless task of searching for a spe- 
cific cure for tuberculosis devoted to its extermination, its accomplish- 
ment would be guaranteed. Why is nothing practical being done? 
The entire medical profession seems to have accepted the theory of the 
contagiousness of tuberculosis. Are we afraid to follow this theory to 
where it leads? If the disease is contagious, it can be prevented. If it 
can be prevented, why are there not already practical measures in opera- 
tion for its restriction ? With the object-lessons of Italy and England 
before us, we can no longer remain inactive consistently with our con- 
victions. 

Inasmuch as we now know that thecontagium of tuberculosis is confined 
to the sputa and pus, preventive measures are much simplified, as all that 
is necessary is to render those substances innocuous. How should this 
be done ? At the present stage of public enlightenment on the subject, 
the one measure which will accomplish most good, with least friction 
with preconceived ideas, is the establishment of special hospitals for the 
treatment of the disease. The voluntary withdrawal of patients to such 
institutions would remove centres of infection from the family hearth- 
stone, and would spread the doctrine of prevention, as well as practically 

^Spedal Hospitals for the Treatment of Tuberculosis. L. F. Flick, Times and ^^ister. 
March 15, 1890. 



THE PREVENTION OF TUBERCULOSIS. 69 

educate the public to its methods. I believe, however, that the time has 
come when we should go further. Tuberculosis should be placed on 
the list of diseases returnable to the board of health, so that a record 
may be kept of the whereabouts of every case, and of its movements 
from house to house. From a careful topographical study of the disease 
in the fifth ward of the city of Philadelphia,^ extending over a period of 
twenty-five years, I am convinced that fully one half of the cases of 
tuberculosis among the poor people have their origin directly or indi- 
rectly in infected houses. A family unsuspectingly moves into a house 
which has just been vacated by a family in which a death has occurred 
from tuberculosis. In the course of time the weakest member of this 
family succumbs to the disease, and a new series of victims is started. 
The public certainly owes a duty to the individual in this matter, and 
that duty can only be exercised through the board of health. By keep- 
ing track of every case of tuberculosis, by showing the family of the 
unfortunate victim how to protect themselves against the disease, and by 
disinfecting every house which has been occupied by a consumptive, 
before a new occupant moves into it, our boards of health could make 
themselves a most potent factor in the restriction of this fearful destroyer 
of human life. 

I am aware that a great cry is being raised in advance against any prac- 
tical preventive measures for the restriction of this disease, upon the 
plea of humanity. Why further burden the life of the poor consump- 
tive, they say, by removing him from his family and friends, and empha- 
sizing his hopeless situation? Sincere as the feelings may be which 
give rise to this conservative protest, it is evident that they are not 
inspired by a thorough understanding of the subject, such as can only be 
obtained by a bedside study of the question. What can be more inhu- 
man than consigning an intelligent human being, with a long, tedious, 
loathsome disease, to the care of those whom he loves, when that care 
implies deprivation and death to them, and despair to himself? The 
classical symptom of consumption is hope, and unbounded faith in ulti- 
mate recovery ; and oh what ingenious cruelty to make the poor victim 
feel that no helping hand is extended to him, and that his chances for 
recovery are curtailed by the poverty of those who love him I The pre- 
ventive measures for the restriction of tuberculosis, as dictated by the 
science of to-day, are all in direct line with humanity ; and the strongest 
arguments which can be advanced for their adoption are bom of the 
great command, '^Love thy neighbor as thyself." It is certainly humane 
to give the poor man who falls a victim to this disease a home in a 
hospital, where he can receive all the aid of medical science for his 
recovery, and where he can feel that he is neither snatching from his 
dear ones the morsel of bread which is necessary for their sustenance, 
nor infecting them with the horrible disease from the grasp of which 
he is trying to extricate himself. It is certainly humane to extend to 

> Contagiousness of Phthisis, L. F. Flick. Transactions of Medical Sodety of State of Pennsyl- 
vania, 1888. 



70 THE PREVENTION OF TUBERCULOSIS, 

the poor protection against a disease against which they have neither the 
knowledge nor the means to protect themselves. Preventive measures 
against tuberculosis imply nothing more; and I trust this convention 
will not adjourn without taking some steps looking to concerted effort in 
this direction. 



XI. 

VENTILATION AND IMPURE AIR AS PROPHYLACTIC 
OR CAUSATIVE OF DISEASE. 

By p. C. REMONDINO, M. D., San Diego. Cal. 

Unimpeded ventilation accomplishes several objects. It is not alone 
in the necessary aeration of the blood that perfect ventilation assists us 
on the road to health and long life, with a better capacity for its enjoy- 
ment, but by its free and constant action, and the thorough diffusion and 
dissemination of the air, it also tends to render inert and harmless those 
disease germs and fomitic productions that are the curse of populous 
centres : by ventilation we either prevent or mitigate the evils that may 
arise from the presence of either fomites or ochlesis. The general popu- 
lace believe too literally that *' sufficient for the hour is the evil thereof" 
to worry over the fact that disease germs have an inherent tendency to a 
tolerably long life, provided they are protected from the light and air. 

When an episode occurs like that connected with the tearing down of 
the fever ward in the old New York hospital, where three out of the five 
masons engaged died of putrid fever in a few days,^ or a case of diph- 
theria or typhoid fever occurs in a room which has had similar cases a 
year or so previously, they are necessarily struck with the fact that the 
disease lurks about where it has once been, without its once occurring to 
them that this lurking is due to a tangible explainable cause, a physical 
avoidable result, and just as plain as that when you sow barley in the 
ground. Providence permitting, you will surely gather a barley crop. 
The fact that an old mattress, a manure heap where the stools have 
been emptied, drinking or bathing water, the dust in the crevices in or 
beneath the floor or in the wall, or wall-paper, carpets, or bedding, may 
have retained and conveyed the infection ^ does not connect the fact to 
the popular mind that all these vehicles have carefully shielded and pro- 
tected the germ from the air, or that most germs have at best but a short 
life if freely exposed to the air, and a remarkably short one if that air be 
dry, warm, and sunny. 

Recent experiments on the bacillus of tuberculosis have shown it to 
retain a wonderfully long vitality, extending for years when buried in the 
ground, while Koch has demonstrated that in the air and sunshine its 
vitality is limited to some minutes or hours. In the Crimea, the ground 
occupied by the French and English army became so foul that the project 

1 Hospitals and their Construction, by W. Gill Wylie. 

* Condensed Report on Typhoid Fever, Mame State Board of Health Rep., 1889. 



72 VENTILATION AND IMPURE AIR, 

of reducing Sebastopol nearly came to an end without any further 
diplomatic or armed interference on the part of the Russians. By dig- 
ging long trenches in the shape of a cross, and building fires at the inter- 
sections of the lines, the ground was drained of the mephitic gases that 
threatened the destruction of the troops. The shifting nomad avoids all 
these dangers, and, as will be explained further on, he also escapes infec- 
tion from cast off clothing, the fact of the exposure to sun and air of the 
clothes having destroyed all infection being one reason, and his own 
better aerated blood being another. 

From the above it will be seen that ventilation means more than the 
simple breathing of a purer air. It also means less danger from infection 
and disease, while deficient ventilation not only prepares the body and 
mind for disease and infection, but it also furnishes the viable causes for 
the disease and infection : hence the importance of the subject in a much 
greater sense than the one in which it is generally considered. 

The busy practitioner, daily occupied with the struggle with disease, 
has his attention fully taken up with the therapeutic necessities of the 
cases before him. He is expected to know what will relieve and allevi- 
ate in this or that case : this is all the patient asks of him : and as he 
may be successful in this regard, so goes his reputation as a physician. 
This is really all that the community expects of him. Should he refer to 
past events, nothing strikes the patient as of any importance, unless it be 
some serious physical accident or illness that may have preceded the 
present complaint. A business reverse, domestic affliction, or a severe 
mental strain, perchance a candidacy for office in some exciting election, 
or doing business in an unhealthy locality or unventilated apartment, 
may have come and gone, but to him these are of no importance ; if he 
cannot go back for a starting-point to a steamboat explosion, a railroad 
collision, or a '^ bad cold which settled on his chest,'* he cannot see any 
reason why his present illness should antedate its commencement be- 
yond a day or two. He may have had occasional headaches, probably 
even some disordered vision and slight vertigo, or, perhaps, felt at times 
unaccountably tired, forgetful, and an inaptitude to attend to business, 
but these are mere nothings, in fact it was not even worth mentioning ; 
a seidlitz powder, or a peptonic or soda-mint tablet, generally has set 
him all right. He does not wish you to think that there is an3rthing 
serious about him, as he knows full well that there is not ; if you will be 
kind enough to prescribe for his present ailment, it is all he desires. 

So it goes. Disease is simply looked upon as something that has a 
spontaneous origin. The past life, trials, and exposure are supposed to 
have left no trace or effect on the organism, and the future is expected 
to look out for itself. Poor patient I he plods along in blissful ignorance 
that the slight ailment, headaches, or weariness are but the picket firing 
of the distant outposts to warn the main body of the approach of an 
enemy, while he, unheeding and in fancied security, finds himself a 
prey to his foes. The laity are not altogether blamable for their igno- 
rance in these matters. Our profession has not taken the pains to have 



_j 



VENTILATION AND IMPURE AIR, 73 

them enlightened, and, unfortunately, that very occupation in which we 
are daily engaged, the healing and reparative art, often obscures from 
our field of vision that preventive branch of our science to which we 
must soon look as to something of paramount importance if we wish to 
raise a rampart against the rapid encroachments of the physical, intel- 
lectual, and moral degeneracy which is fast undermining the great mass 
of the population in civilized nations. 

Statistics may at times be erroneous and unreliable, but there is no 
mistaking the fact that nervous and morbid irritability, as well as idiocy 
and lunacy, are on an alarmingly rapid increase. In England alone — 
where statistics are reliable — since 1859 ^^ increase has been excessive, 
the total of idiots and lunatics being, after making all allowance for 
increase of population, all of 33 per cent, greater than it had been for 
the same period of time previously. Throughout the land, asylums, hos- 
pitals, retreats, jails, and like institutions for the physically or morally 
wrong are multiplying, and infirmities and depravity are increasing at 
an equal pace. We all admit that for certain efiects there must be spe- 
cific causes. To find this cause falls to the province of the hygienist and 
demographist. As physicians, we are well aware that a pathologist must 
of necessity first be an expert physiologist ; he must first understand the 
condition of the tissues in healdi and their normal action to be able to 
appreciate when they have deviated therefrom. 

Let us, for example, take the Indian of America. Catlin tells us that 
in all his observation, both in North and South America, he never saw 
an idiot, lunatic, deformed, rachitic, deaf or dumb Indian, either male or 
female ; neither did he, at any time, after the closest inquiry, find a tribe 
that ever had any premature mortality, deaths from teething, cholera 
infantum, or infantile diseases; neither did the woman abort or have 
premature births. 

My own observation among the Sioux, Chippeways, Winnebagoes, 
and the California tribes of Indians is confirmatory of the above ; to 
which I might add, that although I have seen many of them drunk, I 
have yet to see the first case of delirium tremens in an Indian. 

Benjamin Ward Richardson, in an instructive lecture delivered in 
1885, before the Association of Sanitary Inspectors, reviewed the rela- 
tions of the nomadic or homeless people of England in their relation to 
health and disease. He observed among this class a peculiar exemption 
to infection from zymotic diseases, mentioning particularly the gypsy, 
whom he has seen camped in neighborhoods infected with scarlet fever 
without incurring any risk, and he has never seen one marked with 
small-pox ; these people have neither phthisis, scrofula, or any kindred 
diseases. From my own observations I do not remember ever seeing a 
feeble-minded, idiotic, or lunatic gypsy. 

If, in a family of six, we were to find three who had partaken of some 
particular article of food who were very sick, and the other three who 
had not touched it well and uncomplaining, we would be safe in assum- 
ing that the particular dish was the cause of the sickness in the first 



74 VENTILATION AND IMPURE AIR, 

three. Now, if one of the well ones should accidentally or intentionally 
eat of the same dish, and likewise sicken and present analogous symptoms 
to the other three, we then would have conclusive evidence that this dish 
was the real and only cause of the disturbance. 

If we apply the same rule to the general physical conditions, we find 
that barbarous and nomadic people were all in the enjoyment of the best 
of health ; that finally a portion became civilized, and then began to 
house themselves in ; that with this change in their habits and customs 
also came ill-health, physical and mental ailments, and general degener- 
acy. We notice further, that those who still follow the old nomadic hab- 
its still retain their health and enjoy exemption from disease, but we well 
observe, whenever any of these adopt the customs of the civilized man 
and go on and house themselves like the others have done, that they 
also sicken, and that their children become like the children of the close 
house-dweller — k prey to all kinds of ills and to premature mortality. 
That the change from an out-door to an in-door life is the cause of the 
departure of health is self-evident, and still better confirmed, when the 
close house-dweller partly resumes the more open-air life of his ances- 
tors and is found to have regained lost health and exemption to disease. 
It needs neither bacteriology nor the pathologist to confirm our deduc- 
tions. 

Some years ago an Indian agent built a number of farm-houses for the 
Indians in his charge. What was his surprise when on a visit some time 
subsequently, to find the house littered with the harnesses, plows, sad- 
dles, with other farming implements, and the Indian camped at a safe 
distance in his tent. On inquiry, the Indians told him that the house had 
made them all sick, and that some of them had even spat blood, and that 
they had moved out and were now all right. 

There can be no doubt that the difference in health, depravity, and 
mortality that exists between strictly nomadic people, uncontaminated by 
border civilization and civilized man, can be attributed in a great meas- 
ure to mode of habitation, as we find that those who live in large and 
well ventilated houses, or whose occupation keeps them out of doors, 
and where the climate allows of free and constant ventilation at all sea- 
sons, that the people more nearly approach the state of perfect health 
enjoyed by the nomad. 

Popular opinion on the subject is very crude. The majority have in 
some manner a vague idea of a carbonic oxide that kills, and some of the 
better informed will tell you of the Grotto del Cane ; they have also 
some idea regarding the favorite Parisian mode of suicide ; and they are 
not astonished at such occurrences as that of the Black Hole of Calcutta, 
the ship Londonderry with its seventy-two dead in the steerage, or at 
the English sloop that smothered all of its seventy passengers between 
Jersey and Southampton ; they also know that they should not venture 
where a candle will not burn. In my opinion it is the erroneous views 
that they hold that prevents them from really and fully realizing that 
there are unseen dangers in unventilated apartments besides mere unre- 



VENTILATION AND IMPURE AIR, 75 

spirable air, and that the cause which daily places people where they are 
sure to suffer irremediable injury is their lack of knowledge concerning 
the real dangers. They rely for safety on the fact that the light burns 
brightly in a certain atmosphere, and that therefore they run no danger, 
the burning tager being their criterion of the respirable condition of the 
air. The laity should be taught, what De Saussure long ago demon- 
strated, that the fresh, invigorating, effervescing mountain air contains a 
greater percentage of carbonic oxide than the air of the plain or sea- 
shore, and that on a bright day, the air of a London or New York park 
actually contains a less percentage of carbonic oxide than the air of the 
Catskills or the hills of Scotland. They should realize that carbonic 
oxide is not inimical to life, but only cannot support life ; that men have 
temporarily labored in an atmosphere with 17 or 1 8 per cent, of that gas, 
whereas ordinary air only has 4 per cent. ; and that persons going into 
such a carbonized air that it will hardly support a candle alive, have 
actually at first not even found it objectionable ; and that but in a few 
isolated instances this is the last source of danger from un ventilation » 
They should also understand that any injury, or even asph3rxia, that may 
result from the presence of this gas in excess, — that such sickness is 
quickly recovered from, provided the condition is not pushed too far. 
Where there is danger, however, the calamity occurs suddenly, and where 
the recoveries are made, they are as prompt. 

As has been pointed out by Brown-Sequard and D'Arsonval, the mor- 
bific element in respired air is the pulmonary emanations, to which they 
might have added the perspiratory efHuvia. That great delineator of the 
human passions and frailties, Shakespeare, has well depicted the effect 
of this efHuvium from skin and breath in his Julius Caesar, where the 
rabble so yelled with a deal of stinking breath and threw up their equally 
stinking, sweaty night-caps, when he refused the crown, that it caused 
Caesar to faint and Casca to hold his own breath for fear of taking some 
of the poison into his own lungs. ^ 

The best account of the effect of this organic poison is from the 
pen of Dr. Holwell, one of the twenty-three survivors who escaped 
alive from the Black Hole. His account, written in i757) ^^^^y shows 
each step of the action of this intoxicant and narcotic poison, which, 
after many hours, left him still conscious, but *^ sensible of no pain and 
of but little uneasiness, with a stupor coming on apace, in which condi- 
tion I laid down to die in peace, and gradually became unconscious. '^ 
The maddening, intoxicating phrensy of the men, as described by Hol- 
well, cannot be ascribed to the mere fear of death, as British soldiers have 
met death, going down with dressed ranks in a foundering troop-ship, that 
confusion might be avoided and the women and children saved. In that 
tempest and storm-tossed ship, however, there was not that poison from 
animal efHuvia accumulating in their blood like fusel oil.^ 

Hutchinson well observes that " we unwisely neglect the study of the 

> Julius Caesar, Act I, Scene II. 

* Family Physician, chapter on Hygiene, published by Cassell & Co., London. 



76 VENTILATION AND IMPURE AIR, 

differences that exist between man and man — a difference, that, for the 
most pait, physiology takes little cognizance of, but which may prove of 
much importance in modifying the processes of disease."^ In our zeal to 
master or carefully to study the disease, we are so apt to make it a self- 
consistent condition, and become so absorbed in our research that we are 
apt to lose sight of first principles. Hutchinson deplored this tendency ; 
and Richardson, — in speaking of our classification of diseases as '' unsys- 
tematic and fanciful, and its nomenclature imperfect, even for the technical 
purposes of language, and inapplicable for the higher development of 
medical scientific research and practice," — also felt that we were draw- 
ing away from first principles.* Were we to keep in mind that heredity 
is only an acquired or cultivated habit ; that, as our forefathers in the 
days of Tacitus roamed through the forests of western Europe with- 
out aid of spectacles, the physique of the German, Gaul, Goth, or 
Briton was the admiration of the warlike Romans, whose superior arms 
and discipline alone enabled them to overcome them ; and that these 
men had neither gout nor phthisis, — we could not reasonably say that we 
owe our infirmities to their simple, martial, out-of-door life. Heredity 
must, therefore, have had a subsequent origin so hs as our diseases are 
concerned, and, as they do not originate spontaneously, where did they 
begin ? Morel, in his work on the degeneracy of our race, places tox- 
emia as a primary cause.' Toxaemia has several sources from which it 
may result, and a careful study into the original cause of diseases will 
generally result in establishing the fact that outside of those originat- 
ing in a specific disease germ, some form of toxsemia is generally the 
starting-point of sickness, and that even most of the other diseases that 
owe their origin to, or that can be propagated from, a bacillus often them- 
selves have their primary birth in toxsemia, whether it be from over- 
feeding, ursemia, or infection from the emanations of respired air, or from 
some animal or vegetable decomposing matter. From whatever source 
it may come, it often produces precisely the same results. 

In a paper read before the Southern California Medical Society, enti- 
tled ^' A Plea for Circumcision," I showed that one of the main dangers 
or results from reflex irritation lies in the toxaemia that it may induce. In 
the paper mentioned, I followed the different reflex processes due to phy- 
mosis up through to the obstinate and irremediable constipation due to 
sphincterismus, a condition described by Agnew,* of Philadelphia. In fol- 
owing up the different steps that the condition assumes, I showed the im- 
mense importance that Sir Lionel Beale attaches to blood composition 
as the ground-work of health or disease, wherein he truly observes that 
'^ blood changes are the starting-points, and may be looked upon as the 
cause of what follows," the other factors being the '* tendency, or inherent 
weakness or developmental defect, of the organ which is the subject of at- 
tack." To which he adds, that he feels convinced that if only the blood 

* The Pedigree of Disease. 

* Diseases of Modem Life. 

* Traits des D6g6n6rescences Physiques. 

* Agnew's Surgery, Vol. I. 



VENTILATION AND IMPURE AIR. *1*J 

could be kept right, thousands of serious cases of illness would not occur ; 
while the persistence of a healthy state of the blood is the explanation of 
the &ct that many get through a long life without a single attack of illness, 
although they may have several weak organs, and that an altered state of 
the blood, a departure from the normal physiological condition, often 
explains the first step in many forms of acute or chronic diseases^. Sir 
Lionel' might have added that the ^'tendency or inherent weakness or 
developmental organic defect," which, after all, is all the foundation or 
ground-work for the hereditary diathesis, is itself the outgrowth of trans- 
mitted toxaemic tendencies, or conditions affecting former generations, 
or of previous toxaemic results in the individual itself, as we can safely 
assert that our fathers, of barbarian memory, left us no inheritage of 
developmental organic defects. The daily increase of these physical 
defects shows plainly that they are so, not from inheritance, but from 
present causes or cultivation, as well as it plainly explains that toxaemia 
lays the tendency to reflex troubles, also on the increase, which in turn 
favor further toxaemia by the disturbances, deterioration, and morbid 
sensitiveness that they occasion, — ^the retroactive effects of either good or 
bad physical condition being here fully exemplified. Fothergill shows 
how this condition of blood, whether due to reflex irritation, unventila- 
tion, or overfeeding, or from mental disturbances, eventually results in 
uraemic difficulties which engender kidney disturbances, notably Bright's 
disease, and that instead of these diseases being the cause of the uraemia 
that finally takes off the patient, the uraemia is the real starting-point 
of the kidney disease, which goes on until such structural change has 
been effected that we reach that point where the kidney is no longer 
equal to its functions — the renal inadequacy of Sir Andrew Clarke.^ 

In the Bradshawe lecture, an extract of which appears in Braithwaite 
for January of 1889, William Carter observes as follows: "According 
to Bouchard, one fifth of the products of the total toxicity of normal 
urines is due to the poisonous products reabsorbed into the blood from 
the intestines, and resulting from putrefactive changes which the residue 
of the food undergoes there." 

One of the changes that full respiration in the open air effects in the 
blood is the destruction of these toxic elements. This is mentioned for 
the purpose of explaining the intimate relations that exist between all 
the causative conditions, physiological or pathological, that tend to 
induce toxaemia. The large-lunged and deep-chested Indian will eat at 
one meal as much food, indiscriminate as to quality or state of pres- 
ervation or of putrefaction, as will do an ordinary white man for three 
days, or even a week ; but toxaemia, with the attending ills, does not 
find in the Indian a favorable resting-place, so that after the most gour- 
mandizing meal he is in no more danger from toxic absorption than he 
is from an attack of delirium after the most generous or protracted 
drunk. Former perfect aeration of the blood has not left him with any 

^ Beale, Urinary and Renal Disorders. 

> J. Milner Fother^^, in Satellite, February, 1889. 



78 VENTILATION AND IMPURE AIR, 

developmental organic defect in the minute structure of his organism, 
and the present perfect condition of his respiratory apparatus oxidizes 
and works off into the outer air all the toxic products that are brought 
to it. He needs neither pepsin nor naphthalin to insure him against 
toxic accidents. 

It is evident that we have different sources by which the blood can be 
charged or over-charged with toxic products, but it must remain fully 
as evident that nature has given us the organs of respiration for their 
elimination. The skin and kidneys are depurative mediums, and very 
important channels it must be admitted, but we must not fail to recog- 
nize that they are not the chemical laboratories that the lungs represent. 
It matters not if all the chemical changes do not take place in the lungs, 
it is through the lungs that the agents are taken that must bring about 
the changes ; and, after all said and done, it may safely be assumed that 
imperfect blood depuration is the starting-point of ill-health, either phys- 
ical, mental, or moral, for what matters it whether you have a pneu- 
monia or phthisis, or are even insane owing to a cardiac derangement, 
or are insane from ursemic retention due to Bright's disease, or you are 
laid out racked with gout, rheumatism, and allied disorders, or are even 
watching the slow approaches of grim death through the slow process 
of senile gangrene, with an amblyopia that even robs you of the comfort 
of reading, and distraction, — we must in every case go back to the pri- 
mary cause, which will always be found to be toxaemia. It is always 
imperfect blood depuration that is the^bw^ et origo malt. 

To what fine distinctions, differences in condition of health or disease 
may be due to, after the developmental defect or inherent tendency 
has once been established, and to what trifling circumstances a person 
may attribute his particular point of divergence from health, may be 
inferred from the fact that even in an apartment where the ventilation 
may be equal in all its parts, a particular form of task may so affect 
the breathing organism by strengthening or weakening the organs of 
respiration that a statistical difference in the health of each class will 
be noticed. For instance, Lombard long ago furnished statistics that 
showed that the copyist was much more prone to phthisis than the book- 
keeper or accountant,^ the steady, unmoving work of the former occupa- 
tion making the difference ; the type-setter in a printing establishment is 
much more subject to the same disease than the pressman. 

Another condition of affairs that must not be overlooked in this con- 
nection is the fact that the predisposition or tendency-causes do not by 
any means cease with the departure from the office or work-room, for the 
better developed muscles of the chest, in the pressman or ordinary and 
more active clerk, when in the outer air, so work as to more effectually 
empty the lungs and aerate the blood, while in the copyist and type-set- 
ter, as in the mosaic worker, they are weak and undeveloped and but 
ill perform their functions, so that even when in the outer air, owing 
both to lesser chest capacity and feebler respiratory movements, aeration 

^ L' influence des Professions sur la phthisic pulmonaire. 



VENTILATION AND IMPURE AIR, 79 

is never as perfect ; so that either in the house, or out-of-doors, he loses 
more ground in the physical scale than the other classes. I have pur- 
pK>sely taken an extreme illustration, — where, however, statistics fully 
support the proposition — to show that the physiological working condi- 
tion of the respiratory apparatus cannot all be overlooked, and that all 
does not depend on sanitary architecture. 

There is much in popular errors that helps to bring about our condi- 
tion of physical degeneracy ; — for example, people look upon cold as their 
great and dreaded enemy, whereas cold, unless in an extreme degree, 
does not and cannot hurt any one primarily. To shut out the cold, 
which is harmless, they shut themselves up with ochlesitic poisons, as 
morbific and fatal in the end as the effects of alcohol or fusel oil : they 
have a vague idea that " catching cold" is to be avoided, but they have 
not the least idea of the lasting poison of ochlesis or in fomites. A man 
wll give a friend a wide berth during the critical period of typhoid fever, 
but as soon as that period is passed, he and his whole family will troop 
into the room, in blissful ignorance of the researches of UfFelmann and 
others into the wonderful tenacity of life possessed by typhoid bacillus ; 
or, so that they avoid the immediate breath of a consumptive, they live 
in fancied security. That this infection, as well as that of typhoid and 
other disease germs, is longer lasting in a dark or north room is not of 
any importance. The lady of the house, on the departure of her consump- 
tive visitor, will at once draw the curtains and close the windows of her 
parlor that the light and dust may not affect her carpets and bric-a-brac, 
perfectly unmindful that the care she bestows to protect these things she 
may do at the expense of the health and life of a son or daughter ; she 
does not know, nor has she taken the pains to learn, nor has any one 
undertaken to instruct her, that the bacillus of such diseases as typhoid 
fever, diphtheria, phthisis, and most diseases which have a specific germ, 
cannot exist and hold their identity in solar light and air, which, as has 
been demonstrated by Koch, kills them in from a few moments to a few 
hours, — which leaves no room for doubt that, by the construction of our 
houses and by the studied exclusion of light and air, we do most for 
the retention of these disease germs, and at the same time contribute to 
the preservation of their vitality. I have alluded heretofore to the injury 
that deficient ventilation does to humanity in producing toxemic condi- 
tions : we now see how the same deficient ventilation tends to maintain 
germ infection. 

It is probably in a bird's-eye view of the many phases that the pathology 
of phthisis has at different times assumed, and of the various forms of 
treatment that these changing views have inaugurated, that we see how 
and wherein the importance of ventilation to life has been so shamefully 
neglected, — how, as it were, in the general advance of knowledge, as in 
a line of battle, the too rapid advance of one portion has risked the fate of 
the battle. The study of the etiology and pathogeny of this disease, and 
the wonderful discoveries of Koch, and the many ideas in regard to its 
pathology, etiology, or pathogeny that have been advanced here and 



8o VENTILATION AND IMPURE AIR. 

there, have all absolutely been insti^umental in obscuring from us the fact 
that air and sunshine are its preventives, and that it matters little what 
therapeutic means we may call to assist, — that unless we add plenty of 
fresh air and sunshine, all our efforts are ineffectual. 

We can easily observe the ludicrousness of the appearance of the legs 
of the Pope's body-guard in their variegated coverings ; — ^but we must cer- 
tainly admit that it is more ludicrous to see a patient going in one direc- 
tion to have the air pumped out of a cabinet wherein he is to sit, on the 
Jourdanet idea of an artificial Anahuac climate, and that rarefied air is the 
proper thing ; and another going in another direction to be enclosed in- a 
Pravaz pneumatic cabinet of compressed air where air will be pumped 
into the cabinet. 

It is very evident that Jourdanet failed to grasp the plain truth, in not 
observing that it is neither the altitude, barometric reading, nor rarefied 
air that gives the Anahuac plateaux and the Colombian or Peruvian 
Andes that exemption from phthisis, any more than it is the depression 
below sea-level and compressed atmosphere of the Kirghis steppes, the 
valley of the Jordan, or of the desert of the Colorado in southern Cali- 
fornia, that exempt their dwellers from the same disease, — any more than 
filling the lungs with a gaseous compound by the mouth or the colon per 
rectum by chemical gases at regular intervals could keep an Indian 
from having phthisis if suddenly taken from his native plains and housed 
in an average boarding-house. The Tartar of the Kirgheez and the Peru- 
vian Indian of the high Andes need no rubber bag of gas with a rectal 
tube, microbe-killer, or medicated woollen garments to protect them 
from phthisis ; and the microbe or bacillus that finds its way into those 
Peruvian homes, — ^which Americans find so peculiar that people sit in 
the chilly air with their shawls without having sense enough to close the 
doors, — ^finds a short existence. 

Davis, a former governor of the British colony in Hong Kong, in his 
work on the customs of the Chinese, tells us that, among the higher 
classes, when a visitor arrives, he finds a ventilation in their large and 
open apartments equal to that out-of-doors, but that the host has 
generally a large assortment of furry coats which are handed out some- 
thing like napkins at an afternoon tea ; — with his other hospitalities, the 
Chinese gentleman sees to it that his guesfs health is not ruined in his 
house.^ It might be added, that the free use of weak and tepid tea, in 
which they all indulge, acts in no small way as a preventive of ursemic 
accumulation, for without going to the extent advised by Sangrado in 
Gil Bias, there is no doubt that many of our people, considering the 
amount of food they consume, take hardly enough fluid to assist proper 
blood depuration. 

The example of the Chinese in regard to ventilation and hospitality 
could be ingrafted into our civilization with benefit not only to our 
health, but to our morality. Some may perchance think that with the 
indiscriminate use of these garments, diseases would be more and more 

^ The Chinese, by J. F. Davis, F. R. S. 



VENTILATION AND IMPURE AIR. 8 1 

disseminated. This would not be the case, however. In the first place, 
there would be less diseases ; and secondly, Richardson, as already ob- 
served, has shown that vagrants who deck themselves out in cast-off 
odds and ends of clothing, which are often infected, hardly ever receive 
any harm from the clothes, the sun and air having effectually slain all the 
bacilli or disease germs. I cannot see why the profession cannot accept 
the fact that pure air and sunshine are the preventive agents, as well as 
the curative means, in phthisis, and drop all of those makeshifts with 
which they torment themselves and the patients, such as the hot air treat- 
ment with which some undertake to circumvent the wily bacillus. 

Gout and rheumatism, as well as asthma, owe their origin to deficient 
blood aeration much more than is generally believed. The classic attack 
of gout suffered by Sydenham when composing his work on gout, as 
well as that other attack suffered by John Brown, — equally as classical 
but more important, as it was the key-note to a revolutionary movement 
in medicine, and the inauguratory point for the conception of the Bruno- 
nian doctrine of sthenia and asthenia, — were undoubtedly due to the 
nveakened and imperfect respiration that at the time affected those two 
beacon-lights of medicine. The English Hippocrates was no doubt 
absorbed, and writing with bated breath his dissertation on gout ; and 
from Brown himself we learn that he was weakened down and below 
his normal condition of health at the time.^ 

Loomis writes, in his edition of" Charcot on Diseases of Old Age," 
of a Confederate officer in whom the gout was developed by confine- 
ment in an unhealthy and damp prison with insufficient food ;' and is it 
not a generally known fact that Holwell, already mentioned, suffered 
from a severe attack of the gout in one foot a few days after his liberation 
from the Black Hole.?' 

I have seen instances of gout developing under similar circumstances, 
notably the case of a physician accustomed to an out-of door life, who 
found himself confined to the bedside of his child affiicted with measles ; 
he never left the little fellow's bedside, and the room was kept closed. 
On the recovery of his son, he suffered severely from his first attack of 
gout. Although his family has no gouty or rheumatic history, they being 
long-lived, hearty people, one week of close air developed a disease that 
may require generations of careful watching and pure air to eradicate 
from the family, should he have any more children. 

On the other hand, the case of the rich and gouty old priest, observed 
by Van Swieten, and mentioned by Fothergill in his work,* is very 
instructive. Here was a cheerful old gentleman of the old school, a 
good liver, who took but little exercise, well fed, and taking his after- 
dinner naps in a room carefully closed to exclude the heat and fiies ot 
summer and the cold of winter. We may rest assured that he used his 
respiratory muscles but to very little purpose, probably never taking a 

^ Brown's Elements of Medicine, Preface. 

« Wood's Med. Library. Vol. June, 1881, p. 91. 

» The Family Physician, CasscU & Co., Vol. IV, p. 971. 

* Gout in its Protean Aspect, p. 164, 



82 VENTILATION AND IMPURE AIR, 

deep respiration, unless after his social pinch of snuff with the burgo- 
master, which undoubtedly induced a healthy sneeze. His capture by 
Barbary pirates, who take no stock in full meals and after-dinner naps in 
close rooms, cured him of his gout : the fresh sea air and the deep inspi- 
ration required properly to propel a galley oar, furnished a medium 
through which a complete oxidation of the urea took place, and an effi- 
cient exhalation of all toxic material. 

Prof. Marfan, of Paris, has related the occurrence of what might 
plainly be called an epidemic of phthisis, where one consumptive in an 
atelier, by promiscuous spitting all over a rough floor, so managed to 
infect the rest of his twenty-two fellow- workers that in six years after his 
own death they began to die rapidly, until fifteen out of the twenty-two 
were gone. Marfan and Vallin laid the blame on the character of the 
floor and the sputa infection ; the old floor was removed, the apartment 
disinfected, a new, well jointed, and smooth floor laid, and the epi- 
demic ceased.* Cases like the above, but not so extensive, are common 
enough to make us feel a wholesome dread of the bacillus, regardless 
of what contrary opinion others may hold, and founded on ever so 
many experiments. But this does not alter the fact that we have depended 
too much on the bacteriological origin of phthisis. Where one per- 
son becomes phthisical through the bacillus, there are a dozen that 
have become so without coming in contact with it. And while in 
our zeal we have pursued this branch of our science, we have closed 
our eyes to the fact that deficient ventilation is the most prolific source 
of phthisis, regardless of the presence or absence of the bacillus. We 
are getting to depend altogether on the bacillus, which, like Falstaff's 
men in buckram, is multiplying and fast becoming the cause of every 
form of disease. 

Another incident wherein the bacillus is made to usurp deficient ven- 
tilation as the cause of a disease is the lately discovered fact that a bacillus 
has been recently found in connection with trismus. To attribute the 
origin of trismus to any bacillary cause, we must altogether ignore all that 
we know of the disease. If the literature on the subject were scanty, or 
obscure and indefinite, and the observers incompetent, and our experience 
in its connection unconclusive, we might begin to doubt ; but such, how- 
ever, is not the case. The literature is very intelligent, authentic, and 
exact on the subject. The work by John E. Morgan, F. R. C. P., en- 
titled "The Diseases of St. Kilda," devotes much intelligent explana- 
tion to the cause of trismus. Morgan was a close observer, and noticed 
that the disease did not prevail on the neighboring Hebrides. In his 
search for a cause, he observed that a like equable, mild climate affected 
St. Kilda and the Hebrides, but he noticed further, that while in the lat- 
ter islands the inhabitants live in the Scotch bothies, such as are found on 
the Scottish coast, built of loose rock and stone, with plenty of crevices 
and an open chimney, those of St. Kilda were built of rocks, but closely 
cemented at every joint ; and that although as in the other islands a peat 

^ Boston Med. and Surg. Jour., vol. 122, No. 18. 



VENTILATION AND IMPURE AIR. 83 

fire is used, the cottage or hut has no hole for the escape of the smoke. 
On inquiry, he found this difference in custom to be due to the scarcity 
of seaweed on the St. Kilda shores. On the Hebrides, either owing 
to different winds or ocean currents, the weed is plentiful, and is used 
for manure, while at St. Kilda the soot that has g^hered on the walls 
and under the roof is scraped off in the spring and used to enrich the 
fields. To allow this soot to collect, the house is kept carefully closed. 
Drs. Morrison and Maxwell, who practised in the West Indies, attributed 
the existence of trismus in those islands to the confined and smoky con- 
dition of the houses. The same may be said of the negro huts on the 
Florida and Georgia coasts where trismus has been observed. And lastly, 
the experience of Joseph Clarke, and subsequently of Collins, in the Dub- 
lin Lying-in Hospital, where by continually improving the ventilation the 
trismus epidemic was checked, would seem sufficiently to prove the foul 
air origin of the disease. 

Maudsley has well said that the mind is the most dependent of all the 
natural forces, and that for its existence all the lower natural forces are 
indispensably prerequisite.^ The time has gone by when the mildly 
lunatic was tortured, hung, or burned at the stake as a criminal, while 
the phrensied, raving maniac was either chased about like a wild beast, 
or considered as a demoniac and deluged with holy water and prayer. 
Pathology has here opened up a study that has not yet fully brought out 
all its fruits. Liver abscesses, or empyema, is now known to derange the 
mind as much as we realize that intestinal irritation will produce night 
terrors. Readers of Silvio Pellico's " My Prisons" will not forget his 
graphic description of the hallucination that he suffered while confined 
under the '* leads" or leaden roof of the Ducal palace at Venice, finally 
relieved by what must have been the spontaneous discharge of an abscess 
into the intestinal tract, when all the mental disturbances at once left 
him. It is also a recognized fact that uraemic retention holds a very close 
relationship to insanity. Dr. Alice Bennet showing in a paper read 
before the Pennsylvania State Medical Society the connection between it 
and Bright's disease.^ The connection between the habitual or exces- 
sive use of stimulants and the development of insanity is too well 
acknowledged to require more than mere mention, except that we may 
add that it is among the lower classes who use the excess of liquor that 
we find the greatest amount of lunacy, and to observe further, that which 
has been more than once suggested in the course of the paper, that by 
insufficient analyses of our subjects we oftentimes connect and mingle co- 
existing effects as cause and effect, and often place a result as a primary 
cause. In this respect we must not forget that among the poor there is an 
inherent tendency to infirmities, mental and moral as well as physical — 
a condition due to the deterioration caused by want, lack of proper nour- 
ishment, anxieties, suffering, and lastly, but not the least, the foul air that 
they must of necessity continually breathe. Liquors and stimulants are 

* Maudsley, Physiology and Pathology of the Mind. 

• Med. News, Oct. 4, 1890. 



84 VENTILATION AND IMPURE AIR. 

the causes to which all the miseries and physical as well as mental afflic- 
tions of the poor are attributed, — as if poverty itself were no misery, and did 
not carry in its train sufficient ills aside from the use or abuse of alcohol ! 
The premature mortality so excessive with the poor, their ailments, 
feeble-minded, rachitic, or consumptive children, depravity, moral degra- 
dation, idiocy, and insanity, — in fact, all that may happen, either in the 
line of physical or of moral degradation, — is attributed to alcohol. Alco- 
hol with them has become a necessity owing to the morbid condition 
induced by foul air. 

A reviewer of Acton's work on prostitution mentions the swarms of 
child prostitutes that infest the low quarters of London, whose existence 
he attributes to '' a brutal stupefaction of the moral senses, resulting from 
an utter ignorance of what is good or evil." Were I to review the 
reviewer, I might ask how ignorance can cause brutal stupefaction of 
the senses, either moral or otherwise. In the present age, we fully under- 
stand that for all effects there must be a specific, self-sufficient cause. It 
may not be found at once, but we should neither jump at a conclusion, nor 
cover our ignorance in the matter by a mere figure of speech. Saying 
that their mothers drank alcoholic liquors, and that precept and example 
have lowered and debased them, even if they are too young to have 
drank themselves, does not satisfactorily explain the existence of the swarm 
of child prostitutes, or how they arrived at the stupefaction of the moral 
senses. My own opinion is, that on alcohol we lay the blame so that 
we may not blame ourselves for the indifference and neglect of the human 
family in our immediate neighborhood : it is a certain relief to the con- 
science to say that they drink — drink has brought it all on them : we then 
wash our hands, like Pontius Pilate, and the Passion Play goes on. Drink, 
however, does aggravate and precipitate many conditions that the poor 
have in them with a strong inherent tendency. Every practitioner knows 
that among the children of the poor, living in crowded tenement-houses 
or basements, there exists a disposition to convulsive and nervous diseases, 
as well as that they are more subject to zymotic diseases ; and that, too, 
where the parents are habitually sober. Nearly every physician who has 
had such practice has often wished for the wealth of a Vanderbilt or a 
Jay Gould, that he might relieve the poor, patient, anaemic little children 
who seldom see any joy, and who seem from birth wedded to a life of 
misery. The question has often occurred to me, while looking on these 
helpless children. Is it possible that the philanthropist and statesman are 
unacquainted with the effects of foul air? That such an air,which will give 
an ordinary gentleman, accustomed to well aired rooms and fresh air, a 
headache that may last him all day, or even produce in such a man an 
illness, must be poisonous, no one will doubt. 

In a concentrated accumulation this foulness has shown serious results 
besides the Black Hole and other such episodes. Guy in his work on 
Public Health quotes from Sir John Pringle, in connection with the work 
of the philanthropist, John Howard. He there relates that in the May 
sessions of 1750 at the Old Bailey, forty persons perished from putrid 



VENTILATION AND IMPURE AIR, 8$ 

fever caused by breathing the foul air that issued from the jail room and 
prisoners' dock ; of this number, four were judges, and the rest officers, 
barristers, and jurymen. That was an extreme case ; but I have often 
visited sick children in rooms and beds where between the fumes of cook- 
ing, the over-heated room, and the steam from drying clothes, added to the 
exhalations of half a dozen large-lunged human beings, the room was so 
offensive that I have cut my visits very short. This air has precisely 
the same efiect as alcohol or fusel oil, and the slow, steady effect on the 
nerves of the susceptible little child is to create a morbid irritability 
which later calls for alcoholic support. The little bodies of these poor 
children have no more resistance, strength, or endurance than their little 
brains ; they are morbidly sensitive, and age early ; want has developed 
a precocious sharpness of instinct, and the foul air that has poisoned their 
young blood has precociously matured their sexual organs, while the 
rest of their physique lacks development. Foul air is more than sufficient 
to cause all these conditions without the assistance of alcohol either in 
the child or its parents. It is the foul air that produces that ^ ^brutal stupe- 
faction" of the moral senses before alluded to. In one London parish, out 
of eighty little girls raised in its work-house, seventy-nine were after- 
wards found, on an investigation, to be on the street,^ and Dr. C. F. Tay- 
lor relates that in one New York asylum for feeble-minded children, 
fiilly two thirds of the children masturbated, the proportion being about 
equally divided between the sexes. By careful investigation it developed 
that among these feeble-minded children the habit came by intuition — the 
morbid excitability of the sexual organs being the cause — without assist- 
ance from either precept or example. The girls were found to begin at the 
age of eight, and the boys at ten.^ Society and the state furnish millions 
for the suppression of the depraved class, when a tenth of the sum would 
effisctually prevent its formation. 

The unnamed author of a remarkably instructive little work* on ven- 
tilation in its relations to life and disease, makes the following true 
observation: "The combined testimony of those who have taken the 
pains to investigate the causes of vice and prostitution leaves no doubt 
that a low condition of body and mind, coincident with a morbid irrita- 
bility of the brain, so far from restraining (as might be surmised) the 
animal propensities and vicious inclinations, has no inconsiderable share 
in their aggravation and production." The effect of foul air on the 
brain has been well depicted by James Johnson, in connection with the 
death of Mr. Justice Hays, who was stricken with paralysis and apo- 
plexy after a day's sitting in the foul air of a court-room. " The blood," 
observes the doctor, " imperfectly aerated, and charged with the exhala- 
tions from numerous lungs breathing the same atmosphere, is impeded 
in its passage through the minute arteries, whose muscular walls con- 
tract and hinder its progress. Hence the sense of fulness, pain, and 

* A Home for the Homeless, by the Hon. Mrs. Wray. 
> Am. Jour, of Obstetrics, Jan., 1882 — ^page 163. 
s House of J. S. Redfield, Clinton Hall, N. Y., 1849. 



86 VENTILATION AND IMPURE AIR, 

throbbing in the head, while the heart beats with increased force to 
overcome the impediment and to drive on the blood."* 

Dr. Johnson's labors in the field of renal diseases are well known, 
and he explains in the above the cerebral action of impure blood, a sub- 
ject with which he is perfectly familiar. It is preposterous to imagine 
that the delicate brain and nerves of a child can stand the continued 
effect of such a poison without harm ; and civilization can only plead 
ignorance as an excuse for its sin in the way of omission, in thus neg- 
lecting the child and allowing it helplessly to grow up food for the jail 
or the gallows. Were the clergy to study physical causes and effects 
more, they would see that the first principle to be instituted to obtain a 
moral man is perfect sanitation, without which all mission work and 
sermonizing might as well be made to the four winds. 

As a summary of what has been advanced in the foregoing paper, it 
may be stated that it has undertaken to show that the visible point of 
departure from a condition of general good health and an unimpaired 
organism is plainly where the nomad diverges from the free out-of-door 
life of his ancestors, and encloses himself within four walls and a roof 
that exclude the sun and air, and retain his own exhalations. Prior to 
this occurrence we can find no history of developmental organic defect — 
neither inherent tendency in any organ or part to disease, to morbid 
irritability of body or mind, or tendency or liability to reflex troubles of 
any kind. That ventilation is the prime factor that induces this won- 
derful moral and physical perfection by allowing the aeration of the 
blood to be fully carried on as the Maker intended, is evident from the 
fiict, as cited by Hirsch, that there are populous industrial centres on 
the high plateaus of the Andes, cities of from 20,000 to 320,000 inhab- 
itants, where the bacillus tuberculosis does not seem to thrive or find a 
lodgment ; so that mere density, industrial pursuits, or civic aggregation 
cannot be said to be the cause of the physical degeneration observed else- 
where. The secret of the exemption in these communities is found in 
the simple fact that either in August or January the thermometer marks 
60** F. ; that their houses are never closed at any time ; if they feel 
chilly, they simply put on an extra shawl or poncho, but they do not 
close the door. It may also be stated that these localities are not finan- 
cially drained to maintain swarms of idiots, lunatics, rachitic, crippled 
paralytics, criminals, or prostitutes, either in reformatories, asylums, 
hospitals, or jails. Such are the facts, and we can draw our own infer- 
ences. One thing is certain, that these people literally live out of doors. 

The erroneous opinions of the public in regard to the effects of good 
or bad ventilation have next to be considered. That ventilation does not 
receive that consideration that it deserves from the public is undoubtedly 
due to the reason that they misapprehend the really dangerous element 
that lurks in non-aerated rooms, and their lack of knowledge in regard 
to the vicious effects of this organic poison ; further, they lack that nice 
appreciation that there exist gradations in efiTects proportionate to the 
> London Lancet, Dec. 11, 1869, page 824. 



VENTILATION AND IMPURE AIR. 87 

causes. They can, as a rule, only appreciate extremes of conditions. 
That each intermediate fraction of space hetween a sane man and a 
phrensied maniac can he accurately filled hy a specimen representing each 
gradation cannot he understood hy them, any more than that one grada- 
tion leads to the other. Neither can they understand why there should 
be preparatory processes to the inception of a diseased condition. When 
the poor consumptive asks you simply to give him something for his pain 
in the chest, or to stop the cough, or to arrest his night-sweats, — it is all 
that he wants — stop tliat and he will he all right, — it fully shows the 
popular idea of disease, and popular appreciation of the processes through 
which the body must pass to reach certain stages or conditions. It can- 
not be said of them, as the French said of the returning aristocracy in 
1 814, " They have learned nothing, but they have also forgotten noth- 
ing." Through civilization our people have learned nothing of benefit 
to their health, and they have lost that instinct for fresh air so dominant 
in nomadic tribes. Oswald relates that when the Circassian chief 
Shamyl-Ben-Haddin was captured by the Russians, in 1864, he offered 
his captors the best part of his rations and all his personal valuables for 
the privilege of sleeping in the open air, feeling that one week more of 
the nausea and headache consequent on his sleeping indoors would drive 
him to suicide. General Houston, who spent his life among the Chero- 
kee Indians, never could endure a close room or a crowded hall for 
more than a few minutes. As our people have forgotten or lost these 
instincts, they should be instructed as to their danger. With no knowl- 
edge or instinct in so important a matter, it is not surprising that they 
so often come to grief. 

There is no reason why they should not understand that the strength 
and endurance, health, and expectation of life must be measured, like a 
chain, by the weakest link, and that if one organ be enfeebled, the appar- 
ent health and strength of the other only hastens the destruction of the 
whole, for, as George Murray Humphry observes, it is requisite to 
longevity that "each organ must be sound in itself, and its strength must 
have a due relation to the strength of the other organs. If the heart 
or digestive organs be disproportionately strong, they will overload and 
oppress the other organs, one of which will soon give way. One dis- 
proportionately feeble organ endangers or destroys the whole." ^ If the 
laity could be made to realize that between lasting and enjoyable health, 
and sickness and lingering misery, there is but a shallow and an al- 
most imperceptible Rubicon to be crossed, whence there is no returning 
except on a compromise made by running the whole machine on the 
basis of the weakest organ, and that one hour spent in a close room 
may be to them that Rubicon, much more attention would be paid to 
the importance of ventilation. The writer has seen, more than once, a 
child bom perfect and sound, but one half-hour's over-heating in a close 
room, by an over-solicitous nurse, produced a nasal stenosis that has 
followed the child into adult life, with the anaemia and all other ills that 

1 Humphry, Old Age. 



88 VENTILATION AND IMPURE AIR. 

accompany such a condition of afiairs, changing the temperament and 
constitution completely from what it would otherwise have been. Ven- 
tilation will not exempt man from all things ; but, from a careful con- 
sideration, it is safe to assume that if all the ills that deficient ventilation 
does create were eliminated, the remainder would require but little care. 
Hippocrates gave us air, water, and locality, as the three ingredients of 
climate. Angus Smith gave us the chemistry of climate, which analyzes 
the quality of the air. After many excursions and exploring expeditions 
in search of something better, we are giadually drifting back to our old 
friends' way of thinking, and we are now as convinced of the uselessness 
of climatic classifications as we are of those of drugs or diseases : in fact, 
we have found out that the many pursuits and side studies, researches and 
discoveries, have, through our zeal, led us somewhat astray. Sydenham, 
Heberden, Boerhaave, Tissot, and Rush all tended to a greater observ- 
ance of nature, and tended more to treat the individual nian than the 
individual disease : the latter they generalized more than we have done. 
Beale, Thompson, Fothergill, Johnson, Hutchinson, Black, and Rich- 
ardson have so far advanced beyond the beaten path that medicine has 
trod during the last sixty years, that they recognize a great fatherhood to 
our ills and pains in one great standing and distinct point, — this being 
where perfect depuration ceases and where imperfect blood depuration 
begins. It is this that marks, as it were, the visible line of physical differ- 
ences as a mass between the nomad and the civilized man, and its cause 
is in a free or an imperfect ventilation. The limits of this paper will not 
permit a dissertation on all the remedial measures that should be instituted 
to relieve the evil conditions pointed out. Were it practicable to re- 
establish the old Spartan tables of the Lycurgan system, — with its black 
broth, bread, olive and fig banquets, and with it the iron money, — it 
would at once sweep free the coming generations from the cursing evils 
that affect the present one in a fast increasing ratio. It would not only 
benefit the poor, whose blood is impoverished by too innutritious food, 
and who are poisoned by foul air, but it would equally benefit the rich, 
as the bill of fare of the Lycurgan board tended not to induce diseases 
due to plethora or uraBmia ; — but it is useless to dwell on such a Utopian 
prospect. Chauncey Depew and Ward McAllister would put their foot 
down on any such proposition. Were people less touchy about the 
question of interference with their immediate personal rights, the oppo- 
site of the method suggested by Dr. Lindley, of Los Angeles, at the last 
meeting of the State Medical Society, — ^that of castrating all male crimi- 
nals for the extirpation of the criminals, — might be adopted, this being the 
removal of the ovaries of every intemperate woman ; — there would be one 
advantage over the method of Dr. Lindley, in this, — there would be no 
chance for a mistake. As the old French detective proverb went, when 
they were in search of a criminal, " Get hold of the woman, and you will 
soon catch the man." According to Dr. Lindley's plan, the wrong man 
might be operated on, as no intemperate woman can bear a child for nine 
months, while she is in a state of inebriety, without affecting the child ; 



VENTILATION AND IMPURE AIR. 89 

and in the choice of sexual selection some otherwise very good men are 
so terribly careless, that I feel that, were it practicable, this would be the 
best way to extirpate the class. This, however, cannot be done. But 
there is something that can be done : intemperate women should not be 
allowed under any circumstances to suckle children. A child would run 
much less risk, in the first place, by being raised by hand ; and, in the next 
place, its future welfare would not be jeopardized either physically or 
morally. 

In this connection I cannot help mentioning the grievous injury in- 
flicted on children who are put out to wet nurses, by the parents' furnish- 
ing beers and liquors to the nurse that she may g^ve a more copious sup- 
ply of milk. As observed by Griesinger, insanity or mental conditions are 
formed in their germ at very remote periods from the time that the actual 
disease appears,^ the generally supposed real causes being only the precipi- 
tating or determining causes. Failure in being able to provide is gener- 
ally in a popular or legal sense limited to the question of a sufficiency of 
food and clothing to keep body and soul together. The state should recog- 
nize this failure in a broader sense. The father of a family may be able 
enough through his labor to provide ample food and clothing, but too 
poor to provide proper air. The child may live, but so warped physi- 
cally or mentally or morally that it were better dead. Food and cloth- 
ing are not the only necessities by any means. They may be like the last 
meal of a condemned man, — sufficient to give him strength to mount the 
scaffold. The state should recognize fully the effects of foul air on the chil- 
dren, and make it a necessity that they should have fresh air. To this end 
it should assume the charge of these children. The Spartans, as well as the 
Indians of southern California, took charge oi all the children, thereby 
assuring the community that they should neither suffer through want nor 
self-indulgence, to the evident benefit of their physical and moral wel- 
fare. Our civilized communities should certainly have charge of the chil- 
dren of those unable or unfit to care or provide for them. We do not treat 
the domestic animals so thoughtlessly. A horseman would be shocked 
to see a thoroughbred colt in a foul and un ventilated barn, or feeding on 
on deteriorating food. His instincts for the welfare of his loved animal 
would even probably induce him to pay double his price, if required, to 
save a noble creature from losing that physique, intelligence, courage, and 
endurance that belong to him, and to keep him from degrading into an 
old hack or common horse, just as philanthropists of old devoted all their 
earnings and fortune to the purchase of Christian captives from the Alge- 
rine corsairs. The same spirit cannot all be dead. Our philanthropists 
and statesmen should fully and thoroughly comprehend the dangers and 
the situation of these children, who in the long run will otherwise only 
grow up to be the chair a canon for our charitable or penal institutions 
later on. In taking charge of these children, it should be the aim of the 
state, not only, as unfortunately it is done now in unavoidable cases, to 
provide a charity home or mere resting-place^ but it should use its endeav- 

1 Griesinger Ment. Path. Woods Med. Lib., 1882. 



90 VENTILATION AND IMPURE AIR. 

ors toward their physical, mental, and moral education, as it does to its 
soldiers from whom it expects future service. They should not be treated 
or made to feel as paupers, but as children only receiving their dues and 
from whom the state expects future recompense, — just as the future horse 
in time will repay his keeper and trainer for all his kindness and care, as 
depicted in the winning horses of Ben Hur in the chariot race, where 
former kindness, good treatment, and training show good results. All 
this is not as Utopian as it is barbarous, cruel, and unchristian to neglect 
it. Where a gentle, weak woman could have guided the child right 
under proper hygienic surroundings, we in after life turn the world 
upside down with swarms of detectives, at a tremendous expense, to hunt 
down the same being who through unhygienic surroundings, has been con- 
verted into a vicious, determined criminal, that the majesty of the law 
may be vindicated. 

We might better begin early, and, by surrounding the little helpless 
human being whom a cruel destiny has intrusted to keeping that is not 
of its own choosing, with better hygiene, better precept, and better exam- 
ple, vindicate the majesty of our enlightenment, civilization, manliness, 
and Christianity. These poor children never know either childish inno- 
cence or childish joys ; for them there are not in after life those memories 
of childhood to soften and make them better, for they have had no child- 
hood ; they have prematurely aged in every sense, and the struggle for 
life, in all its bitterness, has been pressed like a full cup to their helpless 
little lips when scarce out of infancy. No wonder that the low quarters 
of our great cities swarm with multitudes of prostitutes scarce out of 
childhood, and that a brutal stupefaction has in them overcome all moral 
sense, — a moral sense that might be said to be stifled at birth, for it 
requires a pure and uncontaminated atmosphere for this to thrive — some- 
thing which the poor child has never enjoyed. 

As observed in relation to the interpolation of various branches of 
science in their eJfTect in obscuring from our view many of the simple 
truths of medicine, and the suggestion that we retrace our steps to spots 
where we know a sound foundation exists, so we may well remark to 
our kindred profession, they of the cloth, that if they were to have less 
theology and more practical. Christian common-sense, it would be 
better for the ends that they profess to wish to reach. It is not beyond 
their province, as the Mosaic law is full of examples. If the great Mas- 
ter was not above realizing that the welfare of his chosen people greatly 
depended on their physical condition, his followers should not consider 
it beneath them to follow his example ; if the Mosaic teachings could 
notice even such trifles as the need of the proper aeration of the excreta 
of the multitude crossing the desert by the aid of the dry, powdered 
earth, our present shepherds should not be slow in recognizing the same 
facts, but now much more urgent by reason of our greater density and 
stability of population. The pulpit, like medicine, is losing much of its 
usefulness in rhetorical flourishes and figures of speech. When the great 
Master was asked the road to salvation, he pointed neither to shelves of 



VENTILATION AND IMPURE AIR, 9I 

theological lore, nor to a collection of tracts on the ethics and cerenlonials 
of religion : his answer was of few words. 

The road to health is equally as simple. Hufeland pointed it out in 
what might be boiled down to a very few words : Breathe pure air ; an 
equable climate ; do n't worry ; and do n't eat or drink more than you 
need. Conditions in the air that favored free ventilation were the pre- 
requisites with Hufeland, Sydenham, Rush, and those of that class who 
may be said to be canonized and sanctified in the heart of our profession. 

The space of this paper will not permit a discussion of the mechanical 
means. The literature on the subject is ample. Billings, Leeds, Eassie, 
and the hygienic works of Buck and Parker, are about complete on the 
subject. The enlarged edition of the lecture delivered by Leeds in Phil- 
adelphia is a short treatise devoted to the elucidation of one system of 
ventilation. 

Some six years ago, while preparing a lecture on ventilation which was 
to be delivered before a meeting of the Teachers' Institute at San Diego, 
I prepared a small wood and tin framed house, with tin chimneys and 
glass sides and roof, which I used during the lecture. This was done 
on the Leeds system, with the aid of small lamps for fires and different 
lengths of lighted tapers to represent persons — manufacturing different 
atmospheres that were introduced into the house. This gave me such a 
good opinion of the system, that I afterwards incorporated it in a resi- 
dence I built, and have every reason to be well pleased with it. 

Before closing, it would be well to suggest that ventilation is not by 
any means always health, or even life. An intelligent supervision and 
understanding are here absolutely necessary. The four judges and thirty- 
six persons who died of putrid fever contracted at the Old Bailey, were 
those who sat in the best ventilated part of the room, hut right in the 
track of the foul air as it was making- its exit from the room. Here 
ventilation, by its unintelligent observance, made deaths. These are the 
cases already mentioned a$ quoted from Sir John Pringle by Guy. Hart- 
ley quotes an apartment in a London house which was all right unless a 
fire was lit in the fire-place, which then ventilated the room. On inves- 
tigation, it was found that the suction caused the filtering of air through 
a side wall, and that in contact with this wall there was an old dust bin, 
which accounted for the bad odors in the room as soon as the fire caused 
a current up the chimney.^ So that evidently great care must be exer- 
cised over the source of the ventilation. 

Aside from the above, it must not be overlooked that a whole locality, 
or even a city, may at times be so imperfectly ventilated as to be danger- 
ous to life. Considering the extent of the broad canopy of the heavens 
and the miles of extent of atmospheric air, this may sound hypothetical 
and impossible, but it has nevertheless occurred. 

In the second week of December, 1873, the city of London was visited 
by one of the densest fogs it had ever experienced. The free escape of 
the smoke and the proper diffusion of gases were so materially interfered 

^ Hartley, Air in its Relations to Life. 



92 VENTILATION AND IMPURE AIR. 

with, that all the emanations from the thousands of smoke-stacks, chim- 
neys, and its millions of lungs and all other sources of effluvia, were 
necessarily prevented from being dissipated, and were retained either in 
the houses or on respiratory levels. 

The result of this condition is well seen in the Registrar General's 
report, which shows that this state of the metropolitan atmosphere was 
not only the means of causing an enormous death-rate, but was also the 
means of producing a large number of premature labors as well, for the 
returns gave, for the week ending December 20, one hundred and eight 
more births than the average number, and seven hundred and eighty 
more deaths than there had been for any one week in the previous ten 
years, after making all due allowance for the increase of population. 

That it was the atmospheric condition that induced these morbific 
changes may well be believed, from the fact that from the London 
Times of the nth and 12th of that month (the fog occurred on the 9th 
and loth) we have an account of the doings of the " Smithfield Club 
Cattle Show,*' then in operation. We there learn that the show was 
interfered with by the sickness and mortality among the animals, many 
of whom were only saved by being hurriedly sent out into the uncontam- 
inated air of the country. What foul air will do can well be surmised 
when the Registrar General's report shows that the mortality of the week 
above mentioned far exceeded the mortality of the cholera week in the 
fall of 1866. 

A proper realization of the fact that man was not built so that he 
should respire about twenty times per minute for amusement or luxury 
is evidently the last thing that strikes the laity. How far in different 
directions this total disregard of what nature has intended has affected 
us injuriously is not appreciated, any more than does our profession 
realize the harm that results from our attributing therapeutic effects to 
agents here or there, when the results are purely to be attained by a 
strict attention to the conditions of the first and main element of the 
Hippocratic trilogy — air. This is well exemplified on the Italian 
Riviera, where the north German or Russian comes for the climate 
aioney but is so utterly indifferent to the quality of the air that he 
breathes, that, by the means of the box stove of the fatherland and the 
liberal use of caulking material industriously inserted wherever a crevice 
might allow the ingress of a little fresh air, he converts as nearly as pos- 
sible the condition of the air of his apartment to that of the air he left 
behind near the far northern Baltic shores. 1 

With a proper appreciation of the many propositions set forth in this 
paper, we would have far less to contend with against quackery, as, by a 
better realization of the causes of disease, the laity would be lifted out of 
the narrow and contracted limits they now occupy in their belief in the 
wonderful efHcacy of this or that drug, or in their insane worship of 
the many " isms" that disgrace the field of medicine, and which have noth- 
ing but the ignorance of the otherwise better informed laity for a stable 

> Bennet, Ptilmonary Consumption. 



VENTILATION AND IMPURE AIR, 93 

foundation. The subject is one of the deepest interest to all, but one 
that the patriot, the philanthropist, and the statesman cannot neglect, for 
it has been said that the race which has the strongest vitality and the long- 
est resistance to decay and death must in the end become dominant.^ 

The day may not be far distant when the state may need that its citi- 
zens shall all have healthy physiques. Without being unnecessarily 
alarmists, we cannot wholly shut our eyes to the fact that to the west 
there exist a horde of semi-barbarians, numerically infinitely superior to 
our nation, who live in a far less productive country, and who are lately 
making rapid progress in all that is advantageous in European civiliza- 
tion, and who are also fast adopting all the recent advances in the art 
and systems of warfare. Like to the ancient Briton, we have called these 
auire-mer barbarians to our shores, and have made them acquainted 
^^ith the greater fertility of our fields, our more genial climate and richer 
mineral resources, and our more desirable food supplies. We have 
been obliged to resort to law enactments and diplomacy already, to curb 
the migratory impetus that all this knowledge has caused. Diplomatic 
fencing generally precedes that of the sword : it may be a long or a 
short interval, but the latter extreme is reached sooner or later. Eng- 
land has Australia, South Africa, and her immense Canadian posses- 
sions as a resort for her superfluous population ; Germany, France, and 
Italy have not so great an excess beyond their power to support but 
that it imperceptibly filters into the United States, to become incor- 
porated as part of our population ; but China does not amalgamate, nor 
has she a locality for her overflow. So that not only as philanthropists 
and as Christians do we owe something in the shape of fostering care to 
our poorer brother, but as statesmen we must realize that the poorer 
brother is really the strength and supporter of the nation, and that in 
time of need he is its real protector. 

^ Richardson. Diseases of Modem Life. 



xn. 

ON THE PREVENTION OF PHTHISIS. 
By B. F. W YMAN, M. D., Aiken, S. C. 

It is usually expected of the author of an article that his paper should 
either contain facts hitherto unpublished, or else it should be a compila- 
tion of known facts so grouped together as to be useful to. the profession. 
It would be sheer egotism for a paper like this to propose more than a 
suggestion, when we take into consideration the magnitude of the two- 
fold subject and of the literature already extant, but it ought to be possi- 
ble to set forth in brief, yet clear and satisfactory, form the main features 
of a subject which, to our thinking, promises so much to the profes- 
sion and to suffering humanity. Therefore all that I claim for this arti- 
cle is, that it is a compilation of certain facts gathered from the researches 
of other investigators, and corroborated by my own experience and 
observation. 

The first which I shall mention is, that consumption is of germ origin — 
the cause, bacillus tuberculosis.^ The second, that residence in low, 
damp localities and the inhalation of cold, dry air are the producing and 
aggravating causes of consumption." Why this is so is because it has 
been satisfactorily demonstrated that the air of low, damp plains is abso- 
lutely dryer than that of warm, dry, pervious soil, and as the expired air 
must contain the normal amount of heat and moisture, if the air inhaled 
should be deficient in these, it must be supplied from the blood of the 
air-passages, thereby leaving an excess of the volatile salts in the air- 
cells, which irritates the mucous membrane and renders it more liable 
to inflammatory invasion. 

Many years of study, experience, and observation have convinced me 
of the correctness and truth of these investigations, and also of the imper- 
ative duty of physicians to lay great stress upon these facts, and impress 
them upon those who are suffering from, as well as those who are predis- 
posed to, this fearful malady. I believe that consumption is as amenable to 
treatment, and can be cured as readily, as any one of our serious constitu- 
tional diseases, provided it be diagnosed in its incipiency, and the proper 
hygienic and medical treatment be resorted to with confidence and pur- 
sued with equal vigor. 

A very great reproach has fallen upon the profession from the fact 
that physicians have failed to insist intelligently and persistently that the 

iKoch. 

* Buchannon. 



ON THE PREVENTION OF PHTHISIS. 95 

disease can be cured, and upon the prime necessity of strict medical treat- 
ment and the removal of the patient to a suitable climate. 

Physicians have erred again by the senseless avidity with which some 
have seized upon every remedy vaunted by no matter whom, and in a very 
short time have abandoned it for some other pr6bably of an entirely differ- 
ent action. This empirical practice has gone a long way to convince the 
laity that the disease is incurable, and that the profession is groping in 
the dark for remedies, — all of which has resulted in many poor sufferers 
being driven into the clutches of quacks. This ought not to be, but 
rather let us claim a well founded knowledge of the cause as well as the 
treatment of the disease, and prove that it can be prevented, and even 
cured, if taken in time and treated in a scientific manner. 

Unfortunately, we who practise at the resorts in the South rarely ever 
see a patient until there is a cavity in the lung and the general health is 
almost a complete wreck from fever and night sweats. I feel assured 
that if the family physician would (as soon as he has detected the least 
tendency to tubercular disease, either in children or adults) advise and 
insist upon removal to some location suitable in climate for the patient, 
and unsuitable to the development of the germ, the per cent, of deaths 
would be reduced to a wonderful degree, many useful lives prolonged, 
and even saved. Children so predisposed should reside in some such 
locality during the acquiring of their education, while adults should 
remain winter and summer for three or four years, with the exception 
perhaps of one or two months, say July and August, which might be 
spent very pleasantly and profitably in the mountains. 

My own experience — which is considerable, I having been located in 
the city of Aiken, South Carolina, for about fourteen years — convinces 
me of the great advantage of permanent residence, over the usual custom 
of spending only a few months during the winter and then returning 
North, thereby incurring the rigors of two spring seasons, which are 
universally acknowledged to be the most trying of all the months of the 
year to invalids. Those who leave early spend one spring at the South, 
and another at the North. I am acquainted with many persons who 
adopted the permanent residence plan, who not only improved, but have 
apparently been restored to health, and who are now in the pursuit of 
their different avocations. 

While the other plan does undoubtedly prolong life, rendering it vastly 
more comfortable, and in some instances even effecting cures, I am sure 
it does not give the same, or even an approach to the same, happy result 
as the one recommended. 

By way of bringing my own city into prominence as a health resort 
for consumptives and others seeking a healthy and high warm home, I 
append an article written some time ago upon this subject. 



1 



96 ON THE PREVENTION OF PHTHISIS. 



THE ADVANTAGES AIKEN AFFORDS TO THOSE SUFFERING FROM 

LUNG TROUBLES. 

If malaria is produced from heat, moisture, vegetable matter, etc., in the form of spores 
or germs of any kind, and these unhealthy agents taken into the system of man produce 
the symptoms known as malarial poisoning, then the situation and climatic influence of 
the locality should receive careful consideration in the choice of a health resort. The 
same care is necessary if the cause of *' malaria," so called, be found to be unhealthy vari- 
ation in an atmosphere loaded with moisture. Moisture in the atmosphere intensifies 
either a hot or cool change. It brings into more active play all the organs of man by 
which the cleansing and balancing of the system are brought about, and makes any cool 
change the more quickly shut off, and thereby perverts the action of these same organs, 
thus retaining in the system all those poisonous materials that tend to lower vital force, 
bring about congestion, and end in the condition known as malarial poisoning. 

The first question, and rightly too, that comes up in speaking of the healthfulness of a 
place is, How about malaria P In attempting to comply with a request to write a short 
article on Aiken as a health resort, I shall begin by saying, Having been a resident as well 
as a practising physician in the town for more than twelve years, I have never seen or heard 
of a malarial chill originating here, and I believe the place to be absolutely free from the 
malarial condition. Its elevation, with consequent pure, rare air, its dry soil, superior 
natural drainage, and freedom from moisture of the soil, shown by absence of dews, fogs 
mildew, rust, etc., places Aiken at once in the position of the '' happy medium " for those 
seeking a resort for the relief of malarial, pulmonary, or other forms of disease. 

Equalization of atmospheric conditions usually means equal and regular action of the 
human system — ^and that means health. These facts are of material advantage to any cli- 
mate, especially one intended as a resort for those suffering from pulmonary affections, 
for in the treatment of these patients a healthful condition of liver and stomach is of vital 
importance, as congestion of these organs, and interference with their circulation, tend to 
keep up and feed congestion and inflammation of lungs and throat. 

When I thus speak of the climatic conditions of Aiken as a resort for those suffering 
from diseases of the lungs, throat, and respiratory passages, my views may be considered 
optimistic ; but I feel as if too much cannot be said on this subject, for I can truthfully say, 
after all these years in the treatment of no small number of these complaints, that I fail 
to recall a single case (where there was any chance for improvement) which was not bene- 
fited, and all realized that climatic influence could be expected to accomplish. I note 
these facts as I feel that a suppression of them might be an injustice to some sufferer 
who may be searching for relief. 

Much more might be said of the climate and other advantages of the place, but I know 
these articles are expected to be brief and to the point. I shall be glad to answer any 
inquiries made by those feeling an interest in the place, or who may be in search of 
health. 



xm. 

REPORT OF THE COMMITTEE ON THE CAUSE AND 
PREVENTION OF DIPHTHERIA. 

By G. C. Ashmun, M. D., Chairman of Committee, 
Cleveland, Ohio. 

Your committee appointed to report upon " The Cause and Preven- 
tion of Diphtheria " would remark, from the fact that so much has 
already been presented upon this subject to this Association in other 
years, that their efforts have been chiefly directed to a report upon the 
clinical and sanitary fields of observation. 

Laboratory work, with its chemical, microscopical, biological, isola- 
tion, and inoculation tests, is highly important, and gives direction and 
accuracy to observation. But the facts, which prompt or are made clear 
by such work and theories deduced therefrom, find their ultimate inter- 
pretation and settlement at the bedsides, homes, and districts of the 
affected, in intelligent application. In public health concerns, the health 
officials stand as the clinical attendants and consultants, only going 
further for their public patients and patrons in the scope of their efforts, 
than private professional attendants can hope to do for theirs. For some 
cause, the public, including medical practitioners, has grown apathetic 
and hopeless in regard to the prevention of diphtheria to a degree not 
experienced toward any other disease. There is a submission to a 
yearly sickness, from this cause, of not less than forty thousand cases 
in the United States and Canada, with an annual death loss of at 
least ten thousand lives ; and this, with little demonstration of organ- 
ized resistance. This condition probably has come from the observed 
limitations of curative agencies, and from the want of satisfactory dem- 
onstration that preventive measures can be adopted and made effective. 
Then, too, with the wide distribution of cases, and constant presence 
of the disease in almost all of our large communities, together with the 
knowledge that where one case is detected, dozens escape detection, has 
this feeling of hopelessness become established. 

Can any one doubt that a similar number of cases and deaths from chol- 
era, yellow-fever, or other of the rapidly spreading epidemic diseases, would 
arouse us to utmost effort to limit and stamp out the destroyer? Yet it 
is from those diseases, which prevail so constantly that we are not sur- 
prised by them, that our greatest losses occur, and the lives thus lost are 
made to appear as being regarded of less value than those lost by sweep- 



98 THE CAUSE AND PREVENTION OF DIPHTHERIA, 

ing epidemics, for whose suppression or prevention money and effort are 
expended without stint. No doubt this state of the public mind in 
respect to diphtheria could be dispelled, and replaced by one of energetic 
resistance and hope, could this Association, or any other body of compe- 
tent investigators and leaders, be able to demonstrate specified causes or 
sources of this disease, which could be resisted and overcome by disin- 
fection, inoculation, isolation, orby any other method compatible with the 
well-being of those unaffected. Unless this can be done and confidence 
infused into preventive measures, this disease remains a constant reproach 
to sanitary science, and the public falls further into submissive inaction. 
With this view before it, and to make its report concise, your committee 
has not deemed it necessary to cite much of the copious literature of 
diphtheria to which all may have access ; but, in order to reach the pre- 
vailing views of observers in this country at the present day, the follow- 
ing list of inquiries was prepared and distributed somewhat widely, with 
a request for a statement of opinions upon the points indicated. 

The attempt was not made to secure as large a number of responses 
and opinions as possible, but rather to secure opinions from men known 
to have had experience and education in contact with the disease, and 
the discrimination to constitute them independent observers. 

In republics, sanitary law, like other provisions limiting or restraining 
individual action for the common welfare, cannot be enforced much 
beyond enlightened public opinion. 

And for this reason such opinion must be constantly " made" by pre- 
senting and interpreting the discoveries and teachings of students and ob- 
sei*vers. Ignorance because of preestablished views is, perhaps, the 
greatest danger and the most difficult to overcome in the advance of san- 
itary and preventive science. This, it appears to your committee, is 
especially true in respect to the present position of public opinion regard- 
ing diphtheria. 

REPORTS RECEIVED FROM MEDICAL PRACTITIONERS IN THE STATES 
OF NEW YORK, OHIO, INDIANA, ILLINOIS, IOWA, NEBRASKA, KAN- 
SAS, AND ARKANSAS. 

EDITED BY B. B. LONGHEAD, M. D., RAVENNA, OHIO. 

/. Is diphtheria dependent upon a specific cause f 

Yes 93 per cent. 

No 3i per cent. 

Not established 3i pcr cent. 

Of 272 cases of diphtheria collected by one observer, one third were 
traced to exposure to the disease, and forty-one other cases occurred in 
houses where cases of the disease had been at some previous time. One 
observer traced every case, excepting the first case, in an epidemic of over 
thirty cases in one school-district, to contact with the disease or with 
those who had recently recovered from the disease. The large per cent. 



