fublic health

and

^Sanitation.

"Wall-Diseases" treated by Inoculation.? At the ninth international congress of and demography, recently held in Madrid, Dr. hygiene E. Vallin, of the French Academy of Medicine, read a very interesting and original paper 011 the presence of saltpetre in the walls of inhabited houses. This, according to the Philadelphia Medical Journal, he described as a disease of the walls due to the presence of As the walls could not suffer without micro-organisms. serious inconcausing venience to the persons whom they were destined to shelter, it was the duty of sanitary reformers to seek to cure the walls and thus save the inhabitants of the h use. The disease was caused by the penetration into the body of the walls of the bacilli of nitrification, and consequently the houses became and cold, damp,

unwhole-

THE INDIAN MEDICAL GAZETTE. The state was likely to occur in damp localities some. and in the presence of nitrogenous organic matter. From the sanitary point of view this disease of the walls could and should be prevented or cured as we prevent Conor cure virulent diseases among men and animals. sequently, Dr. Vallin proceeded to speak of the walls of a house just as if they were human beings, and went systematically through the various symptoms of thendiseases. Pealing first with the prophylaxis of walldiseases, he pointed out that the primary step to be taken was to thoroughly drain the ground around the walls and isolate them from the surrounding earth, if possible, by a trench and by the use of cement, asphalt, Thus the access of water bearing nitrifying or coal-tar. bacteria that are aerobic would be prevented. It was also very necessary to mix the mortar used with antiseptic solutions, such as dissolved sulphate of copper, etc. Where these precautions had not been taken and the disease had broken out, then the treatment indicated was as follows : First to scrape off and wash away all superficial traces of saltpetre, etc. ; then the walls should be inoculated with active cultures of the anti-nitrifying bacilli, which impoverish farm-manure by decomposing the nitrates and by throwing off in the atmosphere a great part of the nitrogen which they contain ; these walls should then be covered over with impermeable paint so as to l-etard the process of nitrification of the aerobic germs, and, on the other hand, to stimulate the growth of the anajrobic and anti-nitrifying germs which remove the oxygen from the nitrates and from ammonia when they cannot supply themselves with oxygen from the atmosphere. This ingenious theory was highly appreciated and formed the subject of many conversations anion" members of the congress. The idea of applying the principles of inoculation to the preservation of material used in building opens out a vast field of possible progress in the domains of sanitary engineering and architecture.

Sawdust Latrines and Urinals.?The use of as suggested by I'r. Vivian Ponre, as a deodorising filter for urine is highly spoken of by Lieut.-Ool. Mayne, I.M.S., in a note to the British Medical Journal. The opportunities aft'orded of testing an arrangement of this kind in an Indian military camp enables Col. Mayne to speak with some authority. Excellent filters for the lines seem to have been made of half barrels. A paraffin tin was placed under each of these tubs, and the liquid which filtered through the sawdust in the barrel fell into the tin and was removed. It was odourless and inoffensive. The upper layer of sawdust is better removed from time to time. One great advantage of the sawdust conservancy system is the lessening of the fly nuisance. The working expense is also fortunately slight. In providing in this country for the large number of ladies brought together lately at a great musical festival lasting over several days, temporary conveniences were run up of an exceedingly simple character in an easily accessible, open, but walledin, portion of the premises. A few wooden partitions In each cabinet an were curtained off. ordinary seat similar to those of pedestal closets, rested on brackets' and beneath was placed a small portable pail filled with sawdust. These pails were changed as soon as the audience had quitted the building. During the whole time, notwithstanding the close, muggy weather which prevailed, every cabinet is said to have been perfectly sweet Dr Veeder (Lyons, N.Y.) has recently drawn attention to matters of military hygiene. "The hos" he wrote a month remain pitals," ago, full, and the soldiers are being mustered out of service hurriedly in a to of sort get them away from the centres of inpanic fection. If the war were to continue, it would not be possible to secure relief in this way except partially and incompletely by changing the location of encampments Apparently it requires only a few weeks at most for ' a camp to become 'stale and all water anywhere within reach unfit for use and then the location must be changed absolutely and entirely, according to current ideas of

sawdust,

.

.

..

[Jan.

