DEPARTMENT OF Books are Not 40 be Taken From the Library Room. > MANUAL OF PUBLIC HEALTH A MANUAL OF PUBLIC HEALTH FOR THE USE OF LOCAL AUTHORITIES, MEDICAL OFFICEES OF HEALTH AND OTHERS BY W. .H. MICHAEL, F.C.S. BARRISTER- AT-LAW W. H. CORFIELD, M.A., M.D. Oxon. PROFESSOR OP HYGIENE AND PUBLIC HEALTH, UNIVERSITY COLLEGE, LONDON, MEDICAL OFFICER OP HEALTH, ST. GEORGE'S, HANOVER SQUARE, &C. AND J. A. WANKLYN, M.E.C.S. CORRESPONDING MEMBER OP THE ROYAL BAVARIAN ACADEMY OP SCIENCES, PUBLIC ANALYST FOR BUCKINGHAMSHIRE, BUCKINGHAM, AND HIGH WYCOMBE [EDITED BY SMITH, ELDER, & CO., 15 WATERLOO PLACE 1874 All rights reserved Those who are called upon to carry out duties con- nected with the Public Health Act of 1872, have to deal with subjects involving three separate kinds of knowledge,— legal, medical, and chemical. The duties are so multifarious, and to many now engaged in them they are so novel, that it seemed advan- tageous, in the production of a Manual of Public Health, to secure the assistance of three gentlemen severally experienced in each of the branches of knowledge involved. Hence the origination of this manual, in which I have had the advantage of the coUaboration of three able and well-known authorities. Although I am responsible for the general construc- tion and editorial supervision of the work, and for whatever faults may exist in it, such merits as may be found in its execution will of course be properly ascribed to the authors and not to the editor. ' The pressing avocations of its contributors have caused a regrettable delay in the production of it. Ernest Haet. 59 Queen Anne St. November 24, 1873. 3% 3 ?> CONTENTS. PART I. CHAPTEE PAGE I. The Cen'tral Authorities ..... 1 n. Local Authorities .7 in. Officers km) Powers of Local Authoeities . 16 IV. Roads and Wats .66 V. Sewers . ,73 VI. Water Supply .80 Vn. Public aj^d Private Lighting ... . . 116 Vm. Nuisances .123 IX. General. ........ 136 Index to Statutes Pertaining to Public Health, Arranged Chronologically ... . 149 Index to Powers under the Sanitary Acts . 151 Index to Penalties under the Sanitary Acts . 167 PART IL I. Eoutine Duties 185 II. Refuse Matters. — Conservancy Plans . . 204 in. Water-Carriage System 220 viii CONTENTS, CHAPTER PAGE IV. Water Sttpplt . 255 V. Epidemic Diseases 264 VI. OVERCEOWDING. — VENTILATION ... . 281 Vn. Inspection op Trades, &c. . . . . . 289 PAET III. I. Water 303 II. Air . 326 in. Milk, Butter, and Cheese 334 IV. Flour and Bread . 346 V. Beer and Wine 355 VI. Tea 362 vn. Sugar 366 Vm. DiSINEECTION . 369 MANUAL OF PUBLIC MEDMNE. CHAPTER I. THE CENTRAL AUTHORITIES. The supreme authority in all matters relating to public health is, by an Act of Parliament passed in the year 1871, lodged in the Local Government Board. This Board, which Local ao- has its seat at Gwydyr House, Whitehall, . consists of a bo~' President, appointed by Her Majesty, and of the following ex'officio members, viz. : — The Lord President of Her Majesty's Most Honourable Consti- Privy Council, all Her Majesty's principal Secretaries of State for the time being, the Lord Privy Seal, and the Chancellor of the Exchequer. Besides these, it has a par- liamentary and a permanent Secretary. By the same Act have been transferred to the newly constituted central autho- rity all the powers and duties of the Poor Law Board, so Powe.. far as such powers and duties refer to England, and all the functions relating to pubHc health hitherto devolving upon the Secretary of State or the Privy Council. All the returns relating to rates, tolls, or dues, other than those affecting the pubHc revenues, which are required to be sent to any other department of the Government, are to be sent in duplicate to the Local Government Board. By the Sanitary Act, passed in the year 1866, a general power of control over the acts of all Local Authorities is given to the Supervision Board, and if any complaint be made to it of the default of lutoSritie^ any such authority as to sufficient sewerage, or adequate ^ water supply, by which the health of the inhabitants of the B i\'ers and 2 MANUAL OF PUBLIC MEDICINE Enquiry as to default of Local Authorities. Order to execute works. Inspectors. Control of officers of Local Au- thorities. district is endangered, or if the roads or footways are im- properly or inefficiently repaired or cleansed, or if there is any default in enforcing the provisions of the Sanitary Acts, the Local Grovernment Board may direct an enquiry as to the allegations in any such complaint, and has power to order the execution of any works necessary to remedy the default which has been proved. This is a very powerful means of remedy in the hands of inhabitants or owners ; for should they fail to obtain relief from the Local Authority of the district in which they reside or have property, they can at once, either separately or conjointly, address a memorial to the Local Government Board, which is always ready to make full enquiry into grievances alleged by in- habitants against Local Authorities. If the Board should make an order directing a Local Authority to perform any duty not hitherto properly discharged, or to execute any works necessary for the maintenance of the health of a district, and the Local Authority should fail to perform the duty ordered, or to execute the works within the time specified in the order of the Board, then the Board has power to appoint some person or persons, and, if necessary, to change such persons from time to time, and by them to execute the works or discharge the neglected duties. When this happens, the Local Authority will have to bear the whole expense incurred by the persons appointed by the Local Board to execute the works, together with all the costs of the proceedings. The Local Government Board appoints inspectors, who hold the enquiries which have just been noticed, and who also attend meetings of Local Boards throughout the country, in order to watch their proceedings, and to advise Local Authorities on any matters incident to the working of the various complicated and numerous Acts of Parliament by which they are constituted, and whose provisions they have to enforce. Besides appointing these officers, the Local Government Board has power to deter- mine the salaries and to issue directions as to the duties of all officers appointed by Local Authorities, where any portion of the salaries of these officers is paid out of funds raised by Parliament. But Local Authorities, much dis- liking any such control, generally prefer to pay the whole THE CENTBAL AUTH0BITIE8 3 of the salaries of their officers, which leaves them entirely ♦ unrestricted as to the amount to be paid and the duties to be discharged by these officials, and it also enables them without appeal to dismiss any officer whenever they* may be so disposed. Much of the previous sanitary legislation of the country is contained in Local Improvement Acts. In many Local of these the provisions have become obsolete, either because ment Acts, of the extended knowledge we possess of hygiene, or on account of the limitations as to rating powers contained in them, although now these limitations so far as relates to sani- tary matters are entirely removed. The Local Government Board has power by provisional order to change these Provisional provisions, either modifying or entirely rejDealing them. A provisional order is practically an Act of Parliament, as no order of this kind is of any validity until it has been confirmed by the Legislature. The various matters which may be settled by the Local Government Board by pro- visional order are alterations in existing Local Improve- ment Acts, alterations of areas, powers to be granted to Local Authorities to acquire lands compulsorily for the various purposes required in carrying out sanitary opera- tions, such as land for town improvements, for sewers, for outfall of sewers, for precipitation of sewage, or for intermittent filtration or sewage irrigation. Local Autho- rities may by agreement acquire lands for these purposes, Acquire- either by purchase or on lease ; but when the owners 5ands.^^ are unwilling to part with their property, then the Local Authority has no resource but to apply for a private Act of Parliament, or to the Local Government Board for a pro- visional order, authorising the purchase and compelling the sale. Provisional orders are also granted for joining two junction of or more districts or two or more authorities, for certain purposes more easily accomplished by joint action, into one authority for these purposes. Where it is necessary to raise large sums of money for carrying out works of a permanent Permanent character, such as sewerage, water supply, and the like, ^^^^ ^* and such expenditure will be more than one year's assessable value of the district, then before raising the money it will be necessary to obtain a provisional order. This provi- B 2 4 3IjmTAL OF PUBLIC MEDICINE Borrowing powers. Formation c f Local Boards. Boundaries. Petition for provisional order. Notices and advertise- ments. Enquiry. Report. Appeal. sional order may grant a power of borrowing equal to two years' assessable value of the district. So also in applying the provisions of tlie Local Govern- ment Act to any district on the application of any Local Board or the majority of owners and ratepayers, or upon petition that any portion of a district should be separated from such district, there must be a provisional order, and in any similair case arising out of the boundaries of districts being undefined, or various authorities coexisting where it is desirable there should be but one, then and in all such cases there is power lodged in the Local Grovernment Board to grant a provisional order. Before, however, such provisional order is granted, a petition is to be lodged at the Local Government Board office ; notices and advertisements are to be issued explicitly stating what is purposed to be done, and what powers are asked for. Upon the receipt of this petition the Local Government Board directs an enquiry to be held in the district from whence the petition has emanated, and at such enquiry a full hearing is given to any one showing any claim to appear as supporting or pre- venting the granting of the prayer of the petition. It is, in fact, an open court in which any one having any interest whatever in the district, whether as owner or ratepayer, niay be heard fully in support of his views. The inspector appointed to hold this inquiry at its conclusion makes his report to the Local Government Board, and a copy of such report is sent to the Local Authority, and may be obtained by any inhabitant. It has happened in some cases that parties dissatisfied with the report of the in- spector have obtained a second enquiry, when the central authority has, in accordance with the prayer of a petition emanating from the dissentients, ordered a fresh enquiry by an engineer with a legal assessor, before whom evidence is again taken — in fact amounting to an appeal, and con- cluding with a report to the Local Government Board, which would then, upon both the reports sent in, determine what course it would adopt. The statute gives power to the Local Government Board either to grant provisional orders as asked for or to modify the requests of the petitioners in the order sjranted; this would be taken to THE CENTRAL AUTHOBITIES 5 include also the power to refuse the application, which is frequently the case. But it is more than doubtful whether the Local Government Board has power to issue a provi- sional order wider than the petition upon which it is granted. Should the a23plication be acceded to, then the order is introduced into a bill for confirmation by Par- liament. This bill is promoted by the Local Government Board, and passed by them through the Legislature, unless any petition is presented against it, in which case it becomes subject to all the incidents of private legislation, is referred to a select committee, and is investigated in precisely the same manner as a private bill. The petitioners employ their counsel and parliamentary agents, and must bring up their witnesses in support of the provisional .order, as the whole charge of the bill becomes lodged in their han-ds, and, unless the bill is passed by both Houses, the provi- sional order is of no value ; for all such orders, as before stated, must be confirmed by Parliament before they become operative. They then have paramount authority, like all acts of the Legislature, but in any case, even before confir- mation, they cannot be reviewed by any court ; this is also- the case with all orders made by the Local Government Board. These orders, which refer to the general business of sanitary authorities, may be granted by the Local Government Board on a great variety of subjects, and are also final and conclusive on the subjects respecting which they treat. These are, as before partially alluded to, super- vision and regulation of the duties of all sanitary authori- ties and their officers, regulation of funds raised for sanitary purposes, and alteration, of areas for sewerage and other purposes within certain limits. The more extensive powers in this direction need, hov/ever, a provisional order. But sufficient has been said to show how extensive are the powers lodged in the Local Government Board, and that the Board is competent to enquire into and remedy any grievance arising in the exercise of the powers of local sanitary authorities or arising from their default. Besides these powders the Public Health Act of 1872 diverts from the Board of Trade to the Local Government Board all their powers and duties under the Alkali Act 1863. These Eesult of enquiry. Confirma- tion of provisional order. Opposition in Parlid- ment. Practice. Effect of provisional order. Orders of Local Grovernment Board. Trans- ference of powers to Local Government Board. Alkali Act. 6 MANUAL OF PUBLIC MEDICINE powers and duties include tlie appointment of inspectors to watch over alkali works, in order to provide for the better condensation of muriatic acid gas, and also give a gene- ral power to the Board to sanction rules and annex penal- ties for the breach of such rules by workmen employed in the manufacture. By the same Act the powers of the Board of Trade with respect to the supervision of the Metropo- metropolitan water supply are also lodged in the Local supply. Government Board. All the powers, duties, and acts which are vested in, imposed on, or required to be done by the Turnpike Home Secretary in relation to turnpike roads and paths, roads.*^^^ highways, and hedges in England and Wales are also trans- ferred to and imposed on the Local Government Board. These powers chiefly refer to supervision of the accounts of bodies charged with repairs of the roads ; but in ad- dition the Board has transferred to it all powers and duties with respect to — The Begistration of Births, Deaths and Marriages, Public Health and Local Government, Drainage and all Sanitary Matters, Baths and Washhouses, Public Monuments, Town Improvements, Artizans' and Labourers' Dwellings, and Local Taxation so far as the Home Secretary is con- cerned, and the powers and duties of the Privy Council as to Prevention of Disease and Vaccination. CHAPTER II. LOCAL AUTHOKITIES. The Public Health Act of last Session lias divided the whole of England into sanitary districts, presided over respectively by a local authority, either urban or rural. Urban autho- rities are either in Boroughs, the Tov^n Council, or in Board of Health Districts, Local Boards of Health, established under the Public Health Act, 1848, or Local Boards under the pro- visions of the Local Government Act,1858,or Commissioners appointed under local Acts, passed for the improvement of the districts over which they act. All other parts of the country are to be in future, so far as public health is con- cerned, under the direction and control of the Board of Guardians of the Union in which the district or parish is situate. But if any part of a Union is in an urban district, then the guardians of such portion do not act in sanitary matters. The guardians have the power to appoint com- mittees of their own number, to whom they may delegate for their year of office all their powers. One third of the number of such committee are to be ex officio guardians, if so many exist, and the appointment of such committee to which is delegated all the powers for the time being of the sanitary authority, must be made at a meeting of the guardians specially convened for the purpose. They have likewise the power to appoint parochial committees, either composed wholly of guardians, or of guardians and rgjte- payers, that is ratepayers of the parish, or contributary place for the sanitary government of which the parochial committee is appointed. This committee is only the agent of the rural sanitary authority appointing it, which remains liable to any duty or obHgation devolving upon it, should the parochial committee make default, in its discharge of Sanitary- Districts. Urban and rural autho- rities. Committees of rural authorities. Parochial Committees. Committee the agent of authority. 8 MANUAL OF PUBLIC MEDICINE Control of Committees. Different . powers of urban and rural autho- rities. Metropolitan Board of Works. District Boards. such duties and obligations. The committee must carry out any regulations imposed by the rural authority, which has also the power to alter the constitution, or altogether dissolve the committee, whenever it thinks fit. There will no longer therefore be difficulty in knowing who is the sanitary authority of any district, as it must for all sanitary purposes be either in boroughs, the town council, or in towns w^here the Local Government Acts are in force, the Local Boards, or in towns which have a local Act, either the commissioners under the Act, or one of the bodies before enumerated, to whom in many cases the powers have been transferred. The great difference existing between the two kinds of local authority is mainly with respect to vesting of existing sewers, supervision of streets, roads, and buildings, the former of which are in rural districts under the control of highway boards, surveyors of highways, or turn- pike trusts, while the powers of regulating the line of build- ings, width of streets, &c. contained in the Local Govern- ment Acts, are not conferred on rural authorities, although the Local Government Board may transfer to any rural authority any or all of the powers of an urban authority. Their ordinary powers and duties are confined to providing a proper supply of water, getting rid of the sulliage of their district, preventing or removing nuisances, regulating common lodging-houses, enforcing sanitary measures in times of epidemic visitation, and supervising bakehouses. In the metropolis, except for certain purposes in the City of London, which is governed by a special Commission of Sewers, sanitary measures are regulated by the Metro- politan Management Act 1855, which came into operation on January 1, 1856. By this Act the whole of London, including the City of London, which is to be taken to mean all parts at the time under the jurisdiction of the Commis- sioners of Sewers, is divided into districts, these districts including either a single parish, or several parishes, or parishes and districts united together, to form a district under the Act. The vestry in all these parishes w^as made elective, and in cases with more than 2,000 rated house- holders were divided into wards, and a certain number of vestrymen, in proportion to the number of rated inhabi- LOCAL AUTHOBITIES 9 tants in eacli parish allotted to each. The vestry thus Election by constituted elects a prescribed number of representatives to form a District Board, who act as a Local Board for their district. Each vestryman must have a qualification by being rated to the extent of 40 L to the relief of the poor, except when the number of poor rate assessments of 402. Rating T 'TP T 111 1 Tr» qualifi- does not exceed one-sixth of the whole, then the qualmca- cations, tion is reduced to 25Z. Each of these district boards sends either one or two representatives to make up the Metro- politan Board of Works, which acts as the sewer authority, regulating streets, and generally has powers to make, widen, or improve streets, roads, or ways, and may expend for any of these purposes any sum not exceeding 50,000Z., without any consent, and exceeding, that sum with the con- sent of the Commissioners of Her Majesty's works and Work y 'J ^ executed by buildino^s : if exceeding^ 100,000?., not without the previous Metro- sanction oi ir'arliament. Board of Members to form a Local Board as an urban sanitary cations. Works. Election of authority, are elected from, and by the ratepayers, who members have been on the rate book for one whole year, and who Boards, have paid all rates except those due within six months of the election; and this holds good even when the rates are compounded for and paid by the owner, the right of all occupiers being specially reserved as to any franchise or right of voting. Any ratepayer may nominate for the office of member any other ratepayer or ratepayers, within Quaiifi- the prescribed number residing within the district, or within seven miles, and possessed of real or personal estate, or both to the value of not less than 500Z. in districts con- taining less than 20,000 inhabitants, or not less than 1,000L in districts where the population exceeds 20,000 ; or it is sufficient if the nominated member of a Local Board is rated to the poor rate, at an assessment of not less than 16L in districts containing less than 20,000 inhabitants, or not less . than 30Z. in districts exceeding 20,000 of population. The Returning Officer, who in the first instance, upon Returning the appointment of a Local Board is nominated by the Local Government Board, but who is afterwards almost uniformly the Chairman of the Local Board, except when he is himself a candidate, publishes a notice of every Officer. 10 MANUAL OF PUBLIC MEDICINE Notice of Election. Nomination. Voting Papers. Agent of Candidate. Eefufal to serve. Casual vacancies. Casting up of votes. Decision as to validity of votes. Declaration of members elected. election of members, stating the number and qualifica- tions required of members, and the mode of voting. These notices are published, and afB.xed to places in the district where notices are usually exhibited. If there should be such a number of ratepayers nominated as exactly fills up the vacancies, then the persons nominated are declared by the Eeturning Officer to be duly elected members for three years ; but subject to a third of the members retiring every year. Should a greater number be nominated than the number of vacancies to be filled up, then an election takes place by means of voting papers, which are delivered at the residences of the owners and occupiers of the district three days before the day of election, which is the day when the voting papers are collected by persons specially appointed for the purpose by the Returning Officer. If it be so wished by any candidate, a person appointed to act as his agent may accompany the person who delivers or collects the voting papers, after giving one day's notice of an intention to send such an agent. A ratepayer nominated is not compelled to serve the office of member of a Local Board. An intimation should be given to the Returning Officer of a refusal to serve, if possible before the collection of the voting papers. This might save the necessity of counting up the votes, or would enable the Returning Officer to de- clare elected the next candidate having the largest number of votes, supposing the refusing ratepayer to be himself among the returned candidates. If the refusal to serve comes from a candidate after elec- tion it will be the duty of the Local Board itself as in any other casual vacancy to elect a ratepayer in place of the member elected. This can be done by the Local Board, either from the candidates or from the body of ratepayers at their discretion. Upon the voting papers being collected, it becomes the duty of the Returning Officer to attend at the office of the Local Board the next day, and on as many succeeding days as may be necessary, there and then to add up the votes. He has the power of striking off any votes which he thinks bad, and his decision is final as to their validity. Having done this he declares who are elected, and lays the voting papers and a certificate of his returns LOCAL AUTHOBITIES 11 Claim of owners to vote. before the next meeting of the Local Board. This certifi- cate and the voting- papers are preserved in the office »of the Preserraticn -.-r^ -. -. IT- J- p • of voting Local Board, and are open to public inspection tor six papers, months. The scale of voting by ratepayers or owners is Scaie of regulated by what is known as Sturges Bourne's Act, and is as follows : — When the rateable value is under £50, one vote, „ £50 and under £100, two votes, £100 „ £150, three votes, £150 „ £200, four votes, £200 „ £250, five votes, over £250, six votes, and this is the greatest number of votes which can be given for one property by a ratepayer ; but the owner can give an equal number: therefore where the owner is also the occu- pier there may be a franchise of twelve votes lodged in one person. All owners, however, must before an election send in a claim to vote to the clerk of the Local Board, when they will be duly registered and a voting paper sent to them as owners, and this application must be renewed each year. Should it, however, happen through negli- gence or oversight that a voting paper has not been sent to an owner or occupier, then any person claiming to vote must himself call on the Returning Officer before the day of election, and in his presence fill up a voting paper, which the Beturning Officer is bound to supply and take charge of. It will be thus seen that a Returning Officer fills a very important office. He cannot be himself a candi- date, although Chairman of the Local Board, and is bound by heavy penalties faithfully to discharge the duties of his office. Should he be at any time disqualified to act, either through his being a candidate, through illness, or other sufficient cause, the Local Board have power to appoint some one else to conduct the election, and this must be carefully observed or the election will be void. The successful candidates have a notice served on them of their election by the Beturning Officer, who also noti- fies the result to the public by placards exhibited at the places where parochial notices are usually affixed. Each member of a Local Board, before he acts, must sign a Failure to supply voting paper. Appoint- ment of Returning Officer by Local Board when office vacant. Notice of Election. 