THE CAUSE AND PREVENTION OF DIPHTHERIA. 99 

answering " Yes" indicates that the specific origin of the disease is very 
commonly accepted. Those answering "No" ascribe the disease to 
atmospheric influences producing catarrhs, and to debilitating influences, 
as bad food and water, impure air, etc. 

2, If so^ is such specific cause developed or preserved in other than 
albuminoid tissues and fluids? 

Developed, 

Yes 413^ per cent. 

No 2i>^ per cent. 

Unsettled 37 per cent. 

Preserved. 

Yes 52 per cent. 

No 17^ per cent. 

Unsettled 30% per cent. 

Many of those answering " Yes" or "No" allowed the one answer to 
answer both questions. It is very doubtful if the meaning of the one 
answering so intended it. 

Among the substances mentioned as preserving the specific cause are 
soil, filth, food, carpets, upholstered furniture, wall paper, clothes, sew- 
age, etc. 

The classification of the various micro-organisms being studied in con- 
nection with the various diseases, — (i) as those strictly " parasitic," i, ^., 
requiring a living organism upon and from which their life, develop- 
ment, and reproduction depends; and (2) those termed "saprophytic," 
living upon dead matter not yet resolved into its elemental parts, — we 
regard as especially important in its bearing upon this question and 
efforts to control diphtheria. 

Experimental cultivation indicates that the diphtheritic bacillus finds 
its best development in animal or vegetable albumen, and may be pre- 
served in it for a long time in a dried state. When it is considered how 
widely distributed the various forms of albumen are, it is quite sufficient 
to explain the opportunity the bacillus of diphtheria enjoys. Under this 
classification and representing our present knowledge, the bacillus of diph- 
theria is both parasitic and saprophytic. It attacks healthy living tissue, 
and can be cultivated, developed, and preserved in dead but not decom- 
posed albuminoid substances. 

J. By what media and channels does the specific cause gain 
entrance to the human organism? 

Media : Air, food, water 90^^ per cent. 

Channels : Air passages, mouth, inoculation 90^ per cent. 

Media and channels not known 9|^ per cent. 

The answer to this question establishes that the prevalent opinion 
among observers is, that the nose and throat are the parts upon which the 
virus usually finds a lodgment. 

Occasional cases are produced by inoculation either upon the skin 



lOO THE CAUSE AND PREVENTION OF DIPHTHERIA. 

where it is abraded, or upon the membrane of the mouth. A large per 
cent, believe the virus is conveyed by the air, by food, and by drinking- 
water, but may be conveyed on the fingers, on spoons, knives, etc., used 
about the sick. 

4, To what extent is there^ and what especial conditions may con^ 
stitute^ individual predisposition to the disease? 

Catarrh 29 per cent. 

Debility 32X per cent. 

Age 16X per cent. 

Conditions and extent unknown 22^ per cent 

The extent of " individual predisposition" is ignored by a large major- 
ity of those answering, a few only considering that it may exist to con- 
siderable extent. Causes of debility are enumerated, as previous sick- 
ness, unsanitary surroundings, malarial poison, bad air, food, and water, 
scrofulous habit, etc. Childhood is considered an especial condition pre- 
disposing to the disease, and a small per cent, consider the disease much 
more fatal among fair-haired, light-eyed children, than among dark chil- 
dren, with dark hair and eyes. 

Of 19,824 cases collected, there were, — 

7 per cent, under one year of age, 
57 per cent, between one and five years, 
28 per cent, between five and ten years, 
5 per cent, between ten and twenty years, 
2 per cent, between twenty and forty years, 
6-10 per cent, between forty and sixty years, 
4-10 per cent, over sixty years. 

J. Is there reason to believe that the disease may he caused by 
germs^ ptomaines^ or products and conditions developed within the 
body^ and independent of specific causes received from without? 

No 80 per cent. 

Yes 13 per cent 

Still unsettled 7 per cent. 

Those answering this question in the affirmative find themselves una- 
ble to account for the disease in isolated cases where no contagion can be 
traced, and hence argue that the specific cause may be developed wifliin 
the body. 

d. To what extent and for what length of time is isolation of per^ 
sons *' affect ed^^ or " infect ed^^ with diphtheria regarded essential as 
a preventive measure? 

But few mention the extent of isolation. Those who do would make 
it as complete as practicable. About five per cent, of the answers received 
mention the /^fected. 

Those answering this part of the question vary from three to ten 
days. 



THE CAUSE AND PREVENTION OF DIPHTHERIA, lOI 

With regard to time of isolation of those affected with diphtheria : 

23 per cent, would isolate until complete recovery only. 
36^ per cent, would isolate from three days to two weeks after recovery only. 
34^ per cent, would isolate from two weeks to two months after recovery only. 
6 per cent, do not consider isolation necessary. 

The answers develop the greatest variety of practice in this matter. 
The classification above shows, as clearly as possible, in tabular form, the 
general sentiment in the medical profession. By complete recovery, the 
answers explain, is meant complete disappearance of membrane, the 
afiected mucous membranes becoming normal, complete restoration to 
vigorous health, etc., — the opinion as to what recovery means varying very 
greatly. Some answer that thorough disinfection takes the place of iso- 
lation after the pseudo-membrane disappears. 

7. What substances and methods of disinfection are regarded 
reliable f 

Most of the answers name more than one substance as reliable for dis- 
infection. The percentage is computed on the number of persons 
answering. 

Substances, Methods, 

Sulphur . . . ' (By fumigation) 48 per cent. 

Mercuric Bichloride (Solution) 40 per cent. 

Heat (Steam — hot air — boiling) . 35 per cent. 

Carbolic add (Solution — spray) .... 16 per cent. 

Free ventilation (Pure air) 14 per cent. 

No substances or methods reliable 5 per cent. 

Many other substances are mentioned, as chlorine gas, chlorides, 
chloral hydrate, boric acid, resorcin four per cent., calcium chloride, etc. 
Those substances that are considered reliable germicides are in general 
the things mentioned. 

8, Can disinfection he depended upon either to take the place or 
shorten the duration of isolation or quarantine? 

Yes tjYi per cent. 

Yes, to some extent 20 per cent. 

No 52% per cent. 

It appears that observers are very equally divided with regard to the 
value of disinfection as a method of shortening or entirely supplanting 
isolation, — ^forty-seven and one third per cent, answering yes either to 
shorten or substitute isolation, while fifty-two and two thirds per cent, 
think it should have no influence on the time of isolation or quarantine. 

p. Should hospitals and stations be provided for isolation^ disin- 
fection^ and treatment of cases of diphtheria for the protection of the 
public health? 

Yes 58^^ per cent. * 

Yes, in crowded districts 18^ per cent. 

No 23)^ per cent. 



I02 THE CAUSE AND PREVENTION OF DIPHTHERIA. 

Three fourths of the answers advise the establishment of such stations 
and hospitals,— quite a per cent, believing they should only be resorted to 
in the large cities and in tenement house portions. 

Some of those who answer "No" consider the matter impracticable 
because many cases are infants ; because it prevails more in cold, wet 
weather, and removal is dangerous ; because many mild cases are not 
recognized ; because before a diagnosis is made the contagion is already 
spread ; because removal would tend to expose others. 

(Scientific isolation of recognized cases of diphtheria is rarely, if ever, 
secured in private homes. Disinfection of bedding, clothing, and all 
articles coming in direct contact with the sick, or closely associated 
with them, require special methods and apparatus to be made reliable. 
Therefore, whether hospitals for compulsory treatment can wisely be 
instituted or not, disinfection stations can and should be erected and oper- 
ated at the public expense. The value and duration of isolation can be 
determined only when made scientifically complete. The same is true 
of disinfection.) 

70. What climatic limitations are known as affecting the develops 
ment and spread of diphtheria f 

None known 58 per cent 

Cold, damp weather 28 per cent. 

Temperate zone 8 per cent. 

Changeable weather 6 per cent. 

The condition of atmosphere noted by many as favoring the spread of 
diphtheria is cold and damp, — some considering such weather as increas- 
ing catarrhal troubles, and hence favoring the spread of the disease. The 
president of the board of health of Hot Springs, Arkansas, reports that 
they have no diphtheria in that city. 

The answers indicate that while the majority of observers consider that 
there is no known climatic limitations affecting either the development 
or the spread of the disease, yet many consider the cold, wet weather of 
fall and spring conducive to its prevalence. 

II. To what extent are domestic or other animals and fowls liable 
to diphtheria and to become sources of infection to human beings? 

Domestic animals and fowls are liable to diphtheria, and are sources of infection to 

a considerable extent 41 per cent. 

to but slight extent 18 per cent 

not at all 6 per cent 

no evidence that they are either 35 per cent 

Nearly sixty per cent, believe that domestic animals and fowls are liable 
to the disease, and that they convey the infection to human beings to a 
greater or less extent. Dogs, cats, swine, cows, and chickens are men- 
tioned as subjects of the disease. They may not only convey the disease 
by direct contact, but they may be carriers of the contagion in their hair 



THE CAUSE AND PREVENTION OF DIPHTHERIA. Io8 

and feathers. This is spoken of as especially true of the dog and cat, 
which are likely to be fondled by children suffering from diphtheria. 

In order to bring the sentiments of these observers before the Associa- 
tion in a form easily grasped, your committee would submit the follow- 
ing brief resume of facts and opinions gathered from a careful study of 
the responses to the series of questions submitted to observers scattered 
over a large portion of the United States. 

It is the generally accepted belief that diphtheria is dependent upon a 
specific germ. Less than one half believe this specific cause is developed 
in other than albuminoid substances, and almost an equal number con- 
sider the question of its development still unsettled. Over one half 
believe that the specific cause is preserved in other than albuminoid 
substances. 

Air, water, and food are the media by which the virus gains entrance 
to the organism, and the air passages, mouth, and throat are the channels ; 
occasional cases arise from inoculation through carelessness or unclean- 
ness. 

A great variety of conditions increase individual susceptibility. They 
prevail in frequency in the order named, — nasal and pharyngeal catarrh, 
debility from any cause, age, etc. 

Many consider the disease much more fatal in scrofulous children with 
light hair and eyes, than in those having dark skin, hair, and eyes. 

The general opinion prevails that the disease is never caused by any 
agent developed within the body, but is always from without. All but a 
very small per cent, consider that those affected with diphtheria should be 
carefully isolated, at least until all traces of the disease have disappeared, 
while many would isolate from one to eight weeks after recovery. 

Sulphur, mercuric bichloride, heat, carbolic acid, and pure air, in the 
order named, are the substances considered most reliable for disinfection. 
Sulphur in the form of sulphurous acid made by burning sulphur in the 
presence of moisture, mercuric bichloride and carbolic acid in solution, 
free ventilation, heat in form of steam, boiling water, and dry heat are 
the methods by which these substances should be used. 

Only a small per cent, consider disinfectants sufficiently reliable to make 
it safe to do away with isolation entirely, although many think the time 
of isolation may be safely shortened where thorough disinfection is used. 

A very large per cent, believe public health demands the maintenance 
of hospitals for isolation and treatment of those affected with diphtheria. 
More especially are such hospitals needed in the crowded portions of 
cities, and among the poor where proper care cannot be afforded. Such 
hospitals would also be of great service where the disease has become 
epidemic, and would enable the sanitary officers to stamp out the disease. 

There are no climatic limitations known as affecting either the develop- 
ment or the spread of diphtheria. It has been found to be most prevalent 
in the cold, damp months of the late fall and early spring, but catarrhal 
affections also prevail more at that season, and diphtheria may find easier 
access to the human system because of the already diseased membranes. 



I04 THE CAUSE AND PREVENTION OF DIPHTHERIA, 

Domestic animals and fowls are believed by the majority of observers 
to be liable to the disease. Many of those answering the question have 
themselves observed cases of diphtheria in dogs, cats, and the common 
barnyard fowls, and have traced cases in human beings to these animals. 
They may also be the media by which germs of the disease are carried 
from person to person, or from house to house, the fur of the dog and cat 
being an excellent vehicle for conveying the virus. 

The investigations of Bretonneau, Trousseau, Virchow, Oertel, Mac- 
kenzie, Klebs, Wood, Formad, Sternberg, Loeffler, Prudden, Northrup, 
Koch, and many others of recent times, in and by strictly scientific 
methods, have led up to and perhaps have demonstrated a specific 
cause for diphtheria, and their conclusions, spread through the writings 
of the last thirty or forty years, cannot fail to have made an impression on 
all students. Yet the fact remains, that so much difficulty has been 
experienced in reconciling the facts observed in this field of disease with 
the conclusions of these students in laboratories and hospitals as to beget 
a very conservative and even doubting state of mind among thoughtful 
observers, on many of the points presented. As a practical question in 
preventive medicine, the determination of cause or causes is imperative, — 
the basis of all action. The more early, precise, and exhaustive such 
determination can be made, the more direct and hopeful the application 
of preventive measures. ' 

It cannot truthfully be said that no advance has been made, in this 
matter, in late years. On the contrary, in the whole field of research in 
respect to the micro-organisms found actively associated with various 
diseases, most pains-taking and exhaustive processes have been applied 
to the discovery, classification, and life history of each and every species, 
with great additions to our knowledge of the subject. Perhaps the most 
important point developed in this field, in most recent times, has been 
the significance attaching to th.e products of these organisms, during 
their process of development and activity, under favorable conditions. 
Such products appear to bear a very causal relation to the phenomena of 
many diseases, and also have been observed to limit the action and life 
of the producing organism, when sufficiently concentrated. On another 
side of this subject, it has been made safe to say that not only has every 
living organism a certain natural and, in a' measure, selective habitat, 
nutriment, method of reproduction, and tolerance of variation from its 
norm, but also has its own special defences against other organisms. 
And while an attack may be overwhelming mechanically, or, by reason 
of numbers simply, overcome such normal resistance, there can be no 
other logical conclusion than that the general or special resistance of one 
organism toward another can be increased or diminished. A part of 
such resistance, by the human organism, has been observed to be a 
process of reception and destruction of certain micro-organisms, by cell 
and gland action, resembling a form of digestion. To secure and retain 
such resisting cell and gland functions, together with integrity of tissues, 



THE CAUSE AND PREVENTION OF DIPHTHERIA, lOS 

the human organism must be in no defective state. The impairment of 
disease resistance may and does come from so many varying causes and 
channels, and is so difficult of recognition and estimation of its signifi- 
cance, as to be still restricted to general terms in description, and only of 
general application in preventive efforts. And although admitted to be 
*^ general,'' as indicated, no process of reasoning can or should lessen the 
force of the universal law, that well organized, developed, and nourished 
living structures resist the entrance of all external agents calculated to 
injure or destroy them better and longer than those of inferior organi- 
zation, imperfectly developed and poorly nourished. 

On the question of specificity in diphtheria, the recent work of Roux 
and Yersin in France and Loeffler in Gernaany gives, perhaps, the index 
and conclusion to bacteriological work in this field up to the present day. 

For the purpose of giving such work its proper recognition and value, 
and at the same time giving opportunity to compare their conclusions 
with the result of observations of the course and spread of the disease 
in this country, extracts are here cited. In the "Annals of the Pasteur 
Institute" MM. Roux and Yersin state it as their opinion that the Klebs- 
Loefiler bacillus is so specifically identified as a cause of diphtheria 
as to render it necessary that all practising physicians should be able to 
isolate and identify this bacillus. 

They themselves have made or verified the diagnoses of diphtheria by 
this method in more than a hundred cases, and they think that not until 
diagnoses are made in this way will thoroughly scientific results be 
obtained. In order to stain the bacillus so that it can readily be seen 
and studied under the microscope, it is merely necessary to move a 
small fragment of the false membrane, by means of a piece of absorbent 
cotton-wool tied firmly to a pair of forceps, or any other safe carrier, 
from which it is transferred to a scrap of blotting-paper, and thence to a 
cover glass, where it is broken down as finely as possible, heated over a 
flame, and stained methyl blue or gentian violet, washing thoroughly 
with water before examining. 

They say that the diphtheria bacillus appears to " stain" more rapidly 
and deeply than any of the indifferent organisms associated, and among 
which they can be seen grouped in small masses as short, straight, or 
curved rods with slightly thinned or rounded ends. In some instances 
they appear slightly clubbed or pear shape ; and they may be granular 
and unequally stained. They assert that, in true diphtheria, these bacilli 
are never absent, and with a little practice it is easy to distinguish them 
from all other forms. This examination may be completed in a few 
minutes, and gives, when confirmed by culture experiments, the most pre- 
cise information. Even the course and prognosis of the disease may be 
followed and indicated by the daily use of the microscope upon the exu- 
date and secretions. Where improvement is taking place the specific 
bacilli become less numerous, while other associated microbes become 
increased in number. These writers assert that some of the associated 
microbes appear to interfere with the growth and activity of the specific 



I06 THE CAUSE AND PREVENTION OF DIPHTHERIA, 

bacillus. These bacilli retain their vitality, when dried, for a considera- 
ble time, and withstand a temperature of 98° C. (208° F.) for a whole 
hour. As a very obvious point in practical application Rouxand Yersin, 
together with Loeffler and many others, state that " the best method of 
arresting the spread of diphtheria is to recognize the disease as early as 
possible. This can be done by microscopic examination, confirmed by 
cultivations on blood serum, both of which can be made available in 
twenty-four hours in private practice and by ordinary practitioners of 
medicine. Active diphtheritic virus can remain in the mouth of the 
affected for a long time afler the malady is apparently cured. Conse- 
quently diphtheritic patients should be allowed to resume their ordinarj^ 
course of life only when they are no longer bearers of the bacillus. The 
virus retains its vitality a long time when kept in a dried state and when 
not freely exposed to air, and it is therefore necessary to disinfect, in a 
steam sterilizing apparatus, the linen and all articles that have been in 
contact with diphtheritic patients. The attenuated virus of diphtheria is 
widely distributed, and readily regains its virulence under favorable con- 
ditions. It is therefore necessary that at the commencement of simple 
forms of sore throat, antiseptics should be applied carefully and thor- 
oughly.*' Klein and some others maintain that domestic animals, includ- 
ing cats, dogs, cows, and some fowls, are aflected with the true diphthe- 
ritic virus, while Loeffler and others regard the disease to which such ani- 
mals and fowls are subject as a separate and distinct disease. Experiments 
appear to demonstrate, however, that certain animals such as guinea 
pigs, rabbits, young dogs, etc., are easily susceptible to the true diph- 
theritic bacillus. 

In conclusion, and for the purpose of exerting some influence upon 
public opinion respecting the cause and prevention of diphtheria, your 
committee would respectfully offer the following propositions to the 
Association, which they hope may be adopted : 

First. We recognize the disease known as diphtheria to be due to a 
specific cause, owing to which all cases become dangerous as sources 
of contagion and infection. 

Second, For the prevention of diphtheria, isolation of those affected 
and infected should be made scientifically complete in all cases ; and we 
believe that by such isolation of all recognized cases the spread can be 
immediately checked. 

T%trd. That while it may not be possible to secure prompt recogni- 
tion and isolation of all cases of diphtheria in the present state of knowl- 
edge and opinion, we believe it the duty of local boards of health and 
health officials to provide stations, apparatus, and agents for the reliable 
disinfection of all bedding, clothing, and articles which may be the 
holders and carriers of diphtheritic virus, such disinfection to be done at 
the public expense and under official control. 



THE CAUSE AND PREVENTION OF DIPHTHERIA, IO7 

DETAILED SUGGESTIONS FOR THE APPLICATION OF EFFICIENT 
MEANS FOR CLEANSING AND DISINFECTING CLOTHING, FURNI- 
TURE, AND PREMISES WHICH HAVE BEEN EXPOSED TO THE 
INFECTION OF DIPHTHERIA. 

DISINFECTION OF CLOTHING BY HEAT. 

All infected articles of clothing before handling or moving should be 
moistened with a watery solution of carbolic acid, or even water alone, 
to prevent germs of the disease passing into the air and thus becoming 
disseminated, and also to protect those engaged in the work of disinfec- 
tion. 

All small and inexpensive articles and cloths, which can be spared 
without serious inconvenience should be destroyed at once by burning. 
Other articles of clothing, bedding, carpets, rugs, and all textile fabrics 
should be placed in sufficient water to cover them and boiled fully one 
hour. 

Mattresses and ''ticks" should be ripped open, the covers boiled and 
the contents replaced if unsoiled. If the contents have been soiled, they 
should be destroyed. Carpets should be ripped into separate breadths 
and boiled. After boiling as indicated, all such goods should be hung in 
the open air and sunlight for two or more days. ** Ironing" all such 
goods while moist, with an "iron" kept as hot as the goods will bear 
without scorching, develops steam under some pressure, and will dis- 
infect in a measure, but will not take the place of prolonged boiling. 
"Steam'' under a pressure of twenty-five pounds to the square inch will 
take the place of boiling, where it can be applied. 

"Dry heat" applied in chambers prepared for the purpose, and in 
which the goods are heated in all portions to a temperature of 230^ F. 
for one hour, will serve the purpose where boiling and steam under pres- 
sure cannot be used. 

DISINFECTION OF CLOTHING BY CHEMICAL AGENTS. 

No, I. A solution of carbolic acid prepared by placing three tea- 
spoonfuls of the acid to each quart of water used (and thoroughly shaken) ; 
or 

No. 2. A solution of "corrosive sublimate" prepared by dissolving 
two drams of the crystals in each gallon of water used ; or 

No. 3. A solution of chloride of zinc prepared by disolving two 
ounces of the crystals to each gallon of water used ; — 

Into either of which solutions the goods and fabrics should be placed, 
and kept under water for twenty-four hours. 

Sulphur gas ^ produced by burning two pounds of sulphur for every 
one thousand cubic feet of space, with sufficient steam escaping in the 
room to moisten the air and surfaces, is a powerful disinfectant ; but such 
gas in a tight chamber, in the presence of sufficient moisture to be effect- 
ive, will injure and destroy clothing. 



I08 THE CAUSE AND PREVENTION OF DIPHTHERIA. 

Any of the above chemical agents require caution in their use, as, taken 
internally, they become dangerous to life. 

DISINFECTION OF FURNITURE. 

This includes the bedsteads, chairs, vessels, and dishes, and all uphol- 
stered and movable articles. These should be washed in the solution No. 
I (carbolic acid) prescribed for clothing, with thorough sponging of the 
upholstered portions. 

After washing and sponging, the bedsteads, chairs, and all articles 
chiefly of wood should be allowed to stand, without wiping or rinsing, in 
the open air for twenty-four hours or more. All earthen, tin, or iron 
vessels, dishes, or utensils should be first washed in the solution, and then 
placed in an oven or other chamber and heated to as high a degree as 
they will bear without injury. After this treatment, all such furniture 
should be thoroughly rinsed, and the rinsing water carefully saved and 
boiled for one hour before being thrown upon the ground or into sewers 
or drains. 

DISINFECTION OF PREMISES. 

The room or rooms should be tightly closed, after clothing and ftirni- 
ture (as indicated before) have been removed, and all metallic surfaces, 
such as gas fixtures, mouldings etc., coated with an ointment made of 
carbolic acid one part, vaseline fifteen parts. Then sulphur should be 
burned in the rooms at the rate of two pounds to one thousand cubic feet 
of air space, with steam enough thoroughly to moisten the air and sur- 
faces. Steam suflScient can be developed by placing three or four hot 
bricks in a tub of water. The sulphur gas should be kept in the room 
for twenty-four hours. After thus fumigating the rooms, the floors, base- 
boards, doors and casings, windows and casings, and every portion of 
wood-work should be washed with solution No. 2, prescribed for cloth- 
ing. The walls and ceiling, if papered, should be carefully scraped, and 
the fragments immediately burned. Then the walls should be thoroughly 
coated with a quick-lime wash, and the outer air and sunlight be permit- 
ted to enter freely for one or more days. In cases where expensive pa- 
pers are on infected rooms, a coating of light varnish may replace the 
work of removing the paper. 

Diligent search should be made for any inlet into the building which 
may convey or permit the entrance of air from any sewer, drain, closed 
cellar or basement, or damp, dark place of any kind under the building 
or connected to it in any way. If any such inlet is found, or any such 
place where air is confined, such inlet should be properly closed, and any 
damp, dark place underneath the building opened up to air and sunlight ; 
and in addition, all such drains and places should be disinfected by a 
solution of the chloride of lime, two ounces to the gallon of water. Sul- 
phur may be burned in such places as prescribed for rooms. 

Outside the building all pools of either rain, soil, or slop water near the 



THE CAUSE AND PREVENTION OF DIPHTHERIA. IO9 

building should be abated by draining and filling. An excessive soil sat- 
uration and retention of water should be relieved by draining. Any ac- 
cumulation of garbage, decomposing animal or vegetable substances, 
muck or dust, should be carted away and burned. 

Also the contents of cesspools, vaults, pits, and ash heaps, where refuse 
matters have been thrown, should be carted away, and all such places 
made sweet and clean. These places can be disinfected by the use of 
chloride of lime in solution as prescribed, or, in moist places, by sprink- 
ling the lime over the surfaces. All dark, damp pits, vaults, drains, 
rooms, spaces under the building or near it, should be freely opened to the 
outer air, thoroughly cleaned, and kept so. 

The care and treatment of persons sick with diphtheria, both at the 
time of their sickness and for some time after all signs of the disease have 
disappeared, are of the utmost importance to promote recovery and dimin- 
ish the work of disinfection. 

A constant use of substances known to be destructive to the bacillus 
and virus of diphtheria during the course of the disease, by washes, gar- 
gles, and spray with steam upon the diseased surfaces, prevents the es- 
cape of the virus to surrounding objects. The complete isolation of the 
affected, the removal of all unnecessary articles of clothing and furniture 
from the sick-room, the prompt attention to and destruction of all secre- 
tions and excretions expelled, the free admission of sunlight and pure air 
to the sick-room will diminish the extent and labor of disinfection. 

The duration of isolation of persons affected with diphtheria should ex- 
tend so long as any of the bacilli are present in the secretions ; and as this 
fact cannot be determined without repeated, skilful, microscopic exami- 
nations, the affected individuals should be kept strictly isolated for not 
less than four weeks after the disappearance of all traces of membrane. 

G. C. ASHMUN, 
F. H. COLTON, 

A. W. Cantwell, 
Peter H. Bryce, 
William T. Councilman, 

Committee » 



XIV. 

MARITIME SANITATION AT PORTS OF ARRIVAL. 

By H. B. HORLBECK, M. D., Charleston, S. C. 

Procedures for the protection of the communities living in cities by 
the sea have advanced from most primitive methods ; and I have con- 
sidered it as not entirel}' without interest to look back into their history, 
at least as it pertains to the city of Charleston, whose people have been 
so often scourged by imported diseases in the past two hundred years. 

It has taken many long years to reach the perfection of method in use 
at this day. It would appear as if no methods for disinfection were 
practised in the past save the detention until the vessels infected purged 
themselves. 

The statutes of South Carolina teem with laws stringently binding 
vessels, whose misfortune it may have been to become infected with 
disease, from approach to the city of Charleston. 

Commencing as far back as 1698, we find in the Statutes at Large, 
A. D. 1698, the following paragraph : 

VIII. — And be it further enacted that the pylott aforesaid shall enquire of every mas- 
ter or commander of every vessel, whether any contagious disease be on his vessel and 
the master or commander of every vessel shall give a true account thereof ; and if there 
be any contagious sickness on board, the pylott shall acquaint the master not to come 
above one mile to the Westward of Sullivan's Island, on penalty of Tenn Pounds on the 
pylott so neglecting ; and the penalty of Fifty Pounds on every master or commander of 
any vessel that shall have any contagious sickness on board his vessel and not coming to 
an anchor as aforesaid, after notice given him. And for the better enabling the said 
powder receiver to perform what is required in this Act, every master for each certificate 
so received, shall pay xmto the said receiver of powder two royals and no more. 

In 1712, we find **An Act for the more effectual preventing of Con- 
tagious Distempers." This is very full, and far too long for verbatim 
reproduction here. We quote : 

. . . And it is hereby enacted by the authority of the West part of this province, that 
from and after the ratification of this Act, that Gilbert Guttery shall be a Commissioner 
for the enquiring into the State of health of all such persons as shall be aboard any ship 
or vessell arriving in this province. 

The act continues, and gives power for search and for sending any 
one to the pest-house on Sullivan's island : 

That if it appear to the Commissioner above mentioned, upon examination, that any 
person on board the said ship is sick of the plague, small-pox, spotted fever, Siam dis- 
temper [yellow-fever], Guinea fever, or any other malignant contagious disease . . . 




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MARITIME SANITATION AT PORTS OF ARRIVAL, III 

he shall order to pest-house . . . nor suffer any one to come on board his said ves- 
sel from any place in this province during the space of twenty days after these orders 
are given, during which time the master or commander is hereby required to cause his 
ship and things on board to be cleansed after such manner as by the said Commissioner 
is directed. 

The act continues, and requires a fine of one hundred pounds in case 
the captain shall refuse to obey the orders of the commissioner in send- 
ing the sick ashore, or allowing any one to board his vessel : 

Further, that no person besides the pUot shall go out upon any vessel coming from 
any port lying to the Southward of the Thirtieth degree of Northern latitude, and if he 
hears of or suspects any distemper he shall wash himself and his clothes before he come 
on shore. Penalty, he shall forfeit and pay the sum of Twenty Pounds. And if any one 
shall go aboard of any vessel before the Commissioner hath been on board, and hath 
affixed notice on some publick place in Charlestown, that those on board the said vessel 
were in such a state of health as they were allowed to come and bring the vessel to 
Charlestown. Penalty, One Hundred Pounds, but if unable to pay the said sum and be 
not a freeholder nor reputable house keeper, or be servants, negroes or the like inferior 
people, they shall be publickly whipt thro the streets of Charlestown. . . . 

The act further provides against all negroes or other goods of what 
kind soever being landed except by order of the commissioner. Cloth- 
ing of the commissioner or any of the company to be washed. 

For what is wanted about the pest-house, either for agreeing with nurses, making 
repairs or other conveniences for the sick, any sum not exceeding Fifteen Pounds a year. 
Those who are of ability to maintain themselves shall do it at their own proper charges ; 
white servants, slaves at expense of masters. Salary to the Commissioner Forty Pounds 
a year, etc 

It will be seen that great precautions were taken, and properly so, as 
yellow-fever — maladie de Siam — was ever at hand to chasten the infant 
colony of Great Britain, and to sap and destroy human life so precious 
in the then struggling population. Year after year, with varying inter- 
vals, the disease came, and from all appearances the quarantine pro- 
cedures in use at that period were entirely powerless. While we have 
searched unremittingly for any specially designed mode and method of 
purifying and cleansing ships while at quarantine, we have failed entirely 
to find, with the resources at our command, any account of any method 
of ridding the pest-infected ships of their terrible burden. The text 
indicates cleansing ; but how } 

Twenty days seems to have been the period of detention. I have 
thought that, in connection with the subject of maritime sanitation, it 
would be interesting to bring to your attention the years from 1683, — 
date of settlement of Charleston, — in which Charleston has been vis- 
ited by yellow-fever. I say advisedly "visited," although for a large 
part of these two hundred years the general impression seems to have 
prevailed that yellow-fever became an inhabitant as securely at home as 
the imported Melia Azederach (China Tree), and as ready to spring up 
by local origin, as it was called, as the seeds of this tree. 

Our quarantine procedures are, of course, arranged to keep out all 
infectious and contagious diseases, but the great cause of apprehension of 



112 MARITIME SANITATION AT PORTS OF ARRIVAL, 

the South Atlantic and Gulf ports of the United States is yellow-fever, — 
practically it is a fight against this disease, — and this must continue as 
long as the people living under tropical climates to the south of us con- 
tinue to permit that disease to be of continued presence among them. 
There is an immense difference in the methods at present for protection 
as compared with the past, but it is a fight which must be ceaseless, and 
requiring our utmost vigilance. The calamities incident to the visita- 
tion in the Mississippi Valley in 1878, almost destroying the city of 
Memphis, would seem to have caused a keen and wide-spread awaken- 
ing, both as to municipal and maritime sanitation, asking for better 
methods with more reasonable assurance of success. Continuing the 
work commenced by the National Board of Health, the United States 
Marine Service have perfected the system of refuge quarantine stations 
on the coast, and, by their proper equipment and use, have somewhat 
relieved the local quarantine service in some cities from much of the 
danger of the presence of an infecting centre. 

But the peril, as I have said, is always here, and must continue ; and 
it has been so fully recognized that the best scientific methods have been 
invoked for relieving ships which have been infected. It would appear 
that up to a very recent date our quarantine stations depended for this 
important work upon the evolution of sulphur dioxide gas in the most 
crude and imperfect method, obtaining a minimum percentage of the 
sulphur gas ; this, together with a general cleaning up of the vessel, con- 
stituted the work. To those acquainted with the practical requirements, 
these proceedings were and have been for a long time regarded as being 
most unsatisfactory, and progress has been made from sulphur fumes to 
sulphur fumes and bichloride of mercury immersion ; and to these have 
been added the use of hot air, dry and moist. 

As we are so deeply interested in yellow-fever, I have looked back 
into the past for some history of its advent to American shores, and in 
St. Mery's work on Saint Domingo I find the following account, which 
I have translated from the French : 



DESCRIPTION DE LA PARTIE DE LA FRANCAISE DE L»ISLE SAINT 

DOMINGO. 

Par M. L. E. Moreau de Saint Mery. 

Philadelphia, 1797. 

In the month of March, 1685, Louis XIV had sent the Chevalier de Chaumont as 
ambassador to the King of Siam, charging him to carry back two Siamese mandarins 
arrived in France about the end of 1682. On the return, the vessels brought two Siam- 
ese ambassadors who arrived at Brest the iSth of June, 1686. These ambassadors set out 
from the same port the first of 'March, 1687, with a squadron composed of two vessels, 
three storeships, and a frigate, upon which were many missionaries and about 400 or 500 
troops sent to the King of Siam, and commanded in chief by Monsieur Desfonges, hav- 
ing under his orders M. De Briean. M. Desfonges declared Siamese General, took gar- 
rison at Bancock in the month of the following October. 

Minister Constance, so celebrated in the Siamese annals, having formed a scheme to 




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MARITIME SANITATION AT PORTS OP ARRIVAL II3 

place upon the throne the son-in-law of the king, a conspiracy which cost him his head, 
in the month of May, 1689, M. Desfonges and the French troops that this minister had 
employed were obliged to quit the kingdom of Siam after having run great dangers and 
having resisted by open force. At length they embarked, carrying also the Frenchmen 
of the Establishment that the Company of India had at Mergui in another point of the 
kingdom of Siam ; but in making route for France they were forced to come to Mar- 
tinique. They arrived at Fort Royal (Port de Paiz) of that island in the month of Decem- 
ber, 1690, the " Oriflamme," commanded by M. De L*£strille, which convoyed two vessels 
of the Company of India, called the ** Loure " and the *' Saint Nicholas," carrying with 
them the spotted fever and a pestilential fever of which the ravages were so cruel that 
from the first of January, 1691, M. De L'Estrille, MM. De Croiset, De Halgoint, De 
Seintre, and more than one hmidred persons, both from these boats and from the island, 
were taken as its victims. It became necessary to camp out in a place set apart for the 
few soldiers that came from Siam who still remained. Unfortunately, M. Duquesne- 
Guiton, commanding two vessels which came from Pondicherry, found himself at the 
same time at Fort Royal, also the vessel called " Le Mignon.^ The contagion spread ; 
and when these three vessels made route for France, in the month of June, 1691, they 
had lost at least half of their crews. 

M. Ducasse, arriving from Europe at Fort Royal the 8th of May of the same year, saw 
soon his own femiily a prey to this cruel malady. It desolated Martinique entire. M. 
Ducasse set out the 27th of July, commanding the " Solide," the " Cheval Marin," and 
tiie " Enurillon," which had been attainted by this contagion. This squadron watered at 
the Isle Saint Croix, where it had orders to take supplies {fUs vivres), but at the same 
time gave the most frightful present in that disease which placed for them the climax 
to the miseries that they had suffered from war, expulsion from country, with the rigors 
of* climate when they were transported. All these plagues reunited in reaping more than 
their half, for the inhabitants of Saint Christopher who were at St. Domingo lost there 
from the 2d to the 7th of August forty men, and left there the germ of the disease. 
They came to Port au Prince on the 12th, when the inhabitants of Saint Christopher 
received of them des rnvres, 

Le Port de Paix was then the first place of Saint Domingo where was manifested the 
disease which carries still the name of Maladie de Siam, Mai de Siam or Matelote, 
which during more than sixty years has immolated almost each year thousands of indi- 
viduals in the Antilles, of which the terror was such^that since the 17th of August, 1692, 
an ordinance prescribes a quarantine to all vessels coming from Martinique to the He 
d'Aix; that in 1694 the Admiralty de Nantes forbid ships' crews and persons coming 
from the West Indies from entering port before an inspection, on the pain of death ; and 
that in 1698 no vessel coming from the West Indies could be admitted into a port of 
France but after an inspection. 

Could this have been the first visitation of yellow-fever on American 
shores ? 

So from these two ships, partly, at least, of the Grand Monarque, it 
would seem we have inherited a disease that was to be carried from 
island to island of the West Indies, — at times with a moderate death-rate, 
at times sweeping off one third of their population,^ to visit sometimes 
for continued residence, appearing summer after summer ; in other cities 
only occasionally ; but always to be terrible, and always to claim victims 
from the human race, sometimes but a few, and oftentimes numbering 
thousands upon thousands; to go from these islands to great cities in 
North and South America, and depopulate them ; so often a visitor in 
some of our South Atlantic and Gulf ports, that the almost universal 
impression prevailed that this disease belonged to the soil. A few held 

^Nott, Charleston Medical Review, January, 1848. 



114 MARITIME SANITATION AT PORTS OF ARRIVAL, 

alofl the light, often single-handed in fight, that this disease was entirely 
a visitor, requiring to be brought and constantly replanted. 

It is exceedingly interesting to follow the various views held as to 
the importation, contagiousness, and noncontagiousness of yellow fever. 

Dr. Lining, who first gave a most graphic account of this disease, 
remarks, — 

And, lastly, whenever the disease appeared here it was easily traced to some person 
who had lately arrived from some of the West India islands when it was epidemical. 

Quoting from Dr. T. Y. Simons, — 

This eminent physician, Dr. Lining, does not give us any evidence in confirmation of 
this sweeping proposition, and it is not unfair to conjecture that his mind was biased by 
the opinion that the disease was first brought to Boston by Admiral Wheeler, from Mar- 
tinique, in 1693. ^^ ^^* Rush, when he recanted his opinion of the propagation of the 
disease by contagion, acknowledged, he was led to ascribe the yellow-fever primarily in 
Philadelphia in 1693, '94, and '97, to contagion, he was influenced by the opinion of Dr. 
Lining and others. 

Dr. John Moultrie, who wrote an admirable thesis in 1749, when he 
graduated in Edinburgh, disagrees with the opinion of Dr. Lining and 
those who advocated the theory of the introduction and spread of the 
disease by contagion. 

Dr. David Ramsay, in a letter to Dr. Miller, of New York, in 1800, 
remarks, — 

The disputes about the origin of yellow-fever which have agitated the Northern States 
have never existed in Charleston. There is but one opinion among the physicians and 
inhabitants, and that is, that the disease was neither imported nor contagious. 

Quoting from Dr. Simons again : 

This was the unanimous sentiment of the Medical Society, who, in pursuance of it, gave 
their opinion to the government in 1850 that the rigid enforcement of the quarantine laws 
was by no means necessary on account of yellow-fever. 

These views were held undisputed until 1839, when Dr. Strobel 
endeavored to prove that the disease was imported. 

Dr. S. H. Dickson, an eminent publicist on the practice of physic 
and Professor of Practice in the Medical College of the State of South 
Carolina, in writing of Dr. Strobel's opinion, saySj, — 

They seem to me weighty, if not conclusive, and if they do not prove, they surely ren- 
der highly probable, the doctrine that yellow-fever is, in this - ountry and climate, as it 
has long been held to be elsewhere, contagious and communicable, or, as Dr. Strobel has 
phrased it, transmissible. Yellow-fever is contagious, or, in other words, a case of yel- 
low-fever having been generated in a favorable season and locality by its unknown and 
undetected cause, becomes itself a generating centre productive of other causes, or of a 
morbid agent capable of producing them. It is transmissible from any one centre to 
another, or from any one of its generative centres to a healthy locality. And this com- 
munication or extension may take place in two modes, — either by consequence of a por- 
tion of atmosphere in which is defined its imdefined specific causes, as in the hold of a 
foul ship from any place where it prevails epidemically, or by the introduction of a sick 
body. 

This was in 1851, a paper read before the South Carolina Medical 
Association. 




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Dr. W. T. Wragg, a distinguished physician of Charleston, writing 
by invitation of the city council as late as July, 1859, ^^ ^^ yellow-fever, 
says, — 

With such views of the nature of yellow-fever, I say without hesitation that I believe 
it to be of local origin in Charleston, dependent upon local causes. 

Dr. £. Horlbeck expresses the opinion, at the same date, that 

Yellow-fever is neither a contagious nor imported disease ; therefore, that no state of 
the atmosphere is capable of rendering the disease epidemic in a city by the simple intro- 
duction of cases from abroad. I believe the yellow-fever of the past and former sum- 
mers to be of local origin, or to any fomites imbued with its contagion. 

From this period for a number of years the war raged of contagion- 
ists and noncontagionists. Language can hardly give utterance to 
stronger faith than the following sentences from Dr. T. Y. Simons : 

I must in candor say that I do not believe the yellow-fever was ever produced in 
Charleston from importation. And this is the result of an experience of thirty years as 
port physician, and twenty-four years a member of the board of health, many years of 
which I have been its chairman. 

Has the disease changed ? Viewing the disease as we do at the pres- 
ent day, and requiring the most rigid precautions, utilizing every 
resource which the highest scientific attainment gives us, the expe- 
rience of the Mississippi Valley in 1878, with yellow-fever extending 
hundreds of miles, and of Jacksonville in 1888, extending to Gainesville, 
Femandina, Meridian, and Decatur, would seem to drive away the last 
clouded doubt as to the importability of this disease, and from the inter- 
esting description taken from St. Mery as to its advent at Le Port de 
Paix in 1690, during the month of December, it has been carried from 
place to place. 

The first appearance of yellow-fever in Charleston, according to Dr. 
Hewett, was about 1699 or 1700, and it was called by him the "infectious 
distemper," and was considered by the inhabitants as a plague. 

In 1703 it again appeared ; also in 1728. The summer was uncom- 
monly hot and dry ; the beasts suffered from want of water, and the 
fever raging with violence swept off an immense number of whites and 
some blacks. In 1732 and 1739 it raged with so much violence, that, 
when at its height, from ten to twelve died daily. It reappeared in 1745 
and 1748 in a mild form ; a few cases occurred in 1753 and 1755, and 
there was a cessation of the disease until 1792, a period of thirty-nine 
years, with the exception of a few sporadic cases which occur more or 
less every year. Dr. Ramsay says,— 

In the year 1792 a new era of the yellow-fever commenced. It raged that year in 
Charleston, and also in 1794-1799, 1800, 1802, 1804, and 1807. A few cases occurred in 
1803 and 1805. In 1793 and 1808 the disease is not mentioned at all, and in 1806 only a 
few cases. In its visitations it extended from July to November, but was most rife in 
August and September ; with a very few exceptions, chiefly children, it exclusively fell 
on strangers. 



Il6 MARITIME SANITATION AT PORTS OF ARRIVAL. 

The unseasoned negroes were not free from its ravages, but they escaped oftener than 
the white strangers, and when attacked they had the disease in a lighter degree, and if 
properly treated, were more generally cured. Persons, both black and white, arriving 
from the West Indies enjoyed similar exemption from the yellow-fever in Charleston. 

In the years 1796 and 1798 it raged with the greatest violence, but 
since that time has considerably abated, both in frequency and violence. 
There were reported in 

I799> 239 deaths. 

1800, 184 " 

1802, 96 " 

1804, 148 " 

1807, 162 " 

From 1807 to 1817 there is no record of the disease. 

White. Black and colored. 

18 1 7, 268 deaths. 249 19 

1819, 172 " 167 5 

1822, 
1824, 
1825, 

1827, 64 " 62 

1828, 

1830. 32 " 31 

1834. 
i835» 
1838, 

1839, 
1840, 

i843» 

1844, 

1849, 

1852, 

1854, 

1856, 

1857, 

1858, 

1864, a number of deaths occurred during the war. No record. 

1871, 212 deaths. 189 23 

1874. 40 " 37 3 

1876, 30 " 29 I 

4502 

In the above list the great preponderance was among the males, and 
the great exemption from the disease among the black race is evident. 
In these one hundred and ten years of which we have a record of mor- 
tality, the disease has occurred twenty-nine times, with an aggregate 
mortality of 4,502 deaths. 

It would be proper that we should consider the aim and objects of 
maritime sanitation, and submit the following as concerning the same : 

The shortest possible detention, with the best guaranty against infec- 
tion, utilizing every modern scientific appliance, applied as quickly and 
as thoroughly as may be possible. 



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From all and the best sources of information this detention should 
never be in a vessel that is known to be infected, or supposed to be, less 
than five days, as against yellow-fever, and that after disinfection. It 
seems to be generally agreed that the period of five days covers the time 
of incubation. This is possibly open to criticism; but some period 
must be fixed for the incubation, and, as a rule, the period named fills 
the bill by common consent. 

In the cases reported by Dr. Carter, U. S. H. M. S. at the Gulf 
Quarantine Station during the past summer, it appears that in two 
instances the fever made its appearance, after thorough fumigation, with- 
in five days. 

This detention, it seems to us, only is necessary in vessels which have 
been recently subjected to yellow-fever influences. Vessels coming firom 
infected or suspected latitudes without recent and direct influences of 
contagion may be given, we think, pratique as soon as entirely fiimi- 
gated, ventilated, and disinfected. 

The methods of obtaining a guaranty have been undergoing evolu- 
tion for several years past ; and the first eflbrt, that we are aware of, 
entitled to ftdl consideration and commendation in the United States of 
America seems to have been at New Orleans, where, as early as 1874, 
improvements in the use of sulphurous acid gas were made, an appara- 
tus having been planned by Dr. Perry for forcing large volumes of this 
gas into the holds of vessels. 

Subsequently, in 1879, William Van Slooten, chemist of the Board of 
Health of New Orleans, recommended to that body, with the approval 
of Dr. Samuel Choppin, that a chamber be constructed for disinfection 
by high temperature, in which the temperature could be raised to 350** 
Fahrenheit. The poverty of the board alone prevented these early 
eflbrts from being carried into eflect. 

In 1880, Dr. Joseph Jones designed and built an apparatus for forcing 
sulphur fiimes into the holds of vessels. It did not reach practical use. 

Under Dr. Joseph Holf s administration from 1884 to 1888 a great 
advance was made in scientific procedures at the New Orleans quaran- 
tine station. 

In 1885, ^ textile fabrics were placed in a mercuric chloride solution, 
I to 1000, and, of course, all the finer fabrics were ruined,^-certainly, 
damaged. Experiments were made with the Troy Laundry Company 
drying-racks and pipes. The drying-room in 1886 was converted into 
a heating chamber recommended by Van Slooten seven years before, 
with the use of the heating chamber and mercuric chloride ; improve- 
ments were also made in the facilities for introducing sulphur fumes, a 
more efiBcient sulphur fiirnace was constructed, and by the use of a fan 
the fiimes were blown into the ship, displacing the common air. 

From this point a steady progress has been made, and improvements 
effected. The drying-room has given place, under the administration of 
Dr. C. P. Wilkinson, president of the Louisiana Board of Health, to a 
great step in progress, namely, the use of a chamber made of steel plates, 



Il8 MARITIME SANITATION^ AT PORTS OF ARRIVAL, 

differing from the heating-room of the Troy Laundry Company in fur- 
nishing a steady, regular, and uniform application of dry and moist heat 
to all hangings, bedding, clothing, and removable infected articles from 
an infected ship, furnishing a temperature of 230° or more, dry heat and 
steam. 

We quote here from Dr. Sternberg, page 81, Report of Committee on 
Disinfectants, American Public Health Association : 

Steam at a temperature of iio^ C. (230 Fahrenheit) maintained for one or two min- 
utes, or of 105'' C. (221 Fahrenheit) maintained for ten minutes, will infallibly destroy 
the spores of bacilli, which constitute the most difficult test of disinfecting power known. 

This opinion is generally concurred in by scientific investigators. 
Parsons, 1884 Government Report, England, says, — 

It may be assumed that the contagia of the ordinary infectious diseases of mankind are 
not likely to withstand an exposure of an hour to dry heat of 220^ Fahrenheit, or one of 
five minutes to boiling water or steam of 212° Fahrenheit 

Under the administration of Dr. Oliphant, president of the Louisiana 
Board of Health, improvements have been perfected in the percentage 
of the sulphur dioxide fumes driven into an infected vessel, and it is 
claimed that with the '^ sulphur furnace now in use at the New Orleans 
station, from 15 to 18 per cent, of sulphur is furnished." 

The sulphur furnace now is use at the Charleston Quarantine Station 
has given 181^ per cent, of sulphur. 

Ship after ship infected with yellow-fever patients has been treated 
after the modem method known as Maritime Sanitation at the New 
Orleans quarantine station, and in no case, as I am advised^ have there 
been evil results following from pratique given. 

At the Montgomery Quarantine Conference, held March 5th, 6th, and 
7th, 1889, the following resolutions were adopted : 

Resolved^ That this Conference endorse the Holt Quarantine and Disinfection System, 
as at present operated at New Orleans, Louisiana, as the best one known for the preven- 
tion of yellow-fever into the ports of the United States, and recommend its uniform 
adoption. 

Resohedt That it is the sense of this Conference that the best form of disinfectant for 
personal baggage is moist heat 

At the port of Charleston, all ballast from suspected or infected ports 
is taken out at the quarantine station, and has been deposited there for 
the past ten years. By the use of a steam winch, twenty tons are lifted 
every hour, and the detention is very limited. 

Dr. Burgess, in his remarks at the Savannah meeting of the American 
Public Health Association, says that among the substances brought on 
board at Havana, which may infect a vessel, is ballast. Ballast is of 
four kinds, — 

First, white or light colored, and tolerably hard and compact stone, 
which commends it. 

Second kind, porous, fusible, bluish gray, brought from Regla ; receives 




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MARITIME SANITATION AT PORTS OF ARRIVAL. II9 

the drainage of a city of 15,000, with much excrement and filth. This 
cannot be regarded as a healthy ballast, and doubtless may become a 
vehicle for infecting a ship. 

Third consists of mud, earth, and refuse scraped up directly from the 
shores of the harbor. This kind of ballast was taken by at least one of 
the three vessels which sailed from Havana for Savannah July 9, 1876, — 
the Spanish bark "Maria," and Spanish brigs *'Pepe" and "Inez." 
Now, although I am not prepared to affirm that the yellow-fever epi- 
demic in Savannah was caused by this ballast, I will say that I can 
easily understand that it may have been. 

Fourth kind of ballast is that which is taken from other vessels, and 
may or may not be infected. 

After ballast, the remaining articles which may be vehicles for the 
conveyance of the germs of yellow-fever aboard of vessels are sugar, 
tobacco, and baggage. Some of the storehouses for sugar are infected, 
as those of San Jos6 and Tallapiedra. They are situated on wharves 
on either side of the ever-infected military hospital and arsenal in a dis- 
trict which is marked yellow on the map, and which, from its peculiar 
low surrounding character, can furnish cases of yellow-fever every month 
in the year. 

It occurs to my mind that there is great danger from ballast receiving ; 
at least, it has been contended that the yellow-fever in Charleston has 
come from ballast, and, as su^ested by Dr. Burgess, possibly the epi- 
demic so terrible in character in 1876 in Savannah, Ga. It was after 
handling ballast that the cases reported by Dr. Carter at the Gulf States 
last summer occurred. Why should not these infinitely small germs be 
stored away in porous rock or sand ready for proper warmth and 
proper surroundings to become active ? 

We have seen, that, from no disinfection at all to primitive methods, 
the evolution of the problem of maritime sanitation for practical pur- 
poses has been accomplished at the New Orleans station. Following in 
the wake of New Orleans, the Charleston health authorities have adopted 
a system of maritime sanitation based on the New Orleans procedures. 
With their full permission and invitation to make use of any part that 
they might desire, we beg to offer to you a detailed description of the 
plant at the Charleston station, illustrated with photogravure prints, 
with rules and regulations governing the administration. 

It might be proper, at this juncture, before entering upon the descrip- 
tion of the fumigation and disinfecting apparatus, to say what the sta- 
tion contains. 

Imprimis, the quarantine station of Charleston harbor is about three 
miles from the city, nearly south-east, situated upon James island at the 
site of Fort Johnson, and easily approached in the open bay from either 
sea or city. 

Two wharves have been built, with convenient pier heads, affording 
22 feet of water at low tide. 

Disinfection and fumigation are practised from one, and ballast-lifting 



120 MARITIME SANITATION AT PORTS OF ARRIVAL, 

at the other. On the ballast wharf, to the west, there is a steam winch, 
capacity twenty tons per hour, railroad track and cars for carrying bal- 
last. 

It is furnished with a naphtha launch for boarding, and also for ready 
and convenient communication with the city. This form of launch has 
given the fullest satisfaction — 25 feet in length. 

On the wharf to the east are facilities for fastening vessels at anchor, 
and affording them sulphur fumes from a 12-inch galvanized tube ; also 
affording them bichloride mercury solution from iron tubes. 

The station is provided, further, with a large and commodious dwelling- 
house for the quarantine officer, convenient office for business, dwelling- 
house for engineer, and one for the captain of the naphtha launch ; also 
barracks for officers, female passengers, and crew of vessels under- 
going fumigation, fever hospital and pest-house, and large storage 
building, boarding skiff for boarding, when required ; naphtha launch 
for boarding and communication with the city, and boat-house for 
same. 

As secretary of the board of health, we have been asked to give the 
following description of the plant and methods in use in Charleston, 
taken from the pamphlet furnished for this use : 

The plant has given the fullest satisfaction. 

The cylinder furnishes steam heat to any desired degree, 240^ being 
used. 

The furnace on a recent occasion has given gas testing iS^^ per cent, 
dioxide of sulphur, and the mercury solution is used with ease and dis- 
patch. 

All clothing, bedding, hangings, mattresses, etc., are taken from ves- 
sels undergoing maritime sanitation and placed in a cylinder, and allowed 
to remain fifteen to twenty minutes, subjected to a temperature of 
240** dry and moist heat, which, it is believed, thoroughly destroys all 
bacteria inimical to human life. The vessel is thoroughly washed down 
inside with bichloride of mercury solution (i to 1000 or 2000, as neces- 
sary) . After an entire cleaning up of the vessel, the hatches are cov- 
ered over, and fumes containing 18 per cent, sulphur dioxide gas are 
forced in and the foul air driven out, one hatch temporarily left open, 
until the vessel is thoroughly filled up with the disinfecting medium. 
This is allowed to remain for twelve to twenty-four hours. In case of 
decided infection or danger the vessel and ship's company are kept at 
quarantine for observation for five days after these processes are carried 
out. 

In accordance with an invitation from Dr. C. P. Wilkinson, president 
of the Louisiana State Board of Health, two representatives of the 
Charleston Board of Health (carrying with them a draughtsman) vis- 
ited New Orleans, June i, 1889, the occasion being the opening and 
inspection of the New Orleans plant by the authorities of the state of 
Louisiana. 



MARITIME SANITATION AT PORTS OP ARRIVAL, 121 

A carefiil study of their plant was made, and new plans were drawn 
out from which the present plant was constructed. 

A cylinder for dry and moist heat was made, 30 feet long by 8 feet in 
diameter, constructed of ^inch flange steel, longitudinal seams double 
riveted, the heads being made hemispherical, and secured by eye-bolts 
and nuts, this plan being common to the Geneste & Hirscher and the 
New Orleans disinfecting apparatus. A crane was also provided for 
swinging the movable head out of place. The cylinder is covered with 
hair felting and canvas, to prevent radiation. A double track, made of 
^k ^y H ^foi^ suspended from the top and running the whole length 
of the cylinder, connects by movable rails with an outside track sus- 
pended from the beams of the building. 

On this track rolls a truck 30 feet long, made in sections, from which 
are suspended clothes racks ; above the racks is a canvas cover to pre- 
vent any dripping of condensed steam, and beneath is a galvanized wire 
netting to catch any £dling articles. Along the bottom of the cylinder is 
laid a double manifold, forming two pipes 4 inches in diameter, extend- 
ing the whole length, connecting at the centre, through the bottom of the 
cylinder, with a T pipe. On the sides of this manifold are circular 
openings, 5-inch centres, and with these openings connect i^inch diam- 
eter pipe coils, secured to manifold by collars on ends and nuts, these 
coils lining the inside of the cylinder. At the ends of manifolds are 
pipes fitted for drawing off the condensed steam, these pipes being 
laid along one side of the manifold, and passing back from the ends to the 
centre, where they connect with valves outside. There is also a per- 
forated steam pipe on the opposite side of the manifold, entering at the 
centre and passing towards both ends of the cylinder for moist heat. 
Steam being admitted through the centre, at T pipe, passes into one 
half of the manifold its whole length, thence through one end of the coils 
(water passing out of the ends of the manifold), thence around the coils 
and out of the other half of the manifold, making a complete circuit of 
the coils and perfect circulation. There is also a drain pipe in the bot- 
tom of the cylinder near the centre. To protect the clothing from 
splashing from condensed steam from the perforated pipe, a zinc plate 
has been placed on the perforated pipe which admits the steam. 

The manifold and circulation are unlike the apparatus in use at New 
Orleans. The cylinder is provided with two weighted safety-valves set 
at ten pounds ; also with steam gauge and thermometer. 

The fumigating apparatus consists of a sulphur furnace composed of 
two pans made of cast iron, 3 feet wide, 5 feet long, and 4 inches deep, 
bolted end to end, covered over at the top with -ft plate, forming a 
wagon top 21 inches above the pans, having doors at the ends for charg- 
ing with sulphur, provided with ventilators near the bottom. In the 
top of this cover at the centre is a lo-inch opening, with curtains of 
sheet iron on either side dropping down to within four inches of the bot- 
tom of the pans. Connecting with this opening is a pipe leading down 
to within six inches of the bottom of a reservoir, made of ^inch iron. 



122 MARITIME SANITATION AT PORTS OF ARRIVAL, 

30 inches in diameter by 5 feet high, placed alongside. At the top of 
this reservoir is a second pipe leading to a No. 4 exhaust fan, and dis- 
charging into a 1 2-inch pipe of galvanized iron running to the head of 
the wharf, whence, by suitable connections, it is led into the hold of the 
vessel. The pans rest on a brick foundation, forming a small furnace at 
one end (with doors for firing and controlling the draught), from which 
fire and smoke pass under the bottom of the pan to the opposite end and 
thence to the stack. 

Upon suitable connections having been made with the vessel, by using 
asbestos twilled-cloth pipes, to allow for the rise and fall of tides, etc., 
a small fire ia made under the pans, heating them up to 400^, or suffi- 
ciently to ignite the sulphur. This can be ascertained by occasionally 
throwing in pieces, care being taken not to heat the pans too hot, as 
this would cause sublimation. As soon as the proper heat is obtained, 
each pan is charged with about 100 pounds— or, in case of larger ves- 
sel, 125 to 150 pounds in each pan — and the fan is started, drawing 
the fumes under the curtains through the reservoir, there depositing 
any fire, and being partially cooled, thence through the fan which now 
forces them through a 1 2-inch pipe to the vessel, this fan being driven 
by a 5 by 7 centre-crank engine. Upon a tower 35 feet high is erect- 
ed a wrought-iron tank 10 feet in diameter by 9 feet high, covered, 
and on the top of this cover a large-sized spirit barrel is secured, 
having a plug in the bottom. There is also a No. 4 brass-lined pump 
connecting with this tank to supply it with water. Pipes also lead from 
the tank to the head of the wharf, where suitable connections are pro- 
vided for hose. The mercury solution being deposited in a barrel on top 
of the tank, is discharged into the tank through a plug in the bottom, 
where it is mixed with water in the tank. One-inch four-ply rubber 
hose and nozzles are provided for conveying the contents of the tank 
from the wharf connections into the hold and vessel. 

A forty-horse-power return tubular boiler, set in brick work, supplies 
steam for cylinder, engine, and pump, the whole apparatus being con- 
tained in a building 78 feet long by 41 feet wide. 

In applying the moist and dry heat to clothing, bedding, etc., the same 
are hung and laid on the racks, arranging them as openly as possible. 
Steam is then turned on to the coils for about fifteen minutes, expanding 
and driving the air out of the cylinder ; the racks are then drawn into 
the cylinder by a rope and pulley, the movable track removed, and the 
head closed and secured. After the temperature has reached 180° to 190® 
of dry heat, the steam is turned into a perforated pipe at the bottom of 
the cylinder till it reaches a pressure of ten pounds ; after a lapse of live 
minutes this pressure- is turned off and applied again. In so doing the 
air confined in pillows, mattresses, etc., is expanded, and by applying 
the heat a second time it penetrates to the centre of the same. Afler 
keeping this moist heat on for about fifteen minutes more it is allowed 
to escape, when the heat from coils will run the thermometer up to 
230*^ to 240^. The bolts in the head are then slackened, and the vapor 




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MARITIME SANITATION AT FORTS OF ARRIVAL. 123 

remaining in the cylinder allowed to escape. The head is then swung 
back, the movable track replaced, and the racks run out, when every- 
thing will be found perfectly dry. No leather or rubber goods should 
be placed in this cylinder. 

We have thus described the present status of maritime sanitation in 
Charleston. As in the past the board of health of this city have endeav- 
ored to utilize every scientific appliance of merit conducive to the high- 
est efficiency, so they now pledge themselves in the future to continue in 
this good work so long as the important mission of keeping contagious 
and infectious disease from our common country is entrusted to their 
care. 

OFFICIAL REGULATIONS. 

Charleston, S. C, February i, 1890. 
From and after this date the following charges and rules for the government of quar- 
antine at this port will be enforced : 

ACT OF THE GENERAL ASSEMBLY, RATIFIED DECEMBER 1 7, 1889. 

To Amend Section 985, General Statutes of South Carolina : 

That in every port in this state, where the Holt System of Maritime Sanitation is in 
use, the following charges shall be enforced, to wit : 

INSPECTION FEES. 

Every schooner or brig |8 

Every bark lo 

Every steamship or ship 15 

FUMIGATION AND DISINFECTION FEES. 

For every schooner, bark, or brig under 500 tons I50 

For every schooner, bark, or brig over 500 tons 60 

For every steamship or ship under 1000 tons ... * 75 

For every steamship or ship over 1000 tons 100 

In all cases the quarantine officer will collect the charges made against the vessel before 
giving permission to leave quarantine, either by captain's draft on consignee or in cur- 
rency, and shall return the same to the board charged with the administration of quaran- 
tine at such port, who shall be responsible for the disbursement of the same. 

QUARANTINE CODE. 

I. All vessels from infected or suspected latitudes arriving with plague, cholera, small- 
pox, yellow or typhus fever on board, or having had same during voyage, must be 
directed by the pilot to proceed to Sapelo National Quarantine Station. 

II. Any vessels arriving at this port bearing the certificate of the National Quarantine 
officer must be brought to anchor at the quarantine station, and there remain until 
released by the order of the board of health. 

III. Vessels from any foreign port direct, or via American ports, with or without sick- 
ness on board, will, during the entire year, be compelled to anchor, and remain at the 
quarantine station until released by written permit of the quarantine officer. 

IV. All vessels arriving at this port with sickness on board, or having had same dur- 
ing voyage, will, at all seasons of the year, no matter from what port either American or 
foreign, anchor at the quarantine station, and there remain until released by order of the 
board of health. 

V. Vessels from infected or suspected ports will, during the entire year, be required 
to discharge any and all ballast at the quarantine station, or such other place as may be 



124 MARITIME SANITATION AT PORTS OF ARRIVAL, 

designated by the health authorities, to have bilges and limbers deaned and sweetened, 
and be subjected to at least one fumigation, and such other disinfection as may be neces- 
sary, and be detained at least five days. 

VI. Vessels arriving with or without cargoes from suspected or mfected latitudes, via 
American or foreign ports, shall be subjected to such fumigation as the Maritime Sanita- 
tion Committee may deem necessary, said procedures to be charged for according to 
methods used. 

VI t. From May i to November i, of each year, no cargo of fruit will be allowed in 
from any infected port. 

Cargoes of fruit from perfectly healthy ports, but suspected latitudes, may be permitted 
up to the dty in lighters, vessels to undergo maritime sanitation of detention, fumiga- 
tion, and disinfection. 

VIII. Pilots must, in each case, before boarding, make inquiry as to the sanitary con- 
dition of vessels ; in no case must they board, if the vessel has had the diseases above 
enumerated, in Section i, on board, or has had same during voyage ; in such cases they 
must direct to Sapelo Quarantine Station. 
By order of the board of health. 

HALL T. McGEE, H. B. HORLBECK, M.D., 

Chairman Committee Health Officer and 

Maritime Sanitation. Secretary Board of Health, 

R. LEBBY, M. D., QuaranHne Officer, 

It occurs to US as an important matter, that as soon as practicable it 
should be the aim and object of American maritime cities to have a plant 
with steam-heating facilities. This is most important in the light of the 
fact that a vessel coming from one American port, having undergone a 
simple cleaning up with sulphur fumes liberated from an old-fashioned 
stove, would most certainly be subjected at a port provided with modern 
scientific appliances to another detention and disinfection. This is most 
vexatious to the commerce of the country, besides being exceedingly 
costly. 

It will thus be seen that the station is well equipped for the business 
requirements of the port of Charleston, the system looking more espe- 
cially to the disinfection and fumigation of vessels as there is prac- 
tically no immigration into the port, and, to use an Irishism, no build- 
ings have been erected to meet a nonexistent requirement. The rules 
for governing the vessels arriving are herewith presented. The fees as 
collected are deposited for expenditure, in the many requirements of the 
station. 

As has been said, all ballast from any port whatever, wherever the 
slightest suspicion attaches, is removed at the station, and kept there. 
All vessels with sickness aboard of a dangerous character — ^yellow-fever, 
etc. — ^are ordered to Sapelo, which is within convenient distance. Where 
any doubt exists as to the procedures necessary, the matter is referred to 
the board of health of Charleston, who have control. 

The results of maritime sanitation, at least as practised at New 
Orleans, with constant open communication with yellow-fever infected 
cities for five years, show that with a limited detention a city may be safe, 
that commerce may go on with very slight detention, and that no longer 
is there necessity for the old rigid law of absolute noncommunication. 



MARITIME SANITATION AT PORTS OF ARRIVAL, 125 

The outlook is a bright one. Certain cargoes undergo maritime sanita- 
tion with immunity from damage. 

Instead of nonintercourse with those cities provided with maritime 
sanitation appliances, constant freedom of intercourse may be permitted, 
and the great commodities of the countries interested interchanged. 
For a city like Charleston, with the ocean ever in sight from its wharves, 
scourged again and again in the past with visitations of yellow-fever* 
with its contiguities and facilities for intercourse and exchange with the 
tropics so near, the prospect is encouraging. With ceaseless vigilance 
and the utilization of modem scientific attainments, the problem would 
appear to be well-nigh solved ; but it wants an unbroken line. The ring 
of the Montgomery convention has no uncertain tone. Its approbation 
should be hearkened to by every South Atlantic Gulf port : Disinfect, 
and use steam heat. They endorsed the Holt Quarantine and Disinfec- 
tion System as the best one known for the prevention of yellow-fever 
in the ports of the United States, and recommended its uniform adop- 
tion. Let yellow-fever, as to the ports of the United States, be a thing 
of the past. 

In closing our paper, we beg to acknowledge how incomplete it is. 
To take up the subject exhaustively, including procedures of the gen- 
eral government, and as practised in foreign countries, would make too 
lengthy a treatise for an occasion of this character. 

We have endeavored to contribute for the members of the Association 
a report of our procedures in Charleston, with a full description and 
illustration of our plant, and to say to them that all that there is for 
maritime sanitation has been done in the last decade, and effected with 
very limited resources. The health authorities of Charleston were of good 
cheer, representations of their necessities were made to state authorities, 
and what has seemed an almost hopeless task has eventuated in a most 
happy result. Attention is called to these latter facts for the benefit of 
those engaged in similar work. Be of good heart. Boldly approach the 
highest authorities. Make them recognize fully their responsibility for 
withholding supplies for the public health, and it must be a pitiful power 
that will deny assistance where just and conclusive argument is afforded. 

A small book with photogravure plates has been prepared by the 
board of health, a large part of which has been transcribed, and ap- 
pended to this paper. 



XV. 

SOME NOTES ON CHEMICAL DISINFECTION. 
By F. p. VENABLE, Ph. D., F. C. S., University of North Carolina. 

Disinfection is one of the most important branches of sanitary science. 
It is far from an exact science ; still, much of the earlier confusion and 
ignorance has been done away with, and an army of earnest workers 
have made great progress toward placing it upon a thoroughly scientific 
basis. By disinfection I mean the application of disinfectants to the 
destruction of the disease-causing germs, and not the quarantining, air- 
ing, cleansing, or similar sanitary measures sometimes included under 
the name. 

However hopeful the progress that is being made, any one glancing 
at the subject will still see much confusion and lack of scientific system. 
System cannot be brought about until facts are assured ; and there are 
few facts, as yet, so firmly established that they afford secure footing to 
those who seek to clear the road still further. 

What are disinfectants, and what shall be our tests for their value? 
A great many substances have been proposed, and not a few are still 
classed among them, which deserve no place in the list, classed there 
sometimes because man has been attempting to disinfect his surround- 
ings from earliest historic times ; and it is difHcult to dislodge belief in a 
favorite remedy. 

Nor are we fully agreed by what method of testing we shall set about 
to purge these lists of all not properly disinfectants. It is by no man- 
ner of means so easy a task as at first glance it would seem. We are 
agreed that the enemies to be antagonized are the living micro-organ- 
isms and their spores, which modern science has revealed to be the 
causes of many diseases. It would seem to be a simple matter to find 
out what bodies were capable of destroying these organisms, but we 
dare not rest content with that. The vitality of the germs must be 
destroyed also. And we cannot place dependence upon laboratory 
experiments, with their comparatively simple conditions. The all- 
important practical question is. Are they destroyed in the surroundings, 
and under the complicated conditions in which they occur where the dis- 
infection is really to be carried out? Experiments have not infrequently 
shown that the action, or rather the result of the action, of the disinfect- 
ant is very different under the two sets of conditions. For instance : 
In the use of heated air, a temperature of i25**-i5o** C. is found in the 
laboratory sufficient to completely devitalize many of these organisms, 
but the difficulty of carrying out such a method in practice, and the lia- 



CHEMICAL DISINFECTION, 1 27 

bility to errors, are shown by Koch and WolfThugel, who have proved 
that after four hours' exposure to that temperature, the interior of a 
roll of cloth, one metre in thickness, was only 34.5** C, and therefore 
not at all disinfected. We cannot rely upon laboratory experiments 
Hlone. Shall we trust rather to the practical results attained by the use 
of disinfectants as recorded by health officers ? Unquestionably we are 
confronted by many difficulties here also. Who can tell why diphthe- 
ria, or typhoid fever, or scarlet-fever strikes the one and spares the other 
where the exposure to infection was apparently the same ? In a mass of 
statistics, how can we consider the many details that have so important a 
bearing on the result, such as how the disinfectant was used, what 
were the chances for after-infection, the virulence of the disease, and the 
climatic conditions? 

If it is true, as bacteriologists claim, that these enemies to health are 
in the soil under our feet and in the air around us — even in its upper 
reaches, coming down to us in hail-stones — then I must confess that I 
strongly incline to the conclusion of Wernich, that labor is misdirected 
in testing the thousand and one things recommended as disinfectants, 
by tests which cannot be regarded as above suspicion. Hope lies rather 
in more thorough study of the micro-organisms themselves, and in seek- 
ing to provide immunity from their attacks. Nature has given a valu- 
able pointer along this line in the immunity afforded in some diseases by 
one attack, and the leaders of bacteriological research are making brill- 
iant discoveries in this direction. Meanwhile, however, through this 
possibly misdirected, yet not wasted, labor upon the disinfectants, our 
protection is mainly secured. 

But much of the somewhat unsatisfactory condition of the practice of 
disinfection comes from ignorance as to the chemical nature and inter- 
action of the bodies used as disinfectants, — ^th^t is, from a lack of chemi- 
cal knowledge and training. It is this side of the subject that I wish to 
bring to your attention to-day. Because chloride of lime may be a good 
substance to use, and carbolic acid may be also, it by no manner of 
means follows that you get the good effects of both by mixing them, as 
is sometimes proposed. Recently a health officer was reported as pro- 
posing to prepare chlorine by the use of oxide of magnesia and sulphuric 
acid. Perhaps he did not mean it, or was incorrectly reported; but 
certainly there is grievous lack of knowledge on the part of many local 
boards of health, of the chemistry of the substances they handle. Hence 
their misapplication and consequent failure, begetting in the minds of 
the people a want of confidence, or even unconcealed distrust and disap- 
proval. The loss of the confidence of the people would be a fatal blow 
to all of our sanitary organizations. 

The desideratum in the use of a disinfectant is to secure complete 
destruction of the micro-organisms and spores with as little injury as 
possible to valuable property. Many of the chemical substances used 
are very powerful even in considerable dilution, attacking clothing, fur- 
niture, varnishes, paints, etc. Some attack one material, some another. 



128 CHEMICAL DISINFECTION. 

It is possible, by a wise choice of disinfectants according to the object 
to be disinfected, to avoid injury in a great many cases. Lists of such 
disinfectants for special purposes have been published in some of our 
sanitary journals, some of them excellent, some open to objections. It 
would be well if our state boards of health should prepare such lists for 
the use of local boards and physicians in general. They would thus 
furnish safe guides where most needed, and save much bungling work. 

Let us take up some of the chief disinfectants, and examine them 
chemically. 

Mercuric chloride or corrosive sublimate is one of the foremost and 
most frequently used. However valuable mercury or chlorine may be 
separately, it is, so far as we know, just this compound that has the 
powerful disinfecting properties. Therefore, if we apply it so as to 
change it to any other compound of mercury, we either destroy or gp^eatly 
diminish its toxic action on the germs. Yet what is more common 
than to apply it to excreta containing sulphur compounds, or albumin- 
ous bodies, thus precipitating the mercury as sulphide or working some 
other complete chemical change in the chloride? It is possible also that 
the ammonia present in stale urine and other bodies interferes with the 
action of the corrosive sublimate. These are no mere chemical theories. 
Actual experiments have shown the mercuric chloride, even in concen- 
trated solutions, incapable of disinfecting excreta and similar matter. 
It cannot be used in conjunction with chloride of lime, as this would 
give us a precipitate of the oxide of mercury. It should not be used on 
metallic surfaces, such as copper, brass, lead, and silver. The latter is 
especially injured by being washed over with such a solution. Lastly, the 
very poisonous nature of the body should always be borne in mind, and 
the use of it avoided where it can in any way become noxious, as upon 
floors and walls where it may dry, become powdered, and so get into 
the air as fine dust. I know diat it is frequently used in this latter way, 
and the danger may seem slight, or altogether exaggerated, yet I can 
but think the risk a useless one to run, especially in view of the known 
ease with which arsenic is thus disseminated. 

Next, let us look at the chemical side of chloride of lime. It is, first 
of all, most important to recognize about this, that it is not a true chemi- 
cal compound, that over forty per cent, of it is lime uncombined, and 
fifteen to twenty per cent, is water, and that the proportion of chlorine, 
the active principle present, varies in the commercial article from twenty 
to thirty-five per cent., and decreases on keeping, sometimes very rap- 
idly. This sudden decomposition makes it dangerous to keep it in 
tightly closed vessels, and loosely closed ones hasten its decomposition 
by admitting the carbon dioxide of the air. Therefore, in making up 
solutions, the strength of the chloride of lime must be at least approx- 
imately known. It is easily possible, in using old *' bleaching-powder,"^ 
as it is called, to get a solution so weak as to be useless ; and it should 
be understood that chloride of calcium is very different from chloride of 
lime, and is comparatively useless. Because of its weakening action on 



CHEMICAL DISINFECTION. 1 29 

the fibre it cannot be used on wool or silk, nor any delicate fabric, and 
its bleaching action prohibits its use on all colored stuffs. In using it in 
the solid form, its strongly alkaline nature must be borne in mind, and 
its power of combining with acids and neutralizing them. Where free 
chlorine is desired from it, of course enough of an acid must be added to 
it to make it distinctly acid. Sulphuric acid would be the cheapest and 
best to use, and next to that hydrochloric (muriatic) acid. The same 
amount of chlorine is gotten in either case. I may remark in this con- 
nection that I greatly doubt whether chlorine reaches its full efficiency 
in a comparatively dry atmosphere. Like sulphur dioxide, it should be 
used in the presence of plenty of moisture. Contradictory experiments 
regarding its use are doubtless partly to be accounted for on this ground. 
Chloride of lime is especially useful in disinfecting excreta, and should 
be substituted for corrosive sublimate. Its strongly alkaline nature aids 
in the action. In fact, lime alone is recommended for this purpose. 