1899.

such matters." Dr. Veeder goes on to emphasise the of the fly as a carrier of infective matter, say from the latrine to the milk can. Perhaps by preventing the "staling" of the "location," and diminishing the number of flies, sawdust as a deodorising and, in one sense, disinfecting, agent lias an important future before it in military hygiene.

importance

The Septic Tank System of Sewage Treatment.?The steps now being taken at Exeter, says the Lancet, mark an epoch in the history of dealing with

sewage. We understand that the Local Government Board have signified their sanction to a loan for carrying out the septic tank system on a scale applying to the whole of the sewage of the city. The system now passes, therefore, from the experimental to the practical stage, and the progress of the undertaking will be watched with the greatest interest by all who are anxious for sanitary progress. Should success attend the scheme thus applied scale?and judging from what has already been on achieved, there is no reason for anticipating any contrary result?a very striking instance will be afforded of the fneat value of studying nature's methods of purification. Indeed, the treatment of sewage is rapidly passing from the domain of chemistry to that of biology, and it is probable that precipitation processes and other chemical methods will be relinquished ere long in favour of natural processes. Natural oxidation and precipitation by bacterial agencies is a gigantic phenomenon of everyday occurrence, and it is only by a careful study into the conditions under which countless and ubiquitous micro-organisms will favourably work that such a satisfactory solution of a long vexed problem has been brought within measurable distance of attainment.

a?large

Soil Pollution and Water-supply.?Dr. Fulton,

iu the

Maryland Medical Journal, recites the case of who buried a barrel of petroleum, and in a short time most of his neighbours had to stop using their wells. Wells 900 feet away were affected ; yet all these neighbours had privies, stables, etc.

a man

Yet the soil does a great work of purifying. The bacteria of the soil are, as a rule, confined to a zone a meter or a meter and-a-half deep, and these organisms are

mortal enemies to disease bacteria.

Only

a

harmful organisms, mainly those bearing spores,

few are

able to withstand sunshine and desiccation. The ordinary bacteria of water are hostile to disease germs. But the breeze drops some living ones into good soil. The sun warms myriads into growth and releases others from the clutch of frost. The rain sends some into our wells.

Up to a high dilution, water increases the danger of soil contamination. For that reason most pits are closets. Cemented pits are not worse than surface offensive, but many are built of loose stone, and as they seldom fill, are said to be self-cleansing. A far worse practise is that of converting unused wells into cesspools, The most primitive thus polluting the water currents. practise is more sanitary than this system, and its prolonged toleration is deplorable. House Ventilation in India.?In a note on this Indian Engineering has recently been considering the problem from the practical engineer's point of view, and remarks as follows :? The problem to him resolves itself into supplying to every inhabitant a certain number of cubic feet of clean air from outside in each hour He is provided with a great number of maxims and rules by which to effect, this supply- Most of these are founded upon the theory that the carbonic di-oxide present in the atmosphere of any enclosure should not be allowed to exceed '00 per There is already 04 per cent, of carbonic di-oxide cent. in the air as nature provides it for us, so that the lungs of the inhabitants and the gas jets, oil lamps, or caudles must not be permitted to add more than 20. they use, per ceut. of carbonic di-oxide to the air of the chamber

subject

Jan.

HOUSE-VENTILATION?ANTI-PL AGUE

1899.]

From this it is clear that air to be admitted that it would be in every hour might be so great mpossible to effect its entry without creating draughts, feet per an air in motion at more than three or four second is not safe or agreeable even in India; for, if the a migh it might be tolerated and even welcomed it is which forces the by current continued unceasingly, and for this, rought about are not permanent enough is apt air in motion at even three or four feet per second to produce a chill when intermittent. should had been laid down that the air of a room to make is than 110 be more required rapidly changed that This being so, and seeing iree changes in an hour. cubic feet of a numan pair of lungs will produce 6 but a simple carbonic di-oxide in an hour, it requires that arithmetical operation to arrive at the conclusion of space should be feet cubic thousand like a something human being that a owed in every room for each adult the percentage of that order in in it, proposes to live the minimum exceed never carbon di-oxide should enclosed.

^'leJ t/nie chamber is small the amount of are

i.