12 MANUAL OF PUBLIC MEDICINE Declaration by Members. Qno war' ranto. Disquali- fication of Members. Members of Joint Stock Companies. Penalty for voting after disquali- fication. Selected members. Unions of Districts. Joint Boards. declaration which is to be witnessed by two other members of the Board, that he is possessed of the necessary pro- perty or rating quahfication to act as a member ; this declaration is to be filed, and any one making one falsely is guilty of a misdemeanour. The election of any member after he has acted, may be impeached by a writ of cpio loarranto^ sued out in the Court of Queen's Bench, and the member may then either resign his seat or defend it, which it need hardly be said may be a very costly process. The qualification of a member will be lost if he becomes a bankrupt or insolvent, or if he compounds with his. creditors, or holds or accepts any office of profit under or becomes a contractor to the Board. He will also be in- capable of continuing a member if he be absent from the district for more than six months at a time, unless in case of illness. But a member does not become disqualified owing to the sale or lease of any lands, or the loan of any money to a Local Board. A member may be interested in Joint Stock Companies which have contracts with the board without losing his qualification ; but he must not, without the consent of the Local Government Board, vote upon any question in which his company is interested. This dispensation of the Local Government Board refers mainly to water companies and other bodies of a like public nature. Members voting after being disqualified subject themselves to a penalty of .£50. In some cases Boards may consist of selected as well as elected members. It has already been stated that where there is a Town Coun- cil, this body becomes the Local Board. ' There is no special election as a Local Board, but the Town Council elected by ballot are, by the Public Health Act, at once constituted as the Local Board. It sometimes happens that there may be a district larger than a borough, or two boroughs may possibly form a district : in any such case the Town Council has power to select members to form, joined to elected members, a board for the district. There may also be unions of districts for various purposes, not- ably to provide an efficient water supply, or an outfall for the sewerage of several districts, or to provide land for sewage irrigation for the same, in these cases a joint sewer LOCAL AUTHOBITIES 13 authority may be created. This joint Board will exercise its powers only for the conjoint work, that is the work in which all the constituent districts are interested, leaving all the internal arrangements of the various districts in the hands of the individual Boards. Thus in the case of providing a main sewer for two or more districts, all the contributory sewers and drains within the districts would be constructed and superintended by the several Boards, while the main artery wouldbe constructed and supervised by the joint Board. A Local Board at its first meeting appoints a chairman. Meetings, who presides over the meetings of the Board and has a casting Vote. If absent any member may be appointed to act as Chairman ; one third of the number of members forms a quorum, and the meetings must be held at least once a month. A Local Board being a corporation should provide a common Seal. It has power to appoint such offi- common cers as may be requisite to carry out the business of the board ; specially, a Clerk, Treasurer, Surveyor, Medical officers. Officer of Health and Inspector of Nuisances. It has also power to appoint committees, to whom may be entrusted Committees varioas sections of the duties belonging in the aggregate to the Board itself ; but all the minutes passed by such Committees should come up for confirmation by the Board and all acts done should emanate from a resolution of the Board itself. The minutes of the Board meetings are to Minutes, be carefully kept ; they may be confirmed and signed at a subsequent meeting ; but minutes of committees should be entered at the time of meeting and signed if possible at the time and by the Chairman then presiding, and by all the members of the Committee who are present. It is very desirable that a Code of standing orders should he formed standing • . * Orders as it will be found much to facilitate business to have good rules laid down for its conduct, which rules should be rigidly adhered to. Standing orders should be so framed as to deal with the time at which meetings are to be held ; regulations as to calling special meetings ; directions as to conduct of meet- ings and attendance of members ; provisions as to entering minutes and as to safe custody of plans, papers, &c. in reference to the business of the board; provisions as to 14 MANUAL OF PUBLIC MEDICINE authentication and signing of notices, documents, etc. ; declarations of duties of officers ; rules for conduct of business between meetings of Local Authority ; regulations as to payments and receipts of monies ; and to collection of rates. Any departure from strict conformity to the duties and obligations of Local Boards is sure sooner or later to entail trouble on the members and may result in a serious pecu- niary loss. It is well, therefore, in every act done or order given to be fortified by the counsel and opinion of the legal adviser of the Board who is most usually, and should Inspectors always be, the Clerk also. Inspectors of the Local Govern- of Sanitary , ment Board can now attend meetings of Sanitary authorities Authorities. hopcd that in cases of difficulty much help may be Port Autho- derived by Local authorities from their co-operation and as- rities. , . , 1 A sistance. There is another authority constituted by the Act of last Session and which may be permanently appointed by provisional order of the Local Government Board, namely a port authority to watch over the health of any port and to inspect the shipping in any harbour, with any other powers and duties which the order may direct and enjoin. This in cases of epidemic visitations may prove to be a provision of great utility, as it will remove the difficulties of conflicting authorities and provide at once for the treat- ment of cases of epidemic disease occurring in ports and harbours or on board shipping within three miles of the coast. A port authority will, subject to the express provi- sion of the provisional order by which it is constituted, have all the powers of the Sanitary Acts. Comniis- Commissioners under local acts are appointed in accord- sioners •iiji r ^ * i i under local ance With the provisions oi the Acts themselves, except ^' when the powers are transferred to the Town Council or to a Local Board when their elections and meetings are go- verned by the rules already set out as appertaining to these bodies. Rural Bural sanitary authorities are in all cases the Guardians AuThorfties. of the Union or such portion of them as belong to the Union exclusive of any portion of any urban district con- Ex officio tained within it. The Board of Guardians consists of ex Guardians. officio members who are the Justices of the Peace residing LOCAL AUTH0BITIE8 15 Election of in the parish and acting for the county, riding, or division in which the parish is situate, and a certain number of Elected Guardians. The election of Guardians is regulated by the Poor Law Acts and is in all essential particulars the G^uarcUans. same as the election of Local Boards and it has been al- ready pointed out how they may discharge their duties either by themselves, by Committees of their own body, or by parochial Committees. There is yet another body which can act authoritatively under the common law to remedy or prevent injury to the public health. This is the Court Leet in every manor, court Lcet. consisting of a committee of the inhabitants of each j)lace, such committee not being less than twelve in number. The powers of the Court Leet are thus set out by ancient authority : ' If there be any ways, waters, ditches, or paths straited, or stopped, or turned out of the right course to a wrong course, unto the noysance of the King's people, ye shall do as to wit. Also of all butchers, fishers, or any other victuallers that sell victuals corrupt and not whole- some for man's body, ye shall do as to wit of them.' Any nuisance existing within the manor can be presented to the Court Leet, which may meet annually and as often there- after as may be necessary, in order that the nuisances com- plained of may be remedied. There are still some powers with respect to roads, and watching and lighting, lodged Powers'stiii in vestries ; but to them we shall refer subsequently ; and y^f^^j^gg^ in some instances under special acts vestries may still be urban sanitary authorities. 16 MANUAL OF PUBLIC MEDICINE CHAPTER III. OFFICERS AND POWERS OF LOCAL AUTHORITIES. officers^of To carrj out properly tlie duties of local authorities good Authorities, officials are indispensable. Upon tlieir efficiency must largely depend the standard of public bealtb of the district, seeing that it is impossible for local authorities, however competent they may be as administrators, to act as the Executive in carrying out the various Acts of Parliament which regulate their authority and define their duties. It is requisite for urban authorities to establish, with the Bye-Laws. conscnt of the Local Grovernment Board, a series of bye- laws, and it is important to note here that these bye-laws must be most carefully framed, as they will have no validity if the powers sought to be exercised by virtue of them ex- ceed those conferred by the Act of Parliament, of and to which they should be the exponents and adjuncts. They should be framed with due regard to the character and wants of the district, and it will be the duty of the Clerk, in carrying on the business of the Sanitary Authority, to see their provisions strictly enforced, and not exceeded either by the Board itself, or its officers. A form of such bye-laws is annexed. The form of Bye-Laws which is here given is, with some trifling alterations adopted by all the Local Boards in England, and is of so much importance as defining the relative duties of Urban Authorities, their officers, and the public, that it is deemed advisable to print it in extenso. URBAN SAISTITARY AUTHOEITY. BYE-LAWS, made and ordained by the Urban Sanitary Authority for the District of , pur- OFFICERS AND POWERS OF LOCAL AUTHORITIES 17 saant to the powers and provisions contained in the PubKc Health Act, 1848, and the Local Government Act, 1858, and the Public Health Act, 1872. As to the Levels Width, ^c, of New Streets, and Sewerage thereof. I. Every new street shall be laid out and formed of such width and width and at such level as the Urban Sanitary Authority struts! shall in each case determine. Every new street, being a carriage road, shall be laid out and formed at least wide, and the Urban Sanitary Authority shall determine in each case what pro- portion of the width of such street shall be laid out as carriageway and footway respectively. Every new street, not being a carriage road, shall be laid out and formed at least feet wide, and there shall be one entrance at least to every such street, of the full width thereof, and open from the ground upwards ; provided always, that when any street shall exceed the length of one hundred feet, it shall be at the option of the Urban Sanitary Authority to determine whether such street shall or shall not be laid out and formed of sufficient width for a carriage road. II. In any case in which an open space shall be left Modification! along one or both sides of any new street throughout its streets in whole length in front of the houses, or in which any new cases!^ street shall not be the principal or only approach to dwell- ing-houses, or in any special cases, the Urban Sanitary Authority may allow of a reduction of the widths herein specified for such streets, whether carriage roads or not, as they shall see fit. The width of new streets shall be taken to mean the whole space dedicated to the public, exclusive of cellar- flaps, or of any steps or projections therein, and measuring at right angles to the course or direction of such streets. III. No building shall be erected on the side of any new Height of street which shall exceed in height the distance from the new^tiSt?, front of such building to the opposite side of such street ; nor shall the height of any building so erected be at any time subsequently increased so as to exceed such distance. c 18 MANUAL OF PUBLIC MEDICINE Drainage of new streets. •Construc- tion of new streets. Thickness of walls. Materials of external walls. Walls carried through roofs. Woodwork in external or party walls. Roofs. In estimating the height of buildings, -the measurement shall be taken from the level of the centre of the street immediately opposite the building, up to the parapet or eaves of the roof. lY. The proposed level and width of any new street having been approved by the Urban Sanitary Authority, the Surveyor shall specify the depth and inclination, form, size, materials, and other particulars of the sewers and their appurtenances, according to which the works for the proper drainage of such street, and of the adjoining pro- perties, shall be carried out. V. The mode of construction of every new street, and the materials to be employed, shall be subject to the ap- proval of the Urban Sanitary Authority. VI. The walls of every new building shall be con- structed of such thicknesses as shall be approved by the Urban Sanitary Authority, and the foundations shall rest on solid ground, concrete, or other ^olid substructure, to be approved by the Urban Sanitary Authority. VII. The external and party or side walls of every new building shall be constructed of brick, stone, or other hard and incombustible substances, unless the Urban Sanitary Authority shall otherwise allow in cases in which it may appear to them that no danger would exist of the spread of fire. VIII. Any external or party wall of a new building, the roof or gutter of which shall adjoin any other house or building, shall be carried up above such roof or gutter to form a parapet of not less than twelve inches in height, measured at right angles to the slope, and above the covering of such roof, or above the highest part of such gutter. IX. ISTo joists, beams, or other woodwork fixed in or upon any external or party wall, — except beams or bres- summers and story-posts under the same, and frames of doors and windows of shops, — shall be brought within four inches at least of the external face of such wall, unless with the previous sanction of the Urban Sanitary Authority. X. The roof or flat of every new building, and every gutter, dormer, and other work or construction connected OFFICERS AND POWERS OF LOCAL AUTHORITIES 19 therewith, except the doors, door-frames, windows, and win- dow frames of such dormer and other construction, shall be formed of or externally covered with incombustible materials, except in special cases when otherwise allowed by the Urban Sanitary Authority. XI. The chimneys and flues of every building shall be Chimneys constructed in such mode, and of such materials and di- mensions, and of such height above the level of the nearest street, as shall be approved by the Urban Sanitary Autho- rity. All hearths and slabs shall be properly bedded in in- combustible materials. IS'o timber or woodwork shall be placed within six inches of the inside face of any chimney or flue, and the brickwork or stonework of such chimney or flue shall be properly rendered. No wood en plugs shall be driven nearer than nine inches to the inside of any chimney or flue. No openings shall be made in any chimneys or flues for any purpose, nor shall any pipe be fixed in any new building for conveying smoke, heated air, steam, or hot water, except in the manner approved by the Urban Sani- tary Authority. XII. The following buildings and works shall be exempt Exempted from the operations of these Bye-Laws : — Common gaols, prisons, houses of correction, and places of confinement connected therewith under the inspection of the inspectors of prisons, county lunatic asylums, sessions-houses, and other public buildings belonging to or occupied by the justices of the peace of the county, city, or borough in which the same are situate, buildings belonging to any canal, dock, or railway company, and used for the - purposes of such canal, dock, or railway, under ^^tS^ pro- visions of any act of parliament, all buildin^J' hoi • 1^'^ing public buildings, and not exceeding in heig^jt thirty feet, as measured from the ground-floor, and notiiexceedin extent 125,000 cubic feet, wholly in one oci distant at least thirty feet from the opposite nearest street or alley, whether public or priva" least thirty feet from the nearest buildings, and from" ground of any adjoining owner, all buildings not exceeding in extent 216,000 cubic feet, and not being public buildings c 2 20 MANUAL OF FUBLIC MEDICINE Space about buildings to secure venti- lation. Space not to be built upon. Height of rooms. and distant at least fifty feet from the opposite side of the nearest street or alley, whether public or private, and at least fifty feet from the nearest buildings, and from the ground of an adjoining owner. XIII. Every building to be erected and used as a dwelling-house, or as a school, shall have in the rear, or at the side thereof, or partly at the rear and partly at the side, an open space or open spaces exclusively belonging thereto, to the extent of at least* square feet in the whole, free from any erection thereon above the level of the ground. And the distance across such open space between every such building and the opposite property at the rear or side shall be ten feet at least ; if such building be either two stories or twenty feet in height above the level of such open space, the distance across shall be fifteen feet ; if such building be three stories or thirty feet in height, it shall be twenty feet ; if more than three stories or forty feet in height, it shall be twenty- five feet ; but no open space, either in the rear or at the side of such building, is to be taken into account as forming part of or making up the total of * square feet above required, unless there shall be at least one door or window on each story of such building opening on to such open space. When, however, thorough ventilation of such open space and buildings is secured, or when on the rebuilding of houses within the town, these dimensions and regulations cannot be adhered to without considerable sacrifice of property, they may be modified in special cases at the discretion of the Urban Sanitary Authority. XIY. Wherever any open space has been left belonging to any building, when the sanction of the Local Board has been obtained for its erection, such space shall never after- wards be built upon, or covered over wholly or in part, without the approval of the Urban Sanitary Authority. XV. Iq any building to be erected, every habitable room, except rooms in the roof, shall be in every part eight feet in height at the least from the floor to the ceiling, and every habitable room in the roof of any such building shall ^ This must differ according to the character of the district. OFFICERS AND POWERS OF LOCAL AUTHORITIES 21 be at the least eight feet in height from the floor to the ceiling throughout not less than one-half the area of such room. XYI. Every habitable room shall have at least one windows, window directly opening on to the external air, and the total area of such window or windows, clear of the sash- frame, shall be at the least one- tenth of the area of every such room, and the top of one at least of such windows shall be not less than seven feet six inches above the floor, and the upper half at least shall be made to open the full width. XYII. Every habitable room hereafter built of less area special than 100 superficial feet, and without a fire-place, shall be of smau^" provided with special means of ventilation, by air-shaft or otherwise, as the Urban Sanitary Authority may determine. XYIII. Every new public building, or any building in- Ventilation tended or adapted for the reception of more than 200 bufidings. persons, shall be supplied with means of ventilation and egress, to be approved by the Urban Sanitary Authority. XIX. All houses and buildings which, in the opinion of Drainage of the Urban Sanitary Authority, are without sufficient drain- approvai^of age, shall be drained in the most effectual manner which ^^^^^^^^s. may be practicable ; and the mode of drainage, and all materials intended to be used in the construction of the drainage of buildings, shall be subject to the approval of the Urban Sanitary Authority. XX. The drains of all houses and buildine^s shall consist Construc- , tion of house of glazed stone- ware or fire-clay pipes or other equally drainage, suitable material, to be approved of by the Surveyor, and they shall be of such dimensions, and shall be connected with the sewers in such manner as the Surveyor shall direct. They shall be laid with water-tight joints, and beneath houses they shall be embedded in and surrounded with well puddled clay. Xo right-angle junctions, whether ver- tical or horizontal, shall be formed. XXI. Proper ventilation shall be provided in the drain- Ventilation /, 1 1 •• IP 1 house age of every house, by special pipe or shaft, or by such drainage, other method as the Surveyor may direct. All other inlets to the house drains shall be properly trapped, with etone-ware or other traps to be approved by the Local Surveyor. 22 MANUAL OF PUBLIC MEDICINE Drainage of subsoil, and prevention of damp. Water- closets, earth -closet, and privies. Cesspools. Ashpits. XXII. The house drainage shall be so constructed, either with additional earthenware pipe drains or otherwise, as to drain the subsoil of the premises, whenever the dampness of the site appears to the Urban Sanitary Authority to render this necessary. And all rain-water shall be so drained or conveyed from the roofs of buildings, as to prevent its drip- ping on to the ground and causing dampness in the walls. XXIII. The situation, dimensions, materials, and con- struction of every water-closet, earth-closet, and privy shall be subject to the approval and be altered according to the requirements of the Urban Sanitary Authority; and if any occupier or person having a right of using the same water- closet, earth-closet, or privy shall not alter the same when required by the Urban Sanitary Authority, then it shall be lawful for the Urban Sanitary Authority to alter the same at the expense of such occupier or person, and such ex- pense shall be recovered in the same manner as the penalties imposed by these Bye-Laws. Every water-closet, earth- closet, or privy shall have an opening of not less than twelve square inches, as near to the top as practicable, communicating directly with the external air, or shall be otherwise furnished with sufficient means of ventilation. XXIV. 