When carbolic acid was first introduced, it was believed to have all 
the qualifications necessary for a perfect disinfectant. At the time of 
Lister's first work in this line, the modes of thorough examination and 
testing for such disinfecting agents were unknown. The discoveries of 
Koch and others in the line of bacteriological research have enabled us 
to eliminate many a formerly trusted agents and greatly weakened the 
confidence once reposed in carbolic acid. Still it is one of the most 
frequently used agents, and deserves to be placed among the few we 
have time to mention here. It seems clear that only in strong solutions 
and by prolonged action is it able to devitalize the bacteria and their 
spores. 

Though not truly an acid, belonging chemically to the phenols, still it 
acts as such, neutralizing bases and forming salts. It is therefore not to 
be used along with basic substances, as is so often done. The com- 
pound with lime has been supposed to be useful, but there is little 
ground to sanction its use. The volatile nature and consequent easy 
loss of the carbolic acid must be kept in mind. Solutions of it in alco- 
hol and oils are, according to Koch, entirely without action. At ordi- 
nary temperatures, it requires fifteen parts of water to dissolve. This 
solubility is sometimes increased to advantage by the addition of hydro- 
chloric or sulphuric acid. Little reliance is ordinarily to be placed upon 
the commercial soaps said to contain it, as the amount present is very 
varying, and frequently too small for any beneficial action. It is easy to 
prepare a strong, good soap, however, by combining solutions of car- 
bolic acid and of ordinary soap. These are frequently useful for disin- 
fecting clothing, the skin, etc. 

As it has been shown to be useful in surgery only in such concen- 
trated solutions and for such a length of time as would have injurious 
action upon the subject, I do not see how it can possibly have beneficial 
action in disinfecting the air of a sick-room unless used in quantities too 
great for the inmate to bear. The same must be true of burning sulphur 
in the presence of the patient. 



I30 CHEMICAL DISINFECTION. 

From earliest times sulphur has been burned for disinfecting pur- 
poses. Homer makes his hero, Ulysses, use it; and if our grand- 
mothers believed in any thing, they believed in sulphur. Many a dog 
has been forced to lap his water from a pan, with the insoluble and use- 
less sulphur lying at the bottom and in some mysterious way prevent- 
ing all mischief. Many a child has, in times of panic at the approach of 
some epidemic, worn about his neck a little charm-bag of sulphur. 
Now so universal a use must rest upon some basis of good done. Dis- 
missing the mysterious action in bag and water — which might be by 
courtesy called catalytic, the chemist's favorite name for reactions he 
does not understand — we find the consensus of opinion to be that the 
vapors of burning sulphur are disinfectant in their action when properly 
used. I do not intend here to enter upon the discussion which has been 
so exhaustively carried on for some time past as to the value of sulphur 
dioxide. Indeed, the necessity for brevity has throughout this paper 
prevented the citation of authorities and their opinions. Suffice it to 
say, that when Sternberg finds that he can pour liquid sulphur dioxide 
upon the bacilli of anthrax without impairing their germinating power, 
we may conclude that sulphur dioxide, without water, is worthless. In 
other words, not sulphur dioxide, but sulphurous acid, is the active 
agent. In common practice, the amount of water present during the 
fumigation is altogether inadequate. Allowing for waste and other 
losses, at least three or four times the weight of the sulphur burned 
should be present in the air of the space to be disinfected. This can be 
easily effected by keeping up a rapid evaporation, boiling the water in a 
vessel exposing a large surface. And, besides, the walls and articles in 
the room should be well sprinkled and wetted beforehand. 

Here the water has a chemical part to play. Without it sulphurous 
acid is not formed, and, as we have learned, it is this that has the devital- 
izing action. Those who busy themselves with the study of such mat- 
ters are becoming more and more impressed with the importance of the 
presence of water in disinfecting action. Chemists have for some years 
had their eyes opened to its important r61e in many chemical reactions 
where its presence or aid was not before suspected. So powerful a 
chemical agent as chlorine is without action, if dry, on many substances 
which it eagerly attacks when the slightest trace of moisture is present. 
Metallic sodium remains bright and unoxidized in dry oxygen. Ordi- 
nary illuminating gas will not burn, if it and the needed oxygen are dry ; 
and some years ago it was proved in my laboratory, and afterwards 
independently discovered and abundantly confirmed by others, that even 
the hydrogen and oxygen that go to form water cannot unite unless 
themselves a little moist. Much of this we cannot now fully explain. 
It may be due to chemical causes, or to physical causes : enough that its 
truth is recognized. 

It is well known that the causes of infection, the microbes, need moist- 
ure for their existence. When thoroughly dried they are inactive, and 
eventually die. But too much water is very prejudicial to them also. 



CHEMICAL DISINFECTION, 131 

and some even maintain that a great dilution of water containing them is 
a practical disinfection of it. Now a dry disinfectant coming in contact 
with an air-dry micro-organism can have little or no action on it, and 
especially will have little penetrating power upon the spore. Water, 
the condition for chemical action, is absent. 

The chemical action in the case of sulphurous acid may be the taking 
of oxygen from the organic matter of the germ, or the combining with 
the complex molecule, and so destroying it, — the taking up of additional 
oxygen and formation of sulphuric acid being the most noteworthy 
chemical tendency on the part of sulphurous acid. Chlorine probably 
acts upon the microbes, as it does in bleaching, by combining with the 
hydrogen of water, and setting free the oxygen which at the moment of 
liberation acts very powerfully on oxidizable matter. 

As to the best disinfecting agents, heat and steam, the difficulties 
are mainly physical, and the mechanic, not the chemist, must be called 
in. Air, even moist air, at a high temperature, acts slowly and some- 
times imperfectly. Steam is to be preferred to it ; but even steam at 
100 degrees has been known to act for five hours without destroying the 
vitality of some very refractory germs ; therefore, in every case too great 
haste must be avoided. As to injurious action: Only varnished and 
painted objects suffer under its action, besides leather, furs, and rubber, 
which are rendered brittle or are otherwise injured by it. 

I have been able to take up only three or four of the chief disinfectants 
and discuss briefly some of their chemical characteristics. I fear that I 
have been able to bring little or nothing that is new before this body ; 
but perhaps I have brought some facts freshly before your minds, and 
through you they may reach a larger, less learned audience, and so put 
an end to some of the misuse and abuse of disinfectants. 



XVI. 

TREATMENT OF SEWAGE BY CHLORINE, PRECIPITA- 
TION, AND SEDIMENTATION. 

By J. H. RAYMOND, M. D., 

Professor of Physiology and Sanitary Science, Long Island College 

Hospital. 

A visit made not long since to the sewage-disposal works at Coney 
Island produced such an impression upon me, that I felt I could do this 
Association no better service than by studying the process there em- 
ployed for the treatment of the sewage, and communicating the results of 
that study to my associates at this annual meeting. 

In the course of my investigations, I found that, since this plant had 
been constructed, certain important modifications had been devised which 
rendered the system applicable to other places in which the conditions 
were in many respects different from those which existed at Coney 
Island. Here the final discharge of the sewage after treatment is into a 
creek which communicates directly with the ocean, so that the necessity 
for an absolutely pure effluent does not exist, and a partial purification 
by sedimentation and precipitation with lime and perchloride of iron 
answers all practical purposes. When, however, the sewage to be 
treated is that of an inland town removed from a water-course, or adja- 
cent to a stream which passes by other towns or villages, the purification 
needs to be carried further. The modifications of the Coney Island plan 
were made to meet this demand for a greater purification ; and the 
description which I shall give will be of this more complete system, 
which has for two years past been in successful operation at Round 
Lake, Saratoga county. New York, near the famous Saratoga Springs, 
and at the New York State Soldiers and Sailors* Home, Bath, Steuben 
county. 

In describing this perfected system, I shall describe the Coney Island 
plant as well, for this is a part of the system. This treatment has been 
in practical operation at Coney Island since 1884, a period of six years, 
certainly long enough to test its efl[iciency. So far as I know it has 
given perfect satisfaction. That this test is a sufiScient one would 
seem to be demonstrated when it is remembered that at times in the 
height of the season more than one hundred thousand persons are con- 
gregated here. It is true that this is not a permanent population ; still, 
from June to October, while many are there but a few hours, a large 
proportion spend the entire day at the island, and the permanent popula- 
tion during this period is at least fifteen thousand. In providing for the 
disposal of the sewage, the calculations must be based on the maximum 



TREA TMENT OF SE WA GE. 133 

number. Two million gallons are frequently received at the sewage- 
works in a single day, 1,000,000 gallons of this often coming in four 
hours. 

At Round Lake there is a winter population of but three hundred. In 
the summer this is increased to six thousand, with a sewage flow of 
from 90,000 to 150,000 gallons per diem. After treatment, the effluent 
is discharged into Round Lake, a beautiful sheet of inland water, on the 
shores of which are the summer homes of many business men, and other 
buildings occupied by those who have come hither to attend the summer 
schools which are held here, and at the same time to obtain needed rest 
and recreation. 

At the Soldiers and Sailors' Home at Bath, there is a permanent pop- 
ulation of fifteen hundred. The effluent here is discharged into the Con- 
hocton river. 

In presenting to you, therefore, a description of this method of sew- 
age treatment I am not inviting you to consider a method which exists 
only in theory, but one which has stood the test of time, and wherever 
used has given entire satisfaction. 

The tanks in which the sewage is received and treated are shown in 
Fig. 3. Each set is duplicated, so that one set may be in actual use 
while the other is being emptied. 

The sewage flows into the tank A, where, owing to the increased area, 
the flow is checked. The proportions of this tank are such that the 
flow through it is not more than one foot per minute, so as to favor sedi- 
mentation. The sewage flows through A and the screen chamber, pass- 
ing through two screens in its course, and overflows through the opening 
F into tank B. In this tank is located a float-valve, which allows a 
water jet to discharge water under pressure into the lime tank E and dis- 
lodge a portion of the slaked lime with which, in a semi-liquid state, the 
lime tank is flUed ; the lime solution flows out through the opposite end 
of the lime tank, and mingles with the sewage at the sewer inlet in A 
(see Fig. 3) while tank B is filling ; the fluid sewage also carries up 
with it the float which operates the automatic chemical discharge box 
H, thereby discharging into the fluid a solution of perchloride of iron. 
The capacity of tank B is say 2,000 gallons ; the fluid now in it has 
been treated by admixture of lime and by sedimentation in tank A, also by 
perchloride of iron in tank B. When the tank is filled to the top of the 
siphon G, the contents are discharged by the siphon into the final set- 
tling tank C, which, being of ten to twenty times the capacity of B, 
allows for storage of several hours' flow, and a consequent final pre- 
cipitation, which is more perfect as the storage time is extended ; that 
is, the effluent after two hours' storage is much better and cleaner than 
after one hour's storage. Four hours give better results than two. 

The bridge wall in C is used to prevent the siphon-discharge from 
stirring up the sediment in the large tank. 

The disinfecting and discharging apparatus being automatic and oper- 
ated by the sewage, it makes no difference whether the tanks are dis- 




Fig. I. 



TREA TMENT OF SEWAGE, 1 35 

charged once a week or once an hour : the mechanism adapts itself to 
the flow. 

This process gives a colorless and odorless effluent free from solid 
particles. 

CHEMISTRY OF THE PROCESS. 

The chemistry of the process is substantially as follows : 
When the sewage enters the first tank, A, it consists of, — 

1 . Organic matter in solution. 

2. Organic matter in suspension. 

3. Chlorides. 

4. Sulphuretted hydrogen and sulphides. 

5. Sulphates. 

6. Carbonates, including ammonium carbonate resulting from the 
decomposition of urea. 

7. Phosphates. 

8. Other ingredients. 

As a result of the addition of the milk of lime, the following changes 
take place : 

The ammonium carbonate, (NH^), CO3, is decomposed, and ammo- 
nia is set free. 

The lime unites with the sulphuretted hydrogen to form calcium sul- 
phide, CaS. 

The lime decomposes the sulphates, carbonates, and phosphates,— cal- 
cium sulphate, CaSO^ ; calcium carbonate, CaCOg : and calcium phos- 
phate, Ca3(P04), being precipitated. As these fall they carry with 
them the suspended organic matters. If magnesia salts are present in 
the water-supply which is provided for moving the sewage, these will be 
decomposed, and magnesium hydroxide will be precipitated. Any iron 
and alumina salts will be decomposed by the lime, with precipitation of 
the corresponding hydroxides. Furthermore, it is probable that lime 
has a tendency to combine with and form insoluble compounds with the 
soluble albuminoids. All these would fall with the sludge. One of the 
important reasons for treating sewage with lime is to precipitate these 
suspended organic matters. They would, in time, without any chem- 
ical treatment, subside ; but this would require so much time that before 
it was completed decomposition would take place, and, besides, enor- 
mous storage facilities would be necessary. These difficulties are obvi- 
ated by hastening the precipitation by the addition of lime. 

When the supernatant liquid passes into the second tank, its composi- 
tion is, in the main, as follows : 

1. Organic matter in solution. 

2. Chlorides. 

3. Calcium sulphide and other sulphides. 

4. Soluble oxides and hydroxides of bases, chiefly potassium, sodium, 
and ammonium, formerly combined with sulphuric, carbonic, and 
phosphoric acids, together with the milk of lime, calcium hydroxide, 
Ca(OH),, which is in excess. 




1 



Jm«m«i M«mi^ •-/-f 




%' - IR. 
Ml 1 Tillll T* 



^r-^v 



Mmtmlm^ja: 






£11 



:1s: 



5E 



i 






P^Mff 



; i M n n ! ! T'" 
Fig. 2. 



THE A TMENT OF SE WA GE, 137 

To this fluid, perchloride of iron, Fe^Cl^, is added, and, as the result, 
some of the soluble organic matters are coagulated and some are not 
affected. 

The chlorides are practically unchanged. 

The calcium sulphide is decomposed and iron sulphide is formed, and 
some sulphur is set free. 

From the oxides and hydroxides of bases, ferric oxide is formed, and 
the bases are combined as chlorides. 

From the excess of calcium hydroxide, ferric oxide is formed, and cal- 
cium chloride. 

The effluent practically contains all of the above ingredients in solu- 
tion, excepting the ferric oxide and such of the organic matters as are 
precipitated : these settle to the bottom of the second and third tanks. 

While sewage would doubtless have been regarded some years ago as 
in a proper condition to be discharged into a water-course after this 
treatment, the demands of sanitary science are not met by this treatment 
alone at the present day. It is an established fact that typhoid fever is 
disseminated by means of the excreta of human beings affected with this 
disease, and that cholera is propagated in the same manner. For other 
diseases the evidence is not so conclusive. In the absence of an epidemic 
of cholera, this disease need not enter into the question. The preva- 
lence of typhoid and its fatality are such that no system of sewage treat- 
ment can be considered as satisfactory that does not insure the killing of 
the bacilli which are now recognized as the specific cause of this disease. 
This demand is met in the system under consideration by the addition to 
the precipitate, or sludge, before its removal, of chlorine gas, which has 
long been recognized as an efficient disinfectant. 

The apparatus in which the chlorine is generated, and the pipes 
through which it is conveyed to the tanks, are shown in Fig. 3. It may, 
perhaps, be better understood by reference to Fig. 4, which represents 
the same generator adapted to the disinfection of cesspools. This may 
be described as follows : 

Into the receiver A common salt and black oxide of manganese are 
placed in the proper proportion, and sufficient water is added to cause 
them to flow through the pipe into the generator F. The valve is then 
closed, and sulphuric acid, which has been poured into B, is allowed to 
flow into the generator through the pipe and valve C. 

It will be seen that chlorine in any desired quantity can be supplied to 
either or all of the tanks. It would seem that the best results would be 
obtained by adding the chlorine to the sewage in the first tank before 
the lime has been added. The whole body of the sewage is then liquid, 
and the action of the chlorine would consequently be more efficient. 
If the chlorine were not added until the sewage had left the first tank, all 
that portion which had settled in this tank would escape the action of 
the chlorine, and this would be in all probability the very portion in 
which the microbes would exist, being to a great extent entangled in 
the precipitate. The addition of the chlorine to this precipitate before 



a. I pi 1 

lit L Hi i 




TREATMENT OF SEWAGE, 139 

its removal undoubtedly diminishes this danger, but does not avoid it as 
certainly as if the chlorine were adde.d before any precipitation takes 
place. The addition of chlorine before the lime and iron modifies the 
chemistry, as already given, to a slight extent only, the organic matter 
being partially destroyed. As may be seen by a reference to Fig. 3, the 
construction of the apparatus is such that chlorine may be added at any 
part of the process. 

The next question which we have to consider is, whether it is possi- 
ble to add chlorine to sewage in sufficient amount to kill the typhoid 
bacilli. For this purpose we naturally turn to the " Report on Disin- 
fection and Disinfectants," made by a committee of this Association. 
At page 155 of the volume containing this report is recorded a series of 
experiments by B. Meade Bolton, M. D., at present Director of Bacteri- 
ology in the Hoagland Laboratory, Brooklyn. In this series are exper- 
iments made to test the effect of chloride of lime upon typhoid bacilli. 
The disinfectant power of chloride of lime, or hypochlorite as it should 
be called, depends on the amount of available chlorine which it contains. 
Dr. Bolton demonstrated that when a solution of hypochlorite of lime, in 
the proportion of i : 2000, is added to a pure culture of the typhoid bacillus 
in bouillon, the vitality of the germ is destroyed, provided that the avail- 
able chlorine is present to the amount of 0.015 per cent., and its action 
allowed to continue during two hours. Experiments were also made 
with typhoid feces, solutions of chloride of lime in various proportions 
being used. As the existence of typhoid germs in these faeces was not 
determined, and as the colonies which developed after the addition of 
the disinfectant were not examined to ascertain whether the germs com- 
posing them were typhoid or only the usual organisms found in the faeces, 
the results of these experiments are of no use in determining the ques- 
tion at issue. Neither can any practical conclusion be deduced from 
the experiments of Seitz,^ as this writer fails to state the amount of avail- 
able chlorine present in his solution. In the absence, then, of other 
data, we shall assume that chlorine added to sewage in the proportion of 
0.015 per cent, will kill the typhoid bacillus in faeces. If at any future 
time it shall be demonstrated that this strength is not sufficient, the 
amount can be increased even to the point of saturation. If a cholera 
epidemic shall appear, or if bacteriological research shall enable us to 
recognize other pathogenic organisms in sewage, the amount of chlorine 
can be regulated accordingly. 



The next question which we have to consider is the cost of this method 
of sewage-treatment, for however efficient it may be, if the expense is 
so great as practically to impose a burden on a community, the system 
cannot be generally adopted. The following facts will be of interest, 

^ ^ Bakteriologischen Studien der Typhus.— Aetiologie." Miincben, 1886. 

* For more recent and complete information on the cost of treatment vide Discussion. 



TREA TMENT OF SE WA GE, I4I 

and some of them will enable us to ascertain the cost of treatment in the 
way described. First, as to chlorine, — 

1 . In I pound of dry common salt there is 0.60684 pound of chlorine. 

2. One litre of chlorine weighs at 32 F., and normal barometer, 
48.897 grains. 

One litre is equal to 0.0353166 cubic foot and 7,000 grains = i pound. 

One cubic foot contains 28.315312 litres, hence 

One cubic foot of chlorine weighs, at above temperature and barom- 
eter, 1384.54 grains, or 0.19779 pound, or, roughly, \ pound ; or 

One pound of chlorine, at above temperature and barometer, fills 
5.0559 cubic feet, or, roughly, 5 cubic feet, and therefore 0.60684 
pound of chlorine at above temperature and barometer gives 3.0681 
cubic feet, or, roughly, 3 cubic feet. 

We thus see that in i pound of dry common salt we have, roughly, 
^ of a pound of chlorine, which, when liberated and reduced to a tem- 
perature of 32° F. at sea level, will yield a volume of 3 cubic feet. 

From the experiments of the Committee on Disinfectants we have 
assumed that 0.015 per cent, of chlorine will disinfect sewage, killing 
the typhoid germs. Fifteen pounds of chlorine will, therefore, disinfect 
100,000 pounds of sewage, and i pound will disinfect 6,666 pounds, or 
833 gallons. One pound of chlorine is 5 cubic feet, so that i cubic foot 
will disinfect \ of 836, or 166 gallons. We have seen that i pound of 
salt will generate 3 cubic feet of chlorine ; therefore 1 pound of salt will 
yield chlorine enough to disinfect 3X166 gallons = 498, or roughly, 500 
gallons. To generate chlorine, equal parts of salt and black oxide of 
manganese, and twice the quantity of sulphuric acid, together with water, 
are used, so that to disinfect 500 gallons of sewage there would be 
required one pound of salt costing J/^ of a cent, one pound of manga- 
nese costing 3 cents, and two pounds of sulphuric acid costing 3 cents, 
or 12^ cents for 1,000 gallons. To each gallon of sewage 3 grains of 
lime costing $1.25 for 300 pounds, and 2 grains of perchloride of iron 
costing 3J4 cents a pound, are added. Thus, the total cost of the treat- 
ment with chlorine, lime, and iron does not exceed 13 cents for 1,000 
gallons. If we allow 50 gallons of sewage a day, per capita — a fair allow- 
ance, I think — we would have in a place with a population of 1,000 per- 
sons, 50,000 gallons of sewage to be daily treated at a cost of $6.50, or 
$2,372.50 per annum, $2.37 for each individual, or .6 of a cent a day. 

Is this cost, $2.37 per annum for each individual, so great as practically 
to impose such a burden on a community that the system cannot be gen- 
erally adopted? 

There are several considerations which must be regarded in the deci- 
sion of this question : 

I . If it shall be determined that the paramount object of sewage treat- 
ment is to kill the micro-organisms which produce disease, then the ex- 
penditure of any amount of money, however great, must not stand in the 
way of accomplishing this result. If there is any other method of attain- 
ing the same end in a cheaper way, then all other methods should be 



142 TREATMENT OF SEWAGE, 

abandoned for it ; and no greater benefit could be conferred upon sani- 
tary science than to make such method known. From the present stand- 
point of our bacterial knowledge, a less amount of chlorine will not 
answer for the destruction of the pathogenic organisms in question ; so 
that it resolves itself into this, that if we wish to kill these organisms we 
must use the specified amount of chlorine. If this is not deemed neces- 
sary, then the amount of chlorine, and the cost at the same time, can be 
greatly reduced, enough only being generated to meet the other indica- 
tions, controlling the offensive odors, etc. For you will remember that 
the cost of the lime and the perchloride of iron treatment was the fraction 
of a cent per i ,000 gallons, while that of the chlorine was more than 1 2 
cents for the same amount of sewage. 

2. But need this $2.37 per capita be all out-go? I have not been able 
to obtain such figures and opinions as will enable me to answer this ques- 
tion definitely, but I am satisfied from the inquiry which I have been able 
to make, that a considerable part of this first cost might be repaid by the 
recovery of some of the chemicals used, and the new chemical com- 
pounds which are formed in the process. If I understand the chemistry 
of the process aright it is this : 

Manganese dioxide (MnO,), sodium chloride (2NaCl), and sul- 
phuric acid (sHjSO^), form chlorine (Clj,), manganese sulphate 
(MnSO^), hydrogen sodium sulphate (2HNaSO^), and water (2H 3O). 
If to this carbonate of soda (Na^COg) be added, we have manganous 
carbonate (MnCOg) and Glauber's salts (Na^SO^) formed. The 
Glauber's salts (Na^SO^) maybe drawn off and crystallized. The man- 
ganous carbonate (MnCOg) may be dried and roasted, carbon dioxide 
(CO 2) being driven off, and manganic oxide (or manganese sesquioxide) 
MujOg formed. Just what would be the most economical way to 
treat this I do not know. 

3. The sludge for the tanks is regarded by farmers who use it as a 
valuable fertilizer. When the plant was originally placed at Coney 
Island, a track was laid from the works to Coney Island creek where a 
scow was located for the reception of the sludge, with the idea of towing 
it to sea and dumping its load. This scow never left the dock, as the 
demand for the sludge by the farmers was greater than the supply. At 
Coney Island the amount of sludge has never been so great as to make 
an attempt to sell it worth while ; but in the treatment of the sewage of 
a large city this might become an important item. Whether it would or 
not, a trial could alone decide. The sludge resembles peat in appear- 
ance, and is absolutely odorless. 

It has been estimated that when large quantities of these chemicals are 
employed in sewage-treatment, half of the cost may be saved by the 
recovery of these or other chemicals formed in the process. 

The following claims are made for this method of sewage-treatment, 
and it would seem that they have all been substantiated : 

I. Concentration. The processes of chemical purification for a large 
town can be carried on in a building 50 by 100, or less. 



TREATMENT OF SEWAGE, I43 

2. Absolute control of all effluvium, which is so thoroughly destroyed 
by the chemical processes used that the interior of the building may be 
kept entirely free from all sewage odors. 

3. Economy io operation, the chemical treatment being largely auto- 
matic, so that all the labor required would be one man to. superintend 
the works, and the temporary help of two men for one day per week to 
remove the sludge. 

4. Convenience. The sludge can be made innocuous and inoffensive 
before removal, so that it can be removed in open carts or stored in 
the neighborhood. It resembles peat in appearance, and has no odor. 

5. Immunity from infection. The disinfection of the sewage can be 
carried far enough thoroughly to kill all pathogenic organisms, so that 
all danger of infection is removed. 

DISCUSSION. 

E. C. Jordan, C. E., Portland, Me. — I was very much interested 
in Dr. Raymond's papers — in the second one, by its specially happy 
treatment and improvement upon what may be seen roughly carried out 
behind railroad embankments across coves and marshes, which form 
along our coast line artificial tidal basins. In front of the culvert or 
waterway left in the embankment along a surf beach may be frequently 
seen a sand or shingle bar that holds back the flood water received at 
high tide. 

There are no uniform conditions so admirably arranged for, as in Dr. 
Raymond's illustrations ; and, in fact, the unequal force of storms and 
extreme high and low tides frequently give too much or too little of a 
good thing. The paper suggests an excellent treatment where similar 
conditions exist. But, in regard to his first paper on the Coney Island 
sewerage methods, my engineering mind was not prepared to accept 
seriously the apparent conclusions arrived at, except, possibly, for that 
particular place, and under the conditions that I knew from my personal 
inspection of the work to exist and from my knowledge of the unstable 
land-tenure at Coney Island. Certainly, unusual and peculiar condi- 
tions must exist when a large community will accept being levied upon, 
after paying the cost of a system of sewers, at the rate of $2.37 per cap- 
ita per annum for the sewage disposal. 

I think most of our cities, if this scheme were recommended to them, 
would feel that a little more money spent investigating other methods 
would be advisable. To illustrate : It would be a pretty serious thing 
for Charleston to pay $2.37 per capita, $118,500 each year in addition 
to general sewer repairs, or for a city of 100,000 inhabitants, for instance, 
to pay $237,000 each year for sewage disposal ; and yet that would 
appear to be the practical conclusion of the paper, at least when physi- 
cal features are similar to those at Coney Island. I was rather expect- 
ing Dr. Raymond to explain the matter in harmony with a view that I 
had supposed was quite well accepted, namely, that physical features 



144 TREATMENT OF SEWAGE, 

was only one of the factors that led to the adoption of this scheme for a 
part of Coney Island, and that lack of harmony among some large real 
estate interests, and the uncertainty as to the extent of future encroach- 
ments of the sea, combined to compel certain parties, under the spur of 
the board of health, to accept this expedient almost regardless of cost. 
I think the system has great merit in its forced application to Coney 
Island, and also for small places where cost can be ignored, and espe- 
cially at small summer resorts where the occupation is oi\ly for a few 
weeks. But, at Coney Island even, I shall not be at all surprised in a 
few years to hear that a method much less burdensome and fully as 
effective, and of much wider range in its application, has been adopted. 

Rudolph Hbring, C. E., New York. — The paper read by Dr. Ray- 
mond gives a very clear and faithful description of the Sewage Precipita- 
tion Works at Coney Island, N. Y. As an engineer, I am unable, how- 
ever, to share the sanguine hopes regarding the practical value of this 
method of treating the sewage. The great practical objection to it is 
the cost, which Dr. Raymond gives as $2.37 per head per annum. 
Such a cost is fatal to the adoption of such works in all large cities, and 
wherever the community cannot afford to pay a large sum for sewage 
removal. For a population such as we find in Charleston — let us say, in 
round numbers, for 50,000 inhabitants — the annual cost for sewage puri- 
fication alone would therefore be $118,500 per annum. For a city like 
Baltimore, with, say, 500,000 inhabitants, the annual cost would be 
$1,165,000. The process may be a practicable one for a small amount 
of sewage, and no doubt it has merits where the expense is a secondary 
consideration. 

Another point is this: If the effluent from the works is discharged 
into the ocean, or into a stream not used for drinking-water, it is entirely 
unnecessary to use chlorine^ which is the expensive element in the pro- 
cess, for the purpose of destroying pathogenic bacteria. And if, on the 
other hand, the water is used for drinking purposes, the large amount 
of chlorine which must be used would probably have some deleterious 
effect upon the water. In either case its advantage is, therefore, some- 
what doubtful : 

Finally, it is not probable that the chlorine, considering the way it is 
introduced into the tanks, actually penetrates all the organic matter to 
such an extent that the bacteria will be destroyed. 

Dr. J. H. Raymond, Brooklyn, N. Y. — The criticisms which Mr. 
Hering makes upon the method of sewage-treatment described in the 
paper are three : i. That it is too expensive to be practicable. 2. That 
if the effluent were discharged into a stream, the water of which was 
used for drinking purposes, the chlorine would probably have some 
deleterious effect upon the water. 3. That the bacteria in the sewage 
would probably not be destroyed. 

I will endeavor to reply to these criticisms : 

I. As to the Cost, At the time my paper was prepared I obtained 
from a New York house the prices of the chemicals employed in this 



TREA TMENT OF SE WA GE, 1 45 

method of sewage-treatment. These figures I used as the hasis ot my 
calculations. I have since learned that these prices were altogether too 
high. The manganese can be bought for one and a half cents a pound 
instead of three cents, and the sulphuric acid for nine tenths of one cent 
instead of one and a half cents. 

I have referred this whole subject to my friend Prof. William McMur- 
trie, of New York, asking him to give his opinion as to the amount of 
reduction in the cost of the treatment by the recovery of the chemicals 
employed. He has kindly sent me the following: "If salt, sulphuric 
acid, and black oxide of manganese are employed for the production of 
chlorine, the results would be as follows : 

" 2NaCl+2H3SO^+MnOa =Cla+Na3SO^+MnSO^+2H,0, yield- 
ing 71 pounds chlorine, we have, — 

117 pounds salt, 25 c. per cwt., 0.2925 

196 pounds oil vitriol, 80 c. per cwt., 1.568 

87 pounds manganese, ij^ c. per lb., 1*305 

Cost of material for 71 pounds chlorine, 3«i77 

*' These 71 pounds of chlorine are sufficient to disinfect 473,000 pounds, 
7,560 cubic feet, or 56,700 gallons of sewage. 

" With no attempt at recovery, the cost would amount to 5.6 cents 
per 1 ,000 gallons. Recovery would be rather troublesome and expensive 
unless the plant were large ; and in the latter case possibly one third to 
one half the cost could be recovered, say 142 pounds salt-cake at 70 
cents per cwt.,= 99 cents, and say 50 pounds MnOg= 75 cents : totals 
.99-|-.75=$i.74. The cost of this recovery would reduce the net profit 
of it so that if we should estimate one third recovery it would probably 
be most nearly realized in practice. I should say, therefore, that in a 
large plant the net cost should be not more tlfan 4 or 4^ cents per 1000 
gallons of sewage treated with chlorine. This of course includes no 
labor, fuel, plant, or other expense than the mere cost of materials." 

Prof. McMurtrie's practical experience has been such as to enable him 
to speak ex cathedrd^ and we may accept his figures as in every respect 
reliable. It will be seen, therefore, that the actual cost of the treatment 
of 1000 gallons of sewage by chlorine is 5.6 cents; — ^the additional cost 
of the lime and perchloride of iron would bring it to about 6 cents. In 
a community of 1000 persons we would have 50,000 gallons of sewage 
to be treated. The cost of this treatment would therefore be $3 a day, 
$1,095 a year, or $1.10 for each individual per annum instead of $2.37 
as I stated in the paper. In a small community it would probably not 
pay to attempt the recovery of the chemicals. In a large community, 
where such recovery would pay, the cost could be reduced to 5 cents 
per 1,000 gallons, or about 90 cents per annum for each individual. 
This, as Prof. McMurtrie states, does not include labor, fuel, plant, or 
other expense than the mere cost of material. But in any method of 
sewage-treatment such expenses would be a necessary concomitant, and, 
so far as I can see, no more in this than in any other. 



146 TREATMENT OF SEWAGE. 

As I Stated in the paper, such a treatment as this is only to be thought 
of when it is deemed necessary to destroy the pathogenic organisms 
there mentioned. In case this were not necessary, the amount of chlo- 
rine could be greatly reduced, enough only being generated to meet the 
other indication, controlling the offence ; and the expense would be cor- 
respondingly reduced. 

2* That the amount of chlorine discharged into a stream would 
probably exert a deleterious effect upon the water. 

If I understand this criticism aright, Mr. Hering means that such 
water would be rendered unfit for drinking purposes. I cannot think 
that Mr. Hering had distinctly in mind the minute quantity of chlorine 
which is discharged in the effluent, or he would hardly have made this 
criticism. If the chlorine remained in the water of the stream as chlo- 
rine, it would be in so extremely dilute a form as not to be recognized 
by the taste, nor would it in any other way make its presence known. 
But as chlorine it would not remain, but would become converted into 
hydrochloric acid, which, in the proportion in which it would exist, 
would be so exceedingly dilute as not to be recognizable, or, what is still 
more likely, it would unite with the bases of the carbonates usually pres- 
ent in such water and form chlorides, these not affecting the water dele- 
teriously in any way, not even to increase its hardness. I think it can 
be demonstrated beyond a peradventure that this objection to the method 
is absolutely without foundation. But, even if the objection had weight, 
which would be the better course to adopt, to discharge sewage into a 
stream the water of which was used for drinking purposes, with its 
contained pathogenic bacteria in an active, living condition, or to 
destroy those germs even at the risk of so affecting the water as to make 
it unfit for drinking, and require those who had depended upon it for 
their water-supply to obtain it from a less questionable source ? It 
seems to me that there can be but one answer to this question. 

3. That it is not probable that the chlorine would actually penetrate 
all the organic matter to such an extent as to destroy the bacteria in 
the sewage. 

It is true that no experiments have been made that will determine abso- 
lutely whether all the germs are destroyed in masses of sewage treated 
by this method ; but we have reason to believe that they would be when 
we recall the destructive power of this gas upon bacteria, and observe the 
sewage after the gas has been added, the amount of free gas which 
escapes being at times overpowering. 

In conclusion, I would simply add that I know of no other treatment 
of sewage which will more certainly accomplish the object which all 
sanitarians regard as so desirable, i, f., the destruction of those germs 
which are known to be disease-producing. If there be any better and 
less expensive way, all other methods should be abandoned for it ; and 
no greater benefit could be conferred by any one upon sanitary science 
than to make such a method known. 



xvn. 

RAILROAD HYGIENE : RAILROAD CARS— PROPER VEN- 
TILATION AS A SANITARY MEASURE TO PRE- 
VENT THE TRANSMISSION OF DISEASE 
AND PROMOTE THE COMFORT 
OF TRAVELLERS. 

By I. SOMERS BUIST, M. D., Charleston, S. C. 

The importance of this subject cannot be overestimated. It is admit- 
ted that the difficulties of ventilating cars are obviously very great, and 
that ventilation, up to the present time, is very bad ; and so much has 
the necessity for improvement been forced upon the public, that at the 
recent meeting of the Medical Congress in Berlin a committee was 
appointed from that body to report upon the subject of Railroad Hygiene, 
embracing all matters appertaining to the proper heating and ventilation 
of cars, the exclusion of dirt, dust, cinders, etc., the character of the 
materials used in the upholstering, as well as the present sanitary arrange- 
ments in use. The attention of sanitary and scientific authorities to this 
matter, by reason of the large increase in the travelling public, has 
had a prominent place, because the necessity for quick, rapid move- 
ment in business affairs, as well as the comfort and safety of travel- 
lers, has become a prominent factor in preserving the well-being and 
health of the general public. The accepted theories as to the origin of 
most infectious diseases, based upon the germ theory and the indestruc- 
tibility of the microbes, add peculiar force to the argument, now adduced, 
of their contagiousness through the influences of unavoidable contact. 
The movement of vast masses of people annually from one section of 
this broad country in search of those climatic influences modifying the 
course and progress of disease, has become, from a sanitarian's point of 
view, a g^eat unsolved problem ; and railroad capitalists as well as 
officials, recognizing the great importance of this subject, are straining 
every nerve, and trying every system suggested that has practicability 
in it, with the view of accomplishing the proper ventilation of cars by 
the introduction of pure air, free from dust, cinders, smoke, etc., and at 
the same time the withdrawal of the impure air arising from the natural 
emanations from the human body as well as the more serious dangers 
accruing from chronic contagious influences. 

The American passenger-car, with an average cubic space of about 
2,500 feet exclusive of that occupied by furniture and the bodies of pas- 



148 RAILROAD HYGIENE, 

sengers, and holding about 75 persons, would require at least 750 cubic 
feet of fresh air per minute, — we will say 1,500 cubic feet, or more than 
half the contents of the car. The introduction of this amount without 
draught is a matter of much difficulty. (Lang and WolfFhugel.) The 
American sleeping-cars, fitted with all the luxuries that wealth can give, 
while externally presenting as complete a system of comfort as could be 
well instituted, yet, in the important matter of furnishing pure air and 
the withdrawal of foul air, are as defective at the present day as at the 
time of the institution of the system. The chief obstacle to the railroad 
sanitary engineer has been, not so much the introduction of pure air as 
the withdrawal of the foul, or, rather, the introduction of a sufficient 
amount of pure air without creating a draught ; and to such a degree 
has this want been felt in the overcrowding of night travel, with the 
debility and exhaustion experienced by breathing the impure air charged 
with carbonic acid as well as microbe poisons, that the weak and sickly 
dread a night's journey as one from which only trouble can arise. 

Mechanical ingenuity and skill have been exercised to the highest 
degree to meet all the requirements necessary to create that equipoise 
essential to success ; and it is not generally known, but it is a recorded 
fact, that to this end nearly two hundred patents have been taken out in 
this country alone. Of these, while some of the needs have been filled, 
none have as yet met with the approbation of the railroad companies or 
the approval of the hygienist or practical physician, when brought to a 
practical test. 

The proper heating of cars, outside of the dangers of the present 
system not alluded to in this paper, is of vital importance, and, when 
combined with imperfect ventilation, is indeed filled with the most 
serious considerations. To describe the inconvenience, distress, and dan- 
ger arising from this sudden change in temperature, as well as the injury 
to the sick and those using night-cars, is unnecessary. It is estimated 
by competent authority that more foundations are laid for serious bodily 
lesions, as well as for a greater transmissibility of contagious diseases, 
from this cause, than from any others operating and at work in the 
present day. We purify ships, and subject them to all the delays made 
necessary by well understood laws of propagation of disease, and detain 
them for periods sufficient to make them healthful ; but precisely the 
same influences are at work on a larger scale in land-travel, with ten- 
fold power of distress and destruction. Railroad officials inform us that, 
after a long journey in a closely confined sleeper, passing as it does in 
rapid flight over long stretches of country, and entering different lati- 
tudes with sudden changes of temperature, it often requires long and 
patient care and purification to make it tenantable. These being rec- 
ognized facts, and the cure of the evils being a necessity, as sanitarians 
it is our duty to recognize all efforts intelligently made to remedy the 
existing defects. As stated before, none of the systems thus far brought 
to light have proved practical in their operations. The attention of 
the members of this health association has been drawn to the recent 



RAILROAD HYGIENE, I49 

discovery or invention made by one of our own citizens, the working of 
which you have been invited to witness, and the plain, practical, as well 
as simple device by which both the objects alluded to in this paper have 
been attained. It is needless to say that the system has borne the test 
of severe criticism and close inspection by railroad experts, and has thus 
far come out triumphant in all its workings. 

Exclusion of dirt, dust, smoke, and cinders, in the system alluded to 
(Emerson's) , is accomplished by keeping the cars closed entirely, neither 
windows nor doors being opened, and all ventilators in the roof of the 
car or upon its sides being closed or removed. It will thus be seen that 
there is no possibility of the introduction of these disturbing elements 
from without : should they enter at any time, they would be as rapidly 
removed as possible, even before they could find lodgment, by the sys- 
tem at work exhausting the foul air, to be now described. The intro- 
duction of air into the car thus practically sealed is accomplished by 
means of an apparatus attached under the car near one of the trucks, 
the motive power being derived from friction, which begins to operate 
at the first turn of the wheel, and continues to work either fast or slow 
until the final stopping of the train. It is understood that while the car 
is stationary, both windows and doors will be opened to admit air if 
needed. The friction power being brought into operation moves a 
series of fans. These fans collect the air, filled as it is with the dust 
and impurities from beneath the moving train, and rapidly pass it for- 
ward into a box attached from about two to three feet from the wheel, 
where it is divested, by passing through water alone, of all impurities, 
and transmitted in a steady, uninterrupted flow into the interior of the 
car by a series of tubes of different sizes and dimensions, placed at 
proper intervals in different parts of the car, either at the sides or in the 
ceiling or on the floor, as taste and utility may direct and practice 
establish. These entrance orifices are so arranged as in no way to 
create draught, or affect the person of the passenger. A series of fans, 
attached to the same motive power and worked in the same apparatus 
and moving in opposite directions, constitutes the exhausting system, 
accomplished 'through orifices of exit placed in the upper part of the car ; 
and as the amounts of air at the entrance and exit are equal, draughts 
are avoided and an even temperature preserved. Pure air coming in 
at all times and in sufficient volume, and the air breathed being as rap- 
idly removed, ^render the ventilation perfect. On the same principle, 
and with the addition of a coil of steam-pipe, heated air is introduced, 
and in cold weather the temperature of the air can be regulated to any 
degree found necessary. Accurate tests made of this invention have 
thus far shown, — 

1. Complete exemption from dust and smoke in the interior of the 
car. 

2. Pure air entering the car in sufficient quantities to meet every 
requirement, even reducing the temperature in the interior many degrees, 
as shown by^thermometrical test. 



150 RAILROAD HYGIENE, 

3. The immediate removal of foul air as rapidly as it is generated — 
the solution of the great problem that has hitherto been the stumbling- 
block in the way of the perfection of the systems. 

The invention claims an ability to reduce the temperature in hot 
weather to one that is pleasant and comfortable. All these considera- 
tions being fulfilled, it is easy to see how great an advance has been 
made in this important direction, and that many of the influences now at 
work to prevent comfortable and healthy travel will be overcome. Your 
attention is respectfully drawn to this enterprise, and an inspection of 
the same invited as sanitarians and hygienists, as it is important for us to 
contribute our influence to all measures conducive to the comfort and 
safety of the public. Shirley Dare, an eminent authority, uses the fol- 
lowing strong language in a recent article on this subject : '' In public 
halls and vehicles the oppression of foul air is insupportable, and amounts 
to direct poisoning of an enfeebled organ, especially the heart. A heart 
seriously weakened, if kept in pure, warm air, fed with delicate, nourish- 
ing food, and kept from fatigue and mental strain, will regain strength as 
naturally as we get rest from sleep. It has greater recuperative powers. 
But a half hour in the mephitic air of a travelling car or public hall 
does more to make recovery impossible than almost any other cause 
mentionable. This is a matter which more than ever deserves to be 
pressed upon the attention of railway companies, to whom the mass of 
our people must trust their lives and health for a share of their time quite 
long enough to injure both. The risk of accident by train is not half 
as great as the certainty of inhaling virulent poison from one to two 
hours daily in unventilated cars. A sanitary commission is needed to 
set the strict, unbiassed facts before railway managers." 



xvin. 

REPORT OF THE COMMITTEE ON ANIMAL DISEASES 
AND ANIMAL FOODS. 

By D. E. salmon, D. V. M., Chairman of the Committee, Washington, D. C. 

Your committee, in presenting its final report, desires to call attention 
to the rapid progress of the last few years in elucidating the nature of 
the more serious diseases of animals, and in preventing their ravages. 
Within seven years the bacilli which cause the two most common dis- 
eases of swine have been discovered and carefully studied. The pro- 
tozoa which apparently cause Texas fever have also been demonstrated, 
as well as the fact that their development in the animal body is in some 
way connected with the ticks that are transported by cattle from the 
infected district. These discoveries clear up many of the mysterious 
characters which for a long time excited the astonishment and frequently 
the skepticism of scientific men in regard to the clinical observations that 
were from time to time made public. 

Then we have seen the successful results of a still more advanced line 
of researches, i. e., the study of the chemical products which accompany 
bacterial multiplication, their application for the production of immunity, 
and even, in one case, the making by synthetical combinations in the 
laboratory of a compound which grants immunity. This at present 
appears to be the ideal achievement, the ne plus ultra of what we can 
hope for in the treatment of the animal body to produce immunity from 
disease. It is a line of investigation which will sooner or later be 
applied to all of the non-recurrent diseases of men as well as of animals, 
and we are justified in believing that with some of these diseases it is 
destined to be of the greatest service. 

Your committee is also gratified at the rapid progress being made in 
the United States in the eradication and control of animal diseases. The 
contagious pleuro-pneumonia of cattle, which four years ago threatened 
to extend over the whole country, has been repressed and eradicated by 
the efforts of the general government, and so thorough has been the work 
that but two herds have been affected by it during the last three months. 
It is now only a question of a few months when the contagion will be 
entirely eradicated from the American continent. Texas fever has also 
been so thoroughly controlled that but few cases have occurred during 
1890 in the country, the marked decrease being indicated by the summer 
insurance rates on export cattle, which have on this account been reduced 
the present year about fifty per cent. 



152 ANIMAL DISEASES AND ANIMAL FOODS, 

The infectious diseases of swine, tuberculosis of cattle, and cholera of 
fowls are now the principal widespread and destructive plagues which 
carry on their ravages without control among the food-producing animals 
of the United States. What action will be taken in regard to these by 
the national and state governments it is yet too early to predict, but it 
seems evident that the general demand for a more rigid and systematic 
inspection of meats will lead not only to the adoption of inspection, but 
will also eventually bring about general measures for the prevention of 
these diseases. 

The subjects of animal diseases and animal foods are inseparably 
connected, so far as the questions considered by your committee are 
concerned. With the preventible diseases of meat-producing animals 
eradicated or controlled, and with a proper inspection at the time of 
slaughter, the animal food of this country would be beyond reproach or 
criticism. With a generally salubrious climate, with the finest pastures 
in the world, with that peculiarly American staple, maize, for feeding, in 
addition to the forage available in other countries, with a complete free- 
dom from some of the worst plagues which affect the animals of the old 
world, with the most improved breeds which the world affords, and with 
the most intelligent farmers found in any country, there is every reason 
why the meat of the United States should be superior to that produced 
elsewhere. Your committee believe that the meat sold in this country 
has already attained to this condition of superiority ; but they find that 
more thorough inspection and the repression of the animal plagues above 
mentioned are nevertheless desirable, and of great importance as sanitary 
measures. With the wealth and civilization of the United States it is 
felt that we should lead the world in taking such precautions, rather than 
to follow in the wake of the most advanced government. 

Referring to its former reports for greater details, your committee 
closes its labors with this general survey of the important questions 
which you have placed in its charge for examination and report. The 
members individually and collectively return their thanks for the honor 
which has been conferred upon them, and for the trust and confidence 
reposed in them by this Association. As a committee, it has been our 
endeavor to point out the dangers with which our people are threatened 
through their food-supply, and the means of removing them, but at the 
same time it has been necessary for us to use such moderate and conserv- 
ative language as would guard against undue alarm among the masses of 
our people concerning so important a part of their daily nourishment 
If we have accomplished something towards the dissemination of more 
intelligent ideas in regard to the diseases of animals, and more definite 
views as to the necessity of pure food and the means of obtaining it, we 
shall consider ourselves fortunate, and well repaid for our labors. 



XIX. 

THE RELATION OF LAND MONOPOLY TO POPULATION 

HEALTH. 

By GEORGE ROMAN, M. D., 

Secretary State Board of Health of Missouri; Professor of Hygiene and 
Forensic Medicine, St. Louis Medical College. 

A declared purpose of this Association is the advancement of sanitary 
science and the promotion of measures for the practical application of 
public hygiene ; and, as all sanitarians know, among the gravest problems 
presenting themselves are those relating to tenement-house. populations 
and municipal slums, or the massing of large numbers of human beings 
within restricted areas or localities. It is known that such districts 
demand the constant attention of sanitary authorities, as it is in these 
quarters that all the most dangerous communicable diseases have their 
chosen seat, and that they are the sources and centres from which our 
domestic epidemics arise and spread. 

It has been a large part of the life-work of many of the members now 
present to grapple with the evils thus presenting, and while no doubt in 
many instances a fair measure of success has been achieved in the control 
of population plagues, still such dangers tend to recur again and again, 
and it seems at last that the remedies applied are but palliative and do 
not reach the actual seat of the disorder. 

The menace and danger to the general public attending the origin, 
growth, and persistence of municipal slums are generally recognized as 
affecting the social order on many sides, health, safety, and morals all 
alike being gravely concerned therein. 

This being the case, and in view of the limited actual achievement 
apparent in the work of eradicating those diseases that are most danger- 
ous amidst our population, it behooves sanitarians to bethink themselves 
whether they have gone to the root of the matter and determined fully 
and truly why it is, with all the advances made in wealth, in invention, 
and apparent civilization, that so much destitution, physical and moral 
and mental degradation and suffering, such a burden of wasting and 
spreading diseases, are seen to-day on every hand. 

In recognition of and obedience to this obligation to seek further the 
true causes of this social phenomenon, it becomes necessary to consider 
What are the vital requisites of man ? What are the natural elements or 
conditions indispensably necessary to the well-being of the body, and its 



154 LAND MONOPOLY AND POPULATION HEALTH, 

keeping in a healthful state ? The reply to these questions would be, 
Earth, air, water, food. 

The conception of physical existence without land is beyond the pow- 
ers of the human mind. We can conceive and know of existence with- 
out air, or at least the smallest amount that will baffle death ; we know 
of life being sustained for varying periods without water or food ; but the 
finite mind cannot grasp the idea of life without land. From the earth 
we come, to the earth we return : fashioned from its elements, sustained 
by its products, we are resolved again into the bosom of the great com- 
mon mother. The oceans and the waters rest upon it, the atmosphere 
is supported by it : the earth is the source, the strength, and the end of 
every form of physical life. 

If land, then, be the first vital requisite, what must be the consequences 
to human health and life if monopoly of it be permitted ? To illustrate, 
let the results that would flow from a monopoly of other vital necessities 
be considered. 

Let it be supposed that at some former time, through force, or craft, or 
grant, or other means which would give legal right to-day, some indi- 
vidual had acquired a title in fee to the atmosphere of this state, with the 
right to collect rent from other individuals for its use in breathing: 
obviously the air lord would have not only the health but the lives of 
such persons in his power, and he could exact such a price for this vital 
necessity as best suited his pleasure or interest; obviously, also, it 
would be to his interest to let every person willing to serve him have 
that amount of air necessary to supply the needs of the body and keep 
it in the most productive condition while engaged in such service. 

As his wealth thus grew, and likewise his avarice, it might be found, 
through competition for this necessity, that, whereas three hundred and 
fifty cubic feet of pure air per day were ordinarily required to enable one 
man to produce a certain amount of wealth, by the device of riveting an 
iron band closely around his neck the physiological demand for air in 
his descendants could be reduced one half, or that the quality supplied 
need be only half as pure while still yielding the same return in labor to 
the air lord, and thus making it doubly profitable : or, it might be, instead 
of working directly for him, that they chose to employ themselves, pay- 
ing to him a specified rental for the air they used. And if, perchance, 
there came into his domain those able to pay but half the rent demanded, 
he would have the undoubted right to attach garrotes to their wind-pipes, 
and thus fence out the air so that they should take no more of his prop- 
erty than they were able to pay for. Should any person, however, 
venture into the air lord's dominion who refused to serve him, or pay rent 
for the air consumed, he could call his servants and legally eject the 
intruder beyond atmospheric bounds, or confine him in a receiver from 
which the air was withdrawn, or nearly so, until the prisoner or his 
friends satisfied the demand for property wrongfully appropriated, and 
for the trespass and outrage committed. He might not have the imme- 
diate power of life or death, but the amount of air given the prisoner 



LAND MONOPOLY AND POPULATION HEALTH. 155 

might be barely enough to keep him alive, or in quality so foul as to 
invite death, but to all intents and purposes such power would lie in his 
hands subject in its exercise only to his caprice or pleasure. 

Let it be supposed, again, that, by means similar to those by which 
the lord just instanced gained his right to lay an air tax, another person 
was vested with the ownership of all the water in the state, and of all 
the rain-clouds that float above it, and that neither famishing man, nor 
sufiering woman, nor fever-smitten child dare take a cupful from brook, 
river, or rain-fall without paying the proprietor for the privilege ; and 
should his lawful demand for payment be denied, he would undoubtedly 
have the right to summon sheriff or constable and drive the delinquent 
from his domain, or confine him in a desert where only the scantiest 
supply of this life necessity could be had : in this case, again, the lord 
proprietor might not possess the direct legal power of life or death over 
the trespasser, but in effect he would, for the dole of water might be so 
small that the prisoner would shortly perish outright of thirst. 

Let it be supposed once more, that there was still another lord who 
came into his rights in the same way as the other two, and whose title 
deed embraced all the sunlight falling upon the state: his right of 
tribute would extend not only to those who took the sunshine out-of-doors 
or within as being necessary to health, but also to those who conducted 
their business by its aid, or whose crops were favored and ripened by its 
influence. In default of the rent, his right undeniably would be to call 
the military or police power to his aid, and commit to caverns or dun- 
geons all delinquents who took the sunshine in the open, and darken with 
impenetrable blinds the doors and windows of the houses of those who 
enjoyed its cheering benefits in that way. 

Other suppositions might be indulged in with reference to the fore- 
stalling of other vital necessities or comforts, as food, clothing, fire, shel- 
ter ; but it would be beside the present purpose, which is to ask sanita- 
rians to consider what would be the effect on population health and 
life if those bounties of nature cited in detail were subject to the con- 
jectured monopolies. Suppose, further, that while each lord found his 
exclusive privilege immensely profitable, it nevertheless occurred to 
them that by combining, and forming a joint monopoly of air, water, 
and sunlight, their revenues could be enormously increased : could and 
would they not do it under perfect shelter of their legal rights? Have 
the metes and bounds of human avarice and money greed ever been set ? 
Would consideration of such facts, that ten thousands of their fellow-men 
were gasping for air, or as many more perishing for water, or a mul- 
titude pining for the sunlight, move them in the least? Probably not, 
for human history shows many instances, from before the time of the 
Mamertine prison to the Black Hole of Calcutta, and later, where all this 
has been done, and many of those who did it died quietly, if not com- 
fortably, in their beds. 

So long as the law of gravitation binds the bodies of men to the earth, 
what need is there for title deeds to air, water, or sunshine ? Does not 



156 LAND MONOPOLY AND POPULATION HEALTH, 

ownership of the land embrace all else, and make possible all other vital 
monopolies ? 

Common justice and humanity would both cry out, however, against 
engrossment of the more palpable necessaries of life, but have stood by 
consenting, perhaps, while such forestalling has merged itself in the 
greater monopoly. 

The grosser form of slavery has vanished, but the substance remains 
under a semblance less plain and revolting. It is not charged that all 
landlords are oppressive in the exercise of their vested rights and powers, 
any more than it is not doubted that in the days of black slavery there 
were many owners who were humane, and careful of the moral and 
physical well-being of their slaves ; but, for all this, a main indictment 
framed against that system was, that in its easy possibilities it put the 
power of human weal or woe, of life or death, in the hands of the mas- 
ter ; and that such power should be so lodged was opposed to the better 
moral sense of mankind. And the same indictment stands now, in the 
time of industrial slavery, against the masters of the land ; for the " dif- 
ference between the ownership of a man and the ownership of that 
element on and from which he must live, if he is to live at all, is one of 
degree and not of kind." The reputed ball and chain, whip-lash, and 
blood-hound of black slavery are replaced by the poverty, necessity, and 
want of industrial slavery ; and who can deny that their power is far 
wider and deeper than was that of the gross insignia of the former phase 
of bondage ? 

That the source and strength of the latter enslavement lie in land 
monopoly is evident from the power of the landlord to exact a price for 
the use of land that the hand of man has never touched to improve, the 
right to claim and appropriate as his own that value which the presence 
and labors of the community as a whole have given to the bare land, 
and to deny its use to his fellows until all his exactions and conditions 
have been agreed to. 

What are the sanitary consequences of the exercise of this power as 
seen to-day in all industrial centres .^ What else but this can explain the 
massing of nearly three hundred thousand people in one square mile in 
the city of New York, when there is plenty of unused land within its 
limits? The conditions seen to-day are very like those induced in the 
walled cities of former times built for defence against armed enemies : 
the walls reared by land monopoly and speculation in this necessity of 
life prevent that dispersal of population so necessary to public health, and 
the prevention and restriction of domestic epidemics. 

The return to labor expended in lines of unskilled or little skilled em- 
ployment is so meagre as to be virtually the wage of a slave, — he gets 
just enough land, just enough air, just enough sunlight, just enough 
food, to enable him to toil ; but even this consideration may be defaulted 
when the multitude of unemployed, bidding against each other for work, 
and the bitter struggle for existence, are remembered. This multitude 
is not only wasted by diseases dangerous to all, but they devour each 



LAND MONOPOLY AND POPULATION HEALTH, 157 

Other ; and the question remains how soon the taste of blood will lead 
them to devour society as at present constituted. 

Out of the wages paid on the principle take-that-or-starve, there is 
little to spare for roof and shelter, and where a number of dependents 
add to his anxieties, the laborer is forced to seek his housing in narrow- 
est quarters, and with little reference to what the health of his family 
may demand ; and thus situated, with thousands more like him, in over- 
crowded tenements, or in wretched hovels, with the uncertainty of em- 
ployment and the certainty of eviction if the rent is not paid confronting 
him, the deplorable and desperate realities of municipal slums are 
created, faced, and endured. 

Some years ago, while in the sanitary service of the city of St. Louis, 
I gathered data in congested centres, where the inmates of houses were 
heaped floor above floor, a family of six perhaps in one small room, 
from which calculations went to show that, situated as they were, all the 
living room on the face of the earth each person could claim was smaller 
in compass than a pauper's grave, six feet by two, — scarcely more, in 
fact, than a soldier occupies standing in the ranks ; so that in literal truth 
they had not where to lay themselves, on land they could call their own 
for the time, — ^but if the rent was not paid the landlord could summon the 
power of city and state and force them to leave ; and where could they 
go ? The world is wide, to be sure, but it happens, so far as the average 
man is concerned, that all the more accessible or desirable parts are 
under fence, with penalties for trespass affixed. 

The avenues of escape from such conditions are not numerous ; — the 
hospital, the prison, the poorhouse, the grave, are the common alter- 
natives that offer, in all of which a freer space is allotted each occupant 
than falls to the members of many a family engaged in a hopeless strug- 
gle to avoid those alternatives. 

It is needless to say here that the atmosphere of such abodes teems 
with dangers to the moral and physical natures, or that such localities 
are nurseries of crime and hotbeds of disease that tax the utmost vigi- 
lance and activity of police and health officers to cope with and repress. 

The waste in human health and life is enormous, the destruction fall- 
ing with greatest severity on the young, the mortality rate reaching an 
unknown proportion, and the death-rate among young children amount- 
ing often to fully fifty per cent, or more of the total mortality. Diph- 
theria, scarlet- fever, and tuberculosis in all its forms, are active, being 
favored among the people by destitution in land, privation of air, insuffi- 
cient or bad food, want of sunlight, etc. ; while imported infections find, 
amid the squalor, hunger, and misery of such masses of people, the soil 
and substance needed for their epidemic spread. 

Effectual isolation and disinfection amid such conditions are almost 
impossible ; and in this circumstance lies the sanitary danger to those 
who are more comfortably situated. So close is the contact or inter- 
course, direct or indirect, between all classes, and so insidious the path- 
ways of disease, that their households may be invaded despite their 



IS8 LAND MONOPOLY AND POPULATION HEALTH. 

utmost care : so true it is that the hurt and wrong in any sense of the 
humblest member of society should be the swift concern and care of the 
greatest. 

No lasting relief to a disorder which so deeply affects civilized man- 
kind everywhere can be expected until a change is made in the laws 
relating to land, which shall prevent the forestalling of the first great 
bounty of nature and its conversion to the uses or profit of the few — a 
monopoly based on no true right of property, inasmuch as no man by 
his labor can produce land, which was freely given for the uses of all 
generations of men along with the other bounties of nature necessary to 
life. 

The plethoric and ever increasing wealth of the few, and the growing 
poverty of the many, are largely based on the power of the former to 
acquire and hold the land, and dictate the terms on which it may be 
used ; and the logical, natural, inevitable outcome of such a system and the 
exercise of such power is seen in every city where thousands are suffering 
and perishing from land famine, unable to use that amount of earth nec- 
essary to prevent their wasting and destruction by all the morbid agencies 
recognized by sanitarians as impending wherever human beings are 
forced into unwholesome contact and habitations. 

No honest denial by any one in a position to know can be made of 
the facts of there being widely spread preventable diseases, poverty, 
misery, suffering, and discontent among our populations, and many 
attempted explanations of these unwelcome facts have been offered ; but 
do they explain ? 

In the course of a considerable official experience in mingling with 
tenement-house populations, I never heard a single person say that it was 
his or her choice to live so ; all craved better conditions, but it was pov- 
erty, necessity, want, that compelled them to dwell amid such surround- 
ings, and all their energies were directed to getting means to pay the 
rent, and something to eat and wear for their families. 

The explanations offered of these social phenomena not sufficing, it 
seems to me that it is the duty of public health men to study the land 
question, and determine its relation, if any, to population health, — 
whether by throwing open to willing labor the natural opportunities to 
produce wealth existing on every hand, from which it is now barred by 
land monopoly entrenched behind human laws, and which would enable 
labor to employ itself if no bargain with an employer could be struck, 
would not effect a momentous change for the better in the sanitary con- 
ditions existing among city populations. 

The rights of the few may be the wrongs of the many, — social, sani- 
tary, material, vital. An unfailing test of a rising civilization is the 
placing of human rights above mere property rights. The struggle for 
human freedom has been waged at all times against those the source and 
strength of whose power lay in land monopoly, in their ability to control 
the surface of the earth on which their fellows moved and breathed. 
The story of freedom, too, is a story of resistance to aggression or flee- 



LAND MONOPOLY AND POPULATION HEALTH, I $9 

ing from oppression, — ^the aggression or oppression of lords spiritual, of 
war lords, and land lords. 

The land is in bonds, and so long as this continues complete human 
freedom is impossible, for justice, liberty, and humanity alike proclaim 
the equal right of every man to the use of that element which is the com- 
mon inheritance of all. This is the struggle which now impends. The 
question how the deliverance may be best accomplished is engaging the 
thought of many minds, and not last among these should be those who 
have the keeping of public health in their charge ; for I am fully per- 
suaded that in a correct understanding of the relation of land monopoly 
to population health will be found the true solution of many grave prob- 
lems that now perplex and bafQe sanitarians. 

To borrow somewhat from Bulwer in conclusion : On many a noise- 
less field, with thoughts for armies, the struggle for human liberty is 
being waged ; and whenever, with fairer fates, freedom opposes might, 
and justice, redeeming the earlier defeat, smites down the forces that 
would consecrate the wrong, — look down. Spirit of Freedom! look 
down and smile on the Free Man's land ! 



XX. 

THE FEDERAL DISTRICT IN THE REPUBLIC OF MEXICO 
AS A SUITABLE RESIDENCE FOR PERSONS PRE- 
DISPOSED TO TUBERCULOUS AFFECTIONS, 
AND FOR RELIEF OF PULMONARY 
CONSUMPTION. 

By Dr. DOMINGO ORVA^TANOS, 
Member of the Superior Board of Health of Mexico. 

There are in all countries over the world some places of a relative con- 
venience, which may be considered as health resorts for persons affected 
with tuberculosis, principally of the lungs ; but few of them only are of 
an absolute advantage as real sanitaria, and these are to be found mainly 
on the high table-lands of both North and South America. Up to the 
present day no serious studies have been made with regard to these re- 
sorts in America, except by Dr. Denison respecting several places situ- 
ated on the eastern slope of the Rocky Mountains, and by Drs. Jourda- 
net and Lic^aga about several towns on the central table-land of the Re- 
public of Mexico. 

In this paper I intend to undertake the study, supported by recent 
data, of the advantages which can be obtained in the federal district of 
the Mexican republic for the establishment of sanitaria for persons pre- 
disposed to tuberculous affections or suffering from incipient pulmonary 
consumption. 

The federal district is a part of the political division of the Mexican 
territory, and is situated in its centre on the table-land of Anahuac, to 
the south of the valley of Mexico, a part of which is formed by it, and 
at the height of between 2,275 and 2,900 metres above the sea-level the 
most of its soil is at an average elevation of 2,600 metres. It is situated 
between o^ 10' longitude east and o^ 10^ longitude west of the meridian 
of Mexico, and between 19® 1 1' and 19® 31' latitude north. It is bounded 
north-east and west by the state of Mexico, and south by the state of More- 
los. It measures, from north to south, 39 kilometres, and from east to 
west 32, its surface being 1,248 square kilometres. 

Toward the south-west and south the federal district is girt by huge 
mountains which form the chain of Las Cruces, Huitzilac, and Cruz del 
Marques ; toward the west is a part of the mountains of Huisquilucan, 
which connect with those of Las Cruces toward the south-east; and 
toward the east are mountains of less elevation. With the exception of 
these heights and a few other mountains of less elevation^ the whole district 



MEXICO AS A RESIDENCE. l6l 

is flat. The ground is generally very fertile. The abundance of flowers is 
remarkable ; and there is only a small part at the north-east, on the shores 
of the lake of Texcoco, where the ground is barren, owing to the efflores- 
cence left by the salt waters of the lake as they evaporate. The city of 
Mexico is situated almost in the centre of the federal district, though 
a little toward the north from the city ; and everywhere in the valley of 
Mexico are to be seen, in all their magnificence, the gorgeous volcano of 
Popocatepetl, the top of which is at 5400 metres above the sea level, 
and the beautiful snow-mountain Iztaccihuatl of 4900 metres high. 

All the mountains in the valleys are of volcanic origin, and formed 
mainly by large masses of porphyry. Basalt is found either in great 
currents, as those of the Pedregal de San Angel, or advancing into the 
valley on which it forms isolated eminences. 

The soil of the valley is formed by the action of the atmosphere on the 
different varieties of porphyritic rocks modified by the influence of the 
lakes and marshes which have been expanding over diflerent parts of the 
valley. The geological sections show that every layer is of marshy ori- 
gin, alternating at diflerent depths with currents and strata of subterra- 
neous water, and resting on alluvial deposits. 

As to the hydrography of the valley of Mexico, we may consider it as 
divided into three basins : The first and the largest one is that of the 
north, which is separated from the others by the chain of mountains of 
Guadalupe and the hill of Chiconautla ; it contains at present three 
lakes, — Zumpango, Xaltocan, and San Cristoval,— the principal supplies 
of which are the rivers Cuautitlan, which leave the valley through the 
cut of Nochistongo, and that which is named Las Avenidas de Pachuca. 
The second basin is that on which the city of Mexico and the lake of 
Texcoco stand ; it is separated from the south basin by the hills of 
Chimalhuacan, Pino, and Santa Catarina. This basin is the lowest in the 
valley, and contains the lake of Texcoco, supplied by many little rivers 
which come down by the declivity of the Cruces at the west, and those 
of El Telapon and Tlaloc at the east. The third basin is that which con- 
tains the lakes of Chalco and Xochimilco. It forms the most fertile and 
picturesque region in the valley ; toward the east it is bounded by the Po- 
pocatepetl and Iztaccihuatl ; toward the south and west by the Ajusco and 
its dependencies, and toward the north by the hills above mentioned. The 
principal rivers these lakes receive are the Tlalmanalco and the Tenango, 
which arise chiefly from the melting of the ice on the volcanic mountains. 

The synopsis of the principal meteorological elements, according to the 
observations made during twelve years (1877-S8), are as follows : 

Barometer, mean amiual 586.42 mm. 

" maximum 598*19 

" minimum S79-8o 

Temperature, mean annual, shade 15.5® Celsius. 

Maximum shade temperature 31.6° 

Minimum shade 1.70 

Maximum maximorum sun temperature 49.2^ 

Minimum minimorum " " 7.2° 



l62 MEXICO AS A RESIDENCE, 

Mean winter temperature 12.9^ 

" spring " 17.8** 

" summer '* 16.6** 

** autumn " 13.5® 

Maximum shade, oscillation in one day 22.3^ (1887) 

in the sun " " 50.7** (1877) 

Mean relative humidity 60** 

Rainfall in winter 22.7 mm. 

" spring 174.0 

" summer 3S9'0 

" autumn 63.5 

Mean cloudiness 5.0 

Prevailing wind North-west. 

Mean annual ozone 4.4 

We are now going to speak about the features of the climate of the 
valley of Mexico : As may be seen by the foregoing record, the mean 
temperature of the air in the valley of Mexico is 15*5^ in the shade. 
Looking for the difference between the month of April, which is the hot- 
test month, and December, which is the coldest month, we have found 
7.5^: that is the annual amplitude of temperature, which, as it is seen, 
is short enough. Accordingly, the climate of the federal district can be 
classified as temperate and almost equable. In observing the variations 
of shade temperature in the course of one month, we observe how remark- 
able the difference is between 25^ in the shade and 52.9^ in the sun. 
The variability of the climate of a country depends upon the difference of 
temperature from one day to another : our climate is essentially variable. 
The unsteadiness of a climate depends on the rapidity and extension 
of the hourly change of temperature, and in this respect our climate is 
almost unrivalled. 

The daily oscillation has been 21.2° in the shade and 50.7** in the sun. 
All the changes of temperature are divided by the mean temperature be- 
tween the annual mean from 18** below zero at 80° latitude, and the an- 
nual mean of 32® ; consequently, between these two extreme tempera- 
tures there is a scale of 50° ; so that we go through that scale in one single 
day, as it has been seen, and we can properly say that in one and the 
same day we experience all the changes, and it seems as if we were con- 
veyed from the pglar frozen regions to the burning zones of Africa. 

This difference of temperature constitutes one of the characteristic feat- 
ures of our climate. In Mexico, with her dry atmosphere, the sun's rays 
produce an extraordinary heating power, so as to give our soil the ap- 
pearance of being scorched. When the sun sinks behind the tops of the 
mountains, the radiation toward the heavenly regions in the valley of 
Mexico begins ; the air, which on account of its dryness is unable to pre- 
vent the heat from reaching the soil, is also unable to prevent its depart- 
ing from it, and this takes place with extraordinary rapidity. We thus 
have in Mexico, on one side, the burning soil, and on the other, not only in 
the regions of great altitude but in the moderate altitude of the valley, 
perpetual cold. In our region the eternal snow begins at an altitude of 
little more than four kilometres, as can be seen on the Popocatepetl and 



MEXICO AS A RESIDENCE. 163 

lartaccihuatl. The valley of Mexico, as already said, is situated at 2,300 
metres above the sea level, and only about two kilometres distant from 
the eternal snow ; that is to say, as distant as a town would be that were 
situated at 50° or 60° latitude. 

'As the refrigeration of the atmosphere goes on, and consequently that 
of the vegetation also, the moment may come when the vapor of water in 
the open air and that which circulates in the plants is precipitated and 
congeals, and frost is the consequence. 

Hoar-frosts are very frequent in our valley on account of the dryness 
of the atmosphere, which contributes so much to radiation. The calm- 
ness of the air and the absence of clouds are powerful auxiliaries, but the 
lack of dampness in the air is doubtless the principal agent. 

When freezing weather occurs in Mexico, a very remarkable phenom- 
enon that takes place every day and to which we are accustomed, but 
which constitutes a subject of astonishment to foreigners, is the great 
difference of temperature noticed between two places situated at a very 
short distance apart, the one exposed to the sun and the other in the shade. 
In the first, we feel scorched because the diathermancy of the air allows 
the rays of the sun to pass through with their full power ; in the second, 
we feel ourselves almost frozen because that diathermancy makes our 
body a powerful radiator of the heat which it has received. 

The melting ice absorbs great quantities of heat, furnished in part by 
ourselves, and if by means of exercise we succeed in getting warm, after 
a little rest this warmth is absorbed by the atmosphere. This is the rea- 
son why in Mexico we often feel colder than we would in New York 
with half-a-yard depth of snow and ice on the ground. 

As a consequence of this powerful radiation of the soil, we observe in 
this region, where a perpetual spring reigns, that dew is very abundant 
at sunrise and at sunset, and then the flowers send forth their perfumes 
into the air. 

The insolation of the valley is remarkable : Twice a year the sun passes 
the zenith, as it happens in all places situated between the tropics : The 
greatest deviation of the rays of the sun when it is in the Tropic of Cap- 
ricorn does not reach 44°. The longest day is thirteen hours and a half, 
and the shortest ten hours and a half. Most of the days are clear, and 
the transparency of the atmosphere is extraordinary ; this, and the re- 
markable dryness of the air, cause the rays of the sun to produce on the 
soil with the utmost intensity its luminous, calorific, and chemical effects. 
These influences give birth to the remarable purity of the atmosphere, 
which constitutes one of the principal advantages of our climate, which, 
besides being temperate and agreeable, makes it to a certain measure 
aseptic. 

As a result, the number of deaths caused by several of the infectious 
diseases in the federal district is proportionally less than in other coun- 
tries. Diphtheria, imported a few years ago, has scarcely been able to 
establish itself; scarlet-fever is rare ; small-pox, which in Europe and the 
United States sometimes attacks persons who have been once vaccinated. 



164 MEXICO AS A RESIDENCE, 

very seldom does so in Mexico ; yellow-fever is unknown on the central 
table-land, and tuberculous diseases, as will be seen presently, are com- 
monly benign, scarce in niany places, and quite unknown in other 
places. 

The death-rate in the federal district, however, ascends to a great per- 
centage — to 40 per cent. This is mainly due to diarrhcea, small-pox, 
pneumonia, and typhus fever, which diseases are caused respectively by 
the impurity of drinking-water and improper food, by half nakedness 
among the lower classes, by intemperance, by want of laws to make vac- 
cination compulsory, and by the absence in many houses of a good sys- 
tem of drainage and sanitary plumbing. 

The federal district is divided for its political administration into the 
municipality of Mexico and the prefectures of Tacubaya, Tlalpam, 
Xochimilco, and Guadalupe Hidalgo, — in the whole, twenty-two mu- 
nicipalities. 

The population in the federal district, according to the last census — 
18S9, for the prefectures, and 1890 for the municipality of Mexico^is 
440,644 souls. 

Tuberculosis is very frequent in this part of the Republic of Mexico, 
situated between sea-level and 1,000 metres above, in which 15 percent, 
of the general death-rate is caused by said disease, decreasing, however, 
from 1,000 to 2,000 metres altitude, and still more from 2,000 metres 
upward. The data of the federal district are comprised in the accom- 
panying table : 

Table showing Percentage of Defunctions caused by Tuberculous Diseases 
OF Every Description, with regard to the General Death-rate in the 
Federal District, from July i, 1885, to June 30, 189a 



Municipalities. 


Alt. above 

sea level, 

metres. 


Population 


Percentage 
of natives. 


Percentage 
of foreign- 
ers and 
strangers. 


Total 
amount 


Mexico 


2,265.5 


327,000 






8.40 



prefecture of tacubaya. 



Tacubaya . 
Santa F^ . 
Cuajimalpa 
Tacuba . . 
Mixcoac 



2,305-5 


12,027 


3" 


2.40 


2.464.0 
2,905.0 


6,083 


5.78 


1.36 
0.56 


2.297.4 


3»i88 


0.73 


2.31 2.5 


2,252 


1-33 


1-33 



5-51 

2.26 
2.61 
2.66 



prefecture of hochimilco. 



Hochimilco .... 

Milpa Alta 

Hastahuacan .... 
Tlahuac and Tlaltenco 
Tulyehualco .... 

Ostotepec 

Atocpam 

Mixquic 



2,271.5 


I4»373 


1. 01 


1.07 


2,271.5 


6.362 


1. 01 


1.07 


2.271.5 


5,910 


1. 01 


1.07 


2,271.5 


S.271 


I.OI 


1.07 


2,271.5 


3.776 


I.OI 


1.07 


2.271.5 


1,876 


I.OI 


1.07 


2,271.5 


;:^ 


1. 01 


1.07 


2,271.5 


1. 01 


1.07 



1.05 
1.04 

1.30 

1.29 

2-57 
0.00 
0.00 
1.16 



MEXICO AS A RESIDENCE. 



165 



PREFECTURE OF TLALPAM. 



Tlalpam 
San Angel . 
Coyoacau . 
Ixtapalapam 
Ixtacaico . 