referred to. Each gas jet should count as three men the ordinary and-a-half. 'erosene oil lamp should count as one man llle designer and surveyor of ventilation appliances change of the is accustomed to provide for the adequate the rules which air contained in these following spaces by can oniy be described as the rules-of-thumb with invented in England or Germany, to correspond ti?ns there, but which have not been sufficiently ,1 modified to suit this country. In England the problem of ventilation, at all events, itself into as ar as private houses are concerned, resolves sittingone of how to prevent draughts. In the ordinary fourteen room in which is an open grate, burning some pounds of coal in eight hours, from 20,000 to 30,000 each cuoicieet of air per hour are sent up the chimney in based nour. And all the arrangements for ventila tion are air on the assumption, mostly justified, that the vitiated ventilais lighter and rises : and natural ventilation, i.e., resolves tioni that does not depend upon fans and motors, 1 into, the provision of shafts or other ducts up ?'s. , it ascent. Now which may rise and gather velocity in its in fact in India and other hot countries?any where a temperaw iere the outside atmosphere is liable to be at air, ure higher than that of the human body?vitiated heavier than the so ar from is actually being lighter, and a niosphere, except in so far as it is created by lamps fed a lamp or has that air the whereas gas jets. But, has passed gas jet is merely exhausted, that which irough the human lung is often positively poisonous. has been Consequently air in hot countries, air that of ?vitiated in the worst sense, is apt to elude the devices a ventilating engineer who has brought his principles of roin Europe. Of course a comparative lightness ventilatvitiated air is not the only force relied upon by of an inclosed ing engineers to change the atmosphere small or howspace. Differences of pressure, however for the purpose are sufficient brought about, walls of a ever light difference of pressure on the different in India, force louse, due to wind, is the most efficient Of course even if the one least consciously employed. the distric langes in the direction of the wind alter rendered bution of such forces and many dwellings are is in certain almost uninhabitable when the wind

already

.

originally

quarters.

against Plague in the Khoja Community of Bombay.

Preventive Inoculations

By "VV. M. Haffkine, D. Sc.

Total

^i^inoss the Aga Khan's Inoculation 1897. on the 27th December mw^aon was opened ApnI 1898> inclusive, 5,000 Khojas

oculated at that station, and 184 others were done in Muniin the rest of the town, giving a total of 5,184 inoculated during the epidemic of 1897-98. This number includes Khojas who had been inoculated

cipal Stations already

last year, daring the epidemic of 1896-97, and who presented themselves this year for re inoculation. On the the Kliojas inoculated last year, but not re-inoculated this year, are not included in the above number, and the analysis which follows does not refer to them. The above number of Khojas was inoculated gradually. On the 27tli December 1897, the opening day of the station, 33 were operated on the 2Sth the number ; upon increased up to 66; on the 29tli it increased up to 119; on the 30th up to 226 ; on the 31st up to 301 ; and so on. During the first 9 weeks the number was increasing steadily, and on the last day of February it reached 4,719. During the other 1\ weeks the total number increased only by 465. Taking the strength of the inoculated during the whole period ofdaily 16? weeks, the average appears as 3,814. In the following comparative analysis the mortality in the inoculated is considered as having occurred not in 5,184 individuals, which is the' number reached at on the last days of the operations, but in a number of 3,814 individuals only, which is the average daily strength taking the above period as a whole.

contrary,

The average daily strength of the Khojas icho remained uninoculated. A census of the of Khojas Bombay taken in the beginning of 1898, by the officers of the Klioja Jamat, under the orders of His Highness the showed the total Aga Khan, community to be 9,350 souls. numbering A certain number of families were, however, away when the census was being taken, on account of the epidemic, and their number could not be obt ined accurately.' The following figures are, therefore, taken as foundation for all the necessary considerations. giving a safe The annual Klioja mortality in years free from plague, as registered in the burial-ground books of the Jamat office, was?in 1892,-385 ; 1890,-301 ; 1894,-335 ; 1895,-349, giving an average of 342 deaths in a year. The mean mortality in the population of Bombay is close upon 35 per mille per annum. for the Khojas a mortality per mille Counting per annum of 25 only, the average of 342 deaths a year gives a population of 13,680, which is likely to be higher than the actual number. During the epidemic of plague which preceded the 16.7 weeks under consideration, the Khojas had 350 deaths in excess of their average mortality. The above number of persons in the community should therefore be reduced by 350, giving a population of 13,330. This number, apparently exaggerated, which exceeds that found during the census by nearly 4,000 (by over ;) is adopted in the following calculations as representing the real Klioja population of Bombay, and the proportion of inoculated and uninoculated is accepted to be as follows :? Average daily strength of inoculated 3,814 (accurate number). Average daily strength of ...

1S97-98,

Station at Up to the

(exactly)

were

in-

...

uninoculated...

...