'No cesspool shall be allowed except when un- avoidable and by special leave of the Urban Sanitary Au- thority when it shall be constructed in such situation and in such manner as the Urban Sanitary Authority shall direct. It shall in every case be made water-tight. It shall be arched or covered over, and a pipe or shaft for ventilation shall be carried up from it, or from the drain communicating with it from the water-closet or privy. XXV. The situation, dimensions, materials, and con- struction of every ash-pit shall be subject to the approval and be altered according to the requirements of the Urban Sanitary Authority ; and if any occupier or person having a right of using the same ash-pit shall not alter the same when required by the Urban Sanitary Authority, then it shall be lawful for the Urban Sanitary Authority to alter the same at the expense of such occupier or person, and such expense shall be recovered in the same manner as OFFICEBS AND POWERS OF LOCAL AUTHORITIES 23 habitation. the penalties imposed by these Bye- Laws, and every such ash-pit shall be of sufficient size to contain the ashes and dry refuse likely to accumulate between the prescribed visits of the scavenger. XXYI. No new house shall be occupied until the house certificate of drainage has been made and completed, nor until such of^cw^^^" house has been certified by the Urban Sanitary Authority, ^o^^^^- or their officer authorised to give such certificate, after examination, to be in every respect conformable to their Bye-Laws. XXVII. In any case where it is certified to the Urban ^"^^^^j^s Sanitarv Authority bv the officer of health of the district, human by the Local Surveyor, by the Inspector of Nuisances, or by any two medical practitioners, that any building or part of a building erected since the constitution of the district is unfit for human habitation, or to be used as a school, factory, or workshop, the Urban Sanitary Authority may, by their order, affixed conspicuously on the building, or part of the building, declare that the same is not fit for human habitation, or to be used as a school, factory, or workshop, and such building or part of a building shall not, after a date therein to be specified, be inhabited or so used, and any person who, after the date or time mentioned in such order, lets or occupies or uses as aforesaid, or continues to let, occupy, or use, or knowingly sufiers to be occupied or used as aforesaid, such building or part of a building, shall be liable for every such ofience to a penalty, not exceeding twenty shillings, for every day during which the same is so let, occupied, or used as aforesaid ; provided always, that if at any time after such order made, the Urban Sani- tary Authority shall be satisfied that such house has become or been rendered fit for human habitation, or such school, factory, or workshop, fit to be used as aforesaid, they may * revoke their said order, and the same shall thenceforth cease to operate. XXVIII. Every person who shall intend to make or lay Notices, out any new street, whether the same shall be intended to be of^new^'^'' used as a public way or not, shall give one month's notice to the Urban Sanitary Authority of such intention, by writing delivered to the Surveyor, or left at his office, and shall at 24 MANUAL OF PUBLIC MEDICINE the same time leave or cause to be left at the said office a plan and section of such intended new street, drawn to a scale of not less than one inch to every forty-four feet ; and every such plan shall show thereon the names of the owners of the land through or over which such street shall be intended to pass ; the level, width, direction, the pro- posed mode of construction, the building line, the proposed name of such intended new street, and its position rela- tively to the streets nearest thereto ; the size and number of the intended building lots, and the proposed sites, height, class and nature of the buildings to be erected therein, and the proposed height of the division and fence-walls thereon, and the proposed plan and dimensions of the sewers, and shall contain the name and address of the person intending to lay out such new street, and be signed by him or his duly authorised agent. Every such section shall show thereon the level of the present surface of the ground above some known fixed datum, the level and rate or rates of inclination of the intended new street, and sewers and drains, the level and inclinations of the streets with which it will be connected, and the level of the lowest floors of the intended new buildings. Notices, XXIX. Every person who shall intend to erect any new of^new^^^*' building shall give a fortnight's notice to the Urban Sani- bmidmgs. ^^^^ Authority of such intention, by writing delivered to the Local Surveyor, or left at his office, and shall, at the same time, leave, or cause to be left, at the said office, detail plans and sections of every floor of such intended- new building, drawn to a scale of not less than one inch to every eight feet, showing the position, form, and dimen- sions of the several parts of such building, and of the water-closet, earth-closet, privy, cesspool, ash-pit, well, and all other appurtenances ; and such plans and sections shall be accompanied by a description of the materials of which the building is proposed to be constructed, of the intended mode of drainage, and means of water-supply. All plans, sections and drawings shall be sent in on drawing paper, tracing cloth or paper, and shall be drawn in ink, and the same shall belong to the Urban Sanitary Authority and be deposited with the Surveyor. OFFICERS AND POWERS OF LOCAL AUTHORITIES 25 A block plan shall be left at tbe same time, drawn to a scale of not less than one inch to every forty-four feet, showing the position of the buildings and appurtenances of the properties immediately adjoining, the width and level of the street, the level of the lowest floor of the intended building, and of the yard or ground belonging thereto. The plan shall show also the proposed lines of house drainage, and their size, depth, and inclination. XXX. The Surveyor shall inspect any works or build- inspection ings in progress of construction at any reasonable time Locai^sur^^ that he may think fit, or that he may be required to do so by the Urban Sanitary Authority ; but the person laying out the work, or the builder, shall give two days' notice in writing to the Surveyor before the commencement of such work, and before any foundations of new buildings, or any sewers or drains, are covered up ; and the like notice shall be given after the works have been completed, which may have been required by the Surveyor to be done in amend- ment of any irregularity, and before such works shall be covered up. XXXI. If in doing any work, or erecting any building, ^^J^^^^g^^. anything is done contrary to the rules herein contained, or veyor in case anything required by those rules is omitted to be done ; ity. or if the Surveyor, on surveying or inspecting any build- ing or work, finds that the same is so far advanced that he cannot ascertain whether anything has been done con- trary to the rules herein contained, or whether anything required by such rules has been omitted to be done ; The Surveyor shall, within six hours after such survev or inspection, give to the builder or person engaged in erecting such building, or in doing such work, notice in writing, requiring such builder or person, within forty- eight hours from the date of such notice, to cause any- thing done contrary to the rules herein contained to be amended ; or to do anything required to be done by such rules, but which has been omitted to be done ; or to cause so much, of any building or work as prevents such Local Surveyor from ascertaining whether anything has been done, or omitted to be done, as aforesaid, to be to a suffi- cient extent cut into, laid open, or pulled down. 26 MANUAL OF PUBLIC MEDICINE Notice of completion of works and buildings. Power to remove new works or buildings not ap- proved by the Board. XXXII. Within one month after any work or building of which notice was given has been completed, the builder or person by whom such work has been done shall give notice to the Local Surveyor thereof, and the surveyor shall forthwith proceed to survey such building or work, and shall report to the Urban Sanitary Authority thereon. XXXIII. The Urban Sanitary Authority shall by their order approve or disapprove of proposed new works or buildings within the times severally specified herein for the deposit of notices thereof, and the owner or person intend- ing to erect any new street or building shall give the notices hereby required ; and if any owner or person shall construct any works contrary to the provisions herein contained, the Urban Sanitary Authority, after calling upon such owner or person to show cause why the works so constructed should not be removed, altered, pulled down, or otherwise dealt with, may, if they think fit, have such work removed, altered, pulled down, or otherwise dealt with as the case may require ; and the expenses in- curred by them in so doing shall be repaid by the ofiender, and be recoverable from him in a summary manner, as pro- vided by the Public Health Act, 1848. XXXIV. Any person ofiending against any of the above bye-laws shall forfeit and pay for every such offence a penalty not exceeding five pounds, and iu case of a con- tmuing offence a further penalty not exceeding forty shil- lings for each day after written notice of the offence from the Urban Sanitary Authority or their authorised of&cer. XXXV. If any workman, labourer, servant, or other person employed in or about any new works, wilfully, and without the privity or consent of the owner or person causing such work to be done, does anything in or about such works contrary to the provisions herein contained, he shall, for each such offence, incur a penalty not exceeding fifty shillings. As to the Regulations of Slaughter -houses^ "pursuant to the Powers, ^c, of the Local Government Act, 1858 : — pjaughter- XXXVI. The occupier of eveiy slaughter-house within houses to be ^^{^ district shall cause the same to be well paved and Penalties. Penalty on workmen, etc. OFFICEBS AND P0WEB8 OF LOCAL AUTHOBITIES 27 houses. laid with proper slopes towards a gully-hole, aud snffi- paved and eiently ventilated, to the satisfaction of the Officer of and to be' Health appointed for the time being by the Urban Sanitary li^^-^^^i^^d' Authority ; and shall cause the whole of the internal brick or plaster surface of such slaughter-house to be thoroughly lime- washed, at least twice in every year — that is to say, in the months of April and September ; and shall cause the wainscoting of such slaughter-house to be painted and kept clean. XXXVII. Every occupier of a slaughter-house shall storage and *^ ^ <-> removal provide and keep a sufficient number of tubs, boxes, or of filth, vessels, with tight and close-fitting covers thereto, con- siaiight^r-° structed to the satisfaction of the Urban Sanitary Autho- rity, for the purpose of receiving and conveying away all manure, garbage, and filth, and shall in all cases, except as hereinafter provided, immediately after the killing and dressing of any cattle in such slaughter-house, cause all such manure garbage, and filth, to be placed in such tubs, boxes, and vessels ; and such tubs, boxes, and vessels, to- gether with their contents, shall be removed to such place, at such interval of time, with such precautions, and within such hours, as may be, from time to time, fixed by the Urban Sanitary Authority ; and all the blood arising from the slaughtering of cattle shall be put into separate tubs or vessels with close-fitting covers, and shall be carried away from the slaughter-house without delay, and shall not be permitted to flow in the channel or sewer, or open street : Provided always, that no blood shall be put into the same tubs or vessels in which the manure, garbage, or other filth are put : Provided also, that the manure, garbage, and other filth shall not be kept or carried away in such tubs, boxes, and vessels, where impermeable covered drains are provided for carrying away the same. All the tubs and vessels which are used for the removal of any manure, garbage, and filth, and all the tubs and vessels which are used for the removal of blood from any slaughter-house, shall, immediately after being used for such removal, be thoroughly emptied, cleansed, and puri- fied, and the floor of such slaughter-house shall then be also effectually scoured and cleansed ; and the whole shall 28 MANUAL OF PUBLIC MEDICINE Every slaughter- house to be supplied with water, and to be cleansed. Hides and skins to be removed. Diseased or unsound cattle not to be slaughtered. Members and ofiBcers of the Local Board to have access to every slaughter- house. Pigs or other animals in slaughter- houses. Dogs in slaughter- houses. Registered slaughter- houses. generally be kept in such a condition that neither within the slaughter-house, nor without it, shall there be any offensive smell arising therefrom. XXXVIII. The occupier of every slaughter-house shall provide the same with an adequate supply of water ; and shall cause the same to be thoroughly washed and cleansed within three hours after the completion on each day of any slaughtering and dressing of cattle therein ; and shall not make nor permit to be made, nor suffer to exist, any cess- pool within such slaughter-house. XXXIX. Every occupier of such slaughter-house shall remove, or cause to be removed, from such slaughter-house, the hides and skins of any cattle that shall be slaughtered therein, together with the blood and offal, either on the same day or on the day next after such cattle shall have been slaughtered. XL. The occupier of every such slaughter-house shall not slaughter, or suffer to be slaughtered therein, any diseased or unsound cattle ; and in case of any diseased or unsound cattle being brought to such slaughter-house, he shall forthwith give information thereof to the Inspector of Nuisances. XLI. All members and authorised officers of the Urban Sanitary Authority shall have free access to every slaughter- house at all times, for the purpose of examining into the condition of the same with regard to the cleanliness, ven- tilation, and management thereof. XLII. No occupier of any slaughter-house shall permit or suffer any pigs or other animals to be kept in any slaughter-house, or premises adjacent thereto, except for the purpose of being fasted previous to killing ; and no occupier of any slaughter-house shall keep or retain any cattle in such slaughter-house for a longer period than forty-eight hours, previous to the slaughtering of the same. XLIII. The occupier of any such slaughter-house shall not keep, or permit to be kept, in such slaughter-house or premises, any ferocious dog, unless such dog shall be securely fastened or muzzled. XLIY. The occupier of every registered slaughter-house shall cause the word * slaughter-house,' together with the OFFICEBS AND POWEES OF LOCAL AUTHORITIES 29 number corresponding with the number under which such slaughter-house shall be registered in the register kept for that purpose by the Urban Sanitary Authority, to be painted or otherwise inscribed, to the satisfaction of the said Urban Sanitary Authority on, over, or adjoining to the outside of the door or entrance to such slaughter-house, and there kept and continued, free from any obliteration or defacement. XLV. The occupier of every slaughter-house shall, if Bye-iawsto desired by the said Urban Sanitary Authority or their 3^^^^^^^^ Surveyor, cause a copy or extract of or from any of these ^^ouse^^^ Bye-Laws which relate to slaughter-houses, written or if required, printed in large characters, and provided by and at the expense of the Local Board, to be affixed in some con- spicuous part of such slaughter-house, and to be at all times continued in such place ; and if such copy, or extract, or any part thereof, should be obliterated or defaced, such occupier shall forthwith affix in the same conspicuous place another copy in lieu thereof. XLYI. Every occupier of any slaughter-house within Penalties the said district, who shall in any respect fail to comply with either of the foregoing Bye-Laws applicable thereto, or in anywise offend against the same, or who, after due notice from the Urban Sanitary Authority, requiring such slaughter-house to be lime-washed and cleansed, shall neglect so to do, or who shall at any time refuse to allow any officer or servant of the Urban Sanitary Authority an inspection of the premises, shall forfeit and pay for each and every such offence, any sum not exceeding the sum of Five Pounds ; and a further penalty of Ten Shillings for every day during the continuance of the offence after written notice thereof from the Urban Sanitary Authority. The said penalties to be recovered and applied as the statute directs. As to Prevention of Nuisances arising from Buhhish, and Keeping of Animals : — XL VII. All occupiers of any premises within the district Nuisances shall whitewash, wash, or otherwise cleanse and keep free &c. Interior of buildings. 30 MANUAL OF PUBLIC MEDICINE Yards, &c., where ani- mals are kept. Refuse, &c., in improper places. Exceptions. Rubbish, &c. durinf^ pro- gress of buildings. from filth, and cleansed, the interior of such premises, so that no offensive smell shall proceed from the sam«. XLYIII. All occupiers of any yards, places, or premises where horses, cattle, pigs, or other animals are kept, either constantly or occasionally, shall provide upon such premises, to the satisfaction of the Urban Sanitary Authority or their authorised officer, a proper receptacle for dung, manure, and all other solid refuse arising on the premises, and a trapped drain for carrying ofip all urine and other liquid drainage from such premises, or into such receptacle ; and if no means for the removal of such dung, manure, and other solid refuse be provided by the Urban Sanitary Authority, every such occupier shall himself remove all such dung, manure, and other refuse, at such interval of time, with such precautions, and within such hours as may from time to time be fixed by the Local Board. XLIX. N'o person shall deposit, throw, or allow to run, lodge, or accumulate upon the surface of any street, square, court, highway, or place, or on any waste or unoccupied ground, or in any uncovered drain, ditch, watercourse, sink, pond, water trough, or other collection of water, or expose or cause to be exposed in any other manner what- ever within the district, any animal or vegetable matter, sewage, waste liquid, fish, ofi'al, ordure, blood, bones, manure, shells, broken glass, china, or earthenware, dust, ashes, house refuse, waste refuse, rubbish, dirt, or runnings from any manufactory, or other offensive or noxious matter whatever, without the special leave of the Local Board. L. Provided always, that no person shall be liable to a penalty for throwing or depositing any sand or ashes in the time of frost upon any footway to prevent accidents, or any manure, or other materials in the time of frost, upon the course of water pipes, in order to prevent the •water therein from being frozen, or any clean litter or other materials in order to prevent noise, in case of sickness. LI. Provided also, that no person shall be liable to any penalty for throwing or depositing on any street, square, court, highway, alley, footway, or other public passage, any rubbish, dirt, or materials, used in or occasioned by the building, rebuilding, or repairing of any house or building, OFFICEBS AND POWERS OF LOCAL AUTHORITIES 31 in cases where such person shall, to the satisfaction of the anthorised officer of the Urban Sanitary Authority, enclose the space where such deposit is made, within a sufficient fence : and shall, where directed so to do by such officer, as aforesaid, lay down with proper materials a sufficient temporary footway for foot-passengers, communicating with the foot-causeway at each end thereof, and fenced off from the remaining portion of the street or thoroughfare by a good or sufficient rail ; the whole enclosure and temporary foot- way to be so constructed as to leave sufficient room for a passage of coaches, waggons, and the ordinary traffic through the said street or thoroughfare, and to be approved of by the said officer. LII. No person shall be entitled to claim exemption from the liabilities attached to any offence against the 49th bye- law under either of the above provisoes, unless such person shall cause the sand, ashes, manure, Htter, rubbish, dirt, enclosing boards, temporary footways, rails, and other materials enumerated in the said provisoes, to be promptly and effectually removed as soon as possible after the cessa- tion of the cause which occasioned their deposit or erection. LIII. Provided also, that no occupier of any farm, or arable or pasture land, who shall use, deposit, or dispose of the dung or manure made or employed by him in farming operations, according to the usual course of husbandry, shall be liable to the penalty imposed by the 49th bye-law, where such dung and manure is not mixed with any night- soil or matter which shall have been removed from any privy, water-closet, or cesspool, and where such dung or manure is not deposited, or left in any heap or midden at, or upon, any place or places within 200 yards of any street or continuous line of houses. LIY. Provided also that the 49th bye-law shall not be taken to prohibit the deposit of ashes or other materials used or required in the manufacture and preparation of bricks, where such ashes and other materials are deposited only in the brickfields or places where such manufacture or preparations are, and may be lawfully carried on, and are not mixed with any animal or vegetable refuse, or other offensive and noxious matter. Removal of excepted things. Exception as to manure, &c., in farm- ing opera- tions. Exception to ashes in brick-fields. 32 MANUAL OF PUBLIC MEDICINE Not to limit 59th section of Public Health Act. Carrying night-soil iSic, through street. Time, and mode of ditto. Offensive matter dropped in streets, &c. Carts, (Sic, not to remain in streets. LV. Provided also, that nothing in the 49th bye-law contained, shall be taken to limit in any manner the power conferred by the 59th section of the Public Health Act upon the Inspector of Nuisances, to order the occupier of any premises whatever, whereon there shall be any accumula- tion of manure, dung, soil, filth, or other offensive or noxious matter, to remove the same within twenty- four hours after notice duly sent to such occupier requiring such removal. LVI. Where any nightsoil, sewage, or any contents of any cesspool, or any other offensive or noxious matter, has to be carried in or along any street, thoroughfare, or place within the district, it shall be carried in vessels properly covered, and no part thereof shall be allowed to fall on the street or surface. LYII. 'No nightsoil, sewage, or other contents of any cesspool, nor any other noxious or offensive matter shall be conveyed through any street or thoroughfare within the district, except within such hours as may be, from time to time, fixed by the Urban Sanitary Authority, nor at any time, except in carts properly covered and secured against any escape of the contents thereof, or any issue of offensive smells from the same, to the satisfaction of the Urban Sani- tary Authority. LYIII. If, in the course of emptying any privy, water- closet, or cesspool, or of removing nightsoil, the contents of any cesspool, or other offensive matter, any of such nightsoil, contents, or other matter should be dropped, spilled, or slopped in any streets, passages, highways, or thoroughfares within the district, the person or persons who are engaged in effecting such emptying or removal shall well and carefully sweep and cleanse the place on which such matter shall have been dropped, spilled, or slopped as aforesaid, and shall effectually remove such sweepings therefrom, within the hours fixed by the Urban Sanitary Authority for such emptying and removal as aforesaid. LIX. No cart, waggon, or carriage used for the purpose of receiving and removing nightsoil, sewage, or other matter from any cesspool, shall be suffered to stand or remain in any public street, passage, highway, or thorough- OFFICERS AND POWERS OF LOCAL AUTHORITIES 33 fare, for any longer time tlian sliall be necessary for the loading thereof. LX. Every occupier of premises in any part of the dis- When occu~ pi^^s tp re- trict in which the Urban Sanitary Authority shall not from move i-cfu&c. time to time give notice that they will cause all refuse to be removed, shall remove from such premises (and in such a manner as not to create a nuisance in the process of removal) all the refuse from such premises (at least once in every week), and shall in the meantime provide, to the satisfaction of the Urban Sanitary Authority, means of storing the said refuse, so that it shall not become a nui- sance to the occupants of the premises on which it arises, or to the other inhabitants of the district. As to Cleansing Footways, ^c. Removal of Refuse, and 0 leasts ing Priv ies . LXI. In case any privy, water-closet, earth-closet, o;' ojjensive cesspool within the district shall be in a foul or offensive state, so as to require cleansing or emptying, and notice under the hand of the Inspector of Nuisances, or other authorised of&cer of the Urban Sanitary Authority, shall be given to the occupier, or left at his place of abode or business, or left with any householder entitled to the use of the said privy, water-closet, or earth- closet, requiring such occupier or householder to cleanse or empty the same within a time to be therein mentioned, and such occupier or householder shall neglect or omit to comply with such notice, then and in every such case the occupier or house- holder to or for whom such notice shall have been given or left as aforesaid shall, for every such neglect or omission, forfeit and pay such sum as shall be hereinafter provided ; and the filth and soil of the said water-closet, earth-closet, privy, or cesspool may forthwith, after the expiration of such notice, be removed by the Inspector of Nuisances, or other authorised officer of the Urban Sanitary Authority at the expense of such occupier or householder, and such expense shall be recovered in the same manner as the penalties imposed by these Bye-Laws. LXII. No person shall empty, or assist in emptying, any Emptying- privy, water-closet, cesspool, or similar receptacle of offen- P"^^^'' ^^-^ D 34 MANUAL OF PUBLIC MEDICINE siye matter within the district, without the use of such deodorisers, and the employment of such other meaus of preventing disagreeable or hurtful effects therefrom, as shall ' be directed by the Urban Sanitary Authority, or any of their authorised officers. Discretion- LXIII. In all cascs in these Bye-Laws where rules are ary povv er m . the Board, laid down to be strictly adhered to, it shall be lawful for the Urban Sanitary Authority, in any particular and special case, to relieve from or modify the laws, in such manner as in their discretion shall meet such particular or special case. Penalties. LXIV. Any person offending against any of the above Bye-Laws, or who shall do any act thereby forbidden to be done, or who shall omit to do any act thereby required to be done by him, or who shall prevent or oppose the inspection hereinbefore provided for by the authorised officers of the Urban Sanitary Authority, shall forfeit and pay for every such offence a penalty not exceeding five pounds, and, in case of a continuing offence, a further penalty, not exceed- ing the sum of forty shillings, for each day after written notice of the offence from the Urban Sanitary Authority or their authorised officer ; such penalties to be recovered and applied as the statute directs. Given under the Seal of Office of the said Urban Sanitary Authority and under the hands of Five of the Members thereof, the day of Five of the Members of the Urban Sanitary Authority. Clerk to the Urban Sanitary Authority. Confirmed — Home Office, Whitehall. OFFICEBS AND POWERS OF LOCAL AUTHOBITIES 35 The Clerk will have to sign notices on behalf of the Board, Duties of to take and preserve minutes of the Board meetings and of all committees, and to assist by his advice and opinion in all measures, taken by the Board. It is impossible, in the present state of the law, to urge too strongly and continuously on all local authorities the necessity of adhering to its very letter, as the courts are most unwilling to allow any restrictions on owners of dealing with private property beyond that expressly sanctioned by statute. Any attempt, therefore, to act in the * svirit ' of the Sanitary Acts must be avoided. The Clerk will be able to appear in all proceedings instituted by or against the local authority, and will generally, between the meetings of the local authority, carry on the business subject to such control by committees or otherwise as the local authority may appoint