2,311.0 


8,831 
10,580 


0.73 


oio 


1.28 


2.317.0 


1.41 


2.21 


2,302.0 


7.018 


1.21 


O.I I 


1.32 


2,303-0 


5.825 


1. 01 


1.07 


2.08 


2,303.0 


3»i27 


1. 01 


1.07 


2.08 



PREFECTURE OF GUADALUPE HIDALGO. 



Guadalupe Hidalgo 
Atzcapotzalco . . 



2,240.0 



6,566 
6,789 



2.23 
0.86 



1.68 
0.37 



3-91 
1.24 



As may be seen by reference to the foregoing table, the deaths caused 
by tuberculous diseases are, with regard to the general death-rate in the 
municipality of Mexico, 8.40 per cent. ; in all the other municipalities the 
average is 2.07 per cent., with the exception of Tacubaya, which gives 
5.51 per cent. In Xochimilco, with 14,000 inhabitants, the average is 
0.94 per cent., and in Actopan and Ostotepec, of about 2,000 inhabitants 
each, tuberculosis is well-nigh unknown. 

If we compare this data with those referring to some other countries, 
we may point out some very remarkable differences. For example : In 
Ei^land, Belgium, Italy, France, and Spain, tuberculosis causes almost 
20 per cent, of the general mortality ; in the United States, in the low- 
lands, 18 per cent., and in the mountain regions, 6.47 per cent. 

Comparing the mortality of tuberculosis of the cities of Mexico and 
Tacubaya with that of other centres of population in the federal district, 
there is a great difference against those of the two mentioned, which is in 
accordance with an almost general law that the more populous a city is, 
the more prevalent the tuberculous diseases. As to Xochimilco, where 
tuberculous diseases are nearly unknown, we believe that it might be at- 
tributed to its population chiefly of Indians, who, as it is known, are very 
resistent to tuberculosis ; and, on the other hand, to the circumstance that 
these places are not in close intercourse with other places in the district. 

Be it as it may, the deduction can be made that the inhabitants of 
rural villages enjoy an almost absolute immunity from tuberculosis. But 
we cannot conclude from this deduction that these localities are suitable 
for preventing the development of tuberculosis, and for curing it. Some 
other circumstances, which will be considered presently, will enable us 
to form a more exact conclusion on this question. 

In reference to the first point, whether the climate of the district is fa- 
vorable for preventing the development of tuberculosis, though we have 
no exact statistics, we are justified in making the following reflections : 
First, there are in the district 165,000 inhabitants natives of other states 
of the republic, and 66,862 natives of foreign countries. In the majority 
of the states of the republic, at from sea-level to 2,000 metres above, tu- 
berculosis occurs frequently in the sea-level regions ; and in the countries 
whence the foreigners come we have already seen that said disease occurs 
much more frequently. May we not believe, then, that many of those 



l66 MEXICO AS A RESIDENCE, 

individuals import from their native lands the germ of tuberculosis, which 
has not been developed by reason of its not having found favorable cir- 
cumstances in them ? May it not be supposed that those persons might 
be identified by degrees writh all the climatological conditions of the place, 
and that many of them acquire the immunity allowed to natives ? Be- 
sides, it has long been known that in these regions, when in a family one 
or several members have died of tuberculosis, the remaining members 
have to emigrate to the high regions of the republic to escape the terrible 
disease. As such emigrants oflen succeed in this, it is believed, and we 
think justly, that the tierrafria (cold land) , as it is called in Mexico, is 
proper for the prevention of the development of tuberculosis in persons 
predisposed to it. 

As to the question whether tuberculosis, once declared, can be cured 
in these regions, we can exhibit several facts in support of the affirmation 
of this question in reference to tubercles of the lungs. 

These facts are, — i . Most of the 350 physicians df the federal dis- 
trict refer to cases of pulmonary consumption cured in its first and sec- 
ond stages. 2. Several of these physicians, as it happens with Dr. 
Lic^aga, relate numerous cases of cure of this disease. 3. It is not 
unfrequent to find, at post-mortems made in the hospitals, unmistak- 
able traces in the lungs of tuberculosis perfectly cured. 4. Of our 
own experience, we have seen several foreigners and many natives of 
the shores of our Republic, who, on ascending to the valley of Mexico, 
have succeeded in being cured of this disease. So that we cannot but 
believe that the climate of the Federal District is a suitable one for the 
cure of pulmonary tuberculosis in its first and second stages. How far 
this is generally true we cannot decide without having exact and extended 
statistics on the matter. 

We have now to consider the causes which produce in many places, 
in the Valley of Mexico, an almost absolute immunity from tubercles in 
the lungs : During many years it was believed that the main cause of 
this immunity was the climate of these regions, which makes the appli- 
cation of the laws of hygiene easy and agreeable. Several mechanical 
theories subsequently found acception, among which one of the most 
commonly admitted was, that residence in the highlands produced an 
enlargement of the chest, owing to the acceleration and amplitude of the 
respiratory movements. This enlargement is positive ; but that it is not 
the cause of the immunity referred to, has been shown by numerous 
experiments in Europe, in aerotherapeutics, which never give the good 
results obtainable by prolonged residence in the altitudes. 

Later it was believed (Dr. Jourdanet), in Europe principally, that 
anoxyhemia^ or lack of oxygen in the blood, was the principal agent. 
But this anoxyhemia has not been demonstrated, and it has not been 
explained how the scarcity of consumption can be due to it ; so we ought 
not to take that into consideration. 

The microbiological doctrines, and especially the latest experiments 
of Koch, furnish, according to our judgment, data enough for the 



MEXICO AS A RESIDENCE. 167 

researches with which we are dealing. It has been discovered that of 
the natural conditions which prevent the origin and development of 
Koch's bacilli, there are three, namely, cold, dryness, and sunlight. 
As to the first, it is known that a temperature below zero destroys them 
entirely ; and it is a long known fact that the limit of altitude where im- 
munity from consumption begins is an altitude approximating the cli- 
mate of the polar regions at an elevation parallel to the line of eternal 
snow, insomuch that consumption disappears at an altitude of 4,000 
metres under the equator, and that it is not found, even at the sea-level, 
in the frozen latitudes, as, for instance, in Iceland. The surface temper- 
ature of the soil in the valley of Mexico very often goes down to zero, 
which is easily understood, considering that frosts are common during 
the whole year, and such descending of temperature must necessarily 
destroy many classes of microbes, and the bacillus of Koch among them. 

Microbes can onl^- live and develop in a moist medium. In our coun- 
try fog is almost unknown: the surface of the soil is quite dry on 
account of rapid evaporation, due to rarefaction of the air, to its move- 
ment, and particularly to its lack of relative humidity. 

But light, above all other conditions, is one of the most important 
agents in the destruction of microbes. Koch's experiments show that 
under the direct influence of the sunbeams, death of the bacillus takes 
place within a lapse of time varying from a few minutes to a few hours, 
and that even diffused daylight acts in a similar manner, though more 
slowly, since culture of bacilli exposed in a window always perish at the 
end of six or seven days. 

In the valley of Mexico the luminous, calorific, and chemical intensity 
of the sun's rays is extraordinary, the diffused light also being very 
remarkable ; and all this undoubtedly contributes, in the first place, to 
the scarceness of phthisis. 

Besides cold, dryness of the atmosphere, and intensity of light, we 
believe there is another circumstance that may in a certain measure con- 
tribute to both the scarceness of the disease in these regions and the heal- 
ing of incipient tubercles in the lungs : we allude to the noticeable exha- 
lation of the odor of flowers, which, as we have already stated, is remark- 
ably abundant in almost the whole district. According to several exper- 
iments of Koch, the essential oils, even in small quantities, kill the bacilli, 
or at least prevent their development, rendering them harmless to man. 
May not the air, so highly aromatized, chiefly at sunrise and sunset, be 
another of the agents that destroy these bacilli both inside and outside of 
the organism ? Though experiments thus far are unfavorable as to the 
action of these scents on the bacilli contained within the lungs, the same 
experiments have been favorable on pure culture of microbes, owing to 
several circumstances unknown to us that have perhaps prevented good 
success in said experiments in man. 



XXI. 

SWINE RED-DISEASE IN MEXICO. 

By JOSfi L. G(3MEZ, D. V. S., 

Prof. National School of Agriculture and Veterinary, Member Superior 
Board of Health, Mexico, Mexico. 

In May, 1886, there appeared in Mexico city, among swine, an 
epizootic disease, unknown in its cause, serious in its effects, and gen- 
erally producing death. The first cases which I had the opportunity to 
observe appeared among hogs brought to this city from the state of 
Guanajuato, and from them the disease spread to those brought from 
the states of Mexico and Michoacan. 

Said disease, up to that time, was absolutely unknown to me, as it 
was unknown, likewise, to other professors, in several states, with whom 
I consulted on the subject. I also applied for information to several 
persons who had been, long ago, in the hog trade, and they all invaria- 
bly told me that such disease was absolutely unknown to them. 

The Mexican authorities, alarmed, with justice, at the outbreak of 
such a terrible epizooty, recommended the Superior Council of Health 
of the Federal District to study the causes of the disease, and to advise the 
proper measures to oppose it and prevent its spreading. Said body, a 
member of which I have the honor of being, deigned to charge me with 
the study of the new disease, and in due time I had the honor to submit 
to their deliberations several reports, of which I now take the liberty of 
making a brief abstract for your honorable association. 

My first labors tended to investigate the nature of the disease, and to 
that effect I made the clinical study of the sick hogs then existing in 
the pens at this city, and of the anatomo-pathological lesions of those 
which died. 

In the sick hogs, I found, as chief symptoms, loss of appetite, chillness, 
high temperature (reaching 40® and 42° C), in some cases epistaxis, 
difficult respiration (noisy and disorderly) , a tendency to lie down, vom- 
iting, diarrhcea (of a yellowish color), nervous disorder, which corre- 
spond to an increased depression .of the encephalic functions. As the 
disease advances the decline becomes more marked, and then comes the 
progressive loss of movements. The hind members of the sick animals, 
when standing, fail to support them. The skin about the neck, in the 
belly, in the cavity under the shoulders, and in the inner part of the 
thighs, shows spots of a violet-red color. 

The progress of the disease is quick, assuming at once an active form : 
it is of short duration, and ends, almost in every case, with death. The 



SWINE RED-DISEASE IN MEXICO. 1 69 

very few subjects which do not succumb have a very long and delicate 
convalescence. 

In some cases, the symptoms of suffering in the thoracic organs pre- 
dominate. In others, the organs of the digestive apparatus seem to be 
suffering ones. Sometimes the former and the latter are attacked, and 
lastly, in some cases, there is a general decay, assuming such propor- 
tions that the sick animal dies suddenly. In view of this I have been 
led to admit four different forms of disease, viz., the thoracic, the ab- 
dominal, the tlioracico-abdominal, and the infectious super-acute, which 
may be characterized by the symptoms and the development of the 
• disease, and, better still, by the anatomo-pathological signs, which some- 
times permit one to see more marked signs in the respiratory organs, 
other times in the digestive organs, and, again, in the former and the 
latter. When the disease has been of an extraordinarily acute charac- 
ter, the signs cannot be clearly appreciated. These signs consist in the 
inflammation of the cerosis of the lungs, the heart, and the bowels, with 
abundant exudation ; in the hepatization of the lungs, the congestion of 
.the liver and the spleen ; in the infection of the ganglia and the mucous 
inflammation of the bowels. 

Apart from the fourth form, which always produces death, and lasts a 
very short evolutive period, the following come in order of gravity, — the 
thoracico-abdominal, the thoracic, and the abdominal, which may be 
considered the least grave of all. 

The lesions described authorize me to define the disease as a pneumo- 
enteritis, or red-disease, on account of the spots in the skin, in certain 
regions, and lead me to the presumption that it is an infectious disease 
of a parasitical nature. 

Influenced by this idea, I began the bacteriological studies of the blood, 
of the exudations, and of the diarrhoeatic liquid, and, after making sev- 
eral microscopical preparations with those humors collected from the 
sick hogs, and from those which died of the disease, I detected in them 
all the presence of a micro-organism which I shall describe hereafter. 

The blood in the corpses of animals having died from this disease 
shows a red hepatic color, its coagulations are thin, and, in contact with 
the air, acquire a red coloration ; when examined with the microscope 
its globules appear in their normal form, but their anatomical position is 
altered, for they are disseminated. By them are observed multitudes of 
micro-organisms, endowed with movements of their own, ovoid in shape, 
and measuring, isolated, o.i micro-millimeter, and 0.25 micro-millime- 
ters either united in two by a transparent connection, or forming groups. 
The same organism is found in the exudations, and in the diarrhoeatic 
ejections. 

After repeating many times the microscopical observations upon as 
many preparations, I became convinced that the presence of the micro- 
organism was constant, and the idea naturally struck me that it must be 
the pathogenic agent of the disease I was studying. 

It was therefore necessary to begin by selecting the means for its cul- 



170 SWINE RED-DISEASE IN MEXICO. 

tivation, and I decided to adopt peptonized broth and gelatine, strictly 
adhering to the technicalities of the illustrious French savant, M. Pas- 
teur. I did so, and obtained results which fully satisfied my aspirations, 
for I succeeded in obtaining the cultivation I was after. 

I shall describe, in a succinct manner, the characters of the cultivations 
in broth, and of the colonies sterilized in gelatine. A drop of blood poured 
into the alkaline broth contained in the Pasteur tubes, and submitted to a 
temperature of from 30** to 35° C, produces within twelve hours a re- 
markable alteration in the broth, and changes its coloration, owing to the 
active prolification of the microbe. The sewing of a drop of blood in 
gelatine (in plate or tubes) by means of a platinum thread does not 
liquefy the medium ; it produces small colonies, which can be seen with 
the naked eye within forty-eight or fifty hours, and these colonies are so 
numerous that they have the appearance of innumerable dots, as if made 
with a pencil. Judging from these characters, it may be said with all 
certainty that the microbe is essentially an serobe. Studies made in the 
laboratory, with this virus preserved for some months in lamp-sealed 
tubes, have shown that it preserves its vitality — a sufficient reason to 
lead us to conclude that this microbe is also an aerobe. 

When I found myself in possession of the virus, I undertook its 
physiological study, and with that purpose I instituted several experi- 
ments, the first ones, as was natural, in animals of the same genus as 
those afflicted with the epizooty, and I was able to observe that the injec- 
tion of the culture of the virus in hogs produced the disease, in all cases, 
and death only in some of them ; and that, inoculating rabbits, these had 
invariably the disease, all of them dying within three or four days. 

The symptoms of the disease, determined in animals submitted to the 
experiments, and the anatomo-pathological lesions of those that died, were 
identical with those shown by hogs in which the disease appeared spon- 
taneously. There can be no doubt, therefore, that the microbe under 
review is the cause of the disease. 

The cultivation of this microbe has a deadly action upon rabbits, as I 
have stated above, and it has the same action upon otiier species, as, for 
instance, rats, pigeons, turkeys, hens, ducks, etc., which characteristic, 
added to its form of micrococcus, diptococcus, and in groups, zogleicus, 
and to the form of its colonies, in gelatine, distinguish it from the one 
which has been described, in France and Germany, as the pathogenic 
agent of the Rouget. 

The physiological properties of the microbe being known, we must, 
naturally, think about the manner of attenuating them in order to utilize 
it in the prophylaxis of the disease. 

I rejected at once the idea of employing the virus preserved in the 
same species, swine, because, as has been seen, although it produces the 
disease in all of them, it kills some, while others escape. I selected 
rabbits for obtaining the virus that might have a preventive action on 
hogs. 

My first experiments in this direction were made on twenty hogs 



SWINE RED-DISEASE IN MEXICO. 171 

from the Hacienda San Antonio Coapa, in the month of December of 
last year, and I inoculated them with virus obtained from rabbits. The 
inoculation produced on all of them a slightly diseased state, but there was 
not any case of death. Encouraged by this result, I repeated my experi- 
ment on 140 hogs, at the same Hacienda San Antonio, and I had not a 
single unfavorable case. The virus obtained from domestic fowls acquires 
a greater degree of virulence than the one obtained from swine, that is to 
say, the former is sure to kill hogs. I employed virus obtained from 
pigeons, in order to make a demonstrative experiment that the virus 
obtained from rabbits had an inoculating action on hogs. I therefore, 
at the same Hacienda San Antonio, inoculated with pigeon virus five 
hogs which had received no injection of rabbit virus, and at the same 
time I inoculated six others that had received the preventing inoculation. 
All the six showed symptoms of the disease, but in such a mild form 
that it could hardly be detected, and up to this date they all fare well. 
Of the five others, three had the disease in its acute form, and died within 
nineteen and forty-eight hours, and the remaining two were very low 
with the disease, but at last recovered after a very long convalescence. 
The virus obtained from rabbits may therefore be considered, thus far, 
as the vaccinating virus for swine. 

Later on I have made inoculations of the same kind in a considerable 
number of hogs, on difierent farms of the states of Puebla and Hidalgo, 
having obtained the following results : In nine centres of hog-breeding, 
when the disease had not made its appearance before the inoculations, I 
vaccinated 3,354 hogs, which are faring well. In four other centres of 
hog-breeding, where the disease had existed some time before making 
the inoculations, or where it raged at the time of making them, 4,214 
hogs received the injection of the virus, and there has been a loss of only 
fifteen or sixteen per cent., — an insignificant death-rate compared with the 
death-rate in the same centres, and those before mentioned in previous 
epochs when they had been invaded by the disease, for almost every hog 
succumbed to it. 

The facts which I have set forth furnish a sufficient guaranty of my 
having succeeded in obtaining the prophylaxis of the Mexican red- 
disease by means of vaccination. I preserve the virus with every pre- 
caution required, as well as the seeds, which I shall be able to renovate 
whenever necessary. The recipients which I employ for transportation 
to distant places consist of tubes, lamp-sealed, to which are joined 
instructions stating the precautions to be taken on opening said recipients 
and taking out the vaccinating liquid they contain. 

' Such is the subject which, as a delegate from the Superior Council of 
Health of the city of Mexico, I have the honor to submit to the hon- 
orable American Association of Public Health. 



xxn. 

LEPROSY AND ITS MANAGEMENT IN MINNESOTA- 

By CHARLES N. HEWITT, M. D., 
Secretary State Board of Health, Red Wing, Minn. 

It is due to the State Board of Health of Minnesota, and to the Nor- 
wegian element in its population, to state the facts as to leprosy in that 
state, and to ask that hereafter, when the Minnesota experience is quoted 
by writers and talkers on this subject, these yacts be noted. 

Leprosy has been carefully watched and studied in Minnesota since 
1872, under the direction of the state board of health, by a committee 
consisting of Dr. Chr. Gronvold, a thoroughly educated Norwegian 
scholar and physician, who has studied the disease under the leading 
authorities of his own country, there and in Minnesota. The other 
member of the committee has, during all that time, been the secretary of 
the board, and is the writer of this note. Before 1872, and ever since 
the Norwegian immigration began, long years before, the disease, in new- 
comers, has been watched not only by resident Norwegian physicians, 
but tAe leading medical authorities on this subject in Norway have 
made successive pilgrimages to the North-western states, because, from 
the peculiar circumstances of the people there, the important questions of 
infection, heredity, sanitary conditions, climatic influences, including better 
housing, food, work, and improved physical and mental condition, could 
be watched in operation where the disease had never been seen before, 
and where no other race was affected. 

As a consequence, the results of this nearly fifty years of consecutive 
study of leprosy by medical experts whose authority is universally recog- 
nized ought to furnish a basis for sanitary regulation, and it has done so. 
At no time since the organization of our board, in 1872, has this ques- 
tion been off our list of every-day problems, and we have therefore neg- 
lected no opportunity for more light in its solution. In 1864, Dr. Holin- 
boe, surgeon of the Leper hospital in Bergen, visited this country, and 
found twelve cases ; — in two, the disease first appeared in this country : 
one had recovered, the rest brought the disease with them. He found 
them in better health than would have been the case in their own coun- 
try. In 1869 and 1870, Dr. William Boeck, of Christiania, the leading 
authority of his time and country on leprosy, came on the same mission. 
He found eighteen cases in Iowa, Wisconsin, and Minnesota, all from 
the Western seacoast of Norway, where the disease is endemic ; — nine 
cases began in the old country, — five, of leprous families ; four had no 
known leprous relations. Of the other nine, the disease began in this 
country ; eight had leprosy in their families in the old country, and the 
disease broke out in from two and a half to ten years afler arrival. 



LEPROSY AND ITS MANAGEMENT IN MINNESOTA, VJZ 

Dr. Boeck inclined to believe the disease hereditary, or if due to infec- 
tion, it must have been in the old country. 

Dr. Gronvold continued the work begun by Prof. Boeck, and in his 
tenth report to the State Board of Health of Minnesota, i882-'83, he re- 
ports ten as having died of the disease since the settlement of the state. In 
none, living or dead, has it been possible to trace the disease to infection 
in this country. One at that date (Boeck's case. No. 2) had fifteen 
gprandchildren, aged from 2 to 22 years, and two great grandchildren, 
all free of the disease. The record of this family to 1890 is the same. 
Another (Boeck's case. No. i) belongs to a very leprous family — father, 
father's sister, sister and brother : he has full grown children and many 
grandchildren, up to 17 years of age, all free of the disease. The 
record to date is the same. In this report Dr. Gronvold quotes Hawaiian 
experience, and states that not a case has occurred in the descendants of 
lepers in Minnesota. 

To account for this important and well ascertained fact, he inclines to 
the belief that changed and better climate, cleanliness and better housing, 
have very largely to do with the result. 

In the eleventh (third biennial) Report of the State Board of Health 
of Minnesota, Dr. Gronvold brings his report up to the end of 1886. 
In the two years but two cases had been added to the list ; eleven cases 
have died since 1876; and there were four well marked cases under 
observation. The average duration of life in the anaesthetic form in 
Minnesota has been seventeen and a half years : in tubercular cases, 
nine years ; — stiH no signs of the disease in descendants of lepers living 
in the state. 

In February, 1888, Dr. G. Armaner Hanson, the discoverer of the 
bacillus of leprosy, and Chief of the Leper Service in Norway, came to 
this country, and asked our assistance in ^ ^finding out the dwelling 
places of the immigrant leprous, and, if possible, also of Norwegian 
immigrants who descend from lepers in Norway." We gave him every 
assistance in our power, and he was in constant consultation with Dr. 
Gronvold. Dr. Hanson read a very important paper on the subject at 
the Minnesota Sanitary Conference, at Rochester, Minn., in May, 1888. 
He denied the heredity of the disease, concluding his paper as follows : 
"Under reasonable sanitary conditions I do not think there is any great 
danger of the disease spreading, if there is any at all. If people wash 
themselves, and take the least care of themselves when they come in con- 
tact with lepers, I do not think there is any danger whatever. It is a 
remarkable fact, that not one of the nurses or servants in our asylums 
have caught the disease, although they daily wash and dress the patients. 
The contagiousness of leprosy must be regarded as being of very nearly 
the same nature as that of syphilis, though no doubt leprosy is not as 
easily transferred. As far as I know hitherto, there is not a single 
example of leprosy spreading here in America, and if the disease is not 
hereditary, you ought to have no fear that the lepers immigrated from 
Norway will spread the disease here." In the July, 1888, number of 



174 LEPROSY AND ITS MANAGEMENT IN MINNESOTA. 

"Public Health in Minnesota" will be found Dr. Hansen's report to me 
of his general conclusions. He writes : *' The number of immigrated 
lepers is larger than I had supposed. I have not found a single case of 
leprosy originated in this country, as one might expect to be the case, 
when so many have immigrated. Most of the lepers I have seen claim 
that they had no symptoms of the disease when they left Norway, and I 
have no doubt that even a professional man well acquainted with the 
disease would have been unable to detect any symptoms of leprosy in the 
person at the time of the immigration. This also shows that it is hardly 
possible to prevent the immigration of lepers, but as the disease shows 
no signs of spreading in this country, the prevention of immigration is 
not necessary. If my opinions are right, the disease does not sprdkd 
here, because of the greater cleanliness and better dwellings of my coun- 
trymen here in this country than in their old home. Though they have 
there plenty of the purest water, and soap is easily accessible, they 
generally use very little of either for the promotion of personal cleanli- 
ness at home ; and, what is of still more weight, the lepers I have seen 
here have their own room and bed for themselves, never being in direct 
contact with sound people. This being the fact, I think there ought not 
to be any fear of leprosy spreading in this country." December, 1888, 
Dr. Gronvold reports, — ''Our experience in the North-west has made it 
probable that the disease to date is not hereditary. Not a single case 
has been discovered, after forty years of investigation, where a child born 
in these states of leprous parents has inherited the disease, nor, for that 
matter, got it in any other way. 

A leading article in the London Lancet of June 29, 1889, is so nearly 
in accord with Dr. Hansen's personal experience and so judicial a sum- 
mary of the matter that I beg to call attention to it in this connection. 
Dr. Gronvold reported seven cases as existing in Minnesota to October 
18, 1889. In a paper in "Virchons Archives," band 114, 1888, Hansen 
states, — 

"One hundred and sixty lepers in all have immigrated to Iowa, Wis- 
consin, Minnesota, and Dakota, of whom thirteen are alive, and perhaps 
three or four more ; all others are dead. Of all the descendants of lepers 
whom I have seen, and these have included the great grandchildren of some 
of them, not one has become leprous. This is, in short, the result of 
my observation, and there is in my opinion only one explanation — that 
leprosy cannot be hereditary." 

Our final report up to September, 1890 (Public Health in Minnesota, 
Vol. VI, No. 8), by Dr. Gronvold, includes every case, some very mild, 
which vigorous search, not only by him but by local boards of health, 
who are interested in the matter, has discovered. The total is sixteen in 
all, and a repetition of the inquiry annually made by our board for the 
last eighteen years results in this conclusion : The disease is dying out^ 
and not a case has occurred in the families of lepers, nor a case of even 
probable contagion in any one. 

These are the facts, after forty years of observation of leprosy in 



LEPROSY AND ITS MANAGEMENT IN MINNESOTA. 1 75 

Minnesota. It has not gone into any other race, nor to the descendants 
of lepers among the Norwegians. The policy of the State Board of 
Health of Minnesota, because of these facts^ is simply this, — to keep 
all cases under observation ; to insist upon no other isolation than that 
they occupy their own rooms and beds, and use their own utensils. 
This they and their families do of their own accord. We have no theory 
in this matter, but shall keep the same patient and careful collection of 
fects as for the last eighteen years, ready to take any action which the 
evidence at any time demands. For this we have the legal authority, 
and the support of popular opinion. 

If other states will make as thorough and careful research, knowing 
every individual case, as our committee does, they will be able to deal 
with the disease as easily and inexpensively as Minnesota does. 

As to the prevention of the importation of the disease, the writer 
would suggest, what has doubtless occurred to others, that it would be 
easy to prevent actual lepers, /. tf., with well marked symptoms, from 
coming, by an arrangement with the Norwegian government, and as 
easily it might be arranged that those from well known infected districts 
should bring certificates of exemption from the superintendent of the 
Leper Service of their country. Of the need for this last restriction we 
have no evidence in Minnesota experience. As to the seclusion of 
lepers in pest houses in this country, I am of the opinion (always judg- 
ing by our experience) that there is not only no need, but that it is not 
justified by any evidence at hand. 

If it is made the rule in any state, the only escape from a reductio ad 
ahsurdum fatal to honest sanitary control of infectious disease is more 
vigorously to apply the same rule to the victims of the infinitely more 
dangerous and fatal diseases, syphilis and tuberculosis, whose victims 
are not limited, as in leprosy, to a very few of a single race, but affect 
all sorts and conditions of men, counting victims by the hundreds of 
thousands, and deaths by thousands, and whose virus is permitted to be 
spread, with a careless abandon, everywhere. 

If leprosy is to be dealt with in pest houses, syphilitic and tuberculous 
persons should not only have similar treatment, but, when of age, crimi- 
nal prosecution for wilful and inexcusable spread of infectious disease. 
It will be a long time before that will be done. 

Give to the dangers of leprosy in the United States the largest pro- 
portions any reasonable interpretation of the actual facts will warrant, 
and until syphilis and tuberculosis are dealt with in practice among 
immigrants as it is proposed to deal with leprosy, there is little justifica- 
tion or sanitary occasion for the stringent regulation proposed for the 
control of leprosy by the inspection of immigrants. I say proposed, 
for unless all Norwegians from the west coast of Norway, and nearly 
all thd rest, are excluded, there will be no probability even that the 
disease will be kept out, because of its long years of incubation. If 
small-pox had such an incubation, we would have long ago found some 
other way to control it than exclusion or isolation of subjects. 



xxm. 

REPORT FROM THE SOUTH CAROLINA STATE BOARD 

OF HEALTH. 

By J. R. BRATTON, M. D., President of the Board, 
YorkvUU, S. C. 

At this point it may be appropriate and in order to recite the history 
of the origin, progress, and present status of the State Board of Health 
of South Carolina, its projectors, patrons, and protectors, and the en- 
vironments which, through ignorance, prejudice, and fear, opposed its 
creation, evolution, and operation in 1877. 

At the regular session of the legislature in 1877, Drs, Manning Sim- 
mons, H. D. Fraser, and Frederick Geddings appeared before that body, 
and, by their appeals to common sense, justice, and humanity, succeeded 
in having the bill passed (which was rejected at a former session) author- 
izing the organization of a state board of health, empowered with cer- 
tain rights and privileges. It therefore appears that by the zealous work 
of these medical gentlemen and their associates in Charleston, aided 
and sustained by a very severe, though true, criticism signed "Quarin," 
on the same subject, the state board of health had its conception in 
Charleston, was delivered by its birth in Columbia in the presence of 
the members of the legislature, and at its baptism was taken in charge 
by these three medical gentlemen as its god-fathers, conveyed by them 
to their homes, reared and educated to maturity, introduced to all sec- 
tions of the state, and employed as a practical, humane instrument by 
which to adopt and diffuse the best possible sanitary measures not only 
along the coast of the state, but into every section of the country. 

In the language of one present at its birth, " The birth of our baby, 
the state board of health, was not easy and comfortable, but with 
agonizing throes, attended with long delay ; its accouchement was pain- 
ful and difficult, and the baby almost still-born." 

Being now planted in every county and section of the state, it has 
already given ample testimony of its benevolent, humane object and 
purpose. 

The history of the sanitary condition of Charleston from 1871 to the 
present time reveals the fact that no yellow-fever, no cholera, nor vari- 
ola, no infectious or contagious diseases, have been introduced into the 
city from foreign or neighboring infected ports. 

The history of our neighbor Florida in 1888, afflicted with yellow- 
fever, so destructive to trade, commerce, and human life, teaches us in 



REPORT SOUTH CAROLINA BOARD OF HEALTH. 1 77 

most solemn language the necessity, utility, and humanity embraced in 
the existence and exercise of state boards of health. 

In 1888 Florida had no state nor subordinate boards of health. Her 
whole coast line was open and free to the admission of trade and commerce, 
and of infectious diseases introduced from the West Indies. Passing on to 
the year 1889, we find that state thoroughly organized with state and 
subordinate boards of health, and better still, with much comfort we read 
of her entire exemption from former infectious diseases to the present 
time. 

What stronger, more satisfactory evidence could be desired to estab- 
lish the benefit and utility of state boards of health in preventing the 
introduction of infectious diseases among any people.^ 

We should not pass by in silence the fact that in 1888, when Florida 
was so afilicted with such severe epidemics, the city of Charleston and 
the entire state were free from infectious diseases from foreign ports. 
How was this exemption effected? Because of the existence of a well 
organized board of health, with all its collateral sub-boards in full asso- 
ciation and harmony, willing to aid in the noble, humane work of pre- 
serving the health and prolonging the lives of the people of the state. 
In a continuation of the purpose of this organization — the study and 
observation of experimentative pathology, the causes which lead to the 
origin and dissemination of disease, and the mode or manner by which 
to prevent the same and thus preserve the health and life of communi- 
ties — we must first notice that as far back as forty years ago the nature, 
cause, and origin of many diseases which were then shrouded in deepest 
mystery have now been freed from such mystery. 

An old French physician prominent in the medical profession once 
said, ^*'It is better to walk in darkness than to stand solidly still," mean- 
ing thereby a negative position. On the contrary, to come nearer home, 
a common sense, practical old Kentuckian always said, ''Be sure you 
are right, then go ahead." Scientists of the medical profession have, 
however, in their investigations occupied a medium position, gradually 
extending their discoveries into the field of science, diffusing so freely 
the light of knowledge of many diseases heretofore mysterious to such a 
degree that the medical world has not only embraced that knowledge 
with utmost confidence, but to-day they stand amazed at the wonderful 
progress made in this direction, even within the past twenty-five years. 
The clouds of mystery that hung like a sickly pall over the nature, 
cause, and efifect of many diseases have now been dissipated by patient 
private study and observation, such changes having affected medicine and 
its associate branches of study, not alone as a preventive, but also as a 
cure of disease. We are now better qualified with a knowledge of epi- 
demic, contagious, or infective diseases, and understand more fully how 
to prevent their diffusion among ourselves and our neighbors. In order 
to secure and extend this important work, the populace must be educated 
in the knowledge of the facts contained therein. They, through their 
representatives in the halls of legislation, should give moral and financial 



178 REPORT SOUTH CAROLINA BOARD OF HEALTH, 

aid in the work set apart for the state board of health. Long since, 
sanitary legislation has been conceived, encouraged, and developed in 
Europe, and such legislation has ever progressed and been more ex- 
tensively diffused, wherein medical science has developed the facts upon 
which to build a true fabric. 

The history of medicine, and the unfolding of simple sanitary meas- 
ures of a domestic character, reveal the fact that the first notice or in- 
formation on the subject of public health, and the preservation of the 
same, originated in England, nearly iifly years since, by the appoint- 
ment of a health officer by the government, aissociated with a temporary 
board of health, which, though temporary in its primeval state, soon 
afterwards became more permanent and efficient in its sanitary work. 
The sanitary measures adopted in that day and country were confined 
principally to the examination or inspection of the water used for drink- 
ing, and the work of efficient draining. In this character of work it 
was an easy matter for the people and their legislators to harmonize, and 
to unite in the application of such sanitary measures as were understood 
in that day and time. In that period, also, inquiry was made as to the 
different proportions of disease in the different sections of the country ; 
and there the discovery was fully established that the percentage of dis- 
ease was much greater in those sections where the purity of the water 
and the drainage were most deficient. In that day medical men promi- 
nent in the profession studied the benefits arising from the association of 
sanitary measures with state authority, and with study and observation 
arose the permanent organization from which arose our modem state 
boards of health. A people educated in sanitary science, even in its 
simplest branches, naturally inquire after and observe the teaching and 
practice of sanitary rules and regulations, and they thus learn the great 
benefits accruing from such measures properly and timely applied, and 
thus encourage co5peration between the state and the medical profession. 
With such state cooperation in the application of sanitary rules and 
regulations, the death-rate in twenty years has fallen from twenty-six to 
seven per i ,000. (See Report British Medical Association, by Dr. Fos- 
ter.) 

A few years since, in a meeting of the State Medical Association, it 
was suggested by a prominent medical professor in the Medical College 
of Charleston that a memorial be sent to the legislature petitioning 
that body to appropriate funds to endow a professorship of sanitary 
science in that medical college. The subject was brought before the 
executive committee, and a committee appointed to attend to that busi- 
ness. The committee in the discharge of that duty received no encour- 
agement on this subject, and therefore, in order to diffuse as much sani- 
tary knowledge as possible among the people, adopted the plan of using 
printed circulars upon the nature of diseases most prevalent among the 
people. These circulars are distributed by the sub-boards among their 
families, and by the school commissioners among the various teachers of 
the schools. In this our day, when great and important truths are being 



REPORT SOUTH CAROLINA BOARD OF HEALTH, 179 

evolved by the earnest, private, patient study of the human system in 
health and disease, — its physiology and pathology, — by those men of the 
profession who have for years past investigated the cause of disease, its 
origin, cause, and effect, we are all more than grateful for their labors 
for humanity, and are amazed at the light of truth, which is now made 
to radiate upon the nature, cause, effect, and treatment of many diseases, 
which in times passed have always been shrouded in deepest mys- 
tery. In this way Koch, Pasteur, and others associated with them, 
have not only gained for themselves wreaths of professional glory, 
but their labors have made them public benefactors of the whole civilized 
world. Should these professors of sanitary and medical science succeed, 
in their investigations and experiments, in unfolding the true nature of 
tuberculosis and hydrophobia, and reveal to the world the means to 
relieve the same, then will every man, woman, and child in the whole 
civilized world rise up and call them blessed. 

VITAL STATISTICS. 

The sub-board of health for every county in the state regret to have 
to report that they are unable to comply with the intended object of the 
act of the General Assembly, approved December 19, 1883, in relation 
to marriages, births, and deaths, for the following reasons : 

1. All the members of the sub-boards of health are married men 
themselves, and though they are no Josephs in a moral sense, still they 
have no desire at this period of their physical and animal — and I might 
add spiritual — existence, to reenact the scenes of Brigham Young and 
marry other women, or the wives of other men, but would much prefer 
to transfer or assign this important work to the priests and trial justices 
of each county, to whom we would ascribe all honor and glory in this 
field of labor, and who have more influence over woman at this critical 
period of her life, when she sweetly fancies that by the act of marriage 
she will enter upon an Elysium of life^ adorned with all its beauties 
and crowned with all the pleasure and happiness allotted to humanity in 
this vale of tears. 

The priest and trial justice delight to deal with the pleasing imagery 
of the newly married around the altar. The physician is called upon to 
deal with its natural, necessary, and oflen sad, reaction, around the bed- 
side, in nine or twelve months after the marriage festival. 

2. No instructions have been given to the physicians and mid-wives 
generally as to whom these reports shall be made in the country or in 
town, whether to the trial justice, the clerk of the court, or the chair- 
man of the sub-board of health, or to the registrar of a county medical 
association. If the returns of marriages, births, and deaths were made 
to the chairman of the sub-board of health, he would be prepared with 
material upon which to base his report. No such arrangements have 
been made, no such instructions given, and though a few physicians in 
towns may be prepared and could report their own work in this depart- 



l8o REPORT SOUTH CAROLINA BOARD OF HEALTH, 

ment of their practice, still the cases are such as would call forth a meagre 
report from the county. 

3. Neither the physicians nor the mid-wives in the towns or counties 
have been furnished with blanks with which to make such reports in any 
way whatever. 

The sub-board of this county would respectfully suggest that with the 
black population, who have their own mid-wives, of their own race, color, 
and capacity, it would be a difficult matter to get a correct report of 
births, unless they were impressed with the idea of a penalty attached 
to a neglect of this duty. They would also suggest that the trial justices 
in the different sections of the county would be the proper persons to 
receive the blanks, distribute them among the negro mid-wives in their 
immediate neighborhood, and require them to report to themselves, and 
thence to the chairman of the sub-board, annually, on the ist of Septem- 
ber. 



XXIV. 

LOCAL BOARDS OF HEALTH. 

By a. a. MOORE, M. D., 

Ex-President of the South Carolina Medical Association, and Member of 
THE State Board of Health of South Carolina. 

On account of the commercial importance and exposed positions of 
our seaports, maritime sanitation necessarily claims the largest share of 
attention from our health authorities. By careful and constant vigi- 
lance they can exclude contagious and infectious diseases from abroad. 
While this also affords some measure of protection to the towns, ham- 
lets, and rural population of the interior, still it is incumbent upon these 
localities to guard their own borders, otherwise they must suffer neglect 
in consequence of the absorbing interest which attaches to the health of 
cities, especially during visitations of cholera, yellow-fever, etc. There- 
fore the attention of this distinguished body of sanitarians is respectfully 
invited for a short time to the organization of our local boards of health 
and their efforts at sanitary improvement in their respective localities, 
and also some of the difficulties that surround them. 

There are thirty-five counties in this state, with eighty local boards of 
health in operation. These boards are composed of two physicians and 
one layman. In the words of the act creating them, they are " subject 
to the supervisory and advisory control of the state board of health 
through its executive committee." At present their functions are purely 
advisory ; but it is generally presumed that they will receive the coop- 
eration and sympathy of municipal boards. But should a conflict of 
authority or opinion arise between them, which has occurred but two or 
three times since they were established, an appeal is taken to the state 
board of health for final adjudication. These boards, by their work and 
advice which are gratuitously and cheerfully given, ought to become, 
with the aid of the laity, valuable auxiliaries to the state board. Among 
their other duties they are expected to investigate the sources of water- 
supply, the drainage and sewerage, the privy system, the condition of 
the markets, and of the meats and vegetables exposed to sale, and the 
ventilation, lighting, warming, and furniture of public school buildings. 
In addition to this, they are required to report immediately to the state 
board of health the appearance in their midst of any contagious or infec- 
tious diseases, and to adopt the necessary measures to prevent their 
spread in the community. And just here, on the very threshold of their 
vital mission, they are often confronted by a most serious obstacle, and 
that is, a surprising apathy and lack of cooperation on the part of the 



l82 LOCAL BOARDS OF HEALTH, 

families afflicted and of the public. Social intercourse will be continued 
in spite of warning and remonstrance. Their very familiarity with some 
of these diseases, such as measles and whooping-cough, seems to create 
an indifference to their dangers, and thus greatly embarrasses the efforts 
of local boards to banish them from their midst. And how this diffi- 
culty is to be surmounted is a perplexing problem, but it is one which 
calls loudly for solution. This, with one or two other kindred topics, 
was fully and ably discussed at the last National Conference of State 
Boards of Health, but without arriving at any definite conclusion, I 
believe. In common with other state boards, ours is now making the 
experiment of issuing health pamphlets through the local boards. By 
these they are distributed to families and schools, and we hope thus to 
create a popular interest in the prevention of these common communi- 
cable diseases. 

Besides this barrier to our progress, a large proportion of our profes- 
sion needs to be awakened from its lethargy, while the actual opposition 
of others, strange as it may appear, has to be combated. This latter 
class — we almost blush to mention it — hold the narrow, contracted, self- 
ish view that hygiene is inimical to their interests. For ^^ sweet char- 
ity's sake " we trust they are but few. 

After this hasty glance at a few of the trials that beset the pathway of 
local sanitarians, and their utter inability to cope with them by persua- 
sion and advice, there appears to be a necessity for some compulsory 
authority to effect their beneficent schemes, guarded, of course, by such 
restrictions as will prevent any arbitrary acts. And this brings us to a 
source where we have encountered some active opposition and should 
have rightfully expected the least, and that is, in our efforts to obtain 
sufficient aid and encouragement from our legislature. While their 
appropriations for all branches of the state government are ample, they 
have not exhibited that degree of liberality to our state and local boards 
of health which is indispensable to enable them to continue, improve, 
and extend their work of sanitary reform. 

In conclusion, our state and the city of Charleston are to be congrat- 
ulated on having the American Public Health Association meet in our 
midst. And we hope and believe that the important subjects to be con- 
sidered here will give a renewed impetus to preventive medicine, and 
that eventually the head of every household will become a sanitarian^ 
and our whole land a nursery of hygiene. 



XXV. 

THE HYGIENIC VALUE OF RATIONAL IRREGULARITIES 
IN HABITS OF LIVING. 

By JAS. F. HIBBERD. M. D., LL. D., Richmond, Ind. 

All human life is a warfare. In the general world man exercises his 
wits to avoid accidents that may injure or destroy him. In his physical 
organization there is a perpetual struggle carried on between him and 
other living things as to which shall conquer. The wild beasts would 
catch and eat man if they could. Man kills and eats some of the wild 
animals, and drives all others away, or selects from them such as he 
can domesticate, commanding their services to aid him in his labors, 
or using them for his own subsistence. So, too, civilized man will find 
a weaker race — it may be the American Indian — which occupies land 
he wants, and, if he can, he will persuade the weaker race to give him 
their land ; but if he cannot, he will occupy at all events, and kill or 
drive away the original owner if he resists. 

These are not matters of hygiene, but they are facts that support the 
declaration that human life is a continual warfare, and that man is 
always ready to kill whatever he deems essential to his own salvation. 

But there is another form of warfare that is subject to the jurisdiction 
of sanitary science, and that is the perpetual struggle that is going on in 
the human organization to resist the causes of disease. No allusion is 
here intended to the common, conscious effort to avoid excessive heat and 
cold, and the countless other visible and avoidable exciters of patholog- 
ical activity, but to that unconscious and involuntary struggle constantly 
carried on by our organs, tissues, and cells to resist the harmful agents that 
are perpetually assaulting them. 

Our bodies swarm with innumerable bacteria of all classes, some of 
which are friendly in resisting or overcoming the other classes, which 
are enemies and seek to maintain themselves and propagate their kind 
by preying upon our vital organs and the cellular tissue, and if our 
organs do not have the power successfully to resist these assaults, dis- 
ease and death result. 

Probably every one in the civilized world has been exposed to the 
causes of consumption. The greater fraction have the power to resist 
the bacillus tuberculosis, and are well ; the smaller fraction, but still a 
wonderfully large sum, do not have the power to resist, so the bacillus 
thrives and increases until tissues are consumed and death ends the 
unequal struggle. 



184 HYGIENIC VALUE OF RATIONAL IRREGULARITIES, 

We suppose the persons who conquer the bacillus do so by virtue of 
their better health, and it is establishing and maintaining this better health 
that the hygienist finds his first and highest aim. For this purpose, it 
seems to me, the sanitarian should inquire if there be any wide-spread 
popular errors that militate against good health, and, if he finds such, 
strive to correct them. Thus investigating, I fancy I have seen some 
such popular errors, and last year I had the honor to read before the 
Association an essay exposing the hygienic error of improper clothing ; 
and now 1 think there is within my field of vision another popular error 
that I will proceed to point out. 

Assuming that a great safeguard against disease in the human family 
is the ability in the members of the family individually to resist the 
causes of disease, and assuming, also, that sound health affords the 
highest condition of such resistance, the important question for the san- 
itarian is, how to establish and maintain the sound health that shall 
offer the most effective resistance against the causes of illness. 

Such sound health must be the product of inheritance and hygiene 
chiefly, of medicaments in a minor degree only. 

Passing inheritance as being only indirectly and to a limited degree 
subject to the management of the sanitarian, let us inquire what there is in 
hygiene that may be manipulated for the best estate of communities by 
attention to the individual. But the hygienic field is too large to be ex- 
amined in toto in a single lesson, so we will confine our inquiry to a sole 
point, viz., the hygenic value of rational irregularities in habits of living. 

Perhaps there is no sentiment more firmly fixed in the mind of the 
average layman than that regularity in living is the very best assurance 
against illness of almost every phase, and, without passing the bounds 
of truth, one may add that the majority of physicians are guided, and 
seek to gui^e others, by the same theory, as an abstract proposition. 

To my mind there is in this sentiment an element of error that leads to 
serious consequences to individual health. That appropriate exercise in 
the open air is a means of establishing and maintaining sound physical 
health will not be questioned, and that the same regimen will conduce 
to mental health should also not be questioned, albeit this alternate 
proposition is not of universal acceptance. When the ordinary individual 
is free to follow his own desires in the matter of exercise without special 
stimulation or hindrance from any source, he will select such modes of 
activity as will successively bring into use about all of his voluntary 
muscles, and he will exercise them until weary, and then rest until re- 
cuperated. This is illustrated in the young of the human family, and 
confirmed by the habits of the young of our domestic animals, especially 
those of the mammalia. 

My contention will be more readily comprehended by stating that the 
regularity of life objected to is met with in quiet children who are nicely 
dressed and taught to sit still and do nothing to soil their fine clothes ; 
and, obedience being one of the good qualities of their class, they re- 
main nearly immobile in the house, or walk in the yard decorously, like 



HYGIENIC VALUE OF RATIONAL IRREGULARITIES. 185 

little ladies and gentlemen, winning the approving smiles and commen- 
dations of their admiring but misguided parents ; and in boys and girls 
who are drilled to go directly to school — reaching the house just as the 
doors are open and the exercises about to begin — not to join in the rude 
and boisterous pastimes and plays of their school-mates at recess, and on 
dismissal of school return straightway home, not stopping to indulge in 
hop-scotch or leap-frog, nor to jump mudpuddles, nor delaying to listen 
to the street organ. Youths thus educated usually become the victims of 
imperfect physical development as the years pass and the corporeality 
increases, and their psychological development is as immature, faulty, and 
imperfect as are their bodies ; they are short of weight for their years, or 
fatty and leucophlegmatic, and stolid or idiotic in mental manifestations. 

To avert those conditions the remedy is, not to dress children so nicely 
that they cannot play and roll in the grass or on the carpet in their every- 
day exercises ; and if not inclined to engage in proper pastimes, they should 
be urged to do so, and, if necessary, induced with suitable rewards or 
appropriate punishment. If the boy at school wears out shoes, or the 
girl rends dresses, in lively play at recess or on the walk home, they should 
not be scolded nor sent into a dark closet for punishment : rather give 
the boy his other shoes, and sew up the rents in the girl's dress, and 
send them out to play again. This is the only way school youth can be 
developed into men and women with sound minds in sound bodies, such 
as will fit them to become able, honest, and happy bread-winners in the 
battle of life. 

But it is my purpose in this paper to invite attention more particularly 
to adolescents who are engaged in such study or labor as trains them for 
the great affairs of life, or are already giving their time and strength to 
the minor r61es of the industries that are to be the vocations of their future. 

Confining illustration to males, let us review the careers of two young 
men, supposed residents of a mid-Indiana city, who may serve as para- 
digms, that, with limited modifications, will illustrate a legion : Aron 
Zylus graduated at the high school at the age of eighteen, and immedi- 
ately took service in a shoe-store, where he remained three years ; he was 
then offered the situation of clerk in the recorder's oflSce, and accepted. 
He was a young man of good appearance, medium height, well propor- 
tioned, weight 120 pounds, with a mild, attentive, undemonstrative dis- 
position. He had been a good child, and, as a school-boy, always quiet in 
demeanor, obedient, performing whatever task was assigned him, not with 
alacrity, but with precision and generally with success. Rarely joining 
other boys in their pastimes and active games, he looked on in a contented 
sort of way. In the shoe-store he was watchful and polite, prompt to 
serve a customer according to expressed desires ; but he never essayed to 
convince a customer that a shoe that pinched his toes was a superb fit, 
that the pinching at purchase made it certain that the shoe would keep 
its shape better, last longer, and be every way more satisfactory than if it 
did not pinch on trial. These qualities made young Zylus a fair, not a 
superior, salesman, so that the shoe- merchant gave him a first-class recom- 



1 86 HYGIENIC VALUE OF RATIONAL IRREGULARITIES. 

mendation, but did not object to his leaving and taking a clerkship with 
the recorder. In the recorder's office Aron found a situation exactly in 
accord with his taste and his abilities. His work was to copy into great 
record-books deeds, mortgages, and other papers with accuracy, neatness, 
and legibility, and this he did to perfection. 

While engaged in the shoe-store, young Zylus walked forth and back 
to his meals six blocks distance, — about a half mile, — and this, added to 
his leg service in the store, was all the exercise he had ; and of this, that in 
the store was in an atmosphere contaminated with the odor of new leather 
and the emanations from the bodies of the customers, their clothes and 
soiled footwear, the last sometimes far removed from the purity of 
mountain air and the aroma of roses. 

Aron had no leisure. His meals were taken with the regularity of 
clock time, and on returning home of evenings, after the store had closed, 
he retired without delay. Being a member of the church, he attended 
service on Sunday, but gave no further attention to religious affairs at any 
time, spending the remainder of the Sabbath in drowsy quiet in his room. 

If regularity of habits and life, and the pursuit of the even tenor of his 
way, were the assurances and safeguards of good health, Aron Zylus 
ought not to have felt a pathological twinge, for he had all these, and 
was temperate in all things as well. But so far from perfect health was 
he, that before he left the shoe-store he suffered from the earlier symptoms 
of dyspepsia, and, regarding these as the result of overeating and insuffi- 
cient quiet after meals, he curtailed his diet and arranged to take thirty 
minutes rest after eating. But his disorder augmenting up to the time 
he entered the recorder's office, he took some medicine, thinking this 
with less labor of his legs in the new vocation would remedy the evil, 
and for a time he did feel better, but presently his stomach troubles re- 
turned in an aggravated form, and before many months his legs began 
to dwindle in size, and lose their former vigor. For further relief and to 
favor his legs, he ceased attendance at church, &nd, to avoid taking cold, 
kept out of the fresh air as far as possible, and maintained his rooms at 
super-heat in the winter and clear of all air currents in the summer. 
Notwithstanding all this, and his most faithful observance of regularity 
in labor, meals, and sleep, he failed slowly in health and strength for 
years, the doctors not at any time feeling entirely sure of a definite 
disease. 

In this state of affairs filial obligations required him to nurse his father 
in an attack of acute rheumatism, wherein the duties incumbent so antag- 
onized Aron's long practised regular habits of living, that his tissues suc- 
cumbed to the unwonted service, and at the age of 30 he died, the two 
attending physicians disagreeing as to the immediate cause of his death, 
one contending for heart failure, the other asserting neurasthenia. 

Irrational regularity in habits of living had exhausted Aron Zylus's 
power of resisting the causes of disease. 

Jason Yolliff, the second young man, completed his common-school 
education at eighteen years of age, and was immediately engaged as 



HYGIENIC VALUE OF RATIONAL IRREGULARITIES, 187 

clerk and collector by a iirm devoted to the lumber business. This gave 
him work in-doors and in the open air alternately at short periods, the 
out-door exercise quite varied and affording opportunities for obtaining 
some amusement without prejudice to his legitimate business. He 
availed himself of these opportunities, and accordingly had the reverse 
of a monotonous life. Besides this he gave three evenings a week 
to the students' club, and the other four evenings to sundry social 
exercises quite varied in character, often making large inroads on his 
regular hours for rest, and frequently leading far away from simplicity 
and regularity in diet. Still further, he found or created opportunities to 
go gunning, fishing, or on a long tramp to visit a friend of either sex, as 
the case might be, and even engaged in an occasional spurt at base-ball. 

Thus passed five years, and then Jason Yolliff was admitted a member 
of the firm employing him and assigned to the duty of purchasing sup- 
plies of lumber, and in pursuit of this service made repeated visits to the 
mountains of Tennessee and the pineries of Michigan, often sub- 
jected to poor food and poorer lodging for many days in succession. 
Within a year his firm bought a tract of timber land in Michigan, and 
young Yolliff was selected to superintend the conversion of the standing 
trees into marketable lumber ; and, as logging must be done when the 
ground is covered with snow, he spent the autumn in making prepara- 
tions and in organizing a working force of men and animals for the winter 
campaign, and then spent the winter in personal superintendence of the 
measures he had planned, occupying the while the rough accommoda- 
tions usual to laborers engaged in this exacting service. The winter 
was a severe one, embellished with several blizzards, and as there was 
plenty of snow, the work was pursued with the utmost diligence and 
full success. Some of the men suffered from frost-bitten feet and fin- 
gers ; but Jason, although exposed to numerous hardships and dangers, 
emerged in the spring in robust health and buoyant spirits. 

The following winter Jason spent in the same forest, engaged in the 
same business ; but the weather was not so tempestuous, and, the prepa- 
rations for living being more complete, there was comparatively little 
suffering, albeit the season was full of hard work, and the exposure of 
all parties frequent and severe. If irregularity in exercise, eating, and 
rest be good sanitary elements, the members of this logging company 
should have found themselves in the spring in an exalted state of salu- 
brity ; and so far as Jason Yolliff was a measure of every one's success in 
that manner of living, the doctrine may be counted established, as the 
vernal flowers greeted him a splendid specimen of manhood, a superb 
sample of physical energy and mental resources. 

Before the advent of another winter Jason was married, at the age of 
twenty-six, and turned over the logging business to his late assistant ; 
but he remained the purchasing representative of his firm, and this 
necessitated the continuance of his annual trips to the Tennessee moun- 
tains and the Michigan pineries, and for supplemental variety in habits 
of living he indulged in a hunting and fishing excursion to the north in 



1 88 HYGIENIC VALUE OF RATIONAL IRREGULARITIES, 

autumn, wherein for a fortnight or longer he and his party lived in im- 
provised encampments, far away from the formalities of civilized society. 
On the thirtieth anniversary of Jason's nativity his wife presented him 
with a new-born son, a second animated and vociferating pledge of his 
successful marital love and duty. 

Here we take leave of our ft-iend Yolliff, his voyage of life three sev- 
enths accomplished, his work so far well done, his reward satisfactory, 
and his prospects for the remainder of his mundane journey, and for 
health, wealth, and happiness in his old age, as fair-promising as can be 
in this world of mutations and uncertainties. Rational irregularities in 
habits of living had established Jason YollifTs power of resisting the 
causes of disease above par. 

In this narrative the incidents of these hypothetical lives are exag- 
gerated, — the picture purposely overdrawn to make material points pre- 
sent the features saliently for the purpose of impressiveness. But the out- 
lines are essentially true, and the lesson they are designed to illustrate 
is, that whosoever is obedient to the popular conception of the impor- 
tance and sanitary value of regular habits of living will in the progress 
of time suffer in health, in usefulness, and in the enjoyment of some of 
the richest blessings of a well directed earthly career. There are several 
conditions that such obedience generates that are inimical to sound 
health, one important one of which is due to that attribute of the human 
organization which allows it to be trained in a selected direction until 
a habit is formed almost as binding as an original endowment. If a 
man adopt a rule to eat his meals at fixed hours with positive punc- 
tuality, and confines his menu to the same edibles for a lengthened 
period, he trains his digestion and assimilative apparatus to this exact 
service, which may afford fair comfort and enjoyment so long as undis- 
turbed ; but even a slight variation brings distress, and, if the variation 
be great, illness. True, he can change this habit, if he will begin the 
work and continue it by short steps of departure, and bear the incon- 
venience accruing until the new habit is established ; but if sudden and 
extensive changes are indulged in, or forced upon him, he is made ill, 
and may suffer permanent invalidism or death. And as the exigencies 
of civilized life render it impossible for any one floating with the currents 
of enjoyable society to escape the sudden and more or less extensive 
variations, — for one is liable to accidents, and must give attention to mar- 
riages, births, and funerals, — it follows that no one can conform to the 
rule of regularity held by the populace in regard to eating and sleeping, 
and maintain the best and safest state of health. 

Of a verity, if one would establish good, useful, and fruitful health, 
one must occasionally have meals irregular in time and material, some- 
times have hunger with no immediate means to satisfy it, and sometimes 
have so much to eat that he is filled to satiety; have bedtime hours 
ranging widely from midnight on both sides, sometimes be sleepy with- 
out present possibility of gratifying it, and sometimes have so much 
leisure to sleep that it cannot all be utilized. 



HYGIENIC VALUE OF RATIONAL IRREGULARITIES. 189 

So, also, in exercise one must have such variety in kind and quality 
that all one's voluntary muscles shall have exercise by turns, and none 
of them be exhausted by too much action. The natural law of muscular 
development is, that a muscle not brought into appropriate play will 
atrophy and lose its resiliency, and the muscle overtaxed will have its 
function destroyed. The bandaged, quiescent arm will have its muscles 
wither and ultimately lose their sarcotic elements. The penman and 
telegrapher who too constantly ply their vocations will at first have the 
muscles involved increase in size and power, but further along fall into 
scrivener's palsy. The man who properly uses all his muscles main- 
tains them strong, pliant, and resilient, and can rely on any of them for 
service when needed. The man who occupies all his days hammering 
stone can hammer stone better than other men, but he cannot copy 
deeds nor run a locomotive. OflScers report that during the late war, 
for an ordinary day's military duty, with regular meals, the soldier who 
had been a farm hand was at the top of the list for eflficiency ; but when 
a forced march with nothing to eat was the order of the day, with a 
skirmish at night on an empty stomach, the counter-jumper whose rou- 
tine of life had been to measure tape all day and frolic half the night 
was far ahead of his country cousin in getting there on time and coming 
up fresh next morning. 

If the foregoing premises be true — ^and their substantial correctness 
seems a postulate — it follows that to establish and maintain the most 
enjoyable condition of health one must sometimes not have enough to 
eat and sometimes too much ; that some days one , must miss all his 
meals and some days eat six or eight meals ; that some nights one should 
have no sleep, and sometimes sleep all day ; that if one's vocation calls 
for the use of only a few muscles, one must find other exercise that will 
require all other muscles to take part and tax them until their nutrition 
and efficiency are at par. 

It can scarcely be necessary to admonish that the foregoing observa- 
tions have reference chiefly to persons in health — those ill should have 
special regimen prescribed by their medical attendants — nor that the 
one precaution to be observed in carrying out the hygienic regulations 
herein suggested is that irregularities must not at any time be pushed to 
such an extreme in abstinence from food or surfeit in eating, from mus- 
cular exercise in labor, play, or amusement, and from sleep that full 
recuperation does not promptly follow all such irregular habits if any 
perturbation attaches to them. 

If the conclusion herein arrived at be sound, is it not the reasonable 
duty of sanitarians to attempt, on all proper occasions, to correct the 
popular error touching the influence of habits of living on health, and 
teach the people that regular modes of living carried to excess are the 
road to invalidism, and irregular habits of life within rational limits the 
highway to health. 



XXVI. 

RECORDS OF FIFTY EXAMPLES OF DEFECTIVE PLUMB- 
ING IN NEW YORK CITY AND VICINITY. 

By albert L. WEBSTER. 
Civil and Sanitary Engineer, New York. 

At the last annual meeting of the American Public Health Association, 
in Brooklyn, the Rev. Dr. Storrs, after a courteous address of welcome 
and a graceful acknowledgment of the progress of medical science, made 
the following appeal to the Association : 

" But we want you to find out some of the things in regard to which 
you have intimated something to-night. 

" We want to know how it is that this dark, sly demon of diphtheria 
creeps into our most carefully fitted and furnished homes equipped with 
every possible appliance for keeping out filth, and leaves the tenement- 
houses and gutters and cellars untouched. We want to know why it is 
that this autumnal swoop of typhoid fever comes upon us every year, 
while we have the purest water in the world, and all the sanitary appli- 
ances that we know of in our houses and along our streets." 

Without attempting to reply to the pregnant queries presented, it may 
not be without interest to the Association to have brought to its notice 
records selected from my note-books, covering the sanitary examination 
of fifty buildings in and about the city of New York ; and, though these 
records are far from being as complete as desirable, they may throw a 
side light on a small area of the field suggested by Dr. Storrs's address, 
and point the moral that " our most carefully fitted and furnished homes" 
are rarely '* equipped with every possible appliance for keeping out filth," 
if we include in that term the air from drain-pipes and sewers. 

It is not the purpose of this paper to discuss the effect of drain air on 
the health of occupants of buildings, or to attempt to show a relation of 
cause and effect between defective plumbing and sickness in the house- 
hold. The nature of the examinations has made it impracticable to 
obtain the sick-rate of the households with any precision worthy of care- 
ful comparison. In a few instances sickness has brought the call for test 
and examination, and a possible causation has been more than hinted at 
in the conditions found ; — such cases, however, are too rare to furnish 
data for discussion. 

My special purpose is to record the actual results of examinations 
covering a fair range of territory and differing considerably in character ; 
and to emphasize the fact, that, though the principles of secure plumbing 



DEFECTIVE PLUMBING IN NEW YORK CITY, 19I 

have been known and preached for a number of years, the faults of 
niany years ago remain our present inheritance, and are being repro- 
duced to-day in much greater abundance than they should be. 

The citation of New York houses as examples is peculiarly pertinent, 
in that the city has a well organized and capable board of health, with 
a special corps of trained plumbing inspectors appointed under civil 
service examination, and a strong code of plumbing regulations and un- 
usual legal facilities for enforcing them. The city was also the first in 
the country to adopt plumbing regulations, and to demand the submissioi; 
of plans and specifications covering new work contemplated. The 
board's control, however, extends practically only to new buildings and 
tenement-houses, unless its good offices artt enlisted through solicitation or 
on complaint. In the year 1890, out of a total of 39,000 complaints com- 
ing to the board in this division from citizens and the Sanitary Police, 
about 3,000 referred to private dwellings and 9,000 to tenements ; and 
from the total number of complaints for which there was cause, about 
89400 were put down to defective plumbing and drainage. Old plumbing 
may be altered, patched, repaired, or even completely torn out and remod- 
elled, without necessary notification to the board. During the year ending 
December 31st, 1890, there were filed with the board in its division of 
Plumbing and Ventilation, 2,622 plumbing and ventilation plans, repre- 
senting more than 3,300 buildings. The total number of inspections made 
in new houses during the year, with a force of fourteen inspectors, was 
58,550— an average of something over thirteen inspections daily for each 
man on the force for every working day in the year. The total number 
of plans filed since the organization of the board in 1881, amounted last 
December to about 12,500. The total number of dwellings in the city 
in 1881, at the time the plumbing regulations were first passed, was 
about 76,000, so that not more than 13 per cent, of the present dwellings 
in the city have come under the control of the board of health. 

Passing from the consideration of bad plumbing by inheritance to 
contemporary bad plumbing, be it remarked that 75 per cent, of all the 
new plans sent to the board of health for approval are returned to the 
architects or builders for correction or revision before they are accepted 
and permits issued. When we reflect that the requirements of the board 
are necessarily less stringent and detailed than those of sanitary engineers 
in private practice, we are forced to conclude that many architects are 
either deficient in their knowledge of correct plumbing practice and ill- 
informed as to what has been tried and found defective, or are indifferent 
to this important subject of their profession. The excellent work of a 
limited and competent minority perhaps only emphasizes the generaliza- 
tion. One of the best known members of the Guild, when confronted 
with defects in drains in one of his recent dwellings, remarked with sur- 
prised candor, '* But I don't know anything about plumbing," and a sub- 
sequent examination' of one of his beautiful houses brought convincing 
evidence that he had spoken the truth. 

Without attempting at this time to outline the principles which should 



192 DEFECTIVE PLUMBING IN NEW YORK CITY. 

govern in good plumbing practice, it is desirable to note that much of 
the cast-iron drain-pipe sold in the market is quite unfit for the use to 
which it is put. The grade of pipe known as " standard pipe," largely 
used in general work outside of the city, is too scant in metal to be se- 
cure. Tested in lengths of five feet, by filling the pipe with water, as 
many as thirteen sand and blow holes have been developed in the body 
of a single length of pipe, through which the water passed in drops or 
fine streams. The frequently urged argument that these holes will rust 
• up is no excuse for the continued use of the pipe, and the city health 
board has long since prohibited its use. Lines of this pipe, passed by 
the plumber as completed and secure, have shown under water test, with 
but six feet head, that not one* joint was sound. 

*' Extra heavy " pipe followed the use of "standard pipe," but tests in 
lengths of several thousands of feet have shown that fully 30 per cent, 
of this grade will develop leaks in the body of the pipe. Only " factory 
tested " or otherwise tested pipe of " extra heavy " grade should be used, 
and the quality of the plumber's workmanship should be controlled and 
checked by a thorough water pressure or air pressure test, extending over 
the entire system of drain and back ventilation-pipes after the work is 
completed. The board of health now require this test, and vertical 
columns over 185 feet high have been successfully subjected to the water 
pressure test without damage to the work. The importance of this final 
trial will be apparent when it is noted that in an ordinary dwelling there 
are from fifty to one hundred caulked joints which may be defective, and 
in large buildings the number of joints is not infrequently several hun- 
dred. In the New York World building twenty-six columns, measuring^ 
with laterals, about a mile of pipe, were successfully tested at a single test. 

There are two important points in the general design of plumbing 
work which are so frequently overlooked that special attention should be 
drawn to them. The first is the necessity of making vertical columns 
as far as possible free from offsets and bends, and providing them with 
a firm support at the base alone, pipe- hooks being used for alignment 
only. The columns are thus rendered in a measure independent of the 
shrinkage and settlement of the building, which not infrequently causes 
the opening of joints ; cases are on record where hidden pipes have been 
pulled apart several inches by unequal settlement in walls and floors. 
If bends are unavoidable, care should be taken to avoid sharp elbows 
or turns in all pipes serving as ventilation-pipes for the drains, through 
which there is no flow or wash from fixtures or other sources. It may 
not be generally known, that the rust scale which forms in soil, waste, and 
ventilation-pipes, free from the wash of fixtures, drops into the pipes 
and accumulates in considerable quantities at bends lower down. An 
offset of two-inch pipe has been found completely choked for several 
inches with the rust which fell from ten feet of pipe above it. It was, of 
course, useless as a vent for the traps below, and had probably been so 
for several years. 

Without departing further from the expressed intent of the present 



DEFECTIVE PLUMBING IN NEW YORK CITY. I93 

paper, to offer the selected records of tests and examinations covering 
about fifty typical buildings in and about the city of New York, the 
following statement is submitted : 

The values of properties given are approximate only, being in general 
based on the assessed valuation. It is of interest to note that their ag- 
gregate value amounts to $5,453,000. 

It may be further observed that the record includes the dwellings and 
business places of lawyers, doctors, ministers, heads of educational in- 
stitutions, merchants, bankers, and public officials, — representing in all a 
broad range of the intellectual classes in the community. 

1. Country residence of a banker, value $60,000. A " masons' trap" 
drain in the cellar connected directly with the house drain, leading to a 
leaching cesspool. The overflow from the cistern led directly into the 
house drain. In times of continuous heavy rains the cellar was flooded 
with back flow from the cesspool. This occurred about once a year, and 
was thought to be due to sub- soil water. 

2. City dwelling of banker, down town, just off Fifth avenue, value 
$36,000. Main drain of '' standard pipe " newly laid, and pronounced 
finished by plumber ; tested with light water pressure of six feet head, 
leaked in streams at every joint. The drain was under basement floor, 
and was to be buried in the ground. 

3. City private hotel, up town. West Side, renovated just before test, 
value $60,000. Several bad joint leaks in vertical column in bath-rooms 
on bed-room floors. Leak at bed-room hand basin. Leak in dining-room. 
Two untrapped area drains. Exhaust drip from steam pump and engine 
directly into house drain. One or two cases of diphtheritic throats, more 
or less severe. 

4. Country residence of retired merchant, value $40,000. Bad leak at 
W. C. floor joint in bath-room, adjoining bed-room, and at same point in 
guests' bath-room. Basin trap in first bath-room, siphons. No house 
traps, or vent on main drain. House drain discharges into tide water. 

5. City dwelling, Lexington avenue, value $23,000. Plumbing, gen- 
erally bad, taken out and entirely removed. Ventilation register in party 
wall of ladies' bed-room communicated — through defective vent flue — 
directly with ventilation register of bath-room in adjoining house. 

6. City dwelling, Madison avenue, doctor's residence, value $65,000. 
Plumbing had been remodelled a year or more before test. An open 
end of a four-inch drain was found in the scullery under the dining-room. 
The scullery floor of flags had formerly been an open area with an area 
drain for rain water. An extension for the dining-room had been built 
over this, and the drain left without provision for supplying water to the 
trap, which had evaporated and left a free passage for the drain air. 
There was also a hole in a lead basin waste, in a dressing-room off the 
owner's bed-room, made by a nail driven through the lead pipe by the 
carpenters in putting down the floor. A child had died of diphtheria a 
short time before the test. 

7. Mid-city dwelling, just off Fifth avenue, value $35,000. Bad leak 



194 DEFECTIVE PLUMBING IN NEW YORK CITY. 

at floor joint in servants' closet, with free passage from this point to but- 
ler's pantry and dining-room above. 

8. Mid-city dwelling, on East Side, value $18,000. Bad leak in 
earthen-ware drain under cellar floor; untrapped back cellar drain. 
Untrapped servants' closet in basement. Defective joint in soil-pipe. 

9. Lexington avenue dwelling, value $20,000. Bad leak at servants' 
closet in basement. An untrapped rain-leader. The occupant, a doctor, 
had died from typhoid or malarial fever six months previous to test. 

10. Mid-city dwelling. West Side, value $18,000. Leak in laundry 
tub waste in basement kitchen, free passage around pipe to dining-room 
above. Within the preceding year there had been scarlet-fever, gastritis 
tonsilitis, and two cases of typhoid fever, one malignant and fatal. 
Plumbing had been tested and renovated six months prior to test. 

11. Home for children in country, value $10,000. Disused cistern 
under kitchen porch foul from discharge from defective drain receiving 
kitchen waste. An open joint in the soil-pipe, under first floor, in closet 
ofl* dining-room. Cellar generally damp and wet, and flooded at times. 
Several cases of diphtheria among the children during preceding year. 

12. Small country dwelling, value $5,000. Cellar wet and frequently 
flooded. Cesspool near house, with direct cistern overflow into house 
drain. Well twenty feet from cesspool, and thirty-five feet from yard 
privy. Family had suflTered from malarial fever. 

13. City oflSce building, down town, two blocks from Wall street, 
value $80,000. Main drain through restaurant in basement. Two 
cement joints in drain untrapped ; tin drip-pipe direct from drain to ice- 
box. Open two-inch joint. Restaurant flooded once or twice a year by 
high tides backing through floor drain to sewer. Restaurant ventilated 
through air shaft to roof, communicating with all floors above. Strong 
odors from restaurant perceptible in all floors above. 

14. Mid-city dwelling. East Side, value $25,000. Old earthen-ware 
drain buried under cellar floor led directly under furnace, and communi- 
cated with its air-chamber. Defective joints under furnace. Smoke 
blown into soil-pipe at roof came out at every furnace register in the 
house. 

15. Country dwelling, value $80,000. Defective joints in soil-pipe. 
One joint for about one inch had no lead whatever. 

16. Suburban dwelling, value $19,000. Defective joints in drain-pipe 
under basement floor. 

17. City dwelling of merchant up town. West Side, new district, 
value $40,000. Built about 1885. Defective joints in waste-pipe, back 
of furring between bed-rooms. Hole in lead basin waste between bed- 
rooms, made by nail driven into pipe by joiners in finishing. A two- 
inch trap ventilation-pipe between bed-rooms, left quite open by mistake 
of plumbers, and afterwards covered with joiner work. A waste-pipe 
led through air-chamber of furnace, but the joints were sound. 

18. City dwelling of banker, on Murray Hill, value $40,000. The 
preceding year $2,000 had been spent in remodelling the plumbing. 



DEFECTIVE PLUMBING IN NEW YORK CITY, 195 

Smoke blown into soil-pipe at roof came out at every furnace register in 
the house, also at soil-pipe of adjoining house. Main drain was found 
to connect through party wall with drain of adjoining house. Cellar 
party wall formed one side of air-chamber of furnace ; defects in masonry 
of basement party wall allowed free passage of drain air from defective 
drain in adjoining house into air-chamber of furnace in house under test. 
Whenever furnace was in use, it was probably drawing part of its air- 
supply from the adjoining defective drain. Children were sick with 
diphtheritic throats. 

19. Country residence of city banker, value $50,000. Defective floor 
joint in bath-room adjoining bed-room. Defective vent coupling in guests' 
bath-room. Defective joint in waste on first floor. Dead end of drain 
under basement floor imperfectly stopped with brick and cement. Sev- 
eral defective joints in drain under basement kitchen floor. Smoke blown 
into main soil-pipe at roof came out in basement hall, in basement kitchen, 
in butler's pantry, in front hall closet, guests' bath-room and bath-room 
adjoining owner's room. Serious case of typhoid fever in the house. 

20. Mid-city dwelling, West Side, value $45,000^ Smoke blown into 
main soil-pipe at roof came out at every hot-air register in the house. 
An old earthen-ware drain with defective joints led under air-chamber of 
furnace. A severe and tenacious case of diphtheritic throat in the house. 
Furnace doubtless drew part of its air-supply from the drain. 

21. Mid-city dwelling just off Fifth avenue, value $30,000. Trap 
ventilation-pipe choked. Leak at servants' closet in basement. 

22. Sixth avenue tenement and store, value $28,000. Broken drain 
in rear basement. 

23. Down town dwelling. West Side, just off* Fifth avenue, value 
$35,000. No trap on main drain. No traps on front and rear rain- 
leaders. No trap on back yard drain, within few feet of which was lo- 
cated cold-air supply to a furnace. 

24. City church, school, and home, value $150,000. Earthen-ware 
drain under cellar floor. Defective joint at base of soil-pipe in cellar. 
Defective joint at junction of waste and earthen-ware drain in cellar. No 
trap on main house drain. A dry mason's trap, covered with loose flag, 
gave direct entrance to the cellar of very foul air from the street sewer. 
One or two cases of diphtheria among the children. 

25. Mid-city dwelling just ofTFifth avenue, value $30,000. Untrapped 
back yard drain and rear rain-leader. 

26. Mid-city dwelling of banker, just off' Fifth avenue, value $50,000. 
Defective joints in trap vent-pipe in fourth floor bed-room ; in soil-pipe, 
centre of house, on third floor ; in sink vent on third floor ; in second 
floor bath-room, centre of house ; at hand basin, centre of house between 
bed-rooms. Fresh-air inlet at street choked. 

27. City dwelling, down town, West Side, value $15,000. Defective 
joint in soil-pipe in closet adjoining bed-room. Defective joint in bath- 
room. Soil-pipe trapped at base. 

28. City dwelling, up town. West Side, value $20,000. Defective 



196 DEFECTIVE PLUMBING IN NEW YORK CITY, 

joint at second floor closet. Waste from kitchen sink, buried under 
kitchen floor, was broken. Defective cover on main house trap. Main 
drain, buried under basement floor, was uncovered, and tested with water 
under five feet head. Drain leaked more or less at every joint. Broken 
hub on main drain. 

