1 
 
 N864 
 
 1883 
 
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 of tt)e 
 
 SZXtot0ion of J£>ealt& affairs 
 CJntoetsltp of JBortf) Carolina 
 
 CfnS boob teas presented 
 
 b2 
 
 North Carolina 
 State Board of Health 
 

 This BOOK may be kept out TWO WEEKS 
 ONLY, and is subject to a fine of FIVE 
 CENTS a day thereafter. It was taken out on 
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gap; 
 
 REPORT OF PROCEEDINGS 
 
 PUBLIC HEALTH^RARY 
 
 N. C. STATE B0VF HEALTH 
 RALEIGH. 
 
 FI RS T AN XTKYI, CONVENTION 
 
 OF THE 
 
 oriH arolina an 
 
 association, 
 
 i «. • 7 |- 
 
 
 HELD AT 
 
 RALEIGH, 
 
 6t)-bL axacl VLlX;, i889. 
 
 RALEIGH: 
 
 Edwards & Broughton, Power Printers and Binders. 
 
 • 1889 , . . . 
 
REPORT OF PROCEEDINGS 
 
 OF THE 
 
 FIRST ANNUAL CONVENTION 
 
 Field at raleigh, 
 
 F^eloruiary 6ttn and 7tli, 1889. 
 
 RALEIGH, N. C. : 
 
 Edwards & Broughton, Printers and Binders. 
 
 1889. 
 
president: 
 
 Hon. A. A. THOMPSON, 
 Raleigh, N. C. 
 
 VICE-PRESIDENTS: 
 
 Hon. J. J. Fowler,.-. ....Wilmington, N. C. 
 
 W. E. Fountain, Esq ,_Tarboro. N. C. 
 
 E. B. Neave, Esq.,..Salisbury, N. C. 
 
 SECRETARIES: 
 
 Dr. Julian M. Baker, .Tarboro, N. C. 
 
 J. C. Chase, Esq.,.Wilmington, N. C. 
 
 EXECUTIVE COMMITTEE: 
 
 Dr. Eugene Grissom, 
 Mr J. L. Ludlow,... 
 
 Dr. W. P. Beall,_ 
 
 Dr. T. F. Wood_ 
 
 Dr. R. H. Lewis,_ 
 
 .Raleigh, 
 
 N. 
 
 C. 
 
 __ Winston, 
 
 N. 
 
 C. 
 
 .. .Greensboro, 
 
 N. 
 
 c. 
 
 - - Wilmington, 
 
 N. 
 
 c. 
 
 .. Raleigh, 
 
 N. 
 
 c. 
 
CALL FOR A SANITARY CONVENTION, 
 
 TO BE HELD IN 
 
 Raleigh, N. C., on Wednesday, February 6th, 1889. 
 
 The interests appertaining to the public health are of such 
 increasing importance that its demands can no longer go 
 unheeded by the general public. The time has come when 
 men of all professions who have given the subjects of pub¬ 
 lic and private sanitation any consideration should assem¬ 
 ble to interchange views, and begin in earnest the study of 
 the living questions which concern healthy homes and 
 healthy towns. 
 
 ^ 1. Many towns in the State have reached a condition of 
 
 '^progress which have brought them face to face with the 
 ^problems of sewerage and water supply, involving vast 
 \^ums of money and the future health of unborn thousands. 
 
 2. Our State has numerous locations, the merits of which 
 .-4* are attracting the attention of physicians and invalids in 
 
 S^manv States North and West, and these must be studied by 
 * us with definite purpose and concerted effort, that we may 
 ^present the public with authoritative statements as to the 
 ^actual condition of our unoccupied sanitaria. 
 
 3. The questions involved by the appearance now and 
 ^then of pestilential diseases in States so intimately bound to 
 V us by railroad communication that their cause is our cause 
 ^in a philanthropic as well as a business sense, that we must 
 sVstudy them and discuss them in order to disarm these epi- 
 
 demies of their greatest dangers, and to quell the panics 
 •a that do more harm, if possible, than the pestilence. 
 
 4. The interests of the public health of the State, while of 
 necessity, at this stage of its development, intrusted to the 
 
4 
 
 CALL FOR A SANITARY CONVENTION. 
 
 medical profession, must be dependent for its vitality upon 
 the interest the general public takes in it, for it is the cause 
 of the people. A convention, therefore, of the representa¬ 
 tives of the people, officials cognizant of the defects of the 
 sanitation of our houses and towns and institutions, and 
 private citizens who have been studying with interest, and 
 practicing with all the lights they have, the minutke of 
 health laws, is a potent way of disseminating information 
 and of studying our defects and the ways to remedy them. 
 
 For these and many other considerations, we, the under¬ 
 signed, deem it appropriate to call a Sanitary Convention, 
 to meet in Faleigli on Wednesday, the 6th day of February, 
 1889, asking that a good attendance may be had of county 
 superintendents of health and other officials intrusted 
 with the supervision of the public health, and of farmers, 
 lawyers, doctors, ministers, civil and mining engineers, may¬ 
 ors of towns, chairmen and members of the boards of 
 county commissioners, Superintendents of asylums for the 
 insane and indigent, officers in charge of hospitals and pen¬ 
 itentiaries, school-teachers, railroad officials, and every citi¬ 
 zen interested in the present and future health of our com¬ 
 munities and homes. 
 
 After organization the following topics will be presented : 
 
 “How can we best secure economical disposal of refuse in 
 our towns ? ” 
 
 “ The prospects ol the future water supply in our larger 
 towns.” 
 
 “ Some of the facts concerning the Sanitaria in our State” 
 
 “What is being done towards providing healthful school- 
 houses in the smaller towns and the country? ” 
 
 “ How can we establish a Bureau of A r ital Statistics, that 
 we may put on record for our guidance and information the 
 destiny of the population as regards births, diseases, deaths, 
 and the history of epidemics dangerous to the public health ? ” 
 
 “ Our inland and maritime quarantine.” 
 
CALL FOR A SANITARY CONVENTION. 
 
 5 
 
 \\ hat is needed to sustain the efforts of the North Caro¬ 
 lina Board of Health ? ” 
 
 The undersigned unite in the above call fully appreciating 
 the great benefits which may result to the health of the peo¬ 
 ple by a full exchange of thoughts, and earnestly bespeak a 
 full representation. 
 
 Hon. John J. Fowler, Mayor of Wilmington. 
 
 Julian M. Baker, M. D., Superintendent of Health, 
 Edgecombe County. 
 
 Thomas F. Wood, M. I)., Secretary N. C. Board of Health, 
 Wilmington. 
 
 R. N. Williams, Esq., Chairman of County Commission¬ 
 ers, Edgecombe County. 
 
 Hon. William E. Fountain, Mayor of Tarboro. 
 
 George Gillett Thomas, M. D., Member of Quarantine 
 Board, Cape Fear River. 
 
 W. G. Curtis, M. D., Quarantine Physician, Southport. 
 
 J. W. Jones, M. D., President N. C. Board of Health. 
 
 H. T. Bahnson, M. D., Salem, Member of N. C. Board of 
 Health. 
 
 J. H. Tucker, M. D., Henderson, Member of N. C Board 
 of Health. 
 
 J. L. Ludlow, C. E., Winston, Member of N. C. Board of 
 Health. 
 
 Hon. Chas. Beaufort, Mayor of Winston. 
 
 , E. B. Borden, Esq., Chairman of County Commissioners, 
 Wayne County. 
 
 J. C. Chase, C. E., Supt. the Clarendon Water W orks Co., 
 Wilmington, N. C. 
 
 Hon. J. E. Peterson, Mayor of Goldsboro. 
 
 Thomas Hill, M. D., Coroner of Wayne County. 
 
 Prof. F. P. Venable, University of North Carolina. 
 
 Prof. W. J. Martin, Davidson College. 
 
 Hon. E. B. Neave, Mayor of Salisbury. 
 
 T. J. Sumner, Esq., Chairman of County Commissioners, 
 
 Rowan County. 
 
CALL FOR A SANITARY CONVENTION. 
 
 6 
 
 J. J. Summerell, M. D., Superintendent of Health, Rowan 
 County. 
 
 W. T. Ennett, M. D., Superintendent of Health, Pender 
 County, and President N. C. Medical Society. 
 
 H. B. Battle, Ph. IX, Director N. C. Agricultural Expe¬ 
 riment Station, Raleigh. 
 
 John McDonald, M. D., Member of N. C. Board of Health. 
 
 Hon. A. A. Thompson, Mayor of Raleigh. 
 
 Richard H. Lewis, M. D., Member of N. C. Board of 
 Health. 
 
 James McKee, M. D., Superintendent of Health, Wake 
 County. 
 
 W. P. Beall, M. D., Greensboro. 
 
 Prof. W. G. Simmons, Wake Forest. 
 
 Fletcher R. Harriss, M. D., Superintendent Health, 
 Vance County. 
 
 W. G. Freeman, M. D., Murfreesboro. 
 
 Hon. Thos. W. Goodrich, Mayor of Henderson. 
 
 And many others. 
 
nvcxisrxjTEs 
 
 OF THE 
 
 SANITARY CONVENTION, 
 
 Assembled 6tii February, 1881). 
 RALEIGH, N. Q 
 
 The meeting was called, to order in the Mayor’s room by 
 Mayor A. A. Thompson, member of the Committee of 
 Arrangements, at 10: 30 o’clock a. m. 
 
 Prayer was offered by the Rev. Dr. Watkins. 
 
 Gov. D. G. Fowle honored the Convention with his pres¬ 
 ence, and delivered a very spirited address of welcome to 
 the capital. After declaring his approbation of the objects 
 of the Convention, he said: I want to call the attention of 
 this Convention to one matter in particular : The Governor 
 of Alabama, under a resolution passed by the Legislature ot 
 that State, has appointed a convention to be held at Mont¬ 
 gomery, on the 5th of March, 1880, for the purpose of adopt¬ 
 ing certain quarantine regulations for the benefit and pro¬ 
 tection of the Southern States. At his request 1 have 
 appointed a committee to be there, and I would ask you to 
 designate certain gentlemen who would be acceptable to 
 them to represent North Carolina in that quarantine conven¬ 
 tion, and a commission will be issued by the Executive of 
 North Carolina to go as accredited representatives of tho 
 State to every man designated by this Convention, even if 
 
 it should be to the number of fifty. 
 
 I believe that this Convention is a move in the light direc¬ 
 tion, and I wish I could say to you to-day that I believe our 
 
8 
 
 MINUTES OF THE 
 
 friends in the capitol will give an appropriation for the pur¬ 
 pose of making tnis organization permanent, but I fear you 
 will not be able teget it at this Assembly. I know, however, 
 that I am addressing men who never give up while there is 
 life, and therefore I am satisfied you will keep up your 
 organization for at least two years, when it will be the duty 
 of the Assembly to assist this organization in the great work 
 it has undertaken to perform. 
 
 I wish I could stay with you this morning, but I only 
 promised the Mayor 1 would stay here a minute. I am now 
 due at my office. Whenever this Convention adjourns it 
 would give me great satisfaction if each and every member 
 of it will come to the Executive office and allow me there 
 to extend to you the courtesies of North Carolina as her 
 chief executive officer. 
 
 The Chairman: The object of this Convention will now 
 be explained by Dr. R. H. Lewis, of Raleigh. 
 
 Dr. R. H. Lewis : I am very sorry indeed to have to make 
 an apology to this assemblage, but unfortunately, for the last 
 week or two my time has been so occupied that it has been 
 impossible for me to prepare an address explanatory of the 
 objects of this meeting. I will, however, try to do the best 
 I can in setting forth the object with which we are assem¬ 
 bled. I expected to address a mixed audience, composed of 
 the laity as well as of the profession, and I regret to see that 
 the former is not more fully represented. It is well known 
 that the medical profession, who have to deal with disease, 
 have been the pioneers in this movement, which is one of 
 the children of this Nineteenth century, and the principal 
 promoters of it, and therefore take the most interest in it. Sani¬ 
 tary science has advanced more rapidly since the germ theory 
 has been more generally accepted as the cause of disease. We 
 cannot yet lay violent hands upon these enemies of the human 
 system and throttle them. It is true we know comparatively 
 little about germs, but we know something. We know, for 
 
SA X IT A R V CO X VENTION. 
 
 9 
 
 instance that they love to dwell in certain localities—that is 
 to say, in filth, and that having developed there, they make 
 inroads upon the system and produce disease. It is the duty 
 of the sanitarian, having discovered the conditions under 
 which they live, to lay waste their country with fire and 
 flood, and, if possible, wipe them off the face of the earth. 
 And the question for us to discuss is the best methods of 
 getting rid of the accumulations of filth. We know that one 
 of the favorite avenues of approach to the human system is 
 through drinking water, as is particularly shown in typhoid 
 fever. As an instance of this, we have the outbreak in Ply¬ 
 mouth, Penn., where the germs were thrown out upon the 
 snow. Soon after a thaw occurred, the snow melted and 
 was washed down a mountain stream into the reservoirs, and 
 just at the end of the computed period of typoid fever, which 
 is 14 days, the first case appeared, and that first case was 
 just below the dam into which the melted snow was washed. 
 This disease continued to spread, and in a short time, com¬ 
 paratively speaking, there were from 800 to 1,000 cases in 
 that town of 10,000 people. A striking thing about it was, that 
 the people who had typhoid fever were the people who drank 
 water from this mountain stream, which, according to the 
 chemist, was quite pure; whereas, the people who drank 
 from the wells, which were simply abominable, were entirely 
 free from this disease. It is, therefore, clear that the ques¬ 
 tion of pure drinking water is a matter of the very first 
 importance. No doubt other diseases enter the system 
 through the drinking water. We know, too, that these ene¬ 
 mies of our system are not all native born, but some of them 
 are foreign; they are savages, so to speak, that come upon 
 our shores from across the sea—cholera, yellow fever, and, 
 possiblv, diphtheria—and we want to devise the best means 
 of keeping them out. That being the case, it is of the first 
 importance we should consider the best means of establish¬ 
 ing an effective quarantine. I do believe that the most 
 important work for the sanitarian lies in the direction of iso- 
 
10 
 
 MINUTES OF THE 
 
 lation, the besieging,so to speak, of these colonies of microbes,, 
 and preventing their spreading. It is more important for 
 sanitation to take that direction than it is to dwell upon the 
 removal of tilth, though both are important. We should do 
 everything we can to establish legislation for that purpose. 
 Another thing which is the very foundation of all sanitation, 
 is that of vital statistics. We wish to devise some practica¬ 
 ble system in order to obtain, as far as possible, these data for 
 the purpose of drawing deductions and making laws. The 
 progress of science is the result of the inductive system of 
 reasoning, and it is necessary to accumulate vast numbers of 
 facts, and from them deduce general laws, and finally organ¬ 
 ize a body for the purpose of carrying out these laws. I 
 would like to say a word for the Board of Health organized 
 for the purpose of carrying out this legislation. We would 
 like to do everything we can to bring about and foster a 
 public opinion that will support the efforts of the sanitarians. 
 While the doctors are the pioneers and promoters of these 
 laws, it is absolutely impossible for them ever to amount to 
 much unless they are supported by the public. The public 
 are too often distrustful of the object of the doctors, and 
 cannot understand why they should try to stamp out disease, 
 and thus destroy their means of living; but they are not 
 animated by selfish motives—they have in view only the 
 good of the people. It is very often the case that those to 
 whom we try to do good do not appreciate our efforts, and 
 are cold and uninterested. We want to stir up interest 
 among the people. I feel very much gratified, as a resident 
 of the city and as a member of the Board of Health, to see 
 such a goodly attendance, and I only regret that the lay 
 element is not better represented. 
 
 Dr. Tiros. F. Wood moved that Hon. A. A. Thompson, 
 Mayor of Raleigh, be the permanent Chairman, and Hon. 
 •J. J. Fowler, Mayor of Wilmington, be the Adce-President of 
 this Association, and J. C. Chase, C. E., of Wilmington, and 
 Dr. Julian M. Baker, of Tarboro, Secretaries. Carried. 
 
SANITARY CONVENTION. 
 
 11 
 
 Hon. W. E. Fountain, of Tarboro, and Hon. E. B. Neave, 
 of Salisbury, were also made, respectively, second and third 
 Vice-Presidents. 
 
 Dr. Wood moved that each person present come forward 
 and register their names in order to determine the status of 
 the Convention, and in order that the President might make 
 the committees, which had to be formed directly. He hoped 
 that each member present, whether layman or otherwise, 
 would register, and thus encourage those who had taken the 
 initiative. 
 
 COMMITTEE ON WAYS AND MEANS. 
 
 The Chairman said the first business was the appointment 
 of a Committee of Ways and Means, and the meeting must 
 decide how many that committee should consist of. 
 
 Dr. Wood moved that the Committee of Ways and Means 
 consist of three members, which was carried. 
 
 Committee on Ways and Mtaris. 
 
 Dr. Jno. McDonald, Washington, N. C., proposed by Dr 
 R. H, Lewis. 
 
 Oscar Pearsall, Wilmington, proposed by Dr. Wood. 
 
 Dr T. F. Wood, Wilmington, proposed by Mayor Fowler. 
 
 , The next business was the appointment of a Committee 
 on Permanent Organization. Chairman asked of how many 
 should it consist, 
 
 Mr. J. C. Chase moved that the Committee on Permanent 
 Organization consist of five members, which was carried. 
 
 CommitUe on Permanent Organization. 
 
 Dr. Eugene Grissom, proposed by Dr. J. M. Hays. 
 
 Dr. W. P. Beall, Greensboro proposed by Dr. R. H. Lewis. 
 Mr. J. L. Ludlow, proposed by Dr. T. F. Wood. 
 
12 
 
 MINUTES OF THE 
 
 Dr. T. F. Wood, proposed by Dr. H. T. Bahnson. 
 
 Dr. R. H. Lewis, proposed by Dr. W. T. Ennett. 
 
 Dr. Wood moved that the Committee on Permanent 
 Organization be allowed until the evening meeting to consult 
 and report. Carried. 
 
 Dr. Wood moved that Dr. .J. W. Jones, President of the 
 North Carolina Board of Health, read his paper on the 
 “ Gains of Sanitation Carried. 
 
 Dr. J. W: Jones then proceeded to read. (For. Dr. Jones’ 
 paper see second part of this volume.) 
 
 Dr. Grissom: It seems to.me that the very philosophical 
 paper just read by Dr. Jones contains not only information 
 of vast value to the public, but suggestions still more 
 valuable. If there is any regulation existing or contem¬ 
 plated by which these papers are to be published, I move its 
 publication. 
 
 Dr. Bahnson suggested that the paper of Dr. Jones be 
 incorporated in the report of the State Board of Health. 
 
 Dr. Wood: \ would like to say that the insertion of that 
 report will depend very much upon what they say at the 
 capitol. At the same time it is very likely there will be no 
 •objection to it, and if not, it will appear in the Biennial 
 Report now in press. That course, though, will not prevent 
 the paper assuming a more popular form, and as a member 
 of the Committee on Ways and Means I would say that if 
 all the papers are like that of Dr. Jones, we should have 
 them printed as coming from this Convention and give them 
 as wide a circulation as we can afford to give them. I hope 
 that paper will not be lost in the report of the North Caro¬ 
 lina Board of Health, but will have a more popular distri¬ 
 bution than a volume of that kind is likely to give it. 
 
 Dr. Tucker : I move the reference of this paper to the 
 Committee on Ways and Means. Carried. 
 
 Dr. R. H. Lewis, on behalf of Dr. Grissom, invited the 
 members of the Convention to visit the Insane Asylum 
 
SANITARY CONVENTION. 
 
 IS 
 
 either as a body or individually, where they would receive a 
 most hearty welcome. 
 
 Dr. W. G. Curtis, of Southport, then read a paper on 
 “ Quarantine ” “ It is due to myself to say, before beginning 
 
 to read my paper, that it was written in the expectation that 
 this Convention would be composed of a large number of per¬ 
 sons from all parts of the State, not only physicians, but 
 others, and that we should have a good many of our legis¬ 
 lators present.” (Dr. Curtis’ paper will appear in the second 
 part of this volume.) 
 
 Dr. Jno. McDonald: It will be a great misfortune if a 
 paper like this and the one preceding it should fail to reach 
 the public. I move it be referred to the Committee on 
 Ways and Means, with instructions to give it as wide publi¬ 
 cation as the means at their disposal will permit. Seconded 
 and carried. 
 
 Dr. Wood : The paper which has just been read is one of 
 great value, and does not apply to the Cape Fear section only,, 
 although that is a large part of the State, but will interest every 
 city connected with Wilmington by railroad. I do not think 
 many of the gentlemen present realize how great our diffi¬ 
 culties are at Wilmington. The practical workings of the 
 law Dr Curtis is modest enough not to say anything about, 
 because he has performed these duties so faithfully for many 
 years. But I would say that the Quarantine Station is 
 located near Southport, at deep water point, Dr. Curtis being 
 resident at Southport as inspector of vessels coming into our 
 port. At his suggestion, some years ago, the State of North 
 Carolina was asked to add to the Quarantine Board two 
 gentlemen from the city of Wilmington, in order that the 
 citizens of Wilmington might be better satisfied that each 
 vessel was properly prepared to enter the river. Now, in 
 managing quarantine we have not only to provide against 
 disease, but also against panic, which the fear of disease 
 causes, and I believe the greatest difficulty of all is to pro¬ 
 vide against panic, which is more expensive than diseases 
 
14 
 
 MINUTES OF THE 
 
 
 are. This amendment having been made to the law at the 
 suggestion of Dr. Curtis, the practical working is just this, 
 that when a vessel is of such a dangerous nature as to 
 require more particular looking after, he telegraphs to the 
 city of Wilmington and informs the members of the Quar¬ 
 antine Board, who pay a visit to the station and inspect the 
 vessel on its merits. If the vessel is not in a condition to 
 be passed at once, the ballast is discharged, the vessel as 
 thoroughly fumigated as means will permit, and is either 
 allowed to proceed to Wilmington, where she takes in her 
 cargo, or else, if she is very dangerous, in the judgment of 
 the Board, and the cleansing has not been sufficient, not 
 only to relieve her of infection, but to quiet the feelings of 
 the citizens, the vessel is required to load at the station, 
 which is twenty-five miles down the river. This causes an 
 expense which is very burdensome, and it is highly likely 
 that such a burden would diminish the trade of the port. 
 As it now stands the two gentlemen who are the represen¬ 
 tatives of Wilmington, are almost forbidden from taking 
 their summer vacation because they have to stand between 
 these infected vessels and the community, and are looked to 
 to protect the people against these infections, and it is a 
 matter of great urgency and absolute necessity that we 
 should have the proper means of disinfection at the mouth 
 of the river. All that was considered necessary heretofore 
 was to take a pan and burn sulphur enough to fill the hold, 
 &c., with the gas, and batten down the hatch until the gas 
 had reached every nook, but that is not now considered suffi¬ 
 cient, and will not satisfy people who read the newspapers. 
 They say “that is all very good, but it is ancient; New 
 Orleans has a plan far ahead of that.” Either North Caro¬ 
 lina must build this quarantine station and relieve the peo¬ 
 ple of Wilmington and those people in the tributary coun¬ 
 try from this anxiety every year, and the damage to her 
 commerce, or else the local authorities will be obliged to 
 build it, which does not seem fair. I particularly desire that 
 
s ANITARY ( ON V KXTl( > N. 
 
 15 
 
 it come as the voice of this Convention, so as to have its 
 proper influence on the Legislature, that the quarantine at 
 Wilmington be properly equipped. I wish to make the fol¬ 
 lowing motion now : 
 
 Resolved, That “it is the opinion of the Convention here assembled, 
 after listening to Dr. Curtis’ paper, that there ought to be a proper 
 quarantine established at the mouth of the Cape Fear River at South- 
 port, and that the General Assembly be asked to make the appropria¬ 
 tion which is set forth in the bill now pending.” 
 
 Dr. R. H. Lewis: I think that if the members of this 
 Convention, particularly those from other sections than the 
 Cape Fear section, would see the members of their counties 
 and other members they know and impress upon them the 
 fact that this quarantine is not needed for the city of Wil¬ 
 mington alone, but for the protection of the whole State, and 
 that it is their duty to vote for this apparently local measure 
 for the purpose of protecting the whole community, and 
 that it is essential for the protection of the people living 
 inland, that it would have a very good effect. 1 beg to sec¬ 
 ond Dr. Wood’s motion. 
 
 Dr. Wood: I would like to state that the quarantine sta¬ 
 tion belongs to the State of North Carolina. One of the 
 oldest laws on our statute book is the law creating a quaran¬ 
 tine at Fort Johnston. It is the ancient property of the 
 State, and for that reason it seems to me that it is the imper¬ 
 ative duty of the State to see that it is perfected and brought 
 to the highest state of efficiency. The State has land down 
 there and every facility, and all that is needed is money. I 
 hope every member of this Convention will see all the 
 members of the Assembly that he knows and point out that 
 the property does not belong to the city ol \V ilmington, but 
 
 to the whole of North Carolina. 
 
 Dr. Bahnson read a paper prepared by Dr. G. G. Ihomas 
 (who had been obliged to return to Wilmington), on “ Inland 
 
1(> 
 
 MINUTED OF THE 
 
 Quarantine.'' (Dr. Thomas’ paper will be found in the second 
 part of this volume.) 
 
 Dr. W. T. Ennett moved that the excellent paper of Dr. 
 G. G. Thomas, read by Dr. Bahnson, be referred to the Com¬ 
 mittee on Ways and Means, with instructions to have it pub¬ 
 lished as soon as possible. Carried. 
 
 Dr. Wood moved that the Chair appoint a committee to 
 select delegates to the number of ten to the Convention in 
 Montgomery, Ala., and suggest these names to the Governor, 
 who had said that he would be willing to appoint such gen¬ 
 tlemen as were selected bv this Convention. 
 
 Committee to select delegates to the Southern Convention, 
 Montgomery, Ala.: Dr. T. F. Wood, Dr. J. W. Jones, Dr. H. 
 T. Bahnson. 
 
 The meeting then adjourned until 8 o’clock p. m. 
 
 EVENING session. 
 
 Mayor J. J. Fowler, Vice-President, in the chair. 
 
 Dr. T. F. Wood read the report of the Committee on Per¬ 
 manent Organization. He explained that they had made it 
 as brief as possible, because it did not seem desirable to have 
 any cumbersome machinery, and they would start out with 
 as simple a one as possible, and leave room for amendments 
 as occasion may demand. 
 
 After some discussion the Constitution, as presented, was 
 adopted: 
 
 NAME. 
 
 Article 1 . This Association shall be known as the North Carolina 
 Sanitary Association. 
 
 objects. 
 
 Art. 2. This Association shall have for its objects the inculcation of 
 the principles and practice of public and private hygienics and the inves¬ 
 tigation of all subjects appertaining to the public health. 
 
SANITARY CONVENTION. 
 
 17 
 
 MEMBERSHIP. 
 
 Art. 3. Any person may become a member of this Association who 
 is interested in the study and promotion of hygiene, provided he is 
 endorsed by a member of the Association in writing and receives a 
 majority of the votes. 
 
 OFFICERS. 
 
 Art. 4. The officers shall be President, Vice-President, Recording and 
 Corresponding Secretary, and a Treasurer. 
 
 MEETINGS. 
 
 Art. 5. The meetings shall be annual, the time and place settled by 
 the Executive Committee. 
 
 EXECUTIVE COMMITTEE. 
 
 Art. 6. There shall be an Executive Committee of five appointed 
 by the President, whose duty it shall be to prepare all business in 
 advance of the meeting of the Association, and shall also determine 
 what papers shall be presented, and shall prepare the programme and 
 settle the place and time of meeting. 
 
 COMMITTEE ON WAYS AND MEANS. 
 
 Art. 7. There shall be a Committee of three on Ways and Means, who 
 shall prepare for the expenses attending the Association, audit all bills 
 before being paid by the Treasurer, and have charge of the publication 
 of the proceedings of the Association. 
 
 DUES. 
 
 Art. 8. There shall be an annual assessment of $... for the support of 
 the Association, the amount to be determined by the suggestion of the 
 Committee on Ways and Means, and approved by a majority vote. 
 
 Dr. O’Hagan said that the Committee on Ways and 
 Means were directed to defray the expenses of publication, 
 but no means were provided whereby these expenses should 
 
 be met. 
 
 2 
 
18 
 
 MINUTKS OF THE 
 
 Dr. Wood said the committee would be glad to receive 
 any suggestions from Dr. O’Hagan. The intention was 
 that the committee would suggest an assessment at each 
 meeting. 
 
 Dr. Grissom moved that the blank be filled by the inser¬ 
 tion of an assessment of two dollars. 
 
 Dr. O’Hagan moved that it be five dollars. 
 
 Dr. Wood desired to have it left to the committee to 
 decide. 
 
 Dr. Grissom’s motion was carried. 
 
 The Committee on Permanent Organization recommended 
 that the present officers of the Convention be made the per¬ 
 manent officers of the Association, which was carried. 
 
 The Chairman called attention to the fact that the con¬ 
 stitution provided for the election of a Treasurer. A dis¬ 
 cussion followed as to the advisability of combining the 
 offices of Secretary and Treasurer, but the Chairman pointed 
 out that the constitution clearly provided for two secretaries 
 and a treasurer. 
 
 Dr. Bahnson then moved that Dr. Grissom be elected 
 Treasurer, which was seconded and carried. 
 
 Dr. Grissom said there could not be a better time than 
 the present for receiving the assessment of two dollars per 
 member, and he would be glad to receive the amount at once 
 
 The members present responded by paying at once. 
 
 Dr. Bahnson moved that the Chairman be allowed until 
 to-morrow to nominate an Executive Committee of five. 
 Carried. 
 
 Dr. Bahnson then read a paper on “ The Water Supplies oj 
 Towns and Cities in North Carolina .” (Dr. Bahnson’s paper 
 will appear in the second part of this volume.) 
 
 Dr. R. H. Lewis said: I have listened, and 1 am sure all 
 of us have listened to Dr. Bahnson’s admirable paper, with 
 very great pleasure. The question of pure water is one of 
 the first importance, and in moving the reference of this 
 paper to the Committee on Ways and Means for publication. 
 
SANITARY CONVENTION. 
 
 19 
 
 I would like to add that they be instructed, if the funds in 
 hand will justify it, even if they cannot publish all the papers 
 of this Convention, that this particular paper be published 
 in pamphlet form for distribution among the towns of our 
 State. Dr. Bahnson has exhausted the subject and put it 
 in a simple and eloquent form, and I am sure nothing would 
 do more to instruct the people of our State on this impor¬ 
 tant question. Should the funds in hand not be sufficient, 
 I will cheerfully subscribe to have this done. 
 
 Mr. Oscar Pearsall : I rise to second that motion, because 
 I am in hearty sympathy with it, and I would like to have 
 some of these pamphlets for distribution in Wilmington. 
 
 Prof F. P. Venable, of the University of North Carolina, 
 said: I would like to call the attention of the Association to a 
 method of purifying water which has lately been mentioned 
 authentically in the papers, and which, I think, is well worthy 
 of the attention of the Association. It is a method that has 
 been put in operation in the towns in the Netherlands, and 
 wonderful results are claimed for it. It is called the “ Anderson 
 Iron Process,” and is dependent upon the purifying action of 
 bright pieces of iron. The water is forced through a pipe 
 into a long boiler of iron, where it comes against a disc, so 
 that it is forced into a broader stream and much more sur¬ 
 face is exposed. Inside the boiler are a number of shelves, 
 on which are placed numbers of little pellets of iron. The 
 boiler is kept revolving all the time, and as it revolves these 
 iron pellets are lifted and made to fall through the stream 
 of water. The continual friction of the pellets keeps them 
 bright. At the opposite end of the boiler is a cone, which 
 gathers the water again and carries it off The water, alter 
 leaving the boiler, is serated by passing over coke, and is 
 then allowed to filter through sand. It comes out perfectly 
 clear and bright, and will stand the test of being kept sev¬ 
 eral years without changing. This is a very severe test, and 
 as a rule, only distilled water will stand it successfully. 1 he 
 cost of this process is $3.35 per 100,000 gallons, and the 
 
20 
 
 MINUTES OF THE 
 
 original plant will cost only $5,000 for a capacity of 
 1,000,000 daily. There are works at Ostend and Antwerp 
 and two or three other places in the Netherlands, and the pro¬ 
 cess has been applied to the waters of the Seine. The pro¬ 
 cess was unsatisfactory at Berlin, and the failure is said to 
 be due to the large amount of iron salts in the water, though 
 that reason was given without proper investigation. 
 
 Mr. J. C. Chase, of Wilmington, continuing the discus¬ 
 sion, said he agreed with Dr. Bahnson that in a question of 
 such vital importance as the supply of pure water the cost 
 ought to be a secondary consideration. With regard to the 
 process described by Prof. Venable, the superintendent of the 
 water works at New Orleans had a process with iron which 
 worked admirably with the water of the Mississippi; but the 
 least quantity which could be used at Wilmington left such 
 a taste in the water that it was immediately discarded. 
 Another difficulty they had to contend with in Wilmington 
 was the tidal influence, and nearly every year they had an 
 irruption of brackish water, which of course no filter could 
 handle. 
 
 Prof. Venable read a paper on “ The Intervention of the 
 Slate in the matter of the Adulteration of Food." (Prof. Vena¬ 
 ble’s paper will be found in the second part of this volume.) 
 
 Dr. Wood : There is a law of North Carolina providing 
 for the examination of adulterated food, and the employ¬ 
 ment of the provisions of the law is optional with the citi¬ 
 zens. Any one having an article of suspected food can have 
 it examined at the expense of the State by sending it through 
 the State Board of Health to the Agricultural Experiment 
 Station. There has, however, been only one application for 
 examination in eight years, and this application came from 
 a whiskey distiller who wanted to know if the State Board 
 of Health would permit the examination of whiskey, as he 
 claimed he had the purest whiskey in North Carolina, The 
 Board replied that they did not consider whiskey a food. It 
 is only by such methods as Prof. Venable explains that we 
 
SANITARY CONVENTION. 
 
 21 
 
 can awaken the people from their lethargy, for the people 
 do not know the extent of these adulterations, and no inter¬ 
 est is excited. In the report of the North Carolina Board of 
 Health, which is now in press, we have only a short table of 
 analyses which were kindly made voluntarily by Prof. 
 Venable, of drugs selected from different druggists without 
 their knowledge that they were to be analyzed. The num¬ 
 ber of analyses made are few, but they are leaders showing 
 exactly the direction that this matter is going to take. The 
 articles selected were bismuth, quinine, laudanum (U. S. Ph.,) 
 and grocer’s laudanum. There were several specimens of 
 these articles and hardly any were pure. These analyses 
 showed that some of the oldest chemists in this country sell 
 bismuth with a trace of lead in it, and other impurities, and 
 whilst they are not harmful, they are certainly not what they 
 pretend to be. It is just this instruction which the people 
 of North Carolina need. They need to have these sermons 
 put under their noses in printer’s ink in simple, short arti¬ 
 cles which they can understand; for it is shown that even 
 people who are trying their best to give us pure food and 
 pure medicines are selling impure ones and are entirely 
 unaware of the fact. I think it highly desirable that papers 
 like Prof. Venable’s should be sent broadcast over the land, 
 and I hope the Committee on Ways and Means will get 
 enough money to print all these papers. 
 
 , Mr. Oscar Pearsall, of Wilmington: I want to call the 
 attention of this Association to a matter of considerable 
 importance, and one which the Association has already 
 pledged its support and influence to. I allude to the rebuild¬ 
 ing of the Quarantine Station at Deep Water Point on the 
 Cape Fear River. I learn to-day that a bill has already 
 been introduced in the Senate providing for an appropria¬ 
 tion, and has been referred to the Finance Committee. The 
 chairman of this committee happens to be an acquaintance 
 of mine, and at my request has expressed his willingness to 
 receive a committee from this Association on this matter. I 
 
22 
 
 MINUTES OF THE 
 
 move, therefore, that a committee be appointed to wait upon 
 the Finance Committee of the Senate to urge the importance 
 of this matter, and 1 would suggest that Dr. Wood be one of 
 the committee, as, being a member of the Quarantine Board, 
 he can give the Senate all the information they require. 
 
 Dr. Roberts seconded the motion. 
 
 Committee appointed to wait on Finance Committee of the 
 Senate: Dr. Wood, Dr. O’Hagan, Dr. Hubert Haywood, 
 Hon. J. J. Fowler, Mr. Oscar Pearsall. 
 
 Mr. J. C. Chase : The Governor of the State very cordially 
 invited the Convention to call upon him either individually 
 or in a body, and I think it is only proper, considering his 
 courtesy in welcoming us here, that we should make a call. I 
 would suggest that the members meet here at 10 o’clock and 
 call at once upon the Governor in a body. This was 
 agreed to. 
 
 The meeting then adjourned till 10:30 o’clock the follow¬ 
 ing morning. 
 
 SECOND DAY. 
 
 7th February, 1889. 
 
 Hon. A. A. Thompson, President, in the chair. 
 
 The meeting was opened at 10:30, with prayer by the Rev. 
 Mr. Cordon. 
 
 Dr. Hanks and Dr. Knox were appointed a committee to 
 inform Gov. Fowle that the Convention proposed to call upon 
 him in a body at 1:45, if it was his pleasure. 
 
 Mr. J. L. Ludlow, C. E., read a paper on “ The Disposal of 
 the Refuse of Towns." (Mr. Ludlow’s paper will be found in 
 the second part of this volume.) 
 
 Dr. Bahnson: I rise to express the thanks of this Conven¬ 
 tion to Mr. Ludlow for the paper he has favored us with, 
 and to move that it be referred to the Committee on Wavs 
 
 V 
 
 and Means for publication. Carried. 
 
SANITARY CONVENTION. 
 
 / 
 
 23 
 
 Dr. Grissom : It is well known that the theory prevailed 
 for a long time but to what extent it is now prevalent 1 
 am not prepared to say that the excessive use of sewage as 
 a fertilizer, and especially upon edible crops, produces an 
 unhealthy element in these crops, and, if I understand Mr. 
 Ludlow, he recognizes that effect. I would like to inquire 
 of him to what extent that theory now prevails, whether it 
 was a mere theory, and whether it has been overturned by 
 further experience? 
 
 Mr. Ludlow: The theory did find a good deal of favor, 
 but it is now established that with the exception of the excre¬ 
 ment of persons suffering from a disease which is infectious 
 by the excrement—as, for instance, typhoid fever—there is 
 no danger either to cattle eating grass or to people eating 
 garden produce fertilized by sewage. There is a garden near 
 Paris fertilized entirely by sewage, and it is famed as pro¬ 
 ducing the finest strawberry crops in the world. The theory 
 is not borne out, excepting in the case where the excrement 
 is from typhoid patients, and the only way of eliminating 
 this danger is in the complete disinfection of the excrement 
 by the physicians attending such cases. We cannot treat 
 the sewage sufficiently to overcome this ; it should be the 
 duty of the physician. 
 
 Dr. Grissom : I am gratified at the explanation given by 
 Mr. Ludlow, and it seems to me to be a source of gratifica¬ 
 tion to those who wish to make the system practicable. 1 
 have myself, in the very limited experience 1 have had dur¬ 
 ing twenty years, had great doubt about the effect ot using 
 sewage as a fertilizer broadcast. I know good effects have 
 followed its use, but I attributed it to the fact that the places 
 where it was used required considerable irrigation, and 1 
 thought the beneficial effects were due not so much to the 
 manurial properties of the sewage as to the irrigation. Still, 
 an experience so limited as my own is not entitled to any 
 great respect, and I am glad to say that the paper will be 
 
24 
 
 MINUTES OF THE 
 
 quite an inducement to study the subject from a more learned 
 standpoint. 
 