and deter- mine. The Clerk to a rural sanitary authority will be the Clerk of the Union. The Treasurer must in no case be the Treasurer. Clerk or his partner. He may well be the Banker of the Board, but there is nothing in his office whicli needs be specially adverted to as differing from the duties of the treasurer of any corporation or large company. The accounts of an Accounts of urban authority are to be audited, if in a corporate district, Authority, by the borough auditor, otherwise by the Poor Law auditor of the district. The Auditor gives public notice of his audit ; the ac- Auditor, counts are open for inspection for seven days to ratepayers, and he has power to strike out of the accounts any items which appear to him improper, and to surcharge those Surcharges, members of the Sanitary authority who have authorised the payment. This power is subject to an appeal either Appeal to the Court of Queen's Bencli or to the Local Government decision of Board, which last body can treat the matter in dispute upon equitable considerations, apart from a strict and tech- nical view of the legality of the payments. Very serious liabilities may be incurred by members of costs of pro- sanitary authorities not acting strictly within the scope of tiiTOwon their authority ; for besides the power of surcharge lodged ^^^^^^^i'^- in the auditor, proceedings in equity may be instituted to prevent expenses being thrown on the rates, thus adding very heavy costs to the first charge falling on D 2 36 MANUAL OF PUBLIC MEDICINE What are disputed items of ac- count. Bortugh Funds Bill, 1872. Eeport of Auditor. Abstract of Accounts to be published. Trans- mission of Accounts. Time for making up Accounts. Accounts of rural Sani- tary Autho- rities. Overseers' Accounts. Surveyor. His duties. those who have consented to payments not authorised by law. These disputed items of account have largely, in the past, consisted of monies paid for the promotion of or opposition to Bills in Parliament not injuriously afiecting the property of the local authority instituting the proceedings, although of importance to the interests of the ratepayers, and incidentally bearing upon the powers and duties of the local authority, such as Water and Gas Bills. These questions will be set at rest in the future by the Bill of last session, which enacts that before incurring any such expenses a special vote of the governing body, passed by an absolute majority, after ten days' notice by public advertisement, and in cases of promotion of Bills a further special resolution shall be passed, and also as to- opposition or promotion, a vote of consent of the rate- payers and owners of the district at a public meeting shall be taken, in the manner provided in the Local Government Act, 1858,' for the adoption of that Act. This involves the necessity, if required, of taking a poll of the district. The accounts being audited, a report is sent b}^ the Auditor to the Clerk of the Sanitary Authority, and an abstract of the accounts is published in the local papers ; a copy of the accounts is to be transmitted to both the Home Secretary and to the Local Government Board, who will, upon appli- cation, furnish to any Sanitary Authority a blank form of accounts. It is better, if possible, to have all accounts made up to the 31st day of March in each year. The accounts of all rural sanitary authorities are audited in every respect in the same manner as their accounts are audited in their capacity as guardians of the poor. Any monies received or paid by overseers on account of any rural authority are to be audited in the same manner as the accounts of overseers collecting or paying any monies for the purposes of the Acts relating to the relief of the poor, and a copy of such accounts are to be transmitted to the Local Government Board. The office of Surveyor to a sanitary local au- thority is one of great importance. Upon his ability and intelligence will very largely depend the success of sanitary work. He will have to report upon all applications for laying out new streets, building new houses, making con- OFFICEBS AND POWERS OF LOCAL AUTHOmilES 37 nections with sewers, and improyements of the district generally ; and where works are done in the district, will have to superintend their execution, and report upon their completion to his Board. If works ordered as private im- provements by the authority are not carried out by the parties upon whom the order is made, it will be his duty to execute them either by day-work under his own super- intendence, or, if of the value or amount of £100, then by a contractor appointed by the local authority after public tender. He has the power, upon receiving written au- Entry int@ thority from the Board, co enter into any premises and examine and lay open any drains or watercourses, &c., in order to remedy or prevent a nuisance. He will, in an urban district, as regards highways in the district, be in Highways, the same position as a surveyor of highways, his Board being constituted the surveyor, and will have the power to do all ministerial acts which a surveyor of highways can perform. He is to make estimates for the Board before any Estimates, rates or contracts are made or entered into, and under sanc- tion of his report, stating it to be necessary, the local au- thority will have power to carry their sewers into, through, or under any lands whatsoever. The bye-laws of a Local Bye-Laws, Board will also entail heavy duties and responsibilities on the Surveyor, and it is only by his constant watchfulness, specially in cases of new buildings, that sanitary regu- lations can be properly and efficiently carried out, and the authority protected from unseemly contention with the ratepayers. It is now imperative on every sanitary au- Medical Offi- thority, whether urban or rural, to appoint, either by Appoint- itself or in combination with the authorities of other sanitary districts, a Medical Officer of Health, such first appointment not to be for a longer period than five years. The Act of 1872 provides that this officer shall be a duly qualified medical practitioner ; but, beyond this. Qualification, requires no other qualification for the office, and unless the Local Government Board pays out of the public revenues a portion of the salary, it has no control over the appointment and salary of, or duties to be salary and discharged by, the Medical Officer of Health. This officer, like the Surveyor, may be alga the Inspector of Nuisances 38 MANUAL OF PUBLIC MEDICINE and has all the powers, whether so appointed or not, lodged in that office. The duties of a Medical Officer of Health, not being authoritatively declared, will depend much on the sanitary authority by whom he is appointed. In theory he should be the mainspring of action in all sanitary matters but there is such jealousy of medical interference and, control not only among sanitary authorities but also on the part of their constituents, as materially to limit the scope of his action and interference. It is believed, and rightly so, that large expenses will always follow the appointment if recommendations certain to be the result of careful sanitary inspecton of any district are to be carried out. In order to avoid this many authorities affix to the appoint- ment so small a salary as to make the duties merely nominal in order to discharge their obligation without entailing any further cost on the district. In theory the Medical Officer of Health should be the health officer of the district, the director of a system of what may be called medical police. That is, he should know, by reports promptly sent to him by raedical practitioners, of any case of infectious or contagious disease, especially when endemic or epidemic, occurring in his district. The register of deaths should be either under his control or always open to his inspection, and he should constantly supervise all the streets and buildings of his district, condemning the latter when unfit for human habitation, and reporting those requiring alterations and amendments, in order to prevent injury to health or life. He should dictate the conditions necessary to be observed in common lodging-houses, manufactories, slaughter-houses, or other buildings of public or quasi-public character. He will be expected periodically to report on the health and mortality of his district, to visit any places brought under his notice by the inspector of nuisances, to examine food supposed to be unwholesome, and take proceedings, or attend to give evidence before the magistrate when the owner or seller of unwholesome food is summoned for that offence. In general, although contrary to all right action in sanitary matters, in the present state of the law and public feeling on the subject, the less obtrusive the action of a medical officer of health, the better will his OFFICERS AND POWERS OF LOCAL AUTHORITIES 39 employers and the public be satisfied. Under the Public Minutes of Health Act, 1848, it was a part of the duty of the General ^* ^* ^' Board of Health, then in existence to declare what should be the functions performed by the Officer of Health, and the following circular, issued by that Board in 1851, will show the view then entertained, and this will be at the present time a most useful guide to those authorities who wish sanitary measures to be efficiently supervised by a competent officer. Following the minute of the General Board of Health will be found the Regulations issued by the Local Government Board, 1872, as to the duties of the Officer, and the two documents may be usefully compared.* Minutes as to Duties of Officers of' Healthy issued by the General Board of Health. 1851. Duties of the Officer of Health, as directed by the General Board of Health, under the 40th section of the Public Health Act, 1848. Whereas it has of late been ascertained by public inquiries into the sanitary condition of towns, that the causes which produce excessive sickness and premature mortality, are definite, palpable, and preventible, and that although such causes press with peculiar intensity on the humbler classes they often severely afflict every other class ; and whereas many diseases break out and spread without the knowledge that they are produced or aggra- vated by common and preventible causes, and it is found by experience that many such diseases give distinct warn- ing of their approach, and may, by prompt attention to such warning, be arrested in their further development and spread ; and whereas from the want of due means of giving such knowledge and warning, excessive mortality prevails, especially in the more densely peopled parts of towns ; and whereas by the 40th section of the Public Health Act, it is enacted that the Local Board of Health may from time to time, if they shall see fit, appoint, with the sanction of the General Board of Health, a fit and proper person, being a legally qualified medical practitioner or a member of the medical profession, and to be called the 40 MANUAL OF PUBLIC MEDICINE General scc/pe of duties. Not to ex- tend to ser- Yices pro- vided for by private prac- tice. primary duties in regard to common or epidemic disease. Visitation of places where epidemic di- seases occur. House to liouse visi- tations to ascertain the numbers affected by premonitory symptoms. Duties in respect to vaccination. Officer of Health, who shall be removable by the said Local Board, and shall perform such duties as the General Board of Health shall direct : — Now, therefore, we, the said General Board, do hereby, under our hands and official seal, direct that the following duties shall be performed by Officers of Health, appointed pursuant to the above section ; provided that any of such duties as may involve the visiting of private premises be performed by consent of the occupier or other person in charge of such premises. 1. The general duties of the Officer of Health will com- prise the duty of giving instructions and directions for the removal or prevention of causes of disease common to several persons, and also for the prevention or removal of causes of disease to individuals, where those causes come within the province of local administration under the Public Health Act. 2. Except in cases where existing disease may be alle- viated by the immediate removal of any of the hereinafter specified causes, the general duties of the Officer of Health shall in no case comprehend treatment for the cure or alle- viation of disease. 3. The Officer of Health shall take all practicable means to obtain the earliest information of the occurrence of cases of fever, of whatsoever type, of small-pox, measles, or other epidemic, endemic, or contagious disease. 4. On obtaining information of the occurrence of cases of sickness or death from any such disease, he shall immedia- tely visit the spot. 5. He shall examine and ascertain, by house-to-house visitation or otherwise, whether others besides those who have died are affected, and he shall give such warning or instructions to the persons affected as may be calculated to induce them to have recourse to medical treatment, or take such measures as the circumstances of the epidemic or other species of disease may appear to require. 6. In case of an outbreak of small-pox, he shall inquire whether any person living in or near the premises are unvaccinated, and urge on the Guardians the duty of see- ing that all unvaccinated persons are vaccinated under the OFFICERS AND POWEBS OF' LOCAL AUTHOBITIES 41 3 & 4 Yict. c. 29, and 4 & 5 Vict. c. 32, and take steps to discover nnvaccinated persons, and secure their vaccination with the least possible delay. He shall also inquire under what circumstances the outbreak originated ; carefully investigating the history of the first case, and the mode in which the disease was propagated. He shall inquire into and report upon the causes which have tended to impede the practice of vaccination, or to render the vaccination in- effectual, and the circumstances which may render re- vacci- nation desirable. 7. In case of the occurrence of any epidemic disease amongst the occupants of any single room occupied by one family, or by more than one lodger, or tenements otherwise overcrowded, the Officer of Health shall give instruction for the removal of the sick, or the diminution of the overcrowd- ing, or for the prevention, by such means as may be avail- able, of the spread of the disease. 8. In the case of a death in any room occupied as a living or sleeping room by survivors, he shall give instructions either for the removal of the corpse to some house or place of intermediate reception to await the funeral rites, or for the removal of the occupiers. 9. In all cases of death, he shall give such instructions to the survivors as he may be authorised to give under any Act of Parliament as to the care of the body, as to the sort of coffin to be used for the prevention of noxious evaporations, and the removal and interment of the body, with such precautions as may be required for the protec- tion of the public health. 10. He shall, after having given such instructions as aforesaid, in such order as he may deem necessary, ex- amine into cases of typhus or other epidemic, endemic, or contagious disease, and inquire whether such disease was caused or aggravated by anything which is capable of re- moval in or about the premises, the living or sleeping rooms, or places of work of the persons attacked, and shall notify the same to the persons responsible for the nuisance ; as in the case of accumulations of filth, noxious cesspools, house-drains, or sewers of deposit, to the officers respon- sible therefor; he shall also, where necessary, give in- Instructions as to inmates of over- crowded rooms. Instructions in cases of death from epidemic Duties in cases of death. Inquiries as to conditions causing or favouring the spread of epidemics. 42 MANUAL OF PUBLIC MEDICINE Instructions for inquiries as to epi- demics amongst children in schools. Instructions for inquiries as to epi- demics amongst workpeople in factories and work- shops. Instructions as to com- munication with minis- ters of re- ligion, medi- cal officers, and others. Instructions as to in- quiries into conditions predisposing structions for lime-wasliing or the application of deodor- ising or disinfectant mixtures or substances. 11. In the case of small-pox, or any other contagious or epidemic disease attacking any child who has frequented any school, he shall, as early as may be practicable, visit such school, and inquire and examine whether there be symptoms of the infection or prevalence of the disease amongst the other children, and give such instructions and advice as may appear to be necessary for the prevention of the spread of the' disease. 12. In the case of the like disease attacking any worker (whether young or adult) in any factory or place of work with others, he shall visit such place of work, and inquire and examine whether there be symptoms of the disease amongst the workers, and give such instructions or advice as may appear to be necessary for the prev^ention of the spread of the disease. 13. Besides his own frequent visitation and inspection of those parts of his district which are the most likely to be the seats of disease, in order that he may ascertain as early as possible the actual occurrence of any form of zymo- tic disease, he shall maintain a constant communication with the Inspector of Nuisances for the district (whose reports he shall examine, and give such instructions there- on as will best insure the speedy discovery of all causes injuriously affecting, the public health), mth the ministers of religion, the registrar of his district, and the Union medical officers ; and shall from time to time examine • the medical weekly returns, and the registers of sickness and mortality furnished by the district medical officers. 14. He shall appoint and notify convenient times at which, when not prevented by extraordinary duties, he will personally attend daily, or at such times as may be convenient, at his office, or other convenient place, to re- ceive information in respect to the occurrence of epidemic disease or matters affecting the public health within the district. 15. Inasmuch as the. ordinary seats of epidemics are also the localities of other classes of disease which shorten life such as scrofula, and its frequent concomitant pulmonary OFFICERS AND POIVEBS OF LOCAL AUTHORITIES 43 consumption, he shall further make a special examination to scrofulous .. and pulmo- of the conditions which produce a predisposition to this nary com- class of disease as well as to epidemics within the district. 16. In his inspection of schools, manufactories, or work- inspections ^ ' ^ ' of schools. shops, he shall take note of the children, young persons, and workpeople, who may appear to be pallid, feeble, sickly, or in a peculiarly low condition of health, and inquire whether such condition has been produced *by overcrowd- ing, by defective ventilation, imperfect cleansing, or any other removable cause of debility or disease. 17. He shall himself exercise such a superintendence i^^^ties in , respect to over measures of prevention or alleviation which he may works^of ^ have recommended as will enable him to ascertain whether recommend- they have been properly and effectually performed ; and if ^^^^* he find any deficiency or delay in the execution, he shall make inquiry into the cause thereof, ?aid report the same to the Local Board of Health. 18. He shall perform all the duties imposed upon him by any bye-laws of the Local Board, whether of inspection or otherwise, in respect of lodging and slaughter-houses, and any other matter affecting the public health in respect of which Local Boards may have framed bye-laws under the Public Health Act ; and in visiting any tenements in pursu- ance of such bye-laws, he shall from time to time make such visits by night, or at such times as the inmates are assembled, and observe and report on the state and action of the means of ventilation in such places. 19. Whilst public works of sanitary improvement or Duties in T . . 1 i 1 in 1 respect to cleansing are m progress, such as the removal oi cesspools the con- fer the formation of new drainage or sewerage works, the works^of^ cleansing out of town ditches, watercourses, ponds, or provement!" canals, he shall give such instructions as to the time and mode of conducting th^ operations, the application of water, lime, deodorizing or disinfecting substances ; and any other means of protecting the public from noxious or offensive emanations as may appear to him to be requisite. 20. He shall, upon any complaint, or upon the emission i>^ities in ^ ^ IT J r 7 r ^ case of com- of any offensive or noxious smell, or the accumulation of plaints or noxious deposits m drams or sewers, report upon the same to the effects from Local Board of Health, or to such officer as may be ap- 44 MANUAL OF PUBLIC MEDICINE Duties in respect to noxious trades and processes. To inquire as to the fact as well as the cause of death where there is no medical cer- tificate. Duties in case of vio- lent deaths. Attendance at the meet- ing of the Local Board of Health. Duties as to keeping a diary and register of complaints. pointed by the Local Board to receive and act upon such complaint. 21. On the occurrence of atmospheric pollution from any offensive process or trade carried on in any manufac- tory, yard, house, or premises within his district, he shall inquire into the cause, and report on the appropriate means for the prevention of such noxious smells and emanations. In case of the refusal or neglect of the occupier or proprie- tor to adopt the measures recommended, or other effectual remedies, or in case of the manufacturing process being of such a nature as not to admit of any effectual remedy, he shall then observe and collect the evidence of the injurious effect of the process in question on health, shall be pre- pared to adduce such evidence whenever called upon by the proper authorities, and shall otherwise assist those authorities by all the means in his power in their efforts for the abatement of the nuisance. 22. In cases where there is no medical certificate, or where, from anything that appears, the deceased died without any regular medical attendance, it shall be the duty of the Officer of Health to examine into and deter- mine as closely as he may the cause, as well as the fact, of the death. 23. In the case of deaths suspected to be from violence, accident, neglect, or carelessness, or when from other cir- cumstances he may deem it desirable, he shall notify the same in writing to the Coroner, and shall present a copy of such notification to the Local Board at their next meeting, and shall in all cases, where practicable, render such services as may be requisite to aid the investigations of coroners or magistrates. 24. He shall attend at all meetings of the Local Board of Health, and report to them his proceedings during the intervals between their meetings. 25. He shall keep a diary, in which he shall make an entry of his visits, and notes of his observations and in- structions thereon, which diary he shall produce, whenever required, both to the Local and to the General Board of Health ; he shall also keep a register of complaints or representations made to him, to be called " The Officer of OFFICERS AND POWERS OF LOCAL AUTHORITIES 45 Health's Application Book," in which shall be recorded the date and nature of every application made to him, the date of its examination, and the result of such examination, and shall produce such book whenever required both to the Local and General Board of Health. 26. On the occurrence or discovery of any source of injury to the public health, or of any epidemic disease, he shall, besides warning the Local Board thereon, send in- formation thereof to the General Board of Health, 27. He shall from the best information he can obtain, make a report not less frequently than once a quarter, of the nature and amount of sickness and death which have prevailed during the quarter. 28. He shall, in such report, describe the progress and effects of any works of amendment which may have been commenced or executed. 