29. Mid-city dwelling just off* Fifth avenue, value $35,000. Defective 
joint in main drain in cellar. Leak in second floor bath-room. Defective 
joint in basin waste adjoining bed-room. Defective joint at servants' 
closet in basement. Untrapped back yard drain. 

30. Mid-city private boarding-school, near Fifth avenue, value $53,000. 
Defective floor joints in bath-room in centre of house, and hole in lead 
waste. 

31. Country dwelling, rector of parish, value $10,000. Defective 
joint in soil-pipe in kitchen. Leaking and open joint earthen-ware drains 
just outside of house wall. Masonry defective, offering free passage of 
air from drains into kitchen. Defective joint in soil-pipe in bath-room on 
second floor. 

32. City dwelling, Madison avenue, value $30,000. Defective joint in 
fresh-air pipe in cellar vault. Untrapped back yard drain and rain-leader. 
Fresh-air inlet choked. 

33. Mid-city dwelling, west of Fifth avenue, doctor's residence, value 
$38,000. Untrapped back yard drain, opening near cold-air inlet to 
furnace. Defective joints in drain buried under basement floor. 

34. Mid-city dwelling near Fifth avenue, value $15,000. Untrapped 
back yard drain. 

35. Large public building in city, value $150,000. Square brick 
sewer, 207 feet long, covered with open joint flags, in basement under 
corridor. Steam from radiator exhausts into drains. Numerous leaks 
in drains. 

36. Country dwelling, value $10,000. Earthen- ware drain under cellar 
floor. Defective joint at base of soil-pipe in centre. Untrapped rain- 
leader. Butler's sink-trap siphoned by discharge of up-stairs fixture. 

37. Large suburban boarding-school for boys, value $50,000. Un- 
trapped area drain near kitchen door. Untrapped rain-leader opening 
near second floor windows. Open joint in basement drain. Defective 
joint under floor in kitchen pantry. Defective joint in disused laundry 
in basement. Defective joint in drain at base of an elevator shaft com- 
municating with all floors above. Defective joint at base of column of 
soil-pipe. Defective joint in butler's pantry. Defective joint under 
floor in laundry. Defective joint in flrst floor bath-room. There had 
been serious sickness in the school the preceding term. 

38. City dwelling, down town. West Side, value $20,000. Defective 
joint in main drain in cellar. Untrapped back yard drain. Damp cel- 
lar. 

39. City dwelling, Stu3rvesant square, value $25 ,000. Untrapped brick 
house drain buried under cellar floor. Air from street sewer blew back 
into cellar freely through defective covering. 



DEFECTIVE PLUMBING IN NEW YORK CITY. I97 

40. City tenement, down town, on made ground, value $35,000. De- 
fective joints in soil-pipe. Cellar flooded by high tides. 

41. Mid-city dwelling, near Fifth avenue, value $30,000. Defective 
joints in drain in cellar. Untrapped rain-leader. 

42. Mid-city dwelling. East Side, value $26,000. Untrapped rain- 
leader. Hole in lead waste from butler's sink. Untrapped back yard 
drain. Untrapped servants' closet in basement. Defective joint in main 
drain. 

43. City dwelling, Madison avenue, up town, built within five years, 
value $50,000. A two-inch trap ventilation-pipe in butler's pantry had 
been left quite open by oversight of plumbers. Smoke from this leak 
followed pipe boxing to floors above, and escaped freely in nursery and 
adjoining bed-room on second floor. Defective joints on main drain in 
cellar. Defective rain-trap covers in cellar. Fresh-air inlet choked. 
Children in the house sick with diphtheritic throats. 

44. Large public building in city, value $3,000,000. Four open ends 
of pipe where fixtures had been removed. Three rain-leaders used as 
soil-pipes. Many fixtures flushed directly from water-pipes. Defective 
joints in soil- and waste-pipes. It is of interest to note that there are 1 15 
fixtures in the building, and 2,650 feet of drain-pipes, with over 800 
joints. Many complaints from occupants of building. 

45. Public office building in city, value $45,000. Defective joints in 
main drain in cellar. Untrapped overflow from house tank into soil- 
pipe. Untrapped back yard drain. 

46. Suburban dwelling, value $18,000. Cistern overflowed directly 
into house drain without trap. Large unventilated grease-trap close to 
cold-air inlet to furnace. 

47. Children's Home in country, value $6,000. Grease-trap, holding 
forty-one gallons, defective, and leaking into cistern. 

48. City dwelling near Fifth avenue, value $30,000. Defective joint 
in servants' closet on basement floor. Trap ventilation-pipe choked. 

49. Armory of N. Y. National Guards, value $200,000. Defective 
joints in soil-pipe. Basin-trap without seal. 

50. Market building, value $450,000. Three lines of earthen-ware 
drains under basement floor. No trap on main drain. Open joint at 
connection of iron and earthen-ware drain. Open joints in iron drain. 
Cement and putty joints in iron drain. Holes in iron drains closed with 
wooden plugs and cement. Imperfectly connected and broken bell-trap 
drains. Untrapped sheet-iron drip-pipes from ice-boxes connected di- 
rectly with drains. No soil- or waste-pipes ventilated to roof. Waste- 
pipes connected with untrapped rain-leaders with defective joints. 
Plumbing throughout very faulty. 

In conclusion, attention may be drawn to the fact that the records 
given above note only the serious and flagrant defects and leaks disclosed 
by the test. 

No mention has been made of faults in the general arrangement in the 
plumbing, of traps without ventilation, of fixtures in ill ventilated and 



198 DEFECTIVE PLUMBING IN NEW YORK CITY. 

badly lighted positions, of antiquated and condemned forms of fixtures, 
and of other faults of greater or less importance, found in abundance. 

A special effort has been made to avoid an over-critical and exacting 
professional standard. In fact, the proof of the defective condition of 
the work under test has, in general, been so apparent and convincing, that 
the presence of the owner during its application has been alone suffi- 
cient to cause an immediate demand for repair and correction. 



xxvn. 

SULPHURING OR BLEACHING DRIED FRUIT A MISTAKE, 
IF NOT A CRIME. 

By JOEL W. SMITH, M. D., Charles City, Iowa. 

The subject of this paper should command the careful attention of 
consumers of dried fruit, of conscientious fruit dealers, and of all health 
authorities. Fruit is now regarded more as a necessity than as a luxury, 
the want of it being a common cause of ill health. 

As fresh fruit is not always obtainable, various methods for preserving 
it are in use, drying being one of the oldest and best for many fruits. 
Middle-aged people recollect when sun or air drying was the only 
method for market. Then some good housewife discovered that more 
rapid drying by artificial heat, with or without the addition of sugar, was 
a cleaner method, safer against fermentation and decay, retained the 
flavor better, and the fruit was also lighter colored, than when sun or air 
dried. The present evaporators are only an enlargement of the idea of 
such more rapid drying, while canning consists in the exclusion of the 
microdrganic germs of fermentation. 

This is an age of progress, yet experience often shows that not all 
changes are improvements. It is about fifteen years since the sulphuring 
or bleaching of dried fruit began. At first only the uniform light color 
was sought, as in apples, pears, etc., but for some years past nearly all 
the large evaporating establishments have ''sulphured" all kinds of fruits 
and some vegetables, and now much of the California sun-dried fruit for 
market is also treated in the same manner. The light color, especially 
of apples, early attracted unthinking consumers and commercial men, 
thus materially increasing the price of such fruit. That caused the prac- 
tice to spread even to those who disapproved of it. The expense and 
trouble were very slight. Fruit so treated is said to dry more readily, 
consequently all now prefer to do it. 

While the apparent change is only in color, there is a loss of the 
natural fruit flavor, even by the most careful sulphuring. Unfortunately, 
some people do not notice the difference, but careful comparison shows 
it, as is admitted by the manufacturers of such fruit. 

The practice began in California with apricots, as early as 1879. At 
the Twelfth State Fruit Growers' Convention, held in Fresno during 
four days in November, 1889, a paper on "Fruit Drying" was read by J. 
L. Mosher, of San Jose, and in his paper he remarked, — " If fruit be 
picked before ripe and over-sulphured to produce whiteness, it is devoid 
of its true rich taste and flavor, and only requires polishing to make 



2CX) THE SULPHURING OR BLEACHING OF DRIED FRUIT, 

buttons,^* (The italics are his.) In discussing the paper, one gentle- 
man said, — '* I believe sulphuring the fruit is the greatest mistake in the 
"world. I do it, but I believe it is wrrong : the flavor of the fruit is gone 
after it is sulphured." 

This change in quality was the first thing that called the attention of 
the writer's family to what was lacking in the " nice, uniformly colored" 
bleached fruits. 

Later investigations have proved the presence of sulphate of zinc, 
*' white vitriol," in all samples of fruit where zinc-surfaced trays were 
used to hold the sulphured fruit while drying. Interested parties have 
charged the German prohibition of American evaporated apples to rival 
trade opposition, but there is no German fruit to compete with them. The 
real cause was the finding of zinc poison in considerable quantity. A 
good paternal government aims to protect its people. 

The advocates of sulphuring fruit say, — (i) It dries quicker, (2) looks 
better, (3) keeps better, and (4) sells better. Besides, it makes ripe, 
unripe, and poor fruit all look alike ; and if not so good for it, but few 
know it. 

Sulphurous acid is formed by burning sulphur, and is readily absorbed 
by water. It abstracts oxygen from many vegetable substances, and 
thereby bleaches them. It also tends to prevent microscopic organiza- 
tions that cause fermentation. The acid in liquid form is colorless, very 
cheap, and smells like burning sulphur; is antiseptic, a preservative 
fluid for some substances, — sample fruits, etc. Sulphur is often burned 
to disinfect sick-rooms of disease germs, and to kill rats, mice, and ver- 
min, but its use with food is objectionable. Ants and other insects, 
it is said, will not touch sulphured fruit, while they readily attack well 
ripened fruit that is not sulphured. The instinct of insects and animals 
is sometimes better than the practice of human beings. In general, sub- 
stances that repel such creatures are hardly safe for human food. 

The effect on consumption has seemed to be a decided falling off in 
demand among the more intelligent class of people. Retail grocers 
know that many who once used dried fruit extensively say, " Somehow 
we have lost our relish for it," and have almost ceased to use it since 
the craze for sulphuring fruits began. Fruit men say, " The public de- 
mands sulphured fruit, will pay more for it, and we will supply it." 
The public will yet show them that it can get its eyes open. As the 
green and canned fruit interests are the only permanent gainers by the 
sulphuring process, they are interested to have it continued. 

It is not easy to obtain a superior quality of unbleached fruit. In 1889 
several retail grocers who understood the question corresponded with 
parties evaporating apples. The reply was, that " if an order for not 
less than twenty barrels was received at one time, apples would be fur- 
nished unbleached, otherwise not." 

The slightly yellowish-brown color of unbleached dried fruit is an 
evidence of ripeness, good quality, and proper drying. The more rapid 
the drying the lighter will be the color, and the fruit will keep well if 



THE SULPHURING OR BLEACHING OF DRIED FRUIT, 20I 

at once properly excluded from the air. When sulphured, the good, the 
poor, and the unripe all look alike. Not so with the unbleached. No 
poor nor unripe fruit can make good dried fruit. The gain of sulphur- 
ing is always with the dealer, and not with the consumer. 

In preferring looks to quality, the people are often at fault. Public en- 
lightenment will correct most dietetic errors. Good health is now sought 
by many, and will be by more in the near future, through correct living, 
rather than by the swallowing of drugs. And in that more excellent 
way, ^^in the good time coming," there will be no demand for sulphured 
and other drugged fruit among intelligent people. 

There is danger from frxiit in metal cans, as is well known, and fresh 
frnit is frequently unobtainable, while both are often more expensive 
than dried fruits. Good unsophisticated dried fruits are always harm- 
less. If green fruits are at times unobtainable, canned fruits dangerous, 
and a popular craze has rendered dried fruits also dangerous, what can 
the suftering public do? It is between the alternatives of using no fruit, 
or that which is injured or poisonous. Is the sulphuring of fruit a mis- 
take, or a crime ? 

To correct the error, enlighten the people and prohibit injurious 
practices. Legal suasion only will stop it at present. The common 
schools in many states are required to teach the eftects of alcohol and 
narcotics. Why not also include the eftects of different foods? 



XXVUl. 

THE SANITARY ADVANTAGES OF THE TURKISH BATH 
TO THE INDIVIDUAL. 

By CHARLES H. SHEPARD, M. D.. Brooklyn, N. Y. 

It may be conceded that he who would reform the world should begin 
by reforming himself. Even to those who recognize that the end and aim 
of all our efforts is the greatest good to the greatest number, the pivotal 
fact remains that it is more important for the individual to be in har- 
mony with himself than that he should seek for harmony with his sur- 
roundings. 

To the patient, self-sacrificing labors of the few who have given years 
of time and thought to sanitary science that the earth might be sweeter 
to live in, the world owes a debt of gratitude it can hardly repay. It is 
the purpose of this paper to add a grain of truth to the many facts 
already collected, by calling attention to the virtues of heat as a sani- 
tary agency, and to give some interesting and valuable data as to the 
most convenient and beneficial manner of using it, which is by the 
Turkish bath. 

It has been said that what is essentially good is always so ancient that 
its origin is a mystery. The earliest written history, and even the most 
remote tradition, give evidence of the use of the hot bath. When the 
Roman legions overran northern Europe, they carried with them per- 
fect facilities for the bath ; and ruins of large establishments erected by 
them for that purpose are still standing in different parts of England, 
France, and Germany. These baths served their armies instead of hospi- 
tals, of which they had none, and there is no doubt that much of their 
physical superiority was due to the frequent use of the bath. They cul- 
minated during what is called the Augustan period of the empire, when 
the emperors, sparing neither expense nor trouble, built baths that 
would accommodate several thousand bathers at one time, and drew 
upon science and art alike to contribute to their perfection and adorn- 
ment. They were the resort of the learned and the noble, as well as of 
the middle and lower classes. In fact, the Thermse, or hot-air baths, 
were at all times, but particularly on holidays and festivals, the theatre, 
lyceum, gymnasium, newspaper, and places of general assembly. 

About thirty-three years ago, an enthusiastic Englishman, David 
Urquhart by name, who had been an accredited representative of his 
own government at the court of Constantinople, called the attention of 
his countrymen to the practice of the bath then in vogue among the 
people of Turkey. Mr. Urquhart's attention was called to this powerful 



SANITARY ADVANTAGES OF THE TURKISH BATH 203 

agent by a sun-stroke when he was not within reach of medical aid, 
and obliged therefore to take the treatment into his own hands. The 
idea occurred to him that if he could be made to perspire he might be 
saved. Accordingly he raised the temperature of an ordinary Turkish 
bath to a very high degree, and remained in it for six hours. At this 
point the constriction of the skin was relaxed, perspiration flowed, and 
his recovery was complete. As a consequence of this incident, the en- 
tire system of hot-air baths as applied to disease was introduced into 
Great Britain. Twenty-seven years ago it was introduced into the 
United States, at Brooklyn, N. Y. 

Time would fail to enumerate all the advantages of this bath, but a 
few prominent facts may be mentioned, that show its supreme import- 
ance to the individual. 

It brings about a perfect condition of external cleanliness. There 
is no other way in which such complete purity of the body can be ob- 
tained, and not only is the outside completely cleansed, but the blood 
itself is thoroughly purified. The action of heat — ^which is, as has been 
stated, the one essential feature of the Turkish bath — relaxes the tissues 
of the body, and quickens and equalizes the circulation, which neces- 
sarily becomes thereby perfectly oxygenated. It arouses the most remote 
capillaries of the dormant parts to their normal action, and carries the 
newly vitalized blood to every section of the body. Each sense is quick- 
ened, the secretions are increased, the excretions are rendered complete ; 
and, in short, each function of the body, including those of the lungs, 
liver, kidneys, and bowels, is brought up to the highest standard. The 
skin is made more active as a breathing organ, and assumes its natural 
roseate complexion, indicative of the generally improved condition. In 
fact, this bath opens every pore of the skin, and hence comes a perfect 
sewage of the body. So intimate is the relation of one function to an- 
other, that according to the perfect performance of each part, so is the 
healthy existence of the whole. All the functions are interdependent. 
If one part of the body is injured, the whole suffers, nor can we benefit 
one part without favorably affecting every other part. 

Wherever there is disease there is impure blood, nor can we cure the 
malady unless we remove the cause. It has been found that an inability 
to perspire is coincident with many diseases; consequently when we 
bring about perspiration by external heat we overcome the disease. 

It will readily be seen that the skin is the most important organ of 
the body, as well as the largest. In fact, it envelops all others, and 
every part of its surface is intertwined with a ramification of minute 
blood-vessels and still more minute nerve fibres. These, when health 
is present, act like sweet bells in unison, but in disease are jangled and 
out of tune. Small wonder is it that when this important organ is im- 
mersed in^hot air noxious matters are quickly destroyed, for every parti- 
cle of the blood must gradually pass through its complex organization, 
and then elimination produces purity and harmony. Thus the power 
of life is transferred to the skin, and one may walk unharmed even 



204 SANITARY ADVANTAGES OF THE TURKISH BATH 

through pestilence. Inasmuch as the health, whether good or bad, is 
clearly shown through this wonderful organ, the subject appeals with re- 
sistless force to the gentler portion of the community, whose satisfaction 
and happiness in life seem greatly to depend on what is called a good 
complexion, and for which all are willing to make many sacrifices. 
Being too much confined to an in-door life, they are consequently subject 
to many neurasthenic conditions which the frequent use of this bath 
would correct. 

The cutaneous exhalation is computed at thirty ounces per day, or 
about twice the average quantity of matter breathed out during the same 
time by the lungs. This renders the skin the most important theatre of 
substantial change. The perspiration, which is of use up to the moment 
of its ejection, is a natural cosmetic. The use of pomades and perfumes 
comes from an instinct to make ourselves more agreeable to one another, 
but the perfume from a healthy, active skin, covering a pure body, in- 
finitely transcends any artificial cosmetic, and makes even the touch elec- 
tric. Through this comes our power with others, and constitutes our 
atmosphere. ^^The redolence of health is like fresh morning air." 

It is of vital importance to the well-being of mankind that the great 
established laws of physiology should be understood and implicitly 
obeyed. The laws of Nature are inexorable ; as they have acted hereto- 
fore, so will they act again under similar circumstances. Pure, healthy 
blood can be produced only by the healthy and harmonious action of all 
the functions concerned in its formation. Pure, healthy bile can be pro- 
duced only by the healthy action of the liver, and so on through all the 
functions of the body. Every structure of the living body is constantly 
undergoing decay and renovation. According to our traditional physi- 
ology, an entire change of material and condition is completed once in 
seven years. With an active course of Turkish baths, this change 
would be brought about much more rapidly. These changes are 
largely dependent on the supply of food, air, and sleep. 

There is a restorative tendency in all mankind, called vitality, or vis 
tnedicatrix naturce^ and it is the part of good sense to cultivate and 
conserve that power. If we oveitax our brain or physical strength, the 
first notice of it will be through the nutritive functions ; and if we over- 
tax the nutritive functions by excessive alimentation, we very soon have 
derangement of the brain and the physical strength. The action and 
reaction are most intimate. 

There is little doubt that intemperance in eating, among the more 
favored classes of society, does more harm every day than intemperance 
in drinking. The most important part of man's vital economy is his 
stomach. It has been well said that man would be a god were it not 
for his stomach. Now, as there seems to be small possibility of pre- 
venting man from destroying his health and strength by overeating, the 
bath comes in as the remedy. It not only helps to regulate the appetite, 
but it removes the excess, which, if allowed to remain, would overload 
the system, producing loss of rest, sleeplessness, and incapacity. 



SANITARY ADVANTAGES OF THE TURKISH BATH 20$ 

The sanitary well-being of the least important individual is of vital 
consequence to every member of the community, as is quickly seen when 
one is stricken down by a contagious disease. A neglect of this duty 
sometimes brings terrible results. For this reason personal habits 
rise into an importance that would not otherwise be recognized. If we 
can so popularize the Turkish bath as to bring it within the reach of all^ 
it will be the means of preventing an immense amount of sickness and 
suffering, not to mention the saving of time and money consequent 
thereon. No one thing could do so much to promote temperance and 
sobriety, were it encouraged as a habit ; for if this were made general, 
restraints would be imposed upon individual excesses by the sense of 
self-respect thereby engendered. Whatever conduces to make people 
clean and temperate diminishes disease and crime, and their penalties. 

A little economy in fuel, which is now so extravagantly used and 
much of it wasted, would suffice to furnish the heat requisite for purposes 
of health and cleanliness to all the community. This comes under the 
head of social economics, and commends itself to our profound attention 
by its intimate connection with our own well-being, and commands our 
respect by the charm which purity throws over intercourse with others. 

The working classes among the Turks know of no means of preven- 
tion or cure but the bath. It is looked upon in the light of a panacea, 
and this conviction accounts in a great measure for the total absence of 
dispensaries and civil hospitals among them, and instances of extraordi- 
nary longevity are common. It is a fact that the Turks have been able 
to move an army with less loss of men than any civilized nation. At one 
time, at an encampment in the neighborhood of Homburg, consisting of 
about I, coo men, in the midst of a hostile country, they had no less than 
two baths, sufficient to accommodate about forty-five persons at one time, 
thus providing for bathing each soldier in the garrison daily. With the 
English army, which is considered to be in the best possible condition, 
the Duke of Wellington reckoned that ten per cent, was to be deducted 
from the effective force on account of sickness. Cases of illness in the 
Ottoman armies are rare, and of deaths therefrom even more so. During 
the Civil War in our own country, it was found that there was a greater 
loss in the hospitals than by the bullets of the enemy. 

Whenever any epidemic, — la grippe^ for instance, — passes through 
the land, all who are in the habit of using the Turkish bath once a week, 
or more frequently, are but little liable to any danger therefrom ; and, as 
is rarely the case, should a bather be overtaken by a prevailing disease, 
the chances for a quick recovery are much enhanced by the previous 
bath sanitation. Moreover, in case of any physical injury the excellent 
condition of the whole system enhances the chances of a speedy recovery. 

Every poor-house, hospital, insane asylum, penitentiary, and all insti- 
tutions where numbers of people are gathered together, should be sup- 
plied with a well equipped Turkish bath. Indeed, it has been for some 
time in use at the reformatory at Elmira, N. Y., with remarkably good 
results, as attested by the resident physician, Dr. H. D. Wey. 



206 SANITARY ADVANTAGES OF THE TURKISH BATH 

Sir John Fife, senior surgeon to a large infirmary at Newcastle, Eng- 
land, states as the result of his experience that in diseases of the skin, 
joints, liver, and kidneys the action of the Turkish bath is immediate 
and direct. 

Dr. Erasmus Wilson, whose name is of world-wide reputation, says, — 
^' I thought I knew as much about baths as most men. I knew the hot, 
the warm, the tepid, and the cold ; the vapor, the air, the medicated, 
and the mud bath ; the natural and the artificial ; the showef , the needle, 
the douche, and the wave bath ; the fresh-river bath and salt-sea bath, 
and many more beside. I knew their slender virtues and their stout 
fallacies : they had my regard but not my confidence, and I was not 
disposed to yield easily to any reputed advantages that might be repre- 
sented to me in favor of baths. But I discovered that there was one 
bath that deserved to be set apart from the rest — that deserved, in- 
deed, a careful study and investigation. The bath that cleanseth the 
inward as well as the outward man ; that is applicable to every age ; 
that is adapted to make the healthy healthier, and to alleviate dis- 
ease, whatever its age or severity, — deserves to be regarded as a na- 
tional institution, and merits the advocacy of all men, and particularly 
of medical men, whose special duty it is to teach how health may 
be preserved, how disease may be averted. My own advocacy of 
the bath is directed mainly to its adoption as a social custom, as a 
cleanly habit ; and on this ground I would press it upon the attention of 
every thinking man. But if, besides bestowing physical purity and 
enjoyment, it tends to preserve health, to prevent disease, and even to 
cure disease, the votary of the bath will receive a double reward." 

Such testimony is conclusive as to the value to the human economy of 
heat, which is the first and most important power in nature. By its 
means we operate in the laboratory ; it is the means by which all culinary 
operations are carried on, all mechanical arts subsist ; the earth gives her 
products, and, in a word, the whole mechanism of the universe is put in 
motion. Heat being one of the best disinfectants, it naturally follows 
that hot air, as we find it in the Turkish bath, is an active agent in 
destroying disease germs ; and so it has proved in thousands of cases, 
notably those of an inflammatory character, and also in rheumatic and 
malarial diseases. All animal poison is quickly destroyed at a tempera- 
ture of 1 60® Fahrenheit. Dr. Watson says that the plague does not 
spread when the temperature is below sixty or above ninety degrees. 
Vaccine matter loses its property of producing the cow-pox, if it is exposed 
for a certain time to extreme cold or to a heat of ninety-five degrees. It 
has been ascertained that steam effectually destroys fresh tubercular 
sputa in fifteen minutes, and the virtue of steam lies in the heat which 
it contained. Typhus fever, measles, and scarlet-fever are said to be of 
rare occurrence in the inter-tropical regions, evidently for the reason 
that germination and fermentation are destroyed by a high temperature 
as they are by a very low one. The tolerance of the human body for 
heat, as well as the absurdity of the idea that hot air is in any way dan- 



SANITARY ADVANTAGES OF THE TURKISH BATH 207 

gerous or even injurious, is amply shown by a multitude of facts. The 
shampooers in the Turkish baths often live to an advanced age ; they 
spend a great part of their lives in the hot chambers ; they are subject to 
great perspiration, but they are neither weakened, diseased, nor ren- 
dered prematurely old by their occupation. On the contrary there is 
invariably an increase of strength and endurance. Mr. Urquhart relates 
that the best shampooing he ever received was by a man ninety years 
old, who had worked in the bath ever since he was eight years of age. 
The power to bear solar heat and preserve the constitution of man 
may be inferred from the immense population of tropical countries. 

According to Prof. Angus Smith, it has been found that the natives 
who work the rice swamps of China, and who drink freely of water and 
sweat profusely, thereby escape the prevalent miasmatic diseases. This 
may be considered an indication of the benefit of heat as a preventive 
of disease. Again : The negroes of the Southern states who live and 
work in the most pestiferous regions of that section may often be seen 
literally broiling in the sun, apparently enjoying the situation ; and there 
is no doubt that the immunity they have from disease is due to their life 
in the hot air, and the continuous sweating consequent thereon. 

The advance in sanitary science has already added years to the lives of 
many and extended the general average, and undoubtedly it will yet lead 
us to a higher plane of life, where we will not attempt to cure one filth- 
disease by introducing into the system another filth condition, even 
though it may be less virulent The idea that a few generations of 
purified life would lead to a higher plane of health is not a mere dream. 
It is a reality to the sanitary reformer, and pregnant with great blessings. 
It should be understood by all that disease comes only by invitation, and 
that the price of good health is constant vigilance. 

It is the harmonious action of all our functions that constitutes health, 
and contributes to the preservation of the race. Disobedience of any 
of these laws is certain to bring what we call disease. It is computed by 
Sir Lyon Playfair, that in England alone there are one hundred and 
twenty-five thousand deaths annually from preventable causes. With an 
ordinarily good constitution, temperate habits, and a Turkish bath once a 
week, man should live to an hundred years and more. 

The habits of society are such that it is almost impossible for any one 
to lead a perfectly physiological life ; but the use of the Turkish bath, and 
the promulgation of the laws of health, will hasten to usher in the day 
when people will live more in conformity with the laws of their own 
well-being. 

Our aim is to make the use of the Turkish bath a habit of the people, 
as it is one that will operate for the removal of all functional disorders. 
This habit, by rendering us more cleanly, will give us greater strength of 
muscle, greater power of digestion, greater immunity from the ills that 
flesh is heir to, greater facilities in recovering health, a longer term of 
life, greater contentment, more equanimity of mind, less desire for 
foreign stimulants, whether physical or mental ; and these will bring 



208 SANITARY ADVANTAGES OF THE TURKISH BATH 

a larger share of self-respect, and diminish those causes of disrespect to 
which we may be exposed from others. To those who desire to give 
their children a clean and wholesome inheritance, the subject is fraught 
with large importance, for few would relish the idea that from their 
faults their grandchildren are to be miserable and sickly. On the con- 
trary, they ordinarrly wish to give them every advantage, and none can 
be more valuable than that of a healthy, vigorous constitution. The 
use of the Turkish bath is a most satisfactory method of developing a 
sound and healthy body, and will be a great help to bring about a more 
reasonable manner of living. If prevention is better than cure, then the 
foundation of a Turkish bath is a greater blessing than the erection 
of a hospital. 

Our people have been too long at the mercy of unscrupulous empirics. 
Let us prove these things in ourselves, and then help to enlighten the- 
public mind. Increased knowledge and opportunities also increase our 
responsibilities. It is our duty to lead, and this is certainly much 
pleasanter than to be pushed, even into the right path. In fact, it is 
much better that this matter should be taken up by those who are striv- 
ing to benefit their fellow-men, rather than that it should be left to those 
bent on simply filling their own pockets. Any harmless agent that will 
do something effectual toward redeeming the race from the thraldom of 
pernicious drugs, even if it do nothing more, is a priceless boon. As 
a matter of personal pleasure, experience shows that there is no greater 
physical luxury. The invigorating tonic effect of the Turkish bath is 
very noticeable to the ordinary bather. With some, this delicious sense 
of refreshment and delight lasts for hours after the bath. This is from 
the free play, as it were, of the machinery of life, — as though oil had 
been poured on the bearings. 

The objections to the Turkish bath arise from prejudice or positive 
ignorance. We have yet to learn of any injury said to have come from 
the use of the bath, that was' not referable to some other cause or to 
a gross misuse of the bath. 

Out of an experience of nearly thirty years we can assert that the 
work accomplished by the Turkish bath in the realm of remedial action 
exceeds that of any other one agency. 

In conclusion, the Turkish bath is the sum of sanitary science to the 
individual. Not that it is to become a panacea for all physical ailments^ 
but a necessary part of sanitary discipline. No agent can do more in 
rescuing mankind from preventable disease and untimely death. This 
constitutes the crowning glory of the Turkish bath. 



XXIX. 

UNDERGROUND WATERS AS SOURCES OF PUBLIC 
WATER-SUPPLIES IN ONTARIO. 

By peter H. BRYCE. M. A., M. D., 
Secretary Provincial Board of Health, Toronto, Ontario. 

When we observe the remarkable situation of Old Canada, but 
notably of Ontario, in its relations to the bodies of fresh water consti- 
tuting the Great Lakes, and note the configuration of the surface of the 
country contributing to the supply of these great lakes, we are naturally 
surprised to see that at some point or other the whole of these immense 
water-sheds contribute their drainage to some one or other of these great 
lakes as completely as if Ontario were an island and the great lakes the 
surrounding ocean. Remembering, too, the comparatively small dis- 
tance north and south that the various water-sheds of the great lakes 
occupy from the points at which their waters are delivered into some 
particular lake reservoir, we are surprised to see how comparatively 
short is the course of each river, even that of the longest, the Ottawa. 
There result from these conditions two remarkable phenomena, without, 
I think, any parallel on the face of the globe. The first of these is the 
unusual exposure of the sources of these streams to the effects due to 
the destruction of their protective forests. Already, as will be noticed, 
all the protection is gone from the head waters of the rivers of western 
Ontario. Follow them along, starting with the Lake Simcoe and Severn 
supply, and note them till we have reached the Humber and Rouge. 
Where are the Nottawasaga, the Sydenham, the Maitland, the Saugeen, 
the Thames, the Irvine and Grand, and the many creeks, as Stony creek, 
Twenty-mile creek, etc., flowing into Lake Ontario from the Niagara 
escarpment? Even in the brief history of fifty years since settlement 
properly began, many of them remain as little more than memories, 
save when the sudden floods of some autumnal storm fill them almost 
as suddenly as does a storm among the rocky scaurs of the mountains of 
Scotland. But note again the water-shed, starting at the upper Ottawa 
and following along the undulating table-land — for it is nothing more — of 
the Laurentides, to where the waters run toward Lake Nipissing and 
the Georgian Bay, then skirting along the line of the C. P. R. till Port 
Arthur is reached, and it will be noticed how really short are the courses 
of the streams flowing into Lake Superior or the Georgian Bay. To 
many who have been on exploring or surveying parties in these northern 
wilds, it may appear that whatever may have happened in western 



2IO UNDERGROUND WATERS, 

Ontario cannot happen in the case of this rocky district ; but we have 
only to listen to the warnings given by those who have studied the sub- 
ject — such as Mr. W. Little, of Montreal, and other members of the 
American Forestry Association — to realize how the same process of 
destruction is going on at a rate in this region incomparably more rapid 
than that which went on in central Ontario. Already we learn from 
lumbermen that the great pine limits of this area are enormously reduced, 
while personal observation^, made in various portions of the region, too 
surely indicate that deforesting by vandal acts and fires is rapidly 
denuding these areas of natural protection to the sources of our Great 
Lakes. 

The second remarkable phenomenon is, that the natural basins into 
which these numerous water-sheds pour their waters constitute so many 
basins which, narrowed at their outiets, serve to maintain an equilibrium 
of waters in proportion to the shallowness of their outlets, and to the 
evaporation which takes place from their surface. The preservation of 
these waters is remarkable in both these respects. For instance, the 
outlet of Lake Superior is a comparatively small stream discharging but 
little more than some of the tributaries of the lake, while the tempera- 
ture of the lake is relatively so low and its depth so great, that the rela- 
tive evaporation from its surface during the short season of summer 
must be infinitely less, proportionately, than from shallow, smaller reser- 
voirs, whose surface would be in proportion much greater were the 
volume of water the same. To illustrate the manner in which the low 
temperature of these lakes is maintained, it may be mentioned that the 
greatest depth of Lake Superior is given as 895 feet, and that of Huron 
1 ,000 feet. Now it will be apparent to all, that apart from the con- 
sideration of the supply to these lakes from the rain falling on their 
surfaces, it will be a very important factor in the maintenance of their 
levels to inquire whether the waters flowing into them have been, or are 
likely to be, so altered in their annual amounts as to create notable 
differences in their levels, — assuming, as seems to have been proven by 
calculations made of the rain-fall registered at the Toronto observatory 
during a period extending over forty years, that the annual precipitation 
of moisture does not greatly vary over a series of years. It might, at 
first sight, appear that the lake levels are not likely to be altered, but a 
closer inquiry reveals the fact that a decrease in lake levels, at some 
points at any rate, has actually taken place. I was recently informed by 
a close observer, that the fall at Kincardine on Lake Huron at some sea- 
sons of the year is at least four feet. That this should take place at 
certain seasons of the year seems inevitable, if we consider some of the 
facts in regard to the decrease in the volume of water observed in the 
streams of some of the older portions of the province. Thus, at the 
time I made a study of the rain-fall of semi-decades from 1840 to 1845, 
to 1870 to 1875, 1 found great variations in the rain-fall of the later spring 
and summer months to have taken place. Thus March has remained 
the same, while in April I found a decrease of not more than half an 



UNDERGROUND WATERS, 211 

inch; a decrease that increases with each month until September. 
Thus, — 

April, May, June. July, Aug., Sept. 

184(^44 48.55 inches. 68.x 01 inches. 

1850-54 40-195 " 48625 " 

1860^4 32.742 « 45.6x7 " 

1870-74 34-670 « 35-«4 " 

Or take May, and we have, — 

1840-44 15015 " 

1850-54 X3.675 " 

1860^ 14.055 " 

187074 8.64 " 

When it is remembered that at a lake-side station, such as Toronto, 
such influences as create such striking differences are less than at more 
inland and upland localities, as those of the central plateau and oak 
ridges, we may affirm that their effects at these points whence so many 
of the rivers of the province take their origin, would be at least as great 
as at Toronto. Again : While it might be said that in a region such as 
tlie Laurentides of the Muskoka district, the numerous small lakes act 
as so many reservoirs containing the waters which flow into them from 
innumerable streams, yet if we consider that such an area denuded of its 
forests presents unlimited stretches of bare rock where the virgin soil 
has been destroyed by fire or wasted away by erosion, we can very well 
understand that the spring rains and melting snows are yearly more 
rapidly swept into these basins and thence int9 the great lakes, instead 
of being stored up in the humus and leaf mold of the hill-sides and 
valleys, thereby producing, as yet of course in less degree, the same 
summer losses to the streams which we know have taken place in the 
streams of central and western Ontario. 

Reverting now to the special subject we have propc^ed for discussion, 
we can understand how important is the bearing of these facts, not only 
on the question of underground waters as a source of public water- 
supply, but also upon that other of paramount importance, namely, the 
retention in the soil of such stores of water as are required in the suc- 
cessful prosecution of agriculture. Leaving the latter out of considera- 
tion for the present, it may appear to some that so long as our great 
lakes remain as unlimited reservoirs, there need be no anxiety as to our 
obtaining abundant supplies of water for public purposes. This might 
be true if all our cities, towns, and villages were situated on the shores of 
some one of these great lakes ; but, unfortunately, all are not. But even 
if they were, their growth, and the methods of disposal of their sewage 
at present in vogue, force upon us the disagreeable fact that we have no 
guaranty that these inexhaustible sources of supply will remain unpol- 
luted to the extent of their yielding supplies of water beyond question in 
the matter of purity. Already we have presages of evil. On the river 
St. Qair we have, growing up on both sides, large towns, both taking 
water from and pouring sewage into the same stream. On the Detroit 
river, Windsor is already having cause to doubt the purity of her water- 



212 UNDERGROUND WATERS, 

supply, with Detroit and Walkerville polluting the river above ; and only 
last week the submission of a scheme to the Provincial Board for supply- 
ing Niagara-on-the-Lake with public water from the river, revealed the fact 
that chemical analysis found the water to be second class in the matter 
of purity, and by no means equal to Lake Ontario water at the bell-buoy 
outside Toronto island. Thus : — 

Niagara River at Lake Ontario at 

Niagara-on-the-Lake. beU-buoy. 

In parts In parts 

per million. per million. 

Chlorine 3.00 3.00 

Freesunmonia .04 none 

Albuminoid ammonia .12 0.02 

Oxygen absorbed in 15 min .24 o.x6 

Oxygen absorbed in 4 hrs. ...... .74 a5o8 

Total solids x 33.00 124.00 

Loss on ignition 48.00 

While it might be unfair to charge this pollution of Niagara river 
water wholly to sewage, yet the fact remains that Buffalo, Tonawanda, 
and Niagara Falls towns on both sides of the river are polluting the 
river. Evidently the rapids, tlie falls, and the whirlpool are not all-suf- 
ficient for purifying purposes. What the fate of Toronto water-supply 
will be in case the scheme of a trunk sewer discharging off Victoria 
Park be carried out, remains to be seen. When, however, it is remem- 
bered that our inland towns, situated on streams of yearly diminishing vol- 
ume, may have shortly — and many have already begun — to explore local 
sources for their supply, we must recognize how important becomes this 
question of underground waters for public purposes. While the problem 
of obtaining these waters for drinking purposes is not a new one, since up 
to the present they have been practically the sole source of our supply as 
taken from wells, yet there can be no doubt that the popular belief that 
these wells are due to the happy accident of striking some isolated 
spring prevails very generally. Manifestly, therefore, it is important to 
those of us who have to deal with these problems of public water-sup- 
plies to inquire to what extent we may look to these underground waters 
for a solution of the difficulty of obtaining public water-supplies for at 
least our inland towns. That their volume is enormous may be con- 
cluded from our knowledge that where surfaces consist of leaf mold, 
humus, or sands and gravels, an amount of water, roughly calculated as 
at least equal to that which flows from the surface into the streams and 
rivers, penetrates the soil, and passing downward is either stored up in 
subterranean reservoirs, or flows gradually along the hidden inclined 
strata, appearing here and there again where the strata have been 
denuded, as springs. Indeed, as regards their amount we may say that 
beneath the surface of the gathering-grounds, creating these immense 
reservoirs of our inland lakes, are stored as great quantities of water as 
those in our lakes, less whatever differences evaporation and the rain-falls 
directly upon the latter may make. It is, perhaps, difficult for us at 
once to realize this, but if we consider for a moment the nature of the 



UNDERGROUND WATERS, 213 

springs which we see cropping out on many a hill-side, we may not be 
surprised at the statement. A spring appearing as a small stream and 
flowing at the rate of ten gallons a minute gives a 24-hour flow of 
14,400 gallons. How small a stream this means is best realized when 
we remember that a three-inch tile running full at a dip of one in fifliy 
gives a 24-hour flow of over 90,000 gallons. If we further remember 
that with an annual rain-fall of 30 inches, of which 15 may be said 
to sink into the soil, the amount of water which an acre would yield 
will keep a spring yielding the above daily amount flowing for 25 
successive days, we can understand what it means to have an up- 
land of miles in extent dipping towards some valley eroded trans- 
versely to the strata, and consisting of an impervious clay below and a 
permeable soil of gravel above. It here becomes important that we 
inquire into the conditions upon which the storage of underground 
waters depends generally, but especially into the conditions which pre- 
vail in Ontario. It will be remembered that we have bordering the 
province along the east and north the gneissoid Laurentian rocks, and 
that superimposed on this, and following each other in regular order, 
die series of Silurian and Devonian rocks, mostly of compact limestone 
or calcareous shale, till the river St. Clair is reached. In central 
and western Ontario these have an elevation of over a thousand feet, and 
from this height the strata dip more or less regularly in every direction. 
All evidence goes to show that at the close of the glacial period these 
rocks were covered with a body of fresh water, and that materials from 
their disintegrated surfaces were gradually deposited in a more or less 
quiet inland sea in an order depending upon their character. In the 
shallower waters the heavier materials of boulders and gravels sank to the 
bottom, or were thrown up on the shores, or were deposited on shallow 
beaches, many of which can be seen in the highlands of Wellington, 
Perth, and Huron counties. Mingling with these deposited drift mate- 
rials would of course be certain proportions of clay, and indeed these 
deeper boulder strata, and in these districts highly argillaceous strata in 
the deeper waters were deposited in a state of great regularity and in a 
state of great purity ; but even under these beds of clay are to be found 
in most instances, as throughout Kent, Lambton, and Essex, a thin 
stratum usually of from one to two inches of flne gravel, with almost 
pure sand above it. The latter over some parts of the oil region is black 
in color, and forms the reservoir for water and in some places gas. As 
the waters receded farther, and these so called Erie clays came into 
shallower water, they became overlaid with strata of finer gravels and 
sand in less regular order, similarly as on the uplands intermixed with 
clay in varying proportions, thereby giving us the warmer loams of 
Waterloo, Oxford, Brant, Norfolk, and Elgin, as also in some portions 
bands of the so called Saugeen clay. To the west, north-west, north- 
east, and east of Toronto, running from the Niagara escarpment to the 
gneissoid rock, again we have, according to the height, these same 
strata more or less regularly appearing, while they are not wholly absent 



214 UNDERGROUND WATERS, 

from the surface of the gneiss, although it is mostly in the smaller lake 
basins or river valleys that they can be said to be of any extent. 

I find it a very difficult matter to discuss, in the time allowed by the 
constitution, a subject so broad and so varied in the conditions under 
which its principles become possible of practical application. Geologi- 
cal, meteorological, climatic, and other physical conditions have all to 
be considered, when we discuss this source of a public water-supply in 
its applicability to any locality ; and hence it might not be of any great 
practical utility to dwell at length on these conditions, as existing in 
Ontario, within which my work especially lies, surrounded as it is by 
the great bodies of fresh-water lakes. 

As, however, there are some principles connected with the subject 
which are of universal application, I may be pardoned if I briefly refer 
to these before dealing with the biological portion of our subject, which, 
as sanitarians, we are more especially interested in. 

Inasmuch as the rain-fall of any region in Ontario may for practical 
purposes be considered as averaging a given amount, say 30 inches as 
snow and rain annually, it must become apparent that it will depend 
upon the nature and condition, as also upon the inclination of the sur- 
face strata, what proportion of this rain-fall will sink into the soil to 
become the source of these underground waters that we have been dis- 
cussing. It will further be apparent that the order of arrangement of 
pervious and impervious beds, as well as the thickness of the strata, 
must become essential factors in considering the amount and constancy 
of any underground supply. Thus, to illustrate this we have only to 
refer to the variation in the prevalent depth at which the water of ordi- 
nary wells is obtained in different sections. For instance, in Ontario, in 
the flat country around Chatham and Windsor, shallow wells of ten to 
twelve feet are most common, these being supplied only from the soak- 
age from the black humic loams lying on the top of practically imper- 
vious clays, and becoming dry when the dry season comes on. Further 
east, as around London, Woodstock, etc., abundant waters for house- 
hold purposes are found in sands and gravels lying on the top of the 
clay. Similar variations can be pointed out as occurring in closely con- 
tiguous districts, and nowhere are they better seen than around Toronto. 
While, however, these shallow wells may afford in many instances 
abundant supplies for the purposes for which they are intended, it is 
apparent that inasmuch as the area of their gathering-grounds is very 
limited, their supplies can easily be exhausted. Let the surface be locally 
eroded by a water-course, and we find, especially in the sands and gravels, 
springs cropping out, creating local bogs, etc., and presenting exactly 
the same general conditions as would a spring far down the declivity of a 
deeply eroded valley, except that in the first case a summer drought 
would cause it to dry up, while in the latter the flow of water would 
not be altered by one season's drought.* 

> The celebrated French engineer, Durand Claye, has classified springs into, — First, springs from 
impermeable layers. There is no water4ayer, properly speaking, in soils of this character ; the place 




UNDERGROUND WATERS. 2lS 

The following cuts will serve to illustrate various conditions which 
occur in the deposition of soils and rock material, and upon which we 
may expect to find the abundance of water in any locality dependent :* 

Such soil has great retentiveness, or ^ 
its hygroscopic character is very high, j^0^^^^^p^/#M// 
reaching 75 per cent, of its own vol- 
ume, or may hold three fourths of its 

own volume of water. With imperme- , ^, , ^^S: . , 

,, , - 1.-11-1 • .„ Impermeable clay, Erie clays (Logan), 

able clays formmg hill-sides, ram will "^ ^ / ^ © / 

flow rapidly from surface, but where this clay has a level surface the land 
will be wet whether on high plateau or in river bottom. Into it 

rain will very gradually penetrate. 
Where impermeable clay has a 
locally denuded surface (as in Fig. 
3 at i), forming local depressions 
or basins, vegetable deposits and 
fresh-water plants are largely 
present, creating waters often 
unwholesome as public supplies. In retentive clays, cultivation, deposits 
of litter and leaf- mold, 
straw, roots of trees and 
grasses, and frost all in- 
crease perviousness of sur- 
face to rain and air by 
loosening the soil. 





Fig. 3. 




Leaf mold, while very pervious 

to rain, has at same time great 

Pjq ^ capacity for moisture. A moss has a 

Leaf mold or virgin soil at top of day. small capacity for retaining moisture. 

The amounts in percentage of volume which various leaf litter or 

mold can retain, according to WoUny, are, — 

of springs in thb case is the surface of the country, and as the surface flow carries away the great 
part of the rain-fall, these springs are always very small. Second, springs from layers entirely per- 
meable. Here the absorbed waters descend in continuous or discontinuous layers towards the 
deepest valleys. The springs are found in the humid and even peaty plains which carpet the bottoms 
of these great valleys. We find them at the bottom of bogs, along water-courses, while the less 
deep valleys, the hill-sides, and plateau, remain dry all the season. Springs of this dass are far apart 
and have considerable yidd. This class of springs exists in the soils of this province, but not to the 
same extent as those of France, in the oolitic limestones of Burgundy, the white chalks of Cham- 
pagne, of Normandy, and in tertiary limestones. To this class belong the springs which supply 
Paris, and these are not always perennial. Third, springs from permeable or moderately permeable 
layers, upon impermeable beds. Following the plain of contact of the permeable and impermeable 
layers, there is established a water level on the side of the hill as well as in the bottoms of valleys. 
These springs are generally numerous, and consequently of a small flow. This class is especially 
characteristic of the strata which are superimposed upon the rocks of the Province of Ontario. 
Fourth, artesian springs, or those which flow from an imprisoned water layer between two imper- 
meable strata and flowing forth from a boring or well. 

1 (a) means unpermeable strata ; {p) means upper humus or leaf mold ; {c) means pervious sands 
and gravels ; {d ) means rock strata. 



9i6 



UNDERGROUND WATERS, 



Depth of Litter, 


Oak Leaves. 


Spruce Leaves, 


Two inches 


5a 1 1 percent 


38.98 per cent 


Eight inches 


53-09 " 


41.65 " 



Permeable sands and gravels receive and retain a very large proportion 
of the rain which falls upon them. At the London asylum sev^age farm 
six inches of vsrater from the ;;• .•.•.v^|/. -•.•;,'/.'.'':''•; •.'• .• :..i- j'--;«. 
open ditches will frequently /•'•;'f'^;-^V.'iV\'-v'v^ ^^^ 

WMmi 





more than 15 per cent, of the , , , , 

, • • ^u •! i_ ^ Permeable sands and gravels (overlaying im- 

volume remams m the soil, but pervious clav), as in Waterloo, Oxford, Brant 
passes downward until it reach- counties, and Oak Ridges. 
es an impermeable stratum. Such soils, when of sharp sand (pulverized 
quartz, gneiss, etc.), are the most favorable for purposes of a sewage 
farm, allowing of the passage of the largest amounts of water, leaving 
organic matter behind in upper film of soil, where it is rapidly 
destroyed by nitrification. 



(«) 



Fig. 6. 

Sand layer in denuded valley on top of clay. It occurs in many places as a common 
source of many surface wells, and even, when over large areas, of artesian water. 




<-. r,-— 






(^) 



Kc) 



Fig. 7. 

Deep sand and gravel strata, finer above, overlaying boulder gravels. These soils over 
extensive areas become the great subterranean water reservoirs, the sources of large 
springs, and, with favorable deep strata, of artesian waters of large supplies. 

In such cases as in No. 8, the rain falling upon the permeable soil at 
(c) passes along the surface of the impermeable bed (&)^ and will be 
found at varying depths from the surface at different points. 

As shown in fig. 9, it will be seen that the permeable strata receive 
the rain-fall and store it as a subterranean lake reservoir, giving an 
artesian supply in proportion to the extent of the synclinal basin to the 
extent of the permeable beds at the surface and to the angle of the dip 
of the underlying impermeable clay or rock stratum. 



UNDERGROUND WATERS, 



217 



In such instances, as in fig. 10, the rain-fall may disappear in faults or 
fissures, or be diverted in various directions according to the varying dip 
of rock strata. 

As springs are nothing more than surface indications of the existence 
of underground streams, they become interesting as an index of the 
locality of such underground streams and of their volume. We have 




Fig. 8. 



Permeable sands and gravels lying between two impermeable beds of clay, with clay 
above and rock below. Such a condition occurs in western Ontario from London 
westward. 



(a) (c) (d) 




Fig. 9. 

Permeable sands and gravels in a basin between impermeable beds. This condition 
is present in many places in Ontario, notably in the synclinal between London and the 
River St. Clair at Chatham, Leamington, etc. 




Fig. io. 

Permeable sands and gravels deposited upon underlying rock, folded and forming an 
anticlinal with a fault and strata at different angles. Such instances occur in the Allegha- 
nies and other mountain ranges, and create local difficulties in obtaining underground 
supplies. 

already referred to the depth of these underground streams as being to 
some extent a measure of their perennial character. Remembering the 
source of their supply, we naturally expect variations in the amount of 



2l8 UNDERGROUND WATERS, 

the flow of a spring at different seasons of the year. These variations 
follow a movement consecutive to that of the rain and subterranean 
streams. Durand Claye, in a table, gives the rain-fall and flow of the 
streams forming the river Vanne, which supplies the city of Paris, thus : 

1869. 
Springs of the Vanne. 



January. . . . 
February . . 

March 

April , 

May 

June 

July •.. 

August 

September . 
October . . . 
November.. 
December.. 



Rain. 


Flow. 


millimetres. 


litres per second. 


20 


1,190 


38 


1,103 


65 


1,232 


24 


1,278 


131 


1,195 


55 


1,150 


42 


1,057 


19 


972 


60 


818 


35 


818 


72 


807 


33 


839 



594 1,057 



In this connection Durand Claye points out, by a comparison of the 
constancy of the source of the river Dhuis as compared with that of 
the Vanne, that the deep springs are much less variable in their flow 
than those from shallow water zones. 

Having discussed some of the principal points in the origin of springs 
and underground water-courses, it will be proper for us now to consider 
them in their application to this province. Unfortunately we have no 
literature whatever bearing upon this subject, and all investigations of 
it have hitherto been of a most partial character. The Geological 
Survey has, I understand, been collecting data with regard to borings 
in different parts of the province, but only as related to salt, oil, and 
gas. The most that we know is gathered from towns and villages here 
and there, which have utilized some local source for fire purposes, and 
in some instances for domestic purposes. Owen Sound obtains an 
abundant supply from a large spring flowing high up out of the hill-side 
from a fissured limestone stratum of the Niagara formation. Kincardine 
obtains, at a depth of 420 feet (also at a depth of 240 probably) a 
splendid artesian flow, while on the hill-side numerous springs crop out, 
supplied by waters flowing along a hard-pan 15, 20, and 30 feet below 
the town, — the present source of wells. 

Goderich obtains a daily supply of nearly 2,000,000 gallons from six 
eight-inch borings down about 240 feet, within a quarter of an acre of 
ground. Walkerton is obtaining, from springs situated on a hill-side, 
enough for a supply by gravitation. Various places in Lambton 
county, as about Forest and in Warwick township, obtain from a sand 
layer some 75 feet deep artesian water coming to within twenty feet of 
the surface. In Chatham and vicinity are a number of artesian wells 



UNDERGROUND WATERS. 219 

comii^ to the surface, or nearly so, from a depth of 64 feet. At Kings- 
ville, in Essex, some borings down to the rock have resulted in no 
water, while others have yielded an abundant supply of sulphurous water. 
Leamington is being supplied by artesian water from 55 feet depth, 
while at St. Thomas they have obtained at the court-house a fine supply, 
and at other points sulphurous water as artesian supply by borings. 
Springy out-cropping up the valley of Kettle creek at St. Thomas, flow- 
ing from the superficial sands and gravels, are likely to be developed finally 
for a public supply. Around London, borings to the rock have supplied 
sulphurous artesian water in some instances, and in others water of a 
perfect character. The city of London is obtaining an abundant supply 
of splendid water from springs which appeared at the surface of the hill- 
side along the bank of the Thames, some three miles below the city, and 
the supply has been enormously developed by simply running a gallery 
along the hard-pan for half a mile or so, and conducting the water to the 
small pumping basin. These waters are gathered on the higher 
grounds, which to the south of this point rise to nearly 200 feet, and are 
formed largely of pervious sands and gravels. No tests that I am aware 
of, have been made of the variations of the flow of these magnificent 
springs. At St. Mary's, and I believe at Woodstock, artesian water is 
obtained. Springs abound above Berlin, a public water-supply being 
there obtained from them, while Guelph too is supplied mainly by 
springs. At Tilsonburg are found artesian waters, while at Dunnville, 
and about Jarvis in Haldimand county, artesian water is obtained within 
a few feet of the surface. Brantford has a magnificent supply obtained 
from perforated pipes laid on the hard-pan 13 feet under the sand and 
gravel of the island in the river. Niagara-on-the-Lake has numerous 
springs, which are now being developed with a view to a public supply. 
St. Catharine's gets the supply from springs forming Decew's creek, 
flowing from the Niagara limestone mountain south of the city. About 
Toronto no true artesian well water has been, so far as I know, 
obtained, although Mayor St. Leger has obtained at his residence on 
Bloor street, neai: High Park gates, water rising in a six-inch boring, 
189 feet deep, to within forty feet of the surface.^ Borings down to the 
rock under the clay at the Mimico new asylum buildings obtained no 
water, nor yet when over 1,000 feet of rock had been bored. Curiously 
enough, artesian water is obtained at Newmarket, situated on the north 
side of the Oak Ridges, while Barrie and Orillia both have artesian 
water at depths of loo to 150 feet. Smith's Falls in the east has 
water, partly artesian, rising in borings in the rock. Penetang and 
Markham are developing springs to obtain public supplies, while, most 
curious of all, Sundridge on the Laurentides, some fifty miles south of 
North Bay, is obtaining abundant supplies of artesian waters at a depth 
of 100 feet. 

Such is, in the briefest possible way, a statement from memory of the 
underground sources of public or private supply which have been 

^ Recently some artesian water has been found. 



220 UNDERGROUND WATERS. 

developed in different parts of the Province. They clearly point to the 
extreme importance of the problem which lies before future engineers 
in the matter of supplying our inland towns with water. It is by no means 
improbable that the problem of applying to these underground sources for 
supplying large cities in Ontario will be discussed in the near future. 
Brooklyn, New York, is now supplied with 30,000,000 gallons a day 
from pipes driven into a sand stratum, within twenty feet of the surface, 
and so abundant is the supply under the level surface of Long Island, only 
a few feet above the sea level, that I personally saw from 125 2-inch 
pipes coupled together within an area of one eighth of an acre, over 
four millions of gallons being pumped day after day. 

I may be pardoned for referring in this connection to the possibility of 
obtaining for Toronto a public supply from these underground sources. 
Here we are hampered again by a lack of data from speaking very posi- 
tively, and yet there is a large amount of information regarding the 
topographical and surface physical conditions, which may serve as a 
basis for discussion. We usually speak of Lake Ontario as being 247 
feet above sea level, while the strata rise towards the north till at King 
Station a height of over nine hundred feet is reached, thence descending 
till Lake Simcoe is reached at seven hundred and seventeen feet above 
sea level. We all remember, too, that running south, some westerly and 
some easterly, are a number of valleys, as those of the branches of the 
Don and various other creeks, some dipping toward the valley of the 
Humber and others towards the Rouge. From what has already been 
said regarding the law governing the deposition of the post-glacial 
deposits, we may expect to find what at most points is found, — ^that over 
the rock strata of this region the Erie clays have been deposited with 
much regularity over probably (as in the west) a thin layer of sand and 
gravel ; and that over them, but less regularly, sands and gravels, vary- 
ing in their calcareous and argillaceous character and therefore in their 
permeability, have been deposited. Were we to assume for a moment 
that no variations have taken place in the level of the underlying rock 
and its superimposed clays, sands, and gravels, it would be an easy 
thing for us, with a known rain-fall, the degree of permeability of the 
strata, and their inclination or dip southward, to calculate with much 
precision the probabilities of obtaining a given amount of water at any 
point. Unfortunately for the calculation, however, deep erosions have 
taken place in these various deposits, and so have been formed river 
valleys dependent for their water-supplies upon springs of the third class 
of Durand Claye. 

Another class of erosions exists in the shape of depressions creating 
small lake basins. From the survey of McAlpine and TuUy we find 
that the whole of those forming the so called Bond Lake system have an 
area of 462 acres and a water-shed of 7,600. From calculations made 
on the basis of this area of 7,600 acres receiving 30 inches of rain-fall, 
half of which soaks into the soil, it would hold a possible supply of 
water equal to 20,000,000 gallons for 135 successive days. Of course 



r 



UNDERGROUND WATERS. 



221 



n 



* — >530 



iSS 



->ro5' 



m 



^^hti 



\ 




i! 



a certain loss by evaporation must be al- 
lowed for. The existence of these lakes 
points to two interesting facts in this con- 
nection, — first, to the existence of pervious 
upper beds, and second, to impervious deep- 
er layers which form an impounding reser- 
voir for the water flowing from the super- 
saturated zone, where the upper pervious 
meets with the underlying impervious layer 
of clay. Now the maintenance of a more or 
less constant supply, in spite of evaporation, 
of the water in these shallow basins through- 
out the summer points to the existence of 
an extended water-zone in the surrounding 
higher lands. Springs along the valleys do 
the same. At Aurora, such supply the vil- 
lage with ample public water, while at New- 
market, as already mentioned, have been 
developed what seems on first appearances 
for this locality a remarkable phenomenon, 
namely, artesian wells. It is further inter- 
esting to note that for a considerable space 
at Holland Landing, and to the eastward 
around the lake basin, is a flat bottom land 
of fine sand. From this there is an abrupt 
ascent of clay, thence a depression till New- 
market is reached, some fifty feet above the 
level of the lake. Since I learned of the 
^ existence of artesian wells in Newmarket, I 
S, have been much disturbed as to how to 
I* account for them.^ They are, as far as I 
V know, the only ones between the two lakes. 
Recalling, however, the existence of the sand 
flat surrounding Lake Simcoe at Holland 
Landing, some fifteen feet above the lake, 
and finding from the levels that Newmarket 
is only fifty feet higher than Lake Simcoe at 
^ the railway station, I venture the following 

explanation as accounting, in part at any 
rate, for their existence. (See diagram.) 

The fact of the existence of this sand layer 
and of the artesian wells makes us curious to 
learn whether, assuming it to be thus con- 
tinuous, it appears to the south of the Oak 
ridges. As Bond and other lakes lie about 
on the height of land, only 26 feet lower 
than the Oak ridges and 200 feet above 
Lake Simcoe, it does not seem at all proba- 
ble that the permeable beds which supply 
these lakes have anything in common with 
the aforesaid sand layer. The same level 
as Lake Simcoe, 717 feet to the south of 
the water-shed, arrived at along Yonge 
street, is seven miles south of Bond Lake ; 

I rk«UM>« lt«w« m\nf». writtnir Vi^rfttn* Irnnwn kt\ m*- 



222 UNDERGROUND WATERS. 

and did these underlying strata maintain the same level, it would 
be near Thornhill that we would expect to find the layer of sand. 
If in this latter locality there should be found a widely distributed 
layer of water-bearing sand superimposed upon a bed of clay, and 
having a head of water extending back as far as the Oak riches, 
there seems no good reason why it should not supply ample water 
for the purposes of a large city. Remembering that McAlpine and 
Tully's scheme contemplated using the Bond lakes, Rouge, etc., and 
recollecting that their summer supply, constantly being reduced by 
evaporation, is wholly dependent upon these underground sources, 
apart from an occasional rain, there surely can be no reason why we 
should not find these same waters in greater quantities in the water- 
bearing sands and gravels from which they flow, and unpolluted by any 
surface wash or contamination, or by the free vegetable growth which 
makes these lakes as they now exist such undesirable sources of supply. 
It will be seen how interesting this local supply becomes when we rec- 
ognise that in the small area of a few miles we have, illustrated, the 
various sources of public water-supplies : First, we have the various 
creeks of the water-shed, which, uniting, create on the east the branches 
of the Rouge, and on the west the branches of the Humber, thus yield- 
ing a river supply, undesirable because of uncertainty through evapora- 
tion during the summer and the certainty of surface pollution. Second, 
Bond Lake and her sister lakes form reservoirs of water, made to 
«ome extent impure with surface drainage, but further enormously con- 
taminated by deposits of organic matter which have been washed into 
them during the past, and from the abundant vegetable growth always 
present in such shallow basins. Third, water from springs flowing from 
the hill-side and supplying the village of Aurora with a public water of 
a perfect character as regards freedom from organic pollution. Fourth, 
at Newmarket, artesian water flowing clear and cold from a sand stra- 
tum over one hundred feet beneath the surface. Now, in order to gather 
that portion of the waters from the first two classes produced from these 
underground supplies in the same state of purity as those in the last two 
classes, it is apparent that all that is necessary will be for a perforated 
tile of sufficient capacity to be laid at a gentle incline in galleries dug 
down to the hard-pan of clay along which the waters flow on the south 
side of the height of land, and collecting them before they appear as 
springs at the surface, flowing thence into the lakes or creeks, at a time 
when they are in a state of absolute purity due to their long under- 
ground filtration, and before they are contaminated by any surface 
wash. Examples of how this can be done may be seen well illustrated 
both in London and in Brantford, where ample supplies of first-class 
water have been obtained ; but if we wish for other authorities, higher 
because they are farther away, we may cite Toulouse, Florence, Lyons, 
etc., as examples of the method. 

It now becomes of interest to inquire into the purity of these supplies. 
As all are well aware, we have distinctive classes of waters, such as 



UNDERGROUND WATERS. 223 

those of our great lakes, of our smaller inland lakes, of our rivers of the 
neiv districts, of rivers with towns situated on their banks, and of wells 
shallow, wells artesian, and deep pipe wells for pumping. These show 
that the various chemical compounds have certain general relations, 
according as the waters have been churned up in the g^eat lake reser- 
voirs, have been flowing out of peat bogs, along clay banks, or through 
limestone districts ; whether they have received the surface drainage from 
cultivated lands or from sewers, or from wells receiving a steady soak- 
age from local sources of pollution, as soil contaminated with excreta or 
barn-yard wash. All are aware that the rain-water falling chemically 
pure, at once dissolves from the surface soil whatever soluble materials 
are present, and that similarly as it descends into the soil it becomes 
loaded with organic impurities in the upper soils. In addition to chem- 
ical impurities, they likewise; through these impurities, become culture 
media through which infinite numbers of bacteria from the soil and air 
find abundant nutriment. Here again we find not only variations in the 
classes of waters, which — according to their temperature, to the class of 
pollution, and to their exposure to agitation, and to the free oxygen of 
the air — present very different species of bacteria and enormously differ- 
ent numbers in a given volume. With regard to the bacterial life of 
waters under these numerous different conditions, we cannot be said as 
yet to have any complete or classified knowledge ; but we do know that 
as the destruction of organic matter is slow or rapid according to cir- 
cumstances, so the degree of purity of a water for drinking purposes 
must depend upon the constancy of a settled condition unfavorable to a 
pollution from any source, and remaining at a temperature inimical to 
the growth of bacterial life. Remembering it is only through the upper 
three feet of soil that organic materials with their contained bacterial 
life usually extend, and that therefore it is in these that the descending 
waters receive bacterial pollution, it is apparent that in the measure the 
waters continue to pass downward through permeable strata will they 
leave behind all suspended matters, whether organic or bacterial, which 
they receive in the upper soils. Manifestly, however, the effect of the 
destructive influences going on in the soil will depend upon the depth 
of the organic materials, and the porosity of the soil as regards move- 
ment of gases, and the depth at which the bacteria of the soil are found 
to be capable of developing. Duclaux has stated that of the agencies 
which render water sterile in its passage through the soil, the first, the 
oldest known, and without doubt the most potent, is the capillary action 
of the soil. Filtration practically retains in the capillary pores the 
materials in suspension in the water, and with them the germs of mi- 
crobes. It is a fact clearly demonstrated, he says, on which I shall only 
insist in order to attempt to indicate slightly what we call capillary 
filtration. 

"It is proper to mention at the outset that the capillary character of 
the channels in which circulates the water of rain has only the effect of 
augmenting the action of the surfaces on the volume of water which 



224 UNDERGROUND WATERS, 

laves them, that is to say, of multiplying the chances which a solid par- 
ticle in suspension in water can have of encountering a portion of wall 
on which it fixes itself, drawn by a force analagous to that which fixes 
coloring matter in a tissue placed in a coloring bath. The effect would 
be the same if the chances of contact were found increased by any other 
cause. ... It could happen, and sometimes does happen, more- 
over, that a long repose causes to adhere to the walls of a vase the par- 
ticles held in suspension in the liquid which it contains. It can happen, 
and without doubt does happen, that a slow filtration through a great 
length of spaces noncapillary, and even somewhat large, produces the 
same result as through capillary spaces shorter and narrower." 

Accepting these conditions as being those upon which the purification of 
ground water primarily depends, it is apparent that we have them sup- 
plied to the full in the case of those waters which create the enormous sub- 
terranean reservoirs which we see may result from downward movement 
of water through permeable soils. Further positive proof has recently 
been given us by the experiments of Carl Fraenkel, of Berlin, on the 
water of pit and driven wells, in Which he shows that pit wells, owing 
to their receiving surface wash and soakage through their walls, as also 
owing to their communication with the outer air, not only are not sterile, 
as are these deeper underground streams, but that in the case of pit 
wells in the neighborhood of habitations, these are too frequently found 
to be enormously contaminated. Thus, in an unused well in the court 
of the Berlin Hygienic Institute, the water first removed was found to 
contain 10,800 bacteria in twenty drops. 

To show the more or less constant differences in the chemical consti- 
tution of waters, I give here a number of analyses of Ontario waters 
from different sources. (See opposite page.) 

From studying these natural waters, it becomes manifest that each has 
some certain characteristics attached to it possessing an advantage in 
some one or more particulars. Clearly, however, the more important 
question is that of their sanitary character, — in other words, of (i) their 
freedom as regards bacterial life, (2) their freedom from such organic 
materials as form a pabulum for these bacteria, and (3) their freedom 
from exposure to those sources of animal contamination, whether direct 
or indirect, likely to introduce pathogenic forms of bacteria. 

From the various classes of waters as we have seen them, and the 
characteristics which specially belong to each, it becomes easy for us to 
form conclusions as to what conditions become necessary to maintain 
such in a state of purity, or, when necessary, to subject them to such 
conditions as will alter them into waters of a superior class. To 
make plain what I mean, I would say that on the one hand we must 
seek to maintain underground waters, as those of springs and artesian 
wells, in a state of biological sterility. Hence (i) we must not con- 
duct them along natural channels or artificial ones made of soil of any 
kind, — in other words, their conduits must be of masonry, tile pipe, or 



UNDERGROUND WATERS, 



225 



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226 UNDERGROUND WATERS, 

of iron, — and (2) we must not, if possible, store them at all ; but if this 
be unavoidable, the storage must be as limited as possible, and in stand- 
pipes where a low temperature is maintained, and where the surface 
presented to the dust and outer air is as little as possible, or else in 
concrete-lined reservoirs, supplying those conditions found in a stand- 
pipe. On the other hand, if we are dealing with the waters of rivers and 
small lakes, it must be our aim to apply such methods as those which ster- 
ilize our standard underground waters. As already seen, one of these is a 
removal of the vegetable matter, suspended and soluble, found in them. 
Hence we apply the principle of filtration on some such scale as we find 
going on in nature, and at the same time allow the action of oxygen, by 
the aid of micro-organisms, to go on in the reduction of soluble organic 
matters, as albuminoid, decomposable materials into fixed salts such as 
those sometimes found in excess in artesian and spring water. The 
same agencies must be set in operation even in a more thorough man- 
ner where, as in many river waters, the pollution is of animal origin, as 
sewage. Remembering, as Hofmann tells us, that the rate of movement 
of underground waters is usually not more than a few millimetres a day, 
it is hardly necessary for us to inquire whether a few feet of a bed of 
sand and gravel, of magnetic iron filings or of spongy iron, or of any of 
the much lauded artificial filters now advertised for the market, can 
supply the conditions for removal of impurities by the law of capillarity 
and adhesion on the one hand, or of oxidation on the other, in any 
degree similar to those whereby underground waters arrive at that state 
of biological purity which is our ideal. 

It was not without reason that legend and romance attached to the 
fountains of the sunny climes of classic lands specific virtues. Greece 
had her Castalian font on Parnassus consecrated to Apollo and the Muses ; 
the Isle of Crete her " many-fountained Ida," sacred to Jupiter ; Petrarch 
celebrated the fountain of Vaucluse ; while healing virtues have attached 
to many a St. Ninian's well and St. Margaret's spring. Certain it is 
that these ancients did not seek in their rivers for those waters of crystal 
purity which supplied for them the nearest approach to the nectar of 
their gods ; but, rather, they found them in the springs of those sylvan 
abodes, where with so much reason were located the habitations of their 
somewhat numerous divinities. 



XXX. 

THE RELATION OF THE MECHANICAL ARTS TO PRE- 
VENTIVE MEDICINE, PARTICULARLY ILI^USTRATED 
BY THE ARTESIAN WELLS AND TIDAL DRAINS 
OF CHARLESTON, S. C. 

By a. N. bell, a. M., M. D., Brooklyn, N. Y. 

The mechanical arts, as a department of knowledge, depend upon the 
active formative processes of the mind which result in invention as dis- 
tinguished from organized knowledge deduced from the contemplation 
of previously recognized truths or phenomena, which constitutes 
science ; — the work of art is invention; of science, discovery. 

During the processes of civilization the arts have always taken prece- 
dence of science. Among crude people in all ages and everywhere, in 
default of a store of information to draw upon, self-preservation depends 
upon manual labor and dexterity ; and the excellence of the products 
depends upon the cultivation of the senses, aptitude for improvement, 
and perseverance. 

It has been by the persistent use of these means and a prodigal use of 
material that the grandest products of genius, since the world began, 
appear to have been accomplished, before the birth of philosophy, repre- 
senting beauty and strength in such exquisite proportions as to supply 
models which modern art, with all the aids of science, strives to imitate 
but makes no effort to excel. It is scarcely necessary to remark that 
reference is here made to ancient sculpture and architecture. Lest 
exception be taken to this citation as being irrelevant, it is well to re- 
member that modern research among the ruins of ancient cities reveals 
sanitary works also of marvellous skill. 

As populations increased and became concentrated, water was 
conveyed in immense horizontal channels, supported upon arcades of 
such prodigious elevation as to puzzle modern engineers in their contem- 
plation of the means used for the construction of such works. Of sewers, 
the Cloaca Maxima^ in Rome, constructed more than twenty centuries 
ago, still retains its strength and adaptation to the purpose for which it 
was originally intended. Alexandria, Jerusalem, Nineveh, Hercula- 
neum, Pompeii, and many other ancient cities whose sites are main- 
tained by the magnitude and excellence of their ruins, reveal reservoirs, 
systems of aqueducts, sewerage, drains, and public baths, also latrines 
and other domestic appliances, which, for ingenuity, excellence in work- 
manship, and adaptation to their purpose, in some respects compare 
favorably with the best sanitary works of the present day. 

Doubtless there were numerous inventions found to be of no practical 



228 MECHANICAL ARTS AND PREVENTIVE MEDICINE. 

utility, and quickly discarded. But we are not justified, on that account, 
in the belief that the fittest only survive. It may be that some of the 
most excellent devices were constructed of perishable material, and are 
consequently wholly lost. 

That the Jews, in ancient times, when the priests were physicians, 
had a tolerably clear conception of practical sanitation the Mosaic record 
bears abundant evidence. There was among them a very intelligent, if 
not indeed scientific, recognition of diseases tHat were preventable, as dis- 
tinguished from those which were not. And omitting mere legendary ru- 
mors with regard to medicine, as at first practised, no attentive reader of 
Hippocrates's works, particularly his treatise on Airs, Waters, and Places, 
will fail to observe that preventive measures were based upon the con- 
templation of physical phenomena. Indeed, the recognition of conditions 
inimical to health, and the use of mechanical appliances in conjunction 
with regulations for the promotion of health, even when no such con- 
ditions were manifest, as illustrated by the Levitical code, the first 
fundamental treatise on medicine (Hippocrates), the high estimation of 
and provision for the practice of physical culture by the most enlightened 
nations of antiquity, all show that the prevention of disease was not only 
the leading sentiment of those who exercised the function of physicians 
among the ancients, but that it also, then, as now, commanded the atten- 
tion of the most highly cultivated people, and the highest degree of ex- 
cellence in the application of the mechanical arts for its cultivation and 
promotion. 

The ancient Romans, as well as the Jews under the Mosaic dispen- 
sation, were a scrupulously cleanly and healthy people, both with regard 
to their dwellings and their persons. And for a few centuries subse- 
quent to the Christian era the Christians were in like manner cleanly in 
their habits. But in the progress of the ages, when the teachers of 
Christianity, who were the most highly educated of the people and the 
leaders of public sentiment, ceased to observe the sanitary laws of the 
Jews and Romans, because they deemed them to be, in common with 
all other Jewish and Pagan laws, sinful, and went to the opposite extreme, 
insomuch as to consider filthiness an evidence of sanctity, it is surely no 
wonder that the period of the Middle Ages, of which this was the begin- 
ning, was characterized by the most appalling epidemics. 

That under the sway of such influences practical sanitation ceased to 
be a virtue, is no more surprising than that all other mundane afiairs fell 
into neglect, stagnated, or retrograded. There was no efibrt to stay the 
progress of disease or to recognize its preventable causes, and ere long 
the people became so demoralized by the prevalence of epidemics, and 
so appalled by the doctrine of the false teachers that their diseases were 
the visitation of God on account of their sins, that they were for the 
time well-nigh bereft of their senses. But no one at this day, who has 
made himself at all familiar with the history of the great epidemics of 
the Middle Ages and the habits of the people, doubts that they were 
due to filthy surroundings. 



MECHANICAL ARTS AND PREVENTIVE MEDICINE. 229 

But passing from mediaeval to modern times, if it were our purpose 
to trace the progress of practical sanitation, it would be an easy matter 
to mark the steps by which it has gained its present attitude and earned 
for itself a new and more comprehensive name. Happily for the well- 
being of mankind in this age of experimental knowledge, medical 
science, as a whole, has kept pace with the triumphs of inventive genius, 
and in none of the branches into which this comprehensive science is 
divided has this coordination been so marked as that which justifies the 
use of the term Preventive Medicine. 

Preventive medicine began as practical sanitation by the application 
of the mechanical arts exclusively, — but so anciently that that which 
the unlearned of its votaries are wont to call the ^^ new science," is, at 
the least, as old as the Mosaic record. And it exists to-day not only as 
the most ancient code of organic knowledge for the protection of human 
life, but because in its progress through the ages, and particularly during 
the present century, it has excelled all other branches of knowledge in 
its triumphs over the enemies of mankind. 