 Dr. O’Hagan : I have listened to the paper of Mr. Ludlow 
 with a great deal of pleasure, and, I think, with a great deal 
 of profit. This question of the disposal of garbage and ani¬ 
 mal matter has become a great public question which is 
 tasking the minds of the wisest and best men in the world. 
 We have not reached it yet, because the population is too 
 sparse, but at no distant day the question will confront us, 
 and it is well that the medical men and the laity should be 
 educated up to the point that they will know how to dispose 
 of it in the most efficient manner. Mr. Ludlow’s paper is 
 valuable inasmuch as he has touched upon all points—not 
 only the sanitary, but the financial as well; and when we 
 have to appeal to the laity and to the municipal authorities, 
 the financial question transcends all others. Our govern¬ 
 ing bodies need to be educated up to the point to know that 
 whatever tends to bring about good health is cheap. Mr. 
 Ludlow’s paper is of very great value, and as an educational 
 paper it ought to be known throughout the State, and I 
 would respectfully suggest that as many copies as the finances 
 of the Committee on Ways and Means will permit be printed 
 for distribution. 
 
 Dr. Thomas F. Wood read a paper on How can we best 
 secure the Economical Disposal of Refuse in our Towns , with 
 some Remarks on the Garbage Furnaces in use” (Paper will 
 appear in second part of this volume.) 
 
 I woulk like to remark before I read my short paper that 
 I for one am very much obliged to Mr. Ludlow for the 
 paper he has just read, and would like to say for the infor¬ 
 mation of the Convention that Mr. Ludlow is the Sanitary 
 Engineer for the State Board of Health, and during the 
 last year he has devoted much of his time to the study of 
 the question. One of his papers is now being printed by 
 the State as part of the transactions of the State Board of 
 Health, and T would like to remark that if any gentlemen 
 
SANITARY CON V ENT ION. 
 
 25 
 
 desire to receive this paper I will cheerfully send them the 
 volume when it is finished, which will be in about two 
 months. The volume will not only contain Mr. Ludlow’s 
 paper, but Dr. Bahnson’s and others, which will be consid¬ 
 ered as text-books for many years to come. The North Caro¬ 
 lina Board of Health desires to keep in advance of the 
 thinking people of the State, and these papers are intended 
 to keep the subjects before them. Knowing what Mr. Lud¬ 
 low’s paper would be I have taken up the more practical 
 part of the disposal of garbage. 
 
 On the motion of Dr. Grissom the paper by Dr. Wood 
 was referred to the Committee on Ways and Means. 
 
 Dr. Wood then introduced Mr. Morse, representative of 
 the Engle Garbage Furnace, and the following is given as a 
 synopsis of his remarks : 
 
 Mr. Morse, on being introduced, said that he was not a 
 sanitary expert and had no arguments to advance on the 
 subject. He wished simply to bring before their notice the 
 workings of the furnace built by the Engle Sanitary and 
 Crematory Company, which he claimed destroyed all garb¬ 
 age, &c., detrimental to health, and was the simplest, most 
 effective and cheapest manner of getting rid of the sewage 
 and garbage of a town. It might be said that this was a 
 broad assertion to make, but he could give evidence to show 
 that he was fully justified in making it. Mr. Morse then 
 described at some length the furnaces which his company 
 had erected on Staten Island and at Milwaukee, &c., and the 
 severe tests which they had undergone, and read testimo¬ 
 nials from the health officers at these places testifying to the 
 complete success which they had achieved. Mr. Morse 
 stated that these furnaces did not require any expert attend¬ 
 ants, and would completely burn up all sewage and garbage 
 matter (with the exception of ashes), and that the combus¬ 
 tion was so complete that there was absolutely no smoke 
 or offensive smell emitted. The residue was also valuable 
 as a fertilizer. Other methods ol utilizing sewage as a tertil- 
 
26 
 
 MINUTES OF THE 
 
 izer were costly and more or less dangerous to health, and, 
 moreover, it had been demonstrated that such fertilizer did 
 not contain more than four per cent, of fertilizing proper¬ 
 ties, as nearly all the ammonia, &c., was lost in its prepara¬ 
 tion. 
 
 Mr. Morse invited health officers and others interested in 
 the subject to communicate with him, and he would be 
 pleased to give estimates and all particulars for the erection 
 of these furnaces. 
 
 Dr. J. H. Tucker read a paper on “ The Duties and Respon¬ 
 sibilities of Superintendents of Health .” (Dr. Tucker’s paper 
 will be found in the second part of this volume.) 
 
 Dr. Jno McDonald, in moving that Dr. J. H. Tucker’s 
 paper be referred to the Committee on Ways and Means, 
 suggested that another assessment be made, as there were not 
 sufficient funds in hand to publish all the papers, and he 
 did not wish any of them should be lost, as it was just the 
 kind of literature needed. 
 
 Dr. O’Hagan said the assessment of $2 was too small to 
 accomplish anything, and he wanted to see it increased. 
 
 Mr. Morse said he wished, on behalf of the Engle Sani¬ 
 tary Furnace Company, to contribute $10 towards the fund 
 for the publication of these papers. 
 
 A resolution was offered thanking Mr. Morse for his gener¬ 
 ous donation, which was unanimously adopted. 
 
 Mr. J. C. Chase thought it was not necessary at that time 
 to increase the assessment. The secretaries intended to at 
 once send out a circular letter which they hoped would have 
 the effect of increasing the membership considerably, and 
 he thought they would then have sufficient funds to meet 
 all the expenses in sight. 
 
 Dr. H. T. Bahnson : I learn since last night that there is 
 an effort being made on the part of several municipalities— 
 Charlotte and Greensboro, &c.—to have a special law passed 
 to protect their water supplies, and it strikes me that this is 
 the time when, if possible, an effort should be made to get 
 
SANITARY CONVENTION. 
 
 27 
 
 general legislation on the subject. I have spoken with the 
 Superintendent of Health of Raleigh, who says he will join 
 in an effort to get a law which will not only cover water 
 supplies already made, but such as may be made in the 
 future. I will ask Colonel Keogh, who is here in the inter¬ 
 est of Greensboro, to favor us with a few remarks. 
 
 Col. Thos. B. Keogh : There is not much that I can say 
 on the subject. Dr. Bahnson has already presented the 
 question, and that is all there is of it. I am here to secure, 
 if possible, special legislation for the protection of our water¬ 
 shed, and to prevent pollution of the supply and the streams 
 which are tributary to it. It appears to me that a movement 
 from the Sanitary Convention would receive more attention 
 from the legislators than anything coming from a private 
 source, and I think it would be much better if you would 
 join as an association and have a bill framed to apply to the 
 whole State, not only for present water supplies, but for all 
 future water supplies. It is a question which affects the 
 whole State, and I think we should be much more likely to 
 succeed if this Sanitary Association took it up. 
 
 Dr. H. T. Bahnson moved that a committee consisting of 
 representatives from the various towns interested in water 
 works be appointed by this Convention, with Col. Keogh, who 
 is one of our members, to draft a bill with a view to general 
 legislation on this subject and prohibiting the pollution ot 
 any water supplies. 
 
 Prof. J. L. Ludlow thought that such legislation would 
 prove very one-sided. He was afraid that it would have 
 the effect of practically confiscating all land surrounding 
 water supplies, as the owners would be prohibited from 
 building on it. 
 
 Dr. T. F. Wood seconded the motion of Dr. Bahnson, as he 
 believed it ought to come forward as the opinion of this 
 Convention that legislation to protect the water supplies oi 
 the country was needed. 
 
28 
 
 MINUTES OF THE SANITARY CONVENTION. 
 
 Prof. Venable moved the amendment that a standing 
 committee of this Convention be formed to undertake such 
 legislation as may be considered necessary from time to 
 time. Carried, and the President announced the Committee 
 on Legislation with reference to water supplies to be Dr. 
 James McKee, Dr. J. H. Tucker, Prof. F. P. Venable. 
 
 The Convention then adjourned sine die, and the members 
 went in a body to call on Gov. Fowle at his office, as pre¬ 
 viously arranged. 
 
MEMBERS OF THE NORTH CAROLINA 
 SANITARY ASSOCIATION. 
 
 - 9 - 
 
 Pi. D. L. Adams ... .Raleigh. 
 
 H. B. Battle, Ph. D., State Chemist. u 
 
 Dr. K. P. Battle, Jr. « 
 
 Julian M. Baker, County Sup’t of Health_Tarboro. 
 
 “ Henry T. Bahnson, State Board of Health.Salem. 
 
 “ W. P. Beall.Greensboro. 
 
 Col. W. F. Beasley....Oxford. 
 
 Dr. VV. J. H. Bellamy.Wilmington, 
 
 W. H. Bobbitt.;.Raleigh. 
 
 John C. Chase, C. E., Hydraulic and Sanitary En¬ 
 gineer .Wilmington. 
 
 Rev. J. H. Clewell.... .Salem. 
 
 Dr. W. G. Curtis, Quarantine Officer.Southport. 
 
 Rev. J. F. Crowell, D. D., President Trinity CollegeRaleigh. 
 
 Dr. B. F. Dixon..Oxford. 
 
 E. B. Engelhard, Esq., Superintendent Water Co. .Raleigh. 
 
 Dr. W. T. Ennett, President N. C. Medical Society, Wilmington. 
 
 John J. Fowler, Esq., Mayor... “ 
 
 W. E. Fountain, Esq., “ .Tarboro. 
 
 Dr. F. H. Fries......Salem. 
 
 F. T. Fuller.Raleigh. 
 
 “ Eugene Grissom, Sup't Insane Asylum.Raleigh, 
 
 “ L. A. Hanks, County Sup’t of Health. . .. .Pittsboro. 
 
 “ Dr. F. H. Harris.Henderson. 
 
 J. M. Hays.Oxford. 
 
 “ E. Burke Haywood.Raleigh. 
 
Dr Hubert Haywood.... ..Raleigh. 
 
 G. W. Hinshaw, Esq.Winston. 
 
 Dr. P. E. Hines .Raleigh 
 
 “ J. A. Hodges.Fayetteville. 
 
 u J. W. Jones, Pres’t State Board of Health.. . .Tarboro. 
 
 T. B. Keogh, Esq. ..Greensboro. 
 
 Dr. A. W. Knox.... .Raleigh. 
 
 u R. F. Lewis, County Sup’t of Health. .. •. Lumberton. 
 
 “ H. W. Lewis, County Sup’t of Health...Jackson. 
 
 R. H. Lewis, State Board of Health.Raleigh. 
 
 ' J. L. Ludlow, C. E., Civil and Sanitary Engineer. .Winston. 
 
 Dr. J. L. Malone.Louisburg. 
 
 “ John McDonald, State Board of Health.Washington. 
 
 Dr. J. W. McGee.Raleigh. 
 
 “ James McKee, County Sup’t of Health. “ 
 
 “ W. P. Mercer.Toisnot. 
 
 Rev. L. L. Nash. .Raleigh. 
 
 E. B. Neave, Esq., Mayor .Salisbury 
 
 Dr. C. J. O’Hagan.Greenville. 
 
 Oscar Pearsall, Esq., Chm’n City Sanitary Com... Wilmington. 
 
 Prof. W. L. Poteat, Wake Forest College .Wake Forest 
 
 Dr. F. W. Potter. County Sup’t of Health.Wilmington. 
 
 “ J. D. Roberts.Durham. 
 
 u S. H. Rogers.Raleigh. 
 
 “ W. I. Royster. “ 
 
 li J. J. Summerell, County Sup’t of Health.Salisbury. 
 
 “ R. W. Tate. Greensboro. 
 
 “ Geo. G. Thomas.Wilmington. 
 
 A^A. Thompson, Esq., Mayor.Raleigh. 
 
 Dr. J. H. Tucker, State Board of Health.Henderson. 
 
 F. P. Tenable, Ph. D ..Chapel Hill. 
 
 Dr. Tlios. F. Wood. Sec’y State Board of Health.. Wilmington. 
 
 The above named, with but few exceptions, attended the Con¬ 
 vention. There were several others present, who have not as 
 yet signified their intention of joining the Association. 
 
APPENDIX. 
 
APPENDIX. 
 
 THE PUBLIC WATER SUPPLY OF TOWNS AND CITIES IN 
 
 NORTH CAROLINA. 
 
 By H. T. Bahnson, M. D., Salem, N. C. 
 
 For much of the matter of the following pages the writer does not 
 desire to claim originality. It is largely a collation of the most perti¬ 
 nent facts established by the researches of eminent sanitary scientists. 
 
 The necessity of a wholesome water-supply for our growing towns is 
 rapidly increasing in importance, and this paper is written with a view 
 to point out imperfections, if any exist, in such supplies as are already 
 instituted, and to furnish data which may serve to prevent similar and 
 perhaps graver errors in future undertakings of this kind. 
 
 If we study the history of modern towns we will be struck by the 
 fact that a public water supply has generally followed a more or less 
 destructive conflagration. The resulting loss of property has induced 
 property-owners to take precautions against such calamities in the future. 
 The average man will freely tax himself to insure the safety of his house 
 and worldly goods, while he intrusts the lives and health of himself and 
 family to the mercy of Providence. If Providence will preserve from 
 disease and death, why will He not protect from fire? Which is the 
 worse misfortune, to have a house burned down, or to see wife and 
 children die of a preventable disease? 
 
 Probably these questions have not been asked; at all events, the prime 
 object of a water supply seems to be the protection of property from 
 fire. A town pays out of its revenues a rental upon the fire hydrants 
 and the householder stints his family in the use of water, with an anxious 
 eye to his water-tax. 
 
 The old heathen did better, as is shown by the remains of their mag¬ 
 nificent acqueducts and public fountains and baths. Their water was 
 used for cleanliness and the preservation of health—not to gorge the 
 insatiable maw of that modern municipal toy, the steam fire-engine. 
 Perhaps they lost more buildings, but they saved more lives. 
 
 Greek and Roman civilization looked to the health and bodily develop¬ 
 ment of the citizen. Their religion consisted of the deification of heroes 
 and the apotheosis of superior physical attributes. In this religion ablu¬ 
 tions for the purification and invigoration of the body of the worshippers 
 bore a prominent part. In the revolt against Pagan rites, which was 
 brought about by Christianity, water was put under the ban because of 
 the importance attaching to it in the heathen ceremonial. Self-abnega¬ 
 tion and mortifying of the flesh took the place of personal cleanliness 
 and attention to physical culture. Personal nastiness became the step- 
 
II 
 
 APPENDIX. 
 
 ping-stone to canonization, and the odor of sanctity was no figure of 
 speech. To the mind of such devotees, disease was of Divine origin, 
 and plagues and pestilences were submitted to with resignation. An 
 effort to prevent such visitations would have been regarded sacrilegious. 
 
 Out of this quagmire of superstition and fanatical perversion of Chris¬ 
 tian tenets the civilized world only gradually emerged after the lapse 
 of centuries. Dogmatism and cant have been relegated to the limbo of 
 the Dark Ages, where they originated, and “pure religion and undefiled” 
 again demands a clean body as the abode of a pure heart. Science, the 
 handmaid of religion, has displaced empiricism in medicine, and inau¬ 
 gurated the warfare upon filth as the cause of disease, which is the 
 crowning glory of this age of progress and enlightenment. Most dis¬ 
 eases can be prevented, some alleviated, and only a few cured. The 
 prevention, therefore, rather than the cure of disease, is the goal of mod¬ 
 ern medical ambition. 
 
 The laws of life and health are daily becoming more clearly known and 
 easier to comprehend, and it is the duty of the physician and sanitarian 
 to bring them to the knowledge of the authorities and the public. But 
 alas! the traditions and the prejudices of centuries are hard to eradicate, 
 and although the ear of this generation can be reached by the propa¬ 
 ganda of sanitation, the truths of its teaching usually require severe 
 lessons to impress them upon the hearts and lives of a people.- In spite 
 of discouragements from wilful ignorance, or worse still, fatalistic 
 indifference, modern sanitary science preaches and fights its crusade for 
 the preservation of health and the prolonging of life, with confidence 
 inspired by a righteous cause and the assurance of a linal victory. 
 
 Water, from the earliest times, has been regarded as the symbol of 
 purity. The sparkling dew drop, the refreshing rain, the bubbling 
 spring, the dancing rivulet, the pellucid stream or lake, the deep, cold 
 well, the crystal snow, the glass-like ice. to the natural eye present the 
 embodiment of purity and healthfulness. It may be transparent and 
 sparkling, grateful and refreshing, and yet, this apparently pure, health- 
 si' ing water has carried in ages past, and is to-day carrying, disease 
 and death to myriads of the human race. Modern science, with ruthless 
 hands, tears away the veil which hides from our unaided eye the work¬ 
 ings of nature’s laboratory, and dispels our fondest illusions. It teaches 
 us that “the moss-covered bucket” is a euphemism for malaria-breeding 
 alga?, and “ the life-giving element” we so eagerly quaff may be foul 
 with pollution from stable and privy and swarming with death-dealing 
 microbes. 
 
 Absolutely pure water does not exist in nature. Even the vapor in 
 the atmosphere which surrounds our earth is laden with impurities and 
 rich in minute organic life. The germs of the latter, owing to their 
 great volatility, are carried by the wind to high altitudes and long 
 distances: and, entangled in the crystals of snow, or gathered by the 
 
APPENDIX. 
 
 Ill 
 
 globules of rain, are precipitated upon the earth’s surface. The red 
 snott of Greenland, the wonder of our school days geography, derives 
 its color from microscopic vegetable spores, and the so-called “mountain 
 fever” has been traced to a similar origin, viz.: vegetable spores from 
 the melting snow, carried into the springs and other sources of water 
 supply. 
 
 But it is upon the surface of the earth, and the few feet of loose soil 
 which compose its crust, that we find the principal sources of water, 
 pollution. Dead and decaying animal and vegetable matter give life 
 and sustenance to innumerable minute organisms, which we call 
 microbes. Some of these are poisonous in their influence, while others 
 serve as scavengers by promoting fermentation and putrefaction, resolv¬ 
 ing organic matter into its chemical constituents and fitting it to be 
 absorbed by the radicles of growing vegetation. Saturated with decay¬ 
 ing organic matter and the products of its decomposition, the water not 
 needed for vegetable growth either evaporates from the earth's surface 
 or passes into an adjoining stream, or percolates into the deeper recesses 
 of the earth, until it is arrested by some impermeable stratum, from the 
 edge of (or a seam in) which it bursts forth again in the shape of a 
 spring. During its course through the deeper layers of the earth, it is 
 constantly undergoing chemical and biological influences. The products 
 of decomposition are thereby further resolved or eliminated by filtration, 
 and the water appears again at the surface of the earth, nearly or 
 altogether free from organic matter. Its purity in this particular 
 depends, of course, upon the depth and character of the filtering mate¬ 
 rial through which it has percolated. During its passage it dissolves 
 and carries with it more or less, according to solubility, of the earthy 
 and mineral matters which it encounters. Springs not being always 
 accessible or of sufficient capacity, it becomes necessary to utilize the 
 water from running streams and lakes or sink wells to the water-bearing 
 stratum. 
 
 A spring or well deriving its water from a wooded or grass-covered 
 arha, protected from surface drainage and not holding in solution an 
 excess of mineral or earthy salts, affords a healthful and perfectly satis¬ 
 factory water-supply. Except in periods of great drought, the small 
 amount of its organic and mineral ingredients would be no disadvantage, 
 but only serve to make the water refreshing and palatable. But these 
 desirable sources of water-supply can only exist in uninhabited, or at 
 most, sparsely settled sections of country. 
 
 Surface drainage from uncultivated ground, especially if this be of a 
 marshy character, contains a large amount of vegetable matter, from 
 the decomposition of which, under certain conditions of soil and tem¬ 
 perature, is developed the malarial poison. It is positively demonstrated 
 that this poison is eliminated from water by filtration through the soil, 
 and no malarial disease can be traced to a well or spring untainted by a 
 
TV 
 
 APPENDIX. 
 
 direct inflow from the surface. Nature’s process may be successfully 
 imitated, and artificial filtration, properly conducted, affords protection 
 against malarial poison in drinking water. 
 
 As a country is settled, however, we have other and more terrible foes 
 to encounter, in the effort to maintain the wholesomeness of our water 
 supply. The rotting garbage which litters our streets and yards, laundry 
 and kitchen slops and waste, the pig-sty and barn-yard, and above all, 
 the privy, furnish pabulum for the development of the germs of what 
 are known as zomotic and filth diseases. Their germs once developed, 
 permeate the soil, and it is only a question of time when, the earth’s 
 filtering power being incapable of arresting them, they invade our 
 sources of water supply, and produce sickness and death. Amongst 
 these diseases are the various forms of diarrhoea and dysentery. 
 
 Common diarrhoea, as distinguished from its specific forms, e. g ., 
 cholera, occurs generally whenever drinking water is sufficiently laden 
 with impurities to cause irritation of the alimentary mucous tract. In 
 periods of drought and consequent supersaturation with impurities of 
 the scanty water supply, diarrhoea and dysentery are especially preva¬ 
 lent and attended with great mortality amongst children and the aged 
 and infirm. That in most cases, diarrhoeas, sporadic and epidemic, are 
 due to a specific poison, acting otherwise than as a simple irritant, is 
 settled beyond a doubt; but this poisonous principle, almost certainly a 
 germ, has not yet been definitely determined. In many cases of diarrhoea, 
 occurring from the use of water, the pollution of the latter has been so 
 great that its excess of organic matter could be determined by micro¬ 
 scopical and chemical analysis, and quite frequently its odor and taste 
 sufficed to condemn it as unfit for use. 
 
 Cholera is a specific diarrhoea. Originating along the water courses 
 in India, where it is always endemic, its germs are carried by travel and 
 commerce to all parts of the world. We know that it is especially 
 transmissible by water, and the latter may be contaminated either 
 directly by choleraic excreta, or by the absorption of the exceedingly 
 volatile germs from the atmosphere. So rapid is their dissemination 
 that neither natural nor artificial filtration can be depended upon during 
 the prevalence of this virulent disease. In an epidemic of cholera, no 
 water should be drunk which has not been thoroughly boiled, passed 
 through a reliable filter, and kept in an air-tight vessel. Boiling destroys 
 the germs of the cholera by coagulating the albuminoids. Filtration 
 deprives it of these coagulated albuminoids, and restores its sapidity by 
 replacing the air expelled in boiling. If it were possible to adopt 
 generally the same precautions at all times, the cases of sickness and 
 death caused by unwholesome water would be reduced to a minimum. 
 Under the influence of a cholera scare, no expense, no sacrifice of comfort 
 01 con\ enience is thought too great to be rendered as a free-will offering 
 at the shiine of this awe-inspiring ]\Ioloch. But cholera rarely visits 
 
APPENDIX. 
 
 V 
 
 our favored shores, and by a rigorous enforcement of quarantine regu¬ 
 lations, we can entirely escape its ravages. 
 
 We read with horror of the desolation wrought by it a year ago in 
 Italy and Spain; of cities decimated and abandoned by their terror- 
 stricken inhabitants; of villages and whole districts depopulated, the 
 living unable to care for the sick or bury the dead. We note with 
 indignant amazement the squalor and filth, the unsanitary conditions 
 which aided the dissemination and augmented the fatality of the pesti¬ 
 lence, and, with Pharisaical complacency, we thank God that we are not 
 as other men are. 
 
 We deliberately close our eyes to the fact that our country is constantly 
 ravaged by diseases even more fatal, and quite as much due to filth as 
 is cholera, for their origin and dissemination. 
 
 Foremost amongst these are diphtheria and typhoid fever. Both are 
 produced by specific organic principles. Rotting garbage affords develop¬ 
 ment to the germs of diphtheria, while the poison of typhoid fever has 
 its origin in decomposing human excrement. The former is frequently, 
 and the latter is almost invariably, conveyed into the system by drink¬ 
 ing water. The deaths in this country every year from these two 
 diseases outnumber by many times the severest epidemics of cholera 
 or yellow fever. The latter, confined to a limited area, arrest the atten¬ 
 tion, while the former, on account of their widespread distribution, are 
 regarded with equanimity, and submitted to as a matter of course. 
 And yet, they are more easily prevented by us than either yellow fever 
 or cholera. The latter diseases are of foreign importation, and a laxity 
 of quarantine, for which we, as individuals or communities, are not 
 responsible, may bring one or both of them upon us. Diphtheria and 
 typhoid fever are home productions—the legitimate fruits of our own 
 filth. The parent who throws his child into the fire, the husband who 
 shoots his wife, the man who slays his neighbor, is justly condemned as 
 a murderer. In what respect does he differ from him who breeds a 
 pestilence that kills his wife, and child, and neighbor ? 
 
 It is possible to evade or contravene human law, but the laws of nature 
 are immutable and implacable; effect follows cause—crime brings pun¬ 
 ishment. The penalty may be delayed, but it is none the less certain. 
 The foul drain, the reeking offal from kitchen and pig-sty, invite the 
 waiting germ to breed the pestilence that throttles and suffocates our 
 darling child, whose agonizing sufferings we are powerless to allay 
 whose piteous appeals for the help we cannot afford rend our bleeding 
 hearts. The offending filth may be in our neighbor’s premises, or on 
 the public highway; this but shifts the responsibility, without mitigating 
 the crime, or giving immunity from its penalty. 
 
 Diphtheria, as a distinct disease, was first described in IS,15, as oiigi- 
 nating in the slums of Paris. Since that time, it has been recognized o\ e 
 the whole civilized world, and is justly regarded as the most fatal pesti- 
 
VI 
 
 APPENDIX. 
 
 lence of modern times. In the city of Brooklyn, the mortality during 
 the past twelve months was nearly one thousand, and in other parts of 
 the country it claims its victims in like or even greater proportion. 
 
 Its transmission by water-pollution is abundantly attested. There is 
 no necessity to go outside of the State for evidence. In Winston and 
 Salem not less than thirty sporadic cases have occurred during the past 
 two years. All of these were in families using well water. The sur¬ 
 roundings were most favorable for its development—garbage plentiful, 
 and pig-sties numerous. In the houses of neighbors using water from 
 the public supply not one case occurred. It frequently happens that 
 diphtheria is prevalent on one ridge or water shed. In one case, under 
 my observation, the disease in the course of years traveled about twenty 
 miles along one ridge, taking the lives of over one hundred children, 
 and, except by contagion, not affecting a single person on parallel ridges. 
 The dreadful epidemics, ten to fifteen years ago, in Company Shops, 
 Charlotte, Newbern and other places in the State, can only be accounted 
 for by the general pollution of the wells. 
 
 Sanitary science teaches us that the virulence of diphtheria can be 
 mitigated, and its germs prevented from propagation, by cleanliness in 
 our premises and surroundings. In the city of Pullman, where sanita¬ 
 tion is enforced by law, the disease is unknown. We know further, 
 that it is highly contagious, spreading rapidly from the person and sur¬ 
 roundings of the sick, and particularly from the body of the dead. Yet 
 the dead body of the little victim is often left exposed to be gazed at by 
 friends and kissed by relatives, the bedding and furniture of the sick¬ 
 room placed in the yard to poison the atmosphere, and the sputa and 
 dejecta of the patient thrown upon the ground to pollute the surrouding 
 wells. Isolation of the sick, thorough disinfection, and prompt sealing 
 up of the dead body will limit the contagion, and yet there is not a law 
 on our statute books to enforce these simple and necessary regulations. 
 Probably more than one thousand children in North Carolina are yearly 
 sacrificed to this preventable disease by our indifference and stupidity. 
 Shall the blood of these slaughtered innocents cry out from the ground 
 in vain ? 
 
 Typhoid fever is not a contagious disease like diphtheria. Its poison 
 does not spread from the person and surroundings of the sick, and if 
 several members of a family or community are stricken down by this 
 disease, they do not contract it directly from one another. The poison¬ 
 ous germs are found only in the evacuations from the bowels of the sick. 
 These, thrown upon the ground, or cast into the privy, multiply with 
 amazing rapidity; and, washed by the rain into a stream, or percolating 
 through the soil into a well or other source of water supply, spread the 
 disease amongst those using the water. Water so polluted gives no evi¬ 
 dence of its fatal properties. Neither by chemical nor by biological 
 analysis can the presence of typhoid fever germs be detected with cer- 
 
APPENDIX. 
 
 VII 
 
 tainty. Natural filtration does not exclude them from a well, and it is 
 unreasonable to hope that artificial filtration can do more. They resist 
 the chemical and biological influences to which they are subjected in 
 passing through the soil, are unaffected by frost, and retain their viru¬ 
 lence indefinitely. The dejecta of a single patient, during the winter of 
 1884-85, were thrown out upon the frozen ground, and by the thaw in 
 April were carried into the reservoir which supplied water to the village 
 of Plymouth, Pennsylvania. In less than one month over seven hun¬ 
 dred, and in less than three months twelve hundred people using the 
 water were stricken down with the disease. 
 
 Typhoid fever respects neither age nor sex, and regards previous con¬ 
 dition only in so far that the negro race is perhaps less liable than the 
 white to its ravages. It flourishes alike in country and town. From 
 the mountain to the sea-shore, wherever human excrement, directly or 
 indirectly, finds access to drinking water, typhoid fever prevails. 
 Exemption can be secured only by having passed through the disease— 
 a second attack is very rarely observed. A neighborhood or community 
 may for a long time escape a visitation, but sooner or later its time will 
 come, unless the proper precautions are taken. An absentee returning 
 home, a transient guest, a child from school, may at any time bring the 
 disease from an infected locality. In these days of rapid and easy 
 travel, such contingencies are of every-day occurrence. 
 
 In the absence of a registration law, we can only estimate the mor¬ 
 tality from typhoid fever in North Carolina by a comparison with other 
 States which have such registration. Giving ourselves the benefit of 
 every advantage, we are forced to conclude that not less than five hun¬ 
 dred of our citizens annually die from this disease. In the United States 
 typhoid fever kills more than thirty thousand every year, and we suffer 
 our share of the mortality. For each death we may count at least 
 eight sick on an average eight weeks. The great majority of victims 
 to typhoid fever are in beginning maturity—the most valuable and 
 productive period of human life. Such a life is certainly worth $1,000. 
 Eight sick for each death means four thousand sick eight weeks each 
 year, or an average of six hundred sick every day in the year. A low 
 estimate of the loss of productiveness and the general and incidental 
 expenses of sickness would be $1 per day for each patient. 
 
 Let us summarize:— 
 
 Five hundred deaths at $1,000- 
 
 Six hundred dollars per day for sickness, 305 days . 
 
 $500,000 
 
 219,000 
 
 And we have a total of 
 
 $719,000 
 
 —a sum equal to the entire revenues of the State, ruthlessly squan¬ 
 dered and literally wiped out of existence—taken from the lesouices ol 
 
VIII 
 
 APPENDIX. 
 
 our State and paid for the questionable privilege of mixing our own 
 ordure with our drinking water. 
 
 These figures are appalling and may seem incredible, but let my reader 
 examine his own family history and visit the neighboring grave-yards, 
 and then make his own calculations. When he has accomplished this, 
 I beg him to compute the anxiety, the sorrow and desolation—a task for 
 which I confess myself entirely inadequate. 
 
 Other sources of water-pollution deserve more than the casual men¬ 
 tion to which I limit myself. The blood and offal from slaughter¬ 
 houses, the waste from manufacturing establishments, the refuse from 
 saw and planing mills, should, for obvious reasons, not be allowed to rot 
 upon the ground and be carried by storm-water into our streams. Sewage 
 from paper-mills and tan-yards is especially objectionable, and the sub¬ 
 soil drainage from cemeteries is literally the draught of death. 
 
 Writers upon cholera in India ascribe its origin and virulence largely 
 to the fact that the washing of clothes is carried on in the water which 
 is used for drinking. How often do we see the washing of the family 
 done at the well or on the bank of the spring? Need we ’wonder if such 
 water is sometimes unwholesome? 
 
 The importance, nay, the vital necessity, for a pure water supply for 
 our people, whether they are scattered over the country or aggregated 
 in towns, must be conceded. As towns increase in population, the dif¬ 
 ficulty of procuring a wholesome water supply, and the dangers of its 
 pollution, are correspondingly augmented. 
 
 It is asserted that a barrel of kerosene, poured into a hole ten feet in 
 the ground, will contaminate all the wells in a radius of a quarter of a 
 mile. Sooner or later, therefore, the poisonous products of decomposing 
 filth must find their way into a well in proximity to a habitation and its 
 out houses. As population increases in a given area, so does the volume 
 of garbage and filth and excrement. In addition to this, vegetation, 
 which would otherwise assist in its disposal, decreases in inverse ratio 
 to density of population. The bare ground of streets and yards becomes 
 supersaturated with rotting refuse, which percolates through the subsoil 
 into the wells. The germs of disease may not be in this pitcher full or that, 
 but they will surely find us some day if we continue to use the water 
 which contains them. A water-bed, or basin, cannot safely be used for 
 concurrent purposes of w^ater supply and the reception of offal. Sick¬ 
 ness and death will follow as surely as the night succeeds the day. A 
 new source of supply, therefore, must be sought, and this is the question 
 that confronts every growing town. 
 
 It is fondly imagined by many that the purity of water can be deter¬ 
 mined by chemical or biological analysis. While water in which gross 
 impurities are detected by either process is justly condemned as unfit for 
 use, the reverse of this axiom by no means follows. There are many 
 sources of error, and I will mention a few: 
 
APPEND IX. 
 
 IX 
 
 1st. Water analyzed to-day and found unobjectionable may easily 
 become foul with pollution to-morrow. It is obviously impossible to 
 analyze water every time we want a drink. 
 
 2d. Water purposely polluted with cholera and typhoid fever poison 
 has been pronounced of good quality by chemical tests. 
 
 3d. Until we can recognize the germs of the various filth diseases, the 
 biological analysis of water can give only negative results. There is 
 •every reason to hope that success will crown the painstaking efforts now 
 being made to isolate and determine these poisonous germs: but even 
 then their exclusion from our water supply must continue to be our only 
 safeguard. 
 
 In the selection of a water supply, we should not be contented with 
 an examination of the contour of the water-shed. It must be remem¬ 
 bered that, in most sections of our State, the crust of the earth is of 
 very recent formation—the result of denudation and atmospheric action 
 upon the underlying rocks. These may, and, indeed, generally do, dip 
 at a considerable angle to the surface. Surface drainage and subsoil 
 drainage, therefore, are often in different or even opposite directions, 
 and our calculations as to the area which supplies this or that water 
 basin are frequently at fault. It must be evident, then, that we should 
 have an accurate knowledge of the dip and strike of the water-bearing 
 stratum. Nowhere could the services of a competent geologist or 
 engineer be more profitably utilized than in the selection of a site for a 
 water supply. 
 
 North Carolina is a well watered State, and our surface is not yet 
 settled so thickly that a suitable area for a wholesome water supply 
 •cannot be found, in most cases, near a town. Such localities should be 
 secured without delay, and zealously guarded against contamination. 
 It needs no argument to convince a thinking man that this course is 
 true economy. What ought to be done should, in all cases, be done at 
 once. It is we who are interested in this matter, now in our own time 
 and generation; for what does it avail us that our town is supplied with 
 pure water ten years hence, if at that time it be remarked of us: “ Ah, 
 yes, I remember him well; he died of typhoid fever eight years ago. 
 And it is an easy matter to so arrange the financial burden that part ol 
 it shall fall upon those who will hereafter participate in its benefits. 
 
 The purity of the water should be the first consideration. We must 
 go to nature for this, and take advantage of her lavish generosity in this 
 direction. In some cases springs may afford a sufficient supply, in 
 others a large stream, in $till others a neighboring lake. These failing, 
 it may be there is an impervious stratum below our polluted water-shed, 
 piercing which, we find an abundance of uncontaminated watei. Such 
 water is utilized in Brooklyn and Memphis, and is the hope of New hern 
 and Goldsboro in our own State. 
 
 Whatever the source, it cannot be too strongly emphasized, that it 
 
X 
 
 APPENDIX. 
 
 must be pure, and must be kept pure. The drainage area of the supply 
 must be kept under the closest supervision, and the health authorities 
 empowered to protect the many against the careless or wanton encroach¬ 
 ments of the few. 
 
 Next in importance to purity is abundance of water supply. It has 
 been well said that the true test of civilization is the consumption of 
 water for domestic purposes. Although custom sanctions the practice, 
 it is manifestly unwise, as well as unjust, to levy a tax on water for 
 domestic use, and, without money and without price to the owner, pour 
 a hundred or a thousand times as much into a burning building. Such 
 a tax bears unequally upon the people, and is, in the case of the very 
 poor, prohibitory. The latter, if possible, avoid using the taxed water, 
 and resort to suspicious, if not certainly polluted, private sources of sup¬ 
 ply. A revolution of the present system can hardly be brought about 
 immediately, but such a reduction of charges as will enable even the 
 poorest to make ample use of pure, wholesome water is a sanitary neces¬ 
 sity, and deserves the earnest consideration of town authorities every¬ 
 where. Sickness is impoverishment, health is wealth ; and not only is 
 the good name of a town injured, but the lives and health of the better 
 classes are imperilled if filth diseases prevail among the poor. 
 
 The introduction of a w holesome and abundant v\ ater supply into a 
 town is simply a question of money—not what it costs to obtain, but 
 what it costs to do without. The inhabitants of a town must be short¬ 
 sighted indeed, if they hesitate at any outlay which will prevent dis¬ 
 ease, increase their health and longevity, correspondingly augment their 
 productive activity, and lessen their death-rate. 
 
 Vienna, in one year, decreased her mortality by typhoid fever from 
 341 to 11 per 100.000 by introducing spring-water in place of that drawn 
 from the Danube river. Baltimore, Brooklyn, Memphis and other 
 American cities have done equally well. How long would it take such 
 a saving of life and health to balance the cost of the most expensive 
 water-works? 
 
 Bad water affords a valid pretext for the use of alcoholic liquors to 
 prevent ics poisonous effects. If our prohibition friends deprive the poor 
 man of his tipple, they should certainly aid in providing something more 
 wholesome to supply its place. Apart from the encouragement and 
 quasi-justification for the use of intoxicating beverages which unwhole¬ 
 some water furnishes, it is an established fact that polluted water causes 
 more deaths, more sickness, more sorrow, misery and destitution than 
 all the stills in the State. 
 
 Sanitation prescribes temperance in all things, and positive avoidance 
 of morbific agencies. Compared to it, prohibition is a rush-light to the 
 sun, an episode, a side-show to a great caravan. Sanitation once 
 established as a governing principle in State and family, prohibition 
 
would naturally become a question of expediency to an elevated and 
 enlightened public sentiment. 
 
 As has been mentioned above, the introduction of a public water sup¬ 
 ply has generally been with a view to protection from fire. Indeed, until 
 within the past forty years, a connection between drinking-water and 
 specific forms of disease was, at best, only suspected. Since sanitary 
 science has positively demonstrated this causative relation, various expe¬ 
 dients have been adopted in a futile effort to correct and remedy the 
 impurities which are known to exist in established water supplies. 
 
 A brief mention of these expedients may prove interesting. The 
 principal ones are sedimentation, aeration, chemical precipitations, and 
 various modifications and combinations of these processes. All of these 
 are imitations of natural processes, and, of necessity, as imitations, fall 
 short of the original. 
 
 Sedimentation takes place naturally in lakes and streams, and, on a 
 smaller scale, in wells and springs. The particles of earthy matter, 
 from their own weight, subside to the bottom, and along with them more 
 or less of organic impurities. Storage reservoirs possess this advantage, 
 and necessarily add much to the appearance and healthfulness of the 
 water, their good effect being proportionate to their capacity and the 
 length of time water is exposed to their influence. In seasons of unusual 
 turbidity, no less than ten tons of earthy matter and one-half ton of 
 decomposing organic substances are thus eliminated from the 20,000,000 
 gallons of lake-water which constitute the daily supply of Cleveland, 
 Ohio. That the elimination of such a mass of putrescent filth is of the 
 greatest advantage must be self-evident. Nevertheless, sedimentation 
 is but a poor safeguard against disease. The infected water which pros¬ 
 trated twelve hundred of the eight thousand inhabitants of Plymouth, 
 Pennsylvania, and killed one hundred and thirty, passed through three 
 storage reservoirs to accomplish its deadly" mission. Sedimentation is 
 limited in its value and adaptability, and care must be taken to prevent 
 stagnation in storage reservoirs. 
 