29. He shall also prepare annually, a printed report and tabular return of the ascertained sickness as well as mor- tality of the district for the year, distinguishing therein the sickness and mortality of the several streets, squares, courts, lanes, yards, and alleys ; and for this purpose, where there is a survey of the district, he shall be furnished by the Local Board, with a tracing or copy of the same, on which he shall mark the seats of epidemic or other disease ; and such report shall set forth the amount of epidemic sickness or mortality which has prevailed in the district, as compared with former years, amongst different classes of persons, and in different localities of the district, and also a comparison of such rate of sickness and death, with the rates of sickness and death amongst other classes and in other places, and any instructions in the way of warning, or for prevention or mitigation of sickness, which the facts may suggest, as well as the particulars of any death which may have occurred from epidemic, endemic, or contagious disease, the amount and causes of infantile mortality (that is, of children under five years of age), and the nature and amount of sickness and death which may have occurred from causes which appear to be preventible, and within the recognised province of public administration, or that appear requisite to be brought within it. To inform General Board in certain cases. To report quarterly. To report on the progress of works Oi amendment. To report annually on the health of the district. Topics of the Annual Report, 46 MANUAL OF PUBLIC MEDICINE Circulation 30. The annual and quarterly reports shall be printed, o repoi s. ^ copy given to each member of the Local Board, and two copies shall be transmitted to the General Board of Health, and one to the office of the Registrar- General, and the Poor Law Board, as well as to each member of the Boards of Guardians, and to each of the medical officers, and incumbents of the several parishes within the district ; and it shall otherwise be circulated for the information o-f the inhabitants of the district, as may be provided by the Local Board of Health. Given under our hands, and under the Seal of the General Board of Health, this Twelfth day of February, in the year of our Lord One thousand eight hundred and fifty-one. * L.S. (Signed) Ashley. Edwin Chadwick. T. SouTHwooD Smith. Minutes as to Duties, Sfc, of Medical Officers of Health issued hj the Local Government Board, 1872-3. Section I. — Qualification, Art. 1. — Ko person shall be qualified to be appointed to the office of Medical Officer of Health under this Order, unless he shall be registered under ' The Medical Act of 1858,' and shall be qualified by law to practise both medi- cine and surgery in England and Wales, such qualification being established by the production to the Sanitary Autho- rity of a diploma, certificate of a degree, licence, or other instrument granted or issued by competent legal authority in Great Britain or Ireland, testifying to the medical or surgical, or medical and surgical, qualification or qualifi- cations of the candidate for such office. Provided that the Local Government Board may, upon the application of the Sanitary Authority, dispense with so much of this Regulation as requires that the Medical Officer of Health shall be qualified to practise both medicine and surgery, if he is duly registered under the said Act to practise either medicine or surgery. OFFICERS AND POWEBS OF LOCAL AUTHORITIES 47 Section II. — Appointment. Art. 1. — A Statement shall be submitted to tbe Local Government Board, showing the population and extent of the District for which the Sanitary Authority propose to appoint the Medical Officer or Medical Officers of Health, and the salary or remuneration intended to be assigned ; and where the circumstances render desirable the appoint- ment of one Medical Officer of Health for two or more Sani- tary Districts, Statements shall, in like manner, be sub- mitted to the Local Government Board, showing the names of the Districts to be combined for that purpose, the popu- lation and extent of each District, the mode in which it is intended that the appointment shall be made, whether jointly or severally by the Sanitary Authorities of those Districts, and the amount of salary or remuneration pro- posed to be assigned to the officer appointed. Art. 2. — When the approval of the Local Government Board has been given to the proposals submitted to them, the Sanitary Authority or Authorities shall proceed to the appointment of a Medical Officer of Health accordingly. Art. 3. — No appointment of a Medical Officer of Health shall be made, unless an advertisement giving notice of the day when such appointment will be made shall have appeared in some public newspaper circulating in the District or Districts, at least seven days before the day on which such appointment is made : Provided that no such advertisement shall be necessary for the appointment of a temporary substitute. Art. 4. — Every such appointment hereafter made shall, within seven days after it is made, be reported to the Local Government Board by the Clerk to the Sanitary Authority, or, in the case of a joint appointment, by the Clerk to one of the Sanitary Authorities by whom the appointment is made. Art. 5. — Upon the occurrence of a vacancy in such office, the Sanitary Authority or Authorities shall proceed to make a fresh appointment, which shall be rejoorted to the Local Government Board as required by Sect. II. Art. 4. of this Order ; but if the Sanitary Authority or Authorities desire to make any fresh arrangement with respect to the 48 MANUAL OF PUBLIC MEDICINE District or the terms of the appointment, they shall, before filling up the vacancy, supply the particulars of the arrange- ment to the Local Government Board in the manner prescribed by Sect. II. Art. 1 ., in regard to the first ap- pointment, and if the approval of the Local Government Board be given, absolutely or with modifications, the Sani- tary Authority or Authorities shall then proceed to fill up the vacancy according to the terms of the approval so given. Art. 6. — If any Officer appointed under this Order be at any time prevented by sickness or accident, or other suffi- €ient reason, from performing his duties, the Sanitary Authority or Authorities, as the case may be, may appoint a person qualified as aforesaid to act as his temporary sub- stitute, and may pay him a reasonable compensation for his services ; and every such appointment shall be reported to the Local Government Board as soon as the same shall have been made. Section III. — Tenure of Office. Art. 1. — Every Officer appointed under this Order shall continue to hold office for such period as the Sanitary Au- thority or Authorities appointing him may, with the appro- val of the Local Government Board, determine, or until he die, or resign, or be removed, by such Authority or Autho- rities with the assent of the Local Government Board, or by the Local Government Board. Provided that the appointments first made under this Order shall not be for a period exceeding five years. Art. 2. — Where any such Officer shall have been appointed after the passing of the Public Health Act, 1872, for one or more Sanitary Districts, and any change in the extent of the District or Districts, or in the duties, salary, or remuneration, may be deemed necessary, and he shall decline to acquiesce therein, the Sanitary Authority or Au- thorities by whom he was so appointed may, with the con- sent of the Local Government Board, but not otherwise, and after six months' notice in writing, signed by their Clerk or Clerks, given to such Officer, determine his office. Art. 3. — ISTo person shall be appointed who does not OFFICEBS AND POWERS OF LOCAL AUTHORITIES 49 agree to give one month's notice previous to resigning the office, or to forfeit such sum as may be agreed upon as liquidated damages. Section IV. — Duties. The following shall be the duties of the Medical Officer of Health in respect of the District for which he is ap- pointed ; or if he shall be appointed for more than one District, then in respect of each of such Districts : — 1. He shall inform himself as far as practicable respecting all influences affecting or threatening to affect injuriously the public health within the District. 2. He shall inquire into and ascertain by such means as are at his disposal the causes, origin, and distribution of diseases within the District, and ascertain to what ex- tent the same have depended on conditions capable of removal or mitigation. 3. He shall by inspection of the District, both systemati- cally at certain periods, and at intervals as occasion may require, keep himself informed of the conditions injurious to health existing therein. 4. He shall be prepared to advise the Sanitary Authority on all matters affecting the health of the District, and on all sanitary points involved in the action of the Sani- tary Authority or Authorities ; and in cases requiring it, he shall certify, for the guidance of the Sanitary Autho- rity or of the Justices, as to any matter in respect of which the Certificate of a Medical Officer of Health or a Medical Practitioner is required as the basis or in aid of sanitary action. 5. He shall advise the Sanitary Authority on any question relating to health involved in the framing and subsequent working of such bye-laws and regulations as they may have power to make. 6. On receiving information of the outbreak of any conta- gious, infectious, or epidemic disease of a dangerous character within the Distnct, he shall visit the spot with- out delay and inquire into the causes and circumstances of such outbreak, and advise the persons competent to act as to the measures which may appear to him to be re- E 50 MANUAL OF PUBLIC MEDICINE quired to prevent the extension of the disease, and so far as he may be lawfully authorized, assist in the execu- tion of the same. 7. On receiving information from the Inspector of Nuis- ances that his intervention is required in consequence of the existence of any nuisance injurious to health, or of any overcrowding in a house, he shall, as early as practic- able, take such steps authorized by the Statutes in that behalf as the circumstances of the case may justify and require. 8. In any case in which it may appear to him to be neces- sary or advisable, or in which he shall be so directed by the Sanitary Authority, he shall himself inspect and examine any animal, carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, or flour, exposed for sale, or deposited for the purpose of sale or of preparation for sale, and intended for the food of man, which is deemed to be diseased, or unsound, or unwholesome, or unfit for the food of man ; and if he finds that such ani- mal or article is diseased, or unsound, or unwholesome, or unfit for the food of man, he shall give such directions as may be necessary for causing the same to be seized^ taken, and carried away, in order to be dealt with by a Justice according to the provisions of the Statutes applic- able to the case. 9. He shall perform all the duties imposed upon him by any bye-laws and regulations of the Sanitary Authority, duly confirmed, in respect of any matter affecting the public health, and touching which they are authorized to frame bye-laws and regulations. 10. He shall inquire into any offensive process of trade carried on within the District, and report on the appro- priate means for the prevention of any nuisance or injury to health therefrom. 11. He shall attend at the office of the Sanitary Authority, or at some other appointed place, at such stated times as they may direct. 12. He shall from time to time report, in writing, to the Sanitary Authority, his proceedings, and the measures which may require to be adopted for the improvement OFFICERS AND POWEBS OF LOCAL AUTHORITIES 61 or protection of the public health in the District. He shall in like manner report with respect to the sickness and mortality within the District, so far as he has been, enabled to ascertain the same. 13. He shall keep a book or books, to be provided by the Sanitary Authority in which he shall make an entry of his visits, and notes of his observations and instructions thereon, and also the date and nature of applications made to him, the date and result of the action taken, thereon and of any action taken on previous reports, and shall produce such book or books, whenever required, to the Sanitary Authority. 14. He shall also prepare an annual report, to be made at the end of December in each year, comprising tabular state- ments of the sickness and mortality within the District, classified according to diseases, ages, and localities, and a summary of the action taken during the year for pre- venting the spread of disease. The report shall also con- tain an account of the proceedings in which he has taken part or advised under the Sanitary Acts, so fej* as such proceedings relate to conditions dangerous or injurious to health, and also an account of the supervision exer- cised by him, or on his advice, for sanitary purposes over places and houses that the Sanitary Authority has power to regulate, with the nature and results of any proceed-, ings which may have been so required and taken in respect of the same during the year. It shall also record the action taken by him,, or on his advice, during the year, in regard to offensive trades, bakehouses, and workshops. 15. He shall give immediate information to the Local Government Board of any outbreak of dangerous epide- mic disease within the District, and shall transmit to the Board, on forms to be provided by them, a Quarterly Return of the sickness and deaths within the District, and also a copy of each annual and of any special report. 16. In matters not specifically provided for in this Order, he shall observe and execute the instructions of the Local Government Board on the duties of Medical Officers of E 2 52 MANUAL OF PUBLIC MEDICINE Health, and all the lawful orders and directions of the Sanitary Authority applicable to his office. 17. Whenever the diseases Prevention Act of 1855 is in force within the District, he shall observe the directions and regulations issued under that Act by the Local Government Board, so far as the same relate to or con- cern his office. Section V. — Bemuneration. Art. 1. — The Sanitary Authority or Authorities, as the case may be, shall pay to any officer appointed under this Order such salary or remuneration as may be approved by the Local Government Board ; and where such officer is appointed for two or more districts, the salary shall be apportioned amongst the Districts in such manner as the said Board shall approve. Provided that the Sanitary Authority or Authorities, with the approval of the Local Government Board, may pay to any such officer a reasonable compensation on account of extraordinary services, or other unforeseen circum- stances connected with his duties or the necessities of the District or Districts for which he is appointed. Art. 2. — The salary or remuneration of every such officer shall be payable up to the day on which he ceases to hold the office, and no longer, subject to any deduction which the Sanitary Authority or Authorities may be entitled to make in respect of Sect. III., Art. 3 ; and in case he shall die whilst holding such office, the proportion of salary (if any) remaining unpaid at his death shall be paid to his per- sonal representatives. Art. 3. — The salary or remuneration assigned to such officer shall be payable quarterly, according to the usual Feast Days in the year, namely. Lady Day, Midsummer Day, Michaelmas Day, and Christmas Day ; but the Sani- tary Authority or Authorities may pay to him at the expi- ration of every calendar month such proportion as they may think fit on account of the salary or remuneration to which he may become entitled at the termination of th^ quarter. OFFICERS AND POWERS OF LOCAL AUTHORITIES 53 Given under our Seal of Office, this Eleventh day of November, in the year One thousand eight hundred and seventy-two. James Stansfeld, Fresident. John Lambert, Secretartf, The greatest opposition to health measures has come in Opposition the past from holders of small cottage property. It is not improve^-^^ merely the payment of increased general district rates which must ensue from putting streets, alleys, courts, and gutters in order, and providing adequate main drainage and water supply ; but that which presses most heavily is the amount of costs which come under the head of private improvement expenses. The medical officer of health, finding fever, small-pox or diarrhoea prevaiHng in a row of cottages, reports, as the result of his examination to the Local Board, that the water supply is defective, the sulliage soaking into the ground, the floors of the cottages broken, uneven, sodden, and the cottage itself in bad repair ; thereupon comes an order to connect each cottage with the main drainage if within 100 feet of the houses, to make water-closets, and to provide efficient water supply, besides putting the house reported on into proper repair. This often means an expenditure of from £10 to £20 per house ; and if the work be not done by Private im- the owner after order of the local authority, then it is carried £pln?es?^ out by the surveyor, and the expense charged upon the owner. This may be, it is true, spread over a number of years as a private improvement rate, but it involves so much difficulty Private im- and trouble to collect these private improvement rates that ^ate!^"^^^^ the expenses incurred are generally sought to be recovered summarily. When, as is unfortunately too common, the greatest possible profit is sought to be wrung out of these miserable habitations of the poor^ it will occasionally entail great opposition to have the profits of two or three years suspended by the necessity to meet expenses incurred for benefits undesired and unappreciated. Undesired and un- appreciated in too many cases by the occupiers themselves^ for those most requiring care are the most unwilling to be ^4 MANUAL OF PUBLIC MEDICINE €ared for, and the most regardless of the simplest precau- tions to preserve health and ensure comfort. It is true these expenses are the results of accumulations of long years of neglect, but they are none the less heartily protested against. While the owners of this class of property have large influence in returning members to the local legisla- ture we can hardly wonder that Boards representing them and their views should look with more than doubt and dis- taste at sanitary measures recommended by Medical Officers of Health. The Legislature itself, and Central Boards created by it, have to some extent participated in these feelings, and the instructions given to Medical Officers of Health in 1851, which have been printed in extenso, pp. 39 et seq., are far in advance of those more recently issued. The remedy for this indisposition to adopt necessary sani- tary measures must either be sought in a higher class con- stitution of sanitary authorities — with some intermediate authority to enforce what may be necessary to the public health of the district, or enactments which shall make the Medical Officer of Health independent of the local authority with power in the intermediate and Central Boards to inquire into any of his recommedations which are not car- ried out, and with power, if judged expedient, to enforce, and, if necessary, to execute them, charging the cost on the defaulting authority. Besides this, we must earnestly desire such an education of the great mass of people who ure the most to be benefited by sanitary measures, as shall make them more ready to appreciate and more anxious to fn "ther by their co-operation what is undertaken for their good. The statutory duties of the Officer of Health are to re- port upon houses in a filthy or unwholesome condition, and thereupon the local authority may order such whitewash- ing, cleansing or purifying as may tend to prevent or check infectious or contagious diseases. In the same way, if he report that any house is so overcrowded as to be dangerous or prejudicial to health the local authority may commence proceedings before justices who may make any order to •abate the overcrowding complained of, and have also power OFFICES 8 Am POWERS OF LOCAL AUTHORITIES 55 to inflict a fine not exceeding 40s. on tlie offending party — under the Artizans' and Labourers' Dwelling Act which Artizans' and is applied to all urban authorities, the Medical Officer of Dwelling Health may report on any premises, whether built before or after the constitution of the district, that is on any dwelling-house or inhabited building, with its yard, garden, outhouses, &c., and upon his report and that of the sur- veyor, after opportunity being afforded to the owner to make any objection to the reports of these officers, such works are to be executed by the owner or by the district, as may be determined by the local authority to be necessary. Against this order there is an appeal to Quarter Sessions. Upon the written representation of four or more householders living in or near any street that anywhere in the neighbourhood they believe any premises to be in a condition dangerous to health, the Officer of Health is forth- with to inspect such premises and to report on them ; but the absence of any such representation will not excuse him from inspecting and reporting any premises which ought to be put into a proper condition. Besides these enact- ments, the Officer of Health or Inspector of Nuisances may, at all reasonable times, inspect and examine any animals or food, and in case any such food or animals be in a con- dition improper for human use, he has power to order their seizure, and to cause them to be brought before a justice, who has power to order that they be destroyed. The person offering such animals or food for sale may be fined £20, or imprisoned, without the option of a fine, for three months. The Medical Officer of Health or Inspector of Nuisances is protected in the discharge of these duties ; for any one obstructing him or any of his assistants in their execution may be fined £5. The Inspector of Nuisances is not the least important of inspector of the officers to be appointed by the local authority, and great care should be bestowed on the selection of a proper person to fill the post. Where the superintendent of police of a district dis- Police as in- charges the duties, there is the advantage of his having ^p^^*^^^* the whole police force as subordinates, and from the nature of their ordinary daily and nightly work they must 66 MANUAL OF PUBLIC MEDICINE One Inspec- tor for a dis- trict. Hindrances to Sanitary Work. Notices to Inhabitants. Complaints, where to be received. Presentment book. Standing orders. necessarily become acquainted with many of the grievances npon their beats calUng for remedy. Still they have many other functions to discharge, and it is doubtful whether the benefit is not greater by appointing one person as in- spector of lodging-houses and nuisances, whose whole time should be given to the discharge of the duties of the office. In these, tact and discretion are quite as necessary as intelligence. It would be incredible, were it not too pain- fully true, how averse the general public is to be subject to any sanitary inspection, however much it is intended to enure to their benefit ; and this specially in the case of the poor, who seem to think it a duty to discourage and depre- cate interference. To overcome this prejudice is essen- tial to an adequate discharge of duty. The Inspector must join the greatest civility with equal firmness, in order to obtain admission into premises the state of which can only be learned by an examination from within. The Inspector should, whenever practicable, act only under express direc- tions and sanction of the Board or its officers, and should take upon himself no responsibility or interference beyond the scope of his duties. It is essential that the inhabitants should know where complaints may be received ; there should, therefore, be fixed times when the Inspector may be seen in his office, and a book for entry of complaints should always be accessible. All letters of complaint received by him should be at once communicated to the Clerk, and every verbal complaint entered immediately in his present- ment book. This book should always be presented either to the local authority at its meeting, or to the committee appointed by the Board for the purpose of dealing with nuisances. A record should be kept by him of all services of notices, and matters not specifically dealt with at any time should be from time to time brought forward to pre- vent them being absolutely lost sight of and neglected. It will be his duty to inspect animals and food, and where ne- cessary to submit to the Medical Officer of Health or to an analyst, where one is appointed in his district, under the Adulteration of Food Act, any animals or food which may appear to him to be unsuitable for human use or food. The standing orders, to which reference has been already made, OFFICERS AND POWERS OF LOCAL AUTHORITIES 57 should provide for such, accord among the various officers of the local authority, and such combined action where necessary, as would prevent the possibility of conflict, and ensure to the subordinate officer at all times the counsel and support of the Surveyor, Clerk, and Medical Officer of Health. Subjoined are the Regulations issued by the Local Govern- ment Board as to the duties of Inspector of Nuisances : — To the Guardians of the Poor of the several Unions, Parishes, and Places in England and Wales, in which such Guardians act as a* Rural Sanitary Authority under the PubHc Health Act, 1872 :— And to all others whom it may concern. Whereas by Section 10 of 'The Public Health Act, 1872,' it is enacted that it shall be the duty of every Rural Sanitary Authority to appoint from time to time an In- spector or Inspectors of IS'uisances, for the purposes of the Sanitary Acts ; And whereas it is thereby further enacted that the Local Government Board shall have the same powers as they have in the case of a District Medical Officer of a Union, with regard to the qualification, appointment, duties, salary, and tenure of office of Officers of Sanitary Authorities, any portion of whose salary is paid out of moneys voted by Parliament ; and that the same person may, with the sanction of the Local Government Board, be appointed the Inspector of Nuisances for two or more Sanitary Districts, by the joint or several appointment of the Sanitary Au- thorities of such Districts : Now we, the Local Government Board, deeming it ex- pedient that Regulations should be made with respect to the appointment, duties, salary, and tenure of office of Inspectors of Nuisances appointed by Rural Sanitary Authorities, in all those cases where any portion of the salary of any such officer is paid out of moneys voted by Parliament, do hereby order and direct as follows : Section I. — Appointment. Art. 1. — A statement shall be submitted to the Local Government Board, showing the population and extent of * The Regulations for Urban Sanitary Authorities are precisely similar. 