With its incorporated resources during the progress of civilization, and 
particularly in modern times, since diseases for the most part have been 
recognized as the result of disobedience to sanitary law, preventive 
medicine, as now understood, comprises the knowledge of preventable 
diseases and their causes, of the means of their prevention, and how to 
apply those means. 

It is based upon the laws of physiology, general pathology, and chem- 
istry. It is therefore at the outset one of the sub-divisions of scientific 
medicine, but by far the most comprehensive one. For its successful 
practice, it demands, in addition to the knowledge required by the 
medical practitioner, a much more extensive acquaintance with other 
branches of knowledge — of the laws of physics, climate, geology, 
botany, biology, bacteriology, and a general knowledge of the mechan- 
ical arts. 

The mechanical arts stand in the same relation to preventive medicine, 
as at present understood, as pharmacy to curative medicine ; and with- 
out a general knowledge of them, and an aptitude for their application, 
a pretended knowledge of preventive medicine is of less practical utility 
than a good knowledge of the mechanical arts is without medical 
knowledge. 

For illustration, no place, to our knowledge, affords better examples 
than the city of Charleston, S. C. Situated on a peninsula between two 
rivers, overlaid with a bed of quartzose sand with great absorptive 
power, there was no apprehension in the minds of its first settlers that, 
with the abundant rain-fall, averaging nearly forty-four inches yearly, 
there would ever be any lack of wholesome water, or any danger of a 
water-logged soil. But we gather from the annals of the city^ that, on 
the increase of the population, ere half a century had elapsed, the water 
in the wells, especially in the more populous portions of the city, had 
» " Year Book," City of Charleston, 1881. 



230 MECHANICAL ARTS AND PREVENTIVE MEDICINE, 

lost its purity and was becoming worse and worse — hard, disagreeable 
to the taste, and unwholesome. The evil went on increasing.* Mean- 
while it was discovered that the bed of sand, which at the first was 
deemed to be a healthful foundation, was, at a depth of about twenty feet, 
superimposed upon a bed of impei-vious clay, and in the populous dis- 
tricts saturated with the soakage of surface filth ; and this bed of filth 
was the measure of the depth of the wells. Without apparently con- 
sidering the danger of such a soil to health, independent of the water- 
supply, a worthy citizen, one Mr. Longstreet, of a mechanical turn of 
mind, determined to sink a well on his own premises deeper than any 
which had hitherto been sunk, in search of better water. Pursuing the 
ordinary process of well-digging, on reaching the bottom of the twenty- 
feet depth of foul sand he encountered the stratum of impervious clay. 
In attempting to penetrate it, he found so much difficulty in keeping 
back the inflow of water from the sand around that he was obliged to 
change his plan by sinking an iron tube, beginning at the bottom of the 
well already at the depth of twenty feet from the surface. When he had 
penetrated the clay to the additional depth of thirty-seven feet, making 
the entire depth fifty-seven feet from the surface, water rose up freely 
through the tube, filling the well above to within six feet of the surface. 
The water thus procured was described as being " similar to, but purer 
than, the ordinary well-water." This was the first step taken in the 
progress of artesian well-boring in Charleston. It was pursued by 
mechanics solely, with several changes of contractors and numerous 
breaks and inventions of new tools, during a period of about seventy 
years, encountering and overcoming obstacles from time to time greater 
than any elsewhere known to the art of well-boring, with the following 
result, from official sources : 

Charleston, S. C, Dec 4, 189a 
Dr, H. B, Horlbeck : 

Dear Sir : I am in receipt of yours of 3d inst., enclosing letter from Dr. A. N. Bell. 
I see by his letters that he has the full particulars of the Marion square well, as pub- 
lished in the " City Year Book" for 1881, and that he wishes information in regard to 
the two wells bored since. Perhaps, however, it would be as well to begin by giving 
depth, size, and flow of each well, as follows : 

No. I. Marion square : Depth, 1,970 feet; size at bottom, 2 and 11-16 inches; present 
daily flow, 200,000 gallons. 

No. 2. George street: Depth, 1,950 feet; size at bottom, 3X inches; present daily 
flow, 300,000 gallons. 

No. 3. Hanover street: Depth, 1,945 feet; size at bottom, $}i inches; present daily 
flow, 1,200,000 gallons. 

I enclose herewith copy of the strata of well No. i, and the same strata were found in 
the other two, with the slight difference of a few inches or feet for dip or inclination.^ 



to 


2 


Mold. 


61 to 65 White sands. 


2t0 


8 


Yellow sand. 


63 to 85 Sandy marl. 


8 to 


12 


Sandy clay. 


85 to 203 Argillaceous marl, with nodules. 


12 to 


17 


White sand. 


203 to 293 " " 


17 to 


50 


Blue clay. 


293 to 390 Calcareous marl. 


$0 to 


61 


Blue clay sands. 


390 to 393 Arenaceous limestone. 






» Strata downwards. 


Artesian well, Marion square. 



MECHANICAL ARTS AND PREVENTIVE MEDICINE. 



231 



393 to 454 Calcareons marl 

454 to 466 Arenaceous limestone. 

466 to 475 Calcareous marl. 

475 to 476 White limestone. 

476 to 489 Calcareous marl. 

4S9 to 540 Alumina magnesian marL 

540 to 794 Marl. 

794 to 836 Micaceous marl, with iron pyrites. 

836 to 960 Marl, with sandstone layers. 

960 to 998 Sand, considerable water. 

998 to xooo Hard sandstone. 

1000 to 121 5 Marl, sand, and clay. 

121 5 to X32X Sandstone, very hard. 

X22I to 1230 Marl, sand, and clay. 

1230 to 13x0 Sandstone. 

1310 to 1345 Dark sand and clay. 

1345 to 1350 Broken shell and shell-rock. 

1350 to 1390 Blue day, with hard layers. 

1390 to 1405 Green sand. 



1405 to 1533 

1533 to 1557 
1557 to X560 
1560 to 1610 
1610 to X820 
1820 to 1845 
1845 to X850 
X850 to i860 
i860 to 1862 
X862 to 1880 
x88o to X900 
1900 to 1910 
X910 to 1925 
1925 to X970 



1970 



Marl, some shell, and some iron 
pyrites. 

Hard sandstone. 

Sand, water-bearing. 

Argillaceous sand and sandstone. 

Blue day and sand. 

Sand, with water. 

Sandrock, hard. 

Loose white sand. 

Sandstone, hard. 

Loose sand, with water. 

Blue day and sand. 

Sand. 

Argillaceous sandstone. 

Alternation of sand beds 8 or 10 
feet thick and sandstone 2 to 5 
feet thick between the beds. 

Sandstone, not penetrated. 



Well No. 2 was begun in April, 1881, and finished in October, 1884. Well No. 3 was 
begun in March, 1885, and abandoned by the contractor after six months' work. In May, 
1886, work was resumed by another contractor, and the well was finished in September, 
1889. Many difficulties were encountered in the boring of these two wells, chiefly owing 
to the upward rush of sand into the pipes whenever any of the numerous water-bearing 
sands were encountered. It will be observed that more than three years was consumed 
in the boring of each of the three wells. 

The analysis of the water from well No. i is given in the " Year Book "for 1881, 
page 278 ; and as the other wells draw their supply from the same source, it may be taken 
as a fair analysis of them all, except that well No. 3, being so much larger and discharg- 
ing more than twice as much as the other two combined, contains a less proportion of 
chloride of sodium and carbonate of soda. 

The water is perfectly clear, and is very soft, and is regarded as the most delightful water 
in the world for bathing. Indeed, Dr. F. L. Parker thinks that when properly heated to 
the right temperature it is as beneficial in cases of rheumatism as the famous Hot Springs 
of Arkansas. It is used for all domestic and manufacturing purposes, though, from the 
quantity of soda it contains, it turns anything which contains starch or gluten a yellow 
color when heat is applied. Hence it is not generally used for cooking, and in the laun- 
dry, where white goods are to be starched, the last rinsing before applying the starch 
must be of cistern or pump water, so as to remove the soda before ironing. Many fami- 
lies in the dty drink no other water, and regard its habitual use as a sovereign prevent- 
ive of dyspepsia. 

Perhaps it would interest Dr. Bell to know that wells Nos. i and 2 fell off in their 
daily flow at least 100,000 gallons as soon as the lower vein of water was reached by the 
pipe of Well No. 3, the diameter of which was so much larger. 

If there are any other points upon which Dr. Bell wishes to be informed, I will be glad 
to furnish them if in my power. 

Yours very truly, 

Zimmerman Davis, 

Secretary-Treasurer Ckarlesion Water-Works Co, 



An analysis, published in the "Year Book" before cited, made in 
August, 1879, by S. T. Robinson, Jr., Assistant in the Laboratory for 
Analytical Chemistry, and Professor Charles U. Shepard, Jr., of one 
United States standard gallon of 231 cubic inches in volume and 
weighing 58,438 grains, there remains, on evaporation, residue grains 
65.0533689, consisting of the following ingredients : 



232 MECHANICAL ARTS AND PREVENTIVE MEDICINE. 

Organic matter and water of crystallization 1733689 

Carbonate of iron 335<>28 

Sulphate of lime -442367 

Sulphate of magnesia 165247 

Chloride of magnesium 230291 

Chloride of sodium 11.390304 

Carbonate of soda 47.258488 

Nitrate of soda 554260 

Silicate of soda 2.524745 

Silica 361700 

Total 64.996119 

The water has a temperature of 99.5" F. 

A second example, of interest to every sanitarian, is, bearing in mind 
the peculiarities of situation, the soil drainage of this locality — the Tidal 
Drains, 

It was my privilege for many years to enjoy the acquaintance of the 
accomplished physician with whom this unique system of soil drainage 
originated nearly forty years ago, — the late Dr. William T. Wragg. 

On a visit to this city, while in the service of the National Board of 
Health in 1879, I obtained a description of the drainage of Charleston 
from Dr. Wrigg, the originator of the tidal drains, and Mr. Louis J. 
Barbot, city engineer, as printed in the report of the National Board of 
Health for that year, from which the following are abstracts : 

Dr. Wragg writes, — 

The topography of Charleston is so flat that in any system of drainage all idea of 
constructing sewers on a declivity was out of the question. To obtain a force com- 
petent for moving water in them, therefore, it was necessary to use the water itself for 
that purpose. Fortunately, we had for this end the rise and fall of the tides. The tides 
would enable us, with properly constructed sewers, to give the water sufficient move- 
ment for the washing out of the solid sewage matter, if scientifically managed. It will 
not be possible to go over the work in detail : I can only give you results. 

The bottoms of the drains were built on a dead level. The level was 30 (or 20) 
inches above mean low water ; the top of the arch a foot above ordinary high water, but 
just above the level of spring tide, so that at each recurrence of spring tide the entire 
capacity of the sewer being occupied by pure sea water all gases would be thoroughly 
expelled. The drains were furnished with water-tight doors at each end. So far in our 
plan we had the means of carrying out our views, but in the construction of the work we 
were compelled, for want of funds, to do what we would willingly have avoided, viz., use 
wooden instead of brick bottoms, and to give them a fiat instead of an egg shape. The 
soil of Charleston is such that at the depth of the drain bottoms there is a stratum of 
quicksand. This, while it would have made it difficult and expensive to lay down brick, 
was an advantage for the wood, since this material, so long as it is submerged, does not 
decay. Hence we had no fears of our work being jeopardized in the future by that 
cause. And here let me say that I have no faith in the city officials who are covering up 
the neglect of the sewers by attempting to screen themselves behind the charge that they 
are falling into decay. The sewers constructed as above detailed had their openings or 
mouths at two very distant points. One set of mouths was at the upper suburbs, the 
other at the extreme lowest end of the city. At both ends they opened into the rivers 
that flow around Charleston on three sides. 

And now as to the manner of managing these drains so as to secure the results 
promised for them. This was provided for in an ordinance framed by the committee 



MECHANICAL ARTS AND PREVENTIVE MEDICINE, 233 

who had conducted the work. A drain-keeper had been selected, and his instructions 
were to this effect, viz., — ^Taking up the description at the point at which the tide is low 
and the drains empty, the gates should be closed and kept so till the next high tide. At 
the moment of the highest tide at the upper end the gates should be lifted, and the outer 
water allowed to rush in till the drains were filled, which would be accomplished in two 
or two and one half hours. At this time the upper gates were to be again closed, and the 
water kept in until the next low tide. Now the lower gates should be raised, and the 
rush allowed to go on until the drains were empty. By this process it will be seen that 
the wash would be always going on in one direction, so that all solid matter would move 
in the same way and tend to pass out at the lower mouths. 

It was not contemplated to depend alone upon the flushing for clearing out the solid 
matter, for, seeing the great length of the longitudinal drains, this process would require 
too much time. So it was made the duty of the keeper to traverse the entire length of the 
drain once in every twenty-four hours, and removing the covers from the man-holes (an 
arrangement in the construction), to sound them carefully, and if any mud or other mat- 
ter should be found there, to remove it at once. It was also his duty, if heavy rain 
should come on while the drains were full of water, to open the lower gates so as to ease 
off the pressure that would arise from the great inflow. He was also instructed to retain 
the night tide in the drains for the use of the engines in case of fire. 

The old drains of the city had been constructed entirely without any plan. They 
were on different levels, and many of them were cul-de-sacs having no outlets. It was 
contemplated, from time to time, to bring these into harmony with the tidal drains. But 
with the change of the city oflicers the new broom made a dean sweep. The first thing 
the new mayor did was to dismiss the drain-keeper and put the care of the drains in the 
hands of the police, who knew nothing, and cared less, about the duty. In the course of 
a few years mud and sand had been allowed to accumulate to such an extent that the 
drains were full, in some places up to the crown of the arch, necessitating a heavy outlay 
to remove it. The clearing out by this process (sending down men and drawing up 
through the man-holes) has never been properly done : the accumulation has never been 
completely removed. Masses have been left in parts of the drains not easily reached, and 
hence the charge made by the city engineer, viz., that the bottom levels have been 
destroyed by the decaying of the floor and the consequent crumbling of the check-walls 
and the arches. The flow of water being impeded by local accumulations of solid matter 
at intervals along the floor he accounts for by alleging that the work was decayed. 

I mentioned above that the soil of Charleston is underlaid by quicksand. This 
stratum supplies an inexhaustible supply of water. It is well known that wood will 
not decay in water : hence the allegation that the plank bottoms have rotted is evidently 
inaccurate. The fault is in the management, and, while I freely admit that the drains 
are not doing what it was claimed they would do, I as fully claim that the failure is not 
in the plan or in the workmanship, but in the management. 

Much discussion went on while the work was in progress, and men of high preten- 
sions to scientific attainment denied that any current would flow from the mouths when 
the gates were opened. To convince them, an exhibition was given, to which all doubters 
were invited ; and to their utter amazement, when the gate was opened they saw half- 
bricks and paving-stones roll out before the impetuous torrent. 

There is one more point to which I wish to allude before concluding. I mentioned 
above that want of funds had forced us to modify our plans in order to bring them within 
the means at our disposal. One of these modifications was this : In order always to 
have at disposal an abundant head of water, it was recommended to form a large reser- 
voir in the marsh above the city and connect it with the system of drains, so that it might 
effect the flushing more perfectly than could be done by the water contained in the drains 
alone. The marsh at Creighton*s bridge, up Meeting street, was selected for the 
purpose. 

This sketch, hastily written and altogether from memory, is quite inadequate to give 
an idea of the intention and execution of the work. But such as it is, it is much more 
than I ever expected to make. William T. Wragg. 

Charleston, S. C, August 23, 1879. 



234 MECHANICAL ARTS AND PREVENTIVE MEDICINE. 

Mr. Barbot writes, August nth and 23d, 1879: 

Very little was understood at that time, in this country, of sanitary works [when the 
first soil drains were laid in Charleston], and of the many reasons that might be given 
why cities of slight elevation above the tide level should make a distinction between 
works of drainage and sewerage. These works, therefore, were designed and built to 
answer both purposes, and from what we have of the old S3^tem of drains and sewers, 
which bred the worst types of fevers by the escape of the sewer gas through untrapped 
laterals into the atmosphere, and through their pervious walls into the soil. 

The only date I can find of their construction is given in an old record made by the 
commissioners of streets and lamps, covering a period from the year 1806 to the year 
1818, when a large number of these works were constructed. From 18 18 to 1856 other 
works of the same character were built. 

The evil consequences of such works as described led to the adoption of the plan of 
tidal drains, so called, but which was not fully carried out. These tidal drains supply the 
places of the old sewers that were destroyed in the streets where the tidal drains are now 
built. These receive the discharges of the street surfaces and from all yard sewers, and 
also from the sewers in all cross streets, besides what is contributed by all yard sewers in 
the same. 

The tidal drains, when first built, worked admirably under the plan of opening and 
closing the gates as laid down in the ordinance regulating the duties of the tidal 
drain-keeper. 

According to high medical authority here, the exemption of Charleston from any epi- 
demic of yellow-fever from 1858 to 187 1 is due to the sanitary effects of these tidal 
drains ; and the recurrence of the epidemic since may be attributed to the fact that from 
some cause these drains were choked up, and were no longer as effectual as originally. 

Louis J. Barbot, City Engimer. 

For fuller information on the subject, and up to date, I am gratified to 
have learned that a paper will be presented by Mr. Barbot, which, 
I have no doubt, will make still more apparent the cause of the ineffi- 
ciency which now obtains in this system. 

It would be an easy matter to extend this paper almost indefinitely by 
particularizing the mechanical arts as applied to disinfecting plants, gar- 
bage destructors, house drainage, lavatory apparatus, ventilating, heat- 
ing, and cooking inventions, life-saving apparatus, school furniture, 
gymnastic apparatus, the sterilization of milk, preparation of meat 
extracts, food compounds, etc., — an all important subject which no 
votary of preventive medicine can afford to neglect. And above all, as 
an aid to science, the miscroscope, in regard to which the world- 
renowned Dr. Koch is reported to have said recently, — 

No, the world must not thank me. The makers of modem microscopes should be 
thanked. Ten years ago, with the microscopes then in use, the bacillus of tuberculosis 
was invisible. Let them keep up their good work, and there will not remain invisible 
a single malevolent animalcule to prey upon the human frame. 

When there is no more fighting in the dark, medical men will fight with better 
success. 

There are now many mechanics who proceed upon recognized princi- 
ples based upon mathematical rules and the laws of physics : these and 
their works are no less scientific than the work of the chemist or the 
bacteriologist. On the other hand, there are not a few who, without 



MECHANICAL ARTS AND PREVENTIVE MEDICINE. 235 

any scientific knowledge, experiment at random ; who copy and under- 
take to combine the results obtained by other and better inventions with 
their own crude devices which they call new, and for which they claim 
extraordinary advantages. Devices of this kind bear the same relation to 
the mechanical arts based upon scientific principles, as do the pretentious 
specifics of empirics who follow in the wake of curative medicine. But 
neither the medical practitioner nor the practical sanitarian can afford to 
ignore such devices. 

The most effectual way of repressing empiricism is to become 
acquainted with its devices and expose them. To ignore it is to multiply 
its dangers. 

Empirical productions generally, whether in the wake of medical 
practitioners, the mechanical arts, or otherwise, are, much like coun- 
terfeit money, mischievous proportionally to the amount in circulation. 
Its detection depends upon a close inspection of its characteristics as 
compared with a thorough knowledge of the genuine article. 



XXXI. 

TIDAL DRAIN SYSTEM OF CHARLESTON, S. C. 
By LOUIS J. BARBOT, C. E., Charleston, S. C. 

To THB Members of the American Public Health Associa* 
TiON — Gentlemen : When I find assembled here to-night, of the medi- 
cal profession and others, gentlemen of such high order of intelligence 
in their respective professions, who have entered upon the study and 
investigation of the causes of diseases with so much zeal and ear- 
nestness, and who, with untiring study, observation, and research, have 
given so much of their valuable time and labor of love in their works 
and endeavors to find the most efficient means for the preservation of 
human life, — in the prevention of the causes of disease, — I can but 
feel inspired by your grand, philanthropic, and patriotic work; and 
the more do I appreciate the distinguished honor your Executive 
Committee have conferred upon me in inviting me to be present, to 
derive information from your scientific sanitary discussions, and to read 
a paper on the Tidal Drain System of Charleston. 

The engineer's study and work are called into requisition, in the 
construction of work for sanitary purposes, as to the proper system 
to be applied, accordingly as the means, topographical features and 
natures of localities have been well studied ; and then only when 
you gentlemen of the medical profession shall have made your scien- 
tific and practical inquiries into the local causes of diseases, by which, 
however, the lives of a whole people may be threatened. Hence you 
are admitted by the profession as the pioneers in all designs which 
look to the preservation of human life from the many ills by which 
it is surrounded. 

The efficient aid which the people have derived from the valuable 
published papers and discussions of the American Public Health Asso- 
ciation on public hygiene, indicating the necessary precautions, and 
care of health, and modes and preventives of disease, are well impressed 
on the public mind, and are read and talked over and made use of 
in practical life. I am sure that all citizens must have applied your 
wise counsels since popular attention was first called to the results of 
your deliberations ; and it gives me unbounded pleasure and satisfaction 
to congratulate you upon the great work of philanthropy in which 
you have been engaged since your organization, and by which hundreds 
of thousands, profiting by the lessons taught on sanitary precautions, 
are to-day enjoying the blessings of health. Such are the great and 
beneficial results which follow the sessions of your grand Association 



TIDAL DRAIN SYSTEM OF CHARLESTON, S, C. 237 

in every city or state in which they may be held, thus giving a strong 
impetus and encouragement to the authorities in the approving and 
undertaking of sanitary measures for the public health. 

I am called upon to present to you this evening a paper on the 
Tidal Drain System of Charleston, S. C, the only city in the United 
States, and I may safely say in the world, where the elevations of 
gpround relatively to the rise and fall of tides, velocity of ebb and stand, 
were made use of as important factors which indicated and led to the 
adoption and application of the tidal system, which has worked well, 
and is capable, when the works are finished as contemplated, of being 
made perfectly effective in every particular for a drainage or sewerage 
plan. 

CONSTRUCTION AND CONDITION OF OLD DRAINAGE WORKS. 

It may be interesting and not out of place to describe beforehand 
the construction and very defective condition of the old drainage works, 
commenced in the year 1806, and to which additions were made from 
year to year, the failure of which led to the conception of the Tidal Sys- 
tem as the one best suited to this tongue of land, its geographical posi- 
tion, and its topographical and geological foundations. The oldest and 
only records of the old drains are to be found in this old book of the 
year 1800, entitled ^^ The proceedings of the commissioners of streets 
and lamps," which I submit as a curious old document. It will repay 
any one, because of the historical items of city administration work, 
to glance at some of its pages. 

I find that the drains built at the earliest period, say from 1800 to 
1840, were so defective, not only in size, form, and improper construc- 
tion, but also from a total absence of any studied depth, level, or 
inclination to which they should all accord, that they could be regarded 
just as so many extensive lines of cesspools, which received from 
year to year the house refuse, privy overflow, and deleterious matter 
from street surfaces and lots, all of which were never discharged owing 
their construction in treacherous ground, causing irregularities and 
undulations. These drains were built under the direction of the wardens 
of the respective wards of the city at different times, as such work 
was needed^ The presumption seemed to be that Meeting street at 
that time would form the western limit of the city ; so, after constructing 
through East Bay street a deep level drain four feet wide and as many 
feet high or more, with flat bottoms as a large intercepting water-course, 
branches or inclined drains were built westerly from time to time to reach 
the summit in a shallow drain in Meeting street. 

The expectation was that the current produced by the flow of 
water during heavy rains would keep all the drains clean and sweet. 
But the rains were few and far between, while the daily influx of 
kitchen and house refuse accumulated at the entrance of each house 
drain, and with the deleterious matter from lots and street surfaces 



238 TIDAL DRAIN SYSTEM OF CHARLESTON, S, C, 

formed a mass of decomposing matter which the eye did not detect, 
but which was very perceptible to another sense from its abominable, 
sickening odor. During a drought of six weeks, which is not an 
uncommon occurrence, this mass of matter assumed a size and weight 
which would fill up completely some sections of the drain undulations to 
the very top, thereby resisting the force of the following rains, and 
in place of beiYig driven out into the Cooper river through the East Bay 
drain, as expected, was only partially levelled and extended, and still 
formed impediments to the escape of the water contributed by the 
rain. There was as now a barrier — the foundation of the old tabby 
work built by the English, extending from the Craven to the Granville 
Bastions, forming a line of the fortifications : the localities would cor- 
respond to the north end of East Bay battery and Market street These 
foundations, extending to the eastward of the old East Bay street drain, 
naturally cut off the percolation and sub-soil drainage towards the 
Cooper river ; hence, the accumulation of water in all the cellars lying 
on west side of East Bay street. Thus there were, from what I have 
shown, a series of detached ponds in all the drains running westwardly 
in the cross streets, all containing filthy water and the decomposing 
animal and vegetable matter in the kitchen, laundry, cesspool overflow, 
with some considerable manufacturing waste, all oif which could neither 
run off nor dry up. 

Such was the condition of the drains in the lower wards of the city. 
Had our forefathers only maintained in these drains a level bottom, and 
continued these to the western extremity of the peninsula, there they 
would have reached a marsh formation — the great marshes of the 
Ashley river — overflowed at every tide, and which would only have 
required the construction of an embankment and inward swinging gate, 
by which a head of water could be got at any time and at every tide, 
thus giving a perpetual current through every drain running from west 
to east, and thereby maintained a degree of cleanliness, an object of 
admirable application of the force of nature, as well as of great utility 
in the prevention of epidemical diseases, by the speedy removal of 
decomposition, etc., etc. The correction of these erroneous constructions 
is even now not beyond hope of rectification, as the extensive water 
parks, the property of the city, may be applied to the useful purpose. 

This condition of things led to excessive moisture, visible in the 
shape of mists and fog^ composed of poisonous gases, the products 
of decomposing matter mixed with watery vapors arising from such 
excessive dampness. From these magazines of rottenness miasmata are 
extensively liberated and diffused, in those barometric states of the 
atmosphere when the air is the lightest, when the bodily strength is 
most depressed, and the entire system of the human being most sus- 
ceptible to an extreme cause of diseases of the very worst types. The 
rise of tide partly filling the drains would, from compression, drive out 
with force the noxious gases, much lighter than the atmospheric air, 
through the house connections and gratings, of which there were always 



TIDAL DRAIN SYSTEM OF CHARLESTON, S, C. 239 

too many on the streets, and in the atmosphere all around ; and par- 
ticularly so in winter, when at night and day the doors and windows 
are closed, the fires and columns of light, heated air in the chimney flues 
being at work, drawing and opening a channel for the movement of 
the fatal poison into our habitations. No effectual trapped inlets then 
existed, nor would they have controlled the pressure of the rising 
tide in the absence of some other channel for ventilation through 
p]p>es carried up to the roofs of houses, or by means of perforated man- 
hole covers with iron baskets attached, containing powerful disinfectants, 
as is practised particularly in the city of London. 

This condition of things called forth letters from the gentlemen of the 
medical profession. I remember reading some years since, on glancing 
over the files of the City Gazette of 1822, an article with head-line "The 
Strangers' Fever." It was from the pen of Dr. Samuel Prioleau, in 
which he traced the cause of this fever, — typhoids, consumption, in fact, 
all the zymotic diseases, — to the gaseous emanations from these sewers, 
which, being compressed by the dew at night, and not driven back into 
the drains on account of the resistance met by the rising tide, would form 
a vapor through the entire city of seven to eight feet in height, and would 
be taken into the system, producing the fever, which became perennial, 
and known as yellow-fever. 

In 1 854-1 858, just two years before the the tidal drains were built, and 
during their construction, Charleston was visited by the severest epi- 
demic of yellow-fever ever known ; the natives took it and died of it. 
I remember two of my brothers having it, and being seriously ill, in 
1854. 

We have seen the serious evils caused by the old city drains. The 
time for action in 1854 had now arrived to accomplish not only a very 
necessary, but a great and good, work. Penalties were inflicted on citi- 
zens for not filling up their low lots — drainage of rain-fall from under 
houses and in cellars. Ponds of stagnant water existed in many parts of 
the city. The soil was a constant bed of wet earth. No temporary ar- 
rangement with the force of the inspectors could satisfy these troublous 
anxieties, and no means within the power of the committee on health 
and drainage could obviate and relieve the many complaints of physi- 
cians and citizens. The evil was radical, and the remedy must be radi- 
cally administered, or the large number of causes of diseases and deaths 
must continue to increase with the number of the augmenting popula- 
tion. Foreigners who came to dwell with us were in anxiety and fear of 
sickness. 

The authority to stay the plague was with the city council, which was 
not slow in giving a proper impetus and in taking favorable action in 
carrying out a work which promised the greatest good for the city. The 
Committee on Health and Drainage were, therefore, charged with the duty 
of preparing a suitable plan for the drainage and sewerage of the city, and 
to report as soon as tlieir plan was matured. Its report was unanimously 
in favor of the Tidal Drain System, which was adopted and ordered to 



240 TIDAL DRAIN SYSTEM OF CHARLESTON, S, C, 

be constructed in 1856. I can but quote the beautiful and forcible con- 
cluding paragraph in the appeal to the council, and which reads thus : 
^' To obtain health and happiness communities have expended millions: 
we only call for thousands, and even assume a portion of that expendi- 
ture. Our soil and climate demand the pecuniary sacrifice, as some may 
consider it, and if we refuse it, we retain our money at the cost of our 
lives. We bargain for a miser's grave instead of a garden of Eden into 
which this beautiful city can be made from its geographical position ; 
where old age without care, and years without infirmity, may bless the 
rising generation and teach them to call this city council ' blessed.' " 

A description of the Tidal Drain System will now be in order, and 
from which you will fully understand and realize the important office 
it fills, compared with the unsanitary appliances which existed before 
its introduction. 

After a full inquiry as to the various modes of drainage proposed by 
the best scientists and engineers in Europe and in this country, and a 
careful study of the whole subject in its most minute details, this tidal 
system was adopted as the one best suited to the low and level position 
of Charleston, situated on a narrow tongue of land from one half to three 
quarters of a mile wide between two rivers, the Cooper and Ashley, both 
feeling the full influence of the tidal wave, the mean rise of which is 5.1 
feet, spring-tide 6.5, storm-tide 9.5 above mean low-water plane Charles- 
ton Harbor, B. M. ; of which reading 11.875 is established on the N. E. 
end of the first step of the United States Custom House. 

The height of this tongue of land in its natural formation ranges from 
9 to 20 feet, a great part of it not more than 10 to 13 feet ; and the artifi- 
cial formation, consisting of all that portion covering all the inlets on 
both rivers, made up for the greater part with filling of city offal and 
rubbish, pine wood, rice chaflf, and saw-dust, being but 5 to 7 feet above 
said plane, and presenting a dead level submerged by every spring tide. 
In a comprehensive study of a system or plan of drainage, therefore, owing 
to the slight elevation of the surface above the lowest tidal plane, it was 
very clear that drains with inclinations were not at all adapted, but that 
it required deep-seated and extensive channels of proper capacity, placed 
at the lowest levels possible, to receive the percoFation of the soil and 
cellars, and planned and constructed in such manner as to be readily 
and frequently washed out by the influence of tides, discharging their 
contents at every fall of the tides into the rivers. As an instance of the 
drainage influence, and the reduction of the level of water in the soil of 
the city, I can say, from my own observation and that of many citzens, 
that the water which stood three feet from the surface in the wells^ and 
in the lots on the streets and adjacent streets to the line of these drains, 
was found after the completion of the drains to be 10 to i§ feet below 
the level of the surface ; in other words, the city was raised just so many 
feet above what may be called the plane of constant saturation or moist- 
ure. It has been held, and properly so, that these drains, well cared for 
and properly worked, have contributed much to the exemption of the city 



TIDAL DRAIN SYSTEM OF CHARLESTON, S. C. 24I 

from those perennial diseases which are so common in warm climates ; 
and many thinking citizens and sanitarians hold that to the neglect of the 
system of working them and its consequences are owed not alone the 
prevalence of yellow-fever in 1871 but in the remarkable amount of mor- 
tallity from this disease. It is scarcely necessary for me to explain at 
any length the principles upon which these drains are properly worked, 
as will hereinafter appear. The whole subject was fully and clearly 
explained in the reports of Dr. William T. Wragg, Prof. William Hume, 
and Mr. James M. Eason, mechanical engineer, in 1855 — 1856, all of 
whom have long since passed away. They were valuable members of 
the city council, and on account of their integrity, energy, scientific and 
practical information, possessed ability to handle the difficult problems 
with which they were charged as the special committee on cleaning of 
streets, filling low lots, disposal of ofifal, drainage and sewerage : hence 
their selection as a special body to study and report on the important sub- 
ject referred to them. To their far-sightedness, painstaking researches, 
and correspondence to arrive at the best plan in this matter the city of 
Charleston owes much. 

LOCATION OF DRAINS. 

The tidal drain starts from the extremity of Chestnut street on Gadsden 
creek which leads into the Ashley river, and passing into Spring street 
follows it to Meeting street, and then runs down Meeting street to the. 
White Point Garden wall. At the intersection of Meeting and Calhoun 
streets, one branch runs eastward down Calhoun street to the Cooper 
river, and another westward to Bennett's mill pond. From this second 
branch there also runs a line southward through Coming, Mazyck, and 
Limehouse streets to the Ashley river. There were five mouths to this 
system, — No. i, Chestnut street ; No. 2, east end of Calhoun street ; No. 3, 
White Point Garden wall ; No. 4, Limehouse street ; No. 5, west end of 
Calhoun street (recently removed). Each mouth is provided with a gate 
which may open or close it. 

The bottom of the drain was intended to form a continuous level, at 
the elevation of i .66 feet above the plane of mean low-tide, so that the 
accumulated tide-water is free to move in any direction to the nearest out- 
let or mouth which it is desired to flush by the operation of gates and 
slide, as hereinafter explained. 

From the elevation of the rise and fall of tide in Charleston harbor, 
and from many observations made particularly of the fall of tide, it was 
calculated that two and a half hours could be obtained for a clean drain- 
age of the entire system ; and when the winds prevailed from the west, 
3 hours could be got ; hence the elevation of the bottom was placed at 
the level of 1.66 feet, as well adapted to a tidal system. 

The average cutting or depth of excavation was from ten to twelve 
feet, which reached a running or quick-sand formation. Piling was be- 
lieved to be unnecessary ; for, where the marsh ravines formerly existed. 



242 TIDAL DRAIN SYSTEM OF CHARLESTON, S. C. 

it was supposed that ample support could be obtained by extending the 
planking laterally a few feet beyond the walls of the drain. 

The planks were two inches thick by twelve wide. Two of them, one 
under each wall and running in its direction, were first laid, then others 
crossing them and projecting six inches beyond the masonry ; forming a 
continuous floor upon which the foundation and walls were built, and 
which was also designed to receive the masonry of a ^ ^segmental invert," 
which was unfortunately omitted, the plank flooring having been used as 
the bottom. The size of the drain is three and a half feet wide in the 
clear, by four feet and a half high to the springing of the arch from the 
chord of the invert. The walls are one and a half bricks, or 14 inches 
thick ; the arches formed in two courses, laid co-centric and on edge, 
nine inches thick. The invert was to have been a segment with radius 
of three feet six inches, and versine of six inches ; the bricks were to be 
specially moulded for the purpose. 

ON FLUSHING OF SEWERS. 

The method of cleaning sewers built on a dead level, and in which 
matter accumulates, by flushing water through them, was practised to a 
great extent in the Holbom and Finsbury division of sewers, and has 
been adopted by the metropolitan commission of sewers, London. Messrs. 
Roe and Wicksted, civil engineers, of England, presented to both houses 
of parliament in 1850- 185 2, by command of her majesty, a report en- 
titled ^'Minutes of Information," collected from experiments made with 
reference to works for the removal of soil-water, or drainage of dwelling- 
houses and public edifices, and for the drainage, sewerage, and cleaning 
of sites of towns. Mr. Roe, the consulting engineer to the commission, 
reported a series of experiments on the velocity of water dammed up to 
various heights in sewers built on a dead level, by which he found that 
he could, by a head of water varying from ten inches to four feet, obtain 
a velocity of very nearly three feet to nine feet per second. It cannot be 
reasonably doubted that, with a head of four feet, a thorough cleansing 
can be effected by this system. 

As the tide flows and ebbs twice in twenty-four hours, it is possible, 
therefore, twice in twenty-four hours to scour and flush out the drain by 
simply opening or closing the gates or slides at the hours indicated in a 
tabulated statement which the city engineer had furnished. 

The proper manner of working the drain-gates, and slide is this : The 
drains at low tide being empty and the gates closed, one gate (usually 
No. I, for reason given) is opened at about one hour before high tide, 
the water rushes in with a four-feet height, sometimes greater, and there- 
fore with an increasing and variable head, and in two hours will fill the 
entire system of five and one half miles in length. Just think of the scour- 
ing force I At the expiration of two hours, that is, one hour after the 
high tide, when the Ashley river is about the same level at which it was 
when the gate was first opened, the same gate is again shut, and the 



TIDAL DRAIN SYSTEM OF CHARLESTON, S, C. 243 

vrater in the drains is kept in until one hour before low tide ; then another 
gate (say No. 2) is opened, and the water rushes out with a velocity due 
to four feet or more of head, and in two hours, that is, one hour after 
low tide, the drains are entirely emptied ; this gate (No. 2) is then shut, 
and the drains are kept empty until one hour before the next high tide, 
when the drains will again be filled as before. 

The water is best taken in at gate No. i , because there the tide- water 
has already dropped much of the silt with which it is charged at the bar 
and in the lower harbor. By an intercolation of the hours of high and 
low tides a tabulated form was prepared by the city engineer many years 
since, to show the hour and minute of opening and closing the gate for 
successfully scouring and flushing out the drains in the manner above 
described. I was present on several occasions to witness the flushing 
some twelve years since, and found the current had suflicient force to 
drive a half brick thirty feet or more beyond the mouth of the outlet. 

A special modification by ordinance in reference to the opening and 
closing of the gates, which seriously interfered with the work of cleaning 
them out by flushing, was introduced for the sake of the Are department, 
and is still in force. It was hoped that it would have been repealed as 
soon as the city had made a contract with the Charleston water com- 
pany, which promised so bountiful a supply of water for fire protection. 
It is this : At the low tide in the beginning or next preceding the com- 
mencement of night, the drains were not to be emptied ; on the contrary, 
the water was to be held over until the subsequent low tide. This was 
done in- order that the fire department, in case of fire at night, might 
have in these drains a vast supply of water. The result of this suspen- 
sion of the operation of flushing for nine days of the month, during 
which the tide was allowed to enter, highly charged with silted matter of 
the flood, which was never let out during that period, allowed the quies- 
cent tide-water to deposit its tribute to swell the accumulations already 
in the drains. The neglect of those years, during which the mouths 
were all left open and the tide-water entered and flowed out as freely as 
in so many rice-field ditches, resulted in filling them with sand and silt, 
until in many places they were completely choked. 

CONDITION OF THE PRESENT DRAINS. 

A thorough examination with .the level, to determine the present con- 
dition of the drains and the relative position of bottom with mean low 
water as originally built, was made by order of Mayor Bryan, and I sub- 
mit the accompanying map of streets in which they are located, with 
profiles showing the present shape of the bottom throughout, compared 
with its original elevation. As you will see, the present bottom is very 
irregular and undulating, at some points varying two feet or more. This 
disturbance, in my judgment, is due to two causes : first, the repeated 
scouring by the force of a full head of tide rushing in and washing out 
the sand formation under the planked flooring of which the bottom was 



244 TIDAL DRAIN SYSTEM OF CHARLESTON, S, C 

made, upon rejecting a construction with masonry invert recommended 
by the committee ; second, to the earthquake, which I am satisfied caused 
an upheaval or vertical movement of tlie marl formation underlying the 
sand stratum, thus disturbing the dead-level grade used in the original 
construction. The second cause is not at all improbable, for shortly 
after that very serious occurence we observed many cavities and fissures 
throughout the city, the sinking down and turning of monuments and 
houses on their bases, and lateral movements of the edge of land on the 
marsh formations to the extent of seven and eight feet, besides the varia- 
tion in elevation of Bench Marks from three to twelve inches. 



PROPOSED EXTENSION TO COMPLETE SYSTEM. 

The extension of the Tidal Drain System by two leading mains ex- 
tending and running north and south through the principal streets in the 
western and eastern portion of the city, where the elevation of surface of 
ground is not more than six to seven feet above the mean low-water 
plane, will give outlets for the discharge of a system of cross-drains con- 
structed with descending gradients, and made up of smaller drains of 
studied capacity and inclinations, having falls both ways from their sum- 
mits, at the points midway between the two neighboring longitudinal 
streets, and then debouching or having their mouths in the main drains of 
those longitudinal streets. The scouring and flushing out of this smaller 
system will be done by automatic flush tanks at the points of summit. 
The scouring of the tidal drains at pleasure by a uniform head of salt 
water, and at any time of day on the falling of tides, will be accom- 
plished by building a ''reserve," which can be formed by constructing a 
dam around and enclosing a considerable part of the marsh and a part of 
two small creeks opposite gate No. i . From this large body of water 
thus retained, even a full head of five feet could at any time, after four 
hours fall of tide, be sent through the drains by means of an inverted 
siphon connection or by a cylindrical wooden penstock, without inter- 
rupting the navigation of the creek. The water thus obtained from sub- 
sidence would have very little matter in suspension, and hence be better 
suited as an inexhaustible supply for the fire department, than the water 
from the inflowing tide, which is charged with fine sand, and detrimen- 
tal to the machinery of the fire steamers. 

These items — the extension of the system, its cross-drains, as well as 
the construction of a dam forming a reservoir of over 20,000,000 gallons 
to fill the drains at all times for fire protection in the absence of high 
tides or failure of the water-works to furnish an adequate supply — are 
important questions, which will require special examination and study at 
a later period. They can well be deferred until the completion of the 
preliminary and all-important work which has to be done now to the 
drain bottom, walls, and gates, in order to ensure for the future a general, 
successful and satisfactory working of the tidal system, which many of 
you will agree with me is the most applicable, advantageous, and eco- 



TIDAL DRAIN SYSTEM OF CHARLESTON, S, C. 245 

Domical one for a city whose surface formation is so level and of such 
slight elevation above the tide-mark. It does away with the difficulty 
presented in sewers with inclinations, which, debouching at low-tide 
mark, would rise to such height in a very short distance on their ascent 
as to place them too high to answer the very important purpose of reliev- 
ing low lots and cellars of water ; and again, if so designed and built at 
such depths to meet this requirement, they would, besides their large 
constructive cost, require the costly appendages of large pumps or re- 
ceiving wells, and expensive pumping machinery, which, outside of their 
original cost, will require for annual maintenance and repairs at least 
$12,000 to $15,000. 

In conclusion, I will say that the true question to decide about a system 
is one of economy of cost and advantage as to location and character of 
the formation of a city ; and, whatsoever plan of drains and sewers may 
be adopted, whether the seperate, combined, doubled, or what else, it 
must present at the smallest cost, the most effectual, practical, and advan- 
tageous results, in comparison with the Tidal Drain System, which can 
be kept clean by tidal currents and the very simple operation of opening 
and closing improved and easily worked gates or slides. 



xxxn. 

THE MICROSCOPICAL, SPECTROSCOPICAL, AND CHEMI- 

CAL ANALYSIS OF BLACK VOMIT AS AN AID TO 

HEALTH OFFICERS IN THE DIFFERENTIAL 

DIAGNOSIS OF YELLOW-FEVER AND 

MALARIAL FEVERS. 

By G£0RG£ T. KEMP, M. D., Ph. D., Hoagland Laboratory, 
Brooklyn, N, K 

Two years ago I undertook, at the suggestion of Dr. Sternberg, a 
chemical and spectroscopical examination of the black vomit of yellow- 
fever, in order to determine the source of the pigment to which the color 
of this vomit is due. While carrying on this work, it happened that I 
was able to obtain some black vomit from cases of those malarial fevers 
which sometimes simulate yellow-fever so closely as to give difficulty in 
making a positive diagnosis. Two specimens of black vomit which I 
obtained from malarial cases presented certain characteristics in common, 
and were also markedly different from the vomit of five cases of undoubted 
yellow-fever, so that I undertook a careful study of the question in hopes 
of discovering differences in the vomit of yellow-fever and of malarial 
fevers respectively — differences which could easily be determined by the 
spectroscope if not by the microscope, and which would enable a health 
officer, upon the arrival of a questionable case in his city, to assure the 
people that the case was not one of yellow-fever, or, in event of the op- 
posite diagnosis, to determine without delay what action to take in the 
matter. 

A spectroscopic analysis of the black vomit of all five cases of un- 
doubted yellow-fever showed beyond question the presence of black pig- 
ment, and failed to detect any other pigment. In three out of the five 
cases the characteristic absorption bands of oxyhemoglobin were plainly 
seen, showing that the blood had not all been decomposed by the action 
of the juices in the stomach. In the other two cases the pigment was 
present as methemoglobin. In all five cases, treating with acetic acid 
gave acid-hematin ; rendering alkaline with ammonia gave alkaline-hem- 
atin, and reducing this with Stokes's fluid gave the characteristic double 
bands of reduced alkaline-hematin. This latter is the most satisfactory 
test when the pigment existed in the vomit as methemoglobin. The 
vomit, though distinctly acid in all five cases, was not sufficiently so to 
transform the pigment into acid-hematin. In all the cases of undoubted 
yellow-fever, blood corpuscles could be detected in the vomit by the use 



ANALYSIS OF BLACK VOMIT. 247 

of the microscope, though I do not insist upon their being universally recog- 
nizable, as competent observers working on a larger number of cases 
have sometimes failed to find them. They are usually found in clumps, 
and the individual corpuscles may be detected on the edge of such clumps, 
or detached and lying in the vicinity. The vomit from all five cases con- 
tained distinct coffee-ground flakes in a clear liquid, which, in two cases, 
after being kept for some time, acquired a distinct red color from oxy- 
hemoglobin. It did not contain bile, although the quantity obtained for 
analysis was always too small to make a satisfactory examination for this 
by isolating the pigments and bile salts. 

THE BLACK VOMIT OF MALARIAL FEVERS. 

The black vomit of malarial fevers was never as acid as that of 
yellow-fever, and was always more or less grumous, and of a muddy 
brown with a faint suggestion of a greenish tint. It always contained 
bile salts as well as bile pigment. Microscopical examination showed 
clumps of brownish material, in which altered blood corpuscles might 
have been detected, but never without a slight draught on the imagina- 
tion. Leucin and tyrosin crystals were abundant in one specimen, and 
sparse in another. Clumps of brownish, radiating, rod-like structures 
were seen in both cases. These sometimes strongly resembled tyrosin 
crystals in their arrangements, but on treating with dilute caustic potash 
the pigment only was dissolved out, leaving behind the clumps of bacilli, 
which broke up into individuals under the action of the caustic potash. 

The spectroscopical examination in neither case revealed oxyhemo- 
globin, which would have shown the presence of undecomposed blood. 
On treating with acid, and then with alkali and Stokes's fluid, however, 
the absorption bands of reduced alkaline-hematin were obtained, show- 
ing beyond question the presence of altered blood pigment here as well 
as in yellow-fever. Once in each specimen, while examining for the 
spectrum of acid-hematin, I saw a band which had not been described 
as belonging to blood pigment, and which I had hoped would possibly 
yield a constant point of difference which could always be detected ; but 
I was subsequently convinced that this was most probably a modified 
derivative of the bile pigments, and the question resolved itself into the 
determination of the presence of bile, which can be done more easily than 
by the spectroscope. In short, therefore, the chief source of pigments 
in the black vomit of yellow-fever, and also of malarial fevers, is the 
pigment of blood acted on by the juices of the stomach. In addition to 
this the vomit of malarial fevers contains both bile pigments and bile 
salts in considerable quantity, showing that the regurgitation of the bile 
into the stomach in malarial fevers is the rule, while in yellow-fever 
(after the first few days) it seldom or never occurs. I find, by referring 
to authorities, that the secretion of bile is greatly diminished in yellow- 
. fever, and Schmidt says it may even be suspended. If, therefore, a 
patient with black vomit is brought in, who is not in condition to give an 



248 ANALYSIS OF BLACK VOMIT. 

intelligent history from which to make a diagnosis, but who is known to 
have been sick for several days, an examination of the black vomit may 
help us considerably in determining whether or not we have yellow-fever 
to deal with. If the vomit is markedly acid, and is composed of coffee- 
ground flakes in a clear, colorless, yellow or red fluid, if these flakes are 
seen to contain red blood corpuscles which can be distinguished as such, 
and if the vomit contains no bile (especially bile salts) , we have probably 
a case of yellow-fever on our hands. If, on the other hand, the vomit is 
feebly acid, thick, grumous, and of a dirty brownish green color, and if 
a careful chemical examination shows the presence of a bile more or less 
abundant, the probability is that we have to deal with a malarial 
fever. 

I have not deemed it necessary to tire the Association with details of 
physiological chemistry involved in these examinations : they can be 
found in standard works on the subject. 

I regret not having had a larger run of cases, from which I might pos- 
sibly have drawn more definite conclusions ; but cases of malarial fever 
with black vomit are rare — at least, we get very few of them in New 
York — and, as I may not be able in the future to continue my investi- 
gation on this subject, I thought it best to present this short account of 
what I had done, hoping that others would take up the work along the 
same line, and feeling sure that I have offered for differential diagnosis 
something suggestive, though not conclusive. That blood is the only 
constant source of the pigment in black vomit of yellow-fever I regard 
as settled beyond doubt. There may be, at times, pigment produced by 
chromogenic bacteria or other pigments ; but these are not constant, and 
are purely accidental complications. 

I reserve for special report a case which I examined this fall at the 
Quarantine hospital on Swinburne island, in New York bay ; and here 
I would take occasion to express my appreciation of the kindness of Dr. 
Wm. M. Smith, health officer of New York, who not only allowed me 
to fit up a laboratory for making these investigations at the Quarantine 
hospital, but showed me every courtesy and gave me every assistance 
possible during the prosecution of my work. The case came in on a steamer 
from various West Indian ports, all of which furnished a clean bill of 
health. The crew had landed at only one port (Cienfiiegos) , which, as 
above stated, was declared to be free from disease. The patient was 
taken sick while at sea, but was up and down and on deck every day 
during the voyage. He was sent first to the Marine hospital, and thence 
to quarantine. Admitted to the latter, the patient seemed dull, but 
could be roused to talk connectedly and answer questions intelligently ; 
skin and sclerotic slightly jaundiced ; tongue dry, brown on margins, and 
morbidly clean; dry in centre; pulse 100; temperature 101°; respira- 
tion 25 ; urine about normal in quantity, markedly albuminous. Patient 
grew progressively weaker ; did not vomit. Nausea felt once after tak- 
ing nourishment. Had convulsion — probably urasmic — and died dur- 
ing the night (3 A. m.). This history was given to me by Dr. Smith. 



ANALYSIS OF BLACK VOMIT. 249 

When the telegram reached me announcing a case at quarantine, I was 
out of the city, and did not arrive until 9 a. m*. the next morning, five 
hours after his death. From the appearance of the patient and the 
scant history. Dr. Smith was inclined to doubt its being yellow-fever in 
spite of the albuminous urine. He was of the same opinion after seeing 
the gross pathological lesion at the autopsy. The patient had never had 
black vomit, but a quantity of a dark-brown, grumous material was 
found in his stomach, and this answered exactly the description I have 
given of the black vomit of malarial fevers, except in the absence of 
clumps of brownish bacteria, which were decolorized and floated apart 
under treatment with dilute caustic potash. Bile was present, — both bile 
salts and bile pigment. There were many more epithelial cells from the 
stomach's mucous membrane than I had ever seen in malarial vomit. 
From an examination of the vomit alone, if the man had vomited this 
matter, I should have thought the case more probably a case of malarial 
fever, thus agreeing with Dr. Smith. 

From a microscopical examination of the liver, spleen, and kidney, 
however, I was led to think otherwise. The liver was fatty (which is 
the rule in yellow-fever, and the exception in malarial fevers), and did 
not contain dark pigment granules. The spleen, was not enlarged^ 
and was free from the pigment so characteristic of malaria. The 
kidney showed acute parenchymatous nephritis, and the urine contained 
albumen and granular casts. From these findings I must say that I regard 
the case as one of genuine yellow-fever. The contents of the stomach, 
as far as bile is concerned, certainly came fully within the description which 
I have given as throwing the chances in favor of a diagnosis of malarial 
rather than of yellow-fever, and if the case was one of genuine yellow- 
fever, I must cite it as an instance in which the test I suggested did not hold 
good. Qn the other hand, — as Dr. Smith is still of the opinion that the 
case was not one of yellow-fever, and as his experience with yellow-fever 
is a very large one, extending over a number of years, and far exceeding 
my own, — I may take the liberty of quoting him against myself in the 
diagnosis of this case, and say that if he is right and I am in error, the 
test still holds good. I have tried to obtain a fuller clinical history of 
this case before it reached quarantine, but up to this time have been 
unable to do so. A full clinical history would do much to settle the 
diagnosis. 

In conclusion, I must again call attention to the fact that this work does 
not claim to furnish a hard-and-fast test for differential diagnosis, but is 
simply an account of some unfinished work, which I shall probably have 
to abandon, which has thus far led to suggestive results, and which I 
now bring before you, hoping that others who may take up work in this 
field in the future may find them of service. 

The following communications have been received, in reply to requests 
for further information on the case, since the foregoing account of it was 
read at the Charleston meeting : 



250 ANALYSIS OF BLACK VOMIT. 

U. S. Marinr Hospital Service, 
Middle Atlantic District, Port of New York, 
Stapleton, Dec. 15, 189a 
Dear Doctor Kemp: Your letter of the 12th inst. is at hand. I am sorry at the 
delay. . . . You have not given any Charleston address, so I send this to the Ameri- 
can Public Health Association. I enclose you a memorandum of the case, such as you 
require. I do hope that it may reach you in time. Sincerely yours, 

Jos. J. KlNYOUN. 

W C s, aet. 22, Ireland, seaman, of S. S. S , admitted to Marine hospital. 

New York, October i8th, 1890, and gave the following history: Landed in Cienfuegos 
ten days before, when he and a shipmate went ashore. On the sixth day thereafter, while 
at sea, he was seized with a chill lasting him for about an hour ; this was followed by a 
fever, from which he was suffering on admission to the hospital. 

From the inception of the disease he has been troubled with nausea and vomiting ; 
pains in the back and limbs ; he gives a history of having chilly sensations, but no rigor ; 
has never had any remission followed by sweating. (This was confirmed by his ship- 
mates.) Physical examination : The skin was of a peculiar yellow color ; eyes injected, 
' and sclerous, tinged with yellow; expression apathetic ; tongue pointed, and covered with 
a light fur ; great pain and pressure over the liver and spleen, also tenderness over the 
whole of the abdomen ; spleen not notably enlarged ; urine scanty, loaded with albumen, 
and contained a large number of casts. Patient has not slept any since the attack came 
on. 

October i8th. Morning. Evening. 19th. Morning. Evening. 

Temperature, 37.4** 38.2** 38.2*' 38.2** 

Pulse, 72 78 72 72 

Respiration, 16 '14 18 19 

Urine, twenty-four hours, 365CC. 
Transferred to quarantine, October 21st, 1890. 

J. J. K. 

Health Officer's Department, State of New York. 
Quarantine, S. I., March 17, 1891. 
To Dr, George T Kemp : 

Dear Doctor: Your communication in relation to the case in question wms received 
while I was too ill to make any acknowledgment or reply. 

I have made a very careful study of this man's case. 

The deputy relied upon the declaration of the captain and purser of the ship, that 
there had been no sickness during the voyage, to which declaration the captain fixed his 
sign manual, and the usual inspection of having the crew pass before the doctor on call- 
ing the roll. 

If the disease was yellow-fever . I had determined to prosecute the captain, and was 
quite anxious to determine the truth of this for the purpose of holding him to a strict 
accountability and punishment. 

My reasons for considering the case one of ** pernicious remittent fever " I give below. 
In this place let me say, in reference to the spleen, that while it was not characteristic of 
malarial fever, as shown by the autopsy, the weight exceeded the average by %% ounces. 

In the case of C e , his associate fireman, who was taken at the same time as C s 

and died in Brooklyn about the same time that C s died, those who made the autopsy 

state that the spleen was seventy per cent, larger than normal. 

The symptoms in the case of C s warrant the conclusion that the man died of "per- 
nicious remittent fever," complicated by constitutional and acquired conditions. Many of 
the symptoms of yellow-fever were absent, and those which indicated that disease were 
not improbably the result of lesions quite independent of that disease. This conclusion 
is reached in view of the following facts : 

First, The time of the invasion of the disease was very certainly determined by the 
patient's story (and it was confirmed by the chief engineer) to be the evening of the sixth 



ANALYSIS OF BLACK VOMIT, 25 1 

day after leaving Cienf aegos. This was the only place where the man was on or near the 
shore until he reached Nassau. This time exceeds the incubative period of the disease 
of yellow-fever. Five days have been considered as the extent of the danger line in the 
development of this disease under the administration of my predecessors at the New 
York quarantine, as it has in that of the present health officer. 

During the eleven years past vessels from infected ports during the infectious season 
have only been detained until five days have elapsed from their departure from the in- 
fected port. Hundreds of voyages have been made each year during this period by 
steamers that come from infected ports in the West Indies to this port, and they have 
only been required to complete five days at quarantine before proceeding to the wharves 
of the dty. Not a case of the disease has ever developed after the expiration of that 
time. In the few instances that have occurred in which cases of yellow-fever have been 
discovered after passing quarantine, it has been found that the invasion period of the 
disease occurred within five days after a possible exposure to the infection, and was con- 
cealed at quarantine by the officers of the steamer, or by the patient himself. Experi- 
ence and pretty careful observation have established the conviction that the infection of 
yellow-fever has a period of incubation as definite as small-pox, measles, and other con- 
tagious diseases ; and that the period of yellow-fever is less than five days. Instances 
have been given in which the time of both the reception and the development of the in- 
fection was well established. In every instance referred to, the period of the incubation 
was less than five days. 

In those cases in which the development of the disease has been apparently prolonged, 
the invasion is so mild that the patient himself misapprehends the character of the dis- 
ease, and does not complain to friends, or, if on shipboard, does not report to the proper 
officer of the vessel. 

Second* Some consideration must be given to the fact that the United States consul at 
Cienfuegos had given clean bills of health during the past season. However derelict at 
some of the West Indian and South American ports consuls may be in giving a full and 
correct report of the infectious and contagious diseases at the ports where they are ac- 
credited, this cannot be often charged to our consuls at Cuban ports. Their reports have 
been uniformly full, and they have been faithful in the discharge of this important duty. 

Third, The disease in C s*s case was ushered in with a chill, followed on several suc- 
cessive days by chills of greater or less severity. This was the statement of the patient 
when admitted to the quarantine hospital, and it was confirmed by the engineer. 

Chills in the invasion of yellow-fever, or at any subsequent stage of the disease, are as 
infrequent as is their absence in intermittents ; and when they do occur, they are doubt- 
less associated with malarial conditions to which the system has been subjected previous 
to, or in connection with, the exposure to the infection of yellow-fever. 

There is in uncomplicated yellow-fever an entire absence of periodicity. In fevers 
which have a malarial origin, although differing much in their type, there is no character- 
istic so marked as pyrexial remissions and acerbations. In yellow-fever there is an entire 
absence of any remission such as chills indicate. When the only paroxysm of fever 
passes away, the one and only remission that succeeds terminates in convalesence or the 
collapse which precedes death. 

Fourth. The disproportion between the temperature and the pulse usual in yellow-fever 
did not exist. On admission the temperature of the patient was loi^ and the pulse 90. 
A high temperature and relatively slow pulse are characteristic of yellow-fever. When 
the temperature is 103® to 105® F., the pulse is frequently 80 to 90. 

Fifth. The secretion of urine after admission to the Quarantine hospital was fully up 
to the average in other fevers. At death the bladder contained about 14 ounces of urine. 

In severe cases of yellow-fever there is no symptom more common than a very scanty 
secretion from the kidneys, and in most fatal cases there is a total suppression for hours 
at least, and in some instances for a day or two previous to death. 

Sixth. The nausea and vomiting which occurred during the early stages of C s's case 

were entirely absent after his admission to the Swinburne Island hospital. In yellow- 
fever this is usually not only an early, but a persistent, symptom until death ensues ; and in 
most cases the ejecta toward the end have the chaf acteristic *' coffee-grounds *' appearance ; 
in other words, the ejecta are composed for the most part of mucus and the broken-down 



252 ANALYSIS OF BLACK VOMIT. 

blood corpuscles which have been discharged from the capillaries of the mucous mem- 
brane of the stomach. 

Seventh. There was no evidence shown by the autopsy of infiltrations from the capilla- 
ries of the sub-mucous membrane of the stomach, and none of the dark patches of ex- 
travasation which exist, and often color a large portion of the mucous membrane of 
the stomach in cases of yellow-fever attended by " black vomit" The cardiac end of the 
stomach was congested; the capillaries were enlarged, and distinctly traceable ; there 
were no echymosed spots ; the congestion seemed such a result as mechanical irritants 
produce, and the opinion formed at the time was that it was one of many evidences of 
the habitual excesses of the man during life. The congestion was not characteristic of 
pathological conditions found in cases of yellow-fever. 

Eighth. The contents of the stomach were feebly add, and the urine had a slightly add 
reaction. In yellow-fever the secretions are much more acid than in normal condition. 

The albuminous condition of the urine was one of the symptoms most suspidous of 
yellow-fever. While this condition always strengthens the presumption which other 
symptoms create, it is, however, not a diagnostic symptom or condition. 

Other diseases than yellow-fever have this albuminous condition of the urine : it is not 
unfrequently found in cases of tropical fever. The following instances are interesting as 
illustrating this statement: 

The medical officer of the steamship C , of the Pacific Mail S. S. Co., passed quar- 
antine the 14th of June, 1889. He was taken ill the 8th of the same month, when en 
route from Aspinwall. The attack was ushered in with a chill, and succeeded by a 
temperature of 104^ F. ; for several days subsequently the remissions and pyrexia were 
well marked. After he arrived at his home in Brooklyn the health authorities of that dty 
conceived that the disease from which he suffered was yellow-fever, and directed his re- 
moval to the quarantine hospital. The doctor was received there early on the 20th. 
When he was admitted there were no symptoms of yellow-fever except the presence of 
albumen in the urine. Under the use of salines the albumen soon disappeared, and his 
convalesence was established. 

£. D. C arrived at quarantine, May 50th, 1889, on a steamer from Mexican ports, 

and touched at Havana. This man came on board at Tampico, where there had been no 
yellow-fever for a long time previously, and did not go ashore at any infected port en 
route to this port He was seriously ill on arrival at quarantine, although able to be on 
deck most of the time. This man died on the 7th of June following, eight days after 
admission to hospital. The symptoms in this case clearly indicated " pernicious remit- 
tent fever." The skin became jaundiced after admission. The secretion of urine was 
moderately free, and contained thirty per cent, of albumen from the time of admission. 
Portions of the liver, spleen, and kidneys were submitted to the pathologist of the New 
York hospital, Dr. Frank Ferguson, for examination. The above diagnosis was un- 
qualifiedly confirmed by Dr. Ferguson. 

Very truly yours, 

Wm. M. Smith, 

Health Oficer. 



xxxrn, 

EXPERIMENTS ON TRAP SIPHONAGE. 

By Prof. J. E. DENTON, Hoboken, N. J. 

The experimental data presented herein represent the results of 
experiments which have been in progress over a period of about a year 
at the Stevens Institute of Technology, having for their special object 
the determination of the ability of the McClellan Anti-Siphon Trap Vent 
to protect simple S traps against the suction influence due to the down- 
ward flow of water in waste-pipes, such as are common to plumbing 
construction. It is believed, however, that the ground covered involves 
so many data regarding trap siphonage in general, that the results may 
be consistently presented as a contribution, to the subject, of a fairly sci- 
entific character. 



Two lines of waste-pipe, 68 feet in height, were erected in an elevator 
shafl: at the Institute. One line was 4 inches and the other 2 inches in 
diameter, and both connected at the top to a tank X (Fig. i ) ," and at the 
bottom to sewer S, 6 inches in diameter, both pipes entering the latter 
through lengths of 4-inch iron pipe, arranged with a fresh-air inlet 
located at different distances as shown in Figs. 2 and 3. By the con- 
nections H, I, and J, 30 gallons of water could be discharged into either 
line of pipe through a i^inch orifice, or a 2-inch orifice, the flow in 
either case occurring through a running trap of the same diameter as 
the orifice. At various levels, la, i, 2, 3-6, on the 2-inch line, and A, B, 
C to F, on the 4-inch line, various traps and fixtures were attached and 
subjected to the conditions of siphonage available. An enlarged view of 
the tank and piping is shown in Fig. 4. The arrangement adopted for 
the measurement of the depth of seal is shown in Fig. 5. A |-inch glass 
tube A was connected with the lowest point of the trap by |-inch piping, 
and the level of the water measured from the shoulder formed by the ell at 
the bottom of the tube. The trap was i^inch diameter, and was sol- 
dered into the tee B. The pipe C connected with the vertical waste 
line by a tee similar to B. The length of the branch C varied from 12 
to 18 inches. 

1 The writer is indebted to the experimental work of Waring, Philbrick, Bowditch, Putnam 
Brown, and Hellyer for valuable suggestions and facts. 
* For Figs. I, 2, 3, 4, and 5, see pp. 254 and 255. 



254 



EXPERIMENTS ON TRAP SIPHONAGE. 



FlwiKirtg Zbtnfe, |g iJi\JOCal{ons Capacity 












^Titi. 



riffi 






Floor. 
S 



Fl^i^. 



K 



-^ 



^»t. 



J' 1 ^ 






Floor. 



^ 
^ 






t ?^ 



1^ 



3a9a7nerit 




Bcwe?n«nt. 

IP 



j-e;^ 



.2 



EXPERIMENTS ON TRAP SIPffONAGE, 



^SS 







Fig. 5. 



256 EXPERIMENTS ON TRAP SIPHONAGE, 

CONDITIONS AFFORDING MAXIMUM SIPHONAGE EFFECTS. 

It IS natural to conceive that the greatest vacuum or suction will be 
produced when a waste-pipe is supplied with a jet of water of the same 
diameter as the pipe. Also it seems to be frequently assumed that the 
greatest vacuum with a given stream of water will occur at the lowest 
fixture on a line of waste-pipe. Neither of these views, however, cor- 
responds with the facts. Thus, when the 2-inch pipe received the flow 
from the tank through the i^-inch connection, a mercury pressure gauge, 
connected at the joint la, showed 24 inches of vacuum; but when the 
2-inch orifice supplied the 2-inch waste-pipe, only 18} inches of vacuum 
was formed. Again : With the i^-inch supply, the mercury gauge, 
attached to joint 6, within about three feet of the lower end of the waste- 
pipe, registered only \\ inches of vacuum, and the 2-inch supply, f of an 
inch. The vacuum at intermediate heights is shown by the following 
table : 

TABLE I. 

Experiments with mercury column or vacuum gauge on a 2-inch waste-pipe, dosed at 
the top, discharging into a 4-inch soil-pipe which was open at its top. 



ion of mercury column. 


All vents closed. 




No. of joint. 


i>^-inch flush. 


2- 


inch flush. 


la 


24.0 inches. 




1875 inches. 


I 


24.0 




20.25 


2 


25.25 




22.5 


3 


'& 




19.0 


4 




12.5 


I 


8.25 




4.9 


1-5 




^'11 


Ime of discharge. 


29 seconds. 


32 


seconds. 



The cause of the superior vacuum with the i^-inch stream I believe 
to be the greater friction of the 2-inch stream, resulting in a less velocity 
of flow, and hence a less intensity of vacuum. Also, the smaller 
stream causes an induced current of air to accompany it, which 
increases the volume of displacement, and may have considerable 
effect in rarefying the air in the branches of the waste-pipe leading to 
the mercury column. The cause of the decrease of vacuum, as the 
mercury gauge is applied nearer to the bottom of the waste-pipe, is^ 
directly traceable to the dynamic ' principle controlling the pressure of a 

1 If a solid stream of water flows continaously, without friction, down a pipe 34 feet in length, open 
to the atmosphere at the lower end, the weight of the column above the bottom is equal to the 
atmospheric pressure, 14 7-10 pounds, or 30 inches of mercury. If, therefore, the vacuum gauge be 
applied at the bottom, it would show zero. Half way up the pipe it would show 15 inches of vacuum ; 
and at the top, 30 inches. If the pipe were made longer than 34 feet, the velocity would become 
greater than that due to the water flowing into a perfect vacuum at the top ; consequently, the 
stream must occupy a less area in proportion to the increased velocity. The atmosphere, there- 
fore, would have a chance to " back up " a pipe longer than 34 feet, and occupy the portion of 
the sectional area not required by the descending stream. In reality the descending stream is 
mixed with air, as may be seen by looking into the pipe through a glass plate properly illuminated. 
The above theory is, therefore, only approximately realized in an actual case. The velocity of flow,, 
for example, in the above table, corresponds to only 6 feet per second, whereas the theoretical 
velocity due to the height is 64 feet per second The distribution of pressures at different heights 
is, however, in general accordance with the theory. 



EXPERIMENTS ON TRAP SIPHON AGE, 257 

column of descending water. The law is, that the pressure of such a 
column shall vary at different levels, by amounts representing the weight 
of the column above the point of observation, just as though the water 
were at rest, or the pipe plugged at the bottom. Hence, the nearer 
to the bottom a fixture is attached, the greater the pressure of the 
water from the superincumbent column above, and hence the less the 
vacuum. 

Another striking fact is, that either a i J- or 2-inch stream delivered 
into a 4-inch waste-pipe will produce greater siphonage effect than the 
same streams in a 2-inch waste-pipe, and yet the vacuum registered by 
a gauge will not exceed f inches of mercury. For example : A f S lead 
trap, with i^-inch seal, attached at la on the 2-inch waste-pipe, closed 
at the top, with no running trap, is perfectly protected from siphonage 
by 13^ feet of i J-inch vent-pipe, or by a i^-inch McClellan vent, either 
with the i^ or 2-inch flush (see Appendix), whereas it is siphoned 
in seven seconds when applied at B, on the 4-iuch line closed at the 
top, by either stream of water. The reason of this is, that the current 
of air induced into motion by the water in the 4-inch pipe, although 
causing a rarefaction to the amount of only f inch of mercury, requires 
a supply of a far larger volume of fresh air, through the vent, to pro- 
tect the trap seal against this small amount of vacuum, at the seal, than 
is required to be supplied by the vent, in the case of a 2-inch waste-pipe, 
to protect the trap against 26 inches of vacuum. A 2-inch stream in a 
4-inch pipe does not, however, produce as great a siphonage influence 
as the same quantity of water discharged through a 4-inch opening into 
a 4-inch pipe. For example, 8 gallons of water delivered into a 4-inch 
pipe through a 2-inch stream was found not to siphon a f S trap at B 
(Fig. i), having i^inch seal, in less than three discharges, whereas the 
same quantity of water discharged into the 4-inch pipe, through a 4-inch 
opening, instantly siphoned the trap. A water seal of i^ inch is equiva- 
lent to about ^ inch of mercury. Hence, by the figures in Table i it 
is evident that the least siphonage influence of the i^ or 2-inch stream 
in either the 2-inch or 4-inch waste lines, closed at the top, should be 
sufficient to siphon a f S trap with i^inch seal if unprotected by any 
vent. Such was found to be the case. That is, such a trap placed at 
the lowest joints in either line was readily siphoned when not vented 
(see Appendix) . At the top of the 2-inch waste line, that is, at joint 
two, the siphonage effect with the 2-inch supply S was sufficiently 
severe, even with the top of the waste line open, to unseal various 
patent unvented traps. The following results illustrate this fact : 

Traps with ball seal, 

1. Cudell, by i discharge of 30 gallons in a 2-inch stream. 

2. Bower, ** " " 

3. Delehanty, 

4. Bennor, 



258 EXPERIMENTS ON TRAP S/PHONAGE. 

Traps with tortuous passages, 

5. Clarke, bottle, 13 discharges of 50 gallons in a 2-inch stream. 

6. Clarke, bottle, i " " " 

7. Puro, 45 " " 

8. Sanitas, 45 " " 

9. Connally, 22 " " 

(See Appendix. Sectional views of these traps are shown in Figs. 
6 to 14.)* 

In all the ball traps except the Bower, the seal due to the ball against 
its seat was not destroyed. More severe conditions of siphonage arise 
when the top of the waste-pipe is closed ; but, unless a trap is protected 
by a comparatively short vent-pipe, the above conditions are sufficiently 
severe to break its seal. This is shown by the following experiments, 
for the details of which see Appendix. 

PROTECTION AFFORDED BY VARIOUS LENGTHS OF VENT-PIPE. 

1. Two-inch supply into 2-inch waste line open at top. A f S trap 
attached at joint 2, and having i^inch seal protected by 35 feet of i^inch 
vent-pipe having three elbows^ was siphoned in one discharge of 30 gal- 
lons from the tank X (Fig. 1). With 25 feet of vent-pipe and three 
elbows the seal was broken by six discharges, the loss of seal from the 
first discharge being \\ inch. With 13^ feet of i^-inch vent-pipe with 
two elbows there was a continued loss of seal for four discharges, aggre- 
gating f inch, and then no further loss could be detected in six succeed- 
ing discharges. 

2. For the 4-inch waste line closed at the top, the same trap fitted 
with 18 feet of 2-inch vent-pipe sufiTered a loss of seal of ^ inch in three 
discharges, but no further reduction of seal could be caused by succes- 
sive discharges. There is, therefore, a certain length of vent-pipe, 
which, if unobstructed, will protect a trap under given conditions ; and 
in order to express the value of any particular device for protecting trap 
seals, a length of vent-pipe can be determined which will afford the 
same loss of seal under any particular conditions of siphonage as the 
patent device. In the various experiments detailed in the Appendix 
will be found a means of determining the siphonage influence caused by 
the friction of various lengths of vent-pipe i}-inch and 2-inch diameter 
respectively. Also, it is shown that the siphonage influence of each 
i|^-inch elbow is equivalent to that of i^^ feet of i^-inch vent-pipe. 

The general conclusion reached is, that 13^^ feet of i^-inch vent- 
pipe with only two elbows, if used as a vent-pipe, will safely pro- 
tect the seal of a f S trap having only i^inch depth of seal against the 
greatest siphonage influence which can be produced by any flow of 
water into a 2-inch waste-pipe of any practical height, even if the waste- 
pipe is closed at the top, subject to such exceptions regarding back 
pressure as are noted. 

^ For Figs. 6 to 14, see p. 259. 



EXPERIMENTS ON TRAP SIPHON AGE. 



259 




Fig. 6. 




Fig. 7. 




Fig. 8. 




Fig. 9. 





Fig. ii. 




Fig. 12. 




Fig. 13. 




Fig. 10. 



Fig. 14. 



260 EXPERIMENTS ON TRAP SIPHONAGE, 

Such a device as the McClellan Anti-Siphon Vent is offered 
as a substitute for the vent-pipe, and in accordance with the above, its 
protective influence has been determined as equivalent to 13! feet of 
unobstructed vent-pipe including two elbows, and it is not subject to 
the exceptions noted, regarding back pressure. 

This device is shown by Figs. 15, 16, and 17.^ It consists of an inverted 
cup made of sheet metal, C (Fig. 2), which floats in a small amount of 
mercury so as to seal the opening K against flow in the direction of the 
arrow X m, while admitting the ingress of air at L in the direction of 
the arrow y, whenever a vacuum exists at the orifice K greater than one 
quarter of an inch of water. The device being attached to a waste-pipe 
A, Fig. 16, in connection with a simple S trap, protects the seal of the 
trap against siphonage, when water is discharged from a plumbing fix- 
ture downward through the pipe A A, by admitting air at the point Q^ 
with sufl[icient rapidity to prevent the suction due to the falling water 
from forming a vacuum at Q. Plumbing practice up to the present time 
has chiefly provided against the formation of a vacuum at Q^by the use of 
what is known as a vent-pipe, the arrangement of which is shown as 
applied to a supposed case of practice in Fig. 17. The pipe A A re- 
ceives the discharge of the several fixtures ZZZ, etc., delivering into 
the sewer S. This pipe is open at the top. From each trap are led 
the pipes XXX, etc., to connect with the pipe V, which is also open at 
the top. 

The latter constitutes the vent-pipe, and when a discharge takes place 
air should be supplied by this pipe by means of the branches Z Z Z, in 
sufiScient quantity to protect the seal of the traps against siphonage. 
The McClellan vent, arranged as a substitute for the vent-pipe, is shown 
applied to the waste-pipe A' A'. If the device can be relied upon to 
protect traps against the most severe siphonage influence, it is evidently 
more convenient for application than is the vent-pipe, even under the 
most favorable circumstances for the erection of the latter. The tests to 
which the device has been subjected, the details of which will be found 
in the Appendix, are as follows : 

1. McClellan ij-inch vent versus 13 J feet of vent-pipe with two 
elbows, applied to J S trap, located successively at joints 2, 3, 5, and 6 
on 2-inch line, closed at the top, flushed with a i^inch stream through 
a i^-inch running trap fitted with a McClellan i^inch vent (see Ap- 
pendix) . 