 Every one has noticed the greenish scum which generally covers a 
 stagnant pond. If we follow the effluent of such a pond, we notice 
 that very speedily the water becomes clear and sparkling, especially if 
 there is enough descent to cause ripples or falls in the stream. r l his 
 process has been successfully imitated by forced aeration in some storage 
 reservoirs, notably at Brooklyn, New ^ ork, where stagnation produced 
 such a scum, and the filthy water was restored to a potable condition. 
 The decomposition and destruction of the vegetable matter composing 
 the scum, was effected by the oxygen in the air forced through it. 
 
 Chemical precipitation by means of alum, various salts of iron, lime, 
 etc., etc., is a useful adjumant to sedimentation and filtration. It is 
 not necessary to inquire whether the action of these agents is strictly 
 chemical, or in part mechanical. They undoubtedly hasten the subsi- 
 
XII 
 
 APPENDIX. 
 
 dence of the grosser organic and inorganic impurities suspended in 
 water, but cannot be depended upon to eliminate the specific germs of 
 disease. These are so tenacious of their vitality that their destruction 
 •could be accomplished only by an amount of purifying agents, which 
 would be of itself dangerous to human life. 
 
 Artificial filtration consists of the passage of water through beds of 
 gravel, charcoal, coke or other porous substances. Theoretically, it is 
 the most promising means for purifying water, and the result of the 
 process, if properly conducted, is most gratifying to the eye and taste of 
 the consumer; a perfectly limpid, appetizing water. The defect in 
 artificial filtration is that it undertakes a thousand or even a million 
 fold as much as nature. It has neither the time nor the surface to effect 
 percolation after nature’s method. More water passes through a filter¬ 
 ing bed under strong pressure in an hour than nature purifies, on the 
 same area, in one or more years. Some filters are arranged for a reversal 
 of current and a scouring of the filtering material, and it is claimed that 
 they are thus thoroughly cleansed. But who can confidently assert that 
 such reversed current and even scouring will remove all the minute 
 impurities which have been forced against the surface or entangled in 
 the interstices of the filtering material? It is not denied that some 
 organic matter remains after filtration, and it is only a natural infer¬ 
 ence, that owing to their minute size and great vitality, the germs of 
 disease shall longest and most successfully resist elimination. The 
 guarantee of a patent filtering company is worthless from a scientific, 
 sanitary standpoint. A crucial test would be the prolonged use, by 
 themselves and families, of water impregnated with typhoid and 
 diphtheritic germs, and passed through their filter. They ought to have 
 at least as much faith in their assertions as is shown by the veterina¬ 
 rian in England, who declares that hydrophobia exists only in the 
 imagination of its victims, and, up to last accounts, had allowed himself 
 to be bitten by 147 rabid dogs. 
 
 Filtration will probably remove malarial poison, and suffice to purify 
 for drinking purposes the water from lakes and rivers. If these are of 
 large size, we might reasonably hope, that if pollution existed it would 
 be so diluted in a vast body of water as to be innocuous. And yet, 
 Chicago, which derives it water supply from Lake Michigan, through a 
 tunnel opening two miles from the shore, is about to extend the tunnel 
 three miles further out to insure exemption from pollution. 
 
 The sum of our knowledge on the subject of artificial purification of 
 water is thus tersely expressed by the English Commissioners: “ Of all 
 the processes which have been proposed for the purification of water 
 polluted by excrementitious matters, there is not one which is sufficiently 
 effective to warrant the use, for dietetic purposes, of water which has 
 been so contaminated.” 
 
 We may add: Water to which sewage has access, directly or indi- 
 
APPENDIX. 
 
 XIII 
 
 rectly, by surface or subsoil drainage, should, from that fact alone, be 
 excluded from all consideration as a possible source of water supply for 
 drinking purposes. 
 
 The sanitary requirements of a public water supply are only two in 
 number, viz.: 
 
 First. Purity — i. e ., absolute freedom from apparent and possible, both 
 present and future, contamination and pollution. This necessitates 
 undisputed control and watchful supervision of the water-shed and the 
 surface area supplying it. 
 
 Second. Quantity — i. e., water in sufficient abundance and cliead 
 enough to be used freely for domestic purposes by all classes. This 
 requirement can only be met when the water works are owned by the 
 town. Such ownership would result in the closing of private wells and 
 springs, which are always liable to pollution. 
 
 Let us summarize the reports of the various public water supplies in the 
 State, as furnished me by friendly correspondents, and see how these 
 requirements are fulfilled. 
 
 Asheville .—Water taken from Swannanoa River, four miles above city. 
 Stream is large, rising in the Black Mountains and flowing through a 
 sparsely-settled and cultivated valley. Water occasionally turbid from 
 rains. Filtered by Hyatt method, a combination of filtration with 
 forced aeration and chemical sedimentation. Supply abundant. Works 
 owned by the city. Meter rates, 25c. per 1,000 gallons. Average cost 
 per year for a family of six persons, $10. Not yet in general use by 
 poorer classes. Water introduced only a year ago, but since its introduc¬ 
 tion a marked decrease of typhoid fever and enteric diseases is noted. 
 
 Charlotte. —Water-works established 1881-82. Owned by a company. 
 Source of supply on outskirts of town, from several small streams and 
 ponds; also surface water. Storage reservoirs of 16.000,000 gallons 
 capacity. Water often muddy and liable to pollution, as company has 
 control of only a small area of water-shed. Average consumption, 
 265,000 gallons per day—a little over one-fourth capacity. Water rates, 
 50c: per 1,000 gallons. Average cost per year for a family of six per¬ 
 sons, $20. Not in general use by poorer classes, but increased health¬ 
 fulness noticed among consumers. 
 
 Concord .—Supply taken from a remarkably pure spring near centre 
 of town. No apparent connection with immediately surrounding area. 
 Capacity, about thirty thousand gallons per day. A orks owned by 
 private individual. Water not in general use. 
 
 Durham .—Works owned by a company. Water introduced two years 
 ago. Supply derived from several springs, six miles north of town, 
 whose waters are impounded and collected into a reservoir. Surround¬ 
 ing country hilly and rocky, with sandy surface and clay subsoil. No 
 habitations near. Reservoir closely fenced and whole works guaided. 
 Water, after heavy rains, slightly turbid from clayey sediment. ( apacit\ 
 
XIV 
 
 APPENDIX. 
 
 four times greater than is demanded by present size of town. Water is 
 pretty generally used—at least, by better classes. Meter rates, 40c. per 
 1,000 gallons. Average cost per year for family of six persons, $16. 
 
 Fayetteville .—Present system of water-works introduced in 1824. 
 Belongs to town. Supply is from springs just outside corporate limits. 
 Water collected in a brick reservoir and conveyed through bored logs, 
 connected by iron couplings. Capacity about eighty-five thousand gal¬ 
 lons per day. In limited use. Rates, .. 
 
 Goldsboro— No public water supply. Contract entered into by city 
 with a Northern company to supply 2,000,000 gallons per day at a price 
 for family consumption of $5.50 per faucet, making average cost pei 
 year for a family of six persons at least $15.00. Supply to be taken, if 
 possible, from driven wells sunk below underlying marl stratum. This 
 would probably be unobjectionable, but if water is taken from Little 
 River its wholesomeness is questionable. 
 
 Greensboro .—Works established during the past year and belong to a 
 company. Supply taken from springs one and one-half miles from 
 centre of town, and beyond a creek, so as to be free from town drainage. 
 Area supplying springs belongs to a private individual, with no dwell¬ 
 ings, and mostly covered with forest. Supply limited and not yet much 
 used. Water often muddy, ascribed to newness of storage reservoir, 
 but as company proposes putting in a filter, there is probably surface 
 drainage. Meter rates not to exceed 25 cents per 1,000 gallons. Average 
 cost per year for a family of six persons $10.00. 
 
 Raleigh .—Works owned by company. Supply taken from Walnut 
 Creek, above any possible inflow of city drainage. Area of water-shed 
 extensive, embracing both cultivated and woodland, and including part 
 of the village of Cary. Special legislation has been obtained for the 
 protection of stream and water-shed, but its great extent renders proper 
 supervision difficult, if not impossible. Capacity ample for present 
 needs. Direct service from pumps, with stand-pipe pressure for fire 
 protection. Water filtered by Hyatt method. Storage reservoir for 
 filtered water. Meter rates, 40 cents per 1,000 gallons. Average cost 
 per year for family of six persons $16.00. 
 
 Salem. —Water-works first established over one hundred years ago. 
 Supply taken from springs of limited capacity and distributed in cisterns 
 throughout the village. Superseded by present system in 1878. Works 
 owned by a company. Supply derived from shallow wells, alongside 
 the course of a stream which drains a section of Winston and Salem. 
 Water always clear and tests have failed to detect connection with 
 stream, or surface drainage. Storage reservoir for fire protection; direct 
 service for ordinary consumption. Rates, 50 cents per 1,000 gallons. 
 Average cost per year for family of six persons $20.00. Absence of 
 zymotic diseases noted among consumers. 
 
 Salisbury .—Works owned by a company. Supply taken from Cane 
 
APPENDIX. 
 
 XV 
 
 Creek, two miles southeast of town, away from town drainage. Area 
 supplying creek, largely cultivated ground. Water muddy and not used 
 for drinking purposes. 
 
 Wilmington .—Works owned by a company. Water taken from 
 Northeast River at its junction with the Cape Fear. River 450 feet wide 
 at site of pumping-station. Subject to tidal influences. Located one 
 mile or less above docks, shipping and sewers, and receives drainage 
 from several cemeteries, slaughter-houses and a large part of the city, 
 through a creek emptying into Northeast River one quarter of a mile 
 above works. Rice fields on opposite side of river, and large guano 
 works one mile above on Cape Fear river. Water discolored from 
 swamps (cypress water), as is the case with nearly all river and pond 
 water in Eastern Carolina. Supply unlimited. In only limited use for 
 drinking purposes, though doubtless far more wholesome than the water 
 in private wells. Meter rates, 20 cents per 1,000 gallons. Average cost 
 per year for family of six persons, $10.00. 
 
 Winston —Works owned by a company. Supply derived from shallow 
 wells alongside of a stream draining mostly cultivated lands and old 
 fields, and receiving surface water from the suburbs of Winston. A 
 dam across the stream and above the wells arrests its flow and serves for 
 pumping purposes. Water never muddy, and tests have failed to show 
 any connection with adjoining stream. Supply more than equal to 
 demand. Water not in general use by poorer classes. Absence of 
 zymotic diseases noted amongst consumers. Meter rates, 50 cents per 
 1,000 gallons. Average cost per year for family of six persons, $20.00. 
 
 As a model for comparison, I wish to describe the water supply of the 
 Western North Carolina Insane Asylum. The water is taken from an 
 impounded mountain stream, six miles from the asylum. The entire 
 surface area of water-shed, which is covered with forest, is owned and 
 guarded by the asylum authorities. Supply is ample for the present 
 needs, and can be nearly doubled by erecting storage tanks in the upper 
 part of the building. Service is direct, with a constant flow, and the 
 water is free to the consumers. 
 
 Approaching nearest to the model set by the Western North Carolina 
 Insane Asylum, we must place the Asheville water supply. Until the val¬ 
 ley of the Swannanoa is well settled, the risk of pollution may be excluded, 
 and the naturally pure water has the advantage of aeration afforded by 
 the swift mountain stream. Durham and CIreensboro A are next in the 
 
 *Since writing the above, I am informed that the impounding lesei voii oi 
 the Greensboro water works is part of an old mill pond, from the main body of 
 which, and the stream supplying it, it is separated only by a bank ol muck and 
 earth taken out for the purpose of deepening it. This reservoir is liable to ovei- 
 flow of back-water, and is partly supplied by seapage, from both pond and 
 stream. Such being the case, Greensboro must be placed lai down on the list 
 of doubt ful or dangerous water supplies. 
 
XVI 
 
 APPENDIX. 
 
 list, their water-sheds only requiring watchful supervision to maintain 
 their integrity. They are at present virtually under control of the water 
 companies and need only to become actually their property to fulfill the 
 first requirement demanded by sanitation. Raleigh's supply depends 
 for its safety upon the permanency of the lively appreciation of danger 
 at present evinced by its health authorities. 
 
 Leaving Concord and Fayetteville out of consideration, because their 
 supply is too limited to be generally utilized, we are compelled to place 
 Winston, Salem, Salisbury, Charlotte and Wilmington in the doubtful 
 list of water supplies, their risk from pollution, and their inability to 
 avert the danger, increasing in the order in which they are mentioned. 
 Without legislation they are all powerless to protect their water supply, 
 while the last mentioned is besides at the mercy of influences beyond 
 human control. 
 
 How well the second requirement is met I leave my readers to decide. 
 How many poor families in our North Carolina towns can afford to pay 
 a yearly water tax of $15 or $20, especially when it is considered that a 
 plumber’s bill of at least equal amount must precede the introduction of 
 water to their premises? 
 
 I would not detract an iota from the praise justly merited by the 
 public-spirited citizens who, realizing the necessity of their towns, and 
 impatient with the apathy of municipal authorities and the general 
 population, have invested their private means in the laudable undertak¬ 
 ing to provide better protection from fire and superior water facilities. 
 It is only just that these public benefactors should reap some rew r ard 
 besides the approval of a good conscience, and no man can grudge them 
 the small dividends that are usually returned by such investments. 
 
 I can only repeat, that to enable all classes to make sanitary use of our 
 public water supplies, the cost must be very much cheapened from the 
 present figures, and the only way to accomplish this result, wdthout 
 injury and loss to individuals, is to vest the ownership of public water¬ 
 works in the town or city supplied by them. 
 
 If I have been followed, it must be evident that individual effort to 
 preserve the purity of a water supply will not avail. Your well or 
 spring may become polluted by your neighbor’s privy or filthy premises, 
 in spite of the strictest attention to cleanliness on your own domain. 
 We have, to be sure, laws for the abatement of nuisances, and anything 
 prejudicial to health may be complained of, and, if proved a nuisance, 
 removed by process of law 7 . The history of the expensive and prolonged 
 litigations for the draining of mill-ponds in various localities in the State 
 may be cited as instances of the cumbersome and inefficient action of 
 the law. In practice, the law has become a prolific field for quarrels 
 and feuds, and an effective means to exhibit spite and ill-will. It is 
 often more honored in the breach than in the observance, and many a 
 
APPENDIX. 
 
 XVII 
 
 man risks the lives and health of himself and family rather than com¬ 
 plain of the filthy habits and practices of his neighbors. 
 
 Whether sanitary laws are disobeyed through ignorance, carelessness or 
 perversity, by yourself or your neighbor, punishment comes, and is as apt 
 to strike the innocent as the guilty. Indeed, in many instances, it is the 
 innocent especially who suffer, for it seems that there is to some extent 
 an immunity from filth diseases in individuals and families who do not 
 know what it is to be clean. They become, as it were, acclimated to 
 their surroundings, and thrive in a filth which would sicken and kill 
 more sensitive and highly organized natures. To these they become 
 producers and purveyors of diseases from which they may be themselves 
 exempt. 
 
 Communities demand protection from such influences, and appoint 
 sanitary inspectors and boards of health, but by limiting their expendi¬ 
 tures and crippling their executive powers by restrictive legislation, the 
 object and aim of their existence is thwarted, if not entirely abrogated. 
 
 For the successful conduct of any business, a knowledge of his duty, 
 executive ability and responsibility are required of an employee. How 
 much more are these necessary in the maintenance of life and health— 
 the business of mankind in this world, next in importance only to the 
 salvation of the soul? Yet. how often do we see in a community a 
 health officer appointed, not for his knowledge and fitness for the duty, 
 but because his services, such as they are, can be obtained for the least 
 money? Some communities, indeed, have no health officer, but entrust 
 their sanitation to the mercy of a sanitary policeman, usually an igno¬ 
 rant hireling, whose principal recommendation is, perhaps, his known 
 disregard for the nuisances he is expected to abate. 
 
 That we may know what we are about, we should first ascertain the 
 facts as to the existence and prevalence of disease in our State. While 
 it may prove difficult, perhaps impossible, to carry out in the rural dis¬ 
 tricts, a system of death records and burial certificates should be enforced 
 in every incorporated community, and the presence of contagious and 
 infectious disease immediately reported to the constituted authorities. 
 The physician who attends a case of such disease should be held respon¬ 
 sible for its isolation and the disinfection of the excreta and surround¬ 
 ings of the patient. In this way only can our atmosphere and soil and 
 water be kept free from the germs which cause and propagate disease. 
 The health officer must prevent the accumulation and superintend the 
 removal of garbage and filth, including the contents of closets and cess¬ 
 pools, in private as well as public premises. To accomplish this, he must 
 be clothed with indisputable authority, and penalties should attach to 
 those who obstruct him in his work, as well as to his failure to carry out 
 these essential sanitary regulations. Returns at stated intervals should 
 be made to the State Board of Health, one of whose functions it should 
 be to direct and control the enforcement of the sanitary laws and hold 
 
 •2 
 
XVIII 
 
 APPENDIX. 
 
 to personal accountability its transgressors. As at present constituted, 
 the State Board of Health is simply an advisory body, with no executive 
 powers and only limited responsibility. 
 
 The public water supplies should be guarded with especial care by the 
 local authorities, but in many instances these would be powerless with¬ 
 out the co operation of the authorities of the State. This is shown by 
 the action of Raleigh in securing special legislation to prevent the pollu¬ 
 tion of its source of water supply. Without such legislation, every 
 public water supply in the State, located outside the corporate limits of 
 a town, is completely at the mercy of every ignorant or wanton trespasser. 
 In Massachusetts, the law prohibits the drainage of any polluted sub¬ 
 stance into a stream within twenty miles above the place where it is 
 used for a water supply, and gives the supervision of public water sup¬ 
 plies to the State Board of Health. The approval of the board is a legal 
 requirement for the introduction of every system of water supply or 
 sewerage. 
 
 The report of the committee on the pollution of water supplies 
 which was read at the annual meeting of the American Public 
 Health Association at Milwaukee, Wisconsin, November 20th-23d, 1888, 
 and from which I have made some extracts in this paper, concludes: 
 “ It is the well considered belief of this Association that it is an impera¬ 
 tive necessity, that State Legislatures should give their boards of health 
 ^hat financial support which would enable them to act intelligently on 
 all questions pertaining to the public water supply, investing them at 
 the same time with the supervision of the said supplies, at d with power 
 to preserve these waters from contamination by sewage or other injuri¬ 
 ous matters.” 
 
 It may be objected that a sanitary law, such as I have outlined, would 
 be too costly. It may cost the one hundredth part of what is annually 
 lost to the State by typhoid fever alone, and perhaps approximate or 
 possibly slightly exceed the one four hundredth part of the entire loss 
 by preventable diseases. If it did not annually save one hundred times 
 its cost, it would be a dismal failure. 
 
 If we look at what has been accomplished elsewhere, these statements 
 will not seem unwarranted. In Michigan the saving of life from scarlet 
 fever in the last eleven years amounted to 3,718; and in 1886 appropriate 
 sanitary measures saved the lives of 298 persons, who, under the usual 
 ^conditions, and according to former epidemics, would have died of 
 diphtheria in a few localities. In Memphis, the death-rate has been 
 reduced in six years from 35 per 1,000 to 23.8 per 1,000. In Chicago, the 
 death-rate has been reduced in the last five years from 26 to 19.46 per 
 1,000, a saving of nearly 20,000 lives. 
 
 Let us take a lesson from Florida. Last winter a case ef yellow fever 
 was smuggled into Key West. There was only a nominal board of 
 health in the State, and the physician who attended the patient, just as 
 is the case in our State, was under no responsibility to report the nature 
 
APPENDIX. 
 
 XIX 
 
 of the disease. Other cases appeared in various parts of the State, and 
 the facts were suppressed. It was nobody’s business to let the truth be 
 known. Need I recall the tenor and panic of the people of Florida, the 
 horrified amazement of the rest of the country when it learned that nearly 
 the whole State was infected by the dreaded pestilence ? Leaving out 
 the deaths and sickness, the mere money loss to the State from the 
 suspension of business and the depreciation of the value of property, can 
 only be reckoned by millions, while the confidence of the civilized world 
 received a shock from which it will take years to recover. A properly 
 constituted board of health would have had timely notice of the first 
 case, and stamped out the disease before it became epidemic. It is 
 needless to say that the first care of the Florida Legislature will be the 
 establishment of a model State board of health. 
 
 Until the year 1885 the Legislature of the great State of Pennsylvania 
 entertained the quite prevalent opinion that sanitation was a local affair, 
 and restricted their sanitary legislation to the larger cities. Then came 
 the Plymouth epidemic, and, as a result, a State board of health. Do 
 we in this State need a similar lesson? 
 
 The North Carolina Board of Health need the moral and financial 
 support of the people of the State to carry out their mission. If these 
 are given grudgingly, only niggardly returns can be expected. Give 
 them enough to prosecute their noble work, and if they fail to fulfill 
 their promise and your expectations, they will deserve to be cast out as 
 unprofitable servants. 
 
 The moral aspect of sanitation has been incidentally touched upon. 
 If I point a loaded pistol at a fellow-man, and pull the trigger, I commit 
 a murder. If I knowingly allow that man to be exposed to a disease 
 which takes his life, am I innocent of his death: Human law may 
 enonerate me, but how can I plead at the bar of God and my own con¬ 
 science? The laws of life and health are plain and simple. They are 
 the laws of God; we know them; happy are we if we do them. The 
 time has come in modern civilization when ignorance and indiffeience 
 cannot be pleaded in excuse for neglecting the enactment and enfoi ce¬ 
 ment of sanitary laws. 
 
 In ghastly mockery of the words of hope and resignation graven on 
 the tombstones of our loved ones, who have succumbed to pieventable 
 diseases, we see standing out in letters of fire, which should scoicli and 
 sear our consciences: ‘ ‘ Strangled by filth ! ‘ ‘ Killed by wilful ignorance 
 
 and neglect!” 
 
 The deaths from preventable diseases in this State are simply muideis, 
 and we are left to decide in how far each of us is answerable to the just 
 
 Judge of all for the crime. 
 
 The ignorance and indifference, the fatal blunders of the past, cannot 
 be remedied; we cannot recall the dead; but if to-day we mend our 
 ways and heed the sanitary demands of the living, our loved and lost 
 ones will not have suffered and died in vain. 
 
APPENDIX. 
 
 XXI 
 
 INLAND QUARANTINE. 
 
 By George Gillett Thomas, M. D., of Wilmington, N. C. 
 
 The outbreak of a disease possessed of the power to communicate itself 
 from one person to another, either by direct contact or through the medium 
 of its germs, or by means of fomites, as it is generally expressed among 
 medical men, is the reason, and a good one if the danger to life is immi¬ 
 nent, for the establishing of such barriers as will prevent the introduc¬ 
 tion of such diseases into a healthy community. The guards which 
 such barriers produce is a quarantine. This is maritime when it takes 
 into consideration the care of vessels, their cargoes and crews, coming 
 from ports known to be infected with dangerous disease. When it opposes 
 the entrance of the disease by inland routes—that is, by railroad and 
 other avenues of reaching the towns, as the county roads, and steam¬ 
 boats and other crafts plying on water-ways between infected points 
 and healthy ones—it is Inland Quarantine; and it is to the study of this 
 portion of the sanitary officer's work that I invite your attention for a 
 short while. The organization and maintenance of an inland quaran¬ 
 tine is generally a matter of much thought and serious trouble to the 
 health officers of communities everywhere that are threatened with an 
 invasion of a dangerous disease. So complete is the confidence of med¬ 
 ical men in the efficacy of vaccination, and the prompt isolation and 
 treatment of persons and their effects infected with small-pox, that it 
 hardly appears necessary to include this among the diseases that would 
 be subject to quarantine of the character we are studying. The same 
 may be said of typhus fever. So that, ordinarily, but two diseases are to 
 be guarded against by quarantine officials—cholera and yellow fever. 
 And practically at present the latter is the important one to consider, 
 because of its relatively frequent appearance on the Southern Atlantic 
 and.Gulf seaboard and the inland towns immediately in communication 
 with the coast towns and cities, as well as because of the peculiarly 
 subtle poison, and its manifold ways of finding a new point in which it 
 may spread and bring panic and death. Cholera, it would seem from 
 the experience of to-day, can be corraled in the place where it first 
 appears, if a strict cordon sanitaire is preserved, and proper steps are 
 taken to destroy the fomites, chiefly present in the alvine dejections of 
 the persons affected, and also to cleanse the town and put it in strictly 
 sanitary condition, thus starving out the disease and stopping its progress. 
 
 It appertains as well to the proper presentation of our subject to say 
 that the first duty of the officials charged with the care of the health of 
 a community in times of danger, and preparing for inland quarantine, 
 is the thorough cleansing of the towns. It is a fact that is beyond con- 
 
 3 
 
XXII 
 
 APPENDIX. 
 
 tradiction that it too often requires the approach of danger, in the 
 shape of mortal disease, to stir up the energies of health officers to the 
 full performance of their duty, and great good is the result that follows 
 in the wake of a settling panic. As this duty is one that is constant, its 
 performance should need no word of advice to spur it up, nor should it 
 be difficult of accomplishment, as the means and the measures should 
 be well known. It is sad commentary on the work of superintendents 
 of health and their officers that it should be necessary to say this much, 
 but its truth should start them into the fulfilment of the labors of their 
 position, and the reminder be robbed of any unpleasantness by any ben¬ 
 efits that may follow it. When the barriers that an inland quarantine 
 imposes are set up, there is need for careful consideration for all the 
 interests involved. Of course, the first care of the quarantinist is for 
 the lives and health of the community under his charge, and to this all 
 other interests must yield. But this must be so regulated as to offer as 
 little embarrassment to trade and traffic over railroads, water-ways and 
 through the country as is compatible with securing the first and main 
 object of his office. He must adopt such laws as will be just and equi¬ 
 table, and enforce them with the severity of military discipline. The 
 hardships that will follow this unfailing application of regulations will 
 diminish as they come to be understood and appreciated, and gross 
 errors can hardly happen when the officials are governed by good judg¬ 
 ment and strict performance of duty. 
 
 What, then, seem to be some of the most important practical details of 
 a well ordered inland quarantine ? 
 
 Let us suppose, or rather let us say, that the first essential is the choice 
 of the persons to whom should be committed the care of the stations, 
 under the direction of the superintendents of health, and the local 
 health board. The latter are presumably informed of the necessities of 
 the occasion, or are able to procure information for the State Board of 
 Health, and their fitness is not now under discussion. Happy the com¬ 
 munity, if they have been wisely chosen ! But these local authorities 
 must see that the underlings are fitted for the duties assigned them, and 
 exact from them implicit obedience to instructions, which, in turn, must 
 be clear and easily understood. This class includes the person or per¬ 
 sons in charge of the station to be maintained near the town, the sani¬ 
 tary police, or detectives, who are to inspect the different routes entering 
 into a town and report the approach of dangerous persons. They should 
 have power to stop these persons, or see that they go through without 
 communication with any one in the community. These men are to be 
 selected for their firmness and judgment, and much depends upon their 
 efficient performance of duty. 
 
 I wish, before going further into this matter, to offer you a letter on 
 our subject from Mr. Henry Haines, the very intelligent superintend¬ 
 ent of the Plant system of railways in Georgia and Florida, which are 
 
APPENDIX. 
 
 XXIII 
 
 connected with the West Indies by a line of steamships owned and 
 controlled by Mr. Plant: 
 
 “Savannah, Ga., January 24, 1889. 
 
 “You ask my views with reference to quarantine matters. I have 
 been compelled through necessity to give the matter a great deal of 
 attention during the last year, and have somewhat definite ideas with 
 reference to it. These, however, I could hardly jot down in this hasty 
 way to stand aggressive criticism; but, firstly and foremost, I must 
 say that I think it is impracticable to try to fence infectious epidemics out. 
 
 I think they ought to be fenced in, beginning with the room in which the 
 first case appears and extending the cordon to the house, to the quarter 
 of the city, to the limits of the city, etc., as the circumstances may 
 require. The next point I wish to make is that I am fully in favor of 
 establishing camps of detention for all persons desiring to leave infected 
 places. I say this after a careful observation of the operations at Camp 
 Perry this past season. It is a fact that not a single case of yellow fever 
 appeared in Camp Perry on any person who had been out of Jackson¬ 
 ville over five days; and this goes to show that a person five days out 
 from an infected place, and not taking any baggage that may be the 
 means of carrying infection with it, could enter into any community 
 without endangering its health. I think that a person bearing a satis¬ 
 factory certificate of detention of this kind ought to be allowed, not as 
 a privilege, but as the right of a citizen of the United States, to enter 
 into any town or community. I think it a great mistake to shut in the 
 population of a large town immediately upon the announcement of a 
 case of yellow fever in that town. If the case or ca^es are carefully 
 guarded in the first place, anybody should be permitted to enter and 
 leave the town as they may desire, so long as they remain outside of the 
 cordon sanitaire. 
 
 “ From what I have seen of baggage fumigation I believe that it is 
 perfectly practicable to have it done without serious inconvenience to 
 travelers, provided it is done at the camps of detention; but once you 
 undertake to fence out infection by quarantine certificates, fumigation, 
 guards, espionage, etc., a condition of affairs is brought about which 
 reminds one of civilization retrograded to its primitive state of anarchy 
 and barbarism. A policy of this kind breeds suspicion, fear, the lowest 
 kind of selfishness, and does not prevent breeding infection. 
 
 “ Or to sum up all that I have here stated, there is but one way in 
 which these measures that I have referred to can be cairied out success¬ 
 fully, and that is by an organized, experienced and disciplined corps, 
 one for which the formation at least exists in the Marine Hospital Ser¬ 
 vice. What that service did last summer, inexperienced and without 
 precedent to go by, should not be a criterion of what it could do another 
 
XXIV 
 
 APPENDIX. 
 
 season, profiting by the experience of the past. The surgeons in that 
 service are unbiased by local predilections, they are unawed by local 
 tyranny. They have the advantage of obtaining information gathered 
 by headquarters from all over the world, and as ilie purpose which they 
 are to serve is the general welfare of the United States, it seems to me 
 right and proper that the expense should be borne, not by the fever- 
 stricken community, but from the public treasury. There are many 
 details connected with this general policy of fencing in an epidemic, 
 rather than fencing it out, which occur to me, as they would to you in 
 discussing the matter at greater length than I can afford here; so I will 
 conclude with one more remark, and that is that I do not want you to 
 allow yourself to suppose for one moment that the yellow fever was 
 introduced into Florida by the Plant Steamship Line. I have prepared an 
 official statement as general manager of that line, which will be pub¬ 
 lished in a few days, and I ask that if you doubt what I have said that 
 you will hold your opinion in suspense until you have received a copy 
 of that statement. I received an invitation a day or two ago, from Dr. 
 Jerome Cochran, State Health Officer of Alabama, to attend a quaran¬ 
 tine conference at Montgomery, on the 5th of March. I am afraid that 
 I cannot get there, but it would be an inducement for me to do so if I 
 could meet you there. 
 
 “ Very sincerely yours, 
 
 “H. S. HAINES. 
 
 “ Dr. Thomas F. Wood, Wilmington , N. C.” 
 
 This is special pleading. For if we are to be governed by its dictates, 
 it is manifest that we will have only to sit still and have others look 
 after interests that most vitally concern us. However honest in his 
 opinions Mr. Haines is, and his known character and position puts this 
 question at rest, it is apparent that he is warped by the claims of the 
 great interests he represents. 
 
 Think of the plan: He wants it ordered that diseased and panic- 
 stricken towns, under the rule of the officers of the general government, 
 shall be alone responsible for the exit of persons and their baggage from 
 the diseased midst into camps of detention, there to be detained until 
 they are declared safe. This declaration shall be final, and serve as a 
 permit of entrance anywhere, and an unquestioned certificate that may 
 be accepted as a guarantee of safety to places which are liable to the 
 disease with which these people have suffered, to which they and their 
 baggage have been exposed. If the restraint is self-imposed, is it 
 supposable that weak humanity will regard it? Paroles are worth 
 nothing when to flee away under any pretence promises safety and 
 rest. We object to his statements that local inland quarantine, which 
 fences out the epidemic, imposes any more hardships upon individuals 
 than the fencing-in process which he extols. We do not suppose any 
 
APPENDIX. 
 
 XXV 
 
 one doubts the wisdom of his suggestion as to the treatment of the dis¬ 
 ease-infected room, house or town, nor do we think it even criticisable. 
 But we fail to see the cogency of his statements which makes disinter¬ 
 ested persons better superintendents of quarantine than those men whose 
 every thought is devoted to the welfare of the community in which they 
 lives and labors, and whose honesty of purpose is proven by their self- 
 sacrificing work in time of dangers. The truth of Mr. H.’s statements 
 may be good in Florida, but our opinion and knowledge of the profes¬ 
 sion in North Carolina assures us it is without foundation here. Mr. 
 Haines deserves the unstinted admiration of us all for his part enacted 
 in Florida during the pestilence. Undeterred by personal inconvenience, 
 unawed by local tyranny or constant danger, he pitched his tent (and 
 this we say literally) in the very front of the battle that was made in 
 Florida against the extension of yellow fever; and his personal supervi¬ 
 sion of all that was done, not only for the people of the State where the 
 greater part of his immense interests are situated, but for the general 
 welfare of the country threatened with a spread of the epidemic, make 
 all of his observations worthy of earnest consideration. But we take 
 it to be a safe rule of action that if danger is abroad in any form, 
 although confined, temporarily at least, in certain limits, sound policy 
 will shut one’s own doors against this danger that is for the nonce inclosed 
 somewhere else. Self-preservation is the natural action which follows 
 the announcement that our safety is threatened, and because some one 
 else promises to keep it off, it none the less behooves us to look out for 
 ourselves and to be ever active and watchful in our own behalf. 
 
 A means of communication by telegraph or letter must be estab¬ 
 lished between the health authorities of infected points or through relia¬ 
 ble persons in such localities, by which continuous and regular informa¬ 
 tion may be had concerning the progress of the epidemic, the movements 
 of persons and their effects leaving such points, or articles of traffic 
 that are sent out, with definite information concerning all such as be 
 intended to reach and stop at the guarded point. Much reliance can be 
 placed in ihe reports of the officers of the general government on all the 
 points, but they are not always specific enough. The approaching con¬ 
 vention of the health officers, and others interested in sanitary work in 
 the Southern States, and those of the West and Northwest in communi¬ 
 cation constantly with the Southern States, will no doubt adopt wise 
 means to provide for the prompt supply of such information as is 
 desired. This convention is called at the instance of the Secretary of 
 the Board of Health of Alabama, and its session will be of great interest 
 to all the States summoned to the council. It will deal chiefly with the 
 subject of inland quarantine, and the methods of its accomplishment, 
 and I could wish that it were my duty to report the result of theii labois 
 rather than my own views. 
 
XXVI 
 
 APPENDIX. 
 
 It is safe to say that railroad authorities, and the owners of steam¬ 
 boats, will aid every just effort that is made to prevent the spread of 
 disease, from motives of sound policy as well as a desire to foster the 
 health and thereby the business welfare of communities along the main 
 lines or along lines tributary to them. 
 
 It is with great pleasure that testimony is here borne to the aid, will¬ 
 ingly and intelligently extended, which the railroad lines coming into 
 Wilmington gave the quarantine officials of your chief city. They not 
 only readily acquiesced in the inconvenient measures which were necessa¬ 
 rily adopted to provide safety for our community during the epidemic of 
 yellow fever in the past year in Florida, but stood ready to do every¬ 
 thing in their power to further and perfect the w T ork of the officials. 
 This experience may not be isolated, but it is none the less worthy of 
 record and recollection. 
 
 To return to the discussion of some of the details of the work before 
 us. A comity of interests having established an exchange of informa¬ 
 tion in the possession of the officials at different points alike threatened 
 by the invasion of disease, giving warning of the movements of persons 
 and baggage, the quarantine officer in charge must be ready to meet an’ 
 emergency arising out of the arrival of persons and their baggage from 
 an infected locality and seeking refuge in his town. This will require a 
 hospital and a house of observation. These should be erected at a point 
 sufficiently removed from the town to render it impossible for commu¬ 
 nication to be had between persons detained and their friends in the 
 community. Due regard should be had in the selection of a site for its 
 healthfulness and water supply, as the care of the quarantined persons 
 must not be so loose as to engender sickness among them arising out of 
 bad judgment in the choice of the quarantine station. As these build¬ 
 ings and the smaller and necessary out-houses will be for temporary use, 
 they can be cheaply built, and destroyed when the danger is over, if 
 there has been disease introduced into them. 
 
 The house of detention, or the one set apart for individuals not sick, 
 but coming from an infected point, we will call the house for observa¬ 
 tion, and into it should be put all such persons as we here indicate, and 
 there to be detained until such time has elapsed, after exposure to the 
 disease prevailing in the town they have left, for its development and 
 appearance. For this, fourteen days will suffice, counting from the time 
 of their departure from their homes, or exposure to material known or 
 suspected of being infected. But simple detention, without disinfection 
 of these suspects and their baggage, would be folly; for the seeds of 
 disease might be resident in these persons or their baggage, and the 
 individuals escape the disease, and yet through the spread of fomites, as 
 germs of disease are generally known, be the source of an epidemic if 
 allowed to pass into a town and come in contact with its inhabitants. 
 The period when quarantine consisted of detention only has long been 
 
APPENDIX, 
 
 XXVII 
 
 past. It is shelved with the idea which excited the ridicule of the oppo¬ 
 nents of this sanitary barrier, that the old Spanish rule of forty days’ 
 detention, to be followed by dismissal without further precaution, was 
 the only indispensable act of the health officer. Suspected persons 
 arriving at the quarantine station should therefore be disinfected—first, 
 in their own persons, by ample provisions for bathing and plenty of soap, 
 care being taken that such ablutions shall be efficient and thorough, 
 including all the body, and especially the hair of the head and the beard. 
 Such clothing as is worn at the time of arrival must not be again used 
 until it has been disinfected along with the baggage, and all clothing or 
 bedding not capable of prolonged boiling, or of being subjected to the 
 fumes of sulphurous acid, or immersion in a solution of the bi-chloride 
 of mercury of standard strength, not exceeding one part of the subli¬ 
 mate to three thousand parts of water, the particular one of these agents 
 to be selected by the official in charge, should be destroyed by fire. The 
 walls of the house occupied by the suspects should be washed in a solu¬ 
 tion of crystallized carbolic acid, of a five per cent, strength, and the 
 grounds immediately around the house and such places as receive the 
 dejections from such persons be frequently sprinkled freely with the 
 same solution, care being taken to guard the water supply against con¬ 
 tamination by this drug or others in solution used as disinfectants. 
 This disinfection, by washing in boiling water, fumigating with vapors 
 of sulphurous acid, or immersion into solution of the mercuric salt, 
 must be done away from the living house of these people, and will 
 therefore require a small chamber, fitted for the purpose, especially for 
 the confinement of the sulphur fumes, if that agent is the one adopted. 
 Washing or boiling, or both, could be done out of doors; but the articles 
 to be treated must be taken from the house of observation, or the recep¬ 
 tacles, as trunks or boxes, containing them, and placed in boiling water 
 to be carried to the place where the final disinfection shall be practiced. 
 The house set apart as a hospital proper should be at least three hun¬ 
 dred feet away from the place where the well people are, and it is need¬ 
 less to discuss its arrangement, as that will follow the necessities of the 
 occasions for its use. But if persons arrive at the station actually dis¬ 
 eased, or be attacked after arrival, they must be immediately and com¬ 
 pletely separated from the well, and communication between them 01 
 their attendants be absolutely interdicted. This rule should be inviola¬ 
 ble. Should such patients die, their bodies should be immediately wrapped 
 in cloths wrung out of the sublimate solution triple the strength 
 already mentioned, and interment should follow as soon as possible. If 
 recovery should follow the treatment, then they should stand on the 
 same footing as suspected persons, and be disinfected by hot bates, v ith 
 plenty of soap, before mingling with the well. Each community, thi ougli 
 its officials, must settle the question of providing for the sustenance of 
 these persons under detention; but it seems a fair nile, that lefugees 
 
XXVIII 
 
 APPENDIX. 
 
 from an epidemic, seeking entrance into a healthy community, should 
 be compelled to provide for themselves through an authorized commis¬ 
 sary, unless their condition is such as would clearly indicate their claim 
 for charity. So much is needed for the proper establishment of the 
 station. 
 