58 MANUAL OF PUBLIC MEDICINE the district for which the Sanitary Authority propose to appoint the Inspector or Inspectors of Nuisances, and the salary or remuneration intended to be assigned ; and where the circumstances render desirable the appointment of one Inspector of Nuisances for two or more Sanitary Districts, statements shall, in like manner, be submitted to the Local Government Board, showing the names of the Districts to be combined for that purpose, the population and extent of each District, the mode in which it is intended that the ap- pointment shall be made, whether jointly or severally by the Sanitary Authorities of those Districts, and the amount of salary or remuneration proposed to be assigned to the Officer appointed. Art. 2. — ^When the approval of the Local Government Board has been given to the proposals submitted to them, the Sanitary Authority or Authorities shall proceed to the appointment of an Inspector or Inspectors of Nuisances accordingly. Art. 3. — No appointment of an Inspector of Nuisances shall be made under this Order unless notice has been given at one of the two ordinary meetings next preceding the meeting or Jieetings at which the appointment is to be made by the Sanitary Authority or Authorities, as the case may be, such notice being duly entered on the Minutes, or unless an advertisement, giving notice of the day when such appointment will be made, shall have appeared in some public newspaper circulating in the District or Dis- tricts, at least seven days before the day on which such appointment is made : Provided that no such notice or advertisement shall be necessary for the appointment of a temporary substitute. Art. 4. — Every appointment hereafter made shall, within seven days after it is made, be reported to the Local Government Board by the Clerk to the Sanitary Authority, or, in the case of a joint appointment, by the Clerk to one of the Sanitary Authorities by whom the appointment is made. Art. 5. — Upon the occurrence of a vacancy in such office, the Sanitary Authority or Authorities shall proceed to make a fresh appointment, which shall be reported to the OFFICERS AND POWERS OF LOCAL AUTHORITIES 59 Local Government Board as required by Section 1. Art. 4. of this Order ; but if the Sanitary Authority or Authorities desire to make any fresh arrangement with respect to the District or the terms of the appointment, they shall, before filling up the vacancy, supply the particulars of the arrange- ment to the Local Government Board, in the manner prescribed by Section 1. Art. 1. in regard to the first appointment, and if the approval of the Local Government Board be given, absolutely or with modifications, the Sanitary Authority or Authorities shall then proceed to fill up the vacancy according to the terms of the approval so given. Art. 6. — If any of&cer appointed under this Order be at any time prevented by sickness or accident, or other sufii- cient reason, from performing his duties, the Sanitary Authority or Authorities, as the case may be, may appoint a fit person to act as his temporary substitute, and may pay him a reasonable compensation for his services ; and every such appointment shall be reported to the Local Government Board as soon as the same shall have been made. Section IL — Tenure of Office. Art. 1. — Every Officer appointed under this Order shall continue to hold office for such period as the Sanitary Authority or Authorities appointing him may, with the ap- proval of the Local Government Board, determine, or until he die, or resign, or be removed, by such Authority or Authorities with the assent of the Local Government Board, or by the Local Government Board. Provided that the appointments first made under this Order shall not be for a period exceeding five years. xArt. 2. — Where any such Officer shall be appointed for one or more Sanitary Districts, and any change in the ex- tent of the District or Districts, or in the duties, salary, or remuneration, shall be deemed necessary, and he shall de- cline to acquiesce therein, the Sanitary Authority or Autho- rities by whom he was so appointed, may, with the consent of the Local Government Board, but not otherwise, and after six months' notice in writing, signed by their Clerk or Clerks, given to such Officer, determine his office. 60 MANUAL OF PUBLIC MEDICINE Art. 3. — No person shall be appointed who does not agree to give one month's notice previous to resigning the office, or to forfeit such sum as may be agreed upon as liquidated damages. Section III. — Duties. The following shall be the duties of an Inspector of IN'uisances in respect of the Sanitary District for which he is appointed, or if he shall be appointed for more than one district, or for a part of a District, then in respect of each of such districts, or of such part : — 1. He shall perform, either under the special directions of the Sanitary Authority or (so far as authorized by the Sanitary Authority) under the directions of the Medical Officer of Health, or in cases where no such directions are required, without such directions, all the duties spe- cially imposed upon an Inspector of ISTuisances by the Sanitary Acts, so far as the same are in force in the District, or by the Orders of the Local Government Board. 2. He shall attend all meetings of the Sanitary Authority when so required. 3. He shall by inspection of the District, both systematically at certain periods, and at intervals as occasion may re- quire, keep himself informed in respect of the nuisances existing therein that require abatement under the Sani- tary Acts. 4. On receiving notice of the existence of any nuisance within the district, or of the breach of any bye-laws or regulations made by the Sanitary Authority for the sup- pression of Nuisances, he shall, as early as practicable, visit the spot, and inquire into such alleged nuisance or breach of bye-laws or regulations. 5. He shall report to the Sanitary Authority any noxious or offensive businesses, trades, or manufactories established within the District, and the breach or non-observance of any bye-laws or regulations made in respect of the same. 6. He shall report to the Sanitary Authority any damage done to any works of water supply, or other works be- longing to them, and also any case of wilful or negligent 0FFICEB8 AND POWEES OF LOCAL AUTHORITIES 61 waste of water supplied by them, or any fouling by gas, filth, or otherwise, of water used for domestic purposes. 7. He shall from time to time, and forthwith upon complaint, visit and inspect the shops and places kept or used for the sale of butchers' meat, poultry, fish, fruit, vegetables, COTn, bread, or flour, or as a slaughter-house, and examine any animal, carcase, meat, poultry, game, flesh, fish, finiit, vegetables, corn, bread, or flour, which may be therein ; and in case any such article appear to him to be intended for the food of man, and to be unfit for such food, he shall cause the same to be seized, and take such other proceedings as may be necessary in order to have the same dealt with by a Justice : Provided, that in any case of doubt arising under this clause, he shall report the matter to the Medical Officer of Health, with the view of obtaining his advice thereon. 8. He shall, when and as directed by the Sanitary Authority, procure and submit samples of food or drink, and drugs suspected to be adulterated, to be analyzed by the analyst appointed under the Adulteration of Food Act, 1872, and upon receiving a certificate stating that the articles of food or drink, or drugs, are adulterated, cause a complaint to be made, and take the other proceedings prescribed by that Act. 9. He shall give immediate notice to the Medical Officer of Health of the occurrence within his District of any con- tagious, infectious, or epidemic disease of a dangerous character ; and whenever it appears to him that the inter- vention of such Officer is necessary in consequence of the existence of any nuisance injurious to health, or of any overcrowding in a house, he shall forthwith inform the Medical Officer thereof. 10. He shall, subject in all respects to the directions of the Sanitary Authority, attend to the instructions of the Medical Officer of Health with respect to any measures wiiich can be lawfully taken by him under the Sanitary Acts for preventing the spread of any contagious, infec- tious, or epidemic disease of a dangerous character. 11. He shall enter from day to day, in a book to be pro- vided by the Sanitary Authority, particulars of his in- 62 MANUAL OF JPUBLIC MEDICINE spections and of the action taken by him in the execu- tion of his duties. He shall also keep a book or books, to be provided by the Sanitary Authority, so arranged as to form, as far as possible, a continuous record of the sanitary condition of each of the premises in respect of which any action has been taken under the Sanitary Acts, and shall keep any other systematic records that the Sanitary Authority may require. 12. He shall at all reasonable times when applied to by the Medical Ofl&cer of Health, produce to him his books, or any of them, and render to him such information as he may be able to furnish with respect to any matter to which the duties of Inspector of ^Nuisances relate. 13. He shall, if directed by the Sanitary Authority to do so, superintend and see to the due execution of all works which may be undertaken under their direction for the suppression or removal of nuisances within the District. 14. In matters not specifically provided for in this Order, he shall observe and execute all the lawful orders and directions of the Sanitary Authority, and the orders which the Local Government Board may hereafter issue, applicable to his office. 15. Where more than one Inspector of Nuisances shall be appointed by a Sanitary Authority, such Authority, with the approval of the Local Government Board, may either assign to each of the inspectors a portion of the district, or may distribute the duties of Inspector of Nuisance^ amongst such inspectors. Section IV. — Bemuneration, Art. 1. — The Sanitary Authority or Authorities, as the case may be, shall pay to any Officer appointed under this Order such salary or remuneration as may be approved by the Local Government Board ; and where such Officer is appointed for two or more Districts, the salary shall be apportioned amongst the Districts in such manner as the said Board shall approve. Provided that the Sanitary Authority or Authorities, with the approval of the Local Government Board, may pay to any such Officer a reasonable compensation on OFFICERS AND POWEBS OF LOCAL AUTHORITIES 63 account of extraordinary services, or other unforseen cir- cumstances connected with his duties or the necessities of the District or Districts for which he is appointed. Art. 2. — The salary or remuneration of every such Officer shall be payable up to the day on which he ceases to hold the office, and no longer, subject to any deduction which the Sanitary Authority or Authorities may be entitled to make in respect of Sect. II. Art. 3 ; and in case he shall die whilst holding such office, the proportion of salary (if any) remaining unpaid at his death shall be paid to his personal representatives. Art. 3. — The salary or remuneration assigned to such Officer shall be payable quarterly, according to the usual Feast days in the year, namely. Lady Day, Midsummer Day, Michaelmas Day, and Christmas Day; bat the Sani- tary Authority or Authorities may pay to him at the expi- ration of every calendar month such proportion as they may think fit, on account of the salary or remuneration to which he may become entitled at the termination of the quarter. Given under our Seal of Office, this Eleventh day of November, in the year One thousand eight hundred and seventy-two. James Stansfeld, President, John Lambert, Secretary. In order to meet the costs incurred by Sanitary Authorities there is an unlimited power of rating. All limitations in local rating in local acts, so far at least as the sanitary work of sanitary authorities is concerned, having been removed by the Public Health Act, 1872. The only limits now existing are in respect of the Artizans' Dwellings Act, which must not exceed 2d. in the pound, and the Libra- ries' Act, which is limited to Id, The rates which are levied by Urban Sanitary Autho- rities are : — 1st. General District Rates. 2nd. Highway Rates. 3rd. Private Improvement Rates. These are levied on an assessment of properties founded 64 MANUAL OF PUBLIC MEDICINE on the poor rates assessment, but it is in the power of the Urban Authority, if dissatisfied with this valuation, to ap- point its own valuer to make a separate assessment. Prac- tically this is the only rate which the Urban Sanitary Autho- rity can be required to make, and it is advisable that so far as possible this should be the extent of the uses of its powers. To this rate there are certain exemptions. Thus land used as arable, pasture or meadow ground, &c., tithes, docks, canals, railways, constructed under the power of an act of Parliament, and reservoirs, are only rated at one- fourth of their assessable value, while churches, chapels, ragged and Sunday schools, mines (except coal mines), volunteer storehouses, and some literary and scientific societies, are altogether exempt. But these exemptions so far as laud, docks, railways, &c., are concerned, do not apply where, as happens in some cases, a highway rate is levied independently of and in ad- dition to the general district rates. The occupier generally pays the rates, but the local board may contract with the owner for their payment by the latter. When the rateable value of the premises does not exceed lOZ. or where the premises are let to weekly or monthly tenants or in separate apartments, or where the rents are collected more frequently than in quarterly pay- ments ; in any of these cases the urban authorities may make a reduction of not less than one- fifth and not exceeding one-third, except where the owner undertakes to pay whether the premises be occupied or vacant, when they have the power to reduce the payment to one- half the ordinary amount. Where this agreement is carried out any franchise belonging to the occupier is preserved. It is also in the power of the local authority to excuse from payment of a portion or all of any rates on the ground of poverty or other cause of a similar character. These rates are all to be made to cover expenses which have been incurred or are proposed to be incurred within six months of the time of levying the rates, that is, either six months retrospectively, or upon an estimate of what will be required during the ensuing six months. 0FFICEB8 AND POWERS OF LOCAL AUTHORITIES 65 Private inprovement rates have been elsewhere suffi- ciently alluded to. The expenses incurred by a rural sanitary authority are divided under two heads : — 1st. General expenses. 2nd. Special expenses. General expenses, other than private improvement ex- penses, are the expenses incident to carrying on the work of the sanitary authority, disinfection, conveyance of infect- ed persons, and all other expenses not declared to be special expenses. Special expenses are those incurred for the construction of sewers and providing water supply in any contributing place within the district, and all other expenses in respect to any contributing place determined by order of the local government board, to be special expenses. Where any joint work is done the local authority may apportion the expenses of construction and maintenance of the works in such pro*- portion as it deems to be fair, and these will be special ex- penses as applicable to each of the contributing places. The local government board have a power to revise this appor- tionment. General expenses are to be paid out of a com- mon fund, and when requisite the overseers will have to pay the amount of such requisition of the local authority out of the poor rates, and as to special expenses out of a rate to be made and levied in accordance with the provi- sions of the Sewage Utilization Act, 1867. That is with the exemption as to land, railways,. &c., being rated only to one-fourth of the assessable value as already pointed out as existing in the case of a general district rate. If the overseers do not comply with the precept of the sanitary authority and pay over the amount required, then proceedings can be taken against them to recover the money summarily. AU sanitary authorities have power to borrow money for permanent works with the sanction of the local government board. The amount is however limit- ed to one year's assessable value of the district, such amount to be repaid in thirty years. This power may, however, be enlarged by provisional order to two years' assessable value and the period of repayment may be extended to fifty years. F (66 MANUAL OF PUBLIC MEDICINE CHAPTER IV. EOADS AND WAYS. TJf ban Au- thorities as surveyors of highways. Turnpike roads. Public roads between districts. Public roads. Evert urban authority is constituted surveyor of highways, and in virtue of such office has exclusive control over all the highways in its district. That is, all roads repairable by the inhabitants at large. They have, as a local authority, no jurisdiction over turnpike roads, but should any such road become out of repair through default of the trustees it will become the duty of the local authority to put it in order, the cost being defrayed by a highway rate which differs from the special district rate before referred to inasmuch as it is levied on all rateable property equally without exemption or deduction; this was a liability formerly incident to a parish or township, but where a parish or township be- comes divided into districts under sanitary authorities, only that part of the parish constituted as an urban sanitary authority within which the turnpike road is situated can be called on to contribute towards the ex- penses of repair. Where a public road forms a boundary of a district, the presumption will be that up to the medium filum vice the road belongs to and is repairable by the district it adjoins and of which it forms the boundary. A very important distinction as to roads is to be borne in mind when considering the question of maintenance and repair. It may be generally stated that a local authority has only power, out of the general district rates, to repair and maintain those roads which were public before the con- stitution of the district, that is, with the exception of any other roads which may have been taken up by the sanitary authority and declared to be public since its formation ; but in all cases where roads were public highways before B0AD8 AND WAYS 67 the date of the estabKshment of a sanitary authority, then contribu- owners and occupiers cannot be called on for any other owners and contribution except that which they make in common with ^^^cupiers. all ratepayers to the general district rate. This is the main reason why so many streets, courts and alleys remain uncared for and in an unsanitary condition. The great cost Maintenance which would fall on the rates, to put these in proper repair, ' i^epair. deters sanitary authorities from undertaking, on account of its magnitude, a work of the first necessity, and a foolish economy in this respect naturally entails complaints from ratepayers who in the more obvious duty of their representa- tives see neglect, without appreciating the saving of expense they would themselves urge. This is a most false economy, for if the streets, roads and ways of a town or district are allowed to become or to remain so out of repair as to become receptacles for filth or to afibrd by their inequalities depressions in which foul water accumulates, it is in vain to look for beneficial results from other sanitary measures. It should therefore be the very first performance of duty on the part of a sanitary authority to put in order and afterwards to keep the foot and carriage ways of its district in thorough repair and cleanly condition by watering, removing obstruc- tions and clearing any filth, snow &c., not only for the direct advantage necessarily following to the health of the district, but also as showing by the attention bestowed on the exterior of dwellings what is expected from the inhabitants as to those parts of their habitations which are exclusively under their own control. Keeping the streets and roads in repair may be done either by the servants of the authority, or by contractors appointed and paid by the local authority, who Contractors, may contract either for scavengring alone or conjoined with removal of ashes and refuse from dwellings, which should be carefully and systemically performed. So the work of reflagging, paving, curbing, channelHng, &c., may either be done by day work or by contract, but no contract above the sum of £10 can be entered into without the particulars being reduced to writing, and no contract for any sum amounting to £100 can be accepted without giving 10 days public notice and inviting tenders for the work. The local authority may at the same time receive tenders for keep- F 2 68 MANUAL OF PUBLIC MEDICINE ing any of the work tliey execute in repair for a term of years if the surveyor has recommended this course to b6 desirable. K€w roads. New roads may be made by the owner of any property for pubhc use through his land by agreement with the sani- tary authority. This may be done at the expense of the person making the road, or, with the consent of two thirds of the sanitary authority, any portion of the expenses may be paid out of any fund at their disposal for public improve- ments, and after the road has been completed in accordance with the agreement, it will become a public highway repairable at the public expense. Where an urban sanitary district is a municipal borough, under the Local Govern- ment Acts, and there is a surplus of the borough fund, such surplus not arising from a borough rate, the Town Council may vote any portion of such surplus to be expended in the improvement of the borough, either by expending the money in drainage works, enlargement of streets, or otherwise, in order to carry out the provisions of the Sanitary Acts. The form of bye-laws before printed at page 16, contains directions as to the making and laying out of new streets. Besides this the sanitary authority may by agree- New streets, mcnt purchase premises either to make new streets or to improve old ones, and this being a permanent work, will be paid for out of monies borrowed for that purpose with the sanction of the Local Government Board. If this is to be done compulsorily it will require a provisional order, as in all cases where land is sought to be acquired otherwise than by agreement. But in most towns there are many streets which are not repairable by the inhabitants at large, that Private is, private streets. In order to determine whether they are to be repaired by the sanitary authority out of the rates or by the private owner, it must be ascertained whether they were public highways at the date of the constitution of the district. This is the date when the Public Health Statutes came into force in the district either by Order in Council or by the order of the GeneralBoard of Health confirmed by pro- visional order, or in cases where there existed Improvement Commissioners, by resolution of such commissioners, or by any of the other powers by which the Local Government BOADS AND WAYS 69 authorities. Paving new Acts can be adopted, such as resolutions of the majority of ratepayers, etc. Under the present state of the law, if at any time a rural Rural district under a rural authority, which now has no control over streets and roads, wishes to have such power, or it ap- pears desirable to the Local Government Board that it should be changed into an urban authority, or ratepayers assessed to one tenth of the rateable value make applica- tion to that effect, then all or any of these powers as to roads may be given to the rural authority. But in future, ^.doption of without the consent of the Local Government Board, the J^^^ai ^ ' Government Local Government Acts cannot be adopted in any rural Acts, district. These powers have been referred to as they have an all important bearing at the present time on streets not highways repairable at the public expense. In streets'^ all such cases the urban authority has power to call on the owners or occupiers of any street which in their opinion is not in a proper condition, to sewer, level, pave, flag, curb, channel, provide the means of lighting, and to metal and make good both foot-way and carriage-way, and even where the foot-path has been a public way the same powers may be exercised. If the notices thus served be not complied Private im- with, then the local authority can do the work and as in explnses^^ all other cases where work is done by a local authority as to which the onus of execution is imposed on owners or occu- piers, the expenses may be recovered from the owners or occupiers, either summarily or as private improvement expenses, in such proportion according to their frontage on to the street as may be settled by the Surveyor, and if there be any dispute, then by arbitration in the manner provided by the Public Health Act, 1848. It is, however, to be noted that incumbents and ministers of churches and chapels and the churches and chapels themselves are exempted from payment and the local authority may un- dertake the work and pay the expenses incident to the frontages occupied by these buildings. When any pri- Adoption of vate streets are thus properly put in order they may gtrJets! be declared, within certain formalities as to notice, etc., public highways, and thereafter be repairable and re- paired at the public expense. Besides this, an urban autho^ 70 MANUAL OF PUBLIC MEDICINE Altering roads. Private rights. Roads de- clared public highways in rural districts. Urban districts. Diversion of road8. rity may alter and amend bridges, make agreements with turnpike trustees for repairing portions of their roads, or removing toll bars within two miles of the centre of the town, and generally may do all such acts as would tend to improve the ways of the district, if, by so doin i t interfere with no private rights. If they do so it must be either by agreement and compensation, or by provisional order or private Act of Parliament, as in the case of other lands of which they wish to possess themselves. In any case no sanitary authority can lessen any rights, or acquire land or property, or dispossess any person of any privilege without making due compensation. And all interference with private rights or property for a supposed public ad- vantage should be attempted in a conciliatory spirit and without an assumption of claim to disregard private posses- sion, which will more than anything else defeat the inten- tions, however good, of a sanitary authority and inter- pose serious obstacles to public progress and advancement. ^nTo new road or way can in future be deemed or taken to be a highway, repairable by the public at large, without three months' notice being given to the surveyor, to whose satisfaction, and also that of the justices, it must be com- pleted and be kept in repair for twelve months, and in addition there must be a vote of the vestry, adopting it as of sufficient utiHty to the inhabitants of the parish to justify its being kept in repair. If the vestry decide against making the road, a justice may then summon the party purposing to make the road before him, and he will determine whether or no the road should become a public way. These powers of the vestry may now be exercised by the sanitary authority. In the case of any owner desiring to dedi- cate a new road, the consent of the sanitary authority in an urban district is an essential pre-requisite, and if it is not satisfied with the condition of the road, the certificate of justices will be of no avail. But before entirely or partially closing any way, v^hether foot-path or carriage-way, with the view to its diversion, certain points must be observed. The surveyor must request the view of two justices, who, if of opinion that the new way would be nearer or more commodious to the public, will BOADS AND WAYS 71 certify that they have viewed the highway, and their opiniGn as to its being nearer or more commodious to the public. There must be a consent in writing from the owner of the- land through which the new highway is to be made, as also a notice exhibited on the spot, and advertised for four suc- cessive weeks in a newspaper circulating in the county, and also for four Sundays on the door of the church in every parish in which the highway is situate. There must be a plan also by a competent surveyor, setting out the old and new highways by metes, and bounds, and measure- ments. The various documents, certificates, plans, &c., are then lodged with the clerk of the peace of the county, who reads them in open court, and they are then enrolled among the records of the court of Quarter Sessions, If any rate- streets out payer is aggrieved by any street being out of repair, or im- repair, properly cleansed, he should make complaint in writing to the clerk of the sanitary authority ; for if it be a public Default of road, it is the duty of the authority to have it put in a authorityo proper state of repair out of the public funds ; if it be a private street, then the authority should call on the owner to do the necessary work. In case of default after due notice has been given to the local authority by written complaint^ a memorial should be addressed to the Local Government Board soliciting their interference. In this way due attention to local matters may be enforced on the sanitary authority.. The statutory powers given to gas, water, and Gas and: telegraph companies to interfere with roads will be noticed under the various chapters dealing with these matters. They are much the same as those given to sanitary autho- rities to deal with the property belonging to these com- panies, and may be stated to be a general power to do what is necessary in the public interest, doing as little damage as possible, and not permanently interfering with the flow of gas or water, &c. Obstructions m. the streets and nui- Obstructions sances are provided against by the Town Police Clauses Act, 1847, which inflicts a penalty of 405., or imprisonment for fourteen days, for ofiences which cause obstructions, annoyances, or danger to the residents or passengers therein. The local authority have also power to require owners to securing take down or secure buildings, walls, or anything affixed water com- panies pipes. 