2. Same conditions, except using 2-inch flush with 8 feet of vent-pipe 
at running trap (see Appendix). 

3. McClellan i J-inch vent versus 13^ feet of vent-pipe and two elbows, 
applied to f S trap, located successively at joints 2, 5, and 6, with 2-inch 
line open at top flushed with i^inch stream, with i^inch McClellan 
vent at running trap (see Appendix) . 

4. Same conditions as above, except using a 2-inch flush (see Appen- 
dix). 

1 For Figs. 15 to 17, see p. 261, 



EXPERIMENTS ON TRAP SIPffONAGE. 



261 




Fig. is- 





Fig. 17. 



262 EXPERIMENTS ON TRAP SIPHON AGE. 

5. McClellan i J-inch vent versus various lengths of vent-pipe and 
elbows, to protect a f S trap, i^inch seal, at joint 4 of a-inch line closed 
at top, and with all vents closed except at f S trap (see Appendix). 

6. McClellan i^inch vent versus 13^ feet and two elbows ij-inch 
pipe, applied to vent, a f S trap at joints C, E, and F on 4-inch line 
open at top and flushed with i^inch stream (see Appendix) . 

7. Same as above, except using 2-inch flush (see Appendix). 

8. McClellan i^inch vent, versus 13^ feet and two elbows of i^-inch 
vent-pipe, applied to | S trap located successively at joints B, C, E, and 
F on 4-inch line, closed at the top and receiving the discharge of the 
largest size plunger closet through a 4-inch opening (see Appendix) . 

9. McClellan i^inch and 2-inch vent applied to several joints of 
4-inch line closed at top. A f S trap was applied at joints B, C, D, 
and E, and protected first by a i^inch McClellan vent and then by 13 J 
feet and two elbows of i^inch pipe. The 4-inch pipe was flushed by 
the plunger closet (see Appendix) . 

10. Same condition as above, except that the 4-inch pipe was open at 
the top. 

The results of all these tests unite in leading to the conclusion that the 
McClellan i}-inch and 2-inch vents are capable of protecting simple S 
traps against the most severe siphonage effects arising in plumbing prac- 
tice as well as can 13 J feet and two elbows of li-inch pipe in the case 
of the li-inch vent, or 20 feet of 2-inch pipe in the case of the 2-inch 
vent. Separate vent-pipes of these lengths will completely protect sim- 
ple S traps having only i^-inch seal against the greatest siphonage of 
any discharge arising in plumbing practice in either a 2-inch or 4-inch 
waste line, but not against some conditions of back pressure. 
Wherever the conditions of plumbing construction require the 
use of vent-pipes with more than two elbows or longer than the 
above lengths, the McClellan vent is superior as a protection against 
siphonage. Against back pressure the McClellan vent has advantages 
over the 13^ feet of vent-pipe, as noted at pages 12 to 14. Ice accumu- 
lation at the top of the vent-pipe is of course liable to render the latter in- 
efficient; also the accumulation of rust from off the inside of vent-pipes 
in an elbow may easily stop up the latter. If rust to the thickness of 
one hundredth of an inch from the internal surface of 10 feet of i^inch 
vent-pipe should accumulate in an elbow, it would more than fill the 
latter, as it would occupy about six cubic inches. 

ACTION OF MCCLELLAN VENT SET OUT OF PLUMB. 

A ftries of tests were also made with a McClellan vent set with its 
axis at inclinations to the vertical of from i in 6 to i in 12. The results 
show that the vent is not rendered at all less sensitive in its action by 
being erected out of plumb to a considerably greater degree than would 
be likely to escape the attention of any workman or inspector (see Ap- 
pendix). 



EXPERIMENTS ON TRAP SIPHON AGE. 263 



DURABILITY OP MERCURY AS A SBAL. 

Aside from the anti-siphon qualities of the McClellan vent when 
properly charged with mercury, it is of course necessary to consider 
w^hether the use of mercury renders the device liable to a loss of effi- 
ciency through the evaporation of the mercury. I have carefully exam- 
ined the condition of the mercury in McClellan vents permanently 
located as follows : 

1. One vent in a bath-tub and water-closet trap, one vent in a sink, in use seven montiis 
in a dwelling-house in the upper part of New York city. 

2. Four vents on sinks, in use two years at a club-house in 29th street, New York city. 

3. Six vents on water-closets, in use one year at the Armory building, 94th street and 
Park avenue, New York city. 

4. One vent in water-closet, four vents on sinks, in use four years in a dwelling-house 
in 20th street. New York city. 

In all these cases there was no absence of fluidity in the mercury 
contained in the vents, and no loss of volume so far as the latter could 
be identified with the original charges. The surface of the mercury was 
covered with a film of oxide and a little dust, which together aggregated 
not more than one sixty-fourth of an inch in thickness. 

When blown upon by the breath, this film would break open and 
expose a clear bright surface of perfectly fluid mercury. 

Regarding the statements found in chemical treatises, to the effect that 
mercury vaporizes, it appears that so far as these refer to mercury at 
ordinary temperatures, the rate of vaporization is of the infinitesimal 
character which is detectable only by weeks of exposure of gold leaf in 
a closed vessel of mercury so pure that no oxide or coating is form able 
to tarnish the surface. Such coating practically prevents even the infini- 
tesimal vaporization referred to by the chemical authorities. Commer- 
cial mercury always contains sufficient amounts of impurities to cause a 
formation of an oxide coating such as was found to be present on the 
mercury in the vents examined in the houses described above. In Ap- 
pendix II will be found a copy of a careful research made by Dr. Thos. 
B. Stillman, amongst various chemical authorities, supporting the above 
views regarding the vaporization of mercury, and confirming the follow- 
ing conclusion, viz. : 

That the use of mercury, as used in the McClellan vent, involves no 
risks of loss of seal from vaporization of the metallic fiuid. 

BACK PRESSURE EXPERIMENTS. 

With the fresh-air inlet open, and located either as per Fig. 2 or Fig. 
3, it appears, from experiments detailed in Appendix, that either a 
4-inch closet or 2-inch tank discharge in the 4-inch waste line does 
not cause a sufficient amount of back pressure to destroy a i^^-inch 
seal in a f S trap located at the lower joints of the waste lines, and 



264 EXPERIMENTS ON TRAP SIPffONAGE, 

protected by a McClellan vent; but 13^^ feet of vent-pipe may allow 
successive discharges to break the seal. With the fresh-air inlet closed, 
experiments show that at the lowest joint of the 2-inch waste line, flushed 
with its i^inch connection, the back pressure forced air through a } 
S trap protected by a McClellan vent, but did not impair the seal after 
the third discharge, whereas, with 13^ feet of i^-inch vent-pipe there 
was a continued loss of seal, until at the thirteenth discharge the latter 
was broken. Experiments show that at the lowest joint of the 4-inch 
line, flushed with its 2-inch connection, a | S lead trap, i^inch depth 
of seal, protected by a McClellan vent, had its water thrown out by 
back pressure ; but with a glass trap having 2-inch depth of seal, the 
latter was not impaired b}' three discharges. The same traps, protected 
by 13^ feet of vent-pipe with two elbows, lost their seals by nine and 
four discharges respectively. The discharge of a plunger closet did 
not break the seals either with the McClellan vent or the vent-pipe, but 
the latter permitted the greater loss of seal. While, therefore, the 
McClellan vent would give immediate warning of the presence of undue 
back pressure due to the stoppage of the fresh-air inlet, the vent-pipe 
would silently allow the destruction of the seal, and offer no evidence 
of the stoppage of the inlet or the unlimited escape of sewer g^s through 
the trap. By studying the action due to the influence of back pressure, 
with a glass trap, it appears that the current of air forced upward through 
vent-pipes gradually spills the water from the trap by oscillations set up 
through the partial vacuum produced in the space E, Fig. 5. With the 
McClellan vent the air in this space is always at greater pressure than the 
atmosphere, so that the oscillations which occur do not cause the level of 
the water in the inner limb of the trap to rise above its original level, 
and therefore no water escapes into the waste line. 

With a vent-pipe 6 inches long and i^^ inch in diameter, there is no 
practical oscillation of the water in the trap, and hence no loss of seal ; 
but with a longer vent-pipe, such as 13^ feet, an irregular pulsation of 
pressure is caused in the upward current of air created in the vent-pipe 
by the back pressure, so that, while the mean pressure is greater than 
that of the atmosphere, the air in the space E is alternately rarefied and 
compressed, thus causing oscillations of level both above and below the 
original level in the trap, and, as a result, water is spilled out of the 
inner limb into the branch C, and thence to the sewer. The branch C, 
and a trap as per Fig. 5, were attached to a Sturtevant fan, and a steady 
pressure, equal to the greatest back pressure encountered, maintained in 
C with a i3j-foot vent-pipe attached. There was then a depression of 
the inner limb, but on oscillation, and hence no loss of seal. The oscil- 
lation which impairs the seal is, therefore, caused by the fluctuations in 
the intensity of the back pressure, due to the fact that the latter is 
produced by a column of descending water or spray (see further explan- 
ations Appendix) . 

The general conclusion is therefore warranted, that with a waste 
system constructed in accordance with the accepted rules of good plamb- 



EXPERIMENTS ON TRAP SIPHON AGE, 26$ 

ing practice, the amount of back pressure liable to be developed at the 
foot of vertical lines, while small, may abstract water from a f S trap 
by the upward current of gas, due to back pressure, so as to destroy a 
i^inch seal if protected by a vent-pipe^ whereas the McClellan vent 
^will permit no practical loss of seal. If excessive back pressure occurs, 
the McClellan vent has an advantage over the vent-pipe by giving warn- 
ing of the existence of back pressure before the seal is broken, whereas 
the vent-pipe silently permits the gradual loss of seal through the oscil- 
latory influence of the upward current of the gas due to the back pres- 
sure. 

GENERAL CONCLUSIONS. 

1. That 13^ feet of i^inch wrought-iron pipe with two elbows will 
safely protect the seal of a f S trap, having only i^ inch depth of seal, 
against the greatest suction siphonage influence which can be produced 
by any flow of water into a 2-inch waste-pipe of any height, but it is 
not a complete protection under certain conditions of back pressure (see 
Appendix). 

2. That a single i^-inch McClellan vent affords the same protection as 
13^ feet of i^inch pipe and two elbows against suction, and better pro- 
tection against back pressure. 

3. That either 2-inch or i^inch McClellan vents at each fixture con- 
nection on a 4-inch waste-pipe closed at the top will protect a f S trap 
with i^inch seal against the greatest siphonage influence of any dis- 
charge occurring in plumbing practice in a 4-inch waste-pipe. 

4. That the use of mercury in the McClellan vent can be relied upon 
to afford a reliable and indestructible seal. 

5. That, therefore, the McClellan vent is a thoroughly reliable pro- 
tection against siphonage to any form of trap, and when used with a 
simple S trap forms a perfectly self-cleansing combination which is 
proof against the most severe siphonage influences arising in plumbing 
practice, including the complete stoppage of the tops of waste-pipes 
by ice. 

6. That considering the liability of vent-pipes to stoppage by ice or 
rust, and the effect of upward currents of air in removing water from 
traps by oscillation (see Appendix) , the ability of the McClellan vent to 
protect the seals of traps is superior to that of vent-pipes. 

APPENDIX I. 

Results of experiments made on a 2-inch waste-pipe and a 4-inch soil-pipe 
discharging into a 4-inch house drain which enters a 6-inch sewer through a 
running trap, with a fresh-air inlet situated 6 and 24 feet, respectively, from the 
vertical line of pipes. 

Protection of | S trap, i4 seal by li-inch McClellan vent or 134 feet of 1 4-inch 
pipe on 2-inch waste line closed at top with no running trap, and all vents dosed 
i4 flush; i S trap at joint No. i. 



266 



EXPERIMENTS ON TRAP SIPHON AGE, 



The 2-inch waste-pipe closed at the top with no vents open and flushed by a 
li-inch waste connection from tank X, without a running trap. 

1. At joint No. I the ij-inch S trap with a ij-inch McClellan vent, lost \ of 
an inch of its seal from six discharges, but remained unchanged during the four 
following. The loss from the first discharge was I of an inch. 

2. At joint No. I the li-inch S trap with iji feet of ij-inch wrought-iron vent- 
pipe with two elbows, lost | of an inch of its seal from five discharges, but 
remained unchanged during the four following. The loss from the first discharge 
was I of an inch. 

3. At joint No. I the mercury column or vacuum gauge read 26 inches of 
mercury. 

Experiments with mercury column or vcuuum gauge on a 2'inch waste-pipe^ 
closed at the top, discharged into a ^-inch soil-pipe which was open at its top, 

VACUUM IN INCHES OF MERCURY. 



Position 

of mercury 

column. 


All vents closed. 


All vents closed. But 8 feet 
of I i -inch vent-pipe on run- 
ning trap of waste con- 
nection. 


No. of joint, 
la 
I 
2 
3 
4 
5 
6 


I i -inch flush. 
24.0 
24.0 
25.25 
23.6 
16.4 
8.25 
1-5 


2-inch flush. 

18.75 

20.25 

22.5 

19.0 

12.5 
4.9 
0.75 


I i -inch flush. 

2.5 
2.25 

2.5 

2.5 

2.0 

1.25 

0.35 


2-inch flush. 

1-75 
2.25 

2.5 
2.4 

2.3 
1.4 
0.25 


Time to discharge 
the entire tank 
of 30 gallons. 


29 sees. 


32 sees. 


70 sees. 


48 sees. 



The tank X used in these experiments held 30 gallons when full. A float and 
index showed the height of the water in the same. In the following account of the 
experiments a ** discharge" means that the entire contents of the tank were allowed 
to run out, and in all cases where a less qu£intity was used it is so stated. 



RESULTS OF EXPERIMENTS ON UNVENTED TRAPS. 

Experiments with unvented anti-siphon traps on a 2 -inch waste-pipe open at 
the top, and discharging at its base into a 4-inch house drain having a running 
trap with 4-inch fresh-air inlet, and into which also discharges a 4-inch soil-pipe 



EXPERIMENTS ON TRAP SIPHONAGE, 267 

open at its top ; flushed through a 2-inch waste connection from tank X with the 
vent on its running traps closed ; all vents closed. 

UNVENTED TRAPS EXPERIMENTED UPON. 

Traps with a ball seal. i. Cudell. 2. Bower. 3. Delahanty. 4. Bennor. 
Traps with tortuous passages, 5. Clarke, Bottle. 6. Clark, Bulb. 7. Puro. 
8. Sanitas. 9. Connolly. 

Experiments at yoint No, 2. 

1. Cudell, A I i -inch Cudell trap having a 2-inch water seal, had its water line 
lowered i of an inch below the breaking point by one discharge from the tank, 
and the trap was left sealed only by the metal ball. 

2. Bower. A li-inch Bower trap having a 2|-inch water seal, had its water 
level lowered | of an inch below the breaking point by one discharge, and the rub- 
ber ball floated below its seat. Repeating the experiment gave the same result. 

3. Delahanty. A ij-inch Delahanty trap having a 6i-inch water seal, had all 
its water siphoned out by one discharge, and the trap was left sealed only by the 
rubber ball. Repeating the experiment gave the same result. 

4. Bennor. A i|-inch Bennor trap having a 3i-inch water seal, in three experi- 
ments had all the water siphoned out by discharging the entire half or one quarter 
the contents of the tank. In each case the trap was sealed only by the rubber ball. 

5. Clarke, Bottle. A li-inch Clarke-Bottle trap having a 3i-inch water seal, 
had its seal destroyed by 13 discharges. The loss from the first was 2| inches, 
and the average from each of the following discharges was one fortieth of an inch. 

6. Clarke, Bulb. A li-inch Clarke-Bulb trap having a 2i-inch water seal, in four 
experiments had its seal broken, once by discharging the full contents, twice by 
a discharge of one half, and once by one eighth the contents of the tank. 

7. Puro. A 1 4-inch Fvno trap having a 2j-inch water seal, had its seal left 
open i inch below the breaking point by one discharge. 

8. Sanitas. A li-inch Sanitas trap having a 3-inch water seal, had its seal 
broken by Vorty-five discharges. The loss from the first discharge was ij inch, 
and the average from each succeeding discharge was ^ of an inch. 

9. Connolly. A i|-inch Connolly trap having a 2i-inch water seal, had its seal 
broken by twenty- two discharges. The loss from the first was H of an inch, 
and the average from each of the succeeding discharges was -^ of an inch. 

RESULTS OF EXPERIMENTS ON A VENTED S TRAP UNDER THE SAME CONDITIONS. 

Experiments with unvented anti-siphon traps on a 2'inch waste-pipe open at the 
top and discharging at its base into a \-inch house drain, having a running trap 
with a ^-inch fresh-air inlet, and into which also discharges a ^-inch soil-pipe 
open at its top ; flushed through a z^-inch waste connection from tank X, with the 
vent on its running trap closed. All vents closed, 

1, McClellan vent, A li-inch S trap with a li-inch water seal, and having a 
li-inch McQellan vent, lost | of an inch of its seal by 6 discharges, but had met 
with no further loss after the 45th discharge. The loss from the first discharge 



268 EXPERIMENTS ON TRAP SIPHON AGE, 

was J|, and the average for each of the following discharges up to the 6th was 
j[^ of an inch. There were very slight oscillations. 

2. Same with 134 feet of vent-pipe. A li-inch S trap with a i4-inch water seal, 
and having 134 feet of wrought-iron vent-pipe, lost | of an inch of its seal by four 
discharges, but remained unchanged during the six following. The loss fix>m the 
first discharge was ^V of an inch, and the average for each succeeding discharge 
up to the fourth was -j^ of an inch. 

3. Same with 25 feet of vent-pipe. A ij-inch S trap with a li-inch water seal 
and having 25 feet of wrought-iron vent-pipe with three elbows, had its seal broken 
by six discharges. The loss from the first discharge was -j^ of an inch. 

4. Same with 35 feet of vent-pipe, A li-inch S trap with a li-inch water 
seal, and having 35 feet of wrought-iron vent-pipe with three elbows, had its seal 
broken by one discharge. This experiment was repeated three times. 



EXPERIMENTS ON TRAP SIP NONAGE. 



269 



2 D 2 p S P 

*S c/5*S c/3*S W 
-^ g:^ --o 

g-!S 1=^ g=^ 




< M 



H 

> 

♦id 







• • • cr & • • • • 



g 

H 



5' 



1 



o» N, 


►4 


- 


l-IMIMI^MOJMMM N< 


No. of experi- 
ments. 


Is 


• 


0*4 


«*• 


00 • • • ^ 


Above the break- 
ing point. 


- ^ 


• 


" 


; • «-«-; ..0^0^ ^ 


Below the break- 
ing point. 



^ 0\ ^ 0\ 



ft»^ ftp' 



No. of, or parts of, 
discharges necessary 
to cause condition 
in column 3. 



I K) K) oj oj a\ M M 

««4 I*** 0^ I*** MH «if ^ 



Initial depth of seal. 



*^ ►♦* "i. "h 
••► •►* •r *« 



MHi-iOJOJM^VlMM 0\ 



Loss of seal from the 
first discharge. 



> > 



'it'Sr' 



Average loss from each 
succeeding discharge. 



04 
O OS NO 



o o 



No. times experiment 
was carried beyond 
discharge in which 
trap ceased losing. 



S.S.S s. 

"I 



vO 



o 

o 

I 

o 

CO ^ 

I 



o 

p 



o o 



II 



270 EXPERIMENTS ON TRAP SIPHON AGE. 

RESULTS OF EXPERIMENTS ON VENTED TRAPS. 
I. 

Experiments on a 2-inch waste-pipe closed at the top a$id discharging at its base 
into a ^-inch house drain into which also discharges a 4'inch soil-pipe open at its top. 
The 2-inch waste-pipe flushed by discharging contents of tank X through a waste 
connection having a vented running trap. All other vents closed excepting the vent 
on the trap being experimented upon, 

A. \\-inch flush vented. The 2-inch waste-pipe flushed by discharging con- 
tents of tank X through a li-inch waste-pipe, having a i S trap protected by a 
li-inch AfcClellan anti-siphon vent, 

1. McClellan vent. At joint No. 2, a ij-inch i S trap with a li-inch water 
seal, and protected by a li McClellan vent, lost ^ of an inch of its seal after five 
discharges, but remained unchanged during the three following. The loss from 
the first discharge was -jV of an inch. There were no osdliations. 

The experiment repeated gave | of an inch of its seal from the third, but 
remained unchanged during the three following discharges. The loss from the 
first discharge was -^oizxi inch. 

2. At joint No. 2, the i J-inch S trap vented by iji feet of li-inch wrought-iron 
pipe with two elbows lost j^ of an inch of its seal after the sth, but remained 
unchanged during the four following discharges. The loss from the first dischaige 
was ^ of an inch. There were no oscillations. 

3. At joint No. 3, the i J-inch S trap with a i J-inch McClellan vent lost J an 
inch of its seal after second, but remained unchanged during the five following 
discharges. The loss from the first discharge was | of an inch. There were slight 
irregular oscillations less than -^ of an inch. 

4. At joint No. 3, the i J-inch S trap with 13 J feet of ij wrought-iron vent- 
. pipe lost I of an inch of its seal after the third, but remained unchanged dming 

the three following discharges. The loss from the first discharge was fj of an 
inch. There were irregular oscillations averaging \ of an inch. 

5. At joint No. 5, the i J-inch S trap with a i J-inch McClellan vent lost j^ of an 
inch of its seal after the second discharge, but remained unchanged during the six 
following. There were no oscillations. The loss from the first discharge was J of 
an inch. 

6. At joint No. 5, the i J inch S trap with 13 J feet of i J-inch vent-pipe lost ^ 
of an inch of its seal after five discharges, but remained unchanged during the ^y^ 
following. The loss from the first discharge was | of an inch. 

7. At joint No. 6, the i J-inch S trap with a i J-inch McClellan vent, lost ^ of 
an inch of its seal after the first discharge, but remained unchanged during the six 
following. There were oscillations of -j^ of an inch. 

8. At joint No. 6, the i J-inch S trap with 13 J feet of r J-inch wrought-iron 
vent-pipe, lost t of an inch of its seal after five discharges, but remained unchanged 
during the four following. The loss from the first was -j^j of an inch. There were 
oscillations of \ of an inch. 



EXPERIMENTS ON TRAP SIPHONAGE. 



271 



TABLE OF RESULTS 

Of experiments on a 2-inch waste-pipe closed at the top with a li-inch vent 
at running trap and flushed by a li-inch pipe from tank X. 



Conditions of 
venting. 


li-inch McClellan vent. 


I3i feet of ij-inch wrought- 
iron vent-pipe with two 90- 
degree elbows. 


Position of trap 


















No. of joint . . 


2 


3 


5 


6 


2 


3 


s 


6 


No. of the experi- 
ment . . . 


I 


3 


5 


7 


2 


4 


6 


8 


Total loss of seal, 
inches . . . 


il 


i 


A 


H 


tt 


1 


A 


1 


No. of discharges 
necessary to cause 
that loss . . 


5 


2 


2 


I 


5 


3 


5 


5 


Loss from first dis- 
charge . 


A 


\ 


\ 


W 


tt 


A 


1 


A 


Average loss from 
each succeeding 
discharge, inches 


^ 


\ 


A 




A 


A 


A 


A 


No. of times exper- 
iment was carried 
beyond the dis- 
charge in which 
the trap ceased 
losing . . . 


3 


5 


6 


6 


4 


6 


6 


4 



B. The 2'inch waste-pipe flushed by discharging contents of tank X through a 
2'inch waste connection^ having its running trap vented by Z feet of \\-inch 
wrought-iron pipe with two ^o-degree elbows. 

1. At joint No. 2, a li-inch S trap having a li-inch water seal with a li-inch 
McClellan vent lost W of an inch of its seal by four discharges, but remained con- 
stant during the four following. The loss from the first was i of an inch, and the 
average from each succeeding discharge was fj of an inch. 

2. At joint No. 2, the same trap with a 2-inch McClellan vent lost i of an inch 
of its seal by eleven discharges, but remained unchanged during the four following. 
The loss from the first was | of an inch, and the average from each succeeding 
discharge was ^ of an inch. 

3. At joint No. 2, the same trap vented by 13J feet of wrought-iron pipe with 
two 90-degree elbows lost H of an inch of its seal by seven, but remained 



272 EXPERIMENTS ON TRAP SIPHONAGE, 

unchanged during the three following, discharges. The loss from the first was i an 
inch, and the average from each discharge was |^ of an inch. 

4. At joint No. 3, the 1 4-inch S trap with a li-inch water seal having a li-inch 
McClellan vent lost | of an inch of its seal by seven, but remained unchanged 
during the four following, discharges. The loss from the first was i of an inch, 
and the average from each succeeding discharge was -^ of an inch. There was a 
slight back pressure at first, but there were no oscillations. 

5. At joint No. 3, the same trap with 13 J feet of ij-inch wrought-iron vent- 
pipe with two elbows lost i an inch of its seal by two, but remained unchanged 
during the four following, discharges. The loss from the first discharge was -5^ of 
an inch. 

6. At joint No. 5, the ij-inch S trap with a ij-inch McQellan vent lost -^ of 
an inch of its seal from three discharges, but remained unchanged during the five 
following. The loss from the first was \ of an inch. 

7. At joint No. 5, the iJ-inch S trap with 13 J feet of 1 1-inch wrought-iron 
vent-pipe lost -^ of an inch of its seal from the first discharge, but remained 
unchanged during the four following. 

8. At joint No. 6, the iJ-inch S trap with a li-inch McClellan vent lost jV ®^ 
an inch of its seal from three discharges, but remained unchanged during the four 
following. The loss from the first discharge was -j^ of an inch. There were 
oscillations of -j^ of an inch. 

9. At joint No. 6, the i J -inch S trap with 13J feet of ij-inch wrought-iron 
vent-pipe lost -^ of an inch of its seal from the third discharge, but remained 
unchanged during the seven following. The loss from the first was i of an inch. 
There were oscillations of -^ of an inch. 



EXPERIMENTS ON TRAP SIPHONAGE. 
TABLE OF RESULTS 



273 



Of experiments on a 2-inch waste-pipe dosed at top and flushed by a vented 
- 2-inch waste connection ; 8 feet of vent-pipe at 2-inch running tank trap. 



Conditions of vent- 
ing. 



I i -inch McClellan 
vent. 



^ «> a 



1 3i ft. of li-inch wrought- 
iron vent-pipe and two 
90-degree elbows. ; 



Position of trap . 

No. of joint . . 

No. of the experi- 
ment . . . 

Total loss of seal, 
inches . . . 

No. of discharges 
necessary to cause 
that loss . . 

Loss from first dis- 
charge, inches . 

Average loss from 
each succeeding 
discharge, inches 

No. of times exper- 
iment ¥ras carried 
beyond the dis- 
charge in which 
the trap ceased 
losing 



2 




s 


I 




6 


H 




A 


4 




3 


i 




A 


A 


A 


\ 


4 


4 


5 



3 
A 



2 


3 


5 


3 


S 


7 


11 


W 


A 


7 


7 


I 


i 


i 


A 


A 


^ 


. . . 


3 


6 


4 



IL 

Experiments on a 2'tnch waste-pipe open at the top but with all vent openings 
closed excepting on the running trap in the wctste connection from the tank X, and 
on the trap being experimented upon. 

The 2'inch waste-pipe open at the top and flushed by discharging contents of 
tank X through a li-inch waste connection having a li-inch S trap protected by a 
li-ifich McClellan vent, 

1. At joint No. 2, the li-inch trap with a ij-inch McClellan vent lost | of an 
inch of its seal after the first, but remained unchanged during the four succeeding 
discharges. 

2. At joint No. 2, the same trap with McClellan vent replaced by 13 J feet of 
li-inch pipe lost fj- of an inch of its seal after the third discharge, but remained 
unchanged during Uie three following ones. Loss after the first discharge was i of 
an inch. 



274 EXPERIMENTS ON TRAP SIPHONAGE, 

3. At joint No. 3, the i J -inch trap with a li-inch McClellan vent lost -j^ of 
an inch of its seal after the second, and remained unchanged during the four follow- 
ing flushes. The loss from the first discharge was j*^ of an inch. 

4. At joint No. 3, the same trap with the McQellan vent replaced by 13J feet 
of pipe lost I of an inch of its seal after the third, but remained unchanged during 
the three following flushes. The loss after the first was fg of an inch. 

5. At joint No. 5, the i J-inch S trap with a li-inch McClellan vent lost i of 
an inch of its seal from three discharges, but remained unchanged during the five 
following. The loss from the first was | of an inch. There were oscillations of -^ 
of an inch. 

6. At joint No. 5, the li-inch S trap with X3i feet of wrought-iron vent-pipe 
lost ^ of an inch of its seal from four discharges, but remained unchanged 
during the four following. The loss from the first was i of an inch. 

7. At joint No. 6, the ij-inch S trap with a ij-inch McClellan vent lost i of an 
inch of its seal from four discharges, but remained unchanged during the six 
following. The loss from the first was | of an inch. There were oscillations of 
^ of an inch. 

8. At joint No. 6, theij-inch Strap with 134 feetof li-inch wrought-iron vent- 
pipe lost 1^ of an inch of its seal from three discharges, but remained unchanged 
during the five following. The loss from the first was i of an inch. 



TABLE OF RESULTS 

Of experiments on a 2-inch waste-pipe open at the top and flushed by a vented 
I i -inch waste connection from tank X. 



Conditions of venting. 



Position of trap, 
joint . . 



No. of 



No. of the experiment . . 

Total loss of seal, inches . 

No. of discharges necessary 
to cause that loss . . 

Loss from the first discharge, 
inches 

No. of times experiment was 
carried beyond the dis- 
charge in which the trap 
ceased losing .... 



I i -inch McClellan vent. 



3 


s 


3 


s 


iV 


i 


2 


3 


A 


i 


4 


S 



1 3ift.of I i-inch wrought- 
iron vent-pipe with 
two 90-degree elbows. 



2 
2 



3 


5 


4 


6 


1 


« 


3 


4 


A 


i 


3 


4 



6 
8 

A 



EXPERIMENTS ON TRAP SIPHONAGE, 275 

B. The 2-inch waste-pipe open at the top and /lushed by discharging contents of 
tank X through a 2-inch waste connection having a one halfS running trap vented 
by a li-inch McCUllan vent, 

1. At joint No. 2, the li-inch S trap with a li-inch McQellan vent lost ^ 
of an inch after the fourth, but remained unchanged during the three following dis- 
charges. The loss after the first discharge was | of an inch. There were no 
oscillations. 

2. At joint No. 2, the li-inch S trap with a li-inch seal having 13} feet of li- 
inch wrought-iron vent-pipe lost |^ of an inch of its seal by three discharges, but 
remained unchanged during the four following. The loss from the first was i of 
an inch, and the average loss for each succeeding discharge was ^ of an inch. 

3. At joint No. 3, the li-inch trap with a ij-inch McClellan vent lost -^ of an 
inch of its seal after the third, but remained constant during the three following 
discharges. The loss after the first was \ of an inch. The suri^ce of the water 
rose \ of an inch for an instant at the first part of the flush. 

4. At joint No. 3, the same trap but McQellan vent replaced by 134 feet of 
vent-pipe lost i an inch after the third, but remained unchanged during the three 
follovring flushes. The loss after the first flush was ^^ of an inch. 

5. At joint No. 5, the li-inch S trap with a li-inch McClellan vent lost ^ of 
an inch of its seal fi'om two discharges, but remained unchanged during the ^v^ 
following. The loss from the first was -j^ of an inch. There were oscillations of 
-j\ of an inch at the end of the discharge. 

6. At joint No. 5, the ij-inch S trap with 13I feet of i<|-inch wrought-iron 
vent-pipe lost -^ of an inch of its seal from the second discharge, but remained 
unchanged during the four following. The loss from the first was i of an inch. 

7. At joint No.. 6, the li-inch S trap with a 1 4-inch McClellan vent lost -^ of 
an inch of its seal from three discharges, but remained unchanged during the 
four following. The loss fix)m the first was -j^ of an inch. There were oscil- 
lations of i of an inch. 

8. At joint No. 6, the 1 4-inch S trap with 134 feet of 1 4 -inch wrought-iron vent- 
pipe lost "i^ of an inch of its seal from three discharges, but remained unchanged 
during the four following. The loss from the first was -^ of an inch. There were 
oscillations oi■^Qi?iS^, inch. 



276 



EXPERIMENTS ON TRAP SIPHONAGE. 



TABLE OF RESULTS 

Of experiments on a 2-inch waste-pipe open at top and flushed by discharging 

contents of tank X through 2-inch waste connection, vented with 

li-inch McClellan vent. 



Conditions of venting-trap 
experimented upon. 



1 4-inch McClellan vent. 



I si feet I i -inch wrought- 
iron vent-pipe vdth two 
90-degree elbows. 



Position of trap experimented 
on. No. of joint . . 

No. of experiment . . . 

Total loss of seal, inches . 

No. of discharges necessary 
to cause that loss . . 

Loss from the first discharge, 
inches 

No. of times experiment was 
carried beyond the dis- 
charge in- which the trap 
ceased losing .... 



2 


3 


5 


I 


3 


5 


A 


A 


A 


4 


3 


2 


i 


k 


A 


3 


3 


s 



6 
7 

A 
3 



2 


3 


s 


2 


4 


6 


fi 


i 


A 


3 


3 


2 


i 


A 


i 


4 


3 


4 



6 
8 

A 



EXPERIMENTS ON TRAP SIPHONAGE, 



277 



III. 

Four-inch soil-pipe closed at the top and flitshedby discharging contents of tank 
X through a li-inch waste connection having a half S trap vented by one foot of 
li-inch vent-pipe leading into a 2-foot branch of 2-inch pipe from joint B to a 
2''iHch McCUUan vent, as shown by the sketch. . 




Dotted portion is the arraixge- 
msivt for experimerU *1. 



Fig. 18. 



1. At joints, the li-inch trap on a 2-inch branch, having 2i feet of 2-inch 
vent-pipe leading to the 2-inch branch with a 2-inch McClellan vent arranged as 
in the preceding experiments, lost | of an inch of its seal after the fourth, but 
remained unchanged during the six following discharges. The first loss was -fg of 
an inch. There were li-inch McClellan vents at £ and D. 

2. At joint B, under the same conditions as in the preceding experiment, except- 
ing that the 2-inch McQellan vent was removed from the 2-inch branch from B 
and 18 feet of 2-inch vent-pipe put in its place, the li-inch trap lost -j^ of an inch 
of its seal after the third, but remained unchanged during the two following flushes. 
The first loss was i an inch. 

3. At joint B, the conditions of the preceding experiment repeated, excepting 
that the 2-inch vent-pipe was increased to 20 feet, the li-inch trap lost | of an 
inch of its seal after the third, but remained unchanged during the four following 
flushes. The first loss was ^ of an inch. 

4. At joint C, the li-inch trap on a 2-inch branch with a 2-inch McQellan vent 
(li-inch McQellan vents at joints D and £) lost i of an inch of its seal after the 
fourth, but remained unchanged during the two following. The first loss was ^ 
of an inch. 



278 EXPERIMENTS ON TRAP SIPffONAGE. 

5. At joint C, the preceding experiment repeated, but with the 2-inch McOellan 
vent replaced by 20 feet of 2-inch vent-pipe with two elbows, the li-inch trap lost 
t of an inch of its seal after the fifth flush. The loss after the first was i of an 
inch. 

6. The previous experiment repeated with the vent-pipe reduced to 18 feet, the 
trap lost ^ of an inch of its seal after the fourth, but remained unchanged during 
the three following flushes. The first loss was I of an inch. There were oscilla- 
tions of 1^ of an inch. 

7. At joint E (a 2-inch McClellan vent at C and a ij-inch McClellan vent at D, 
besides the 2-inch vent from B), the li-inch trap on a li-inch branch with a i J- 
inch McClellan vent lost I of an inch of its seal after the fourth, but remained 
unchanged during the three following. The first loss was i of an inch. There 
were oscillations of | of an inch and slight back pressure at times. 

8. At joint £, the li-inch trap under the same conditions as the preceding 
experiment, but with the McClellan vent replaced by 13I feet of 1 1-inch vent-pipe, 
lost I of an inch of its seal after the sixth, but remained unchanged during the 
three following flushes. The first loss was i of an inch. Oscillations slightly less 
than in the former experiment. 

9. At joint F, the il-inch S trap with a il-inch McCleUan vent (2-inch 
McClellan vent at C and li-inch McQellan vents at B, D, and £) lost ^^ of an 
inch of its seal from one discharge, but remained unchanged during the five 
following. 

10. At joint F, the il-inch S trap with 13! feet of li-inch wrought-iron vent- 
pipe (2-inch McQellan vent at C and li-inch McQellan vents at B, D, and £) 
lost i^ of an inch of its seal from seven dischaiges, but remained unchanged dur- 
ing the three following. The loss from the first was i of an inch. 



EXPERIMENTS ON TR^P SIPHONAGE. 
TABLE OF RESULTS 



279 



Of experiments on a 4-inch soil-pipe closed at top and flushed by li-inch waste 
connection vented as shown in the sketch. 









Trap on 
















2 -i nch 












I i -inch 


branch 


134 ft. of 


18 ft. of 


20 ft. of 


Conditions of venting-trap 


McClellan 


with 2- 


i^-inch 


2-in. vent- 


2-in. vent- 


experimented upon. 


vent. 


inch 


vent- 


pipe. 


pipe. 


pipe. 








McClellan 
















vent. 










Position of trap experiment- 






















ed upon. No. of joint . 


E 


F 


B 


C 


E 


F 


B 


B 


B 


c 


No. of the experiment 


7 


9 


I 


4 


8 


10 


2 


6 


3 


5 


Vents in use ^ . . ^^y. 
besides the S^*;;^-^^^^^- 


D 


B 
D 


E 
D 


E 
D 


D 


B 
D 


E 
D 


E 
D 


E 
D 


E 
D 


one on the ) 




E 








E 










trap beings 


C 
B 








C 

B 












experiment- > 2-in.McQellan 


C 


None 


None 


C 


None 


None 


None 


None 


ed upon ) 






















Total loss of seal in inches 


1 


A 


» 


i 


i 


A 


A 


A 


i 


1 


No. of discharges necessary 






















to cause that loss . . 


4 


I 


4 


4 


6 


7 


3 


4 


3 


S 


Loss from first discharge in 






















inches 


i 


^ 


A 


A 


i 


i 


k 


i 


A 


* 


No. of times experiment was 






















carried beyond the dis- 






















charge in which the trap 






















ceased losing . . . 


3 


S 


6 


2 


3 


3 


2 


3 


4 


• • 



I i'inch flush. Four-inch soil-pipe open at the top and flushed by discharging the 
contents of tank X through a li-inch waste connection having its trap vented cts 
shown in the sketch. No other vents were open. 

Same as Fig. 18. 

1. At joint C, the li-inch S trap with a li-inch McQellan vent lost^ of an 
inch of its seal from two discharges, but remained unchanged during the four 
following. The loss from the first was \ of an inch. 

2. At joint C, the il-inch S trap with I3i feet of li-inch wrought-iron vent- 
pipe lost i of an inch of its seal from three discharges, but remained unchanged 
during the four following. The loss from the first was f^ of an inch. 

3. At joint E, the 1 4-inch S trap with a 1 4-inch McCellan vent lost J of an 
inch of its seal from three discharges, but remained unchanged during the five fol- 
lowing. The loss from the first was f; of an inch. 



28o 



EXPERIMENTS ON TRAP SIPHONAGE. 



4. At joint E, the ij-inch S trap with 13I feet of li-inch wrought-iron vent- 
pipe lost ^0 of an inch of its seal from three discharges, but remained unchanged 
during the five following discharges. The loss from the first was i of an inch. 

5. At joint F, the li-inch S trap with a li-inch McClellan vent lost I of an 
inch of its seal from two discharges, but remained unchanged during the four 
following. The loss from the first was 1"^ of an inch. There were oscillations of 
I of an inch. 

6. At joint F, the li-inch S trap with 134 feet of wrought-iron vent-pipe lost 
i of an inch of its seal from four discharges, but remained unchanged during the 
four following. The loss from the first was i of an inch. 



TABLE OF RESULTS 

Of experiments on^a 4-inch soil-pipe open fiill at the top and flushed by discharg- 
ing the contents of tank X through a li-inch waste connection 
with vented running trap. 



Conditions of venting. 


li-inch McClellan 
vent. 


13J feet of il-inch 
wrought-iron vent- 
pipe and two 90- 
degree elbows. 


Position of trap. No. of joint . 

No. of experiment 

Total loss of seal in inches . . 

No. of discharges necessary to 
cause that loss 

Loss from first discharge in inches 

Average loss from each succeeding 
dischar&fe. in inches 


C 
I 

2 
i 


E 
3 
* 
3 

iV 


F 

5 
\ 

2 


C 

2 
i 
3 


E 

4 

3 
\ 


F 
6 

4 
i 


No. of times experiment was 
carried beyond the discharge in- 
which the trap ceased losing . 


4 


5 


4 


4 


S 


4 



2'tnch flush. Four-inch sail-pipe open full at the top and flushed iy discharging 
the contents of tank X through a 2-inch waste connection having its trap vented by 
a 2-inch McClellan vent as shown in the sketch. 

Fig. 18. 

1. At joint C, the li-inch S trap with a li-inch McQellan vent lost -j^ of an 
inch of its seal from one discharge, but remained unchanged during the four 
following. 

2. At joint C, the li-inch S trap with 13} feet of li-lnch wrought-iron vent- 
pipe lost -^0 of an inch of its seal from three discharges, but remained unchanged 
during the four following. The loss from the first was i of an Inch. 



EXPERIMENTS ON TRAP SIPffONAGE. 



281 



3. At joint E, the i J-inch S trap with a li-inch McQellan vent lost ^ of an 
inch of its seal from one discharge, but remained unchanged during the five 



The loss from the first was -5^ of an inch. 



following. 

4. At joint E, the li-inch S trap with 13J feet of li-inch wrought-iron vent- 
pipe lost i of an inch of its seal from two discharges, but remained unchanged 
during the four following. The loss from the first was -j^ of an inch. 

5. At joint F, the li-inch S trap with a li-inch McQellan vent, lost i of an 
inch of its seal from three discharges, but remained unchanged during the seven 
following. The loss from the first was -^ of an inch. The water in the fixture 
limb of the trap rose i an inch during each flush. The mercury column applied at 
this joint showed i inch. 

At joint F, the li-inch S trap with 13 J feet of li-inch wrought-iron vent-pipe 
had its seal broken by six discharges. The loss from the first was | of an inch. 

The loss of seal is here due to the upward current of air through the vent pipe 
due to the back pressure. See note, experiment 3, page 54. 



RESULT OF EXPERIMENTS 

On a 4-inch soil-pipe open fiill at the top and flushed by discharging the contents 
of tank X through a 2-inch waste connection with vented running trap. 



Conditions of venting. 


li-in. McClellan vent. 


13J feet of i^-inch 
wrought-iron vent- 
pipe and two 90- 
degree elbows. 


Position of trap. No. of joint . 

No. of experiment 

Total loss of seal in inches . . 

that loss 

Loss from first discharge in inches 

Average loss from each succeeding 
discharge, in inches . . 

No. of times experiment was car- 
ried beyond the discharge in 
which the trap ceased losing . 


C 

I 

A 

I 

tV 


E 

3 

I 


F 

S 

\ 

3 

xV 


C 

2 

3 


E 
4 
i 

2 


F 

6 

Broken 

6 

i 


4 


5 


7 


4 


4 






282 



EXPERIMENTS ON TRAP SIPffONAGE. 



EXPERIMENT ON A 4-INCH SOIL-PIPE. 



I. 



^'inch flush. Four-inch soil-pipe /lushed by discharging contents of a plunger 
closet of the largest capacity at joint C, through a 4-inch i S trap vented by a 1- 
inch vent — the 2-inch waste-pipe being open at the top, 

A. Four-inch soiLpipe closed at the top and no vents open except on the trap of 
closet^ and the trap being experimented upon, 

1. At joint B, the li-inch trap with a li-inch McClellan vent on a \k- 
inch branch had its seal broken after three flushes. Loss after the first was | of 
an inch. 

2. At joint B, the same trap, with the li-inch McClellan vent replaced by I3i 
feet of I i -inch vent-pipe had its seal broken after two flushes. The loss due to 
the first was -^ of an inch. 

3. At joint B, the same trap, but with a li-inch McClellan vent placed on it 
besides the 2-inch vent, lost -^ of an inch of its seal after the seventh, but 
remained unchanged during the five following flushes. The loss from the first 
flush was -f; of an inch. 

4. At joint C, the li-inch trap on a li-inch branch with a li-inch McQellan 
vent had its seal broken in two flushes. Loss from the first flush was } of an inch. 

5. At joint C, the same trap with the McClellan vent replaced by two feet of i J- 
inch vent-pipe with one elbow had its seal broken in three flushes. The loss 
from the first flush was | of .an inch. 

6. At joint C, the li-inch trap with a 2-inch McQellan vent had its seal 
broken in four flushes. Loss from the first was fj of an inch. 

7. At joint C, the same trap with the McClellan vent replaced by 16 inches of fl- 
inch vent-pipe entering 5 feet of 2-inch vent-pipe fi-om trap of the plunger closet, 
as shown in sketch, had its seal broken in seven flushes. The loss after the first 
was I of an inch. 








8. At joint C, the li-inch trap placed on a 2-inch instead of a i\- 
inch branch and vented by a 2-inch McClellan vent lost ^ of an inch of its seal 
in four, and remained unchanged during the nine following flushes. The loss after 
the first was -^ of an inch. 



EXPERIMENTS ON TRAP SIP HO NAG E. 283 

9. At joint D, the li-inch trap on a li-inch branch with a li-inch McClellan 
vent had its seal broken in four flushes. The loss from the first was -^ of an inch. 
The water in the trap rose | of an inch in first instant of flush. 

10. At joint D, the same trap with the McClellan vent replaced by 134 feet of 
1 4-inch vent-pipe had its seal broken on the third flush. The loss after the first 
dbcharge was i of an inch. 

11. At joint D, the 1 4 -inch trap on a 2-inch branch with a 2-inch McClellan 
vent lost } of an inch of its seal after the eleventh, but remained constant for the 
three following flushes. The water in the trap rose y^j of an inch in the first 
instant. 

12. At joint £, the i4-inch trap on a i4-inch branch and with a i4-inch 
McClellan vent lost I of an inch of its seal after the eighth, but remained un- 
changed during the four following flushes. The loss due to the first was J of an 
inch. All vent openings were plugged except a 2-inch McClellan vent on trap at 
the plunger closet. 

13. At joint F, the i4-inch S trap with a i4-inch McClellan vent, lost \ of an 
inch of its seal from three discharges, but remained unchanged diuing the four 
following. The loss from the first was -j^g- of an inch. 

14. At joint F, the i4-inch S trap with 134 feet of i4-inch wrought-iron vent- 
pipe, lost i of an inch of its seal from the first discharge, but remained unchanged 
during the five following. 



284 



EXPERIMENTS ON TRAP SIPffONAGE. 



t 




1 

1 


In experiment 
No. 7, the li 
ft. of li-in. 
pipe from the 
S trap con- 
nected with 
Si ft. of 2- 
in. pipe from 
the trap of 
the plunger 
closet. 






8. 

! 
1 

1 


•SMoqx9 93jq; 
ipm 's9did-)a9A *ni-f 1 
•y* 4S pire -ui-z -ij \i 


PQ 




s 

ft 

a -5 


-06 QUO q;t/u. S9q3ut z 






■SMoqp 
33iS&p-o6 OAq qji^ 


PQ 






PQ 


"73 
-I 

Si 

41^ 


u.?- - - 


in 


-PID^W q^ni-j pire qoui-f I 


PQ ro< t^ h2 


1** 


11 


1 

i 
1 


•adid qDUBjq qoui-j uq 


U 00 :!j2 't h2 





11 

•T s 

1^ 


•3did qouBjq qoui-f i uq 


Q ^•♦F H: •^D 


CO 


S 

U vo "I ^52 


; 


d 

1 


M !2.«Hi 00 H« 


't 






h 
121 






PQ *-*S ^ • 

C2 




SI 

PQ 


u, n^- '^ H: 


^ 




^1 


11 -'^y ■i^ii 
si:-M -111 


ft- 

Us 

g..SS5 



EXPERIMENTS ON TRAP SIPHON AGE, 285 

B. Four 'inch soil-pipe closed ai the top^ but having McCUllan vents on several 
floors^ and flushed at joint d by a plunger closet of the largest capacity. 

1. At joint B, a li -inch trap on a li-inch branch with a li-inch McClellan 
vent (li-inch McQellan vents at C, D, and £, and also a 2-inch McClellan vent on 
trap at the plunger closet), lost f^ of an inch of its seal after the fourth, but 
remained unchanged during the four following flushes. The loss from the first 
flush was I of an inch. 

2. At joint C, the li-inch trap on a li-inch branch with a li-inch McClellan 
vent (the li-inch McClellan vents at B, D, and £, also a 2-inch McQellan vent on 
the trap of the plunger closet) lost i an inch of its seal after the fourteenth, but 
remained unchanged during the three following flushes. The loss from the first 
flush was i of an inch. 

3. At joint D, the li-inch trap on a ij-inch branch, and with a li-inch McQel- 
lan vent (li-inch vents at B, C, and E, and also a 2-inch McQellan vent on trap at 
the plunger closet), lost -^ of an inch of its seal after the third, but remained con- 
stant during the three following flushes. Loss from the first flush was ^ of an 
inch. Thewater in the trap rose -s^e of an inch at first. 

4. At joint £, the same trap and vent (but with li-inch McQellan vents at C 
and D, and a 2-inch McClellan vent on trap at the plunger closet) lost ^ of an inch 
after the second, but remained unchanged during the two following flushes. The 
loss from the first was i of an inch. 

5. At joint F, the li-inch S trap with a ij-inch McQellan vent (li-inch Mc- 
Qellan vents at B, D, and £, and a 2-inch McClellan vent at the plunger closet) 
lost I of an inch of its seal from three discharges, but remained unchanged during 
the four foUowing. The loss from the first was f;- of an inch. There were 
oscillations of i of an inch. 

6. At joint F, the li-inch S trap with iji feet of li-inch vent-pipe (li-inch 
McQellan vents at B, D, and £, and a 2-inch McClellan vent at the plunger 
doset) lost ]^ of an inch of its seal from six discharges, but remained unchanged 
during the five following. The loss from the first was ^ of an inch. 



286 



EXPERIMENTS ON TRAP SIPHON AGE. 



TABLE OF RESULTS 

Of experiments on a 4-inch soil-pipe closed at the top, but having McClellan 
vents on several floors, and flushed by a plunger closet of largest capacity. 















134 ft- 


Conditions of venting-trap 
experimented upon. 




I i -inch McClellan vent 




li-in. 
vent- 


. 












pipe. 


Position of trap experimented 














upon. No. of joint . . . 


B 


C 


D 


E 


F 


F 


No. of the experiment . . . 


I 


2 


3 


4 


5 


6 


Vents in use be- ( li-in. McClellan 


C 


B 


B 


C 


B 


B 


sides the one 


vents . . 


D 


D 


C 


D 


D 


D 


on the trapse 




E 


E 


E 




E 


E 


being experi- 


2-inch McClellan 


on trap 


on trap 


on trap 


on trap 


on trap 


on trap 


mented upon. 


vent . . 


of 


of 


of 


of 


of 


of 




closet 


closet 


closet 


closet 


closet 


closet 


Total loss of seal, inches . . 


h 


i 


h 


A 


\ 


A 


No. of discharges necessary to 














cause that loss 


4 


14 


3 


2 


3 


6 


Loss from first discharge, inches 


i 


i 


h 


i 


h 


h 


No. of times experiment was car- 














ried beyond the discharge in 














which the trap ceased losing . 


4 


3 


3 


2 


4 


6 



C. Four-inch soil-pipe open at the top, having McClellan vents on several floors, 
and flushed at joint C by a plunger closet of the largest capacity, 

1. At joint C, a li-inch S trap with a li-inch McClellan vent on a li-inch 
branch (a 2-inch plug out of the top of the 4-inch soil-pipe) lost -j^ of an inch 
after the fifth, but remained constant during the foiu* following flushes. The loss 
from the first flush was -j^ of an inch. 

2. At joint D, the li-inch trap on a li-inch branch with a li-inch McCellan 
vent (li-inch McClellan vents at joints B, C, and E, and a 2-inch McClellan vent at 
C, 2-inch opening in top of soil-pipe) lost ^ of an inch of its seal after the fourth, 
and remained unchanged during the four following flushes. The loss after the first 
was ^ of an inch. 

3. At joint E, the li-inch trap on a li-inch branch with a li-inch McClellan 
vent (li-inch McClellan vents at joints C and D, and a 2-inch McClellan vent at 
C) lost ^ of an inch of its seal after the second, but remained unchanged diuing 
the two following flushes. The loss after the first was ^ of an inch. 

4. At joint F, the li-inch S trap with a li-inch McClellan vent (li-inch 
McClellan vents at B, D, and E, and a 2-inch McClellan vent at the plunger closet) 
lost xV of an inch of its seal from six discharges, but remained unchanged during 
the four following. 



EXPERIMENTS ON TRAP SIP NONAGE. 



287 



S- At joint F, the ij-inch S trap with 134 feet of li-inch vent-pipe (li-inch 
McClellan vents at B, D, and E, and a 2-inch McClellan vent at the plunger 
closet) lost \ of an inch of its seal fix)m six discharges, but remained undianged 
during the four following. 



The loss from the first was xV of an inch. 



TABLE OF RESULTS 

Of experiments on a 4-inch soil-pipe open at the top, having McClellan vents 
on several floors, and flushed by a plunger closet of largest capacity. 



Conditions of venting trap 
experimented' upon . 



Position of trap experimented upon. No. 
of joint 



No. of the experiment 



Vents in use besides 
the one on the trap 

bdngexpcrimented] ,..^^ McClellan 
upon. 



I i -inch McQellan 
vents . . . 



vent 



Total loss of seal, inches 



No. of discharges necessary to cause that 
loss 

Loss from first discharge, inches . . . 

No. of times experiment was carried be- 
yond the discharge in which the trap 
ceased losing 



li-inch McClellan vent. 



c 


D 


E 


I 


2 
B 


3 


None 


C 

E 


B 


on trap 
of 


on trap 
of 


on trap 
of 


closet 


closet 


closet 


h 


A 


h 


5 


4 


2 


h 


h 


i 


4 


4 


2 



F 

4 

B 

D 

E 
on trap 

of 
closet 

i 
10 



13* ft. 
li-in. 
vent- 
pipe. 



F 

5 

B 

D 

E 
on trap 

of 
closet 

i 



16 



Back-Pressure Experiments with the Fresh-Air Inlet open and lo- 
cated AS PER Fig. 3. Top of 2-inch Waste Line closed. 

1. A three-quarter S lead trap, i J -inch seal at joint F on 4-inch line, flushed 
with a 2-inch connection and protected with a li-inch McQellan vent, lost \ of an 
inch of its seal by three discharges, and suffered no fiirther loss in three more 
discharges. The loss by the first discharge was -jV of an inch. The experiment 
was repeated twice, with practically the same results. 

2. Under the same conditions, but using 13^ feet and two elbows of li-inch 
vent-pipe, the seal was broken in nine discharges. The loss from the first 
discharge was -^ of an inch. Air was forced through the seal at the seventh 
discharge. The experiment was repeated twice on diflerent dates, with practically 
the same results. 



3. In order to observe the behavior of the water in the trap under the above 
conditions, a one-half S glass trap with 2-inch depth of seal was applied at joint 
F, and protected alternately by a McClellan vent and 13I feet of vent-pipe. 



288 EXPERIMENTS ON TRAP SIPHON AGE. 

With the former there was no loss of seal by four discharges. The water was 
depressed at the beginning, in the inner limb of the trap, about i-inch, and then 
oscillated about the same distance, but the level did not rise above its original 
height, and hence no water escaped from the trap into the waste-pipe. With the 
vent-pipe the upward current of air produced a suction influence upon the air over 
the water in the inner limb of the trap, which at irregular intervals made the 
pressure at this point (the space marked E, Fig. 5) less than that of the atmos- 
phere, notwithstanding that the mean pressure in the limb C, and throughout the 
vent-pipe, was greater than that of the atmosphere. Hence osdlladons of the 
water in the trap occurred, which permit the level in the inner limb to rise above 
the original height, and consequently the water escapes from the trap. The oscil- 
lations vary in violence, so that the first discharge produces more loss of seal at 
one time than another, but the average effect of several discharges was always 
about the same. The loss of seal with the glass trap, was I of an inch in three 
discharges, and then no more for further discharges ; but had its depth of seal been 
only li inches, it would have been siphoned like the lead traps, as the latter could 
be seen to suffer the same oscillations by looking into the outer limb, though the 
amplitude of the movement could not be nicely determined as with the glass trap. 



Back-Pressure Experiments with the Fresh-Air Inlet open and lo- 
cated AS PER Fig. 2, and the 2-inch Waste Line closed at the top. 

Besides the preceding special experiments regarding back-pressure action, there 
are the following results : 

Soil-Pipe Open, The 4-inch soil-pipe op6n full at the top, and flushed by 
discharging the contents of tank X through a 2-inch waste connection, having its 
trap vented by a 2 -inch McClellan vent. 

1. At joint F, the i^inch S trap with a i|-inch McClellan vent lost \ of an 
inch of its seal from three discharges, but remained unchanged during the seven 
following. The loss from the first was ^^ of an inch. The water in the trap 
rose \ inch from back pressure during each discharge, but no air passed through 
the seal. 

2. At joint F, the i-^-inch S trap with 13 J feet of i|.inch wrought-iron vent- 
pipe had its seal broken by six discharges. The loss from the first was ^^ of an 
inch. The loss of seal is due to the oscillations caused by the upward current of 
air through the vent-pipe. 

Special Experiments to determine the comparative effects of Back Pressure on a 
i\-incA S trap, vented by a i^inch McClellan vent, and 13 J feet of \\-inch 
wrought-iron vent-pipe. 

Experiments with Fresh- Air InUt closed, and located as per Fig, 3. Two-inch 
waste-pipe, open full at the top, and flushed by discharging contents of tank X 
through a ij-inch waste connection, having its running trap vented with a i-J-inch 
McClellan vent. Top of the 4-inch soil-pipe closed. Fresh-air inlet removed 24 
feet from the bottom of the 4.inch waste line, as per Fig. 3, and closed. 

1 . Vacuum Gauge, At joint No. 6, the mercury gauge gave f of an inch back 
pressure. 

2. At joint No. 6, a i^-inch three-quarter S trap with a ij-inch McClellan 



EXPERIMENTS ON TRAP SIPHON AGE, 289 

vent lost -j^ of an inch of its seal from three discharges, but remained unchanged 
during the five following. The loss from the first was -^oi^j^i inch. The water 
rose in the trap \\ inches from back pressure at the beginning of the discharge, 
and some air was forced through. The experiment was repeated, with similar 
results. 

3. At joint No. 6, a i^-inch three-quarter S trap with 13^ feet of i^-inch 
wrought-iron vent-pipe had its seal broken by thirteen discharges. The loss from 
the first was ^ of an inch. The water in the trap rose \ of an inch from back 
pressure at the beginning of each discharge. The experiment was twice repeated, 
with similar results. 

Two-inch waste-pipe closed at top ^ with a i^inch McClellan vent at running trap. 
Four-inch waste-pipe open at top, and flushed with a 2-inch connection through 
vented running trap. Fresh-air inlet closed, and located as per Fig, 3 . 

1. A three-quarter S lead trap, i-!^.inch seal at joint F on 4-inch line, protected 
by a i^-inch McClellan vent, lost its seal in one discharge by the air forced 
through it. 

2. A three-quarter S lead trap, i^-inch seal at joint F on 4-inch line, protected 
by 13-^ feet of i^-inch pipe with two elbows, lost its seal in nine discharges. Loss 
by first discharge -f^ of an inch. 

3. A one-half S glass trap, 2-inch seal at joint F on 4-inch line, protected by 
a ij-inch McOellan vent, suffered no loss of seal by three discharges. The water 
in the trap could be seen to oscillate violently i\ inches, but the level in the inner 
limb was never above the original height, so that no water escaped into the waste 
line. 

4. The same trap under same conditions, but protected by a i-^-inch vent-pipe 
• 13^ feet long with two elbows, lost its seal by four discharges. The loss by the 

first discharge was one inch. Air was forced through at the third discharge. The 
loss of seal was due to violent oscillations of the water, the level of the latter in 
the inner limb oscillating above the original height. There was a strong current 
of air flowing upwards through the vent-pipe, but it appears that the pressure of 
the air in the space £, Fig. 5, fluctuated above and below that of the atmosphere, 
so as to induce oscillations of level sufficient to permit water to escape from the 
trap into the waste-pipe. 

The \4nch soil-pipe open full at its top, and flushed by discharging contents of 
plunger closet cU joint C. The 2-inch waste-pipe open full at its top, and the fresh- 
air inlet in the house drain closed, and located as per Fig, 3. 

1. At joint £, the li-inch S trap, with a i J. inch McClellan vent, lost ^ of an 
inch of its seal from two discharges, but remained unchanged during the three 
following. The loss from the first was i of an inch. The water in the trap rose 
two inches from back pressure during the first part of the flush. There was a 
vacuum during the latter part of the discharge, but there were no oscillations in 
the water in the trap, and no air passed through the seal. 

2. At joint £, the li-inch S trap with 13} feet of li-inch wrought-iron vent- 
pipe, lost ^^ of an inch of its seal from seven discharges, but remained unchanged 
during the tiiree following. The loss from the first was i of an inch. The water 
in the trap rose i of an inch from back pressure during each discharge. The loss 
of seal is due to the upward current of air through vent-pipe. 



290 



EXPERIMENTS ON TRAP SIPffONAGE. 





1. plug out 
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Top2-in. 

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EXPERIMENTS ON TRAP SIPHONAGE, 29I 

Experiments to see the Effect of placing the McClellan Vent out 

OF PLUMB. 

Top of 2'inch waste-pipe closed^ Init trap on the waste connection vented by 8 
feet ofii'inch wrought-iron vent-pipe , \\4nch flush in use, 

1. At joint No. 2, a li-inch S trap having a li-inch McClellan vent set plumb, 
lost ^ of an inch from five discharges, but remained unchanged during the five 
following. The loss from the first was i an inch, and the average from each suc- 
ceeding discharge was yj^ of an inch. There were no oscillations. 

2. At joint No. 2, a li-inch S trap having a li-inch McClellan vent set out of 
plumb, I in 6, lost ^ of an inch in six discharges, but remained unchanged for the 
four following. The loss from the first was i^^ of an inch, and from etch succeed- 
ing, up to the sixth, discharge 3^2 ^^ ^^ \n!^. There were slight oscillations of \ 
of an inch. 

Top of waste-pipe closed^ and all vent^ closed, i }i-inch flush, 

1. At joint No. 2, a 1 4-inch S trap having a 1 4-inch McClellan vent set plumb, 
lost f of an inch in five discharges, but had no fiirther loss during the five follow- 
ing. Loss from the first was 4 ^n inch, and the average loss from each of the 
succeeding, up to the fifth, discharge was 3^3 of an inch. 

2. At joint No. 2, a 1 4-inch S trap having a i4-inch McClellan vent set out of 
plumb I in 12, lost ( of an inch of its seal in five discharges, but met with no 
fiirther loss during five following. The loss from the first was 4 sui inch, and the 
average from each of the following, up to the fifth, discharge was ^2 o^ ^^ vd^, 

3. At joint No. 2, a 1 4-inch S trap having a i4 McClellan vent set out of 
plumb I in 8, lost f of an inch of its seal in three discharges, but met with no 
fiirther loss. The loss from the first was 4 an inch, and the average loss from 
each of the succeeding, up to the third, discharge was j^, of an inch. 

Experiments to show the effect of various lengths of \\-inch wrought-iron vent- 
pipes on the protection of the trap seals. Experiments on a 2-inch waste-pipe. 

Experiments with a 1 4-inch three-quarter S trap vented by different lengths of 
1 4 -inch wrought-iron vent-pipe having several 90-degree elbows, trap being 
connected with a 2-inch waste-pipe that was flushed under variable conditions. 



292 EXPERIMENTS ON TRAP SIPHON AGE. 

Experiments on a li-incA S trap with a li-incA McClellan vent set out of plumb. 



Condition of waste-pipe. 


Top of waste-pipe closed 
and trap of waste connec- 
tion vented. 


Top of waste-pipe 
and all vents 
closed. 


Condition of setting of vents. 


Vertical. 


Out of 
vertical 
I in 6. 


Vertical. 


Out of 
vertical 
I in 12. 


Out of 

vertical. 

I in 8. 


Total loss of seal . . . 

No. of discharges or parts 
of a discharge necessary 
to cause tnat loss . . 

Loss from first discharge In 
inches 

Average loss from each suc- 
ceeding discharge in 
inches 

No. of times experiment 
was carried beyond the 
discharge in which the 
trap ceased losing . . 


tl-in. 

5 

J-in. 

5 


6 
4 


t-in. 

5 

J-in. 

5 


t-in. 

5 
1-in. 

5 


l-in. 

3 
4-in. 

3 



A. Top of a 2'inch waste-pipe and all vents closed. 



Waste-pipe flushed by discharging tank X, through a li-inch waste connection, 

1. At joint No. 2, the 1 4-inch S trap with a ij-inch water seal, having 25 feet 
of 1 4 -inch vent-pipe with three elbows, had its seal broken by eleven dischaiges. 
The loss from the first was } of an inch, and the average from each succeeding 
discharge was ^, of an inch. Air began breaking through the trap on the eighth 
discharge. 

2. At joint No. 2, the 1 4-inch S trap with a 1 4-inch water seal, having 30 
feet of 1 4 -inch vent-pipe with three elbows, had its seal broken by two dischaiges. 
The loss from the first was ^ of an inch. 

3. At joint No. 2, the 1 4-inch S trap with a i4-inch water seal, having 33 feet 
of 1 4-inch vent-pipe with three elbows, had its seal broken by two discharges. 
The loss from the first was i-inch. 

4. At joint No. 2, the 1 4-inch S trap with a 1 4-inch water seal, having 35 feet 
of 1 4 -inch vent-pipe with three elbows, had its seal broken by a discharge of half 
the contents of tank X. 

II. 

Waste-pipe flushed by discharging contents of tank X throu^ a 2-inch waste 
connection, 

I. At joint No. 2, the i4-inch S trap with a i4-inch water seal, having 134 feet 



EXPERIMENTS ON TRAP SIPHON AGE, 293 

of li-inch vent-pipe with two elbows, lost ^ of an inch of its seal by eight, but 
remained unchanged during the three following, discharges. The loss from the 
first was ^^ of an inch, and the average for each of the following, up to the eighth, 
discharge was ^g of an inch. There was an oscillation of \ of an inch at the end 
of each discharge. 

2. At joint No. 2, the i<&-inch S trap with a li-inch water seal, having 25 feet 
of li-inch vent-pipe with three elbows, had its seal broken in four flushes. The 
loss from the first was } of an inch. There were oscillations of i of an inch. 

3. At joint No. 2, the li-inch S trap with a li-inch seal, having 33 feetof li-inch 
vent-pipe with three elbows, had its seal broken by one discharge. The seal 
remained unbroken till air was drawn into the waste-pipe through the vortex of the 
escaping water in the tank at the end of the discharge. 

4. At joint No. 2, the ij-inch S trap with a li-inch seal, having 35 feet of li-inch 
vent-pipe with three elbows, had its seal broken by one discharge. The seal 
remained unbroken till air was drawn into the waste-pipe through the vortex of 
the escaping water in the tank at the end of the discharge. 

B. Top of 2-inch waste-pipe closed^ btU trap on waste connection vented. 



Waste-pipe flushed by discharging contents of tank X through a li-inch waste 
connection^ having its trap vented by eight feet of li-inch vent-pipe. 

1. At joint No. 2, the li-inch S trap with a li-inch seal, having 30 feet of li- 
inch vent-pipe with three elbows, had its seal broken by seven discharges. The 
loss from the first was } of an inch, and the average from each of the following 
discharges was ^ of an inch. 

2. At joint No. 2, the li-inch S trap with a li-inch seal, having 33 feet of li- 
inch vent-pipe with three elbows, had its seal broken by three discharges. The 
loss from the first discharge was i of an inch. 

II. 

Waste-pipe flushed by discharging contents of tank X throu^ a 2-inch waste 
connection, having its trap vented by 8 feet ofik inch vent-pipe. 

1. At joint No. 2, the ij-inch S trap with a ij-inch seal, having 13J feet of 
ij-inch vent-pipe with two elbows, lost fj of an inch of its seal by seven dis- 
charges, but remained unchanged during the three following discharges. The 
loss from the first was i an inch, and the average for each succeeding, up to the 
seventh, discharge Was 5^ of an inch. 

2. At joint No. 2, a li-inch S trap with a li inch seal, having 25 feet of 
I i -inch vent-pipe with three elbows, had its seal broken by three discharges. The 
loss from the first discharge was ^| of an inch. There were irregular oscillations. 

3. At joint No. 2, a i J -inch S trap with a i J -inch seal, having 35 feet of 
li-inch vent-pipe with three elbows, had its seal broken by a discharge of one 
half the contents of tank X. 



294 



EXPERIMENTS ON TRAP SIPHON AGE. 



s. 



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EXPERIMENTS ON TRAP SIPHONAGE, 295 

Comparisons of values as Protectors to the trap seals of iJ-inch 
wrought-iron vent-pipes, having 90-degree elbows, with i i -inch 

straight WROUGHT-IRON PIPES WITHOUT ELBOWS. 

Top of7,Jnch waste-pipe closed^ and all vents plugged. 

One and one half inch flush from Tank X. Experiments at Joint No, 
4, on the 24nch waste-pipe, A ih^nch S trap at Joint No. 4 vented by various 
combinations of elbows and pipes ^ vis, — 

1. With two elbows and 10 inches of li-inch vent-pipe, as per sketch (Fig. 
20), the I S trap lost ^ of an inch of its seal from three discharges, but remained 
unchanged during the seven following discharges. The loss from the first dis- 
charge was J of an inch, and the average loss from each succeeding, up to the 
third, discharge was ^ of an inch. 

2. With one elbow and 6 inches of vent-pipe, as per sketch (Fig. 2i),i the I S 
trap lost I of an inch by two discharges, but remained unchanged during the 
seven following. The loss from the first discharge was ^ of an inch, 

3. With 2 feet of straight vent-pipe, the loss was ^ of an inch from four dis- 
charges, but remained unchanged during the three following. The loss from the 
first was j^, and the average loss from each following, up to the fourth, discharge 
was ^ of an inch. 

4. With 4i feet of li-inch vent-pipe, the loss from three discharges was } of 
an inch, but remained unchanged during the four following discharges. The loss 
from the first was i of an inch, and the average loss, up to the third, was ^ of an 
inch. 

5. With 12 feet of ij inch vent-pipe, the loss from five discharges was ^ of an 
inch, but remained unchanged during the three following discharges. The loss 
from the first discharge was i of an inch, and the average loss from each of the 
succeeding discharges, up to the fifth, was ^ of an inch. 

6. With 12 feet of vent-pipe having a 90-degree elbow at its end. The loss 
from six discharges was ^ of an inch, but remained unchanged during the four 
following discharges. The loss from the first discharge was r^^ of an inch, and the 
average from each of the succeeding discharges, up to the sixth, was ^ of an inch. 

7. With 24 feet li-inch vent-pipe, the loss from four discharges was } of an 
inch, and remained unchanged during the five following discharges. Loss frx>m 
the first discharge was -^ of an inch, and the average loss for each succeeding dis- 
charge, up to the fourth, was -j^ of an inch. 

8. With 24 feet of i J-inch vent-pipe, having one 90-degree elbow at its end, 
there was a loss of } of an inch in six discharges, but no change during the four 
following. Loss from the first discharge was J of an inch, and the average loss 
from each succeeding discharge, up to the sixth, was ^ of an inch. 

9. With a ij-inch McClellan vent. Lost i an inch from four discharges, but 
remained unchanged dvuing the four following. The loss from the first discharge 
was :j|^ of an inch, and the average loss from each of the following, up to the fourth, 
discharge was ^ of an inch. 

y For ngs. 20 and 21, see page 296. 



296 



EXPERIMENTS ON TRAP SIPHONAGE. 



dp' 





Fig, 21. 



Fig. 20. 



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Fig. 23. 



Fig. 22. 



EXPERIMENTS ON TRAP SIPHON AGE. 



297 



Conditions of venting. 



1, 2 90-degrec elbows and 10 inches of li- 

incb vent-pipe 

2. r dbow and 6 inches of li-inch vent-pipe 

3. 2 feet of I i -inch pipe, no elbows , , 

4, 4^ feel of li-inch pipe, no elbows 

5. 12 feet of 1 1-inch pipe, no elbows 

6, 12 feet of li-inch pipe, 90-degree elbow 

at end .....*.. 

7< 24 feet of I i -inch pipe, no elbows 

8. 24 feet of li-inch pipe, 90-degree elbow^ 

at end 

9, ij-inch McClellan vent , . . , 












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SECOND SERIES. 

1. The li-inch S trap, having a li-inch seal, and vented by 12.3 feet of ij-inch 
wrought-iron pipe, including ten 90-degree elbows arranged as per sketch (Fig. 
22), had its seal broken in two discharges. The first loss was i} of an inch. 
The experiment was repeated five times with the same results. 

2. The I i -inch S trap vented by 30 feet of i J -inch straight wrought-iron pipe 
without elbows, lost its seal by two discharges. The first loss was t of an inch. 
The experiment was repeated four times. 

3. The ij-inch S trap, having ij-inch seal, and vented by 7J feet of wrought- 
iron vent-pipe, including five 90-degree elbows arranged as per sketch (Fig. 23),! 
lost I inch of its seal by fifteen discharges, but remained unchanged during the 
five following. The first loss was ^ of an inch. 

4. The li-inch S trap vented by 16 feet of li-inch straight wrought-iron pipe, 
lost ^f of an inch in thirteen discharges, and remained unchanged during the four 
following. The loss from the first was ^ of an inch. 

^ For Figs. 22 and 23, see page 296. 



298 



EXPERIMENTS ON TRAP SIPHONAGE. 



5. The same with 18 feet of vent-pipe without elbows, had its seal broken by 
eleven discharges. The loss from the first discharge was -^oizxL inch. ' 

6. The same with 17 feet of vent-pipe without elbows, lost i-^^ inches of its 
seal by seventeen discharges, but remained unchanged during the two following. 
The loss from the first was } of an inch. 



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without 

with 

without 

without 

without 



Feet. 
12.3 

30 

75 
16 
18 
17 



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5 

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Broken. 

Broken. 

I 

Broken. 



2 

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II 

17 



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RESULTS. 

The experiments with the 30 feet of li-inch pipe without elbows gave the same 
results on the seal of the S trap as ten elbows. Hence the ten elbows are equiva. 
lent to 17.7 feet of straight pipe, or one elbow to 1.77 feet of pipe. The experi- 
ments with the 17 feet of straight pipe and the ^h feet with five elbows, gave 
nearly the same results. Hence, the five elbows are equivalent to 9 J feet of 
straight pipe, or one elbow to i .9 feet of pipe. The mean of both sets of experi- 
ments gives 1.8 feet of pipe for the equivalent of one elbow. 

Miscellaneous experiments on siphonage of a three-quarter S trap, on a 2-inch 
waste-pipe , open at top, with vent-pipes running from basement to roof under most 
favorable practical conditions. Also with three-quarter S trap unvented. 

The 2 -inch waste-pipe open full at the top, and flushed by discharging contents 
of tank X through a li-inch waste connection, having its running trap vented by a 
li-inch McClellan vent. 

Experiments with a li-inch S trap at joints Nbs. 5 and 6. 

I. At joint No. 6, the 1 4-inch S trap vented by 60 feet of straight wrought-iron 
vent-pipe (li-inch diameter for 20 feet above the trap, and 2-inch diameter for the 



EXPERIMENTS ON TRAP SIPHON AGE, 299 

remaining 40 feet), lost -^ of an inch of its seal from five discharges, but remain- 
ed constant during the three following. The loss from the first was -j^ of an inch. 

2. At joint No. 6, the 1 4 -inch S trap, with its vent-pipe removed and the vent 
opening plugged, had its seal broken during three experiments ; — ^in the first, from 
the second discharge ; and the loss from the first was i of an inch ; — in the. 
second, from the fourth discharge, with a loss of j^ of an inch from the first. And 
in the third experiment the seal was broken by the second, while the loss from the 
first discharge was i|-inch. 

3. At joint No. 5, the li-inch S trap, vented by 48 feet of straight wrought- 
iron pipe (li-inch diameter for 20 feet from trap, and 2-inch diameter for the 
remaining 28 feet), lost j^ of an inch from the second discharge, but remained 
unchanged during the two following. The loss from the first was ^ of an inch. 

4. At joint No. 5, the li-inch S trap, with the vent-pipe removed and vent 
opening plugged in two experiments, had its seal broken by one discharge. 

5. At joint No. 5, the li-inch S trap, with the vent-pipe the same as No. 3 
excepting that two 90-degree elbows were placed in the i J -inch pipe, lost } of an 
inch of its seal from four discharges, but remained unchanged during the two 
following. The loss from the first was i of an inch. 