 Persons from infected points passing through the town under quaran¬ 
 tine should, if in railroad cars, be locked in during the transit through 
 the town, and no outside person should be allowed to have communica¬ 
 tion with them or to handle their clothing, except such persons as are 
 necessary for the railway service. Due notice should be served upon all 
 persons that violation of this rule will subject them to isolation at the 
 quarantine station, and passengers should be informed by the sanitary 
 police, or by circulars distributed among them, that the same punish¬ 
 ment will follow their leaving the coaches and attempting to reach the 
 guarded town by other avenues. 
 
 The travel by water is more difficult of management, but the same 
 supervision and care, altered to the changed circumstances, will serve 
 in this case as well as in that of railway travel. Provision should be 
 made looking to the disinfection of the coaches occupied in transit by 
 these infected persons and their dangerous baggage. This is a matter 
 easy of arrangement with the railroad authorities by intelligent and 
 liberal health boards. 
 
 It will readily appear to those of you acquainted with the character of 
 river travel, that there is constant need of the sharp eye of the sanitary 
 officer. The quarters of the crew and the points about a steamboat 
 where dirt of the worst kind will accumulate, the bilge, form excellent 
 breeding places fora disease, if the germs are once introduced. For the 
 time, at least, of the quarantine, they should be known to be clean and 
 well aired, and the bilge should be very frequently discharged, and 
 means adopted for cleansing and disinfecting all points reached by it. 
 
 Should there a colonization of refugees from an epidemic be allowed 
 in any part of the State, where, on account of climate and altitude above 
 the sea level, no danger is feared of a local outbreak of the disease, the 
 health officers general of the State should protect other localities from 
 visits of these refugees, except under the same restrictions as apply to 
 persons directly from a diseased town. Such oversight should be exer¬ 
 cised that the movements of these people should be known from day to 
 day, and towns having established quarantines notified of their depart¬ 
 ure from the community which has received the colony. It would be 
 well to demand that these persons should possess themselves of a permit 
 from the local health officer, with their destination set out in the 
 permit, and this should be declared under oath. 
 
 The experience of the past summer in allowing the entrance of per¬ 
 sons from Florida into one of our mountain towns was anything but 
 pleasant to the cities on the seaboard in more or less communication 
 
APPENDIX. 
 
 XXIX 
 
 with it. In the city of Wilmington, within seventy-two hours after the 
 anival of the refugee train in Hendersonville, there appeared three per¬ 
 sons, all of them of the refugee colony, hoping to slip into the city and 
 get passage by steamer to New \ork, that being a cheaper route than 
 by rail, but which would have forced them to remain within the cor- 
 poiate limits, if they had reached here undetected, for four or five davs, 
 with their baggage. Fortunately, they were found out and turned back 
 to seek another route to the North. It is very charming to open one’s 
 door to the needy and the frightened person, flying from disease, and, 
 may be, death; but it is false charity to accept such strangers as guests, 
 if they will bring disease to one’s neighbor less advantageously situated 
 than the host whose hospitality seems so Christian-like. 
 
 The disposition of freight arriving from infected points is much more 
 difficult of management than persons or their effects. To interdict the 
 reception of such materials as would be classed as freight would often 
 clog the commercial interests of a town, and a wise discretion is needed 
 for the proper care of such cases. Perishable articles, as vegetables or 
 fruits, should be laid under embargo, as it is generally the case that there 
 is more or less of such matter in a state of decay, and this condition 
 favors the increase of the seeds of disease, if they had found a lodgment 
 in the crates before their shipment. Woolen goods of all sorts, coal, 
 hides, and wooden packages of all freight that contain materials likely 
 to be damp, should have special inspection and attention. The stern 
 necessity of the preservation of the public health at the expense of all 
 other objects, may make it expedient for the quarantine official to destroy 
 with fire material that reaches his town, when such destruction may work 
 a hardship upon some persons. As the life and health of every inhabi¬ 
 tant of a community has a money value, it is not saying too much to 
 claim that it will be a burden that tax-payers ought willingly to assume, 
 which will reimburse the losers for the material destroyed for the gen¬ 
 eral weal. 
 
 Fortunately, there is but little to be feared from such sources of danger 
 in yellow fever epidemics south of us; but if any one of the coast towns 
 of the State should unhappily be stricken with the scourge, then the 
 inland towns would have ample room for the application of these rules. 
 
 If it should be cholera or small-pox that is guarded against, the danger 
 is alike threatening everywhere, and careful inspection is called for in 
 this department of quarantine. There is a safe rule governing the man¬ 
 agement of this particular class of dangerous articles, which I can illus¬ 
 trate by the regulations of the quarantine at the mouth of the Cape Fear 
 river: Every vessel from a suspected port must come to the station for 
 inspection, and disinfection and detention are ordered in each case upon 
 the quarantine physician’s judgment, and not by fixed rules ; that is. 
 while it is safe to stop for examination all articles from suspicious local- 
 
XXX 
 
 APPENDIX. 
 
 ities, it is not sound policy to permanently detain or destroy them because 
 of their having come from such places. 
 
 The general government has amply provided for the care of the mails 
 in times of danger, and though it is not proven that yellow fever has 
 ever been transmitted through the mails, their disinfection serves to 
 allay uneasiness, even if unnecessary. 
 
 The fact that yellow fever has been carried from Savannah, Ga., to 
 Chattanooga, Tenn., from Florida to Decatur, Ala., and to two other 
 towns in Mississippi; that it spread several years ago with alarming 
 rapidity up the Mississippi river, reaching out into towns far removed 
 from the river, and which had previously escaped the scourge—all these 
 and many like well known facts are important to remember, and the 
 outbreak of the fever in our own State, or at points north or south of 
 us, will require the establishment of inland quarantine at all places in 
 North Carolina having a lower altitude than 800 to 1,000 feet above sea 
 level. Previous immunity may be plead to offset this remark. But if 
 wise precautions are not taken in times of danger, neglect, based upon 
 escape in the past, will, at some time, work a disaster that will be more 
 costly in lives and treasure than quarantine can ever spend in money. 
 
 The expenditure of money, the untiring vigilance of health officers, 
 the cleanliness of towns, and over all the watchful eye of the State 
 Board of Health, can prevent disease from finding a foothold; but no 
 one, or all of them, can secure the ousting of the enemy, except with 
 great loss, if once his entrance is admitted. 
 
 The powers of the State Board of Health should be mandatory, and 
 not simply advisory, as they are now. To them local authorities can ap¬ 
 peal for help and advice when needed; information will follow' the ask¬ 
 ing; means and measures for combatting danger will be furnished them 
 under wise and liberal law's; and, in sudden emergencies, reliance can 
 be placed upon the personal supervision of the general officers of the 
 State Sanitary Police, bringing wuth them experience and comfort, 
 where, without them, dismay and panic, and probably disaster, might 
 follow' their unaided efforts. 
 
APPENDIX. 
 
 XXXI 
 
 MARITIME QUARANTINE. 
 
 By W. G. Curtis, M. D., Quarantine Physician of the Port of 
 
 Wilmington, N. C. 
 
 Few people, either in the profession of medicine or out of it, have 
 given much attention to the subject of maritime quarantine. By those 
 living afar from the highways of commerce, where, perhaps, only the 
 balsamic odor of the pines and the sighing and rustling of winds among 
 their foliage attract the senses, it does not seem so practical a matter 
 as to those living near the ocean, where tides are ebbing and flowing, 
 and ships sailing to and fro, bearing strange peoples and cargoes from 
 unknown countries. But the rivulets, beginning in the highlands of 
 the interior, all run towards this mighty ocean, broadening as they go. 
 The great lines of railroads, converging always towards that point 
 where there is a seaport, run up the valleys, and there is a continual 
 circulation from the mountains to the ocean, from the ocean to the 
 mountains, interchanging commodities and ideas, and, sometimes, 
 unhappily, diseases. 
 
 From land to land, in both hemispheres, stretches this vast and bound¬ 
 less ocean. Here and there upon its shores lies a city, built by the inex¬ 
 orable demands of commerce—in one place clean and beautiful to look 
 at, in another festering with poverty and disease. 
 
 But with them all, trade and commercial relations with other cities is 
 the ruling idea, without which no city can have an existence ; and, as 
 if placed by Providence to foster and make easy commercial dealings, 
 here is this mighty ocean ready to bear upon its bosom the ships of the 
 world, with whatever freight may be offered for transportation. 
 
 Hence, we have rags from Calcutta, from Egypt and Italy, intermixed 
 more or less with cholera germs ; coffee from Rio de Janeiro, in infected 
 bags'; sugar, taken from infected warehouses and wnarves in Havana; 
 emigrants from Italy, carrying cholera and small-pox; and vessels carry¬ 
 ing these cargoes go to New York, Philadelphia, Wilmington, Charleston, 
 and all ports of the Atlantic and Gulf coast, and so on o\er the woild, 
 trading and poisoning, civilizing and infecting, until one is fain to wish 
 he did not live in a world which began business in the Garden of Eden, 
 by trading with the Devil, and getting sold. 
 
 All nations and peoples, however, have objected to this mixtuie of 
 disease germs with goods and merchandise, and have in vaiious ways 
 protested against it. For it is so obviously the duty of e\ eiy govei nment 
 to protect the lives, liberties and property of its citizens, that no doubt 
 has ever existed of the propriety of enacting sanitaiy laws, and of 
 making them efficient, so far as there existed scientific knowledge as a 
 basis for such laws; and so great has been the necessity for protection at 
 
XXXII 
 
 APPENDIX. 
 
 times, that governments have passed laws having no basis but supersti¬ 
 tion, or the arbitrary will of the ruler. In the absence of law the pop¬ 
 ulace have often taken matters into their own hands, and there has been 
 rioting and outrages horrible to contemplate. The subject has always 
 been, and is, a difficult one. What was the source of infection ? How 
 did it travel and propagate itself ? If a person was exposed, how long 
 was the period of incubation, and when might he consider himself, and 
 be considered safe ? How could the infecting germ or element, whatever 
 it might be, be destroyed ? There must be various kinds of infection, 
 for what would produce cholera would not produce yellow fever or small¬ 
 pox. Now what would be the most powerful disinfectant for each 
 variety, or would the same one answer for all kinds of infection ? Our 
 forefathers found it quite impossible to answer these questions, but they 
 did not stop fighting, and did the best they could. And sometimes, in 
 their blind groping, they discovered something of wonderful value, 
 which has lasted until our day, and which, it is to be hoped, will last 
 during all coming time. Edward Jenner discovered vaccination as a 
 protection against small pox, for which no honor that could be bestowed 
 upon his name would be too great. 
 
 Now, in our day, we are still groping, and we think that perhaps we 
 have got results of importance. We have got it down fine on germs. 
 We have spirilli, and baccilli, and bacteria, each producing its own form 
 of disease. We have captured the rascals and are trying to find out their 
 sensations when put into the various kinds of torture chambers we have 
 invented for their entertainment. We are boiling them with moist heat 
 and baking them with dry heat; we are feeding them on bi-chloride of 
 mercury, and generally doing our best to make them look sick, with, as 
 I said before, results of importance. 
 
 The discovery of micro-organism concerned in the production of infec¬ 
 tious disease, of course led naturally to experiments for their destruc¬ 
 tion, and to the application of the discoveries made to the holds of ves¬ 
 sels, and to articles of cargo and clothing containing germs. At the 
 quarantine station for the port of New Orleans the methods for the 
 destruction of disease germs and consequent complete disinfection of 
 vessels has been practiced with great carefulness for several years, with 
 the result of apparently giving complete protection to, not only New 
 Orleans,-but the whole Mississippi valley. At any rate, no case of yel¬ 
 low fever has appeared upon any vessel treated by the methods in use at 
 that port. 
 
 Formerly, and not so very long ago either, the form of protest was so 
 crude and inefficient that to us it seems that the remedy was worse than 
 the disease. 
 
 Quarantine means detention for forty days. This appears to have been 
 in many places an iron-clad rule, and it does not require a very vivid 
 imagination to realize the horrors it entailed upon defenceless human 
 
APPENDIX. 
 
 XXXIII 
 
 beings, shut up in the narrow limits of an infected ship. In later 
 days the period of detention has been varied, and the limit of variation 
 has been so great in different places as to lead one to the opinion that no 
 definite rule could be established, but that the period of detention was 
 purely experimental and empirical. 
 
 The fact is, that detention alone, when applied to an infected ship, is 
 making a bad matter a great deal worse. All that is done should be 
 done with the utmost practicable celerity. To illustrate this idea, let us 
 consider the rapidity with which germs increase in number. A solution, 
 absolutely freed from all germs, and showing no life under the micro¬ 
 scope, will, soon after being exposed to the air, teem with life. The hay 
 baccillus has been observed to double itself every twenty minutes, which, 
 in twenty-four hours, would make numbers so great as to be far beyond 
 human conception. 
 
 Sewage contains 75,000,000 germs to. the quart when fresh, but when 
 stagnant and putrefying would contain one hundred times that number. 
 The bacteria of yellow fever is probably as prolific as any of the species, 
 and from one centre will develop enough offspring to infect a city. So 
 that the sooner we can get at the source of danger and destroy it, so 
 much the better. 
 
 Thus the sick and the well should be at once separated—the sick for 
 treatment, the well for observation—and both should be taken from the 
 ship and placed in quarters provided by the State. Then, and only then, 
 can the ship be thoroughly disinfected, and disease germs destroyed, so 
 that her voyage can be safely completed—not only safely for herseff, 
 but safely for the public. 
 
 There must be some risk, for we have not arrived at perfection in any¬ 
 thing,but the risk must be reduced to a minimum, especially for the public. 
 We therefore set aside the principle of detention for any particular number 
 of days, as too purely empirical for a profession which is striving to get 
 a little nearer exactness than was thought to be possible in former times. 
 A vessel coming at quarantine, therefore, should be treated purely upon 
 its merits, and without regard to any other vessel. She should be care¬ 
 fully inspected, and all persons on board examined, and the truth of all 
 papers verified, so far as they certify to the sanitaiy condition of the 
 ship. If her record is satisfactory in all respects, the vessel should be 
 allowed to proceed on her voyage without further detention. But on 
 the contrary, a record involving probable infection being discovered, 01 
 a certainty of it, from the presence of actual disease of an infectious 
 nature on board, our responsibility becomes grave indeed, and we ha\e 
 to proceed with the utmost caution. Many interests aie to be consideied, 
 
 and all of them important interests. 
 
 First, the safety of the public, wdiich is, of course, greater than all 
 others; second, the safety of those on board, who must be divided into 
 two classes, the sick and the well; third, the rights and interests of the 
 owners; and lastly, the commercial interests of the port or city. Th e 
 
XXXIV 
 
 APPENDIX. 
 
 vessel must be treated so that no germs of disease escape to adjacent 
 lands, or to residents thereon; and the best manner of doing this, is to 
 proceed without delay to our task, which is by no means easy. We take 
 all the sick out of the ship, and place them in a hospital for treatment. 
 This hospital should be as far from other dwellings as is practicable, 
 and should be provided with competent nurses. Then the well who 
 have been exposed to infection should be taken to another place apart 
 from the sick, where their clothing can be disinfected and themselves 
 be under observation, until a certain period from the date of the last 
 case, which period has been ascertained to be beyond the limit of danger. 
 These things being done, we proceed to discharge all ballast or cargo of 
 every kind, so that every part of the ship can be got at and exposed to 
 such processes of disinfection as we are able to command. After this is 
 finished, which will occupy several days, it is probable that the period 
 of incubation will have passed, and that we can send the well on board 
 again, and permit the ship to proceed on her voyage without danger to 
 anybody. By this method, we have done nothing which any reasona¬ 
 ble human being could complain of, and we have protected our people. 
 
 And this is the quarantine of modern times, perfected by experience, 
 rid of superstition, and without any of the horrors of ancient times. 
 This is what every city that depends on commerce for its growth and 
 prosperity must have, if it expects to keep in the foremost rank or to 
 sustain itself in the fierce competition for wealth and honors. 
 
 And why should not every city have such a quarantine establishment? 
 All citizens who do business in cities, all persons who visit cities either 
 for pleasure or for purposes of trade—the wealthy who own stock in 
 banks, railroads or manufactories, and the poor who go thither for em¬ 
 ployment. should insist upon it that the ways and means for maintain¬ 
 ing the public health should be kept up to the highest standard. Public 
 opinion on these points ought to be so strong that our legislators can 
 have no doubt as to what they ought to do. The cost is nothing. The 
 expense cannot be urged as a reason for neglecting such important inter¬ 
 ests. A few cents from each person is all that is necessary, and this 
 taken in such a way that nobody will ever know they have paid it. 
 
 How utterly insignificant appears the small expenditure required, 
 when compared with the immense benefits to be gained! Is there any 
 one bold enough to dispute the proposition, that no worthier object can 
 occupy the human mind than that of preventing the occurrence and 
 spread of such diseases as cholera, yellow fever, small pox and plague ? 
 And that it is possible to root out these diseases from the face of the earth 
 is, I think, sufficiently demonstrated. I say it is possible, but I fear 
 this happy consummation will not be reached in our day. 
 
 North Carolina is happily situated, if the experiment is to be tried, 
 with the object of publishing to the world that, within her broad limits, 
 
APPENDIX. 
 
 XXXV 
 
 no case of either of those infectious diseases can find a foothold. The 
 point of greatest danger to the people of North Carolina is the Cape 
 Fear river. Through this avenue a vast commerce is transacted, bring¬ 
 ing the ships of all nations to our very doors. We are near the West 
 Indies, and many of her ports are constantly dangerous. We must have 
 coffee and sugar, molasses and rum : we want oranges, bananas, cocoa- 
 nuts, and spices of all kinds, and we want to sell the productions of our 
 own State in exchange for them. Hence, we have to inspect every ship, 
 and subject each one to the rules and regulations of a rigid quarantine. 
 If we neglect this, pestilence will as surely come in as the sun shines. We 
 all know what that means ; we have seen it before our eyes during the 
 whole of the last summer, desolating homes, destroying, by its fell 
 touch, the noblest and the bravest of our people, ruining private busi¬ 
 ness, and causing fortunes to melt away like dew before the morning 
 sun, driving defenceless people—women, children, and the poor—out of 
 their homes, to wander among strangers, to be shunned and pointed at 
 as unclean, to be arrested, and perhaps imprisoned, by shot-gun officials. 
 We know all these things, and what they cost. It is not necessary to 
 go over all the sickening details; but in a paper whose object it is to 
 induce the good citizens of North Carolina to make preparations to avert 
 impending evil, it is best thus briefly to advert to them. 
 
 North Carolina has upon her statute books a good and efficient quar¬ 
 antine law. It has been tested and found to have ample powers, and its 
 working is smooth and satisfactory, and but little change is asked for. 
 The weak point is, that we have no hospital or building for those placed 
 under observation, and we have no wharves where ships can discharge 
 ballast and cargo previous to disinfection. The law provides for these, 
 and a bill has been introduced into the present Legislature asking for an 
 appropriation. We hope and believe that a wise legislative body will 
 not hesitate in voting the appropriation asked for. If they do, the 
 Quarantine Board will be well equipped, and will be able to do all that 
 is possible, in any way, at least equal to that of any other State. 
 
 In a purely commercial poini of view, 1 tnink the question one of the 
 utmost importance, and worthy of serious attention by the Legislature. 
 
 A remarkable change has taken place at the eo trance to the Cape Fear 
 river. The depth of water on the bar lias been so increased that vessels 
 drawing nearly twenty feet of water can ent* r the harbor at Southport, 
 and the U. S. Government is endeavoring to increase the depth in the 
 channel of the river as far up as Wilmington. The attention of capital¬ 
 ists has been drawn to the yreat value of this harbor, and several lines 
 of railroads are projected or in process of construction, the shorter 
 distance from the citie> of the West to ports on the Cape Fear, n eaning 
 cheaper transportation and increased value for the productions of the 
 interior. 
 
XXXVI 
 
 APPENDIX. 
 
 In this view, therefore, the citizens of the State and their representa¬ 
 tives here should wish to make of Wilmington a city with a clean record 
 for healthfulness—a city fortified in all her approaches by the most im¬ 
 proved sanitary devices—a city beyond reproach, where, at any season 
 of the year, they may safely go with their wives and children on business 
 or pleasure. Laws passed with those ends in view will be approved by 
 the people everywhere. 
 
 The time will surely com 1 when cleanliness will really be next to god¬ 
 liness—when the authorities of cities and towns will be held to a strict 
 account for neglect of sanitary matters. 
 
 So far as North Carolina is concerned, the matter may be summarized 
 in a few words: Impose an impassable bnrr er to the entrance of cholera 
 and yellow fever by a perfect quarantine establishment, vaccinate your 
 children and teach them its value, so that in turn they will not neglect 
 their own; keep your cities clean and well drained; let the sun shine 
 into your houses every day, if possible, and peace will dwell within your 
 walls and plenteousness within your palaces. 
 
APPENDIX. 
 
 XXXVII 
 
 THE NECESSITY OF STATE INTERVENTION TO PREVENT AI 'UL- 
 
 TERATION OF FOOD AND DRUGS. 
 
 By Prof. F. P. Venable, Ph. D., F. C. S., Chapel Hill. 
 
 The pui it\ of our foods and drugs should be a matter of paramount 
 importance to us. It is a matter affecting both health and pocket. The 
 sanitary officers who look after the air we breathe and the water we 
 drink ought certainly to inspect our solid food as well. Danger does 
 not lurk in sewer-gas or in the miasm of the marsh only, nor in contami¬ 
 nated wells and foul reservoirs alone. We might avoid all of these 
 sources of disease and yet fall victims to poisons in our foods or impure 
 medicines. 
 
 And yet it is very difficult to effectually arouse interest in this subject. 
 An occasional newspaper article filled with sensational exaggerations 
 gains the public attention for a bri- f while, and then barter and sale go 
 on as before, and the same luck that attends the tottering footsteps of 
 the baby and the staggering drunkard is looked to to befriend us and 
 help us escape the greed and criminality of our fellows. 
 
 What this indifference springs from I cannot tell. Perhaps for most 
 of our citizens the coffee or tea is so poorly prepared that the genuine 
 article would be unrecognizable; or the fat and s da and bad cooking 
 are productive of such indigestion as to completely mask the effects of 
 any mildly poisonous adulterant. The majority of people who think 
 upon the subject at all may regard adulteration as beyond their power 
 to check or remedy, and throw themselves upon the mercy of the more 
 honest dealers. 
 
 But whether we choose to stop and think it over or not, the purity of 
 our food and its wholesomeness is an exceedingly important subject; 
 whether we prepare it right or not, is another matter also very impor¬ 
 tant, and the remedy for which is within the power of each individual. 
 The remedy for the first must be sought for collectively. 
 
 Sensationalists in books and newspapers have unquestionably been 
 guilty of exaggeration as to the frequency and the dreadful nature of 
 adulteration. The matter is bad enough without exaggeration. Let us 
 inquire into the extent to which adulteration of articles of food is prac¬ 
 ticed, using only entirely reliable data. 
 
 The National Board of Health some years ago appointed a committee 
 to draw up a report as to the extent to which the adulteration of food 
 was practiced in the United States, but no report has ever been pub¬ 
 lished. Of course the work of such a committee must of necessity have 
 been very incomplete, yet it would have been of great value, and it is 
 to be hoped that some department of the Government will carry out. 
 
 4 
 
XXXVIII 
 
 APPENDIX. 
 
 such an investigation. In the place of general and full statistics I give 
 some compiled from various boards of health and other authorities by 
 Battershall, which will enable us to form a judgment as to the extent of 
 adulteration. Over 45 per cent, of the ground coffees examined were 
 found to be adulterated: 50 per cent, of the baking powders used in the 
 United States contain injurious substances; 50 percent, of the honey 
 examined by the Massachusetts Board of Health in 1885 was adulter¬ 
 ated; so, too, was 58 per cent, of the cheaper confectionery; over 70 per 
 cent, of the samples of vinegar examined in 1884 fell below the stand¬ 
 ard; 71 per cent, of the olive oil was spurious; 60 per cent, of the mus¬ 
 tard, 61 per cent, of the pepper, ami 45.66 per cent, of the different 
 spices were adulterated. A w T ell enforced law of the United States 
 Government protects us from fraud in imported teas. All of this should 
 show us conclusively that impure, unwholesome food is sold very com¬ 
 monly, and some protective measures must be adopted against such 
 adulterations. 
 
 Feverish competition in trade unquestionably leads to much of the 
 adulteration. Efforts at underselling reduce the prices below all margin 
 of profit, and the dealer can only avoid loss by selling an inferior, adul¬ 
 terated article. A merchant sees goods around him sold at prices which 
 he knows are under the market value of the genuine article. Foolish 
 seekers after so-called “ bargains " are attracted by such bribes, and the 
 merchant’s trade will probably be drawn away unless he, too, yield to 
 the pressure and keep the cheap, fraudulent stuff on sale himself. Who 
 is to call the halt in such a competition? Which of the competitors 
 will turn back to honest ways ? Nothing but the stern hand of the law 
 can ever put a stop to such fraudulent practices. The rich can buy of 
 high-priced grocers, and even they are often deceived in the safeguards 
 they imagine thrown around their purchaser. The great mass of the 
 people, who are compelled to carefully look to the expenditure of every 
 dime, lack knowledge and power to protect themselves from deception 
 and injury. Should not the State give us protection, then? 
 
 How great the adulteration of food in North Carolina is, we have no 
 direct means of judging Wealth is lacking as a safeguard, however, 
 and dishonest manufacturers must find the State a promising field for 
 the sale of their wares. Driven from the markets of the large cities by 
 jealous inspection and rigidly enforced laws, they find defenceless prey 
 in the citizens of North Carolina. Fortunately, as an agricultural peo¬ 
 ple, much of the food is home-raised, but coffee, sugars, spices, cheese, 
 canned goods, lard, and many other groceries and all of our medicines 
 are beyond our control. In the towns, of course, the number of articles 
 of food gotten from outside the State is largely increased. 
 
 How to correct this state of affairs and put an effectual check to the 
 adulteration of foods and drugs should be one of the foremost questions 
 with the people, and will become the cry when they wake up to the 
 
appendix. 
 
 XXXIX 
 
 dangers threatening them. The State, by proper laws, has «establishe d 
 a fertilizer control station, which has enabled the farmer to secure pure 
 food for his plants. The laws have worked successfully and have proved 
 beneficial. Cannot the same power interpose in behalf of the food of 
 the people—a far more important matter? Wise laws, faithfully and 
 prudently administered, would prove a blessing to the retail merchant 
 as well as to the consumer. An honest dealer would be glad to have an 
 inspection which would enable him to tell whether his goods were pure 
 or not. Only a short time ago one of our merchants came to me much 
 troubled about his goods. He suspected adulteration in them and 
 wished them analyzed. The expense of single private analyses prevented 
 this, and he was forced to transfer his custom from one Northern whole¬ 
 sale firm to another in the hope of finding an honest one. The brunt of 
 the law should fall upon the wholesale merchants and manufacturers. 
 
 The law must be clear and direct, and, experience has shown. \ery 
 carefully worded. It must include all of the machinery necessary for 
 its enforcement, providing for inspection, analysis and the suitable pun¬ 
 ishment of offenders. Some of the States have passed laws which have 
 become dead letters from Jack of this very machinery. Several of the 
 States have very full enactments against the adulteration of food which 
 seems to have worked well. Nearly all of the States have at least partial 
 laws on the subject. I hope, in the not far distant future, this State 
 will be mused to the necessity for some such law, at least authorizing 
 inspection and prohibition of the sale of injurious articles. 
 
 The question may be raised whether such laws effect any diminution 
 in fraud. The records of the Paris municipal laboratory, of which 
 further mention will be made, show that they do. This laboratory 
 reported in 1881 that the following proportions of the samples analyzed 
 were found “bad”: Milk and cream, 50.66 per cent.; wane, 59.17; foods 
 and drugs generally, 50.48. The November report for 1888, after seven 
 years enforcement of che law, shows, of milk, 9 per cent.; wine, etc., 55; 
 foods and drugs, 21 per cent. “ bad.” A very wonderful decrease. 
 
 The work of this laboratory extends now to a supervision of the manu¬ 
 facturing establishments, thus striking at the very root of the evil. An 
 incident related of a London chocolate and cocoa dealer shows the neces¬ 
 sity for watching the manufacturers. This dealer was desirous of secur¬ 
 ing pure flake cocoa and of supplying his customers with the same. As 
 he was unable to purchase the pure article at the factories, he secured 
 pure materials, berries, etc., and took them to a factory to be prepared 
 for him. The preparation which the manufacturer returned him from 
 his own pure materials was subjected to analysis and found adulterated. 
 The dealer was forced to build and run a factory himself to secure the 
 pure article. 
 
 Against wine adulteration the laws do not seem so effective. From 
 the time of the Romans it has been a fact that even dealers owning vine- 
 
XL 
 
 APPENDIX. 
 
 yards cannot secure pure wines of the more famous brands. Such a 
 thing as pure sherry, for instance, is not to be procured. German experts 
 are actually discussing the point as to whether a different law or a 
 modification of the existing one should not be passed for this special 
 wino. The wine is tampered with in spite of all warnings, and Germany 
 must either give up her law or her sherry. But such cases do not con¬ 
 cern the people. It is the simple, plain, every-day food that we want 
 pure, and only by governmental intervention can its purity be secured. 
 
 The struggle against adulteration has been going on ever since man’s 
 greed overcame his honesty. Governments have striven to protect their 
 subjects, but with indifferent success, down to this age, in which the 
 introduction of scientific methods of inspection and testing has put it 
 into their power to tell the good from the bad. Greece had her wine- 
 inspectors, England her “ ale-tasters ” and “ assizes of bread.” The 
 crudity of general tests applied is well illustrated by the account 
 given of the way in which the “ale-tasters” examined the liquors for 
 an excess of sugar. Clothed in leather breeches, they sat upon a wooden 
 bench on which some of the liquid had been spilled. The relative diffi¬ 
 culty experienced in rising gave them an indication of ihe amount of 
 sugar. 
 
 The old-time laws did not fail for lack of punitory clauses—fines, im¬ 
 prisonment, sitting in the pillory with the loaves of false bread tied 
 about the neck, or parading the streets with similar decorations, riding 
 for a day enthroned in the city garbage-cart—everything, down to 
 enforced consumption of the adulterated articles. This latter was some¬ 
 times equivalent to the death-penalty. At Biebrich-on-the-Rhine a 
 dealer was forced to drink his own wine. He died from the effects. 
 Very often the penalties were excessively severe, as burning and bury¬ 
 ing alive, in Germany. Yet the ease with which they escaped detection 
 and the profits of the business were too great a temptation. Adultera¬ 
 tion flourished, and the governments were unable to suppress it. Modern 
 legislation in England was largely brought about by the careful scien¬ 
 tific work of the distinguished chemist Aceum. But the first Parlia¬ 
 mentary commission and general legislation were due to the influence 
 of the Lancet and its Sanitary Commission, under the leadership of Dr. 
 Hassall. This Commission was appointed in 1855, and effective legisla¬ 
 tion in England on this subject dates from that year. 
 
 Mere legislation, without proper machinery for enforcement of the 
 laws, will not check adulteration. The case of France may be cited as 
 one of inefficient legislation at first, afterwards made effectual by a 
 system of inspection, fints and publication of the offences. The account 
 is taken from Count Wihair’s report. Under the laws of France the 
 average yearly convictions from 1846-1850 was 196; 1851-1855, 6,780; 
 1856-1860, 8,442; 1861-1865, 4,605; 1866-1870, 3,014; 1871-1875, 3,209; 
 1876-1880, 3,398. 
 
APPENDIX. 
 
 XLI 
 
 In spite of these con^ iclions, adulteration of foods and drugs was very 
 common. The difficulty of detection, the indifference of the public, 
 the small amount involved in each transaction, the trouble, annovance 
 and expense of prosecution and the doubtful recompense following it, 
 even in cases of success, were causes operating upon human nature 
 applying in France as well as elsewhere. 
 
 In January, 1881, was established the most effective engine against 
 adulteration yet devised—the municipal laboratory already mentioned. 
 Scientific experts analyzed samples brought them by inspectors or the 
 general public, and the results are still regularly published. Manufac¬ 
 turing establishments are visited and everything fraudulent confiscated. 
 Those guilty of breaches of law are prosecuted and in every respect the 
 law firmly administersd: 24,655 visits of inspection were made in 1881; 
 a great many more are made now annually; 6,517 specimens were ana¬ 
 lyzed in 1881; between 2,000 and 3,000 per month are analyzed now. 
 The cost to the public is made exceedingly low. The result has been 
 that the number of samples found adulterated has been reduced over 50 
 percent. The certainty of inspection, examination and the publicity 
 are having due effect. 
 
 It seems to me North Carolina might adopt, at a low cost, a system of 
 inspection making public the results. Much would be gained by it. 
 This State has now the proud privilege of being one of the only three in 
 the Union without legislation against adulteration. The others are 
 Arkansas and Mississippi. There is a law, however, allowing those 
 desiring to have analyses of suspected articles to he made through tne 
 Board of Health. 
 
 It seems to me clearly the duty of North Carolina to protect her citi¬ 
 zens in this matter so important to their welfare. The citizen should 
 demand it as his right, for individually he is helpless against the pur¬ 
 veyors of his foods and medicines. It will cost the State something, of 
 course, but can we afford to be “ penny wise and pound foolish”? To 
 quote a distinguished Frenchman, “It is an axiom universally admitted 
 at the present day that no expenditures of the government prove so 
 profitable as those which are made in bettering the public hygiene.” 
 
XLII 
 
 APPENDIX. 
 
 HOW CAN WE BEST SECURE ECONOMICAL DISPOSAL OF 
 
 REFUSE IN OUR TOWNS ? 
 
 By J. L. Ludlow, C. E., M. S., Civil and Sanitary Engineer, 
 
 Winston, N. C. 
 
 In the great book of nature we are taught that extreme dangers 
 attend the accumulation of filth within communities of human habita¬ 
 tions. We are taught that the products of the vegetable kingdom, 
 having once served the uses of man as food, and having passed from the 
 body as the waste product of the animal kingdom, has become a delete¬ 
 rious substance, unfit for the uses or surroundings of mankind, at least 
 until it has been given an opportunity of passing through nature’s trans¬ 
 forming cycle, to reappear as vegetable matter fit again for the support 
 of the animal kingdom. 
 
 This simple lesson has been sadly demonstrated in many cases of pre¬ 
 ventable sickness, deaths and serious epidemics, until at last it is to be 
 hoped that the necessity of filth removal and disposal has become fully 
 realized by every intelligent thinking human being. It affords me 
 extreme pleasure to reasonably assume that this is emphatically the case 
 with such an audience upon such an occasion as this, so that I may con¬ 
 fine myself to the essential object of my theme, the economic disposal, 
 after removal has been accomplished. I shall endeavor to present the 
 subject from a thoroughly sanitary standpoint, believing as I do firmly 
 that no method that is insanitary is economical. 
 
 The filth to be removed and disposed of may be comprehensively 
 classified as Sewage and Garbage. By Sewage is understood the ani¬ 
 mal excretions and the fluid and semi-fluid refuse of the abodes of 
 mankind and of factories. By Garbage is embraced the solid animal 
 and vegetable refuse of dwellings, stores and other abodes, such filth 
 as is common in the street-sweepings, ash barrels and market refuse. 
 
 The substance of sewage and garbage being radically different in their 
 composition, are subject to very different methods of disposal, though 
 some methods are measurably applicable to both, and in some cases the 
 two may be operated upon in combination. 
 
 In a recently prepared paper for the Biennial Report of the North 
 Carolina Board of Health I have endeavored to demonstrate that the 
 most sanitary and most economic method of sewage removal is by a 
 water carriage system of sewers of the “separate system.” Garbage 
 must be removed by manual and horse labor. In some cases they should 
 be removed to the same point, in others to different points, as will appear 
 in what follows. I will thus dismiss the subject of removal and pass 
 first to the 
 
APPENDIX. 
 
 XLIII 
 
 DISPOSAL OF SEWAGE. 
 
 When the sewage has been conducted by the sewers to a suitable outfall, 
 beyond the point where it might exercise a dangerously contaminating 
 influence upon the atmosphere and health of the community, it may be 
 turned into a natural water-course of sufficient magnitude with practical 
 safety, except in closely populated districts where towns are at close 
 intervals along the stream, or where the public water supply of one 
 town may be taken from the same stream that contains the sewage of 
 the towns above it 
 
 Though there be several matters to be taken into consideration before 
 turning the sewage of large towns and cities into the natural water¬ 
 courses, where such disposal of the sewage is practicable it affords a 
 simple and apparently economic solution of the problem. Its economy 
 is questioned on the ground of the thereby wasted manurial properties 
 contained in the sewage. In a country needing and using a great quan¬ 
 tity of artificial fertilizers this objection becomes an extremely valid 
 one and renders the various utilization schemes a suitable subject for 
 our consideration. 
 
 It can hardly be questioned that at least a partial purification and utili¬ 
 zation of sewage is desirable from an economic sanitary standpoint. 
 We have the record of many cases where sewage utilization has been 
 practiced with profit as well as to great sanitary advantage. 
 
 From time to time various plans have been brought out, and experi¬ 
 mented with, for disposing of sewage in a satisfactory manner. Some of 
 these have demonstrated their own inadequacy, while others have proved 
 themselves of great efficiency. The various methods may be compre¬ 
 hensively classified as follows, viz.: Burning, Freezing, Electricity, 
 Distillation, Filtration, Precipitation, and Irrigation on Land. In what 
 follows I shall attempt to briefly describe and to point out the defects, 
 merits and adaptability of these various expedients. 
 
 Burning .—Assuming a sewage flow of 60 gallons per capita per day 
 the composition of sewage from a “ separate system would be practi¬ 
 cally 158 parts of solids in 100,000 parts of sewage. Thus it will be readily 
 seen that the great proportion of water prevents the practical applica¬ 
 tion of this system. 
 
 Freezing .—The presumed utility of this plan was based upon the sup¬ 
 posed purification effected by the process ot freezing water. It was 
 proposed to thus free the sewage from the greater portion of the 
 water contained in it, and to obtain a harmless and useful product, as 
 ice. It is now, however, so well determined that water in fieezing 
 entangles suspended and dissolved impurities, and, moreover, that many 
 forms of microbia are not in the least affected by freezing, that this pro¬ 
 cess must be put under the ban as insanitary and impractical. 
 
XLIV 
 
 APPENDIX. 
 