72 MANUAL OF PUBLIC MEDICINE thereto wliieh are in a ruinous or dangerous state, and tke surveyor may at once put up a hoarding or fence for i^he protection of passengers. All expenses are to be paid by owners, who may be also indicted for a public nuisance, if there is any danger of the building, &c. falling on the public highway. Where houses are dangerous to health, they will fall under the duties already pointed out as appertaining to the Medical Officer of Health, and the local authority must see to their being put into such a condition as will make them fit for habitation without injury to health. Hurai In rural districts, under a rural authority, roads will remain, as to their government, in the same position as before the passing of the Public Health Act, 1872. It is, however, to be remembered that the rural authority is both the sewer and nuisance authority of the district, and as such, except as to the maintenance of the roads, will have ample power to provide for the health of the inhabi- tants. It cannot make stringent bye-laws, such as would be applicable to streets in the crowded thoroughfares of a town, but in all the particulars essential to the sanitary condition of roads and buildings will be found practically to be possessed of sufficient scope of authority. 73 CHAPTER V. SEWERS. Wherever there is an urban autliority, there all the Sewers v6stG(i in sewers existing at the time of the constitution of the urban district, or afterwards constructed, are vested in the sani- ^^^^^^^^^^ tar J authority. This is not so with rural authorities, which, although by the Public Health Act, 1872, made the sewer authority, have no control over sewers existing before they were so constituted, except in so far as they take over the powers of sewer authorities constituted under the Sewage UtiHzation Act, 1865, when these bodies have constructed sewers under that Act. Highway Boards who Highway have made drains and sewers under the Highways Act for road drainage, or acting as the local authority under the Nuisances Removal Acts, have constructed sewers and drains to avoid or remedy nuisances, have still control over these. This is a state of the law which urgently calls for altera- tion, and which must continue to create difficulty in rural Difficulties parishes. It is hardly clear what is the exact definition of state ottiie a sewer or of a drain ; but the former may be said to be the larger channels used for the removal of water or fluid Sewers and sulliage of all kinds, while the term drain is more properly definition, applicable to a small sewer used for removing fluid from one block of building. On a sanitary authority is cast by Duties of law the duty of providing adequate sewers for draining authorities the district; on the private individual the duty of pro- as to sewage, viding outlets competent to drain his property into the sewers provided at the public cost. This duty, we have already seen, applies to roads equally with buildings. Sewering a district may be divided into two parts, the collecting of sewage and its disposition. The former requires Collection of 74 MANUAL OF PUBLIC MEDICINE merely mechanical engineering which can always be ac- complished when once the outfall is determined. The latter, a matter of great and apparently increasing difi&culty, a difficulty which can be removed by no general legislation, as it is impossible to suppose that any public measure could be passed by the Legislature which would confer on sani- tary authorities the necessary power. Sewage outfall means the acquirement of land, either by agreement or compulsorily. It is only the quantity of land necessary to be taken which will differ, whatever plan may be adopted to prevent suUiage being or becoming a nuisance. Where water is used as the carrier, there will of necessity be a large quantity daily to be disposed of. This cannot be turned with safety into rivers, however large their volume, without some preparatory process of defaecation. IS'ow, whether this process be chemical or mechanical, whether chemical substances or mechanical means be used for precipitation and deposition, or the earth itself by means of irrigation or filtration be the medium employed, land is ultimately the essential requisite. In the present state of the law, land may be acquired by agreement either by pur- chase or on lease ; but it is only in a very few instances that land under these conditions is available. Whatever may be the stringency of laws against creating a nuisance by the means adopted by local authorities, there is a very general dislike to the proximity of sewage works by owners of pro- perty, and by owners ©f adjoining or adjacent properties. Compulsory acquirement of land is therefore the almost uni- versal necessity. To acquire the requisite land compulsorily by public statute, without enquiry into the merits of every individual case, is totally beyond the province or power of general legislation, and would not be for a moment tolerated. We must, then, fall back on the law as it is, which gives to local authorities the power to acquire land compulsorily by provisional order or by a private Act of Parliament. The steps necessary to accomplish either of these have been already briefly sketched out, and they must in every in- stance be followed by sanitary authorities, except where land can be obtained by agreement. The local authority must be governed by the necessities of the process to be SEWERS 75 adopted as to the quantity of land to be taken. Once having Quantity of obtained the requisite powers, the local sanitary authority taken, would proceed to construct the main sewer. For this pur- pose, the local authority has power to purchase any rights as to sewers vested in any person, and, for the purpose of constructing new sewers, may enter upon any lands what- ever where, upon the report of the Surveyor, it may be shewn to be necessary. If without their district, whether it be an easement or possession of land absolutely, there must, if assent be withheld, be a provisional order, and three months' notice given to owners of an intention to take Three lands, and also to all parties interested either in the roads ^tice.^' or properties adjoining, or who would be Hkely to be in- terested in the works to be constructed. All these parties may object against the proposed works to the Local Government Board. But within the boundaries of the district, so far as main sewers are concerned, the local authority has absolute power. This is otherwise as to sub- sidiary sewers intended to drain a block of buildings, or as subsidiary to drains. These must pass through the property of the person whose premises are to be drained, or through a public street or road, unless by consent of the owner of drains, any other land. The public sewers thus constructed are to be maintained by the local authority, who can alter, Main- arch over, or improve them, and if necessary may dis- ^TiicT^^ continue, close up, and destroy any they may deem to have become unnecessary. If, however, they by so doing substituted deprive any one of the lawful use of any sewer, they must provide another as effectual for his use as the one of which he is deprived. It is further to be noticed that should any premises be sufficiently drained before the construction of Allowance any new sewers, it is then the duty of the local authority to ge^ers^^^^^*^ deduct from the amount of rates otherwise chargeable in respect of such premises a sum which shall appear to be just. The sewers are to be so cleaned by the sanitary au- cleansing thority as that no nuisance shall arise from them, and that sewers, they shall not be injurious to health ; and this is accom- plished by providing for such rapid transmission of their contents, without detention, to the outfall, as that no gases shall be given off from the sewage matter passing along them, sewers. Private sewers. 76 MANUAL OF PUBLIC MEDICINE Bights of owner and occupier. Regulations as to junc- tions with sewers. Unautho- ri.-ed com- munications. Inter- ference. Compulsory- drainage. deposit of solid matter being thus prevented. Any owner or occupier of premises within the district has a right to cause his drains to empty into the sewers of the authority of the district, but he must give notice to the authority, and must comply with their regulations, and also must do the work under the control of their surveyor, or some other person appointed by the local authority ; otherwise he will, if neglecting these regulations, be subject to a penalty of £20, and the local authority may close any communication he has, without their consent, made with the sewer. No one can cause any sewer or drain to communicate with any sewer of the local authority without their written consent, and if any one does so without authorization, then a penalty of ^5 will become forfeited to the Local Board, and a further penalty of £2 a day for every day during which the offence is continued after notice in writing has been served to discontinue the connection. Nothing is to be allowed to interfere with the sewers of the authority, and if anything is erected or constructed in any way interfering with the sewers, the authority may alter or remove it, charging the expense on the offender. Into their sewers the local authority may cause all build- ings within 100 feet to be drained, or into the sea if within that distance, otherwise a covered cesspool must be con- structed at such a distance from the house as the Local Board may direct ; and no house can be erected, or old house rebuilt, which has been pulled down to or below the ground-floor without providing proper means of drainage by covered drains, in accordance with a report of the Surveyor. But this is generally made a part of the bye- laws which usually provide that, with the plan sent in for a new house, there shall be also a plan of the intended drainage. The use of sewers provided by a local authority is not confined to persons living within the district, for others living in premises adjoining or near to a sewer may make an agreement with the local authority for payment for the use of the sewer. The payment may be a yearly sum to be determined by arbitration. This may be by one arbitrator if both parties concur in the appointment, ptherwise each party selects an arbitrator, or the amount SEWER8 77 closets, &c. may be settled by the Justices. All disputes as to tbe amount of compensation may in this way be determined by two Justices ; but their determination cannot extend to determine the right to compensation when this is dis- puted. The local authority, upon the report of their sur- water- veyor, may not only cause drainage to be constructed for any premises, but also a water-closet, earth-closet, privy, and ash-pit, if either of these be wanting ; and if, after notice, the owner or occupier fail to comply with the re- quirements of the local authority, the work may be exe- cuted by them and the cost recovered as private improve- ment expenses. All factories and warehouses must have a sufficient Factories, number of water-closets and privies under heavy penalties, and the local authority is bound to see that these and all other conveniences in the district, as well as sewers and drains, are kept in such a condition as not to be a nuisance or injurious to health. To do this, large powers are given to all sanitary authorities. Upon their written authori- Examina- zation, the Surveyor, with as many assistants as he may servers and require, is empowered not only to enter into premises after 24 hours' notice in writing, or in cases of emergency with- out any notice whatever, but he may also open any ground in order to examine into the condition of drains, water-closets, privies, and cesspools. The expenses of doing this will have to be borne by the local authority if it should turn out to have been unnecessary ; otherwise it will fall on the owner or occupier. In addition to this there is also power, if necessary, to Examina- enter, examine, and lay open any lands for the purpose of making plans, surveying, measuring, taking levels, or examining the course of any sewers, but this can only be done on the order of two justices after notice to the owner or occupier. After the order has been obtained, 24 hours' notice must be given, except in cases of emergency, and the entry made between 10 in the forenoon and 4 in the afternoon. So also as regards gas companies, water com- panies, and telegraph companies, whose powers will be noticed hereafter, there is power lodged in the local au- thority to alter the position of their mains or pipes, doing as tion of lands. 78 MANUAL OF PUBLIC MEDICINE Powers of inhabitants as to closing drains, UIXU.lUg& « xtt/C/UvtJiy ex- TT U . penses of taking down jjuildings . Removal, compensa- TT tion for JjUiidings . Drainage of, bye- TT u. JLO) W i3 dO ij\J Jjuiiciings . TT Buildings, line i^rescribing of TT of Burial Board ^PpQJJJ^JJ^gJ}^ q£ TT U . Kji-UOiLl yJCuLXHjcXil. Y A n ATI f "\7 eta JL>U.XJclil XJKjaiL\X . AirnnintTYiPTrf rk^P T^tt TT u . vestry XiiLL idiL JJUdlU. • Sanitary Authority TT U. TVlt1"\7 no nrvncfn XilclJ Ut) LOIlbtl- tuted at option of vestry -R • 1 -R A -Duriai Jjoarcl . Borrow] ng money on TT xJurial ±)Oaras. Transference of U. & R. powers of Burial grounds Repair of fences of U. Bye-laws Making of U. Cattle . Slaughtering powers u. as to Cattle . Impounding of u. 154 INDEX TO TOWERS UNDER THE SANITARY ACTS statute 10 & 11 Vict, c 89. s. 25 . 11 & 12 Vict. c. 63. s. 67 . 29 & 30 Vict. c. 90. s. 41 . 10 & 11 Vict. c. 34. s. 73 . 29 & 30 Vict. c. 90. s. 19 . 10 & 11 Vict. c. 34. s. 121 11 & 12 Vict. c. 63. s. 78 . 10 & 11 Viet. c. 34. s. 143 35 & 36 Vict. c. 79. s. 56 . 11 & 12 Vict. c. 63. s. 36 . 18 & 19 Vict. c. 121. s. 5 . 23 & 24 Vict. c. 77. s. 5 . 35 & 36 Vict. c. 79. s. 13 . 11 & 12 Vict. c. 63. s. 66 . 14 & 15 Vict. c. 28 . . \ 16 & 17 Vict. c. 41 . .J 30 & 31 Vict. c. 113. s. 15 21 &22 Vict. c. 98. s. 35 . 28 & 29 Vict. c. 75. s. 8 . 31 & 32 Vict. c. 130. s. 20 18 & 19 Vict. c. 121. s. 12 11 & 12 Vict. c. 63. s. 85 . 26 Vict. c. 17. ». 5 . 35 & 36 Vict. c. 79. s. 18 . 23 & 24 Vict. c. 77. s. 12 . 29 & 30 Vict, c. 90. s, 24 . 21 & 22 Vict. c. 98. s. 71-74 29 & 30 Vict. c. 90. s. 46 . 18 & 19 Vict. c. 121. s. 19 18 & 19 Vict. c. 121. s. 20 18 & 19 Vict. c. 121. s. 30 29 & 30 Vict. c. 90. s. 34 . 35 & 36 Vict. c. 79. s. 47 . 31 & 32 Vict. c. 130. s. 21 Subject Cattle Cellar dwell- ings Cellar dwell- ings . Cellars . Chimneys jdisterns, public Cisterns, public Clocks, public , Collegiate bodies Committees Committees Committees Committees . Common lodg- ing houses Common lodg- ing house Companies, sewage Compensation . Compensation . Compensation . Complaint XlJontracts Constitution of districts Contributions . Conveyances . Conveyance of sick persons Corporations . Corporations . Costs Costs Costs Costs Costs Determination of tenancies Power as to Impounded, sale of Provisions as to Coverings for . Regulation of. Construction of Construction and maintenance of . Provision of . Diversion of sewers ^7 Appointment of Appointment of Appointment of Appointment and regulation of Bye-laws as to j> Acts as to Shareholders in Payment of . Making of For demolition of premises Making before a Justice Entry into when necessary Avoidance of Mode of raising For sick persons, provision of Provisions as to Saving rights of Sanitary authorities constituted Recovery of . Proceedings before Justices as to Proceedings as to nuisances may be paid out of rates Recovery of . Provisional orders . Notices as to . INDEX TO POWERS UNDER THE SANITARY ACTS 155 Statute Subject Power as to Urban or Rural 35 & 36 Vict. c. 79. s. 39 . 23 & 24 Vict. c. 77. s. 11 . 29 & 30 Vict. c. 90. s. 23 . 21 & 22 Vict, c, 98. s. 25 . 28 & 29 Vict. c. 75. s. 9 . 30 & 31 Vict.c. 113. s. 10 18 & 19 Vict. c. 121. s. 21 18 & 19 Vict. c. 121. s. 22 29 & 30 Vict. c. 90. s. 33 . 10 & 11 Vict. c. 89. s. 22 . 10 & 11 Vict. c. 34. s.71-2 18 & 19 Vict. Q. 121. s. 11 21 & 22 Vict. c. 98. s. 33 . 31 & 32 Vict. c. 115. s. 7 . 11 & 12 Vict. e. 63. s. 54 . 11 & 12 Vict. c. 63. s. 63 . 11 & 12 Vict. c. 63. s. 143. 18 & 19 Vict. c. 121. s. 11. 18 & 19 Viet, c, 121. s. 14. 28 & 29 Vict. c. 75. s. 5. . 29 & 30 Vict. c. 90. s. 31 . 11 & 12 Vict. c. 63. s. 98 . 10 & 11 Vict. e. 34. s. 76 . 11 & 12 Vict. c. 63. s. 146. 21 & 22 Vict. c. 98. s. 62 . 21 & 22 Vict. c. 98. s. 63 . 23 & 24 Vict. c. 77. s. 4 . 24 & 25 Vict. c. 61. s. 24 . 26 & 27 Vict. c. 40. s. 7 . 28 & 29 Vict, c. 75. s. 6 . Differences Diseases, pre- vention of Disinfection . Disqualification Districts Districts Ditches . Ditches, open . Dividedparishes Divine service . Doors Drains . Drains . Earth closets . Entry upon lands Entry upon lands Entry upon lands Entry Entry on premises Entry on lands Entry on lands Estimate of Rates Expenses Expenses, re- payment of Expenses Expenses Expenses Expenses Expenses Expenses of Sanitary Authority Settlement of Expenses of pro- vision for Provisions as to Limitation of Combination of Union of Cleansing of . Covering and im proving Expenditure in Regulating vehicles during How to be made to open Inspection of Alteration of Provisions as to To examine drains, waterclosets, &c. To inspect places used for sale of food For purposes of Pub- lic Health Act 1848 Power of, as to nui- sances For abatement of nuisances By Sewer Authority for making and repairing sewers When to be exer- cised Preparation of Of taking down buildings, how to be defrayed Allowance of time for Recovery of . Apportionment of . Defrayal of . Proceedings as to recovery of under £20 Under Bakehouse Act, how defrayed Payment of . U.&R. U.&R. U.&R. U. U.&R. U.&R, U.&R. U.&R. U.&R. U. U. U.&R. U. U. & K U. U. U. U.&R. U. & R. U. &R. U. &R. U. U. U. U. U. U. &R. U. U. &R. U. &R. 156 INDEX TO TOWERS UNDER THE SANITARY ACTS Statute Subject 29 & 30 Vict. c. 90. s. 50 . 30 & 31 Vict. c. 113. s. 14. 30 & 31 Vict. c. 113. s. 17. 30 & 31 Vict. c. 146. s. 18. 31 & 32 Vict. c. 130. s. 19. 31 & 32 Vict. c. 130. s. 31. 35 & 36 Vict. c. 79. s. 16 . 35 & 36 Vict. c. 79. s. 17 10 & 11 Vict. c. 34. s. 108. 27 & 28 Vict. c. 48. s. 4. . 29 & 30 Vict. c. 90. s. 19 . 30 & 31 Vict. c. 103. s. 9 . 11 & 12 Vict. c. 63. s. 59 . 21 & 22 Vict. c. 98 s. 34 . 21 & 22 Vict. c. 98. s. 46 . 29 & 30 Vict. c. 90. s. 19 . 10 & 11 Vict. c. 34. s. 124. 18 & 19 Vict. c. 121. s. 11. 26 & 27 Vict. c. 117. s. 2 . 21 & 22 Vict. c. 98. s. 32 . 18 & 19 Vict. c. 121. s. 41. 18 & 19 Vict. c. 121 . 11 & 12 Vict. c. 63. s. 71 . 11 & 12 Viet. c. 63. s. 80 . 12 «Sc 13 Vict. c. 94. s. 8. . 24 & 25 Vict. c. 61. s. 29 . 10 & 11 Vict. c. 89. s. 37 . 10 & 11 Vict. c. 89. s. 38 . 11 & 12 Vict. c. 63. s. 68 . 11 & 12 Vict. c. 63. s. 117 24 & 25 Vict. c. 61. s. 9 . 24 & 25 Vict. c. 61. s. 10 . Expenses of water supply Expenses Expenses (sewer authorities) Expenses Expenses Expenses Expenses Power as to Kecovery of . Expenses Factories Factories Factories Factories Filth . Fires Fire engines . Fireplaces and furnaces Fireplugs Food Food Footways and pavements . Forms Forms Gas pipes Gas pipes Gas supply General Acts . Hackney car- riages Hackney car- riages Highways Highways Highways Highways Of Joint Sewage Board, how de- frayed Payment of, in parishes Under Workshops Kegulation Act, how defrayed Kecovery of . Defrayal of . Kates for payment of, by Urban Sani- tary Authority Kates for payment of, by Kural Sani- tary Authority Consumption of smoke in Ventilation of Kegulation of Special Ventilationof Kemoval and sale of Prevention of, bye- laws as to Vested in Sanitary Authority Kegulation of Provision of . Inspection of Inspection of Cleansing of . Use of . Schedule of . Moving of Examination of Contracts for Application of Licensing of . Definition of . Vesting of Surveyors of . Kepair of (without districts) Substitution of Sani- tary Authority for vestries, as to INDEX TO POWERS UNDER THE SANITARY ACTS 157 statute 24 & 25 Vict. c. 61. s. 26 . 35 & 36 Vict. c. 79. s. 36 . 26 Vict. c. 17. s. 6 . 10 & 11 Vict. c. 34. s. 80 . 10 & 11 Vict. c. 34. s. 83 . 24 & 25 Vict. c. 61. s. 25 . 29 & 30 Vict. c. 90. s. 37 . 33 & 34 Vict. c. 53 . 21 & 22 Vict, c. 98. 6. 32 . 31 & 32 Vict. c. 115. s. 5 . 10 & 11 Vict. c. 34. s. 64 . 10 & 11 Vict. c. 34. s. 68-70 10 & 11 Vict. c. 34. s. 79 . 11 & 12 Vict. c. 63. s. 60 . 18 & 19 Vict. c. 121. s. 29 24 & 25 Vict. 0. 61. s. 28 . 29 & 30 Vict, c. 90. s, 10 . 18 & 19 Vict. c. 116. s. 6 . 18 & 19 Vict. c. 121. s. 13 29 & 30 Vict. c. 90. s. 46 . 21 & 22 Vict. c. 98. s. 38 . 30 & 31 Vict. c. 113. s. 8 . 21 & 22 Vict. c. 98. s. 34 . 29 & 30 Vict. c. 113. s. 7 . 29 & 30 Vict. c. 90. s. 20 . 35 & 36 Vict. c. 79. s. 15 . 35 & 36 Vict. c. 74. s. 6 . 29 & 30 Vict. c. 90. s. 40 . 35 & 36 Vict. c. 79. s. 53 . Subject Highways Highways Highway meet- ings Hoards . Holes Horses, &c. . Hospitals Hospitals House refuse . House refuse . Houses . Houses . Houses . Houses , Houses . Houses . Houses . House to house Human habi- tations Incorporation . Incumbent of churches Inhabited places Inspection of buildings Inspection of books Inspection of district InspectorLocal Government Board Inspector of Nuisances Joint Boards Joint Board Power as to Encroachments on . Transfer of powers as to Local Go- vernment Board Kegulations as to . During repairs, set- ting up of In streets, protec- tion of Bye-laws as to; li- censing and regu- lating Provision of Deemed to be within nuisance district Eemoval of . Provisions as to Numbering . Eemoval of pro- jecting Shoreing of during repairs Purification of Overcrowding of Regulating line of, in streets Compulsory drain- age of Visitation Prohibition on use of ^ Provisions as to Undertaking of works for Settling boundaries of Bye-laws as to By auditor Regulations as to . Powers of Articles offered to be analysed to be submitted by to analyst Provisions as to As Sanit. authority 158 INDEX TO POWERS UNDER THE SANITARY ACTS Statute Subject Power as to Urban or Rural 30 & 31 Vict. 113. s. 11-14 30 & 31 Vict. c. 113. s. 12 35 & 36 Vict. c. 79. s. 29 . 30 & 31 Vict. c. 113. s. 13 30 & 31 Vict. c. 113. s. 14 35 & 36 Vict. c. 79. s. 30 . 35 & 36 Viet. c. 79. s. 32 . 11 & 12 c t. c. 63. s. 132 31 & 32 Vict. c. 130. s. 41 10 & 11 Vict. c. 34. s. 127 21 & 22 Vict. c. 98. s. 46 . 11 & 12 Vict. c. 63. s. 84 . 24 & 25 Vict. c. 61. s. 22 . 21 & 22 Vict. c. 98. s. 75 . 28 & 29 Vict. c. 75. s. 7 . 30 & 31 Vict. c. 113. s. 4 . 30 & 31 Vict. c. 113. s. 5 . 35 «fe 36 Vict, c, 79. s. 41 . 11 & 12 Vict. c. 63. s. 138 29 & 30 Vict. e. 90. s. 48 . 11 & 12 Vict. c. 63. s. 140 10 & 11 Vict. c. 89. s. 39 . 10 & 11 Vict. c. 89. s. 40-68 12 & 13 Vict. c. 94. s. 8 . 35 & 36 Vict. c. 79. 8. 44 . 18 & 19 Vict. c. 121. s. 43 35 & 36 Vict. c. 79. s. 33 . 35 & 36 Vict. c. 79. s. 43 . 35 & 36 Vict. c. 79. s. 55 . and Joint Sewerage Boards Joint Sewerage Boards Joint Sewerage Boards Joint Sewerage Boards Joint Sewerage Boards Joint Sewerage Boards Joint Sewerage districts Justices Justices Knackers' yards Lamps Posts Lands Lands Land liand Lands Lands Lands Legal proceed- ings Legal proceed- ings Liability- Licenses Licenses Lighting streets Loans Local Acts Local Acts Local Acts Local Act Eegulations as to . Constitution of Constitution of Powers of Expenses of . Expenses of, how defrayed Use of sewers in . Jurisdiction of Jurisdiction . Kegistration of Vested in Sanitary Authority Purchase or lease of by agreement . Purchase of . Compulsory taking of Compulsory taking of Compulsory pur- chase of for distri- bution of sewage Appropriation of . Mortgage of Institution of Appearance in Limitation of ex- emption from Of hackney car- riage,payment for For hackney car- riage, regulations as to Contracts for . By Public Works Loan Commis- sioners Saving of Kepeal of Removal of limits of rating Relation of general Act to U.