Miscellaneous experiments on siphonage of a three-quarter S trap on ^-itich 
waste-pipe, under various possible practical conditions, 

I. 

The 4'inch soil-pipe, with the ^-inch plug out at its top, and flushed by a 2-inch 
waste connection, having its running trap vented by a 2-inch McClellan vent. 

At joint E, the li-inch S trap, with its vent opening plugged, lost ^ of an inch 
of its seal from the first discharge, but remained unchanged during the three 
following. 

II. 

The 4-inch soil-pipe with the 4-inch plug out at its top, and flushed by dis- 
charging the plunger closet cU C, with its trap vent plugged. 

At joint E, the i^-inch S trap, with its vent plugged, lost i of an inch of its seal 
fix)m one discharge. The 4-inch plug was then replaced at the top of the soil-pipe, 
and a 2-inch plug removed. The experiment was continued without refilling the 
trap, which lost i of an inch more of its seal from the second discharge, but had 
ceased losing up to the fourth, when the experiment was discontinued. 

III. 

The 4-inch soU-pipe, with a 2-inch plug out cU its top, and flushed by a 2-inch 
waste connection from tank X, having a 2-inch McClellan vent on its running 
trap, 

1. At joint E, the ij-inch S trap, with its vent opening plugged in two experi- 
ments, had its seal broken on the first and second discharge respectively. 

2. At joint E, the i^inch S trap, vented by 48 feet of wrought-iron vent-pipe 
with two i^inch 90-degree elbows (the pipe was i^-inch diameter for 20 feet 



30O EXPERIMENTS ON TRAP SIPHONAGE, 

above trap, and 2-inch diameter for the remaining 28 feet), had its seal broken 
by four discharges. The loss from the first was } of an inch. 

3. At joint E, the i J-inch S trap, with a i J-inch McClellan vent, lost i-inch of 
its seal from three discharges. The loss from the first was f^ of an inch. The 
' experiment was not carried beyond three discharges. 

The 4'tncA soil-pipe, with a ^-inch plug out at its top and flushed by a plunger 
closet, with the vent on its trap closed. 

At joint E, the i4-inch S trap, with a i J-inch McQellan vent, lost i of an inch 
of its seal from the first discharge, but remained unchanged during the four foK 
lowing. 

The 4'inch soil-pipe, with a 2-inch plug out at its top, besides a 2-inch McCleUan 
vent on the running trap of the 2-inch waste connection. Flushed by plunger closet 
with unvented trap, 

1. At joint E, the i J-inch S trap, with a i J-inch McQellan vent, lost } of an 
inch of its seal from the first discharge, but remained unchanged during the three 
following. 

2. At joint E, the i J-inch S trap vented by 48 feet of wrought-iron vent-pipe, 
with two elbows (i J-inch diameter 20 feet from trap, and 2-inch for the 
remaining 28 feet), lost ^ of an inch of its seal from four discharges. The loss 
from the first was } of an inch. 

The 4-inch soil-pipe, with a 4-inch plug out at its top and flushed by a 2'inch 
waste connection, having a 2-inch McClellan vent on its running trap. 

At joint E, the i J-inch S trap, with a i J -inch McClellan vent, lost i of an inch 
of its seal from two discharges, but remained unchanged during the three follow- 
ing. The water in the trap rose | of an inch at the first of each flush. 

The 44nch soil-pipe closed at its top, and with all vent openings plugged. 



Flushed by the 2 -inch waste connection from tank X, with the vent on its run- 
ning trap plugged. 

At joint E, the i J-inch S trap, with its vent opening closed, in three experi- 
ments had its seal broken by one discharge. 

II. 

Flushed by the plunger closet at joint C, with the vent on its running trap 
plugged. 

At joint E, the i J-inch S trap, with its vent opening closed, in three experi- 
ments had its seal broken by one discharge. 

The 4-inch soil-pipe closed at its top, and with no vents open, and flushed by 
the 2'inch waste connection, with the vent on its running trap plugged, 

I . At joint B, the mercury column, or vacuum gauge, read i of an inch of 
mercury. 



EXPERIMENTS ON TRAP SIPHONAGE. 3OI 

2. At joint B, the li-inch S trap, with its vent opening dosed, had its seal 
broken by one discharge. 

3. At joint B, the li-inch S trap, with i«|-inch McQellan vent, had its seal 
broken by one discharge. 

4. At joint B, the li-inch S trap, with 30 inches of li-inch wrought-iron pipe 
with two 90-degree elbows, lost | of an inch of its seal in two discharges. 

5. At joint B, the 1 4-inch S trap, with 134 feet of wrought-iron vent-pipe with 
one elbow, had its seal broken by one discharge. 

The 4'tnck soil-pipty with a 7,4nch plug out at its tap and flushed by the 2'inch 
waste connection J with the vent on the running trap closed. 

1. At joint B, the 1 4 -inch S trap, with its vent opening closed, had its seal 
broken by one discharge. 

2. At joint B, the i^inch S trap, under the same conditions as in experiment i, 
but with 8 gallons in the flushing tank, lost i i of an inch of its seal from three 
discharges, but met with no further loss during the two following. 

TTie \'inch soil-pipe closed at its top, with all vent openings closed and flushed 
by plunger closet at joint C, hcLd the vent on its trap plugged, 

1 . At joint B, the mercury column, or vacuum gauge, read \ an inch of mer- 
cury. 

2. At joint C, the 1 4 -inch S trap, with its vent opening plugged, had its seal 
broken by one discharge. 

The 4-inch soil-pipe^ with the \'inch plug out at its top, flushed by plunger 
closet, 

1 . Vacuum gauge at joint C, read 4-inch of water. 

2. At joint C, the 1 4-inch S trap, with its vent opening plugged, met with no 
loss of its seal. 

3. At joint C, the 1 4-inch S trap, with its vent opening plugged and with the 
tank discharging through the 2-inch waste connection at the same time the plunger 
closet was discharged, met with no loss of its seal. 



302 



EXPERIMENTS ON TRAP SIPHONAGE, 



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EXPERIMENTS ON TRAP SIPHONAGE. 



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304 expjSriments on^ trap siphonagr. 



APPENDIX II. 

NOTES ON THE VAPORIZATION OF MERCURY. 
By Dr. T. B. Stillman. 

Mercury remains unchanged upon long shaking up with either air, hydrogen, 
nitrogen, or carbonic add. — Gmelin-Kraut, Anorganische Chemie, Vol. Ill, page 
741. 

Mercury solidifies at -40 degrees C. At 662 degrees Fahr. it boils, and yields 
a transparent, colorless vapor of great density. The metal volatilizes, however, to 
a sensible degree at all temperatures above 19 degrees or 2i degrees C. [66 
degrees to 68 degrees Fahr.] ; below this point its volatility is imperceptible. Pure 
mercury is quite unalterable at common temperatures, but when heated near its 
boiling point it slowly absorbs oxygen and becomes converted into a dark-red 
powder. — Fowne's Manual of Chemistry. 

Mercury retains its lustre even on long exposure to ordinary air. — Encyclopaedia 
Britannica. 

Mercury is a brilliant, mobile liquid, which vaporizes slowly even at ordinary 
temperatures. Perfectly pure mercury undergoes no change in air or in oxygen 
gas at the ordinary temperatures, even when shaken about in the gas for a long 
while ; but if mercury containing traces of foreign metals, such, for example, as 
that ordinarily met with in commerce, be exposed to the air, a gray pulverulent 
coating will, after a while, appear on its surface. This coating is composed of 
oxides of the contaminating metals mixed with finely divided metallic mercury — 
Elliot & Storer, page 571. 

Mercury is the only fluid metal at ordinary temperatures. At 360 degrees C. 
it boils, and at a slightly higher temperature distils over, but is volatilized to some 
extent at all temperatures above its freezing-point, as may be proved by suspend- 
ing a piece of gold-leaf in the neck of a bottle containing a small amount of mer- 
cury. — Chemical Technology — Wagner, edited by Prof. Wm. R. Crookes, F. R. S. 

This reaction requires several weeks for its performance, and the air must be 
enclosed, as follows : 

Place at the bottom of a bottle some mercury, and suspend in the neck a bit of 
gold-leaf; in a few weeks the lower portions of the gold will become white from 
the condensation of the vapor of mercury upon it. — Chemical Physics, Miller, 
page 371. 

Mercury — ^permanent — ^unacted upon by water. In contact with aqueous solu- 
tions of the alkaline chlorides, and exposed to the air, mercury is attacked to a 
certain extent with formation of HgCl. — Dictionary of Solubilities, Storer, page 

358. 

The experience of M. Merget proves that mercury develops its vapor at ordi- 
nary temperatures, and that these vapors propagate themselves in the air. — M. Reg- 
nault in Compte Rendus 73, page 1462. 

Annales de Physique [3d serie, t. XI, 1844] contains an article upon the ten- 
sion of the vapor of mercury at all temperatures from zero to 100 degrees C. 

Also Regnault states, Comte Rendus 7^, page 1462, — I admitted in the 
researches that the tension of mercury is nihil at the temperature of melting ice. 
This hypothesis is not absolutely correct. Mercury volatilizes itself sensibly at 



EXPERIMENTS ON TRAP SIPHONAGE. 305 

this temperature. This experience proves that at -13 degrees C. the vapor of 
mercury develops sufficiently to form an image on a daguerreotype with an expos- 
ure of 12 hours. 

The experiments of M. Merget simply confirm the statement that all liquids 
are more or less volatile at ordinary temperatures. The experiments were made 
with pure mercury and large surfaces of exposure. This latter is also a requisite 
for the effect of the vaporization of the metal upon the daguerreotype plate and 
the production of an image. 

In the process of evaporation the vapor of mercury is supplied from the upper 
or superficial layer of the liquid metal only, and as Miller [Chem. Physics, page 
372] states. It is therefore evident that the extent of surface exposed must greatly 
influence the amount and rapidity of evaporation independently of the tempera- 
ture. Now if the evaporating surface be in any way protected, evaporation is 
entirely suspended. 

The protection afforded the McClellan vent by the coating of oxides, or other 
metals, &c., upon the surface of the mercury contained in it, would therefore pre- 
vent such evaporation as described, even if the lattere were not confined to infini- 
tesimal amounts. [See Elliot & Storer, quoted above.] 

A very complete article upon the diffusion of the vapor of mercury will be found 
in Compte Rendus, vol. 73, pages 1356, '57, '58, '59, '61, by M. Merget, one of 
the conclusions being, that the phenomenon of the vaporization of mercury is 
continuous, which is only interrupted by the solidification of the metal. [The 
remarks given cover this extract.] 

At 40 degrees C. it gives off a great volume of vapor which is made use of in 
the daguerreotype, etc., and even at ordinary temperatures, and even as low as 
-13 degrees C. it vaporizes, so that one must take precautions regarding this latter 
when in a room with a considerable quantity of mercury. Lehr. buch der Chemie, 
Graham Otto, Vol. II, page 1063. [The remarks given cover this extract.] 

Mercury vapor shows at ordinary temperature appreciable tension. At 20 
degrees C. the same is 0.0268 m. m. ; at 100 degrees C. equals 0.5 m. m. Pure 
mercury remains imaltered in the air, etc. From Neues Hondwortubuch der 
Chemie Fehling, 65 th. — Lieferung. 

Watts's Dictionary of Chemistry states as follows : Mercury remains unaltered 
when agitated for any length of time in oxygen gas, air, etc., but any foreign 
metals mixed with it become oxidized, etc. 

Karten [Pogg. Ann, t. XXI — 245] states that mercury at temperatures below 
o degrees C. gives off sufficient vapor to bring out the image on a daguerreotype 
plate held over it. [The remarks given cover this extract.] 

The conclusions to be drawn from the above references are as follows : 

The fact that gold-leaf must be suspended in a narrow space over pure mercury 
for weeks before amalgamation by vaporization is effected, shows that the latter is 
infinitesimal in amount, and the rate imperceptible by ordinary means of observa- 
tion. [See Wagner & Miller's statement.] 

The experiments were made with the utmost delicacy upon pure mercury, and 
the results shown indicate that the greatest care and skill were necessary to detect 
[at ordinary temperatures] the vaporization. 

The conditions are entirely altered, however, when the ordinary commercial 
mercury is used, since the latter contains traces of lead, copper, iron, etc., which 
produce a thin coating of oxides upon the surface of the metal, preventing any 
tendency to vaporization. Not only is this tnie at ordinary temperatures, but 



306 EXPERIMENTS ON TRAP SIPHONAGE, 

it continues up to the boiling-point of the metal, so that the boiling-point of the 
commercial metal is very much higher than that of pure mercury. Pure mercury 
is not available for ordinary use, as its preparation requires processes which 
increase its cost about 30 per cent, above that of commercial mercury. Assum- 
ing, therefore, that the McClellan vents are to use commercial mercury, the latter 
impurities will protect it against loss by vaporization, even to the infinitesimal 
extent to which the statements in chemical treatises really apply, for ordinary 
temperatures. 



PROCEEDINGS AND DISCUSSIONS OF THE 
EIGHTEENTH ANNUAL MEETING, 



Charleston^ S. C., Decemb er i( 



EXPERIMENTS ON TRAP SIPHONAGE. 



ERRATA. 

Page 253, second paragraph, fifth line, insert running trap and before " f resh^tir uUet.^ 

Page 258, trap No. 6 should be styled the Clarke-Bulb, 

Page 258, number of discharges of " Puro ** trap should be / instead of **4S." 

Page 259, the figures are numbered in the same order as the names of trsip^, pages 257 
and 258, 1. ^., Fig. 6 is the Cudell trap ; Fig. 7 the Bcwer trap, etc. 

Page 260, ** Fig. 2 " should read Fig. ij ; "Arrow Xm " should read Xm. 

Page 262, for pages " 12 to 14 " read 26s to 26s* 

Page 264, seventh line from bottom, for " on ** read no. 

Page 267, italicized paragraph foot of page beginning " Experiments with unvented anti- 
siphon traps, etc, belongs near top of page under heading "Un vented Traps 
Experimented Upon." 

Page 277, insert flushes after " following " at foot of page. 

Page 281, fourth paragraph, last line, read page 288, 

Page 293, Part II, Experiment I, read lost ii-i6 of an inch of its seal, etc 

Page 305, instead of "remarks given page 3," read remarks given in the first three para 
graphs of this page. 



Following is the programme authorized by the Executive Committee 
for the first day's work of the Association : 

Morning Session, at id o'clock, at Hibernian Hall. 

Calling meeting to order, by the President of the Association. 

Announcement from the Local Committee of Arrangements, by H. 6. Horlbeck, M, D., 
Chairman Local Committee, and Health Officer of Charleston. 

Announcement and reports from the Executive Committee. 

Report of the Treasurer. 

Election of new members. 

Paper on The Federal District in the Republic of Mexico, as a suitable residence for 
persons predisposed to tuberculous affection, and for the relief of pulmonary consump* 
tion, by Dr. Domingo OrvaRanos, Member of the Superior Board of Health of Mexico, 

Paper on The Prevention of Tuberculosis; a Century's Supervision in Italy, utidcr 



^ 



J 
\ I 



3o6 



EXPERIMENTS ON TRAP SIPHONAGE. 



it continues up to the boiling-point of the metal, so that the boiling-point of the 
commercial metal is very much higher than that of pure mercury. Pure mercury 
is not available for ordinary use, as its preparation requires processes which 
increase its cost about 30 per cent, above that of commercial mercury. Assum- 
ing, therefore, that the McClellan vents are to use conmiercial mercury, the latter 
impurities will protect it against loss by vaporization, even to the infinitesimal 
extent to which the statements in chemical treatises really apply, for ordinary 
temperatures. 



PROCEEDINGS AND DISCUSSIONS OF THE 
EIGHTEENTH ANNUAL MEETING, 



Charleston, S. C, December 16-19, 1890. 

(Note. Owing to the exceedingly imperfect and incorrect work of the so called phono- 
graphic stenographer, employed to report the Proceedings of the Eighteenth Annual 
Meeting of the Association at Charleston, the Secretary finds himself unable to present 
the usual verbatim report of the discussions and remarks, which has been pronounced, 
especially by members not in attendance at the meetings, to be so interesting and valuable 
a feature of the annual volume. The gross illiteracy of this man, his errors in orthogra- 
phy such as would be discreditable in a student at a primary school, his omissions of whole 
sentences and of the material parts of others, make his report such a jumble of imperfect, 
disconnected, and ungrammatical sentences that the Association would only be disgraced 
by its publication, and any attempt to rectify his errors and omissions would necessitate 
submission of the MS. to every speaker at the sessions. This is all the more to be 
regretted as the meeting was one of notable interest, the papers of a high order of merit, 
and the discussions upon them, participated in by an unusual number of members, of 
especial value. This does not, however, appear in the mutilated report furnished, in 
which the one often reiterated paragraph to which no exception can be taken is the fol- 
lowing: 

"The President : * Are there further announcements from the Ex. Committee? * 

" Further announcements were read." 

" The President : ' Are there further announcements from the Ex. Conunittee ? ' 

*• Further announcements were read." 

The Secretary has, therefore, by the advice of the Publication Committee, and under 
the authority of the Executive Committee, been compelled to restrict himself to a mere 
recital of the business transacted.) 

Tuesday, December 16, 1890. 
MORNING SESSION-'IO O'CLOCK, 

Following is the programme authorized by the Executive Committee 
for the first day's work of the Association : 

Morning Session, at 10 o'clock, at Hibernian Hall. 

Calling meeting to order, by the President of the Association. 

Announcement from the Local Committee of Arrangements, by H. B. Horlbeck, M. D., 
Chairman Local Committee, and Health Officer of Charleston. 

Announcement and reports from the Executive Committee. 

Report of the Treasurer. 

Election of new members. 

Paper on The Federal District in the Republic of Mexico, as a suitable residence for 
persons predisposed to tuberculous affection, and for the relief of pulmonary consump- 
tion, by Dr. Domingo Orvafianos, Member of the Superior Board of Health of Mexico. 

Paper on The Prevention of Tuberculosis ; a Century's Supervision in Italy, under 



3o8 PROCEEDINGS-^EIGHTEENTH ANNUAL MEETING. 

the influence of the preventive laws of the Kingdom of Naples, enacted 1782, by Law- 
rence F. Flick, M. D., of Philadelphia, Member Pennsylvania State Board of Health. 

Paper on Ventilation and Impure Air, as prophylactive or causative of disease, by 
P. C. Remondino, M. D., President Board of Health, San Diego, California. 

Paper on The Prevention of Phthisis, by B. F. Wyman, M. D., Aiken, S. C. 

Afternoon Session — at 4 o'clock. 

Paper on Swine Red-Disease in Mexico, by Jos^ L. G6mez, Member of Superior 
Board of Health of Mexico. 

A Paper on the Sanitary Advantages of the Turkish Bath, by Charles H. Shepard, 
M. D., Brooklyn, N. Y. 

A Paper on Some Chemical Notes on Chemical Disinfection, by F. P. Venable, Ph. D., 
F. C. S., University of North Carolina. 

Evening Session— at 8 o'clock, at Grand Opera House. 

Paper by Rev. Robert Wilson, D. D., LL. D. 

Meeting called to order by H. B. Horlbeck, M. D., Chairman Local Committee, 
Health Officer of Charleston. 
Address of Welcome by Hon. G. D. Bryan, Mayor of Charleston. 
Address by J. S. Buist, M. D. 

Address by H. B. Baker, M. D., President of the Association. 
Address by J. P. K. Bryan, Esq. 
Address by Rev. C. S. Vedder, D. D. 
Music. 

The Association met at 10 o'clock, and was called to order by tbe 
president, Dr. Henry D. Baker. 

Dr. Henry B. Horlbeck, chairman of the local Committee of Arrange- 
ments, made the following announcements on behalf of the committee : 

Gentlemen: — I beg to extend to the Association, by order of the 
managing committee, the privileges of the Charleston Club, 3 Meeting 
street, near Battery. The members will find files of periodicals, foreign 
and of the United States, also leading newspapers ; and will be made 
welcome. 

The City Hospital is situated at the west end of Calhoun street. The 
wards of this hospital are lined with glass and iron. 

The directors of the Charleston Orphan Asylum and Enston Home 
will also be glad to have the members visit these institutions. 

At the Enston Home will be found, for this country, a novel form of 
charity. Twenty very substantial and handsome brick cottages, donated 
by William Enston " for to make old age comfortable," based upon the 
ancient charity in Canterbury, England. 

The Orphan House is well worthy of a visit. 

The Charleston Library Society will be glad to have the members 
interested in old literature visit that institution. Many very rare and 
ancient books will be found there. 

Capt. J. H. Small, chairman of the board of commissioners of Charles- 
ton Orphan House, invites the Association to visit that institution. It 
will repay any of the members, even if the Association cannot go as a 
body. 



PROCEEDINGS— EIGHTEENTH ANNUAL MEETING, 309 

The president's address will be read this evening at the Grand Opera 
House. Exercises to commence at eight o'clock. Speeches of welcome 
from distinguished citizens will be made. 

On to-morrow the Association will accept the invitation of the Emer- 
son Ventilating Car Company to inspect the merits of their new patent. 
They will leave the city at half past one o'clock, and probably go to 
Otranto, where a collation and refreshments may be expected. 

On Thursday, at one o'clock, the Association will leave the city to go 
to inspect the Maritime Sanitation plant recently erected at Fort Johnson 
quarantine station in the harbor. The Secretary of the Treasury has been 
kind enough to place the revenue cutter Lot M. Morrill at the disposal 
of the Association for the excursion. 

Announcements from the Executive Committee were next in order. 

The secretary announced that under the direction of the Executive 
Committee, he had addressed communications to the chief health authori- 
ties of Mexico, Central America, Cuba, and the United States of Colom- 
bia, inviting their cooperation in the work of the American Public Health 
Association. No responses to these communications were received from 
any country addressed, except Mexico. Following is the correspondence 
that passed between the secretary of this Association and the secretary of 
the Superior Board of Health of Mexico : 

AMERICAN PUBLIC HEALTH ASSOCIATION. 

Secretary's Office, 

Concord, N H., July 16, 1890. 
Dr. Juan J. R. de Arellano, 

Secretary National Board of Health, Mexico, Mexico: 

Dear Sir : — At the annual meeting of the American Public Health Association held 
at Brooklyn, N. Y., in October last, the secretary of the Association was instructed to 
enter into communication with the health authorities of Mexico, Central America, Cuba, 
and the United States of Colombia, for the purpose of securing a more intimate coopera- 
tion in public health matters between these countries and those already embraced within 
the territorial domain of the American Public Health Association. To this end the Asso- 
ciation desires that the countries named shall be represented by their ablest sanitarians at 
the annual meetings, and in its Advisory Council, and on the Executive Committee. 

This Association has become the largest and most influential organization in the world 
in shaping public health opinions. In territorial area it now embraces the United States 
of America and the Dominion of Canada. Each state in the Union, the Army, the Navy, 
and the Marine Hospital service, the Dominion of Canada, and each province, is also rep- 
resented. 

So influential has this organization become, that it now practically dictates and shapes 
the public health legislation of this country and Canada. The Association feels that in 
the restriction and prevention of contagious and infectious diseases in particular there 
should be a closer cooperation between the health authorities of the United States and 
Canada and the countries lying south of the United States, and that by such cooperation 
the sanitary interests of all would be greatly enhanced. 

You are therefore cordially invited to send representatives from your board to the next 
annual meeting of this Association, which will be held at Charleston, South Carolina, in 
December next. You will be advised of the exact date later. [Dec. 16-19, 1890.] 

If this invitation is favorably looked upon by your board, you are respectfully requited 
to invite, on behalf of this Association, any state or provincial board of health in your 
country also to send delegates to the said meeting. 



3IO PROCEEDINGS— EIGHTEENTH ANNUAL MEETING, 

I inclose with this communication a list of the officers and committees of the Associa- 
tion for the present year. It would give me pleasure to answer any communications or 
inquiries that you may be pleased to make. 

Very truly yours, 

Irving A. Watson, 

Secretary. 

[translation.] 

Mexico, Aug. 7, 1890. 
Dr. Irving A. Watson, 

Secretary American Public Health Association, Concord, N. H. : 

Dear Sir : — I have had the honor of receiving your communication, dated the i6th of 
July last, in which you notify me that the American Public Health Association has invited 
the Superior Board of Health of Mexico to send representatives to take part in the next 
meeting, which will take place in Charleston, S. C, the i6th to the 19th of December of 
this year. 

I am instructed by this board to notify you that we appreciate and esteem to its full 
value your kind invitation, and agree with the ideas presented in your letter, and believe, 
above all, those which relate to the restriction and prevention of infectious and contagious 
diseases, and that there ought to be a more efficient cooperation between the health 
authorities of the United States and those of this Republic 

This board have agreed to bring the matter before the government for its approbation, 
and to designate the delegates, whose names will be sent you later. This board desires, 
as you suggest, that the other heatth authorities of the Republic be notified of the invita- 
tion that you have extended ; and in order to inform them, please send thirty copies of the 
preliminary circular. 

It gratifies me to sign myself your afiEectionate and obedient servant, 

[Signed] J. J- R- de Arellano, 

Sec, Superior Board of Health, 

The following notification was received later, announcing the delegates 
to be sent from Mexico : 

AL SOR. DOR. IRVING A. WATSON, 
Secretario de la Asociacion Americana de Salubridad Pt^BLicA. 
Concord, N. H. 
Este Consejo ha tenido k bien nombrar representantes para que concurran a la reuni6n 
de la Asociaci6n Americana de Salubridad Publica que tendri lugar este afio en Charles- 
ton S. C. al Sor. Dor. Domingo Orvafianos, Miembro de este Superior Consejo y de la 
Academia N. de Medicina, Profesor de la Escuela N. de Medicina y del Instituto Medico 
Nacional, Miembro de la Society Francaise d* Hygiene, y al Sor. Prof. Jos^ L. G6mez, 
Miembro de este Superior Consejo y de la Academia Nadonal de Medicina y Profesor 
de la Escuela Nacional de Agricultura y Veterinaria. 
Lo que tengo la honra de comunicar d V. protestandole mi consideraci6n distinguida. 
Libertad y C0NSTITUC16N. MEXICO, Nobiembre 15 de 1890. 

J. J. R. de Arellano, 

Secretario, 

Great applause followed the reading of this correspondence. 
Dr. Albert L. Gihon, Medical Director U. S. Navy, offered the fol- 
lowing' resolution : 

Resolved, That the American Public Health Association expresses its high apprecia- 
tion of the action of the Mexican government and of the Superior Board of Health of the 
' Republic in sending delegates to the Association, and cordially welcomes them to the 
fraternity of American sanitarians who are laboring in the common cause of Public 
Health. 



PROCEEDINGS— EIGHTEENTH ANNUAL MEETING. 311 

The resolution was unanimously adopted. 

The treasurer's report was read, and referred to an auditing commit- 
tee, consisting of Dr. George H. Rohd and Dr. Samuel H. Durgin. 
(See treasurer's report elsewhere.) 

Several applications for membership which had been approved by the 
Executive Committee were presented, and the persons named therein 
were duly elected. 

Dr. B. F. Wyman, of Aiken, S. C, presented an invitation to the 
Association, in behalf of the mayor, the board of trade, and the people 
of Aiken, to visit that famous resort at such time as might suit their 
convenience. The invitation was accepted by vote of the Association. 

The first paper presented was on " The Federal District in the Repub- 
lic of Mexico, as a Suitable Residence for Persons predisposed to Tuber- 
culous Affection, and for the relief of Pulmonary Consumption," by Dr. 
Domingo Orvananos, Member of the Superior Board of Health of Mex- 
ico. (See page i6o.) 

At the request of Dr. Orvaflanos this paper was read by Dr. Albert L. 
Gihon. 

The next paper was on " The Prevention of Tuberculosis ; A Century's 
Supervision in Italy, under the Influence of the Preventive Laws of the 
Kingdom of Naples, enacted in 1782," by Lawrence F. Flick, M. D. 
(See page 60.) 

The next paper in order was on "Ventilation and Impure Air, as 
Prophylactive or Causative of Disease," by P. C. Remondino, M. D. 
(See page 71.) Dr. Remondino not being present, Dr. Roh6 consented 
to read the paper ; but when called upon, he stated that he had examined 
the paper and found it to be of considerable length, too long to be read in 
the time allotted to it ; that a partial reading would not do justice to it ; 
and he therefore moved that it be read by title and referred to the Com- 
mittee on Publication. The motion was carried. 

The next paper was on the " Prevention of Phthisis," by B. F. Wyman, 
M. D. (See page 94.) 

These papers were ably discussed by Drs. Albert L. Gihon, J. N. 
McCormack, William Bailey, J. H. Raymond, J. D. Plunket, L. F. 
Flick, P. H. Bryce, F. P. Vandenbergh, G. H. Roh6, H. E. Ames, 
H. A. Johnson, B. F. Wyman, Geo. T. Kemp, and others. 

Dr. J. N. McCormack offered the following resolution : 

Resolved^ That a committee of five members be appointed by the president, to investigate 
and report to the next meeting of this Association such practicable methods of precaution 
against tuberculosis as are of universal application amongst the common people, including 
the destruction of the sputum of all tuberculous persons. 

This resolution was referred to the Executive Committee without dis- 
cussion. 
Dr. Albert L. Gihon offered the following resolution : 

Resolvedy That a standing committee of five members be appointed by the president, 
to formulate practical prophylactic measures for the prevention of the spread of tuber- 



312 PROCEEDINGS— EIGHTEENTH ANNUAL MEETING, 

culosis, especially looking to the protection of the healthy members of the community 
from tuberculous infection. 

This resolution was also referred to the Executive Committee, without 
discussion. 

AFTERNOON SESSION— 4 O'CLOCK. 

The Association met at four o'clock. 

Called to order by the president. 

The first paper presented was on the " Swine Red-Disease in Mexico," 
by Prof. Jos^ L. G6mez. (See page 168.) 

At the request of Prof. G6mez, this paper was read by Dr. Gihon. 

The next paper was on the " Sanitary Advantages of the Turkish Bath," 
by Charles H. Shepard, M. D. (See page 202.) Dr. Shepard not being 
present, the paper was read by Dr. William Bailey, of Louisville, Ky. 

A paper on ''Some Notes on Chemical Disinfection" (page 126), by 
Prof. F. P. Venable, Ph. D., was presented and discussed by Drs. Ash- 
mun, Lewis, Venable, Robinson, Hibberd, Flick, Ames, Raymond, Roh6, 
Clark, Durgin, Perkins, Gihon, Bailey, C. A. Lindsley, Daniells, and 
others. It was generally conceded that the report of the Committee on 
Disinfection and Disinfectants presented the most reliable information 
upon the subject under consideration. The use of corrosive sublimate 
was thoroughly discussed, and the prevailing opinion was that it is a very 
effective disinfectant, and, if properly used, unattended with dangers. 

On motion of Prof. F. C. Robinson, the following vote was adopted : 

Voiedf To instruct the secretary to advise each state board of health, which has not 
already done so, to issue directions to all local boards of health and health officers in refer, 
ence to the preparation and proper use of disinfectants, basing such directions upon the 
report of the Committee on Disinfectants of the Association. 

EVENING SESSIONS O'CLOCK, 

The evening session was held at the Grand Opera House. The night 
was stormy, but despite this drawback there was, in addition to the mem- 
bers of the Association, a good representation of business men and a fair 
sprinkling of ladies in the audience gathered to listen to the addresses of 
welcome in honor of the American Public Health Association. 

On the platform, besides the officers of the Association, were members 
of the state and city boards of health, members of the city council, and 
other prominent citizens. 

The meeting was called to order promptly at 8 o'clock, by Dr. H. 

B. Horlbeck, chairman of the local committee of arrangements. Rev. Dr, 

C. S. Vedder offered prayer. The order of the programme was fully 
carried out. For the addresses, see pages 1-29. 



PROCEEDINGS— EIGHTEENTH ANNUAL MEETING, 313 

SECOND DAY. 

Wednesday, December 17, 1890. 
MORNING SESSION— g O'CLOCK. 
Following 18 the programme for the second day's session : 

Morning Session, at 9 o'clock, at Hibernian Hall. 

Calling meeting to order, by the President of the Association. 

Announcement from the Local Committee of Arrangements, by H. B. Horlbeck, M. D., 
Chairman of Local Committee, and Health Officer of Charleston. 

Announcement and Reports from the Executive Committee. 

Election of new members. 

Reports from Standing Committees. 

Paper on What Constitutes a Filth Disease, by Samuel W. Abbott, M. D., Secretary 
of the Massachusetts State Board of Health. 

Paper on Some Original Observations on the value of Microscopical, Spectroscopical, 
and Chemical Examination of Black Vomit, as an aid to Health Officers, in distinguish- 
ing Yellow-Fever from Malarial Fever, by George T. Kemp, Ph. D., Director of Physi- 
ology and Experimental Therapeutics, Hoagland Laboratory, Brooklyn, N. Y. 

The Association will adjourn about 1 2.30 p. m., to take an excursion tendered by the 
Emerson Car Ventilating Company to inspect their new method of ventilating cars. Dr. 
J. Somers Buist, prior to going, will give a demonstration of the same. 

Afternoon Session at 4 o'clock. 

Paper on Underground Waters for Public Purposes, by Peter H. Bryce, M. D., Secre- 
tary of the Provincial Board of Health, Toronto, Ontario. 

Paper on Sulphuring or Bleaching Dried Fruits a Mistake if not a Crime, by Joel W. 
Smith, M. D., of Charles City, Iowa. 

Evening Session at 8 o'clock. 

Paper on Sanitary Improvement of Stagnant Lakes near the Seashore, by Joseph H. 
Raymond, M. D., of Brooklyn, N. Y. (Illustrated with the stereopticon.) 

Paper on The Treatment of Sewage by Precipitation and Saturation, by Joseph H. 
Raymond, M. D., of Brooklyn, N. Y. (Illustrated with the stereopticon.) 

Paper on The Relation of the Mechanical Arts to Preventive Medicine, particularly 
illustrated by the Artesian Wells and Tidal Drains of Charleston, by A. Nelson Bell, 
M. D., editor of "The Sanitarian," Brooklyn, N. Y. 

Paper on The Tidal Drain System of Charleston, by City Engineer L. J. Barbot 

The meeting was called to order by the president at 9 o'clock. 

Dr. Henry B. Horlbeck, chairman of the local committee of arrange- 
ments, made the following announcement. 

I beg to make the following announcement : The Association will 
accept the invitation of the Emerson Car Ventilating Company to take a 
run into the country on the North-Eastern Railroad, Atlantic Coast Line. 
On this trip the principle and practice employed in the ventilation of 
cars will be explained, and a practical test exemplified. At 12 o'clock 
Dr. J. S. Buist will address the Association as to the ventilation of the 
cars. Immediately succeeding his remarks, the Association will walk 
to the east end of Broad street, take a train of horse-cars, and then pro- 
ceed to the North-Eastern Railroad depot. 



314 PROCEEDINGS'-EIGHTEENTH ANNUAL MEETING. 

To-night a paper will be read by Dr. J. H. Raymond, illustrated by 
a stereopticon. 

To-morrow, at i o'clock, the Association will visit the quarantine 
station at Fort Johnson, leaving Custom House wharf at i o'clock, first 
proceeding there at 12 o'clock. 

Dr. Horlbeck will read a paper on " Maritime Sanitation." 

The secretary reported several applications for membership which 
had been favorably passed upon by the Executive Committee, and the 
persons named therein were duly elected. 

The report of the Committee on the "Cause and Prevention of Diph- 
theria," was read by Dr. G. C. Ashmun, chairman. (See page 97.) 

The report was discussed by Drs. Wyman, Roh6, Brj'ce, Kemp, 
Cantwell, Hibberd, Bahnson, Carter, Daniells, McCormack, and others. 
The report was adopted. 

Dr. George H. Rohe offered the following resolution : 

Resolved^ That the report of the Committee on the Cause and Prevention of Diph- 
theria be printed in pamphlet form as soon as practicable, and that copies be furnished 
to each state board of health. 

Referred to the Executive Committee. 

Dr. J. H. Ranch offered the following resolution : 

Whereas, Diphtheria, scarlet-fever, typhoid fever, and measles are frequently intro- 
duced into this country by immigrants, mainly owing to the fact that at some of the 
maritime ports no precautions whatever are taken to prevent their introduction, — ^there- 
fore, be it 

Resolved, That in the opinion of this Association, said diseases should be placed on 
the list of quarantinable diseases. 

Referred to the Executive Committee without debate. 

Dr. Frederick Montizambert said, — " Mr. President : I should like to 
submit to Dr. Ranch whether he would not feel disposed to add vari- 
cella to his list. That disease, although possibly not very dangerous to 
the country at large, yet carries off a number of young people annually. 
Moreover, it has quite a special importance in quarantine work from 
the occasional difficulty, pretended or real, in diagnosing between it and 
modified small-pox. Chicken-pox should, in my opinion, certainly be 
a quarantinable disease. With the modern appliances of a properly 
equipped quarantine station the detention carries no terrors and causes 
no discomfort to the patient or his attendants, and the advantages of 
having this disease on the list is very decided. At a port where chicken- 
pox is not quarantined the temptation to ship surgeons is ever present to 
endeavor to pass off their cases of small-pox as being only chicken-pox. 
You may say that is the business of the quarantine officer, and he must 
form his own diagnosis quite independently of how the case may be 
reported to him by the ship surgeon. That is very true. But the evil 
may be done before reaching quarantine, and in this way : If the sur- 
geon knows that both chicken-pox and small-pox are to be quarantined, 
and a doubtful case occurs on the voyage, he will isolate it at bnce from 



PROCEEDINGS— EIGHTEENTH ANNUAL MEETING. 315 

the very first. But if small-pox be quarantined, and chicken-pox not^ 
the temptation will be for the ship surgeon to call all doubtful cases, and 
all cases of modified small-pox, "only chicken-pox," to keep them in 
their own places in the crowded steerage, and to try and get them past 
the inspection at quarantine. And this keeping such cases in the steer- 
age, in the hope of evading detection and escaping detention at quaran- 
tine, of course greatly increases the risk for the other passengers, and, 
through them, for the country at large through which they are about to 
spread." 

Dr. Charles Smart, chairman of the Committee on the Pollution of 
Water-Supplies, said his committee had no report to offer at this time. 
He supposed it had been generally understood that the report made at 
the Milwaukee meeting released tlie committee from further duty, unless 
there should be some special reason for further work. A final report at 
this time would be impossible. If the committee were to be continued, 
it should report from time to time any progress made in relation to 
water-supplies. 

The first paper read at this session was on " What Constitutes a Filth 
Disease," by Samuel W. Abbott, M. D. (See page 30.) 

The next paper was on " Some Original Observations on the value of 
Microscopical, Spectroscopical, and Chemical Examination of Black 
Vomit, as an aid to Health Officers in distinguishing Yellow-Fever from 
Malarial Fever," by George T. Kemp, Ph. D. (See page 246.) 

Dr. J. S. Buist read a short paper on " Railroad Hygiene." (See 
page 147.) 

Dr. Thomas F. Wood offered the following resolution : 

Whereas, In view of the approaching centennial, in 1896, of the discovery of vaccina- 
tion by Edward Jenner, and in view of the fact that in no time has the great prophylactic 
power of vaccination been more firmly established in the conviction of the great body of 
the medical profession and in that of the more enlightened public than now ; and 

Whereas, There has been no period when the enemies of the practice of vaccination 
have been so determined and so well organized, — therefore, be it 

Resolvtd^ That the American Public Health Association appoint a committee to act in 
concert with the Jenner Centennial Committee of the American Medical Association, if 
deemed advisable, with the view to perfecting some plan whereby the approaching cen- 
tennial may be observed in some such substantial manner that the history, practice, and 
statistics of the whole subject shall be restated, in order to complete a fitting monument 
to the great discoverer. 

Referred to the Executive Committee without discussion. 
Dr. J. H. Raymond offered the following resolution : 

Resolved^ That the report of the local Committee of Arrangements on the Health 
Exhibit in connection with the seventeenth annual meeting of the American Public 
Health Association, held at Brooklyn in 1889, and the awards made by said conmiittee, 
be adopted by the Association and published in the forthcoming volume of the Transac- 
tions. 

Referred to the Executive Committee without discussion. 

Prof. W. W. Daniells moved that a committee on Car Sanitation be 



3l6 PROCEEDINGS— EIGHTEENTH ANNUAL MEETING. 

appointed by the president, to consist of five members. The motion was 
unanimously adopted. 

The time having arrived for the excursion announced in the pro- 
gramme, the Association adjourned to meet at 4 o'clock, p. m. 

EVENING SESSIONS O'CLOCK. 

The excursion consumed more time than was anticipated, consequently 
there was no afternoon session. The meeting was called to order at 8 
o'clock. The following papers were read : 

" Sanitary Improvement of Stagnant Lakes near the Seashore," by 
Joseph H. Raymond, M. D. (See page 57.) 

" The Treatment of Sewage by Precipitation and Saturation," by 
Joseph H. Raymond, M. D. (See page 132.) 

'* The Relation of the Mechanical Arts to Preventive Medicine, par- 
ticularly illustrated by the Artesian Wells and Tidal Drains of Charles- 
ton," by A. Nelson Bell, M. D. (See page 227.) 

"The Tidal Drain System of Charleston," by City Engineer L.J. 
Barbot. (See page 236.) 

The reading of these papers having occupied so much time, the Asso- 
ciation adjourned without discussion. 

Dr. Bryce's paper on " Underground Waters for Public Purposes" 
(see page 209) , was made the special order for Thursday morning. 

THIRD DAY. 

Thursday, December 18, 1890. 
MORNING SESSION—g O'CLOCK. 
The following programme was adopted for the third day's session : 
Morning Session at 9 o'clock, at Hibernian Hall. 

Calling meeting to order, by the President of the Association. 

Announcement from the Local Committee of Arrangements, by H. B. Horlbeck, M. D., 
Chairman of Local Committee, and Health Officer of Charleston. 

Announcement and reports from the Executive Committee. 

Election of new members. 

Filling vacancies in Advisory Council. 

Unfinished business. 

Reports from Standing Committees. 

Paper on The Vaccinal Protection of Passengers from Cuba, by Frederick Monti^am- 
bert, M. D., Quarantine officer of the Dominion of Canada, Quebec, Canada. 

Paper on Maritime Sanitation at Ports of Arrival, by H. B. Horlbeck, M. D., Quaran- 
tine officer of the port of Charleston, S. C. 

The U. S. Revenue cutter. Lot M. Morrill^ will take the members of the Association 
to the Quarantine station for the purpose of examining the system of maritime sanitation 
as practised at the port of Charleston, leaving the wharf in the rear of the Custom House 
at I o'clock. 

Evening Session at 8 o'clock. 

Paper on The Hygienic Value of Rational Irregularities in Habits of Living, by James 
F. Hibberd, M. D., of Richmond, Ind. 



PROCEEDINGS—EIGHTEENTH ANNUAL MEETING, 317 

Paper on The Relation of Land Monopoly to Population Health, by George Homan, 
M. D., Secretary of the State Board of Health of Missouri, St. Louis, Mo. 

Paper on Climate in Phthisis, by W. H. Geddings, M. D., of Aiken, S. C. 

Paper on House Drainage, by Albert L. Webster, Sanitary Engineer, New York. 

Paper on Trap Siphonage, by Prof. James E. Denton, Stevens Institute of Technology, 
Hoboken, N. J. 

Report from the State Board of Health, South Carolina, by J. R. Bratton, M. D., 
President of the State Board of Health. 

The meeting was called to order by the president. 

Dr. Henry B. Horlbeck, chairman of the local committee of arrange- 
ments, made the following announcement : 

I beg to announce that the Association will leave the hall about half 
past 1 2 o'clock, and walk a short distance to the Custom House wharf, 
just in rear of the custom house ; at i o'clock they will embark on the 
United States revenue cutter Lot M, Morrill^ Captain Baldwin, and visit 
the maritime sanitation plant at Fort Johnson, Charleston harbor. The 
steamer will pass Fort Sumter and Fort Moultrie, and, if sufficient 
water can be had at the wharf, will land at Sumter. Possibly a short 
run will be made to the jetties which are being constructed by the United 
States government for deepening Charleston bar. 

At 12 o'clock. Dr. Horlbeck will read a paper explanatory of Maritime 
Sanitation. 

All who desire to accept the invitation of the Aiken authorities to visit 
Aiken on Friday will please leave their names with Dr. Wyman, at the 
table on the right of the chair. 

The Advisory Council will meet this evening, after the evening 
session, in the large hall on the lower floor. 

The secretary reported that the Executive Committee had considered 
the resolution offered yesterday by Dr. Thomas F. Wood, and recom- 
mended its adoption in a new draft, as follows : 

Resolvedy That a committee of this Association be appointed to confer with a similar 
committee of the American Medical Association, to observe in some appropriate way the 
centennial of vaccination. 

The resolution was adopted in accordance with the recommendation 
of the Executive Committee. 

The secretary also reported that the Executive Committee had consid- 
ered the resolution offered by Dr. Ranch, and had amended the same by 
inserting the words ^^ and varicella," and recommended its adoption as 
follows : 

Whereas, Diphtheria, scarlet-fever, typhoid fever, measles, and varicella are frequent- 
ly introduced into the country by immigrants, owing mainly to the fact that at some of the 
maritime ports no precaution whatever is taken to prevent thtfir introduction, — therefore, 
be it 

Resolved^ That in the opinion of this Association said diseases should be placed on the 
list of quarantinable diseases. 

The resolution was adopted as amended. 



3l8 PROCEEDINGS^BIGHTEENTH ANNUAL MEETING, 

The Executive Committee having considered the resolution submitted 
by Dr. Roh^, recommended its adoption as follows: 

Resolved^ That the report of the Committee on the Cause and Prevention of Diph- 
theria be printed in pamphlet form as soon as practicable, and that copies be famished 
to each state board of health. 

The resolution was adopted in accordance with the recommendations. 

The Executive Committee having considered the resolution offered 
Tuesday by Drs. McCormack and Gihon, relative to the Prevention of 
Tuberculosis, reported the same in the following draft, and recom- 
mended its adoption: 

Resolved^ That a committee of five members be appointed by the president to investi- 
gate and report to the next meeting of this Association such practicable methods of pre- 
caution against tuberculosis as are of universal application among the common people, 
including the destruction of the sputum of all tuberculous persons. 

The resolution was unanimously adopted. 

Dr. A. N. Bell offered the following resolution : 

Resolved^ That a committee of five be appointed, of which Dr. Ranch shall be chair- 
man, to inquire into the expediency of and power to arrange for a special department for 
the exhibition of sanitary goods and appliances at the international fair in 1893. 

Referred to the Executive Committee without discussion. 
Dr. Henry Mitchell offered the following resolution : 

Resolved^ That the Committee on the Cause and Prevention of Diphtheria be requested 
to append to their report definite and detailed suggestions for the practical application 
of the most efficient means of cleansing and disinfecting clothing, furniture, and premises 
which have been exposed to the infection of diphtheria. 

Referred to the Executive Committee. 

The Auditing Committee reported that they had examined the treas- 
urer's report and found the same correct. The report was adopted. 

The following communication was presented by the Mexican delega- 
tion through Dr. Gihon : 

Charleston, S. C, i8th Dec., 1890. 
Gentlemen : We are directed to express to you the cordial good-will of the Mexican 
Board of Health, and assure you of the interest they manifest in sanitary progress ; and 
should this honorable American Public Health Association find it convenient to meet 
in the City of Mexico in the year 1892, we cordially offer every facility that the board 
affords. We hope most earnestly that the meeting of that year will be held in the City of 
Mexico. 

DR. DOMINGO ORVARANOS. 

DR. JOSfi L. G6MEZ. 

The communication was referred to the Executive Committee. 
Next in order was a paper entitled "Underground Waters for Public 
Purposes," by Peter H. Bryce, M. D. (See page 209.) 

The president announced that a discussion of the papers read by 
Mr. Barbot and Dr. Bryce was in order. 



PROCEEDINGS—EIGHTEENTH ANNUAL MEETING. 319 

Rudolph Herring, C. E., of New York. — The paper of Mr. Barbot 
contains a description of a method by which sewage may be removed 
from flat and low territories situated at tide- water. The tidal sewers 
which he describes are novel in our country. I can recall quite a simi- 
lar instance in Hammerbrook, a suburb of Hamburg, Germany, where 
a large sewer is quite level, and is flushed, as in Charleston, by the tide- 
water, which has a rise and fall of about ten feet. This sewer was built, 
or at least designed, about 1845, by Mr. Lindley, an English engineer. 
The success of tidal sewers depends upon the hydraulic gradient which 
may be given the water while it passes through the sewer. It is ques- 
tionable to my mind whether a good flushing velocity can be obtained 
in the Charleston drains, with their present construction, anywhere but 
near the ends, where the hydraulic surface would have the greatest incli- 
nation, and consequently cause the greatest velocity of the water. The 
remodelling proposed by Mr. Barbot in his paper, by giving the drains 
a regular and smooth bottom and interior surface, will greatly augment 
the velocity, and therefore the efficiency, of flushing in the drains. A 
smooth surface has a marked effect in increasing the velocity of water. 
We may say that if the drains were properly lined, as compared with 
their present condition, the velocity could be doubled, and the time 
required to fill or empty them be reduced one half. Besides having this 
value, a smooth surface likewise is of great sanitary value in preventing 
deposits and the retention of sewage matter in the recesses due to the 
present roughness and unevenness of the interior. 

The actual results tliat may be obtained from a reconstruction of the 
drains depend upon the length of the drain between the entrance and the 
exit of the water. Whether the " impetuous torrent," which Dr. Bell 
supposes it might be, will occur or not, depends entirely upon the 
smoothness and the length of these drains. With a tide of five feet, how- 
ever, even the shortest drain would not, in my opinion, give a velocity 
which would merit such an appellation. 

The paper read by Dr. Bryce gave a very interesting account of the 
various conditions under which we can obtain ground-water supplies. 
Such supplies are being more and more favored, and where the water 
can be obtained in sufficient quantities it is unquestionably the best 
source, where proper precautions are taken in the collection, and where 
it is not polluted by organic or objectionable mineral matters. Dr. 
Bryce assumes, if I remember rightly, that the rain-water, to start with, 
possesses a high degree of purity. This, we find, is rarely the case. 
The rain washes the atmosphere, and brings with it multitudes of bac- 
teria in the floating organic matter and dust contained in the air. Direct 
analysis of rain-water proves this, and also the comparative analysis of 
the water in ponds before and after rains. In the latter case, the number 
of bacteria per centimeter is usually much increased. The purification 
of rain-water is, according to recent researches, not due to a capillary 
action of the soil, which. Dr. Bryce asserts, causes the purification if the 
distance through which the water percolates is only long enough. The 



320 PROCEEDINGS'-EIGHTEENTH ANNUAL MEETING 

essential requirement for purification of rain and other water in soil is 
the intermittency of its percolation. If rain-water were falling continu- 
ously, so as to completely fill the interstices of the soil, — in other words, 
if the soil acts like a sponge, — no purification would result. It is neces- 
sary to allow the water intermittently to drain out of the soil, so that air 
can alternately be drawn in from the atmosphere. This air, through its 
oxygen and with the aid of the bacteria contained in the soil, efifects the 
purification. 

To show that purification in soil is quite independent of the straining 
process so commonly associated in the mind with filtration, the Massa- 
chusetts State Board of Health made numerous experiments, one of 
which was the filling of a tank ^y^ feet in depth with gravel-stones from 
which all sand had been washed. Some were as large as the ball of the 
thumb, and others as large as a pea. Sewage was poured upon these 
stones daily, but intermittently and a little at a time, making in all the 
equivalent of 80,000 gallons per acre daily. By this application each 
stone in the tank was kept covered with a thin film of liquid, slowly 
moving downward and continually kept in contact with the water con- 
tained in the spaces between the stones. The liquid reaching the bot- 
tom, or a depth of ?iv^ feet from the surface, had nearly all the organic 
matter removed within twenty-four hours. After the gravel had puri- 
fied the sewage in this manner for a year, all the stones at the top looked 
clean, and the efiluent at the bottom was clear and bright, and compared 
favorably with the water of wells used in many cities for drinking pur- 
poses. It is clearly shown by this and other experiments that it is not 
filtration through capillary tubes, but aeration of the thin film of impure 
liquid covering each stone or grain of sand, which effects a purification. 

It is further a curious fact, that ground-water stored in open reservoirs 
will more readily become stagnant and objectionable than if flowing 
water is so stored. All the reasons for this fact are not yet fully known ; 
but in practice engineers consider it essential, if ground- water is used for 
a supply and is to be kept pure, that either sunlight must be kept off by 
having covered reservoirs, — such as are common in Europe, and are 
now being introduced in our own country, — or that an artificial system 
of aeration must be applied to the water. These requirements are not 
found to be so necessary when river-water that has been exposed to the 
air for a long time is used for a public supply. 

E. C. Jordan, C. E. — Mr. Barbot's very interesting description of 
the Charleston sewers started my reflection by the conditions that his 
paper described, and the absence of any corresponding representation on 
the plan and profile of the sewer ; namely, he speaks of their being quite 
badly filled up in places, and of the need of their being cleaned out and 
generally improved. I should like to have seen on the profile the depth 
of the material that the tide does not flush out, and just where it is for 
the most part located. I can certainly imagine where some of it can be 
found. It seems to me very likely that quite a share of the difficulty is 
properly attributed to the uneven bottom, occasioned quite possibly, as 



PROCEEDINGS—EIGHTEENTH ANNUAL MEETING. 321 

claimed, by the earthquake ; but it is borne in upon my mind that effec- 
tive flushing of a sewer like Charleston's, with the small head of tide 
there existing (five feet), can only be accomplished under the best of 
conditions and over comparatively short lengths. 

The sewer is practically a storage tank for the sewage during the 
incoming tide, and needs to be thoroughly tight against filtration from 
the surrounding soil that the flushing force may have the least amount 
of work to do, and, furthermore, the walls need to be smoothly faced, so 
that the least resistance may be offered. Until certain corrections are 
made in the defects occasioned by the earthquake, or by insufficient 
inspection during construction, I hardly think Charleston should be 
an ostrich with her head in an unflushed sewer, and claim immunity 
from trouble because she has got a system that is unique, but which 
when properly cared for is no doubt exceptionally adapted to her needs. 
I trust Mr. Barbot may be permitted to carry out his desired improve- 
ments. 

Until recently I think I should have found myself in accord with Dr. 
Bryce's conclusions, but the explanation of how we may prevent pollu- 
tion of water-supplies, and of the phenomenon why certain ground- 
waters are pure that might well be suspected, — even rain-water not 
always being pure, as Dr. Bryce asserts, — has been very clearly set forth 
in what we may properly call the advance sheets of the Massachusetts 
Board of Health Report foir this year, a paper recently published by 
Hiram F. Mills, C. E., a member of the Massachusetts State Board of 
Health. Dr. Bryce's theory of how natural filtration and purification 
go on by the water zigzagging down through various filter-beds to its 
final reservoir, and by degrees losing its impurities, must, at least to a 
large degree, give way to the experiments that show that the good work 
is mostly done in the first few inches at the surface, owing to the inter- 
mittent application of the water, which, after its subsidence, leaves the 
opportunity for the air to enter and maintain conditions by which its 
oxygen and certain bacteria lodged there can best fight for purification. 

In closing the discussion. Dr. Bryce said, — Replying to the criticisms 
which have been made on the principles of purification of water, which 
have been accidentally referred to in my paper, I have to say .that pri- 
marily the paper is one intended to deal with the geological and physi- 
cal conditions under which underground waters are stored up, while the 
fact that such are sterile under favorable conditions was referred to as 
indicating the desirability of looking to such sources more largely than 
at present is done for public supplies. 

Had I proposed to take up exhaustively the question of how such 
waters are purified, I might have done so in a manner which I imagine 
would have been satisfactory to my critics ; at any rate, it would have 
shown that I am not unaware of the important part which bacterial life 
plays in the purification of water through its destruction of organic mat- 
ters in the upper soils. This subject has recently been discussed by me 
in a paper on '^ How Soils Dispose of Sewage," and I am sure that 



322 PROCEEDINGS—EIGHTEENTH ANNUAL MEETING. 

when these gentlemen have read my views therein set forth, they will be 
quite certain that I hold no heretical views on this subject of soil purifi- 
cation. 

Were these gentlemen more intimately acquainted with the examina- 
tion of air and soil for bacterial organisms, they would have been aware 
that my remarks about rain-water as water in the air, and before it 
touches the soil or roofs of houses, is speaking relativel}*^ perfectly cor- 
rect, for it is only during the first few minutes of a rain-storm that the 
rain contains any number of organisms, while the very moment it touches 
soil it becomes laden with innumerable forms. Arguments such as that 
where it is shown that a pond of water is more impure after than before 
a storm are wholly misleading, since the impurities are due not to the 
germs from air to any great extent, but to the impurities gathered by 
the rain-water washing the surface of the soil, from which it drains into 
the pond. 

I regret that the subject of ground supplies from the stand-point of 
certainty as to quantity, its constancy, and its availability from the stand- 
point of cost, has not been taken up in this discussion, since we might 
fairly have expected from our engineering friends much practical and 
useful information bearing upon this question, — enormously important, 
whether we view it from the sanitary or from the financial stand-point. 

A paper on " Sulphuring or Bleaching Dried Fruits, a Mistake if not 
a Crime," by Joel W. Smith, M. D., was read by title and referred to 
the Committee on Publication. (See page 199.) 

Dr. Walcott made a verbal report for the Committee on Resolutions 
in relation to commissioner of health. He said the committee had taken 
no action in the matter during the year, inasmuch as the conditions were 
not favorable for securing national sanitary legislation. 

The Committee on Sanitary and Medical Service on Emigrant Ships 
reported through Dr. S. H. Durgin, its chairman. (See page 43.) 

The next paper was on "The Vaccinal Protection of Passengers from 
Europe," by Frederick Montizambert, M.D. (See page 51.) 

Dr. Montizambert oflfered the following resolution : 

Whereas, At the seaports and in the interior communities of this continent an out- 
break of small-pox is started from time to time by persons who have passed the quaran- 
tines of the American ports apparently perfectly well, but in the stage of incubation of 
small-pox contracted before sailing, and who develop the disease subsequently to land- 
ing; and 

Whereas, Nothing can prevent this but vaccination or revaccination within a time 
limit before, or within the first day or two after, sailing, — therefore be it 

Resolved^ That in the opinion of this Association it is desirable that every effort be 
made to secure the enforcement of such protection by the inspecting government medi- 
cal officers at the ports of departure. 

Referred to the Executive Committee. 

Dr. G. P. Conn made a report in behalf of the Committee on the 
Disposal of Garbage and Refuse, in which he said that the committee 
was not prepared to make a final report, and he moved that the papers 



PROCEEDINGS—EIGHTEENTH ANNUAL MEETING, 323 

and communications relative to the subject, now in the hands of the 
committee, be referred to the new committee on the same subject. The 
motion was carried, and the matter so referred. 

Dr. George H. Roh^, for the Committee on Causes and Prevention of 
Infant Mortality, stated that there was no additional report to be made 
at this meeting. 

Upon motion, it was 

VoUdy That the report of the Committee on Sanitary and Medical Service on Emi- 
grant Ships, together with Dr. Montizambert's paper, be printed in pamphlet form and 
sent to members of congress, the Canadian parliament, and to the congress of Mexico. 

Dr. J. D. Plunket offered the following resolution : 

Whereas, Owing to the fact that cholera has prevailed during the past summer in 
Europe, Asia, and Africa ; and 

Whereas, There is a possibility that it may be introduced to this continent during 
the coming year, — ^be it therefore 

Resolved, That all maritinve quarantine authorities be invited to continue special care 
to prevent its introduction, and that all other health authorities continue to do every- 
thing in their power to improve the sanitary condition of the country. 

Referred to the Executive Committee. 

Dr. Benjamin Lee offered the following resolution : 

Resolved, That in view of the persistence of cholera in the kingdom of Spain, this 
Association suggests to the quarantine authorities of all ports of entry the expediency of 
restricting the importation of rags from Spanish ports, for such period as they may deem 
necessary for the protection of the public health. 

Referred to the Executive Committee. 

Dr. Albert L. Gihon, delegate to the Section on Hygiene, Interna- 
tional Medical Congress, made a verbal report. 

The next business on the programme was a paper on " Maritime San- 
itation at Ports of Arrival," by H. B. Horlbeck, M. D. (See page no.) 

Mr. W. F. Morse offered the following resolution : 

Whereas, Many members of this Association are particularly interested in the ques- 
tion of garbage disposal, and as the report of the members of the committee present refers 
to the fact that the report of the chairman, by them referred to the Executive Committee, 
contains the results of the investigations and processes of the several methods for an im- 
proved system of garbage disposal, which have been under examination by the Associa- 
tion for the three years past, — therefore, 

Resolved, That it is the sense of the Association that the report made by the chairman 
of the Committee on the Disposal of Garbage and Refuse be read as a report of prog- 
ress. 

Referred to the Executive Committee. 

Dr. Horlbeck's paper on Maritime Sanitation at Ports of Arrival was 
discussed by Drs. Wood, Carter, Bell, and others. 

The Association then adjourned, the time for the excursion announced 
in the programme having arrived. Few if any of the members of the 
Association and their lady friends failed to avail themselves of the oppor- 



324 PROCEEDINGS—EIGHTEENTH ANNUAL MEETING, 

tunity of visiting the quarantine station, which included the delightful 
trip around Charleston's grand water front. 

The trip was mad» in the handsome United States revenue cutter Lot 
M. Morrill. Captain Baldwin was in charge, and this was a guaranty 
that every one would receive the very best of attention and a safe and 
swift voyage. Dr. Horlbeck looked after the pleasure of his numerous 
guests. 

The hygienic expedition left the custom-house wharf promptly at one 
o'clock, and it was five when the disembarkation took place. The course 
of the expedition was out into the harbor, passing near Forts Sumter 
and Moultrie, and thence to Fort Johnson, where the party got off and 
critically inspected the quarantine station. The plant was examined 
with manifest interest, and all seemed pleased with the manner and work 
of the station. 

During the stay, shells, the flora of the island, and other souvenirs 
were collected. Leaving the quarantine station, the Morrill returned by 
the city front and gave the visitors a picturesque panorama of the city. 
Going up the Cooper river some distance the vessel made a short excur- 
sion into Wando river, and steaming down the bay returned to the 
custom-house wharf. 

A substantial and well prepared lunch was served on the return trip. 
Dr. Horlbeck and the other members of the com mittee, with Collector 
Johnson and Captain Baldwin, gave the party a most delightful trip. 

EVENING SESSION— 8 O'CLOCK, 

The meeting was called to order at 8 o'clock. At this session the 
papers announced in the programme were read, after which the Asso- 
ciation adjourned to allow the Advisory Council an opportunity to meet 
and transact the business before it. 



FOURTH DAY. 

Friday, December 19, 1890. 
MORNING SESSION— g O'CLOCK, 
The following programme was announced for the last day's session : 

Morning Session, at 9 o*clock, at Hibernian Hall. 

Calling meeting to order by the President of the Association. 

Announcement from the Local Committee of Arrangements, by H. B. Horlbeck, M. D., 
Chairman Local Committee, and Health Officer of Charleston. 
Announcement and reports from the Executive Committee. 
Election of new members. 
Report of Advisory Council. 
Election of officers. 

Appointment of new Advisory Council. 
Appointment of committees. 
Reports of Standing Committees. 
Unfinished business. 



PROCEEDINGS^EIGHTEENTH ANNUAL MEETING. 325 

Paper on Leprosy and its Management in Minnesota, by Charles N. Hewitt, M. D., 
Secretary State Board of Health, Red Wing, Minn. 
Miscellaneous business. 
Final adfoumment. 

The meeting was called to order at 9 o'clock by the presidents 

Dr. Horlbeck, chairman of the local Committee of Arrangements, made 
the following announcement : 

The local management beg to say that a special train will leave the 
South Carolina Railway station, Line street, at i p. m. to-day, to convey 
any members of the Association to accept the invitation of the people of 
Aiken, S. C. The chairman of the committee of local management 
will be glad to assist any of the members who may desire to have their 
railway tickets extended for a limited period. The local management, 
on this the last day of the meeting, beg to offer a God-speed to their 
departing guests, and to say that it will be their pleasure, at any and 
all times, either to welcome any membersof the American Public Health 
Association to the city, or to furnish them with any information, statisti- 
cal, or otherwise, as to the sanitary condition or history of Charleston. 
Come again. 

The secretary reported that the Executive Committee had considered 
the resolution offered by Dr. Bell, relating to a sanitary exhibit at the 
international fair in 1893, and recommended the adoption of the resolu- 
tion in a new draft, as follows : 

Resolved^ That a committee of five be appointed, of which Dr. Ranch shall be chair- 
man, to inquire into the expediency of having a sanitary exhibition at the international 
fair in 1893. 

The resolution was adopted. 

The Executive Committee, having considered the resolution submitted 
by Mr. Henry Mitchell, recommended its adoption. Following is the 
resolution : 

Resolved^ That the Committee on Diphtheria be requested to append to their report 
definite and detailed suggestions for the practical application of the most efficient means 
of cleansing and disinfecting clothing, furniture, and premises which have been exposed 
to the infection of diphtheria. 

Adopted. 

The Executive Committee recommended the adoption of the resolution 
submitted by Dr. Montizambert, as follows : 

Whereas, At the seaports, and in the interior communities of this continent, an out- 
break of small-pox is started from time to time by persons who have passed the quaran- 
tine of the American or Canadian ports apparently perfectly well, but in the stage of 
incubation of small-pox contracted before sailing, and who develop the disease subse- 
quently to landing ; and 

Whereas, Nothing can prevent this but vaccination within a time limit before, or 
within the first day or two after, sailing, — therefore be it 

Resolved^ That in the opinion of this Association it is desirable that every effort be 
made to insure the enforcement of such protection by the inspecting government medical 
officers at the ports of departure. 

The resolution was adopted. 



326 PROCEEDINGS—EIGHTEENTH ANNUAL MEETING. 

The Executive Committee, having considered the resolution offered 
by Mr. Morse yesterday, reported it back, with the recommendation that 
it be referred to the Committee on the Disposal of Garbage and Refuse, 
and the resolution w^as so referred. 

The Secretary read a list of names proposed for membership, which 
had been approved by the Executive Committee, and the same were duly 
elected. 

The report of the Advisory Council was next in order, and was pre- 
sented by Dr. George H. Roh^, secretary, as follows : 

The Advisory Council met, pursuant to the call of the president, and 
elected Dr. George H. Roh^ secretary. 

The Council recommend the adoption of the following resolutions, 
referred to them by the Executive Committee : 

Resolved^ Firsts That this Association is in hearty sympathy with the views of its presi- 
dent, Dr. H. B. Baker» as expressed in his annual address, as to the duty of the United 
States government to take positive action in reference to national sanitation. 

Second, That the matter be referred to the Advisory Council, with the request that 
the members of said Council, representing the states and territories of the Union, coop- 
erate with the Committee on National Legislation in urging such legislation as will tend 
to secure the desired results. 

The Council recommend for election the following officers, to serve 
during the ensuing year : 

For President. 

Dr. Frederick Montizambert, of the Province of Quebec, Canada. 

For First Vice-President. 

Dr. Thomas F. Wood, of Wilmington, N. C. 

For Second Vice-President. 

Dr. Henry B. Horlbeck, of Charleston, S. C. 

For Treasurer. 

Dr. J. Berrien Lindsley, of Nashville, Tenn. 

To fill vacancies on the Executive Committee, 

Drs. Geo. Homan of Missouri, Cantwell* of Iowa, Clark of New York, and 

Daniells of Wisconsin. 

Invitations to the Association to meet next year were received firom 
the following cities : Kansas City, Mo. ; Cleveland, O. ; Cumberland 
Gap, Tenn. ; Buffalo, N. Y. ; and Baltimore, Md. 

After discussion, the Council desire to recommend Kansas City, Mo., 
as the place for the next meeting. 

It was moved and seconded that the report be adopted. Carried. 

Upon motion, the secretary was instructed to cast the ballot of the 
Association for the election of the officers recommended by the Advisory 
Council, and the president declared the officers so voted for elected. The 
president then introduced Dr. Frederick Montizambert, the president- 
elect, who spoke as follows : 

" Gentlemen : I thank you very sincerely for the honor you have 
done me, and I beg to assure you that it will be my earnest endeavor, 
during my term of office, to maintain, in as far as may in me lie, the high 



PROCEEDINGS^EIGHTEENTH ANNUAL MEETING. 327 

standard to which this Association has risen under the long line of my 
distinguished predecessors. And in that endeavor I shall trust mainly 
to your kindly cooperation and support." 

The president then proceeded to the appointment of the new Advisory 
Council and the special committees for the ensuing year. (See lists 
elsewhere.) 

Upon motion of Dr. H. P. Walcott, Dr. Henry B. Baker's name was 
added to the Committee on National Health Legislation. 

Upon motion of Dr. Roh^, Dr. Henry B. Baker's name was added to 
the Committee on Restriction and Prevention of Tuberculosis. 

Dr. Henry P. Walcott announced that he was requested by Dr. Stem- 
berg, chairman of the Committee on Protective Inoculations in Infectious 
Diseases, to say that the committee did not deem it best to make a report 
at the present time, especially in view of the discovery announced by Dr. 
Koch, and that a fuller and more comprehensive report could be made 
at some future time. 

The report of the Committee on Animal Diseases and Animal Food 
was presented, and was read by Dr. Roh^. (See page 151.) 

Upon motion of Dr. Roh6, a vote of thanks was extended to the retir- 
ing president. Dr. Henry B. Baker, for the able and dignified manner in 
which he had presided over the meetings of the Association. 

Dr. A. Gihon, U. S. N., offered the following resolution, which was 
unanimously adopted : 

Resolved^ That the thanks of the Association be tendered to the honorable the mayor 
and aldermen for invitation to visit Charleston and for courtesies extended, to the citi- 
zens who have extended courtesies, to the ladies who have contributed to the enjoy- 
ment of the Association by their presence at the meetings and by their presence on the 
excursions given, to the secretary of the treasury for the use of the U. S. revenue cutter 
Lei M. Morrilly to Captain C. H. Baldwin and officers of the revenue cutter Lot M, Mor- 
rill for kindly attention and courtesies on trip to quarantine station, to Hon. T. B. John- 
son, collector of the port, to the Charleston Club, to the Charleston library, to the Emer- 
son Ventilating Car Company for pleasant excursion and privilege of examining new 
mode of ventilation of cars, to Dr. Holbeck, chairman, to members of the Local Com- 
mittee, to the commissioners of the Orphan House, to the various railroads for reduced 
rates, to the News and Courier y the Worlds the Sun^ and the Zeitungy and to the commis- 
sioners of the Enston Home. 

Adjourned to meet in 1891 in Kansas City, Mo., at such time as the 
president, secretary, and chairman of the local Committee of Arrange- 
ments may fix. 



REPORTS OF COMMITTEES. 



PRESENTED AT THE EIGHTEENTH ANNUAL MEETING OF THE AMERICAN PUBLIC 
HEALTH ASSOCIATION, CHARLESTON, S. C, DECEMBER 16-I9, 189O. 



REPORT OF THE COMMITTEE ON NECROLOGY. 

Dr. Jedediah H. Baxter died of apoplexy at his residence in Wash- 
ington on December 4, 1890, aged fifty-three years. His death, just 
after he had reached the object of his long ambition, and just as he 
was placed in an office whose duties he was admirably calculated to ful- 
fil, is a sad comment on the uncertainty of human affairs. His untimely 
end is a hard blow also to his many friends, who expected so much of 
him in his new field of usefulness. 

Dr. Baxter was born in Stafford, Vt., May 11, 1837. ^^ ^^59 ^® ^*^ 
graduated from the academical department of the University of Vermont, 
and entering the medical department of the same institution, he was 
graduated M. D. in i860. Upon receiving his degree he established 
himself in Washington, but in 1861 relinquished private practice and 
entered the United States service as surgeon to the Twelfth Massachu- 
setts Regiment. He was promoted to be surgeon of the United States 
Volunteers in 1862, and was brevetted colonel in 1865. In 1867 he was 
appointed assistant medical purveyor, and in 1874 was made chief med- 
ical purveyor, which office was created expressly for him. In 1875 he 
received the degree of LL.B. from Columbia University, Washington. 

He was a member of the American Public Health Association, the 
American Medical Association, the District of Columbia Medical Asso- 
ciation, the District of Columbia Medical Society, a corresponding mem- 
ber of the Boston Gynaecological Society, and of the Philadelphia Acad- 
emy of Natural Sciences. He was a contributor to scientific periodicals, 
and the author of *' Medical Statistics of the Provost Marshal General's 
Bureau." In 1876 he married Florence Tryon, daughter of the late Will- 
iam Tryon, of Washington. 

On August 16 last he was appointed surgeon-general of the U. S. 
Army in the place of Surgeon-General Moore, retired. His friends had 
frequently urged his appointment to the office whenever a vacancy occur- 
red, and when Surgeon-General Barnes died in 188 1 he was promised 
the post, but lost it through the assassination of President Garfield. 

His death occurred from paralysis, with which he was stricken on 



PROCEEDINGS— EIGHTEENTH ANNUAL MEETING. 329 

December i , on the third day, at two o'clock in the morning. He was 
buried in Arlington cemetery, five foot battalions, a platoon of light 
artillery, and two troops of cavalry acting as escort. The War Depart- 
ment closed its doors on the day of the funeral. 

Dr. Charles Lin^us Allen, of Rutland, Vt. died suddenly of apo- 
plexy July 2, 1890. 

Dr. Allen was born in Brattleboro on June 21, 1820. He was grad- 
uated from Middlebury college in 1842, and from the Castleton Medical 
College in 1846. The deceased was a professor in Castleton Medical 
College before the war, and afterwards became president of the institution. 
He left there, however, to accept the professorship of civil and military 
hygiene in the University of Vermont at Burlington. While there he 
went to the war, and was appointed a member of the examining board 
of brigade surgeons, being associated with those celebrated physicians Drs. 
Clymer and Brinton. He resigned the position in 1864. He was a 
member of the local board of pension examiners, ar\d with the exception 
of the time during Cleveland's administration he had been connected with 
the board since the close of the war. In 1857 he was acting professor 
of chemistry and of materia medica in Middlebury college. 

Dr. Allen was secretary of the state board of health, and had been 
connected with the board since its organization. He did a vast amount 
of work as secretary, for which he received no compensation. He edited 
the *' Sanitary Visitor," and did much valuable work in the interest of 
the health of the state. 

The deceased was the first president of the Rutland Medical Club, an 
honored member of the Vermont State Medical Society, of the American 
Public Health Association, the American Medical Association, the 
American Academy of Medicine, also the International Medical Associa- 
tion, always attending the meetings of each if it was possible to do so. 
He was an honorary alumnus of Rush Medical College of Chicago. 

His father was Dr. Jonathan Adams Allen, of Middlebury, who was a 
prominent physician of his day. The deceased was twice married, his 
first wife being Harriet Wood, whom he married June 14, 1854, and by 
this marriage he had two children, — Frances L., wife of Edward D. Page, 
of San Francisco, and Harriet W., wife of Rev. J. C. Goddard, of Sal- 
isbury, Conn. He married his second wife, Gertrude Lyon, of Glade 
Mills, Penn., on May 31, 1865. She died about a year ago. Three children 
survive, — Edwin Lyon, Charles William, and Harris Campbell, the two 
former residing in Rutland. A brother. Dr. J. Adams Allen, president 
of the Rush Medical College of Chicago, also survives the deceased. 

Dr. William Brodib, of Detroit, Mich., died at his home on July 30, 
1890. 

Dr. Brodie was bom at Fawley Court, Buckinghamshire, England, 
July 28, 1823, and at the time of his death had just entered upon his 
68th year. 

In 1833 young Brodie emigrated to America^ settling on a farm near 



330 PROCEEDINGS—EIGHTEENTH ANNUAL MEETING, 

Rochester, N. Y. Later on he entered, and through his own efforts 
maintained himself at, Brockport college. Here he remained three years, 
graduating with honors. 

In 1847, ^^" Brodie removed to Michigan, where, in the office of Dr. 
Wilson, of Pontiac, he began the study of medicine. He then returned 
to the East, where in 1850 he graduated from the College of Physicians 
and Surgeons, New York city. Returning to Michigan, he settled at 
Detroit, and at once obtained through Dr. Zina Pitcher the position of 
house surgeon at St. Mary's hospital. Dr. Brodie was also examining 
physician for St. Andrew's and St. George's societies. For a time he 
was secretary of the American Medical Society. 

At this period Dr. Brodie edited the Peninsular Journal of Medicine 
and Surgery, published at Detroit. He has held the position of presi- 
dent of the Audubon club, a society organized for the prevention of the 
wilful killing of game and the collection of zoological specimens. In 
1850, Dr. Brodie took his first degree in Masonry. When the war began 
Dr. Brodie was appointed surgeon of the First Regiment Michigan Vol- 
unteers. When his term expired he was appointed brigade surgeon of 
the Sixth Division, U. S. A., but his appointment was not confirmed, 
and soon after he returned to Detroit. Shortly after his arrival at De- 
troit, Dr. Brodie was elected alderman from the first ward : two years 
later he was elected to the council, a