 Electricity .—Under this plan it is proposed to effect a separation of 
 the organic and inorganic substances of sewage by “galvanic, magnetic 
 or electrical action.” This is to be effected by passing magnetic or elec¬ 
 tric currents through the mass and thereby ozonizing the sewage. 
 From the few experiments of which we have record it is shown that this 
 plan has but feeble capacity for fulfilling the claims made for it. At 
 any rate, the separation of the parts of sewage can be accomplished by 
 other and more economic means. 
 
 Distillation .—In this process it is first proposed to precipitate the 
 sewage by chemical agencies, and to treat the sediment by acids and heat 
 in closed retorts to extract the oils and fatty substances. While partial 
 success attends a similar treatment of garbage—“ Vienna Garbage Pro¬ 
 cess”—it is hardly probable that enough of these products are contained 
 in sewage sludge to render a return comparable with the cost. Further, 
 the harmful elements, most of which are contained in the effluent from 
 precipitation, cannot be practically treated by such a process. Hence, 
 this process must be classed as insanitary in itself, though it may have 
 some merit when operated in combination with some other method. 
 
 Filtration .—In this system the sewage, as it is delivered at the out¬ 
 fall is passed upon and through prepared beds of sand, gravel, ashes, 
 shavings, straw, burnt clay, animal charcoal, wood charcoal, or other 
 porous material. 
 
 The action is to arrest the solid matters suspended in the sewage and 
 retain them upon or in the filter-bed. In passing through the filter the 
 atmospheric air contained in the filter and drawn in with the sewage 
 in a measure oxidizes the organic matter contained therein, rendering 
 the liquid effluent measurably purified. 
 
 There have been practiced two different methods of filtration—down¬ 
 ward and upward. The downward filtratioi being the most natural, is 
 the most efficient and of the most common use. By this method the 
 sewage is applied at the top of the filter, passes downward, the effluent 
 entering provided drains or receptacles at the bottom. 
 
 The efficiency of a filtration plant will be almost wholly dependent 
 upon the skill and care with which the filter is prepared, and upon the 
 size of the filter proportionate to the quantity of sewage to be filtered. 
 
 The filtering material not destroying, but retaining the suspended 
 impurities of the sewage, will become extremely foul. It must then be 
 either cleansed or renewed. Cleansing the filter of these impurities, 
 which naturally have become to a very advanced state of putrefaction, 
 is a serious difficulty. If it is washed by water, what is to be done with 
 the resultant, it being almost as foul as the original sewage. If it be 
 dried, a nuisance is the probable result, as well as serious damage to the 
 filtering material. If it be burned, a total loss of the manurial proper¬ 
 ties, as well as of the filtering material, is the result. 
 
 » 
 
APPENDIX. 
 
 XLV 
 
 It will be well to notice here what is the manurial loss when sewage 
 is burned, or turned in its crude state into a water-course. The chief 
 fertilizing ingredients of sewage are ammonia, phosphoric acid and 
 potash. The amount of these voided annually by the average individual 
 of a mixed population of all ages and both sexes, according to the best 
 analysis, is 12.96 pounds of ammonia, 5.23 pounds of phosphoric acid, 
 and 2.9 pounds of potash. Their combined value, based upon their 
 values as constituents of concentrated artificial manure, such as guano 
 and the various brands of commercial fertilizers, is $2.25. Then we have 
 $22,500 as the manurial value of the annual sewage of a town of 10,000 
 population. It should be noted, too, that this valuation does not take 
 into account the fatty substances and vegetable matter from kitchen 
 slops, nor the organic matters from stables and slaughter-houses which 
 may be turned into the sewers. Neither does it include various other 
 putrescible matters always present in town sewage. When it is consid¬ 
 ered that all these fertilizing ingredients have been taken directly from 
 the soil, their wholesale destruction and non-utilization must appear a 
 serious error. 
 
 As a result of a great number of analyses by Messrs. Lawes and Gilbert, 
 and other authoritative analysts, it is shown that of the 12.96 pounds of 
 ammonia voided annually 11.82 are contained in the urine and but 1.64 
 in the faeces. Of the 5.23 pounds of phosphoric acid, 3.85 are contained 
 in the urine and but 1.38 parts in the fmces. Further, it was determined 
 by the Rivers Pollution Commissioners that in 100,000 parts of London 
 sewage there were but 44.69 parts of suspended matters, while the total 
 solids in solution was 72.2 parts; and it was deduced that of the money 
 value of the fertilizer ingredients of the sewage 15 parts were in solution 
 to 2 parts in suspension. Now, it must be observed that the manurial 
 elements of sewage almost accurately correspond to the harmful sub¬ 
 stances. Then it will be clear that any method of treating sew age which 
 does not contemplate the arrest of the impurities in solution must fall 
 far short of being a satisfactory disposal, either from an economic or 
 sanitary standpoint. Hence, Filtration, though arresting and peihaps 
 deodorizing all the suspended impurities, but passing almost unchanged 
 the soluble ingredients, must of itself be condemned as an incomplete 
 and altogether unsatisfactory system of sewage disposal. 
 
 Precipitation .—In this system various chemicals, mineials, albumi¬ 
 noids and other substances are utilized to effect a dissolution of the 
 natural combinations in sewage. The various processes under this head 
 cover such a wide field, both in their number and range of principles, 
 that to satisfactorily epitomize them is a difficult task in the proper 
 magnitude of a paper for this occasion. I can, at best, only direct 
 attention to the broad and admirable utility of this system uf sewage 
 
 disposal. 
 
XL VI 
 
 APPENDIX. 
 
 Under this system we have a means of abstracting all the suspended 
 and nearly all of the dangerous dissolved impurities. We have the sew¬ 
 age in a suitable condition for complete purification and utilization by 
 the action of the soil and of growing plants. 
 
 Briefly described, it consists of effecting a thorough admixture of the 
 sewage with precipitating agents and collecting the mixed product in a 
 series of tanks at the outfall. While at rest in the tanks, the precipitants> 
 in the action of precipitation proper, and of seclusion or absorption, 
 cause a subsidence to the bottom of suspended and dissolved impurities.. 
 It should be observed here that a precipitating agent which forms an 
 insoluble precipitate with ammonia, phosphoric acid or potash would be- 
 objectionable in case utilization on land is a desideratum. 
 
 The sewage, after having passed through three or four successive pre¬ 
 cipitations, is reduced to a comparatively pure effluent, when it may be 
 turned into any small water-course or further purified upon land. 
 
 The residue in the tanks containing the putrescent and other deleteri¬ 
 ous but manurial properties is in a semi-fluid state, containing perhaps 
 90 per cent, of water. This may be further dried by various plans, and 
 rendered into a suitable form for utilization as fertilizers. 
 
 The manurial value of the sludge will be directly dependent upon the 
 completeness of the precipitating process. Likewise the precipitating 
 agents should be determined according to the extent of purification and 
 manurial retention relatively desired in the sludge and effluent liquid. 
 If it is intended to continue the purification process by irrigating land 
 with the liquid effluent, the extent of purification may be greatly les¬ 
 sened in the precipitating tanks, with a corresponding decrease in th& 
 cost. In such a case a simple treatment with milk of lime or lime-water 
 would arrest the suspended impurities and give an effluent in a suitable 
 condition for purification by the soil and growing crops. 
 
 The lime treatment, augmented by a further treatment of sulphate or 
 a salt of alumina, with an occasional treatment of iron, will give a com¬ 
 paratively pure effluent, retaining most of the organic impurities, dis¬ 
 solved and suspended, in the precipitate. Still further aiding this by 
 the use of proper absorbents would probably retain 95 per cent, of all 
 the sewage impurities in the precipitated sludge. The substances 
 escaping precipitation would probably be a portion of the oils and fats, 
 ammoniacal salts and the alkaline nitrates and nitrites. Though these 
 escaping substances are practically harmless, their loss is to be regretted, 
 owing to their manurial value and to the possible chance of their being 
 changed to a putrescible condition by coming in contact with living 
 organisms. This loss is less to be regretted, however, in the case of 
 nitrates and nitrites, since they serve as a safeguard against the danger 
 of appropriating the effluent water for domestic uses, their presence in 
 water being generally taken as prima facie evidence of previous sewage, 
 contamination. 
 
APPENDIX. 
 
 XLVII 
 
 It should be observed here that the complete results indicated above 
 have not been attained in the various precipitation processes which have 
 been practiced in many towns and cities of Europe; but, relative to this, 
 it must be considered that the European practice has been, in many if 
 not most cases, in connection with the combined or storm-water system 
 of sewers, and where the relative volume of solids in suspension to that 
 in solution would be much greater than in the sewage collected by the 
 “ separate system, making much more complex and difficult the process 
 of precipitation. 
 
 It may be safely concluded that a precipitation process, with properly 
 selected precipitants, deodorizers and absorbents, affords a very satisfac¬ 
 tory system of disposing of a great portion of the impurities contained 
 in the sewage of towns and cities, though a complete disposal by this 
 process may be prohibitory from its great cost, relative to a similar 
 completed disposal by irrigation. 
 
 Irrigation. —This system I shall discuss under three (3) subdivisions, 
 viz.: Broad, Surface Irrigation , Contracted Surface Irrigation , and 
 Sub-surface Irrigation. The essential principle of each of these is the 
 same, viz., that the soil is the natural purifier or contains nature’s agen¬ 
 cies for the purification of excrementitious and other putrescent matters; 
 that it is the natural agency of the conservation of energy, in that it 
 transforms the waste products of animal life into vegetable matters, 
 again suitable and necessary for the support of animal life. 
 
 Underlying all the great and immutable laws of nature, there is one 
 physical law greater than all others, in that the continued operation of 
 all the other laws is dependent upon this. This law is known as the 
 principle of the conservation of energy. By it all of the energy in 
 nature is preserved indestructible. It may be transformed, but it can¬ 
 not be destroyed. 
 
 The continuation of animal life is due to the transformation of the 
 potential energy in the plant, to energy of rest and of motion in the 
 animal kingdom. That wasted energy of man exists in excrement is 
 undoubtedly proven by its rapid transformation into myriads of micro¬ 
 organisms which are destructive to animal life. That this energy is 
 again transformed by the soil into suitable shape for the uses of animals 
 is amply attested by the luxuriant vegetation on fertilized land, and by 
 the barren fields where fertilizing is not practiced. Having such evi¬ 
 dence of the transformation of energy and consequent annihilation of 
 putrescent impurities, it must be accepted as a justifiable claim that the 
 soil is nature’s agency for effecting filth purification. 
 
 The process by which the soil transforms putrescent matters into food 
 for roots and plants is known as nitrification, and consists in the conver¬ 
 sion of ammonia and the nitrogen of organic matter into nitiic acid. It 
 is effected by the agency of lining organisms which exist in soils to a 
 depth of three or four feet and act as a ferment upon the substances to 
 
 be purified. 
 
XLVIII 
 
 APPENDIX. 
 
 Broad Irrigation means that the sewage is to be utilized in the treat¬ 
 ment of a large area of agricultural land, having in view the application 
 of just sufficient sewage to feed the growing crops, thus effecting the 
 purification and the abstraction of all the manurial impurities of the 
 sewage. The soil is not supposed to have any artificial drainage; conse¬ 
 quently, all the water contained in the sewage must be either absorbed 
 or evaporated. Now, the amount of sewage of a 10,000 population town 
 would be equivalent to a mean annual rainfall of 45 inches on 150 acres 
 of land. The evaporation from the soil is naturally about 75 per cent, 
 of the rainfall. The amount of water carried off through the soil, then, 
 amounts to Hi inches. To double the quantity of water on the soil by 
 irrigating with sewage, we might expect an evaporation of 50 per cent, 
 of the whole, leaving four times the natural amount of water to be car¬ 
 ried off through the soil. It will be clear, then, that unless the irrigating 
 area is very great, the soil will become water-logged, and. in a few years, 
 be not unlike a vast meadow or swamp. This contingency might be 
 overcome by a net-work of open ditches ramifying through the irrigat¬ 
 ing area; but this would encourage flowing over the soil instead of 
 through it, with the result of great loss of dissolved manurial properties 
 and incomplete purification. 
 
 Other than the objection of the vast area required, the system of broad 
 irrigation is admirably adapted for sewage disposal and utilization when 
 the sew’age is all absorbed by the soil, and yet does not render it too cold 
 and wet for the growth of crops. 
 
 In all the systems of irrigation there is one imperative requisite, viz.: 
 that the suspended matters be removed before the seyyage is passed upon 
 the land. If this is not accomplished, putrefaction must take place upon 
 the surface, with a consequent nuisance and loss of manurial properties. 
 More than this, the pores of the soil will become clogged, with a conse¬ 
 quent loss of nitrifying capacity. 
 
 Contracted Surface Irrigation, or intermittent downward filtration, 
 differs from broad irrigation in that it contemplates the irrigation of a 
 quantity of soil just sufficient to purify the sewage, with secondary con¬ 
 sideration to the extent of utilization in the growth of plants. It is also 
 intended that the soil shall not only serve in its absorbing and nitrifying 
 capacity, but that it shall also serve as a filter, passing the purified 
 water through and away from the irrigated area by means of a system 
 of under-drainage. 
 
 We have various examples to prove that under this system the sewage 
 has been very completely purified, the organic impurities being reduced 
 to a mere trace in the effluent. But it will be readily observed that by 
 applying the sewage to such contracted space, say one (1) or one-half (•£) 
 acre per 1,000 population, the complete utilization cannot be accom¬ 
 plished by the growing crops, the sewage being applied to the soil at all 
 times, whether it is beneficial or injurious to the crops. 
 
APPENDIX. 
 
 XLIX 
 
 Iii the successful operation of this system intermittency of application 
 of the sewage is an essential feature. By this means tlie sections, when 
 thoroughly taxed, are given an opportunity of self-purification by drying 
 out and having the pores in the soil recharged with a fresh supply of air. 
 To this end the irrigating area is generally subdivided into three or four 
 parts; if in four parts, then each part has six hours of service to eighteen 
 of rest, whereby the efficiency is greatly increased. 
 
 Sub-surface Irrigation.— This consists of applying the liquid effluent 
 of sewage to the soil by means of open-jointed drain tiles laid some eight 
 or ten inches below the surface. From the tiles the sewage soaks into 
 the surrounding soil and is utilized by growing plants. The efficiency 
 of this system is much aided by under-drainage of the treated area. It 
 is admirably adapted to suburban residences, where it may be thus safely 
 disposed of in the back-yard without causing the least nuisance. The 
 system is also well adapted for isolated public institutions, but it is ill- 
 adapted on a sufficiently large scale for towns and cities. 
 
 Illustrating the efficiency of the irrigation system, I will quote from 
 the admirable work on sewage treatment and utilization by W. H. Cor- 
 field: “At the Lodge farm, near Barking, England, where the soil is 
 gravelly and very porous, it was found that the organic nitrogen of the 
 sewage was reduced from 3.66 to 1.87 parts per 100,000 by fifty or sixty 
 yards of surface-flow; after a further surface-flow, to .624; and, at the 
 issue of the main drain of the farm, to .329 parts per 100,000; the ammonia 
 being reduced during the same flow from 4 to 0.8 parts per 100,000, 
 while the nitrates and nitrites, which were absent from the sewage, 
 appeared in the effluent water to the extent of nearly 3 parts per 100,000.” 
 This latter change would indicate that nitrification by the soil had been 
 very complete. 
 
 Again, at Breton’s farm, near Romford, England, the experiments of 
 the committee of the British Association shows “ that the porportion of 
 nitrogen escaping in the effluent water to the total quantity applied is 
 .1067, or about one-tenth.” 
 
 Many other instances might be cited, all of them showing that the 
 impurities of the sewage, when applied to practical irrigation, are almost 
 wholly eliminated from the effluent water. 
 
 Though these brief, rambling remarks may not indicate such great 
 capabilities as are really possessed by precipitation and irrigation, yet in 
 the light of all the facts, brought out by a wide, practical application of 
 these systems, the broad statement may be made, viz.: That given town 
 sewage, a process of precipitation with deodorization, supplemented by 
 subjecting the liquid effluent to intermittent downward filtration 
 through prepared soil, and the application of the precipitated sludge as 
 a fertilizer, will effect a practical purification of the sewage and quite 
 extensive utilization by growing crops. Further, by supplementing 
 precipitation by broad irrigation will so purify the sewage that the efflu- 
 
L 
 
 APPENDIX. 
 
 ent may be fit for all other than dietetic uses, with a complete utilization 
 of the manurial parts of the sewage by the growth of various crops. 
 
 That the sewage can also be utilized profitably by this system is shown 
 by the results of the Pullman, Illinois, system of irrigation, where an 
 annual profit of more than $4,000 has been accomplished. It is well to 
 observe here also that Pullman is an extremely healthy city r , having an 
 actual death-rate of but seven or eight per thousand inhabitants. 
 
 DISPOSAL OF GARBAGE. 
 
 Of this, I propose to discuss two methods, viz.: Utilization with Sew¬ 
 age Sludge as Fertilizer, and Destruction by Fire. 
 
 Before entering into the methods of disposal, however, it is necessary 
 to understand clearly the composition of the substance to be disposed 
 of. To determine this, I will quote from a recent report on the Destruc¬ 
 tion of Town Refuse, by Mr. Thomas Codrington, M. Inst., C. E.: “In 
 towns in which water-closets are general, the house refuse consists of 
 cinders and ashes mixed with vegetable and animal waste, broken glass 
 and crockery, and tbe rubbish of all sorts that finds its way into the 
 dust-bin or ash-pit, including often trade refuse and garden refuse in 
 greater or less proportion. In some towns the trade refuse, market 
 garbage and the sweeping of paved streets amount to as much as the 
 house refuse. The trade refuse consists of coarse paper, straw, shavings, 
 broken stoneware and glass, engine ashes, brick rubbish, spoilt fruit, 
 fish and turned provisions, etc. Market refuse is strictly the animal and 
 vegetable matters removed from markets, but it is often mixed with 
 other refuse.” 
 
 “The annual reports of Mr. G. Weston, the surveyor of the parish of 
 Paddington, give the constituents of the dust collected from a popula¬ 
 tion of about 112,000, and they may be taken as giving the fair average 
 composition of London town refuse. In 1880, 20,600 tons of “dust” 
 were collected, and the materials, when sorted out, were in the following 
 proportions per 1,000 tons—other years give much the same results: 
 
 London Refuse. Per 1,000 tons. 
 
 Ashes .. 526 tons. 
 
 Breeze (cinders). 288 “ 
 
 Soft core (animal and vegetable refuse). 142 “ 
 
 Hard core (broken pottery, etc.). 29 “ 
 
 Coal. H “ 
 
 Bones .... “ 
 
 Rags. 4 i “ 
 
 Old iron... 3£ “ 
 
 Old metals (brass, pewter, etc.). ^ “ 
 
 White glass. f “ 
 
 Black glass. 2^ “ 
 
 1,000 tons. 
 
APPENDIX. 
 
 LI 
 
 Some of tli 6 haid coie is used for road foundations, and the soft core 
 is sometimes mixed \\ ith garbage and street sweepings and sent away 
 as farm manure. 
 
 Where the privy and ash-pit system, or the pail system is in use, the 
 finei ashes aie mixed with excreta, either in the closet or subsequently, 
 to make a portable manure, and the contents of the ash-pits are gener¬ 
 ally more or less fouled with excrementitious matter. In Manchester, 
 where pail-closets prevail, of 1,000 tons collected from the closets and 
 ash-pits in 1880, the constituent parts seem to have been as follows: 
 
 Manchester Refuse. p er 1,000 tons. 
 
 Ashes and excreta in pails__645 tons. 
 
 Dust and cinders ________ 345 ^ 4 4 
 
 Fish and bones..... 14 44 
 
 Dogs, cats, hens, rabbits, etc. 
 Boots, rags, hats, paper, etc.. 
 
 Vegetable refuse.... 1 44 
 
 Glass, pottery, bricks, etc. ....... 6 “ 
 
 Old iron and tinware .. ..... 4 44 
 
 1,000 tons. 
 
 For every 1,000 tons collected from the closets and asli-pits, about 290 
 tons of slaughter-house, market and shop refuse, and street sweepings 
 were besides collected—the whole being about 250,000 tons.” 
 
 The quantity of town refuse seems to range from 200 to 300 tons per 
 year per thousand population. 
 
 Now, I will consider that the garbage is collected at the outfall of the 
 sewerage system; that the sewage is subjected to a precipitation process, 
 retaining much of the manurial properties in the precipitate; that the 
 precipitated sludge requires artificial drying or an addition of some dry 
 substance to render it in a portable shape to be utilized as a fertilizer; 
 then determining the approximate composition of the garbage from the 
 data given above, we shall see what disposition can be made of it. We 
 may safely take the table of London sewage as a fair specimen of the 
 composition of the garbage of a sewered town. Of this, all the ashes, 
 one-half of the “soft core,” and the bones may be advantageously 
 applied to the sewage sludge—these amount to 5994 per thousand tons, 
 or of the total garbage. 
 
 In a town of 10,000 population, with a complete system of garbage 
 collection, there will be. according to the above data, 2,500 tons of gar¬ 
 bage annually, of which 1,500 tons would be available for mixing with 
 sewage sludge, and 1,000 tons to be disposed of otherwise; but of this 
 1,000 tons, it will be observed that there remains but 177$ tons of “ soft 
 core,” and lOf tons of rags to be necessarily destroyed—a total of 188 
 
LII 
 
 APPENDIX. 
 
 tons, leaving 7334 tons of available fuel. In such a town entirely sew¬ 
 ered, we would have approximately 600,000 tons of sewage annually; 
 from it would be obtained 6.000 tons of precipitated sludge; of this 
 there would be 5,400 tons of liquid and 600 tons of solid matter. Adding 
 to the sludge the 1,500 tons of absorbents available from the garbage 
 and 400 tons of ashes resulting from burning the 911 tons of cinders, coal, 
 soft core and rags would change the sludge to a mixture of 3,500 tons of 
 solid and 5,400 tons of liquid. To raise this liquid from a mean tempera¬ 
 ture of 50° to evaporation would require 1,719,600,000 heat units; but 
 assuming the cinders to have one-third of the thermal units available 
 from the same weight of coal in an ordinary steam boiler and furnace, 
 we may obtain, by means of a small furnace, from the 911 tons of cin¬ 
 ders, etc.. 4,318,000,000 heat units, or 3£ times the amount required to 
 completely dry the sludge and render it a desirable form of poudrette. 
 
 The commercial value of this poudrette may be obtained as follows: 
 Of the $33,500 worth of manorial matters, above shown to be contained 
 in the sewage, at least one half may be retained in the precipitate and 
 in the poudrette, amounting to $4.50 per ton; the garbage additions, con¬ 
 sisting of slaughter house refuse, ashes, animal and vegetable matters, 
 bones, etc., will increase the value to $4.75, making the value of the 
 3,500 tons of poudrette $11,875. 
 
 The cost of reducing the sewage to 6,000 tons of sludge by precipita¬ 
 tion and further reducing this to a portable manure by means of the 
 “ filter press” and heat would be $5,000; the cost of similar reduction 
 by the method above outlined would probably be very much less; but, 
 to be on the safe side, I will estimate it the same. The cost of collecting 
 and hauling the garbage, at fifty cents per ton, would be $1,350, the 
 cost of burning the 188 tons of garbage would be $50, making the total 
 cost of producing the 3,500 tons of poudrette $6,300—giving a profit 
 from the works of $5,575 per 10,000 population. 
 
 Now, this profit, capitalized at five per cent., gives $111,500—an 
 amount generally sufficient to meet the cost of the sewerage system per 
 10,000 population and to provide several public conveniences in the 
 poorer quarters of the municipality. 
 
 Further, it should be observed that we have remaining in the sewage 
 effluent $11,500 worth of manure, most of which may be profitably 
 utilized by irrigation on land, and at the same time very completely dis¬ 
 posed of. 
 
 That the above plan, necessarily but briefly and generally outlined, is 
 capable of a very wide application, must be apparent; let us summarize 
 and note its broad accomplishments. 
 
 We have both sewage and garbage at a point wherefrom the health of 
 the town cannot be endangered. We have the sewage deodorized in 
 precipitation. We have all the putrescent suspended and much of the 
 dissolved impurities retained in the sludge, including most of the putres- 
 
APPENDIX. 
 
 LIII 
 
 cible animal organisms. We have the sewage sludge transformed to a 
 condition of easy utility and in a ready condition to be utilized and puri¬ 
 fied in the soil. We have a thorough and systematic removal of both 
 sewage and garbage—its complete disposal without creating a nuisance. 
 What more can be desired from a sanitary standpoint ? It is complete. 
 From an economic standpoint the same, whereas we see from the above 
 careful and authentic calculations that the whole system, under favora¬ 
 ble circumstances, may be made self-sustaining. 
 
 That this seems, upon its face, incredulous, I freely admit; and further, 
 I admit that it surpasses the best results that have ever been accom¬ 
 plished m practice. But no system has ever been practiced upon this 
 line with any such completeness as is herein contemplated. Yet. when 
 we consider that while the energy in nature cannot be either increased 
 nor lessened, the animal kingdom, by its reproductive power, is con¬ 
 stantly increasing the energy of its kind, is it unreasonable to suppose 
 that the vegetable kingdom has a similar capacity? Man dies and is 
 consumed by worms and growing plants, yet the energy of man is 
 increased by the natural increase of man. Plants die and are consumed 
 by man and other animals, but the energy of plants is increased by the 
 multiplicity of their reproductive power. A grain of corn or wheat 
 planted in the soil is reproduced in an hundred fold. The acorns from 
 one tree will bring forth hundreds of trees. Likewise the few pounds 
 af ammonia, potash, phosphoric acid, etc., in the sewage and garbage 
 of any community, when placed in the soil, will reproduce plant-life in 
 great multiplicity. Considering this, then, the aspect of incredulity dis¬ 
 appears, in that the system contemplates the reproductive application in 
 the soil of all the waste products of the community. 
 
 That the system is sanitary , I can see nothing to the contrary. That 
 it is, further, economical , is shown wherein its operation may be made 
 at least self-sustaining. 
 
 Since the subject of garbage cremation is to be presented by one* 
 much more able to handle it than myself, I conclude to forego its con¬ 
 sideration in this paper. 
 
 * Dr. Thomas F. Wood, Secretary N. C. Board of Health. 
 
 F-' 
 
 D 
 
LIV 
 
 APPENDIX. 
 
 THE DUTIES AND RESPONSIBILITIES OF COUNTY SUPERIN¬ 
 TENDENTS OF HEALTH. 
 
 By J. L. Tucker, M. D., Member of N. C. Board of Health. 
 
 Dr. Mapother, in his “ Lectures on Public Health,” defines “ Hygiene 
 or Sanitary Science ” to be “ an application of the laws of physiology 
 and general pathology to the maintenance of the health and life of 
 communities by means of those agencies which are in common and 
 constant use.” The law, recognizing the utility of a science thus defined, 
 gives to the several counties m this State local boards of health, whose 
 executive officers are to be chosen from the physicians legally qualified 
 to practice, and are to be known as County Superintendents of Health. 
 The “ Duties and Responsibilities” appertaining to this office are sub¬ 
 jects to which I would ask your brief attention. 
 
 The act regulating the duties of this important office may be briefly 
 summarized: 
 
 It shall be his duty to collect vital statistics, to make medico-legal 
 post-mortem examinations for coroners’ inquests, to attend prisoners in 
 jail, poor-house and house of correction, and to make examination of 
 lunatics for commitment. He shall be the sanitary inspector of the jail 
 and poor-house of his county, making monthly statements to the board 
 of commissioners. The duties are further enlarged and the responsi¬ 
 bilities increased so as to bring, with the advice of the local board of 
 health, the important matter of inland quarantine under his control. 
 Diseases dangerous to public health, viz., small pox, scarlet fever, 
 yellow fever, and cholera, are to be quarantined and isolated at the 
 expense of the county, town or city in which they occur. It shall be 
 his duty to abate nuisances; and finally, the important matter of vacci¬ 
 nation is committed to his care. 
 
 The field thus outlined is broad enough, and the soil sufficiently fertile 
 to invite occupancy, with a promise of a rich harvest, not alone to the 
 physician and sanitarian, but as well to the philanthropist and public- 
 spirited citizen. 
 
 The system of medical and sanitary inspection, as applied to our jails, 
 almshouses and houses of correction, has already yielded fruits of a 
 most gratifying character, and the increased interest this matter is 
 receiving at the hands of our superintendents, in more detailed reports 
 to the Monthly Bulletin , promises still greater results, which, from the 
 very nature of the work, must commend it to the support of all good 
 people throughout the State. But unfortunately, many of our counties 
 are without health boards, and their public institutions are left without 
 the care and superintendence of health officers. 
 
APPENDIX. 
 
 LV 
 
 It is almost incredible in this enlightened age, in which all the lines 
 of ait and science aie advanced an age so prolific of good works—that 
 there should be a penal institution or a house of alms in the State in 
 which the inmates aie denied the blessings of sunlight, pure air and 
 wholesome food; and yet, sickening and revolting as the recital is, such 
 enoimities aie being constantly brought to the notice of the medical 
 profession, some of whose members have been prompt, in language 
 caustic and eloquent, to expose and denounce these cruelties. It has 
 been but a short while since a distinguished* President of the North 
 Carolina Medical Society, in his annual message to that body, directed 
 public attention to this matter. Describing his visit to a North Carolina 
 city, ^ here lie found a singular blending of “wealth and religion,’ 
 piety and sin, in a city partly noted for the culture, elegance and refine¬ 
 ment of her citizens, he thus describes his visit to the jail: “Inside an 
 encircling brick wall, pierced by two small windows, was an iron cage, 
 twelve feet square and twelve feet high; the cage was divided by one 
 iron floor into two stories; each of these was subdivided into two cells 
 and a passage-way. After my eyes had become accustomed to the dim 
 light, I counted twenty-four human beings huddled in these confined 
 quarters. They were clothed in rags, and a few tattered pieces of 
 blankets and sacks constituted their bedding. Many of these poor 
 wretches had laid there for many months awaiting trial for petty 
 offences. The place was reeking with filth, and the stench was beyond 
 description. Every sanitary necessity was absent.” 
 
 Other gentlemen, in language no less pungent, have directed attention 
 to these foul blots upon our civilization, and to our county superin¬ 
 tendents of health belongs the duty of redressing the wrongs. Let it 
 not for a moment be supposed that our superintendents will fail in their 
 duty. Frequent inspections, with detailed statements to the county 
 commissioners, and given to the public through the Monthly Bulletin , 
 setting forth the sanitary need of each and every public building, with 
 suggestions as to the hygienic needs of the inmates, will arouse a senti¬ 
 ment in the counties which officials dare not oppose. Failing in this, 
 let us take the matter to our grand juries, and in official capacity deliver 
 them homilies on public hygiene, setting forth the dangers of overcrowd¬ 
 ing, foul air, impure water, and unwholesome food, and, in the name of 
 a common civilization, demand an abatement of these nuisances. The 
 need of greater oversight upon the one thousand resident insane in the 
 several counties cannot be too strongly emphasized. A register setting 
 forth age, residence, cause and type of insanity, with frequent reports to 
 the county commissioners as regards conditions, wants and needs of these 
 people, will go far towards securing for them the care and treatment 
 which an enlightened and civilized people are expected to bestow on the 
 
 * Dr. H. T. Bahnson, meeting of Medical Society at Charlotte, 1888. 
 
LVI 
 
 APPENDIX. 
 
 ignorant, helpless and unfortunate. These questions involve grave 
 responsibilities, and are important enough to command the best executive 
 ability and the profoundest medical and sanitary knowledge. 
 
 Let it not be said, as has been said recently by a distinguished alienist,* 
 that “those under county care are daily passing downward, by steady 
 stages, to the level of hopeless alienation in such accumulating numbers 
 that humanity sickens at the conception, both at what they endure now 
 and what life has in store for them, and all who hold them dear.” Let 
 us urge upon our county commissioners the need of better facilities at 
 our almshouses for the care and treatment of the insane, especially for 
 those who are awaiting commitment into the asylums of the State, and 
 as far as possible, let us use our efforts to ameliorate their conditions. 
 Earnest, intelligent and brave endeavor on the part of our superin¬ 
 tendents will remove present evils. 
 
 There are other fields to which the labors of our health officers can be 
 profitably carried. The subject of public school education, to which the 
 masses of our people are looking with so much interest, and the impetus 
 which this important work will receive by the passage of the Blair bill, 
 now pending before the National Congress, must render the matter of 
 school inspection, by competent and trained sanitarians, of paramount 
 importance. We are fast getting away from the traditional log school- 
 house, with its open crevices, its large chimney and its roaring fire, and 
 in its place we are substituting frame buildings, tightly ceiled, with all 
 possible defects of ventilation, and heated by that greatest curse of the 
 age—the modern stove. To-day, in many of the rural districts, we have 
 a number of school buildings, twenty feet square and ten feet pitch, 
 giving a total air space of about 4,000 cubic feet, in which forty pupils 
 are being taught—just a little over 100 feet per capita of air space, and 
 with no other method of air displacemeut, except through a raised 
 window or open door, the temperature at one moment sending the 
 mercury to the roasting point and in the next lowering it to freezing. 
 What an admirable opportunity is here offered to the medical expert in 
 the study of the causative effect of foul air, cold draughts and varying 
 temperature in the production of winter catarrhs, to say nothing of the 
 more serious lesions of pleurisy and pneumonia; and what a volume of 
 interesting facts might be gathered in the study of the personal history 
 of each individual pupil, as regards the development of pulmonary 
 consumption, or the long list of nervous ailments which neurologists 
 trace directly to such influences. It can scarcely be expected that a 
 costly and cumbrous system of inspection should be given in the present 
 development of our school system. But as physicians and sanitarians, 
 we can properly and profitably advise as to the location, size and 
 arrangement of these buildings, grounds, drainage and water supply; 
 
 * Eugene Grissom, M. D., LL. D., report Raleigh Insane Asylum. 
 
APPENDIX. 
 
 LVII 
 
 methods of supplying sunlight, so as to minimize dangers to the eyes; 
 furniture (seats and desks) adapted to all ages and sizes, and at the same 
 time direct attention to the more salient points of danger to the health 
 of the inmates. 
 
 In illustration of this point, I will mention that a few years ago, in the 
 county of Vance, near the village of Townesville, an epidemic of typhoid 
 fever occurred in the neighborhood school. There were more than ten 
 cases (cannot be accurate as to numbers) in an enrolled school of about 
 twenty-eight pupils. Dr. Wm. R. Wilson, a most competent and skillful 
 physician and sanitarian, failing, after a most vigorous search, to find 
 any possible cause for the epidemic in the several homes of the pupils, 
 carried his investigations to the school premises. Here he learned that 
 many of the . upils had suffered during the year from diarrhoea, dysen¬ 
 tery and other ailments, and that the session had been unprofitable to 
 scholar and teacher alike. An examination of the surroundings disclosed 
 a polluted spring as the source of contagion. The ground overlying the 
 spring was covered with undergrowth, and had been used by the school 
 for months as a “privy walk,” and here we had soil saturation, or 
 possibly excretal washings direct, water pollution, and. as a necessary 
 consequence, that disease of filth, typhoid fever. The nuisance was 
 abated, a new supply of water secured, the epidemic stopped, and Dr. 
 Wilson ever afterwards became a most active and zealous advocate of 
 preventive medicine. It is a source of real regret that another State is 
 to-day receiving the labor and teachings of this faithful and accom¬ 
 plished physician, whose first interest in public hygiene dates from this 
 little incident. Doubtless, similar instances might be reported from 
 other portions of the State, all calling, more eloquently than words, for 
 medical and sanitary inspection. 
 
 Let us urge our superintendents to give to each and every school in 
 their respective counties one careful and thorough inspection annually, 
 and to file with the Superintendent of Instruction a report of the same, 
 setting forth clearly whatever suggestions may appear necessary to 
 promote the health and comfort of the school. 
 
 The subject of vaccination in our public schools should address itself 
 more to our superintendents of health. I cannot, in the limits of this 
 paper, recount the many arguments in favor of vaccination, and, indeed, 
 to physicians such arguments are unnecessary; but as we are honored 
 to-day by the presence of so many distinguished laymen, I hope I will 
 be pardoned for recalling the well authenticated immunity enjoyed by 
 the German army in the Franco-Prussian war. 
 
 The Germans never do things by halves. They believe in preventi\e 
 medicine, and practice it in its highest and fullest sense, and in nothing 
 is the strength of this proposition more beautifully exemplified than in 
 the matter of vaccination. By statutory provision every infant is 
 required to be vaccinated before it attains the age of one year; the child 
 
LV1II 
 
 APPENDIX. 
 
 is revaccinated at twelve, and the subject who comes to discharge his 
 military obligation to the sovereign is again re vaccinated, the operation 
 being repeated until the surgeon is satisfied that the person is insus¬ 
 ceptible to vaccinia. The German army may, therefore, be regarded as 
 a thoroughly vaccinated body of men. In France, on the other hand, 
 vaccination and revaccination is not compulsory; perhaps it is done or 
 not, as the danger of an epidemic may determine. During the war 
 small pox prevailed to an alarming extent, and both armies were equally 
 exposed to the contagion, with the following results: The French army, 
 scarcely more than one-half the strength of the German, suffered the 
 frightful mortality of 23,468 from small-pox, while the German army 
 suffered the insignificant loss of 263 men. 
 
 Another instance, quite as convincing, may be cited of Zurich, Swit¬ 
 zerland. With a compulsory vaccination law in force small-pox was 
 entirely stamped out, and for years was unknown; and yet, in three 
 years after the repeal of the law, the death-rate shows 85 from small-pox 
 in 1,000 deaths from all causes, or about one-twelfth of all deaths were 
 from small-pox. Can any sane person require stronger proof of the 
 prophylactic power of vaccination against small-pox? 
 
 The immunity enjoyed by our State for the past two decades from 
 small-pox epidemics has lulled the people into a state of security utterly 
 unwarranted by the history of the disease. Of the nineteen hundred 
 and fifteen persons committed to the jails, as reported to the Bulletin 
 for the past six months, only three hundred and seventy-three give 
 evidence of successful vaccination—about one in five. A conservative 
 estimate would place more than four hundred thousand of our people 
 without this great prophylactic, and it is high time the importance of 
 this matter was being pressed upon the attention of health officer, physi¬ 
 cian and the general public. 
 
 The advancement of public hygiene in this country for the past twenty 
 years has been due largely to the increased attention given by the State 
 and county boards of health to the collection, preservation, classification 
 and publication of vital statistics. 
 
 The chief statistics bearing on public health are of deaths, births and 
 marriages. With these reports should be bulletins announcing all 
 diseases dangerous to public health—especially those of an epidemic 
 character. There are few persons who will question the value of such 
 statistics, not alone to physicians and sanitarians, but as well to politi¬ 
 cians, legislators, business men, and the citizens at large. Without a 
 knowledge of the number of persons dying, the locality and cause of 
 such deaths, it is impossible to know when sanitary remedies are needed, 
 or, indeed, what remedies are to be applied. Without a comparison of 
 the death and birth rate, it is impossible to form an idea of the “ ebb or 
 flow of the tide of human life.” or as Dr. Billings so strongly expresses 
 it: “Protection to public health cannot be given wisely without a 
 
APPENDIX. 
 
 LIX 
 
 knowledge of the persons and places who stand most in need of it, and 
 this knowledge can only be obtained by a systematic, complete and 
 continued registration of the births and deaths in every community of 
 the State. Such registration is, as it were, the eyes of the State Board of 
 Health, and without it the board is like a blind man fighting a prairie 
 fire.” The statistics already collected in this State are suggestive, but 
 are too meagre to admit of much valuable discussion. We are behind 
 other States in this important matter, and few questions can engage 
 your attention to-day more profitably. 
 