9,516 (approximate, probably exaggerated number, which includes also those inoculated last year and not re inoculated

during

the

demic of 1897-98. Total

By

thus

...

epi-

13,330

calculating

upon an exaggerated strength of the uninoculated,_ the^ risk of exaggerating their death-ratio during the epidemic under consideration is avoided. Total number of deaths in Inoculated and Uninoculated which took place during the period under consideration. the 16i During weeks, between the 27th December 1897 and the 20tli April 1898, 184 deaths in all occurred in the community. Of these, 6, including 2 of plague, took Khoja place in Khojas inoculated in the of 1896-97, and not epidemic re-inoculated since ; 7 deaths, 3 of plague, occurred including in the 5,184 Khojas inoculated or re-inoculated this year ; and 171 deaths occurred in the uninoculated Khojas. Number of deaths from plague in Khojas during the period under consideration. In the years 1892 to 1896, while there was no plague in the mortality in Khojas during the same part of the year, between the 27th December and 20th April, was 131,96,100, 106 and 96 respectively, or on the average 105, in a normal population of 13,680 individuals. In the reduced population of 13,330, as it stood at the of the period under consideration, it should have beginning been proportionately 102. The advent of the plague may have altered the

Bombay,

of Khojas inoculated during the epidemic of and their average daily strength.

INJECTIONS.

THE INDIAN MEDICAL GAZETTE.

34 course of the mortality, other causes than

namely, the liability to deaths from

may have been influenced by the fact that, during the plague year preceding the period under consideration, double the usual number of individuals had been carried away by death. The normal mortality must have been also reduced by a part of the community having left the city. Admitting, however, that, of the total number of 184 fully the usual proportion of 102 died of other causes than plague there remain 82 deaths in excess of that number which are attributable to plague alone. Sixty four of this number were actu illy acknowledged as plague deaths by the relatives of the deceased, or certified as such by the Klioja

plague

Jam^hon]^.

attributable to other causes, 4 occurred in inoculated this year, 4 in inoculated last year, and the rest, 94, in uninoculated. , Of the 82 deaths attributable to plague, 3 occurred in inoculated this year, 2 in inoculated last year, and 77 in

UITheCnlunes,

sexes and asres, and full addresses of all these 184 persons are given in the Appendices Nos. II and IV.* These data have been very carefully verified, in all their details, from the Jamat and the inoculation documents, and by means of a minute house-to-house investigation carried out by Mons. Haffkine personally. The distribution of deaths among the inoculated and uninoculated is as follows ; #

9,516 uninoculated (probably exaggerated number) had 77 deaths from plague and 94 deaths from other causes.

inoculated this year (accurate number) had 3 3,814 '

plague and 4 deaths from other causes. more than the was due to plague, and of deaths above proportion supposing that the inoculated had remained, after inoculation, as as were the uninoculated, they should disease to susceptible have had, according to their relative strength, 31 deaths from plague and 38 deaths from other causes. The actual result is the most striking of all that have been observed up to now. .... ,. , ,, , , Among the 77 uninoculated who died of plague, there was 1 babe below 3 years of age, and 4 people above GO, giving a total of 5 deaths. Among the 94 uninoculated^ who died of other causes than plague, there were 33 deaths in babies of 3 and 23 in people above 60 giving a total of years and below, deaths from

Admitting that among the uniiroculated not

of individuals of tliesi two extremes ^The ^proportion inoculated, very considerable, but aees

was

who were

of

smaller

than their proportion among the uninoculated (see Appendix No. 1). In order to eliminate this source of possible error, deaths from plague and 56 deaths from other which occurred in uninoculated outside the age of 3 to 60 from the comparison altogether, and years may be excluded after that the figures are still as follows

the'5

causes!

9,516 uninoculated (probably exaggerated number) had 72 deaths from plague and 38 deaths from other causes.

3,814 inoculated (accurate number) had 3 deaths from plague and 4 deaths from other causes. The

in the mortality in the uninoculated and inoculated Khojas.

difference

This represents a difference of 89*7 per cent, of deaths from plague in favour of the inoculated part of thecommunity, and of 73;3 per cent, of deaths from what has been returned as " other causes," in favour of the same part of the community. After making all allowances for inaccurate classification of deaths in the uninoculated group, with which the inoculated is being compared, and admitting that a part of the excess of deaths in the uninoculated may be due to a certain number of sickly people having abstained from inoculation, the result still contains an indication that, besides the protection a opposite sido showed similar changes.' changes showed slignter extent, and the iliac sometimes showed slight en of them looked normal. The lumbar usually ? la i and soft or somew wero either and pale largement in size from hazel-n firm. The cervical and axillary varied i being peas and usually shewed merely engorgement, c P showed blood ; but sometimes some of them were enlarge mesenteric Tluabove. appearance described 1 } o the size of peas and beans and were either slig \ ably engorged. Tho supra trochlear and popliteal y or oedema aroun or engorged. There was 110 hemorrhage of the ym no enlargement and of the abovementioncd glands, 0 ,'ionjc phatic vessels was observed. The condition under described been has was as such already organs whet 0

Public Health and Sanitation.

Public Health and Sanitation. - PDF Download Free
10MB Sizes 0 Downloads 14 Views