 Without suggesting a plan by which this important branch of the 
 service can be perfected, I can express the belief that “ where there is a 
 will there is a way.” Different States have different plans—some better 
 than others, but none are perfect. No one at all acquainted with the 
 workings of the North Carolina Health Board will, for a moment, doubt 
 that the genius and wisdom of her executive officer will bring “order 
 out of chaos,” and, in the near future, unfold to us the details of a plan 
 that will secure to us complete and accurate returns of births, deaths 
 and marriages in every city, town and county in the State. With such 
 statistics, the board will demonstrate to you what sanitary science, 
 practically applied, is capable of accomplishing, and that it is not, as has 
 been said, “a mere jumble of unproved hypotheses.” 
 
 The present law under which our statistics are collected displays its 
 weakness in its great elasticity. An amendment here and there of a 
 primitive character, to bear equally upon superintendents, county 
 officials, doctors, midwives, undertakers, and the heads of families, will 
 have a most salutary effect in removing existing evils. But the question 
 may be pertinently asked: What are you going to give in return for 
 such exactions from doctors, county officials, and the people at large? 
 The answer is simple. If we were to apply the money test as to the 
 value of the life of each citizen who dies from a preventable disease, as 
 suggested by Dr. Farr, and corroborated by the veteran sanitarian, 
 Edwin Shadwick, of England, it would make a sum so large that capi¬ 
 talists would be startled. It is enough for us to say that the amount 
 saved to the State, as thus demonstrated, is so enormous that the most 
 visionary dreams of speculation can offer nothing so alluring. But this 
 is the weaker side of the question. 
 
 In return we promise diminished sickness, improved health, increased 
 longevity, and the resultant blessings of happy and cheerful homes for 
 every man, woman and child in North Carolina. “With decreasing 
 mortality there comes increasing longevity. Statisticians tell us that 
 the duration of human life has been advanced from twenty-eight and 
 below to forty-one years under the ordinary workings of sanitar\ law, 
 and that if mortality can be reduced to fifteen per thousand, and main¬ 
 tained at that figure, that the rate will be advanced to fifty-four yeais, 
 and if we can reach eight per t housand, as suggested by the distinguishe 
 
LX 
 
 APPENDIX. 
 
 Dr. Richardson, in his beautiful picture of the ideal City of Hygeia, with 
 her broad streets, lovely courts and faultless drains, her extended parks 
 and silvery lakes and pure water, it will carry it up towards ninety. 
 
 The application of sound sanitary laws, as applied to the military forces 
 in England, notably to the Royal Guards, shows a reduction of twenty 
 per thousand to six and five tenths, and under more rigid enforcement 
 in the German army the rate has been lowered to only five per thousand, 
 with almost a total exemption from dysentery,'diarrhoea, typhus and 
 typhoid fever. And so in England and Wales, statistics, as applied to 
 the people at large, show a reduction of the death-rate from forty per 
 thousand to twenty, and in localities where sanitary details are practi¬ 
 cally and systematically administered, even as low as fifteen per thou¬ 
 sand. Similar results can be obtained in this country—in our own Stafte 
 and for our own people; and, as guardians of the public health, charged 
 with the sacred trust of saving human life and lessening human suffer¬ 
 ing, we should press the importance of these matters upon the people 
 and arouse a sentiment commensurate with the great interests involved. 
 
 Lord Derby, years ago, felt the need of popular aid in solving the 
 problem of public hygiene, when he declared that “ no sanitary improve¬ 
 ment worth the name will be effective, whatever acts you pass or what¬ 
 ever powers you confer on public officers, unless you create an intelligent 
 interest in the matter among the people at large.” 
 
 Let our county superintendents of health take this great lesson to 
 heart, and, in all matters affecting public health, let them assume leader¬ 
 ship and teach the people the great benefits and blessings that follow 
 when sanitary laws are wisely administered. 
 
APPENDIX. 
 
 LX I 
 
 SOME GAINS FROM SANITATION. 
 
 By J. W. Jones, M. D., President N. C. Board of Health. 
 
 Advance in civilization is founded on enlightened self-interest. The 
 people have a right to protest against any demands on them unless there 
 be promise of profitable returns, and to demand of the government the 
 protection of their lives, their health, and their fortunes. 
 
 The real health of a people is not counted by its gold, silver and acres. 
 These are sources of material and physical greatness; above these, as 
 high as the heaven is above the earth, as a simpler question of value, is 
 the health of the people. Here is the manhood, the real civilization, the 
 source of its content, happiness, and its good will to men. 
 
 The best interest of the State is absolutely dependent on the family 
 relation, and these on the godliness, good order, and clean, ine-s of the 
 individual. The greater part of the wealth of a nation is 'hat income 
 which is the outcome of national health. Public health, hen, should 
 be, as Lord Beaconsfield years ago expressed it, of the first c» nsideration 
 to the State, and should have the first care of the statesman. The pros¬ 
 perity of the State is the aggregate of the average prosperity of its citizens, 
 and every increase of individual prosperity, every dollar earned by the 
 citizen, is so much earned for the State; or, every detracti >n from the 
 individual prosperity, of his time, or his money, or even his life, is so 
 much taken from the State’s social capital. And equally true is it, that 
 all a man earns over enough for his living is so much added to the public 
 capital; or that his living cost more from any cause than his earnings, 
 that deficit is that much loss to the commonwealth; so, then, in the case 
 of the premature death of a productive individual, his death is a with¬ 
 drawal of so much productive industry from the State; or, in case of his 
 sickness, the suspension of such income as that would come from his 
 labors if he were in good health. And so it follows, that as to man s 
 ability to make available the forces of nature and the resources of the 
 country, will be the value of the lands, and that any detraction from the 
 citizen’s ability is that detraction from the land’s value. 
 
 Mr. Farr estimates the value of a Norfolk agricultural laborer at £246, 
 and that of a professional man at £300. In that of a minor it is the 
 deferred annuity which represents the probable earnings of his manhood, 
 minus the amount spent in his maintenance during his unproductive 
 childhood. Taking the relations of the different ages, their occupations 
 and conditions, he has undertaken the laborious task of averaging these 
 various factors to reach the mean value of the individual. Fiom the 
 statistics furnished him by the English Government, he makes the 
 approximate minimum inherent money value in the U nited Kingdom of 
 every man, woman and child at £159, or !s79o. a head. In the United 
 
LXII 
 
 APPENDIX. 
 
 States, under conditions of higher interest and wages, on Mr. Farr’s esti¬ 
 mates, his money value is put at $1,000, but more than this by some. 
 
 Vital statistics are made up from the reports of deaths, births, mar¬ 
 riages, diseases and any other matter that pertains to the health of a 
 people. Tlicpresent value of a person is his future earnings, minus his 
 necessary outgo in realizing these earnings. 
 
 From a study of carefully kept vital statistics, and tables of present 
 values of annuities, the health and wealth of a country can be calculated 
 with great accuracy. 
 
 If the present value of a person is $500 a year, and that person dies 
 twenty years sooner than the natural termination of the life of a healthy 
 working life-time, the loss to the community is the present value of the 
 annuity of $500, with the interest for tw r enty years; or, if he should be 
 sick, the cost of the lost time is a withdrawal of so much from the public 
 capital, together with the cost of his living, nursing, medical attention, 
 and medicine during his illness. 
 
 The advances made in the arts and sciences, the incidents of war, and 
 the destruction of life by disease in the great armies of the world, and 
 the great epidemics, first led the way to the study of sanitation. The 
 appalling disaster by disease in the last Crimean campaign has been 
 turned into a victory to military sanitary science. The ravages of typhus 
 fever in badly ventilated shipholds and prisons attracted the attention 
 of the philanthropist, John Howard, and led sanitary physicians to 
 look to the construction of buildings in regard to disease. The pale 
 faces and unsteady walk of the operatives, doomed to live in the badly 
 ventilated and badly lighted houses and factories, was everywhere seen. 
 So much had the public mind become impressed by these conditions, 
 that in 1802 England manifested her recognition of the needed sanitary 
 reform by the passage of a series of legislative acts for the whole king¬ 
 dom. This was the beginning of our present system of State medicine. 
 
 In 1847 Mr. Chadwick made his great report to the Government “on 
 the sanitary condition of the laboring classes,” and so great was the 
 impression made by this report that it resulted in the revising of the old 
 poor law which had been in existence ever since the reign of Elizabeth, 
 and had grown to be a burden instead of a relief to the poor. This revi¬ 
 sion has served as a foundation and a guide, not only for England, but 
 for all other enlightened nations as well, and from its date preventive 
 medicine became a distinct branch of learning. To-day every enlightened 
 government has its health department, nearly every State in our Union 
 has its State and local boards of health, and in most of our schools and 
 universities sanitary science is taught as a part of the course of instruc¬ 
 tion. Where sanitary science has been taught, and its regulations 
 applied, there has been a corresponding lowering of the sick and death 
 rates. 
 
APPENDIX. 
 
 LXIII 
 
 To the question, “ What are some of the gains by sanitation we 
 shall pass a reference to the sentiments of grief for the dead that should 
 not have died, and to the sick that should not have been sick, and the 
 joys for the saved from death and sickness, and reply only to that part 
 of the question that can be answered in the language of figures. 
 
 Before the flood the average length of life was between 700 and 800 
 years. After the flood it gradually fell till it went down to 18 or 20 
 years; as learning revived, length of life increased. At the time of the 
 beginning of the sanitary reform it was about 27 in England. At this 
 time it is about 45 years. 
 
 The length of life in the reign of Victoria has increased 10 per 1,000, 
 from 35 to 45. The government of this great and good Queen has ever 
 been a friend to the reform; her Prince Consort Albert was ever pleased 
 to promote it. 
 
 Dr. McVail, in his presidential address before the Sanitary Association 
 of Scotland, last year, said in substance, that the death-rate in England 
 and Wales in 1861 was 22.595 per 1,000, and in 1885 it was 19.310 per 
 1,000, and that the reduction between the years of 1861 and 1885 would 
 make an annual saving in England and Wales, with a population of 
 30,000,000, of 100,000 lives. In American money, estimating each life at 
 $1,000, and 20 cases of serious sickness to the death, at a cost in lost 
 time, medicine, doctor’s bill, nursing, food and rent of $100, the saving 
 was annually $300,000,000; and that the children in one year have now 
 divided among them nearly two millions of years of life more than 
 would have been the case thirty-five years ago. 
 
 In London within the last century the death-rate has been reduced 
 from 50 to 22 per 1,000, a gain of 28; in 1884, that of her contagious 
 diseases from the average of 5.25 to 3.4. 
 
 In France, within this century, the average length of life has been 
 increased 10 years, an aggregate of four hundred millions of years for 
 the whole population. 
 
 Mr. Chadwick, in a paper on military sanitation, gives the following 
 rates of deaths and gains in the great armies of Europe: 
 
 In the guards a quarter of a century ago the death-rate was 20 per 
 1,000—now it is 6£; while that of the home army was 17 per 1,000, 
 reduced to 8. The rate of the whole English army, home and abroad, 
 is 17. Germany has the lowest death-rate of any nation, namely, 5 oi 6 
 per 1,000. In France, it is 10 per 1,000. In Austria, it is 11 per 1,000; 
 for the whole nation, 32. In Italy, 11 per 1,000. In Russia, 18 pei 1,000, 
 three times heavier than Germany. In these United States, 9 pei 1,000, 
 the nation, 19. The men in the army are healthier than the class at 
 home from which they were drawn, due to strictly applied sanitary 
 
 regulations. 
 
 The actual mortality of both armies in the late civ il \\ ai fiom all 
 causes, from May, 1861, to June, 1866, was 504,369; killed in battle and 
 
LX IV 
 
 APPENDIX. 
 
 died of wounds, 143,969; died from sickness, 360,400, in both armies. 
 At this the whole civilized world stands amazed and appalled, and justly 
 so. It was the work of the demon of war, and yet our annual loss of 
 life by preventable sickness, taking our population at this time to be 
 60,000,000, is 120,000, almost equal annually to what it was by diseases, 
 killed in battle, and died from wounds in our late civil war in both 
 armies, which was 126,000 annually. 
 
 There has been the most extraordinary gains by antisepticism since 
 1880, when Pasteur first saw the microbe of puerperal fever. It is seen 
 in every department of medicine, but more especially in obstetrics and 
 surgery. One case will serve our purpose to-day. In La Maternite, 
 Paris, there is a line on the wall showing the total death-rate of women 
 confined in that hospital from 1792 to 1886. The record is divided into 
 three periods; the first that of inaction, in which the mortality was 
 from 9.3 to 20 per cent.; the second, the battle of hygiene against infec¬ 
 tion and contagion, with a mortality of 2.3; and third, the victory of 
 antisepticism, with a mortality of less than one per cent. 
 
 The gains from vaccination have been accumulating since the day of 
 Jenner. In Paris, where the laws requiring vaccination are feebly 
 enforced, the mortality from small-pox is from 10 to 136 to the 1,000; 
 while in the German cities, where vaccination laws are enforced, the 
 death-rate is but 1.44; in London, under compulsory laws, it is but 6 to 
 the 1,000; while in parts of Switzerland, it runs up to 8 and 10 to the 
 1,000. The possibility of protective inocculation in other diseases is yet 
 unknown. There are promises that in the near future its triumphs will 
 be as great in some other diseases as it has been in small-pox. 
 
 Some years ago Messrs. Simons and Chadwick made the estimate that 
 England and Wales lost annually 200,000 lives from preventable causes; 
 France, 250,000; and Spain, 190,000. Mr. Billings estimates the loss of 
 the United States at 100,000 on the census of 1850. These figures mean, 
 that the United States loses annually of her citizens who should be 
 saved, 100,000, at a money loss in deaths and sickness of $300,000,000 on 
 the census of 1850, counting the cost of the dead at $1,000 and each case 
 of sickness at $100. 
 
 North Carolina, with an estimated population of one and one half 
 millions, has annually, from preventable sickness, 3,000 deaths and 
 60,000 cases of serious sickness, at a money loss of $3,000,000 for deaths 
 and $6,000,000 for sickness. Total loss from deaths and sickness, 
 $9,000,000—a loss of $6 a head for every man, woman and child. The 
 present death-rate of Raleigh is 38.4. Suppose we reduce this death-rate 
 just one in the 1,000 this year, we save 15 lives and prevent 300 cases of 
 sickness, and save $45,000. These figures show that one in every 500 
 of our population of 50,000,000, or one-fifth of one per cent., die that 
 should not die; and that one in every 25 of our population are sick who 
 should not be sick. 
 
APPENDIX. 
 
 LX V 
 
 Sir James Paget thinks, from estimates made from reliable data, from 
 reports of the benevolent and charitable institutions of England, that the 
 annual loss of time in the United Kingdom is about one-fortieth of the 
 working time, or nine days a year for every man, woman and child 
 between the ages of 16 and 65 years. 
 
 We shall take it that two-fifths of the people of North Carolina are 
 between the ages of 16 and 65 years; then North Carolina, with a popu¬ 
 lation of one and one-half millions, loses annually by sickness 9,000,000 
 days’ work, and putting the cost of lost time, living and nursing during 
 sickness, medicine and medical bills at $2 per day, $18,000,000. Raleigh, 
 with an estimated population of 15,000, loses 9,000 days’ work, in money 
 value $18,000. The larger part of these losses could and should be pre¬ 
 vented. 
 
LXVI 
 
 APPENDIX. 
 
 THE SEWERAGE OF CITIES AND TOWNS. 
 
 By J. L. Ludlow, C. E., M. S., Member North Carolina Board of Health, 
 Civil and Sanitary Engineer, Winston, N. C. 
 
 “ We live or we die—live well or miserably—live our full term, or perish 
 prematurely, according as we shall wisely or otherwise determine.” 
 
 Dr. Henry Maccormac has left this truism as a monument to his 
 superior intelligence, and to his studied appreciation of the perfect 
 development of Nature, as designed in Divine creaiion when it was 
 given to mankind to enjoy or abuse—a free agency of the effects of 
 creation and the natural laws thereof. 
 
 The various diseases by which humanity is enfeebled, both bodily and 
 mentally—languishes in most intense suffering, and brought to prema¬ 
 ture death—are not our natural heritage, but the perversion of a 
 glorious heritage by man’s abuse and neglect of the laws and demands 
 of nature. 
 
 Baldwin Latham, the eminent English sanitarian, says: “To those 
 who have carefully studied the physiology of animal life, it will be clear 
 that life and health depend upon rightly understanding and practicing 
 those laws which constitute sanitary science.” Hippocrates long ago 
 formulated the cardinal principle of sanitary science and hygiene as the 
 maintenance of “pure air, pure water, and pure soil.” It is for the 
 preservation of these natural elements that a sewerage system, and 
 other sanitary measures, become a necessity in cities, towns and villages 
 where life and health are fully appreciated, and our natural heritage 
 would be protected. This natural heritage may be described in the lan¬ 
 guage of Dr. Stephen Smith: “Man is born to health and longevity; 
 disease is abnormal, and death (except from old age) is accidental; and 
 both are preventable by human agencies.” 
 
 Diphtheria makes dark and desolate the former joyous and happy 
 home by taking away the joy and boundless pleasure-producing jewels— 
 the innocent children. Typhoid fever takes the life of a citizen in the 
 prime of manhood, with all his wealth-producing powers fully devel¬ 
 oped. An epidemic of scarlet fever, yellow fever, typhoid, diphtheria, 
 dysentery, or some other of the preventable diseases, multiplies desolate 
 homes, intense suffering and premature deaths, and we raise our hands 
 in horror and wonder how a kind and loving Providence can inflict 
 such a calamity upon our religious and worshipful community. By 
 thus relieving ourselves in sentimentality we may restore the equilib¬ 
 rium of a guilty conscience, but we utter the rankest blasphemy 
 against the Divine Creator and His well-defined laws. We are the cause 
 of the epidemic; we are the guilty ones. It is the criminal disregard of 
 
APPENDIX. 
 
 LXVII 
 
 the laws of Nature that causes this preventive sickness and premature 
 death of our fellow-man, and it is we, ourselves, who must carry the 
 moral responsibility. 
 
 Self-preservation is the first desire of all life, from the lowest organism 
 to the crowning monument of creating mankind. There is a universal 
 longing and effort to this end, and there is much proof to demonstrate 
 that this is likewise a duty imposed by the Creator. The Mosaic dis¬ 
 pensation clearly illustrates this fact, and likewise demonstrates the 
 universally proven and accepted maxim, that cleanliness of a commu¬ 
 nity is the first law of self-preservation—the preservation of man’s 
 natural heritage of health and longevity. 
 
 With the advanced knowledge of the law of cause and effect, resulting 
 from the sanitarian’s scientific study and investigation, and with the 
 results of sanitary measures before us, we cannot, as intelligent people, 
 attribute the consequence of our own neglect and carelessness to a 
 providential cause. We must recognize that a large proportion of the 
 diseases which are inflicted upon humanity are the effects of prevent¬ 
 able causes, and that it is possible, through the medium of sanitary 
 measures, to so reduce the death-rate as to materially increase the 
 average duration of life. 
 
 The alchemist of old expended his time in search of a hidden sub¬ 
 stance of nature which he supposed to exist, and to be, in fact, an elixir 
 of life, supposing, with much reason, that there existed some subtle 
 force of Nature which, if utilized, would prove to be a panacea for all 
 the ills to which he reasoned that man was the natural heir. Had lie 
 reversed Ms law of nature, and followed the true natural law, he would 
 have found that flesh is not heir to disease, but that disease is the heir 
 to the violations of nature’s laws in the flesh, and readily found his 
 elixir of youth in these same sanitary measures which the studen t in 
 sanitary science and the preservation of human life teaches us to observe 
 and diligently practice. 
 
 The romantic Ponce de Leon, when he left the crowded metropolis of 
 Spain and sailed across the ocean to an unknown and uninhabited 
 country, in search of the fountain of perpetual youth, acted with some 
 reason. From a city, where pure air, pure water and pure soil had 
 been destroyed by the unnatural accumulations of filth and uncltan- 
 ness—a very hot-bed of disease and death to Gfod s own fiee, fail and 
 unpolluted country, where naught had yet come to destroy the life- 
 giving and life-sustaining elements of pure air, water, and soil, was 
 indeed to find a fountain of perpetual youth, for who can gainsay that 
 fifteen years added to the average life is not at least as if to transform 
 
 age to youth ? 
 
 This same fountain of youth is ours but for the taking of it. V\ ould 
 we enjoy it in congregated communities of cities and towns, to v hich 
 we are wont to repair? Then but remember that public filth is public 
 
LX VIII 
 
 APPENDIX. 
 
 disgrace, and that sickness and death is the natural consequence of the 
 abuse of nature’s laws; but public cleanliness is public honor, and the 
 practice of sanitary measures is to secure intellectuality, advanced civil¬ 
 ization and achievements, health, happiness and longevity. To main¬ 
 tain this public cleanliness, provision must be made for the preservation 
 of the natural elements of pure air, pure water and pure soil, by at once 
 removing the effete substances of the body, and all other filth, to points 
 remote from the community, by the construction of a sanitary system 
 of sewerage, and practicing other sanitary measures in conjunction 
 therewith. Without this provision, the natural soil will become foul 
 and polluted, and, in time, totally unfit for human habitation. 
 
 Would you not leave to your posterity the city, town or village 
 abounding in filth, disease and premature death, with all their train of 
 unhappiness, pauperism, crime, enfeebled mind and body, and a degen¬ 
 erated civilization? Then have a care how you carry on the process of 
 soil-pollution; for, when the soil becomes impure the air becomes like¬ 
 wise impure by the foul emanations from the soil. The water is also 
 polluted by absorption from the air and transfusion from the soil; and 
 you have flagrantly disregarded the cardinal principle of sanitary 
 science and nature’s laws, and sickness, epidemics and premature death 
 is the natural result. But the soil, you say, is a purifier of filth. It is: 
 but this property of the soil is limited. By constant absorption of 
 impurities, the soil is overloaded, and itself becomes impure, and it is no 
 longer a purifier, but a polluter, in the effort to purify itself. Behold 
 and beware of the sad history of Rome, once the proud metropolis and 
 centre of civilization of the world, but now a plague-stricken city for 
 seveial months of each year. 
 
 Ancient Rome, under the rule of the Pagan Kings, had her Cloaca, 
 Maxima and other sewers, which ramified the entire city. Massive 
 baths, aqueducts and the accompanying sanitary measures maintained 
 her cleanliness, and the observance of nature’s laws enabled her to be 
 a grand metropolis of health, wealth and power. But, with the fall of 
 Rome, we find the necessity of sanitary provisions lost sight of or 
 unheeded, and the more modern Rome destroying the sewers, tearing 
 down the massive baths and aqueducts to build churches and monaste¬ 
 ries, totally disregarding the accumulated nastiness of the years during 
 the fall and recuperation. Until to-day, Christian Rome, with her glori¬ 
 ous heritage of past achievements, having permitted these sanitary 
 works to pass into decay, has many pages of her more modern history 
 blackened by the most horrifying accounts of terrible scourges of plague 
 and epidemics, paying the natural penalty of soil-pollution, as the most 
 deadly and dangerous plague-spot that has ever blotted creation. 
 
 Under the present regime , Rome is again giving due attention to sani¬ 
 tary measures, and the death rate is being gradually reduced, and the 
 deadly Roman fever is being rapidly obliterated. 
 
APPENDIX. 
 
 LXIX 
 
 If we investigate any age or any people of which history records the 
 advancement of civilization, art and science to any degree of refinement 
 and excellence, we find that the importance of sanitary measures were 
 fully appieciated and invariably adopted. Thus, Alexandria, Carth- 
 age, Heiculaneum, Jerusalem, Nineveh, all had their complete systems 
 of sewerage and water supply. Under the Mosaic dispensation, all sani¬ 
 tary laws then known were religiously observed, and we find that the 
 Jews had a clear knowledge of the necessity of removing all effete sub¬ 
 stances and filth from within and about their habitations. The duty 
 and necessity of observing and practicing these laws of nature against 
 soil-pollution was a prominent part of the inspiration to Moses when 
 pursuing the divine task of leading the Hebrew tribes out of the wilder¬ 
 ness of death and destruction. The devout adherence of the Jews to the 
 practice of the sanitary laws prescribed by Moses has given to that race 
 to enjoy greater health and vigor, even to the present day, than any 
 other race of people on the face of the earth, in similar circumstances. 
 
 As we advance in history to the middle or dark ages, we find that the 
 importance of sanitary measures which had characterized the Jews and 
 the Rome of the Pagan Kings was entirely lost sight of, and the statute 
 books bore no trace of these important laws—the first in importance for 
 the preservation and promotion of advanced civilization and refinement. 
 With this decline, there is recorded a parallel decline in art, science and 
 civilization. Beyond question, enlightenment and sanitation are insepa¬ 
 rable companions—the advancement of the one requires the advance¬ 
 ment of the other. 
 
 For the thousand years preceding the protest of Luther, that cardinal 
 law of Christianity, that “cleanliness is next to godliness,*’ was com¬ 
 pletely disregarded, and filth, by force of circumstances, was sanctioned 
 by the influence of the Christian church. The Christian outlaws of 
 Pagan Rome, to maintain their faith, were forced to seek refuge from 
 their prosecutors in the dark and filthy catacombs beneath the city, and 
 filth and unclean personal appearance became a measure of the sanctity 
 and personal sacrifice for their Christian faith. Through this cause the 
 importance of cleanly surroundings was wholly lost sight of. But the 
 laws of nature could not be defied, even for such a good cause, with 
 impunity; and as this neglect extended from person to community, from 
 community to city, there came, in due time, the inevitable result. Out¬ 
 raged nature aroused them from their insanitary neglect by the natural 
 consequence of pestilence in various forms visited upon these disregard- 
 ants of nature’s laws. Epidemics of plague, typhus and cholera devas¬ 
 tated Europe from the 14th to the 17th centuries, much more terrible in 
 fatal results than was ever caused by the most bitter warfare in history. 
 England, in twenty-two (22) years of continuous warfare, lost 79,700 
 lives, but in one (1) year alone cholera robbed her of 144,860 lives. 
 
 6 
 
LXX 
 
 APPENDIX. 
 
 During the prevalence of the plague at York, in 1664, there was one 
 (1) death to every three (3) persons living, but during the cholera 
 epidemic of 1832 there was one (1) death to each 142 persons living—an 
 improvement directly traceable, by the resurrected city archives, to the 
 improved sewerage and drainage of the city. In the year following, the 
 city of London is supposed to have lost 75,000 lives by her last visitation 
 of the plague, Black Death, as it has been called. 
 
 The history of the town of Chester furnishes another lesson of the 
 fearful results attending the utter neglect of sanitary precautions which 
 characterized the degenerate civilization of the middle ages. Of this 
 we have the following record: 
 
 “ In 1507 sweating sickness was very severe in Chester for three days; 
 ninety-one died. In 1517, great plague; grass a foot high in the streets. 
 1550, sweating sickness. 1603, great plague; sixty died weekly; in all, 
 650 persons. 1604, plague: 812 deaths. 1605. plague still increasing; 
 1,303 deaths. In 1649, 2,099 persons died of the plague.” 
 
 Such was the inevitable result of the disregard of nature’s laws for 
 self-preservation, “pure air, pure water and pure soil.” These unfor¬ 
 tunate people, in their blind ignorance, charged all their mysterious 
 sickness and deaths to Divine Providence, as some are inclined to do 
 even in this enlightened era, but forgot their garbage-heaps, foul streets, 
 dirty houses, personal uncleanness and their total lack of sanitary pro¬ 
 visions. Ignorance cannot be plead in mitigation of violations of civil 
 law, much less in physical laws of nature. Nature’s laws were made 
 unchangeable for all time—irradicable as creation itself. “God never 
 breaks His laws; He never permits them to be violated with impunity. 
 They operate in the material universe with inevitable accuracy.” 
 
 Gladly do I turn from this sad history of the past to the more cheerful 
 task of recording the benefits that have been derived from the prac¬ 
 ticing of sanitary measures, but this pleasure is checked by the thought 
 that, even in the brilliant enlightenment of our present century, the 
 lessons of the past have been but poorly learned. We have had—and 
 even now are having—black spots in our own country: our New Orleans, 
 our Memphis, our Jacksonville epidemics, and many others of greater 
 or less magnitude. It behooves us, as a country and as a State of 
 enlightened people, that these terrible lessons be not passed over lightly 
 and unheeded. By the epidemics of New Orleans, in 1853, there were 
 5,122 deaths from yellow fever, with a total of 7,000 deaths from all dis¬ 
 eases. In one day—August 22—the deaths from yellow fever numbered 
 239. This great number of deaths were recorded, and it is generally 
 believed that there were many deaths also which were not recorded. 
 Of the condition of the city at the time of the outbreak of the epidemic, 
 we are told that the streets were reeking with filth, and miasmic odors 
 prevailed throughout the city, caused by the decomposing animal and 
 vegetable matter that had been scattered promiscuously throughout the 
 
 
APPENDIX. 
 
 LX XI 
 
 city. Everything had, of custom, been thrown into the streets that the 
 inhabitants desired to be rid of, and lax there, seething and rotting. 
 The canals and their tributaries, and the city drains as well, were covered 
 with a green slime so completely that the water was entirely hidden 
 from view. In the pools were dead animals floating about, with every 
 other description of animal decomposition. It was by this wretched 
 insanitary condition that the seeds of epidemic were united and developed 
 with such disastrous results in the loss of human life. Yellow fever 
 and kindred maladies were more or less prevalent in the city till 1862, 
 when active sanitary measures were put into effect. The drains were 
 cleaned out; the streets were scraped, swept and washed of all dele¬ 
 terious matter: the canals and their tributaries were cleansed of their 
 germ-festering scum; stringent orders were issued against throwing any 
 filth or decaying vegetable or animal matter in the streets or open courts; 
 all refuse matter was required to be placed in proper receptacles, and 
 was then promptly removed without the city and disinfected. Every 
 household was required to clean up its premises and keep them clean. 
 The entire city was placed in as thorough sanitary condition as the loca¬ 
 tion and local conditions would permit. The gratifying result of this 
 was that not one of the 160,000 inhabitants, or the many thousands of 
 totally unacclimated troops, was stricken with yellow fever during that 
 year. These sanitary measures had so improved the general healthful¬ 
 ness of the city that for the summer of 1862 New Orleans is said to have 
 shown a less rate of mortality than any other city in the country. These 
 results were continuous, and, with this as a beginning, the city entered 
 upon a new era of substantial freedom from epidemic and malarious 
 diseases. They exchanged spoons for health. How can we appreciate 
 the enormous, immeasurable benefits accruing to the city from these 
 sanitary measures? 
 
 The financial loss by the yellow fever epidemic of 1853 may be closely 
 approximated as follows: 5,122 lives, at $1,000 each (which is a mini¬ 
 mum estimate), amounts to $5,122,000; estimating five cases of sickness 
 to each death (the Jacksonville epidemic shows ten cases to each death), 
 the cost of which, including loss of time, medical attendance and nurs¬ 
 ing, at a low estimate, would be $40 each, or $1,024,400, making a total 
 of $6,146,400. 
 
 The city of Memphis, Tennessee, disregarding the valuable lesson 
 taught by this short page of the history of New Orleans, scrupulously 
 neglected all sanitary measures. The streets had been allowed to become 
 filth channels. The soil of the city was permitted to become not unlike 
 a vast compost heap, through the lack of a sewerage system to remove 
 the filth, instead of carrying on the continued process of soil-pollution. 
 The laws of nature had been totally disregarded and violated, with the 
 consequences that we have been taught by the history of centuries, even 
 from the time of Moses, to be inevitable. 
 
LXXII 
 
 APPENDIX. 
 
 In 1878 we see Memphis visited by a terrible epidemic of yellow fever 
 with a fatality almost unparalleled. The commerce of the city was 
 entirely suspended, thousands of the inhabitants were dead and dying, 
 and many others making every effort to desert the city. The city gov¬ 
 ernment was bankrupted and disbanded; demoralization and panic were 
 general throughout the city until cold weather came and put a check 
 upon the ravages of the dreaded yellow visitor. In the meantime, 5,022 
 persons had lost their lives by the criminal negligence of those in 
 authority over the sanitary and general condition of the city. 
 
 Only after this costly lesson was the city induced to seek relief by 
 complying with the lawful demands of nature through the practice of 
 sanitary measures. A sanitary system of sewerage was adopted and 
 executed with scientific skill and efficiency. Other sanitary reforms, 
 made possible and efficient by the construction of sewers, were put into 
 practice, with the gratifying results best told in the decreased mortality 
 and absence of epidemics since these measures were executed. * * * 
 
 Under the former condition of the city the annual death-rate per 1,000 
 inhabitants was 109, while under the present regime , as shown by the 
 statistics of 1887, it has been reduced to 23.56 per 1,000. With the 
 changed sanitary condition seemed to come a new confidence and 
 interest in life. New vigor and energy characterized the inhabitants of 
 the city, and its healthfulness attracted immigration, with a consequent 
 great increase in industrial and commercial importance, and an increased 
 population from 83,592 in 1880 to 65,000 in 1888. 
 
 The financial value of this increased prosperity can hardly be esti_ 
 mated, at least the proportion due to the changed sanitary condition. 
 We can, however, demonstrate a great financial saving in human life 
 and healthfulness alone, directly due to the sanitary measures put into 
 practice. 
 
 The average population for the years from 1880 to 1888 has been, in 
 round numbers, 45,000. The average death-rate reduction may safely 
 be placed at 50 per 1,000 inhabitants, or a total saving of 2,250 lives annu¬ 
 ally. At the least valuation placed upon a human life in the United 
 States this saving of life would amount to $2,250,000 annually. The 
 number of cases of sickness likewise prevented may be safely estimated 
 at eight to each death, making 18,000, the cost of which, including loss 
 of time, medical attendance and nursing, at $50 each, would have been 
 $900,000. These two items make a total annual saving of $3,150,000. 
 
 Estimating six per cent, upon the cost of the sewerage system, and 
 adding the annual expense of carrying on the work of the very excellent 
 city Board of Health, makes a total annual expenditure of $36,337.86 to 
 effect this enormous annual saving of human life—in money value only. 
 
 The epidemic of yellow fever at Jacksonville, Fla., and other Southern 
 towns, during the past year, is but further results of the lack of sanitary 
 measures. In all the towns where this epidemic secured any foothold, 
 
APPENDIX. 
 
 LXXIII 
 
 it can safely be asserted that little or no attention had been previously 
 given to their sanitary condition. Th^se communities were living 
 amidst the accumulations of their own filth, with utter disregard to the 
 natural law against air, water and soil pollution. The inevitable result 
 was a severe epidemic, with all its train of moral, physical and financial 
 loss. Hundreds were suffering the most intense agony, and premature 
 deaths were numbered by the score before sanitary measures were 
 apparently thought of. But, when such an epidemic has already settled 
 upon a community, it is then too late to prevent the damages by any 
 hygienic means. This should be effected before the outbreak to render 
 a full return. Though it is happily conspicuous of the epidemic at Jack' 
 sonville, that, owing to the efforts of the Sanitary Committee and Board 
 of Health, and the greater knowledge of its treatment by the medical 
 profession, the rate of fatality has been reduced to one (1) death to ten 
 (10) cases of sickness, and the extent of the epidemic has been compara¬ 
 tively very limited—the number of cases having been 4,700. But when 
 the seeds of such epidemics have once found a suitable locality for 
 development and growth, their destructive effect is beyond the control 
 of human agency. From the history of New Orleans, Memphis and 
 Jacksonville, it seems to be clearly deduced that a yellow fever epidemic, 
 like every other, may be prevented by the practice of sanitary measures. 
 But, when the prevention is not applied, and a foothold is obtained, cold 
 weather alone can check its ravages. 
 
 Dr. Morris H. Henry, a prominent expert on the origin and treatment 
 of yellow fever, recently speaking of the Florida epidemic, has this to 
 say regarding the intimate relation of disease and death with insanita¬ 
 tion arid unclean surroundings: “ The popular idea of yellow fever is, 
 that its presence is accidental. * * * Yellow fever is no more the 
 result of accident than were the plagues of the East or the great plague 
 of London. The plague of London was not a punishment from Divine 
 Providence. It was a natural sequence of the absence of all sanitary 
 laws, and the failure to adopt any prophvlatic measures to prevent the 
 spread of what are now known, in plain Anglo-Saxon, as filth diseases." 
 
 BENEFICIAL RESULTS FROM SANITATION. 
 
 Illustrating the reduction of disease and mortality of towns and cities, 
 due directly to the construction of efficient systems of sewerage, I vt ill 
 first quote Sir Douglass Galton, K. C. B.. F. R. S., an eminent English 
 sanitarian, in an address before the Sanitary Institute of Great Britain. 
 “ It may be accepted as certain that in every case where the seweiage of 
 towns has been devised in sound principles, and where the woiks ha\e 
 been carried on under intelligent supervision, a largely reduced death- 
 rate has invariably followed. The records of Newcastle afford evidence 
 of this fact. The quinquennial period ending in 1881 showed a death- 
 
LX XIV 
 
 APPENDIX. 
 
 rate of twenty-three per 1,000, whilst the death-rate of 1881, after the 
 completion of the system of sewerage, was only twenty-one per 1,000.” 
 
 “At Munich the typhoid fever mortality per 10,000 inhabitants per 
 quinquennial period was as follows: 
 
 From 1860 to 1865, when there was no sewerage system.--16.8 
 
 From 1866 to 1878, when there was partial sewerage system-13.3 
 
 From 1875 to 1880, when the sewerage system was complete-8.7 
 
 “ Similarly, at Frankfort-on-Main, the deaths from typhoid fever per 
 10,000 inhabitants were: 
 
 From 1854 to 1859, when there was no sewerage system. 8.7 
 
 From 1875 to 1887, when the sewerage system was complete.2.4 
 
 “At Dantzic the figures present some striking characteristics; the 
 deaths from typhoid fever per 100,000 living were as follows: 
 
 From 1865 to 1869, when there was no sewerage or water-supply-108 
 
 From 1871 to 1875, after the introduction of water-supply. 90 
 
 From 1876 to 1880, after the completion of a sewerage system_ 18 
 
 “ At Hamburg, the deaths per 1,000 of total population were: 
 
 1838 to 1844, before the commencement of the construction of sew¬ 
 
 erage works.„---48.5 
 
 1871 to 1880, after the completion of the sewerage works__13.3 
 
 “ During the time that the works were in progress, viz., from 1872 to 
 1874, the mortality from typhoid was as follows: 
 
 In the unsewered districts...40.0 
 
 In the districts for the most part sewered... 32.0 
 
 In the fully-sewered districts ..... 26.8 
 
 Dr. Buchanan, as “Medical Officer of the Privy Council” of England, 
 in the ninth report, has shown the marked improvement to health fol¬ 
 lowing the introduction of systems of sewerage and water supply in 
 twenty-five cities and towns, with an aggregate population of 593,736 
 persons. 
 
 This report shows the effects of providing for the purity of the air, 
 water and soil of towns, by providing water from an uncontaminated 
 source, and by the prompt removal of all effete and refuse matter before 
 putrefaction and soil-pollution could take place, by a reduction of 24 
 per cent, in the mortality of typhoid fever alone. Dr. C. W. Chancellor, 
 
APPENDIX. 
 
 LX XV 
 
 Secretary of the Maryland Board of Health, and a thorough sanitarian, 
 states in his "Report on Improved Methods of Sewerage Disposal and 
 Water Supplies" (from which these quotations are taken), that it is fair 
 to presume that diphtheria and other zymotic miasmatic fevers would 
 be similarly affected. 
 
 Concerning the benefits derived in England, during the period from 
 1870 to 1880, from sanitary measures, the Local Government Board, in 
 their report, speak as follows: 
 
 “On the demonstration of various model instances, it may be held 
 that the reduction of the general death-rate by per cent., as reported, 
 satisfactory as this is, cannot be considered more than one-tliircl of the 
 results obtainable by advanced sanitary administrations and further 
 sanitary works. The pain and misery and the social disorder occasioned 
 by excessive sickness and premature mortality are greatly beyond pecu¬ 
 niary estimation.” 
 
 Mr. Baldwin Latham, the eminent English engineer and sanitarian, in 
 his work on “Sanitary Engineering,” gives tabulated results, in the 
 annual death-rate reduction per 1,000 inhabitants, following the intro¬ 
 duction of systems of sewerage in various English towns and cities, 
 from which the following list is taken: 
 
 Banbury—population 10,000: death-rate reduction 23.4 to 20.5—12| per ct. 
 
 Cardiff— “ 38,000; 
 
 Cray den— “ 30.000; 
 
 Ely— “ 8,000; 
 
 Wacclesfield— “ 27,000: 
 
 Newport— “ 25,000; 
 
 Salisbury— “ 9,000; 
 
 33.2 to 22.6—32 perct. 
 23.7to 18.6—22 perct. 
 23.9to20.5—14 perct. 
 29.8to28.7—20 perct. 
 31.8to21.6—32 perct. 
 27.5to21.9—20 perct. 
 
 Unfortunately, the lack of statistical records of American towns and 
 cities precludes the possibility of illustrating as fully the advantages of 
 sanitation in our own country; yet the fragmentary data that has been 
 compiled shows equally or greater gratifying results than the above 
 showing for European towns and cities. The statement will pass unchal¬ 
 lenged, that in any American town or city where any attention whatever 
 has been given to sanitary measures, greatly reduced sickness and mor¬ 
 tality among the inhabitants has been the result. 
 
 The city of St. Louis, Missouri, furnishes an average specimen of the 
 benefits to be derived from the construction of sanitary works. In I860, 
 when the city had given little or no attention to sanitation, the annual 
 death-rate was 32 per 1,000. This extreme rate of mortality continued 
 until the year 1865. During 1865-’70 a proper sewerage system was 
 constructed and accompanying sanitary 7 reforms were put in opeia- 
 tion, with the result that the death-rate in 18<0 "was 20 per 1,000 inhab¬ 
 itants—a saving of twelve human lives and 120 cases of pre\entable 
 
LX XVI 
 
 APPENDIX. 
 
 sickness in each thousand of the city’s population. The population of 
 St. Louis, in 1870, 310,864; in 1860, 160,773. The average population 
 from 1865 to 1870 may be taken at 298,341. Thus we have, as the result 
 of the sanitary works, the saving of 298.34-j-12, or 3,580 human lives 
 and the prevention of 35,800 cases of sickness annually. The financial 
 value to the city of these results is shown by the following estimate, 
 based upon minimum values: 
 
 3,580 human lives at $1,000 —....$ 3,580,000 
 
 35,800 cases of prevented sickness at $50... 1,790,000 
 
 Total annual saving of....$ 5,370,000 
 
 In the foregoing pages I have endeavored to clearly show the evil 
 results of sanitary neglect, and the varied and positive benefits to be 
 derived from the practice of sanitary measures. I have also endeavored 
 to demonstrate that the essence of all sanitation is the maintenance of 
 pure air, pure water and pure soil in and about the habitations of man. 
 Now, the question will naturally arise: How can these elements be pre¬ 
 served in their primeval purity, and what are the constituent features 
 of sanitation as regards this object? Of these three elements, the one 
 directly requiring the most of human agency is the soil. 
 
 It is but feebly realized what an important part the soil performs in 
 providing health and happiness to our lives. Upon this very largely, if 
 not wholly, depends the purity of the air and water. Polluted soil 
 means polluted water and impure air. If we preserve the purity of the 
 soil, the air and water will retain their purity. 
 
 The soil is the medium by which nature transforms the waste product 
 of animal life into vegetable life. Nature has provided that when any 
 of her agents, whether it be air. water or food, has once served the pur¬ 
 pose of sustaining animal life, that it becomes totally unfit for its further 
 promotion, without another transformation—becomes, in fact, destruc¬ 
 tive to animal existence; but, through this very process, these agents 
 have lost that which is detrimental to vegetable life in furnishing the 
 combustion of the animal kingdom. They are then prepared for the sup¬ 
 port of vegetable life, and, by vegetable growth, the chemical combina¬ 
 tions are made which causes this inert matter to become again prepared 
 for the nourishment of man and animals. The vegetable kingdom 
 requires for its support that which forms the waste product of the animal 
 kingdom. It utilizes these and renders a product again suitable for the 
 healthful use of the animal kingdom. Such is the cycle of the subtle 
 forces of nature in a grand development. While the atmosphere plays 
 quite an important part in this process, the first few feet of the soil is 
 the grand laboratory where the chemical disintegrations and combina¬ 
 tions are effected. Consequently, when the soil is polluted by accumu- 
 
APPENDIX. 
 
 LXXVII 
 
 lations of filth, this transformation is carried on in order that the soil 
 may again purify itself. This process of transformation of matter has, 
 either as an agent or as a result, the development of low forms of micro¬ 
 scopic life, known as bacteria, in direct proportion to the amount of 
 filth with which the soil is charged. These minute organisms play a 
 large part in the processes of the organic world, and have direct relation 
 to many of the common diseases. And it has been clearly demon¬ 
 strated that most all, if not every one, of the infectious and contagious 
 diseases are directly produced by and dependent upon specific forms of 
 these micro-organisms; that these minute organisms, developed in the 
 decomposition of filth, are the direct cause of what are known as filth 
 diseases, viz.: Typhoid, yellow and scarlet fevers, diphtheria, cholera, 
 dysentery, etc. 
 
 The soil being very porous, is constantly laden with large quantities 
 of water and air, and when these bacteria are present in the soil the 
 water and air in the soil become likewise their carriers and direct com¬ 
 municators to the human body. Ground-water is constantly flowing 
 through the soil under the same hydrostatic laws which govern the flow 
 in streams, always seeking a lower level, and the streams and wells are 
 thus supplied. But when the water has become charged with bacteria, 
 they are not arrested by its flowing through the soil. The soil will arrest 
 course material, such as grease and slime, but the bacteria diffuse with 
 ease, and follow the flow wholly unobstructed; and by their own develop¬ 
 ment and multiplicity, and their accumulating numbers, they derive an 
 accelerated vigor in their power to destroy human life. 
 
 Hence, a privy-vault or cess-pool, leeching into the soil and developing 
 bacteria, charges the surrounding soil with multitudes of disease-pro¬ 
 ducing micro-organisms, which, in turn, pollute the giound-water and 
 air-cells, the ground-water flowing on to supply the neighboring stream 
 or well; and from there these disease-germs are directly introduced into 
 the system by an innocent-looking, sparkling beverage which nature 
 intends should be healthful and life-sustaining. But by this contamina¬ 
 tion it is transformed into a rank poison, and when once introduced into 
 the system, the disease-germ finding suitable conditions for development, 
 intense suffering and premature death is the result. 
 
 Water being the principal agent lor conveying nutrition to eveiy pait 
 of the human system, deleterious matter with which it may be chaiged 
 is passed very rapidly and completely to the whole system by the natuial 
 absorption of the blood. 
 
 Directly from polluted soil we likewise have polluted air. Decompos¬ 
 ing matter is invariably exposed on the surface of polluted soil. The 
 gases evolved from this, as well as directly from the polluted soil, aie 
 absorbed into the atmosphere. The gases from animal decomposition 
 are, like those from the soil, charged with bacteria. By the piocess ol 
 transfusion of gases the air we breathe is then contaminated ith these 
 
LXXVIII 
 
 APPENDIX. 
 
 disease-germs. The air, when so polluted, makes an effort to oxidize 
 and purify the deterioiating elements, with the result of lost vitality 
 and unfitness to sustain animal life in health. 
 
 In the act of breathing, these noxious elements are introduced into the 
 system, with the result of lowered natural vitality and great suscepti¬ 
 bility of disease, and the blood becomes corrupted just as effectually as 
 if it were inoculated by any known poison. 
 
 Pure air, pure water, and wholesome food are the three important 
 agents for the healthful promotion of human life; they are likewise the 
 weapons of defence against the ravages of disease and premature death. 
 These natural agents, provided in their normal purity, comfort, health 
 and longevity are the results; if, as is so sadly frequent, they are provided 
 in an abnormal, polluted state, diseases, epidemics and premature deaths 
 are the natural sequence. Popular sanitation, then, resolves itself into: 
 1st. The provision of wholesome food products, and the disuse of such 
 food as has been rendered unwholesome by vicious adulterations, by 
 improper cooking, by decomposition or decay. 2d. The provision for 
 the constant exchange of breathed or vitiated air of the buildings in 
 which we reside for a new supply from the atmosphere without. 3d. 
 The maintenance of the purity of the soil in and about the habitations 
 of mankind, and in the source of private and public water-supplies; and 
 4th. The prompt removal of the effete substances which nature throws 
 off from the human body, and all other filth common to a dwelling or 
 community, to some point without, where its contaminating influence 
 cannot be exercised. 
 
 The sanitarian and scientist will continue to more clearly understand 
 the specific nature of the propagating germs of different diseases, and, 
 perhaps, discover the agent for their destruction. They will further 
 teach many valuable lessons for the protection of man’s natural heritage 
 of health and longevity. But the four factors of sanitation given above 
 compose a wide field of sanitation, and a thorough observance and prac¬ 
 tice of their teachings will lead to incalculable results for good. They 
 are of such vital and imperative importance that they should constitute 
 a popular study, and the knowledge of their effects and importance be 
 not confined to but a few persons. All should study, understand and 
 practice them. It is the latter two of these factors which leads directly 
 to my subject. It is the necessity for the prompt removal of filth and 
 the preservation of the purity of the soil which makes a sanitary system 
 of sewerage a positive necessity for towns and cities. 
 
 I have already shown that when the human excreta is permitted to 
 accumulate upon the soil, or to leech through it from privy-vaults or 
 cess-pools, in any community, the result is, impure air, water and soil. 
 The same is true of bath-room slops, kitchen slops, waste water, cast 
 promiscuously upon the surface of an undrained soil, to become a stag¬ 
 nant pool or hidden moat, and all the other various forms of filth com- 
 
APPENDIX. 
 
 LXXIX 
 
 mon to the habitations of man in congregated communities. It seems, 
 then, that there can be no further question as to the advisability and 
 necessity of getting rid of these substances at all hazards. The question 
 then arises: How can this best be accomplished? 
 
 Before proceeding to a discussion of the various expedients for the 
 removal of filth, I desire to call further attention to the condition of 
 things where no such provision is made, but where the deposition of 
 excretal matters is made in cess-pools and midden pits. While such a 
 practice was carried on by, and in harmony with, a primitive condition 
 of society, it must be alluded to, as we need not go back to any remote 
 period to find the people addicted to such a loathsome custom. 
 
 Repulsive as it is, we are forced to admit that it is a practice of our 
 own time and of many of our own towns, and, in many cases, with lit¬ 
 tle or no useful restrictions. It is not uncommon to find large sections 
 of many of our towns, with the only place of easement a rough struc¬ 
 ture enclosing a heap upon the surface, or a shallow, open, unwalled 
 cess-pool, within thirty or fifty feet of the kitchen-door, or of the well 
 which is supposed to furnish wholesome and pure water; that such a 
 supply can be furnished is emphatically an anomaly. It seems, therefore, 
 urgently proper that some evidence be given here of the dangerous 
 condition engendered by such insanitary practices. 
 
 It has already been demonstrated that excrementitious matter leech¬ 
 ing through the soil is fraught with great danger to life and health; 
 that when it is accumulated upon, or within the soil, it is thus con¬ 
 veyed to adjacent wells, is just as certain and just as plain as that 
 the well renews its supply of water as fast as it is drawn out; the bacteria 
 of putrefying human excrement passes, with water, through the soil 
 with but little less retardation than the water itself. To give positive 
 evidence of this, I will quote from reports and analyses given by Dr. 
 W. H. Corfield, “ Professor of Hygiene and Public Health at Univer¬ 
 sity College, London, ex-President of the Society of Medical Officers of 
 Health,” etc.: 
 
 “Thus, at Harpenden, Dr. Hunter reported, in 1864, that the wells 
 were near to the cess-pools, and that the water was so execrable that it 
 was actually abandoned by the people themselves. At Bridgeport, where 
 the cess-pools were often mere excavations in the soil, the well-water 
 became turbid after rain, and it has been known to smell offensively, 
 looking yellow, tasting strongly, with a pronounced drainy smell. 
 
 In the reports of the Medical Officer of the Privy Council (of England) 
 are continually found such statements as that pumps and wells aie 
 “ foul and unfit for use by infiltration from cess-pools; that the contents 
 of wells are very foul, it being sometimes necessary to add chloride of 
 lime to the water to destroy the offensive odor; the wells and cess-pools 
 appeared to exchange with great facility.’ 
 
LXXX 
 
 APPENDIX. 
 
 At Rugby it has been physically demonstrated that the wells were fed 
 by the cess-pools, and in many cases “the fluid thrown into the cess¬ 
 pool in the morning is pumped from the well at night,” and yet the 
 taint was only apparent at intervals, or when the water had been kept. 
 Thus a rank poison was—and is—not infrequently innocently self- 
 administered. Such subtle enemies of life do not warn us of their 
 approach with a blowing of trumpets or ostentatious appearance, but 
 they make their deadly march upon us in an obscurity in which only 
 the trained expert can detect them, rendering popular protection from 
 them only in the practice of preventive methods. 
 
 The source of pollution of well-water was pointed out in 1844 by the 
 Health of Towns Commission (England): 
 
 “As houses are built, and neighborhoods become more crowded, the 
 pollution of springs (and wells should be added) by the permeation of 
 matter from cess-pools becomes greater.” And though the cess-pools 
 may be deepened, and even cemented, this pollution of soil and water 
 cannot be wholly overcome. 
 
 The first report of the Rivers Pollution Commission (English), 1868, 
 contains some analyses of such well-water. In the case of a very deep 
 well, known as Bevington Bush Well, at Liverpool, in “ 100,000 parts of 
 water there were 86.7 parts of solid impurities, containing 12.61 parts of 
 chlorine and 8.721 parts of combined nitrogen, of which 8.678 parts 
 were in the form of nitrates and nitrites,” which is strong evidence of 
 “previous sew^age contamination.” The amount of the pollution of 
 this water is clearly given in the following statement made in the report: 
 
 “Since its descent to the earth as rain, 100,000 pounds of the water 
 had been contaminated with refuse animal matter equivalent to that 
 contained in 86,510 pounds of average London sewage.” 
 
 The above example shows that even the great depth of a well does 
 not prevent its being contaminated in this way; though it does tend to 
 show that there is a greater chance for the oxidation of the organic 
 matters in percolating to a depth than to a shallow well. The report 
 gives, as a general conclusion about deep-well water, that “when the 
 well is at a distance from thickly-inhabited places, the quality of the 
 water is generally excellent, but as the population around it increases, 
 the water gradually becomes mixed with a lager and increasing propor¬ 
 tion of excremental soakage.” 
 
 Several interesting examples of the pollution of well-water by excre- 
 mentitious matters are given in the third report of the same commission. 
 Such water is there described as “the bright and sparkling, but often 
 dangerous, beverage drawn from shallow wells, sunk into ground reek¬ 
 ing with filth and excrementitious matters.” Thus the water from a 
 well at the Blue House School, in Frome, “ contained unoxidized sewage 
 matters, besides exhibiting a very large anterior pollution of the same 
 kind.” 
 
APPENDIX. 
 
 LXXXI 
 
 k Of the water from a well in Durham (England), described as one of 
 the best, it is said that “this water, though clear and sparkling, is shown 
 by our analysis to be little else but the percolations from sewers and 
 cess-pits; 100,000 pounds of it contain the inorganic remains of as much 
 excrementitious matter as is present in 62,360 pounds of London sewage, 
 whilst the large proportion of chlorine which it contains shows that a 
 good deal of urine mixes with it.” 
 
 Of the water from the wells in Whitney, varying from a depth of six 
 to fifteen feet, it is said that “the water from these wells is frightfully 
 polluted and entirely unfit for human consumption. One of them which 
 we have analytically examined is supplied chiefly from percolations 
 from sewers and^ cess-pools, and contains a large portion of unoxidized 
 sewage matter, besides ammonia from urine.” From these instances it 
 is very plain that well and spring water is dangerously polluted by 
 storing excrementitious and other filth matters upon or in the adjacent 
 soil. This could not be so unless the soil was first contaminated by these 
 elements, since the water takes its foreign and impure substances from 
 the soil as it percolates through it, having fallen to the earth in rain as 
 a pure and wholesome beverage. 
 
 That impure soil makes impure air there is no more question. We, 
 therefore, have clear and positive proof that the deposition and accumu¬ 
 lation of excremental and other domestic filth upon or within the soil 
 about our dwellings is fraught with great dangers, and it is a positive 
 and infallible cause of diseases, epidemics and premature deaths, when 
 produced in any congregation of dwellings, whether it be village, town 
 or city. Such matters should be removed to points outside the commu¬ 
 nity without any delay, regardless of cost. * * * * 
 
 The various methods by which excremental and other domestic filth 
 is removed from within communities have been classified under three (3) 
 systems, viz.: 1st. Direct removal; 2d. Pneumatic; 3d. WAter carriage. 
 The first is generally applied to excremental matters only; the second 
 to fmcal matters, and a minimum quantity of water; the third to excre¬ 
 mental and all other liquid filth. 
 
 Under direct removal are classed all the dry methods, such as the tub 
 or pail systems—the “Eureka,” “Goux,” “Rochdale,” “Manchester,” 
 etc. Dry closets—“ Moule’s,” “Phillips’,” “Taylor’s,” “Sanford’sCarbon 
 
 Closet,” etc. 
 
 Of the pneumatic the most important are the Lieurniei, Beiliei. ’ 
 “LeMarquand” and the “ Shone Pneumatic Ejector.” The water-car¬ 
 riage systems may be comprehensively classified as the combined and 
 
 separate. 
 
 To effect a sanitary solution of the problem of filth removal, any sys¬ 
 tem must comprehend a duty, which may be briefly stated, as follows. 
 The immediate, rapid and complete removal of all domestic filth, such 
 as waste water, water-closet, bath-room, bed-room, laundry and kitchen 
 
LXXXII 
 
 APPENDIX. 
 
 slops, to some point or points without the town or city where it cannoj 
 exercise a contaminating influence upon the health of the inhabitants. 
 
 In examining the various systems, I desire to determine to what extent 
 they accomplish this object, and from which may be derived the greatest 
 sanitary efficiency. 
 
 The Eureka tub plan was thoroughly experimented upon at Hyde, 
 England. It consisted of the ordinary tub, containing a small quantity 
 of disinfecting and deodorizing mixture, placed under the privy seat for 
 the reception of fa?cal matters only, no slops being permitted to be added. 
 The sizes of the tubs were adapted for several days' service. When 
 becoming full, they were exchanged for a fresh tub. The full ones were 
 covered by a tightly fitting lid and hauled in a close cart to a manure 
 manufactory, where the contents were treated with more disinfectants, 
 and ashes were added, making a manure of little value, containing only 
 from one to two per cent, of ammonia. 
 
 The working of the plan was generally considered a very dangerous 
 nuisance, and was soon abandoned. The plan did not embrace either of 
 the three essentials of a sanitary plan: neither an immediate, rapid or 
 complete removal of domestic filth. 
 
 The Goux system, otherwise known as the “Patent Absorbent Closet 
 System,” consisted of the ordinary tub or pail system, modified by lining 
 the tubs with some sort of absorbent material. The absorbent material 
 was made from any sort of refuse animal or vegetable fibrous matters, 
 mixed with a small percentage of sulphate of iron or lime sulphate. It 
 is pressed closely to the bottom and sides of the tub by a suitable mold, 
 leaving a cavity in the center of the absorbent material; These tubs are 
 designed as receptacles for exci emental and bed-room slops only, and are 
 to be removed weekly or twice a week. In practice, this plan has been 
 found to be of but little use. The absorptive capacity is very soon 
 exceeded, and the tub soon becomes the simple pail method, the only 
 accomplishment being the prevention of soil pollution, with no regard 
 for the purity of the air surrounding the tubs. The distinguishing feature 
 of the Rochdale system is the provision of a receptacle for a disinfecting 
 fluid, so that it can be applied to each deposition of fasces and urine. 
 These tubs are to be emptied weekly or semi-weekly. 
 
 In the Manchester system a receptacle for ashes is provided, so that 
 the ashes can be immediately applied to the dejecta, acting as an absorb¬ 
 ent and as'an arrester of decomposition. The ashes must be applied by 
 hand, after the style of the Hebrew children, with the paddle, under the 
 Mosaic dispensation. 
 
 I have but simply described these modified pail systems, as I think a 
 popular acquaintance with their details to be of little value. Wherever 
 they are used the natural tendency will be to harbor the filth in the 
 community for a long time—at least until the receptacles are full and 
 running over, and as long as there is an absence of unpleasant odor. It 
 
APPENDIX. 
 
 LXXXIII 
 
 is so well determined that any method of retaining filth within the 
 neighborhood is insanitary, that it would seem a dangerous practice to 
 thus encourage this retention. 
 
 I am rather of the opinion that the common pail or tub closet for the 
 deposition of excremental matters is even preferable, as their infallible 
 effect upon the olfactory nerves serves as a constant reminder of their 
 danger and of the necessity for frequent removal. It may be freely 
 asserted that any pail system, without embracing daily removal and 
 thorough cleansing and disinfecting of the receptacles, is an extremely 
 dangerous and unmitigated nuisance. ‘ 4 Moreover, this very frequent 
 collection of filth by hand from houses, and its removal almost neces¬ 
 sarily under the eye and nose of the household, is universally condemned 
 by our domestic habits as nasty and offensive.’" The pail system can 
 never become any success, either from an economic or sanitary stand¬ 
 point. It fails to accomplish either of the three requisites of a sanitary 
 solution of the filth-removal problem. It is neither immediate, rapid 
 nor complete. 
 
 DRY-CLOSET SYSTEMS. 
 
 While the dry-closet systems likewise fail as a sanitary solution of 
 filth-removal, they are entitled to somewhat more consideration, since 
 they, in a great measure, overcome the dangers of the pail or tub sys¬ 
 tems, and may be said to have a conditional adaptability of some value. 
 That they do, in fact, serve as a very valuable method for villages and 
 very small towns, I shall attempt to demonstrate. 
 
 The principle upon which these systems are operated, is that ashes, 
 charcoal, and some sorts of dry, pulverized earth, have extensive prop¬ 
 erties as deodorants, disinfectants and absorbents of excremental mat¬ 
 ters. It proposes to directly apply one of these substances immediately 
 upon the excremental matters. As stated above, however, it disregatds 
 any disposal of “slops” and other household wastes. The systematic 
 application of these properties of dry earth has been effected by some 
 mechanical applications, introduced by Mr. Moule, and designated as 
 the Moule system. All other systems are but modifications of the essen¬ 
 tial features contained in the Moule system, hence a description of 
 this will quite comprehensively embrace the whole dry-closet system. 
 Quoting from the prospectus of the Moule s Patent Earth Closet Com¬ 
 pany, we have this description of the system: "It is founded on the 
 fact of the deodorizing power of earth, a given quantity of dry earth 
 destroying all smell, and entirely preventing noxious \apois and othei 
 discomforts. The practical application of this povvei consists in a lesei- 
 voir for containing dry earth, and an apparatus foi measuiing and 
 delivering the requisite quantity, so as to deal with every opeiation in 
 detail.” The essential features of this system, then, would seem to be, 
 
LX XXIV 
 
 APPENDIX. 
 
 that the earth should be dry, and that each faecal deposition should be 
 at once covered with a sufficient quantity of dry earth. The application 
 of the dry earth may be done mechanically or by the hand; the mechanical 
 arrangements, however, seem never to have applied this to the dejecta 
 in a completely satisfactory manner. It would seem likewise difficult 
 to apply it by hand so that the entire dejecta would be covered to the 
 requisite depth without a large quantity of soil is used, and as the supply 
 of the soil, even in the necessary quantity, is the expensive part of the 
 system, this becomes a formidable objection. The earth or ashes for 
 this purpose is stored generally in a reservoir built into the back part 
 of the closet, and the requisite quantity is applied to each stool. By a 
 chemical action of the dry earth the complete disintegration of the 
 fa?cal matters takes place, and no excremental matter can hardly be 
 detected in the mixture, except by a slight odor that arises therefrom. 
 An accumulation of several weeks is the general custom, and then the 
 mixture is removed and dried and used again, and perhaps again as dry 
 earth. While the substance still has great absorbent properties, it can 
 hardly be considered a safe custom to repeat the use of the same soil 
 without having first given it an opportunity of purifying itself by pro¬ 
 moting vegetable growth. 
 
 The dry-eartli system has been operated in many military camps, 
 schools, colleges, hospitals and prisons with varied success. Wherever 
 it has proved a failure, or caused any nuisance or disease, it may be safely 
 asserted that it was due, not to the system, but to the improper work¬ 
 ings of the system, such as a too limited supply of earth or improper 
 mechanical application. The great drawback to its use has been the 
 enormous quantity of earth to be supplied, and the difficulty in obtain¬ 
 ing earth suitable f or this purpose. The most suitable soil is rich garden 
 mold; following this, in order of merit, is peaty soils, black cotton soils, 
 clays, etc.; the poorest is sand. 
 
 The quantity of soil determined by practice to be sufficient to remove 
 all smell from an average adult stool, varies from 1-J to 24 pounds, 
 according to the nature of the soil used, and 2£ pounds of prepared 
 proper soil is necessary for each use of the urinal. Provision should be 
 made for three (3) uses of the urinal per twenty-four (24) hours, making 
 a total per adult of 8f pounds daily. It would, therefore, require for a 
 mixed population of adults and children, such as is found in a town or 
 village, 6f pounds per person per day, a total per 1,000 population of 
 6.375 pounds, or a total of 2.328,468 pounds, or 1,164 tons per year, and 
 this, together with the ordure to be removed, would amount to 1,424 
 tons, making the total transportation per annum, per 1,000 persons, 2,588 
 tons. The cost of this system may be estimated as follows: To dry, 
 pulverize, haul, distribute, collect and haul away, could hardly cost less 
 than $2.00 per ton, or $2,848; the resultant product, after being made 
 into a poudrette, might be sold for 50 cents per ton, reducing the cost to 
 
APPENDIX. 
 
 LXXXV 
 
 $2,136 per annum per 1,000 persons. Now, applying this to a town of 
 10,000 inhabitants, there would be required 11,640 tons of earth per 
 annum, and a cost of $21,360, showing clearly the impracticability of 
 operating the system in any but very small communities or detached 
 public institutions. 
 
 In very small and sparsely populated communities, where each house¬ 
 hold could be induced to prepare its own dry earth, and utilize the 
 resultant upon their garden, the cost would be reduced to a minimum, 
 and give a service which would be a large improvement upon the cess¬ 
 pool or pail methods. 
 
 Besides the impracticability of this system for larger towns, the ser¬ 
 vice it gives is but trifling as compared with the water carriage system. 
 For every pound of human excreta treated by this dry-earth method, it 
 is estimated that there is 190 pounds of other fluid refuse, of which it is 
 likewise essential that it be removed, and which is removed by the 
 water-carriage system. We have, then, when applied to large commu¬ 
 nities, a system at greatly increased cost, but giving only f i- 1 part of the 
 service which is essential, and which is given by the water carriage 
 system; and yet, though this system lacks all the sanitary requirements 
 of sewage disposal, it is likely the best that can be adopted when there 
 cannot be obtained sufficient water for the water-carriage system. 
 
 To close the discussion of the conservancy systems, I will quote from 
 an authority which must, indeed, carry conviction, it being probably 
 the best authority that can be found—-the Committee of the British Asso¬ 
 ciation on the Treatment and Utilization of Sewage: “ All conservancy 
 plans, including midden heap and cess-pool systems, pail closets, dry-ash 
 and dry-earth closets, etc., are quite incompetent as the solution of the 
 general questions of the removal of the refuse matters of a population. 
 Such plans deal only with a small part of the liquid measure; towns 
 which resort to one of them require, therefore, to be sewered. Such 
 plans, moreover, all violate one of the most important of sanitary laws, 
 which is, that all refuse matters which are liable to become injurious to 
 health should be removed instantly and dealt with afterwards. With 
 all these plans, it is an obvious advantage on the score of economy to 
 keep the refuse about the premises as long as possible; and the use of 
 deodorants of various sorts, or even of disinfectants, proves that this is 
 the case, and that these systems all depend upon a fallacious principle. 
 They should, therefore, be discouraged as much as possible, and only 
 resorted to as temporary expedients, or with small populations, under 
 exceptional circumstances." 
 
 PNEUMATIC SYSTEMS. 
 
 The Pneumatic systems which I have named above have been suc¬ 
 cessfully operated in several cities abroad and have proved themselves 
 
 7 
 
LXXXVI 
 
 APPENDIX. 
 
 to be of good sanitary service and especially applicable to low-lying dis¬ 
 tricts, and such places where sufficient grade for the water-carriage 
 system cannot readily be obtained, and at places where the sewage must 
 be pumped to be conveyed to a proper outfall. 
 
 The distinguishing feature of these systems is, that the sewage is trans¬ 
 ported by air instead of by water. The pipes of this system are sealed, 
 air-tight, and may be laid regardless of grade (except in the Shone sys¬ 
 tem). By a central pumping station the air is exhausted from them, 
 causing a rapid flowing in of external air through the tilth receptacles 
 to which they are attached. This sudden influx of air carries the sew¬ 
 age before it at a great velocity until it is all collected and disposed of. 
 The objections that may validly be made to this system are the excessive 
 cost and the improbability of thorough cleansing of the pipes by the 
 passage of air through them. Inasmuch as we have nut a city in our 
 State which would probably have to resort to this method, I will forego 
 a more detailed description of it, and pass on to the 
 
 WATER-CARRIAGE SYSTEM. 
 
 Water, being itself the great scavenger of nature, cleansing our 
 bodies, our clothes, our homes, our food and cooking utensils, it is, in 
 fact, the natural agent of all cleanliness. When it has performed this 
 service then it becomes itself foul and loaded with various impurities, 
 and is no longer in a condition fit for the uses of our homes, and is a 
 great source of danger to health if permitted to remain about our habi¬ 
 tations. Consequently, it should be gotten rid of at once in the most 
 expeditious manner. In getting rid of this waste water, it is made, by 
 the aid of gravity, the carrier of excrementitious matter and all domestic 
 filth. We have, then, a method effecting the immediate, rapid and 
 complete removal of domestic filth by an agency which, being itself an 
 oxidizer, checks the putrefaction until it is removed beyond a point of 
 contaminating influence. This agent being water, this method is very 
 properly known as the water-carriage system. 
 
 By the proper application of the laws governing the flow of water in 
 pipes, and by the proper regard for known features concerning the flow 
 of sew r age through pipes, this system is made to solve, in the greatest 
 sanitary degree, the problem of filth removal. In proof of this state¬ 
 ment, we have the many cases of death-rate reduction—some mentioned 
 but many others omitted in this paper—due to sanitary measures; all 
 have been effected where the water-carriage system has been operated. 
 Indeed, it could not be otherwise, for the principle is obviously the correct 
 one, causing, as it does, the immediate, rapid and complete removal of 
 all deleterious substances. It does not permit filth to be harbored and 
 experimented with upon the premises, nor to remain and pollute the air, 
 water and soil immediately surrounding our dwellings. It emphatically 
 
APPENDIX. 
 
 LXXXVII 
 
 should, and does, first remove the dangerous excretal and other effete 
 substances, to a point beyond the power of exerting deleterious influ¬ 
 ences, and permit experimenting and utilization schemes to be practiced 
 aftei v aids. I do not mean to say that the manurial properties of sew¬ 
 age should not be utilized and returned to the soil, but it is unques¬ 
 tionably the proper order that it should first be harmlessly removed and 
 rendered itself harmless. The evil should certainly first be overcome, 
 even should it cause the sacrifice of some good. 
 
 In the preceding pages I have shown that the tendency and the prac¬ 
 tice of all the conservancy or dry systems is to retain the filth about the 
 premises for a long time after having simply deodorized it by dry earth 
 or ashes; that it is thereby rendered harmless is only a presumption, 
 and its correctness has not been borne out by any evidence whatever. 
 Since we know so little of the effect of dry earth upon the disease-germs 
 developed by putrefying excretal matters, but know so well the evil 
 effect of these germs upon the health and life of man, it must be freely 
 admitted that any system of conservancy is based upon an unsafe and 
 wrong principle. 
 
 The only safety lies in getting rid of these obnoxious agencies in the 
 most expeditious manner, and this is admirably done by the water- 
 carriage system, in the cheapest manner possible, by the simple aid of 
 gravity. It has been determined in practice that it costs but one-tenth 
 to convey by water and gravity of the cost by cart removal. 
 
 It may be objected that a water-carriage system of sewerage, con¬ 
 necting as it does all parts of the town or city by a vast net-work of 
 underground channels, has a tendency to fVeely circulate evil effects 
 from accumulations in the sewer, and consequent generation of delete¬ 
 rious gases. But this is not a valid objection, as it can only occur from 
 faulty construction, and is not a fault of the system itself. In construct¬ 
 ing a system of sewers, it is not simply necessary to dig ditches and drop 
 in the pipes, fit the joints with a little cement, and pass on. Such hap¬ 
 hazard work in anything will surely prevent successful operation, and 
 the evil results following such a course as this cannot justly be attributed 
 to the fault of the principle. It is the abuse of the good principle that 
 produces the evil. 
 
 In practice we have two water-carriage systems of sewerage, the “Sepa¬ 
 rate System” and the “Combined System/' Under the “Separate 
 System ” the sewers are small and designed to carry only such substances 
 as come properly under the head of sewage, which may be defined as 
 the liquid and feculent refuse from dwellings and their appurtenances, 
 leaving the storm-water and surface drainage to be treated separately. 
 
 Under the “ Combined System,” storm-water, surface and subsoil 
 drainage is ako included. Before discussing the relative merits of the 
 two, I will briefly formulate the essential features for fulfilling the 
 sanitary functions of a sewerage system. It should convey all sewage 
 
LXXXVIII 
 
 APPENDIX. 
 
 immediately and rapidly to the outfall, so that there can be no time for 
 decomposition or generation of gases while passing through the sewer; 
 to effect this, it should be of proper size and gradient, of smooth bore, 
 and laid to true alignment and gradient. It should be so well ventilated 
 that there would be a constant interchange of air from within and with¬ 
 out the sewer, so that what gas, if any, might be generated, would be 
 so diluted as to be practically harmless. It should be occasionally 
 flushed, so that no accumulations which might adhere to the sewer from 
 irregular flow would become sufficiently decomposed to generate sewer 
 gas. It should be impervious to water and sewage throughout its length, 
 to preserve the soil from sewage pollution. To recapitulate, the prime 
 essentials of a sanitary sewerage are: 
 
 1st. Immediate, rapid and complete removal of sewage beyond the 
 point of danger. 
 
 2d. It should prevent the accumulation of noxious gases by sufficient 
 ventilation and proper construction. 
 
 3d. It should be susceptible to effectual flushing. 
 
 4th. It should be impervious. 
 
 Any sewer deficient in either of these requisites is a foe to humanity, 
 and should be at once either reconstructed or its use discontinued. 
 
 For the “Combined System” the sewers are necessarily made very 
 large; they are usually constructed of brick and of various shapes. The 
 preferable shape is ovoidal, with the smaller end down, as this form 
 provides maximum velocity to the minimum flow. The brick is likely 
 to be more or less rough and porous, causing retardation of flow, accu¬ 
 mulations of shiny substances, and organic matters, and soil pollution. 
 In time of severe rain, when the sewer is running full, or nearly full, 
 the excretal matters, being in suspension, are left adhering to the sides 
 of the sewer and in the crevices at the joints, and this filth must remain 
 there, decomposing and giving off noxious gases, until an equally severe 
 storm comes again to wash this down and deposit a fresh supply of this 
 antidote of health as the flow recedes. 
 
 With each heavy rainfall, there are various substances which pass 
 the catch-basin and form deposits on the bottom of the sewer, causing 
 accumulating obstacles to the flow. By these obstructions, the sewage 
 forms itself into innumerable cess-pools, which, in the dry-weather 
 flow, is unmolested in its natural development of sewer gas and bacteria, 
 jeopardizing the health and life of every inmate in each house with 
 which the sewer is connected. It should be borne in mind that the 
 native heath of bacteria is in just such dark and damp places as this 
 affords. It is the great amount of sewer-gas that is thus generated 
 which makes it next to impossible to sufficiently ventilate such sewers. 
 They can be ventilated, and much external air introduced into the 
 sew T er, but not in sufficient quantity to overcome or purify the great 
 volume of gas that accumulates in such sewers. A very great and 
 
APPENDIX. 
 
 LXXXIX 
 
 extremely popular objection to the combined system is, the great cost 
 of providing such large sewers for carrying the storm-water to a distant 
 point on account of its contamination when mixed with excrementitious 
 matters, whereas, if it were not so polluted, it could, in most cases, at 
 least, be readily turned into the natural channels and safely left to care 
 for itself. 
 
 From what is above set forth, it may be reasonably claimed that 
 neither of the essentials named above can be secured by the “ Combined 
 System.” 
 
 On the other hand, each of these essential features can be secured and 
 all these objections overcome by the “Separate System,” when designed 
 and constructed with proper engineering skill, under the guidance and 
 direction of, and with due appreciation for, the sanitary requirements 
 and the laws of sanitary science. There are many and divers objections 
 to the “Combined System,” both from an economic and a sanitary 
 standpoint, which I might discuss, but I trust that enough is said to 
 convince my readers that it is a radically wrong plan to turn excretal 
 filth into the storm-water sewers. If storm sewers must be built, it 
 will add but comparatively little to the expense to construct at the same 
 time a system of impervious pipe sewers from the domestic filth only. 
 
 SEPARATE SYSTEM. 
 
 By a skillful application of the principles of the “ Separate System, 
 the solution of the filth-removal problem is greatly simplified. Instead 
 of planning the sewers for the maximum of extremely variable flow, as 
 in the “Combined System,” with an enforced disregard for the dry- 
 weather or sewage flow, we deal directly with this flow, with a com¬ 
 parative certainty as to its amount, which, as compared with the rain¬ 
 water flow, is quite regular. It remains, then, but to determine the 
 quantity of sewage which the system will be required to convey, and 
 the proper adjustment of the size, form and kind of sewer proportionate 
 to this service, to secure immediate, rapid and complete removal. 
 Having secured this, each of the other sanitary requirements aie but 
 matters of proper design and construction. That the sanitary featuies 
 and health preserving efficiency of a system of sewers has been effected 
 by the “ Separate System ” to a degree closely approximating perfection, 
 has been in many cases demonstrated, both in this country and in 
 Europe, where the system has been put into operation undei a studied 
 appreciation of the sanitary requirements and skilled direction. 
 
 The essential feature of this system is, that the sewers shall be small, 
 or of a size just sufficient for the service which it is designed to perfoim. 
 It has been determined that a small quantity of any fluid, " hen passing 
 through a large channel or conduit, will have a sluggish flow and a total 
 incapacity of removing obstacles in its path; but this same quantity, 
 
xc 
 
 APPENDIX. 
 
 when contracted in a small or suitable conduit, flows with a rapid and 
 accelerated velocity, with effectual scouring properties, removing any 
 ordinary obstacles that may be in its path. Hence it is that the small 
 sewers of the “Separate System” give a service vastly superior to those 
 of the “ Combined.” 
 
 To illustrate this: It has been determined that a six (6) inch pipe run¬ 
 ning half full of sewage, with a grade of 1 in 40, will give a velocity of 
 3 feet per second, while the same quantity of sewage passing through a 
 twelve (12) inch pipe with the same grade will have a velocity of but 
 2 feet per second. Again, a 12-inch sewer, flowing half full, with a 
 grade of 1 in 200, will give a velocity of 3| feet per second, a thoroughly 
 self-cleansing velocity, while the same quantity of sewage, flowing 
 through a 36-inch sewer, with the same grade, will give a velocity of 
 If feet per second, which is not a self-cleansing velocity. 
 
 The popular demand for large sewers is almost wholly founded upon 
 fallacy. There has been, to some extent, a strong demand on the part 
 of the laity and board of town commissioners that the sewers should 
 be made “plenty big enough and some to spare,” with the result that 
 the sewer falls far short of fulfilling the sanitary demands, and the 
 accumulations therein encouraged and effected make a serious item of 
 expense in their removal. The popular demand regarding sewers should 
 be that they be made small enough to perform the required service in an 
 economic and sanitary manner. In a small sized, properly laid sewer, 
 and properly adjusted to the required service, stoppages will rarely, if 
 ever, occur, while, if it were replaced by a large sewer, stoppages will be 
 constantly occurring, causing a large cost of maintenance and seriously 
 interfering with the sanitary service which it is sought to obtain. 
 
 It has been so thoroughly demonstrated by actual experiment, that 
 there can be no further question as to the efficiency of small pipe sewers. 
 A system of pipe sewers, properly adjusted and not too large for the 
 work to perform, with proper grades and proper construction in all its 
 parts, will immediately , rapidly and completely remove the domestic 
 filth from without the town to a safe outfall, before any decomposition 
 can take place, and while the sewage is comparatively innocuous and 
 harmless. Not the least recommendation of the “ Separate System” 
 is the wide application to which it is adapted. Its cost being but one- 
 fifth or one-sixth of the “Combined System,” the smaller sized cities, 
 such as we have in North Carolina, which would be debarred from the 
 advantages of sewerage by the great cost of the “Combined System,” 
 can have all the benefits of the removal of domestic filth before the soil 
 has become saturated and polluted by its habitual accumulation, by the 
 application of the “Separate System,” and at a comparatively small 
 expenditure. 
 
 The scope of this paper will not permit going into the details of 
 sewerage plans and construction. But I desire to briefly notice certain 
 
APPENDIX. 
 
 XCI 
 
 general principles, features and facts connected with sanitary design 
 and construction of a sewerage system, which should be well known 
 and practiced, especially by boards of city commissioners, when the 
 subject of sewerage is brought up for discussion. 
 
 PLANS. 
 
 Whether it is intended co construct a system of sewerage for the entire 
 town or city, or to construct sewers only for the most thickly populated 
 districts or streets, the first thing to be done is to have a complete system 
 designed, embracing the entire municipality and the natural drainage 
 area contiguous thereto. Having the design for the system as a whole, 
 such parts as are desired may be constructed at once without interfering 
 with the future construction. This section, being a part of a final whole, 
 is perfectly adjusted to the future demands upon and the future exten¬ 
 sions from it. It is a permanent fixture, and unlike sewers which are 
 so frequently built by piecemeal, and without any order as to harmo¬ 
 nious connections, it will not have to be torn up and reconstructed when 
 it is desired to sewer the remaining portions of the town or city. But 
 the system may be extended as required, and from the inception to the 
 completion the system will be adapted to all its parts, and continually 
 serve as a properly adjusted part of the development into an harmo¬ 
 nious whole, each part being properly adapted to the service which it is 
 intended to perform in securing the sanitary benefits of a properly con¬ 
 structed system of sewerage. 
 
 The importance of this point cannot be overestimated, for it must be 
 clearly seen that in a comprehensive system all the parts must be in 
 intimate relation to each other, and, in fact, they will be largely inter¬ 
 dependent for thorough and successful service of the system, and unless 
 it is designed as a whole, this regulation of the parts cannot afterward 
 be obtained. 
 
 MATERIAL AND FORM OF SEWERS. 
 
 The material to be used in the construction of sewers should be vitrified 
 salt-glazed earthenware pipe, up to a size sufficient to discharge 5,000 
 gallons of sew’age per minute, viz.: An egg-shaped sewer with diameters 
 of two and three feet, with a grade of one inch in five hundred. 
 
 This material being subjected to an intense heat to take the salt glaze, 
 is very hard, durable and impervious. The glazing protects the sewer 
 from the disintegrating action of the acids common to sewage, and 
 secures a smooth surface for the sewage flow, aiding the cleansing 
 properties of the sewer. The form of these pipe-sewers should be 
 circular up to a diameter of eighteen (18) inches, and with some qualities 
 of pipe to twenty-four (24) inches. Circular form is preferable, as it 
 
XCII 
 
 APPENDIX. 
 
 better resists the resultant of the external and internal forces acting 
 upon it, and because, in the manufacture of sewer pipe, it is the most 
 economic and the truest in form. 
 
 The elliptical or egg-shaped sewers have much in their favor in that 
 they secure the greatest cross-section of flow for the wetted perimeter 
 or frictional surface, and for their greater ability to resist the vertical 
 pressure upon them which is the greatest of the external forces. So, 
 that for sewers laid at a great depth, they are preferable to the circular 
 form. In the iarger sizes, especially where the volume of flow is likely 
 to be subject to great fluctuations, they are likewise preferable. Their 
 form should be made by compounding circular arcs of three different 
 radii: the smallest radius for the bottom, a larger one for the top and a 
 still larger radius for the two sides. The relative lengths of the vertical 
 and horizontal diameters varies in the practice of different authorities, 
 but a safe preference is the vertical equal to 1£ times the horizontal 
 diameter. 
 
 SIZE OF SEWERS. 
 
 The size of the sewers in any system is dependent upon two factors: 
 the volume of sewage and the grades obtainable. The chief objects to 
 be obtained in regulating the size of sewers are, that they shall readily 
 carry the maximum volume and secure a self-cleansing velocity. The 
 velocity of flow is dependent upon the volume and rate of inclination. 
 A small-sized sewer must have a greater rate of inclination than a larger 
 one to secure the same velocity, but the larger sewer must in turn have 
 the same relative volume of sewage to its carrying capacity. Thus a 
 ten (10) inch sewer flowing half full, to give a velocity of 4 feet per second, 
 must have a grade of 1 in 180, while a twelve (12) inch sewer will give 
 the same velocity at a grade of 1 in 160, but it must be likewise flowing 
 one-lialf full, i. e., the volume of discharge must be 1,410 gallons per 
 minute, almost one and one-half (1^) times the volume necessary to 
 secure the same velocity in the 10-inch sewer, which is 952 gallons per 
 minute. Thus we see the need of the conscientious and painstaking 
 performance of duty by the engineer in properly adjusting the size of the 
 sewers of a system to the obtainable grades. The velocity necessary to 
 secure self-cleansing properties has been determined by experiment and 
 practice to be not less than three feet per second in sewer-pipes of less 
 than twelve inches diameter, and not less than two and one-half feet 
 per second in pipes of twelve inches or greater diameter. 
 
 The minimum rates of inclination to secure this velocity is given by 
 Latham as follows: A 4-inch house-drain, 1 in 90; a 6-inch sewer, 1 in 
 140; a 10-inch sewer, 1 in 230; a 12-inch sewer, 1 in 450; a 15-inch.sewer, 
 1 in 550. But these figures presuppose the sewer to be flowing 
 one-lialf (4) full, but it is so frequent that the flow will be somewhat less 
 than this, that it is desirable, when working to minimum grades, to 
 
APPENDIX. 
 
 XCIIJ 
 
 figure for a gi eater velocity when flowing one-half (i) full, in order to 
 secure a self-cleansing velocity for the miniuium flow. This velocity is 
 taken at 4 feet per second for sewers of less than 12 inches diameter, and 
 at 34 feet for 12 inches and greater diameter, in determining the follow¬ 
 ing desirable minimum gradients: 
 
 Diameter 4 inches, gradient 1 in 53 
 
 * • 
 
 6 
 
 . 4 
 
 4 4 
 
 1 “ 
 
 80 
 
 4 4 
 
 8 
 
 * * 
 
 t 4 
 
 1 “ 
 
 105 
 
 4 4 
 
 10 
 
 4 4 
 
 4 4 
 
 1 “ 
 
 133 
 
 * 4 
 
 12 
 
 4 4 
 
 4 4 
 
 1 “ 
 
 238 
 
 4 4 
 
 15 
 
 4 4 
 
 4 4 
 
 1 “ 
 
 300 
 
 4 4 
 
 IS 
 
 4 4 
 
 4 4 
 
 1 “ 
 
 350 
 
 I have already referred to the fallacious popular demand for large 
 sewers, so I deem it proper to show the actual carrying capacity of 
 various size pipe sewers, when properly constructed, believing that the 
 municipal authorities who would intelligently act upon a sewerage 
 project will find the information of great value and assistance. In 
 preparing the following tabulated statements, I will assume a quantity 
 of 60 gallons of sewage per capita per diem, one-half to flow off in eight 
 (8) hours—the sewers to flow one-half full—which is a liberal assump¬ 
 tion. I will assume also the above minimum gradients, and deduce the 
 following data of the actual carrying capacity of properly constructed 
 pipe sewers: 
 
 Diameter of 
 Sewer. 
 
 Rate of 
 Inclination. 
 
 Gallons discharged 
 per hour. 
 
 Equivalent 
 
 Population. 
 
 4 inches. 
 
 1 in 53 
 
 4,716 
 
 1.258 
 
 ,6 “ 
 
 1 “ 80 
 
 10,539 
 
 2,812 
 
 8 *• 
 
 1 “ 105 
 
 19,003 
 
 5,068 
 
 10 “ 
 
 1 “ 133 
 
 29.385 
 
 7,836 
 
 12 “ 
 
 1 “ 238 
 
 34.402 
 
 9,174 
 
 15 “ ' 
 
 1 “ 300 
 
 52.280 
 
 13,941 
 
 18 
 
 1 “ 350 
 
 77.917 
 
 20.778 
 
 Thus \\ e see that a four (4) inch drain is amply sufficient for dwellings 
 and good siz. d hotels, boarding-houses, schools and public institutions, 
 and an eight (8) inch pipe is proper for many street mains. 
 
 Sewers that are unnecessarily large are not only a useless expenditure 
 of money, but they seriously deteriorate the sanitary service. Ill-planned 
 sewers of excessive size frequently serve to carry off the sewage when 
 the poor construction would cause stoppages in sewers of the proper 
 size. But such carry-off of the sewage is not the service that is contem- 
 
XCIV 
 
 APPENDIX. 
 
 plated in this paper: it is insanitary and extremely dangerous. It cannot 
 be too often repeated that ill planned and improperly constructed sewers 
 are dangerous tilings to have about, and, in most cases, become worse 
 than no seivers at all. “ Eternal vigilance,” both in design and construc¬ 
 tion, is the price of the full measure of sanitary service of a sewerage 
 system. 
 
 FLUSHING AND VENTILATION. 
 
 These are classed together, as the object to be attained by each is the 
 same, viz., to prevent the generation and dangerous accumulation of 
 sewer-gas. There would be but little or no danger of this in a well- 
 constructed system, removing the sewage rapidly to the outfall, if the 
 sewers were always canning the same volume; but, as the flow is quite 
 variable for different days and for different hours of the same day, there 
 is a possibility of slight generation of sewer-gas by the small particles 
 and slimy matters adhering to the sides of the pipes, which would 
 probably accumulate to dangerous proportions were no provision made 
 to check this accumulation. This danger is, however, very effectually 
 overcome by flushing and ventilation . 
 
 By flushing is obtained a periodic washing of the sewer of any particles 
 that may be held in check from any cause. It is effected best by flush- 
 tanks, which discharge automatically at regular intervals with a great 
 velocity and consequent cleansing power. 
 
 In a well designed and constructed system the periods of flushing may 
 safely be from 24 to 36 hours apart, but in other case§ it may become 
 necessary to flush once or twice each day. 
 
 The quantity of the flush should be sufficient to secure a depth of 
 flow slightly greater than that of the maximum volume of sewage. 
 
 A flushing apparatus should be placed at the head of each main and 
 lateral sewer, and in some cases, at intervals along long lines of mains. 
 Extensive systems of sewers should be divided into flashing districts, 
 the districts to be .flushed consecutively, beginning at the head of the 
 system. 
 
 It will be evident that by such systematic and thorough cleansing the 
 generation or accumulation of any great volume of sewer gas is pre¬ 
 vented. The slight quantity which is in practice generally found to 
 exist in sewers is innoccuously disposed of by proper provision for 
 ventilation. 
 
 This consists of open shafts, connecting the sewer.with the external 
 air, causing a constant interchange and circulation between the atrnos. 
 pheric and sewer air. The sewer air is thereby diluted to a harmless 
 degree and left free to maintain a uniform tension, whether the flow of 
 sewage be warm or cold, great or small, thereby preventing its power 
 to force the trap connections of houses with which the sewer may be 
 connected. 
 
APPENDIX. 
 
 XCV 
 
 It is desirable that means of access to and inspection of all the parts 
 of a sewer be provided by the construction of man-holes and lamp-holes 
 at short intervals along its course, and they may be constructed so as to 
 serve in a dual capacity, and act as ventilating shafts, thereby greatly 
 assisting to obtain the desired ventilation. 
 
 DEPTH TO WHICH SEWERS SHOULD BE LAID. 
 
 This is a local consideration, dependent upon the nature of the soil 
 and other characteristics of the locality to be sewered. They should, 
 in all cases, be at sufficient depth to secure the proper gradient of house 
 drains to the rear of the dwellings along their course, so that for sites of 
 great irregularity of contour they should be laid at a greater depth than 
 for localities of a gently rolling or level surface. 
 
 Since no branch from a sewer should be made by a vertical connec¬ 
 tion, it will be seen that an unnecessary depth of the sewers is a useless 
 additional cost, both to the main sewers and to the house connections, 
 so that the minimum allowable depth of sewers should be carefully 
 determined according to the surrounding conditions. 
 
 Upon this subject there is a paragraph contained in my report upon 
 the sewerage of the city of Raleigh, which, I think, will bear repetition 
 here, as follows: 
 
 “In determining the minimum depth to which the sewers shall be 
 laid, I have departed from the general custom of laying the sewers to 
 such depth as to drain cellars, and have no provision for cellar service. ' 
 The advantages to be derived from cellar service in sewer pipes is the 
 drainage of wet or flooded cellars in wet weather, and permitting the 
 placing of hopper-closets in damp, dark, out-of-the way places in cellars. 
 While these may be advantages, the first, at least, they are attended by 
 very great disadvantages and objections. The sewers, in many cases, 
 must be laid to nearly twice the depth to provide cellar service—more 
 than, doubling the cost of construction. The limited extent to which 
 cellars are liable to be flooded in this city. I do not think would justify 
 such increased expenditure. The great objection, however, to such 
 service—and I deem it a very serious one—is the provision and encour¬ 
 agement that it gives for placing hopper-closets in cellars. In such a 
 climate as this, such a practice would,be extremely dangerous. Closets, 
 to be maintained healthfully, must have an abundance of the great 
 purifying elements—sunlight and fresh air. In the dark corners of 
 cellars they can have neither of these, and in the warm season (consid¬ 
 ering human carelessness) I see but little to prevent them from becoming 
 very hot-beds of disease-germs—a constant menace, not only to those 
 persons immediately around them, but to the entire city. I have, there¬ 
 fore, designed that the minimum depth of the sewers should be just 
 sufficient to be below all water and gas pipes, beyond a possibility of 
 
XCVI 
 
 APPENDIX. 
 
 contaminating the water service. Such depth I consider to be six (6) 
 feet below the street surface. 
 
 “ We might permit of cellar service by the sewers in the strictly busi¬ 
 ness portion of the city, where first floor and cellar space is very valuable, 
 in such cases as the Sewerage Committee should deem urgently desirable, 
 but with the greatest restrictions thrown around their use, and the care 
 of and frequent inspection of closet connections.’’ 
 
 In a city or town where cellars are liable to be frequently flooded, pro¬ 
 vision should be made for overcoming it, as it is very detrimental to the 
 health of the community. Rather than place the sewers to a great depth 
 for cellar connections, however, it will be found more economic and 
 of much greater sanitary service to lay a pervious subsoil drain beneath 
 the sewers at sufficient depth to lower the water level of the soil below 
 the deepest cellars. In localities where the water level is high, the soil 
 retentive and wet, and where phthisis is a prevalent disease, a system 
 of subsoil drains should be constructed in conjunction with the sewerage 
 system. The drains may be either beneath or beside the sewers in the 
 same trench, thus drying the subsoil, which has been found in every 
 case to greatly decrease the prevalence of this sickness. 
 
 In the foregoing pages I have consumed as much space as the occasion 
 of this paper will permit, and perhaps more than my readers may enjoy, 
 yet much that should be said is but only imperfectly and incompletely 
 alluded to. 
 
 I have, however, endeavored to demonstrate the advantages of prac¬ 
 ticing sanitary measures and the clangers arising from their disregard. 
 I have shown that the essentials are the provisions for the maintenance 
 of "pure air, pure water and pure soil''’ in and about our homes. It 
 has also been made evident that the first provisions looking to this end 
 are a pure and wholesome supply of water and the construction of a 
 sanitary system of sewerage. Having these as a foundation, a complete 
 and perfect system of sanitation easily becomes a reality; without fliese 
 prime essentials no amount of raking and scraping and garbage-collec¬ 
 tion can be developed into an effectual sanitary service. With these 
 provisions, other sanitary measures may be carried out to perfection 
 and preventable sickness and premature death may be wholly eliminated 
 from the list of the results of moral criminality. 
 
 That what has been said in this paper may conduce, to some extent, 
 to the consummation of this greatly-to-be-desired end, has been the 
 earnest wish of the writer throughout its preparation. 
 
 Winston, N. C., January 10, 1889. 
 
 % 
 
APPENDIX. 
 
 XCVII 
 
 HOW CAN WE BEST SECURE ECONOMICAL DISPOSAL OF 
 REFUSE IN OUR TOWNS? SOME REMARKS ON THE 
 GARBAGE FURNACES IN USE. 
 
 By Thomas F. Wood, M. D., Secretary North Carolina Board of Health, 
 
 Wilmington. 
 
 The refuse of towns consists of two distinct classes, most conveniently 
 considered under the general terms Wet and Dry. 
 
 The wet includes kitchen refuse, and night-soil, dead animals, etc. 
 The dry includes street sweepings, ashes, cast-off clothing, shoes, sweep¬ 
 ings of workshops, etc. The division of garbage as above is not in 
 reality one which is observed, but w^hich, if observed, would make pos¬ 
 sible a more ready way of collection and disposal. 
 
 What to do with garbage is a question which has been answered in 
 
 the past in some of the following ways: The dry garbage usually dumped 
 
 in some of the suburban localities, generally to fill up wet or low places, 
 
 making a foundation for future building lots. When the once harmless 
 
 dry garbage became decomposable by moisture and commenced to send 
 
 out its malodorous effluvia, particularly if it happened to be a season of 
 
 unusual sickness, there would be a grand display of dosing it with carbolic 
 
 acid and lime, or else giving it a covering of nice clean sand. There is 
 
 hardly a town on the Atlantic coast that has not committed just this 
 
 folly. More than this, there is hardly one of these towns which has not 
 
 made it a rule to thus dispose of dry refuse; or, at any rate, permitted 
 
 scavengers to go on in an old rule handed down to us from the remote 
 
 times. Then, as our towns have spread out, and these dumping-grounds 
 
 became valuable for lots, it possibly had passed out of the memory of 
 
 the ones most interested—the intending purchaser—that the foundation 
 
 his new house was about to be built on was composed of old shoes, cab- 
 ** 
 
 bage-stalks, rags, bones of desiccated carcases of domestic animals, and 
 his well must penetrate a subsoil of decomposed organic matter, which, 
 if purposely intended to poison his drinking-water, could hardly have 
 been better prepared. 
 
 All would look exceedingly fair with a handsome little cottage, painted 
 and adorned, even on a dumping-ground foundation; and when sick¬ 
 ness came, the theories of malaria would account for it sufficiently to 
 lead the owner to look to a river or creek a mile off, possibly, and not to 
 his foundation. In fact, he might disclose the wonderful fact that his 
 well yielded genuine sulphur water—from the products of decomposi¬ 
 tion of his subsoil basis. The writer recalls two cases of this sort. In 
 the suburbs of one of our larger towns a good spring of clear water was 
 discovered, possessing the remarkable odor of sulphur (or sulphureted 
 
XCVIII 
 
 APPENDIX. 
 
 hydrogen), and so at once raised to the rank of a medicinal spring. 
 Ladies and children trooped to the place to imbibe the health-giving 
 fluid, with entire confidence. But the fatal day came; the ditcher’s 
 spade invaded the region, going down through the ancient layer of decom¬ 
 posing garbage, and the sulphur disappeared from the wa,ter, and its 
 repution departed! 
 
 The other case was one reported of a New England watering place. 
 It became quite noted for the strength of its sulphur water, and it 
 became necessary to pull down and add to the hotel. In doing this, the 
 ancient privy vault was destroyed or removed, and the sulphur disap¬ 
 peared from the water, and the glory of the resort departed. 
 
 We need not dwell upon the harmfulness of garbage, as anything so 
 capable of being a nuisance to our sense of cleanliness, and so certain an 
 index of laziness and neglect, ought to be systematically fought against. 
 Five years ago the North Carolina Board of Health issued a pamphlet 
 entitled “ A Year's Campaign Against Dirt," being suggestions to citi¬ 
 zens of cities, towns, villages and hamlets how to keep their streets and 
 homes in a healthful condition. It had a large circulation, and stimu¬ 
 lated some towns to a serious consideration of the ways and means, but 
 what was the practical application of the lesson is not yet apparent in 
 our towns. 
 
 Long years of observation have brought the writer to the conclusion 
 that the failure to keep our streets rid of the garbage is due to the failure 
 to destroy it. The ceaseless round of hauling it to waste places, seeking 
 new places when necessary, then going back to the old dumping-ground 
 when decay has reduced the piles of dirt to admit of it, engenders habits 
 of indifference, besides being fruitful source of complaints of neighbors 
 and passers-by. 
 
 Another cause of imperfect service by scavengers is the waste of time 
 in hauling to the dumping-ground. Of necessity such accumulations 
 must be distant from habitations, and a long haul means expense; and 
 this latter obstacle is so great that subterfuges are often resorted to, 
 especially the subterfuge of neglect. 
 
 Plans, therefore, to be effectual must be expeditious; must be inex¬ 
 pensive; must hold out encouragement to the authorities having super¬ 
 vision of it that some real good is being done. 
 
 Let us take up two of the plans which have had somewhat recent 
 trials. The city of New Oi leans adopted the plan of removing the gar¬ 
 bage by the river; having a long river-front, with a short haul across 
 the city to wharves, loading on dumping-scows and discharging at 
 some convenient place beyond the possibility of barm. A similar plan 
 was suggested in Wilmington, but was never carried out, although there 
 the facilities are very good. The river-front is two miles long, the tide 
 ebbs and flows twice daily, making it possible to establish upper, lower 
 and middle wharves at which to load the scows, with mud-flats above 
 
APPENDIX. 
 
 XCIX 
 
 and below the city upon which the garbage could be deposited, accord¬ 
 ing as the tide was running, up or down; making, in all, an economical 
 arrangement. 
 
 Doubtless there would be some objections to a plan, however good, 
 when we come to the practical working details; but if not left to the 
 stupid management of such labor as is usually selected in our towns, but 
 supervised with due intelligence by officers of energy, could be made to 
 accomplish good results. 
 
 At the present time there is more hope for the establishment of thorough 
 policing of our streets, alleys and back yards by the introduction of gar¬ 
 bage furnaces. 
 
 When it is demonstrated that the filthy accumulations of our towns 
 are being destroyed beyond the possibility of further harmfulness, and 
 without nuisance in the process of destruction, citizens will take courage 
 and imbibe new ideas of energetic removal, the garbage carts will make 
 prompter visits to the furnaces, and our towns will have the appearance 
 of cleanliness unknown now. 
 
 At the Milwaukee meeting of the American Public Health Association 
 last November, Dr. Kilvington, of Des Moines, gave us a historical and 
 practical description of the.garbage furnace, from its first inception to 
 the outcome in the Engle furnace. With my colleague, Dr. Bahnson, I 
 witnessed the working of the Chicago crematory, through the kindness 
 of Dr. Oscar DeWolfe, health officer of that city. The furnaces did 
 their work, consuming immense quantities of garbage of every sort, 
 excluding night-soil. These furnaces had the defect of not consuming 
 the smoke and gases of combustion, and, although the chimney was 
 very high, the odors were quite perceptible, and would not fail, at some 
 times, to be a nuisance in thickly settled parts of the city. The difficulty 
 of consuming the smoke and offensive gases is accomplished in the Engle 
 furnace, one of which was established recently and started operations as 
 a demonstration of the capacity of this model, for the benefit of the 
 visitors to the American Public Health Association, and there is one also 
 at Des Moines. This furnace accomplishes its work most thoroughly, 
 and in the smaller towns would do even better. 
 
 The following description of the Engle furnace is from a paper by Dr. 
 S. S. Kilvington, in the Sanitarian for December, 1888: 
 
 “In conclusion, let me invite your attention briefly to the only 
 remaining patent left for our discussion—the Engle crematory, an 
 invention which has demonstrated or is demonstrating its own success 
 in the cities of Minneapolis, Des Moines and Milwaukee. As constructed 
 in the city of Minneapolis and duplicated here in the city of Milwaukee, 
 we have an elongated each furnace. Its cremating chamber is 38 feet 
 long by 5 feet wide. It has a height of arch from the grate to the dome 
 of 7 feet clear. 
 
 “As shown in the accompanying cut, representing a vertical longi¬ 
 tudinal section of the structure, at the end of the grate nearest to the 
 
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APPENDIX. 
 
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 chimney flues, but not in connection therewith, is the primary fireplace. 
 Beneath the grate, throughout the whole length, is an elongated ash-pit, 
 which is floored with fire-clay tiles, and which forms the roof of a super¬ 
 heated smoke flue, which I shall presently describe. At the end of the 
 furnace most remote from the chimney shaft is a fire-grate, four feet 
 below the level of the first, upon which a secondary fire burns. Between 
 this and the chimney shaft runs the long horizontal smoke flue to which 
 I have already referred, with its superheated tiled roof, continuing for a 
 length of 28 feet to the chimney shaft, which rises 100 feet in height. 
 The building in which the furnace is enclosed is of three stories. At the 
 level of the first floor is a double row of doors, the upper of which gives 
 opportunity for feeding the primary fire and for stoking the burning 
 material, while the lower row opens into the ash-pit and permits the 
 removal of ashes. At the farther end of the furnace, upon this same 
 floor, are doors for supplying the secondary fire and removing any ashes 
 it may produce. The second floor is at the level of the top of the brick 
 furnace, and upon this floor are delivered the bodies of dead animals, 
 which, by means of pulley attachments, are lowered through a large 
 tubular shaft, rising to the level of this story and discharging into the 
 furnace at a point near the primary fire. To the level of the third story 
 rise from the furnace dome three tubular shafts fifteen feet in length, 
 into which the miscellaneous refuse wagons immediately discharge their 
 contents from the upper floor upon which they drive. Preparatory to 
 the operation of the furnace, the fires are started in the primary and 
 secondary fireplaces, and are maintained until a sufficient degree of heat 
 prevails throughout the furnace and in the superheating flue beneath the 
 ash-pit. I have already emphasized the fact that animals are discharged 
 into the furnace nearest to the primary fire, while other miscellaneous 
 material is distributed through the small tubular flues along the remoter 
 portions of the grate. This arrangement contributes to the aid of the 
 primary fire, the best fuel-forming materials to be burned first, thus 
 diminishing the amount of fuel required to maintain the action of the 
 furnace. The products of combustion are carried over the grate and 
 thence over the secondary fire, burning at a lower level at the opposite 
 end, and there consumed; thence any small amount of remaining smoke 
 or gas is carried along through the superheated horizontal flue, under¬ 
 going further combustion, until the chimney shaft is reached. The 
 ashes of the debris , falling through the bars of the grate, light upon the 
 fire-tiled floor of the ash-pit, where they are again consumed, while 
 liquids, dropping upon it, are instantly evaporated, and the final ashes 
 are deposited. The arrangement by which the scavengers dump directly 
 into the flues minimizes labor and insures greater cleanliness. 
 
 “ Among the questions likely to be asked under this topic is that which 
 relates to the primary cost of construction. Definite answers to this 
 query cannot be given, for the reason that with any one of the furnaces 
 
 . 8 
 
CI1 
 
 APPENDIX. 
 
 we have described cost must depend very largely upon location, avail¬ 
 ability of materials, command of skilled labor, and the size and capacity 
 of the furnace which the circumstances and extent of the population 
 demand. Equally important is the question of the cost of operation. 
 This, again, is insusceptible of a definite reply. Location, available fuel 
 supply, economical management of the furnace fires, the class of garbage 
 or refuse to be burned, and the proper disposition of fuel-forming mate¬ 
 rials—these are all considerations which largely affect the question of 
 working cost. The Mann furnace in Montreal is said to be operated at 
 a cost of twenty-five cents per ton of miscellaneous refuse, and of 
 seventy-five cents per ton of night-soil. It is claimed that the Rider 
 furnace will do about the same thing. 
 
 “An estimate of the expenses of operating the Engle crematory in 
 Minneapolis for a period of five days, during which the furnace was 
 worked by three men entirely new to the task, two of whom were on 
 duty by day and one by night, gives the following facts and figures: 
 
 “Consumed in five days: 33 horses, 59 dogs, 103 barrels of hotel and 
 commission-house refuse, 12 loads of market offal and 70 loads of manure, 
 weighing, in all, over 200 tons. Total cost of labor and fuel for this 
 period, $38.25, or $7.65 per day—the entire weight of refuse being 
 destroyed at a cost of 19 cents per ton. The ash deposited in the course 
 of the consumption of this material is exceedingly small in quantity, 
 weighing less than 200 pounds per day. 
 
 “This estimate, eminently satisfactory as it is, is not altogether a fair- 
 one. The men employed were wholly inexperienced. The furnace, at 
 the beginning of these five days, was cold, and it required several hours 
 to superheat it. The fuel used was simply lath edgings and coal screen¬ 
 ings, or 4 breezed The glut of horses was unusual, and crowded out the 
 ordinary supply of garbage. It is safe to say that upon an average run, 
 over an extended period, fifteen to twenty cents per ton of refuse would 
 pay for the labor employed and the fuel consumed. 
 
 “ So far, then, as a brief period of time has permitted careful observa¬ 
 tion, the principal American crematories ma\ be said to have demon¬ 
 strated their fitness for the task of waste destruction. The possibility 
 of burning the refuse materials of a great city without imposing upon 
 its people a pen.dty of insanitary consequences in the performance of the 
 ;act has been established beyond the shadow of a doubt. Nuisance is far 
 more apt to arise from mismanagement in the handling of the material 
 to be burned than it is likely to ensue from the products of cremation. 
 The odor which arises from the direct burning of night-soil, even without 
 any special precaution for the consumption of gases formed, is not so 
 obnoxious as might be imagined, resembling the smell of burned leather. 
 The commercial value of the solid residue of combustion has yet to be 
 tested. It will vary, of course, according to the method of cremation. 
 The innocuous character of the ash must be demonstrated in each indi- 
 
 t 
 
APPENDIX. 
 
 CIII 
 
 vidual case. The only analysis of this material, as produced by the 
 Minneapolis crematory, that I have had an opportunity to obtain, has 
 beeh made within a few days past by Professor James A. Dodge, Pro¬ 
 fessor of Chemistry in the Minnesota State University. The sample 
 which he examined was selected in small quantities from different parts 
 of the ash-pit, but it was taken therefrom within a few hours of the 
 initial starting of the furnace and before the ash-pit had become thor¬ 
 oughly superheated. Consequently, it may be assumed that it contains 
 some proportion of organic matter wdiich would be consumed under 
 more average circumstances. 
 
 “ The following is the report of the analysis made to me by Professor 
 Dodge: 
 
 “ ‘ Dr. S. S. Kilvington. President of the Minneapolis Board of Health: 
 
 “ ‘ Sir: I hereby report to you the results of my analysis of a sample 
 of ashes lately received from you. 
 
 Moisture___ 
 
 Organic matter... 
 
 Sand and clay..— 
 
 Sodium chloride... 
 
 Iron...... 
 
 Lime, CaO----- 
 
 Magnesia, MgO.... 
 
 Potassa, K20........ — 
 
 Soda, Na20... 
 
 Anhydrous phosphoric acid, P205... 
 
 Anhydrous carbonic acid, C02... 
 
 Soluble silica, S02_.-... 
 
 Sulphur in sulphates and sulphides.. 
 
 Oxygen combined with part of the iron and 
 part of the sulphur, and loss- 
 
 2.82 per cent. 
 
 10.68 
 
 49.19 
 
 2.83 
 
 1.96 
 
 10.26 
 
 2.68 
 
 2.57 
 
 8.16 
 
 1.49 
 
 1.24 
 
 1.59 
 
 3.75 
 
 100.00 
 
 ‘“I append the following notes on the foregoing analysis: 
 
 ‘•‘The organic matter is partly unburned carbon and partly nitro¬ 
 genous matter, communicating considerable odor to the ashes. The iron 
 is probably mostly in the stat^ of oxide of iron, but partly in the state of 
 sulphide of iron. The latter gives some odor. The lime and magnesia 
 are mostly combined with the phosphoric acid, making about eighteen 
 per cent, of phosphates of lime and magnesia. 
 
 “ ‘The potassa is mostly combined with carbonic acid. The soda is 
 probably combined partly with carbonic acid. The silica is probably 
 combined with soda and some potassa. The sulphur probably exists 
 mostly in sulphate of lime. The precise manner and proportion in 
 which the above bases and acids are combined cannot be determined. 
 
 “ ‘ Very respectfully yours, James A. Dodge, 
 
 “ ‘ Professor of Chemistry .’ 
 
CIV 
 
 APPENDIX. 
 
 ‘ Professor Dodge appends to his analysis the following considerations: 
 
 ‘‘•It will be seen that this ash contains manj constituent elements 
 which make it of some value as a fertilizer. The product of any «uch 
 furnace, employed in the destruction of animal and vegetable refuse, 
 would be enhanced in value by the admixture of the product of a night- 
 soil crematory. This fact is illustrated by the management of the Glas¬ 
 gow plant. I have at hand samples of the ash of the Engle crematory 
 at Minneapolis, which I shall be happy to submit either to the olfactory 
 organs or the chemical retorts of the members.’” 
 
 The greatest defect in garbage removal in our towns is the inadequacy 
 of carts and wagons supplied for the work. In most places, the carts 
 are frequently taken off for grading or other street work, and the piles of 
 garbage accumulate until its removal is a matter of extremest difficulty 
 and always an offense to the citizens. In making up estimates for towns 
 for the year, the garbage carts should be amply provided for; they 
 should be used for no other purpose; they should be under the control 
 of the Superintendent of Health, or sub-officers of health responsible to 
 him for their work. A regular schedule should be devised for every day 
 in the week, and it should be adhered to, and the people should be made 
 acquainted with the rounds of the carts or wagons. The people should 
 be required to have their garbage ready for the carts promptly, and if 
 attended to promptly, it would receive a very large co-operation; and in 
 
 cases of failure, which of course there would be, there could be framed 
 a penalty. 
 
 w 
 
INDEX. 
 
 Page. 
 
 Address of welcome by Governor Fowle__ 7 
 
 Assessment of members of Association..... 18 
 
 Bahnson, Dr. H. T., motion made by...... 18 
 
 Paper read by......... 18 
 
 Remarks made by.....12, 22 
 
 Chase, Mr. J. C., motion made by...... 11 
 
 Remarks made by......20, 22, 26 
 
 Committee on Permanent Oganization...... 11 
 
 On Water Supplies..... 28 
 
 On Ways and Means..... 11 
 
 To select delegates to Southern Convention_ 16 
 
 To wait on Finance Committee of Senate... 22 
 
 Constitution of the Association........ 16 
 
 Curtis, Dr. G. W., paper read by...... 13 
 
 Engle Garbage Furnace, explanatory remarks concerning, by Mr. 
 
 Morse........ 25 
 
 Ennett, Dr. W. T., motion made by.... 16 
 
 Food, adulteration of, remarks concerning, by Prof. Venable and 
 
 Dr. Wood....20-21 
 
 Funds of the Association -------18, 26 
 
 Grissom, Dr. Eugene, remarks by--12, 18 
 
 Motions made by......18, 25 
 
 Insane Asylum, members invited to visit.... 12 
 
 Jones, Dr. J. W., paper read by.----- 12 
 
 Keogh, Col. Thos., remarks by.-. 27 
 
 Lewis, Dr. R. H., explanatory address by.... 8 
 
 'Remarks by....-.. 16 
 
 Ludlow, Mr. J. L., paper read by... 22 
 
 Remarks made by....- -...- - 21 
 
 McDonald, Dr. John, remarks by....13, 26 
 
 Officers, election of.....-.10, 11, 18 
 
 List of.-... 2 
 
 O’Hagan, Dr., remarks by...-.— 24 
 
 Motion made by.-... 18 
 
 Pearsall, Mr. Oscar, motion made by....-. 10 
 
 Remarks by.-.-. 21 
 
 Permanent Organization, report of Committee on... 16 
 
 Quarantine, discussion concerning, by Drs. Lewis, McDonald and 
 
 Wood...-.. 15 
 
 Resolution relative to.... 16 
 
C VI 
 
 Index. 
 
 Page. 
 
 Sanitary Convention, call for a....... 3 
 
 Sewage, effect of, upon crops.--- 23 
 
 Thomas, Dr. G. G., paper of (read by Dr. Bahnson).... 15 
 
 Tucker, Dr. J. H., motion made by..... 12 
 
 Paper read by........ 26 
 
 Venable, Pjof. F. P., motion made by____ 28 
 
 Paper read by______ 20 
 
 Water, method for purifying____18,20 
 
 Water supplies _ ______19, 26, 27 
 
 Wood, Dr. Tlios. F., motions made by....10, 11, 12, 16 
 
 Paper read by____ 24 
 
 Remarks by_______12, 13, 15, 18, 20 
 
 Resolution offered by........ 15 
 
 APPENDIX. 
 
 s 
 
 The Public Water Supply of Towns and Cities in North Carolina: 
 
 H. T. Bahnson, M. D., Salem..... 1 
 
 Inland Quarantine: George Gillett Thomas, M. D., Wilmington, N. C. 21 
 
 Maratime Quarantine: W. G. Curtis, M. D., Wilmington, N. C_ 31 
 
 The Necessity of State Intervention to Prevent Adulteration of Food 
 
 and Drugs: Prof. F. P. Venable, Chapel Hill, N. C_ 37 
 
 How can we Best Secure Economical Disposal of Refuse in our 
 
 Towns? J. L. Ludlow. C. E., Winston, N. C_.. 42 
 
 The Duties and Responsibilities of County Superintendents of Health: 
 
 J. S. Tucker, M. D........ 54 
 
 Some Gains from Sanitation: J. W. Jones, M. D.___ 61 
 
 The Sewerage of Cities and Towns: J. L. Ludlow, C. E., M. S. 66 
 
 How can we Best Secure Economical Disposal of Refuse in our 
 Towns? Some Remarks on the Garbage Furnaces in Use: Dr. 
 Thos. F. Wood_____ 97 
 
9 
 
\ 
 

1 
 
 N864 
 
 1889 
 
 WA 
 
 1 
 
 N864 
 
 1889 
 
 North Carolina Sanitary 
 Association 
 
 Report of proceedings 
 
 DATE 
 
 ! IN ~ f. 
 
 ISSUED TO 
 
 1884 
 
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