&R. U. &R. U.& R. U.& R. U.&R. U.&R. U.&R. U. U. U. U. U. u. u. U.&R. U.&R. U.&R. U.&R. U. U.& R. U. U. U. U. U.&R. U.&R. U.&R. U.&R. U.&R. INDEX TO POWEBS UNDER THE SANITARY ACTS 159 statute Subject Power as to Urban or Rural 24 & 25 Vict. c. 61. s. 2 . Local (rovern- Adoption of by Cor- u. ment Acts porations 35 & 36 Vict. c. 79. s. 34 . Local Grovern- Consent when ne- U. & R. ment Board cessary 29 & 30 Vict. c. 90. s. 35 . LodgingHouses Regulations as to . U. & R. 26 & 27 Vict. c. 40. s. 9 , Magistrates Jurisdiction oi U. & R. 35 & 36 Vict. c. 79. s. 58 . Main Sewerage Provisional orders U. & K. Districts as to 18 & 19 Vict. c. 121. s. 18 Manure . Sale of . U. & R. 29 & 30 Vict. c. 90. s. 53 . Manure . Periodicalremovalof U. OC K. 11 & 12 Vict. c. 63. s. 41 . Map of Sewage Provision of . u. 21 & 22 Vict. c. 98. s. 50 . Market Place . Provision of . u. 10 & 11 Vict. c. 14 . Markets . Act TJ. 10 & 11 Vict. c. 34. s. 78 - Materials Sale of . TT u. 35 & 36 Vict. c. 79. s. 10 . Medical Uiiicer Appointment oi TT S-n T> U. OC R. of Health . 35 & 36 Vict. c. 79. s. 11 . Medical Officer Duties of U. & R. of Health 18 & 19 Vict. c. 116. s. 6 . Medicines Dispensing of . U. & R. 31 & 32 Vict. c. 115. s. 10 Medicine Temporary supply of U. & R. zo 05 Vict. c. 77. S. 0 . Metropolitan Constituted local au- U. OC ±1. . Vestries and thorities District Boards 18 & 19 Vict. c. 121. s. 44 Mines Saving of rights of U. & R. working 18 & 19 Vict. c. 121. s. 45 Millowners Protection of . U. & R. 28 & 29 Vict. c. 75. s. 12 . Money . Loan of . U. & R. 35 & 36 Vict. c. 79. s. 41 . Money . Kaismg 01, on a U. & R. mortgage of lands 21 & 22 Vict. c. 98. s. 57 . Mortgages Issue of. U. 35 & 36 Vict. c. 79. s. 41 . Mortgages Of lands U. & R. 29 & 30 Vict. c. 90. s. 27 . Mortuaries Provision of . U. & R. j 18 & 19 Vict. c. 121. s. 44 Navigation Of rivers, saving of U. & R. i 18 & 19 Vict. c. 121. s. 31 Notices . Service of U. & R. 21 & 22 Vict. c. 98. S. o4 . Notices . Bye-laws as to U. 1 21 & 22 Vict. c. 98. s. 61 . Notices . Authentication of . U. 24 & 25 Vict. c. 61. s. 11 . Notices . Service of U. 29 & 30 Vict. c. 90. s. 21 . Notices . Service of U. & R. 31 oc oZ Vict.c. loO. s. 10-17 Notices . Service of TT u. 31 & 32 Vict. c. 130. s. 21 Notices . As to determination u. of tenancies 1 31 & 32 Vict. c. 130. s. 33 Notices . Service of u. oi OC oZ Vict. C. loU. S. o4 Notices . Signature of . TT u . lO 06 ly V ICU. C. IZl. S. Zi NoxiousTrades Proceedings against U . OC XV. 10 & 11 Vict. c. 34. s. 65 . Nos. on Houses Renewal of . U. 18 & 19 Vict. c. 121. s, 8 . Nuisance Definition of . U.&R. 18 & 19 Vict. c. 121, s. 11 Nuisances Abatement of U.&R. 18 & 19 Vict. c. 121. s. 17 Nuisances Abatement of, when U.&R. persons causing same cannot be 1 found 160 INDEX TO POWEBS UNDER THE SANITARY ACTS Statute 29 & 30 Vict. c. 90. s. 19 . 10 & 11 Vict. c. 89. s. 21 . 11 & 12 Vict. c. 63. s. 64 . 11 & 12 Vict. c. 63. s. 35 . 11 & 12 Vict. c. 63. s. 37 . 11 & 12 Vict. c. 63. s. 40 . 35 & 36 Vict. c. 79. s. 48 . 29 & 30 Vict. c. 90. s. 34 . 31 & 32 Vict. c. 115. s. 11 31 & 32 Vict. c. 130. s. 18 29 & 30 Vict. c. 90. s. 19 . 29 & 30 Vict. c. 90. s. 36 . 30 & 31 Vict. c. 113. s. 16 24 & 25 Vict. c. 61. s. 16 . 18 & 19 Vict. c. 121. s. 38 21 & 22 Vict. c. 98. s. 67 . 29 & 30 Vict. e. 90. s. 51 . 29 & 30 Vict. c. 90. s. 54 . 31 & 32 Vict. c. 115. s. 9 . 31 & 32 Vict. c. 130. s. 38 21 & 22 Vict. c. 98. s. 57 . 35 & 36 Vict. c. 79. s. 40 . 21 & 22 Vict. c. 98. s. 34 . 11 & 12 Vict. c. 63. s. 74 . 29 & 30 Vict. c. 90. s. 16 . 28 & 29 Vict. c. 75. s. 10 . 21 & 22 Vict. c. 98. s. 56 . 35 & 36 Vict. c. 79. s. 20 . 35 & 36 Vict. c. 79. s. 21 . 29 & 30 Vict. c. 90. s. 28 . 28 & 29 Vict. c. 75. s. 13 . 11 & 12 Vict, c, 63. s. 73 . Subject Nuisances Obstructions Offensive trades Offices . Officers . Officer of health Order Owner and oc- cupier Owner . Owners . Overcrowding . Overcrowding . Parish . Paving streets . Penalties Penalties Penalties Penalties Penalties Penalties Permanent works Permanent works Plans Pleasure grounds Police, chief officer of Pollution of streams Poor rate Port sanitary authorities Port sanitary authorities Post-mortem examination Powers . Premises Power as to Extension of, defi- nition of Prevention of in streets Kegulation of Provision and main- tenance of . Appointment of Appointment of Of Local Grovern- ment Board, pub- lication of Eecovery of costs from Meaning of . Execution of works by Created a nuisance . Convictions against Amendment of defi- nition of Deposit of plans and sections of Recovery of . Application of Reduction of Recovery of . Recovery of . Recovery of . Borrowing money for Extension of mean- ing of Deposit of Provision of . Proceedings by Prevention of Inspection of books of ^ Constitution of Expenses of . Provision for Cumulative Purchase of Urban or Rural U.&R. U. u. u. U.&R. u. U.&R. U. & R. U.&R. U. U.&R. U.&R. U.&R. U. U.&R. U. U. & R. U.&R. U.&R. U. U. U.&R. U. u. U.&R. U.&R. U. U.&R. U.&R. if. &R. U.&R. U. INDEX TO POWERS UNDER THE SANITARY ACTS 161 statute 18 & 19 Vict, c. 121. s. 14 21 & 22 Vict. c. 98. s. 36 . 29 & 30 Vict. c. 90. s. 22 . 31 & 32 Vict. c. 130. s. 5-11 31 & 32 Vict. c. 130. s. 12 18 & 19 Vict. c. 116 11 & 12 Vict. c. 63. s. 90 . 11 & 12 Vict. c. 63. s. 90 . 21 & 22 Vict. c. 98. s. 57 . 24 & 25 Vict c. 61. s. 23 . 31 & 32 Vict. c. 115. s. 6 . 18 & 19 Vict. c. 121. s. 13 21 & 22 Vict. c. 98. s. 32 . 18 & 19 Vict. c. 121. s. 39 21 &22 Vict. c.98. s. 75-77 24 & 25 Vict. c. 61. s. 27 . 29 & 30 Vict. e. 90. s. 47 . 35 & 36 Vict. c. 79. s. 22 . 35 & 36 Vict. c. 79. s. 24 . 35 & 36 Vict. c. 79. s. 29 . 35 & 36 Vict. c. 79. s. 45 . 35 & 36 Vict. c. 79. s. 46 . 35 & 36 Vict. c. 79. s. 47 . 35 & 36 Vict. c. 79. s. 58 . Subject Premises,entry on Premises Premises Premises when dangerous to health Premises when dangerous to health Prevention of disease Private im- provement expenses Private im- provement rates Private expen- ses Private im- provements Private im- provement expenses Privy accom- modation Privies . Proceedings . Provisional orders Provisional orders Provisional orders Provisional orders Provisional orders Provisional orders Provisional orders Provisional orders Provisional orders Provisional orders M Power as to Por abatement of nuisances Purchase of Cleansing and dis infecting Proceedings as to Inspection of Act as to Declaration of Making and levy- ing of Borrowing money for Kecovery of expen- ses of Provisions as to Order for by Jus- tices Cleansing of . Eegulation as to . Obtaining Repayment of costs of obtaining Provisions as to Dissolution of Local Grovernment dis- tricts by Constitution of Local Govern- ment districts by Formation of united districts by Confirmation of Securities under Regulations as to costs of Powers to dissolve districts Urban or Rural U. &R. U.&R. U.&R. U. U. U.&R. U. U. U. U. R. U.&R. U. U.&R. U. U. U.&R. U.&R. U.&R. U.&R. U.&R. U.&R. U.&R. U.& R. 162 INDEX TO POWERS UNDER THE SANITARY ACTS statute Subject Power as to Urban or Rural OC OK) Vict, C. yU. S. -iO . . irubiic convey- Provisions as to, TT J^T Tt ance with respect to carriage oi sick persons 35 & 36 Vict. c. 79. s. 44 . Public Works Loans by U. & K. Loan Com- missioners 11 & 12 Vict. c. 63. s. 78 . Pumps . Construction of U. 35 & 36 Vict. c. 74. s. 9 . Purchaser Ordering analysis U. & K. of articles of food, &c. 11 & 12 Vict. c. 63. s. 87 . Kates Making and levying of TT u. 11 & 12 Vict. c. 63. s. 89 . Kates Assessment to TT U. 11 & 12 Vict. c. 63. s. 96 . Kates Reduction or re- TT u. mission of 11 OC iZ Vict. C. Do. S. IV^ Kates Amendment of TT U • 11 & 12 Vict. c. 63. s. 103 Kates Collection oi . TT u. 11 OC Vict. C. Do. S. lUo Kates Distress for . . TT U . 21 & 22 Vict. c. 98. s. 54-5 Kates Provisions as to TT U. 30 & 31 Vict. c. 113. s. 16 Kates (sewage) How to be levied . TT T> U. OC K. 11 & 12 Vict. c. 63.S.109-10 Keborrowing . To pay off securi- TT u. ties do & do Vict. c. 79. s. 19 . Kemedies Non-payment by TT JP^ T> U . OC K. overseers for 1 ft <^ 1 Q Vipf n 191 c 1 ^ Kemovai oi U. & R. Nuisances z\) oc du Vict. c. 90. s. 2o . Kemovai of sick Provisions as to • U . OC XV. 01 St OO "\7C/^4- ^ no ^ K.Q zi zz Vict. c. yo. S. Oo . Kent charges . Issue of . TT u . ZL oc zZ Vict. c. yo. s. oy . Kent charges . Kegister of . TT u . zi oc ZZ Vict. c. yy. s. d7 . Kepair of high- Provision for . . TT U . ways TT U . Zi oc Zz Vict. c. 98. s. 7d . Keports , Provisions as to Z6 oc Z4 Vict. c. 77. s. 14 . Keports . Preparation of TT Ji-r T? U . OC XV. 29 & 30 Vict. c. 90. s. 11 . Keservoirs Making and main- TT St T> U . oc K. taining 18 & 19 Vict. c. 121. s. 32 Kesolutions Proof of TT H-r T? U. OC XV. do cz do Vict. c. 79. s. 21 . Kiparian sani- Contributions of, to TT St- T> U . oc K. tary authori- port sanitary au- ties thorities Zi oc zZ Vict. c. yo. s. 68-9 Kivers, &c. Interference with . u. zl oc 22 Vict. c. 98. s. 70 . Kivers, &c. Arbitration as to TT 35 & 36 Vict. c. 79. s. 56 . Kivers . Diversion of sewage TT JP-- T> U. OC XV. from 21 & 22 Vict. c. 98. s. 39 . Koads Agreement tor mak- TT U . ing K. 35 & 36 Vict. c. 79. s. 5 Kural sanitary Definition of . districts 35 & 36 Vict. c. 79. s. 8 . Kural sanitary Powers and duties of R, authorities 35 & 36 Vict. c. 79. s. 13 . Kural sanitary Appointment of R. authorities committees by INDEX TO POWEBS UNDER THE SANITARY ACTS 163 statute 35 & 36 Vict. c. 79. s. 17 . 35 & 36 Vict. c. 79. s. 23 . 35 & 36 Vict. c. 79. s. 24 . 35 & 36 Vict c. 79. s. 6 . 35 & 36 Vict. c. 79. s. 9 . 35 & 36 Vict. c. 79. s. 53 . 35 & 36 Viet. c. 79. s. 34 . 21 & 22 Vict. c. 98. s. 32 . 35 & 36 Vict c. 79. s. 46 . 21 & 22 Vict. c. 98. s. 3a . 24 & 25 Vict. 28 & 29 Vict. 30 & 31 Vict. 30 & 31 Vict 35 & 36 Vict 30 & 31 Vict. 21 & 22 Vict 28 & 29 Vict. 28 & 29 Vict. 28 & 29 Vict 30 & 31 Vict 11 & 12 Vict 11 & 12 Vict 11 & 12 Vict c. 61. s. 4-7 c. 75. s. 14 . c. 113. s. 3 . c. 113. s. 15 c. 79. s. 56 . e. 113. s. 15 c. 98. s. 29 . c. 75. s. 3 . c. 75. s. 4 . c. 75. s. 9 . c. 113. s. 2 . c. 63. s. 43 . c. 63. s. 44 . c. 63. s. 45 . Subject Kural sanitary authority Rural sanitary district Rnral sanitary district Sanitary au- thorities Sanitary au- thorities Sanitary au- thority Sanitary pur- poses. Scavenging Securities Sewage . Sewage Sewage Sewage Sewage works . Sewerage Sewer authori- ties Sewer authori- ties Sewer authori- ties Sewer authority Sewers . Sewers . Sewers . Power as to Expenses of . Application to of ur- ban sanitary pro- visions Constitution as an urban sanitary district Meetings of . Vesting of property in Legal position of . Definition of by Lo- cal Grovernment Board Contract for re- moval of, bye- laws as to Under provisional orders 1. Outfall and dis- tribution of with- out district 2. Contracts for sale of 3. Contracts for pur- chase and lease of lands, for receiv- ing Distribution of with- out district Contracts for sup- ply of ^ Distribution of with- out district Contracts as to Diversion of from rivers Contribution to Deduction from rates for Their appointment . Construction of sewers by Combination of Definition of . Vesting of Purchase of rights in Construction and al- teration of Urban or Rural R. R. R. U.&R. U.&R. U.& R. U.&R. U. U.&R. U.&R. U. U.&R. U.&R. U.&R. U.&R. U.&R. U. U.&R. U.&R. U.&R. U.&R. U. U. u. 164 INDEX TO POWERS UNDER THE SANITARY ACTS statute 11 & 12 Vict. c. 63. s. 46 11 & 12 Vict. c. 63. s. 49 24 & 25 Vict. c. 61. s. 8 , 28 & 29 Vict. c. 75. s. 4 . 29 & 30 Vict. c. 90. s. 8 29 & 30 Vict. c. 90. s. 9 35 & 36 Vict. c. 79. s. 32 . 29 & 30 Vict. e. 90. s. 29 . 29 & 30 Vict, c, 90. s. 30 . 29 & 30 Vict. c. 29 & 30 Vict. c. 10 & 11 Vict. c. 10 & 11 Vict. c. 10 & 11 Vict. c. 10 & 11 Vict. c. 11 & 12 Vict. c. 10 & 11 Vict. c. 11 & 12 Vict. c. 35 & 36 Vict. c. 24 & 25 Vict. c. 29 & 30 Vict. c. 29 & 30 Vict. c. 29 & 30 Vict. c. 30 & 31 Vict. c. 24 & 25 Vict. c. 24 & 25 Vict. c. 35 & 36 Vict. c. 18 & 19 Vict. c. 90. s. 32 . 90. s. 29 . 34. s. 125 34. s. 127 34. s. 128 34. s. 131 63. s. 62 . 34. s. 108 63. s. 56 . 79. s. 50 . 61. s. 18 . 90. s. 5 . 90. s. 6 . 90. s. 7 . 113. s. 6-7 61. s. 12 . 61. s. 13 . 79. s. 42 . 121. s. 45. Subject Sewers Sewers Sewers Sewers Sewers Sewers Sewers Ships Ships Ships Sick persons Slaughter houses Slaughter Slaughter houses, &c. Slaughter houses Slaughter houses Smoke . Soil, &c. . Solicitor . Special Act Special drain- age districts Special drain- age districts Special drain- age districts Special drain- age district Special Drain- age Rates Special Drain- age Rates Stamps . Streams . Power as to Cleansing of . Compulsory provi- sion of Payment for use of by owner of pro- perty beyond dis- trict Construction of by sewer authorities, making and re- pairing Draining into Draining into by persons beyond district Use of by subjacent district Removal of sick from When within dis- tricts of local au- thority Provisions as to Removal from shipi Licensing of . Registration of Bye-laws as to Inspection of . Provision of . Consumption of in factories Collection of . Taxation of Bill of . Meaning of Constitution of against Evidence, of forma- tion of Extension of . Levy of Payment of . Exemptions, repeal of Protection of . INDEX TO POWERS UNDER THE SANITARY ACTS 165 statute Subject 10 & 11 Vict. c. 34. s. 67 . 10 & 11 Vict. c. 34. s. 79 . 11 & 12 Vict. c. 63. s. 68 . 11 & 12 Vict. c. 63. s. 69 . 11 & 12 Vict. c. 63. s. 70 . 21 & 22 A^ict. c. 98. s. 32 . 21 & 22 Vict. c. 98. s. 34 . 35 & 36 Vict. c. 79. s. 32 . ^18&19Vict.c.l21.s.33.34 7 & 8 Vict. c. 101. s. 35 . II & 12 Vict. c. 91. s. 8 . 11 & 12 Vict. c. 91. s. 9 . 23 & 24 Vict. c. 16. s.- 12 . II & 12 Vict. c. 63. s. 42 . 35 & 36 Vict. c. 79. s. 50 . 21 & 22 Vict. c. 98. s. 26 . 20 & 21 Vict. c. 50 s. 2 . 21 & 22 Vict. c. 98 s. 41 . 33 & 34 Vict. c. 78. s. 4 . 33 & 34 Vict. c. 78. s. 17 . 33 & 34 Vict. c. 78. s. 19 . 33 &34 Vict. c. 78. s. 45 33 & 34 Vict. c. 78. s. 46 . 35 & 36 Vict. c. 79. s. 26-7 35 & 36 Vict. c. 79. s. 28 35 & 36 Vict. c. 79. s. 7 . 35 & 36 Vict. c. 79. s. 16 . 35 & 36 Vict. c. 79. s. 4 Streets . Streets . Streets (high- ways) Streets (not highways) Streets (not highways) Streets . Streets . Subjacent dis- tricts Summons Surcharges Surcharges Surcharges Surplus . Surveys . Taxation Towns Council. Trustees Turnpike roads Tramways Tramways Tramways Tramways Tramwp.ys United districts United districts Urban sanitary authorities Urban sanitary authority Urban sanitary districts Power as to Enlarging and im- during proving Precautions repair of Control of Compulsory paving of May be deemed such and repaired Watering of . Construction of, Bye-laws as to Use of sewers in Proceedings as to By auditors, regu- lations as to By auditors, regu- lations as to Proceedings as to enforcement of before Justices In boroughs, appro- priation of Payment for . Of solicitor's bill . Transfer of powers to Transfer of powers of to bodies cor- porate Agreement to re- pair Provisional order allowing construc- tion of Construction of by joint authorities Leasing of Tolls on Bye-laws and regu- lations as to Formation of . Governing body in Powers and duties of Expenses of . Definition of Urban or Rural u. u. u. u. u. u. u. U. &K. U. & K. U. & K. U & R. U. & R. U. u. U. & R. U. U. U. U. U. U. & R. U. & R. U. U. U. 166 INDEX TO POWERS UNDER THE SANITARY ACTS Statute Subject 35 & 36 Vict. c. 79. s. 23 . 21 & 22 Vict. c. 98. s. 34 . 29 & 30 Vict. c. 90. s. 52 . 21 & 22 Vict. c. 98. s. 34 . 10 & 11 Vict. c. 34. s. 123 21 & 22 Vict. c. 98. s. 51 . 29 & 30 Vict. c. 90. s. 11 . 21 & 22 Vict. c. 98. s. 33 . 31 & 32 Vict. c. 115. s. 4-5 11 & 12 Vict. c. 63. s. 57 . 21 & 22 Vict. c. 98. s. 31 . 28 & 29 Vict. c. 75. s. 11 21 & 22 Vict. c. 98. s. 52 11 & 12 Vict. c. 63. s. 71 11 & 12 Vict. c. 63. s. 76 10 & 11 Vict. c. 34. s. 74 11 & 12 Vict. c. 63. s. 75 11 & 12 Vict, c 63. s. 77 11 & 12 Vict. c. 63. s. 94 24 & 25 Vict. c. 61. s. 20 29 & 30 Vict. c. 90. s. 12 29 & 30 Vict. c. 90. s. 50 35 & 36 Vict. c. 79. s. 26 21 & 22 Vict. c. 98. s. 53 23 & 24 Vict. c. 77. s. 7 29 & 30 Vict. c. 90. s. 11 29 & 30 Vict. c. 90. s. 13 21 & 22 Vict. c. 98. s. 34 28 & 29 Vict. c. 75. s. 15 30 & 31 Vict. c. 146. s. 9 . 30 & 31 Vict. c. 146. s. 10 30 & 31 Vict. c. 146. s. 19 Power as to Urban sanitary provisions Ventilation Vessels . Walls . Water Water Water . Waterclosets . Watercloset s and privies, cleansing of Waterclosets (public) Watercourses . Watercourses . AVater mains . Water pipes . Water rates Waterspouts . Water supply Water supply Water supply Water supply Water supply Water supply Water supply Waterworks Wells, foun- tains, &c. Wells . Wells, foun- tains, &c. AVork . Works of dis- tribution of Application of to Rural Sanitary district Bye-laws as to Regulations as to Structure of. Bye- laws as to Price to be paid for Supply of Supply of Alteration of Provisions as to . Provision of When foul, obtain ing order for cleansing Not to be polluted . Carriage of . Moving of Making and levying of Affixing to houses Provision of . Provision of to public baths and wash-houses Stopping of . Agreements as to . Expenses of . Recovery of ex- penses Districts united for Purchase of Vested in Authority Digging of Vesting of Workshops Workshops Workshops Local Pulling down. Bye- laws as to To be improvement of land Entry into Inspection of Proceedings as to INDEX PENALTIES UNDER THE SANITAET ACTS.' Statute 7 & 8 Vict. c. 101. s. 33 9 & 10 Vict. c. 74. s. 14 18 & 19 Vict, c. 70. s. 15 18 & 19 Viet. C.121.S.36 35 & 36 Vict, c. 74. s. 1 35 & 36 Vict, c. 74. s, 2 35 & 36 Vict, c. 74. s. 3 Subject Accounts . Accounts . Accounts . Admission on pre- mises Adultera- tion Adultera- tion Adultera- tion Offence Refusal to produce to auditor Eefusal by Baths and Washhouse Com- missioners to allow inspection of Board of Commis- sioners refusing the inspection of Obstruction to in exe- cutingNui sancesRe- moval Act Of articles of food, or drink, or drugs Selling knowingly articles of food which have been subjected to To increase weight or bulk Penalty 405. Not exceeding 5^. Not exceeding bl. Not exceeding 5^. 1st offence not exceeding 50/. ; 2nd offence guilty of a misde- meanour and im- prisonment not ex- ceeding 6 months with hard labour Not exceeding 20/. Liable to penalties under i foregoing sections ^ Penalties may be recovered before the following jurisdictions :— As to England, by any Metropolitan Police Magistrate or other Stipendiary Magistrate, sitting alone at a Pohce Court, or other appointed place, or by the Lord Mayor of the City of London, or any Alderman of the said City, sitting alone or with others at the Mansion House or Guildhall, and generally before any two Justices. 11 & 12 Vict. c. 43. Appeals in almost all cases to the Court of Quarter Sessions. 11 & 12 Vict. c. 633, s. 135. 68 INDEX TO PENALTIES UNDER THE SANITARY ACTS Statute 35 & 36 Vict, c. 94. s. 19 35 & 36Vict. c. 94, s. 19 10 & 11 Vict, c. 89. s. 28 26 & 27 Vict, c. 40. s. 3 26 & 27 Vict. c. 40. s. 4 26 & 27 Vict. c. 40. s. 4 26 & 27 Vict. c.40. S.4 26 & 27 Vict. c. 40. s. 6 10 & 11 Vict. c, 34. s. 79 10 & 11 Vict, c. 89. s. 36 Subject Adultera- tion Adultera- tion Animals Bake- houses Bake- houses Bake- houses Bake- houses Bake- houses Bars Bear-bait- ing, &c. Offence Selling knowingly liquor which has been subject'to mix- ing or causing to be mixed any dele- terious ingredients with any intoxicat- ing liquor exposed for sale Licensed Victuallers convicted of pull- ing down placard stating the fact of Exposing for sale otherwise than in a market Limitation of hours of labour of persons under 18 years of age, continuation of ^sTeglect of cleanliness of Order to execute works for cleanliness, non- compliance with Sleeping places near to, letting of Authorized officer re- fusal to admit into Taking down, &c., erected across street while repairs or alterations are being Keeping places for Penalty For 1st offence not ex- ceeding 20^. or im- prisonment not ex- ceeding 1 month; for the 2nd and any subse- quent offence not ex- ceeding 100^. or im- prisonment not ex- ceeding 3 months. Where person is a licensed victualler in case of 2nd offence liable to forfeit his licence and premises A continuing penalty not exceeding 405. Not exceeding 405. or imprisonment for any term not exceeding 14 days For 1st offence not ex- ceeding 21. ; for 2nd offence not exceed- ing 61. ; for a 3rd and each subsequent offence a continuing penalty of ll., but no greater penalty to be imposed than 10^. Not exceeding bl. A continuing penalty of 1^. Not exceeding 205., and for each subsequent offence a penalty not exceeding bl. For each offence a pe- nalty not exceeding20/. Not exceeding bL Not exceeding bh or imprisonment for any term, with or without hard labour, not ex- ceeding 1 month LSDEX TO PENALTIES UNDER THE SANITABY ACTS 169 statute 10 & 11 Vict, c. 89. s. 36 11 & 12 Vict. C.63.S.148 10 & 11 Vict, c. 89. s. 28 9 & 10 Vict, c, 74. s. 14 11 & 12 Vict, c. 63.S.21 21 & 22 Vict, c. 98. s. 60 10 & 11 Vict, c. 34. s. 82 10 & 11 Vict, c. 34. s. 81 15 & 16 Vict, c. 85. s. 40 9 & 10 Vict, c. 74. s. 34 11 & 12 Vict. C.63.S.115 10 & 11 Vict, c. 89. s. 20 10 & 11 Vict, c. 89. S.-22 lO&ll Vict, c. 89. s. 28 lO&ll Vict, c. 89. s. 28 10 & 11 Vict, c. 89. s. 28 10 & 11 Vict, c. 89. S.28 Subject Bear-bait- ing Boards . Book Books Books Books Building materials Building materials Burial grounds Bye-laws . Bye-laws . Carpet . &c. Carriage, &c. Carriage . Carriage . Carts Offence Any person discovered in places kept for Defacement of belong- ing to Boards of Health Exposing for sale one of an obscene natui-e Kefusing inspection of Under Baths and "Washhouses Act Kefusal to produce by Local Board of Health Kefusal to produce to auditor of ac- counts of Local Boards For keeping deposits of an unreasonable time Not lighting, fencing, or enclosing, de- posits of Committing nuisance in Offences under . Offences against Beating of in streets, except door mats, beaten before 8 o'clock in the morn- ing Disregarding route of during divine service Standing longer than necessary Free, or timber, or cross-beam, being drawn upon Interrupting traffic in streets Eiding on shafts of . Penalty Not exceeding 5^. Not exceeding 51. Not exceeding 405. or imprisonment not ex- ceeding 14 days Not exceeding 51, Not exceeding 51. Not exceeding 405. Not exceeding 51., and a continuing penalty of 405. Not exceeding 5L, and continuing penalty not exceeding 405. a day Not exceeding 51. Not exceeding 51. Not exceeding 5L, and a continuing penalty not exceeding 405. a day Not exceeding 405., or imprisonment for any term not exceeding 14 days Not exceeding 405. Not exceeding 405., or to imprisonment not exceeding 14 days Not exceeding 405., or to imprisonment not exceeding 14 days Not exceeding 405., or imprisonment for any term not exceeding 14 days Not exceeding 40s., or imprisonment for any term not exceeding 14 170 INDEX TO PENALTIES UNDER THE SANITARY ACTS statute 10 & 11 Vict, c. 89. s. 28 10 & 11 Vict, c. 89. s. 28 10 & 11 Vict c. 89. s. 24 10 & 11 Vict, c. 89. s. 26 10 & 11 Vict, c. 89. s. 28 10 & 11 Vict c. 34. s. 73 ll&12Vict c. 63. s. 67 10 & 11 Vict c. 65. s. 58 10 & 11 Vict c. 65. s. 59 10 & 11 Vict c. 89. s. 30 10 & 11 Vict c. 89. s. 31 11 & 12 Vict c. 63. s. 37 10 & 11 Vict c. 89. s. 35 11 & 12 Vict C.63.S. 66 11 & 12 Vict c. 63. s. 66 14 & 15 Vict c. 28. s. 14 16 & 17 Vict c. 41.S. 11 16 & 17 Vict c. 41. s. 12 Subject Carts Cattle Cattle Cattle Cellar doors Cellars, &c. Cemetery Cemetery Chimneys Chimneys Clerk CofFeeshop keepers Common lodging houses Common lodging- houses Common lodging houses Common lodging houses Common lodging houses Offence Driving at one time more than two, &c. Cleansing of, &c., in streets Straying in street Eeleasing or attempt- ing to release from pound Slaughtering of, &c. . Occupier not making or not keeping the same in good repair Occupation of, when not fulfilling cer- tain conditions pre- scribed by Act Damaging Committing nuisance in Setting wilfully on fire Accidentally allowing to catch fire Holding office of trea- surer to Local Board Harbouring disorderly persons Receiving lodgers without registration Refusing to admit in- spector Oifences against bye- laws Offences against Act . Third offence against Act Penalty Not exceeding 40s., or to imprisonment not exceeding 14 days Not exceeding 405., or imprisonment for any term not exceeding 14 Not exceeding 405. Imprisonment for any term not exceeding 3 months Not exceeding 405., or to imprisonment not exceeding 14 days Not exceeding 6L A continuing penalty not exceeding 205. a day Not exceeding bl. Not exceeding bl. Not exceeding bL Not exceeding 10s. Not exceeding 100^. Not exceeding bl. Not exceeding 40s. Not exceeding' 405. Not exceeding bl., and a continuing penalty of 405. a day In default of payment of penalty imposed, im- prisonment for any term not exceeding 3 months Disqualified to keep com- mon lodging houses within five years or any shorter period from conviction INDEX TO PENALTIES UNDER THE SANITARY ACTS 171 statute 29 & 30 Vict, c. 90. s. 35 10 & 11 Vict, c. 89. s. 34 11 & 12 Vict, c. 63. s. 17 ]0& llVict. c. 89. s. 28 18 & 19 Vict, c. 116. S.14 11 & 12 Vict. C.63.S. 104 10 & 11 Vict. c. 89.6. 28 10 & 11 Vict. C.89.S. 28 10 & 11 Vict, c. 89. s. 28 10 & 11 Vict, c. 34. S.71 10 & 11 Vict, c. 89. s. 28 11 & 12 Vict, c. 63. s. 54 10 & 11 Vict, c. 89. s. 29 11 & 12 Vict, c. 63. s. 28 11 & 12 Vict, c. 63.S.28 Subject Common lodging houses Constables Declara- tion Dirt or offensive matter Preven- tion Act Distress . ferocious Bog, ferocious Dog, ferocious Doors Door bell , Drains, &c. Drunken persons Elections . Elections . Offence Not obeying regula- tions as to When on duty, har- bouring of by licensed victuallers Falsely or corruptly making Throwing down or causing to run in street within dis- trict of Local Board Obstruction of execu- tion of Constables refusing to levy Suffering to be at large when un- muzzled Owner of, letting it at large, knowing sam^ to be in a rabid state Setting at large, after notice given and during time specified in such notice Not making to open inwards within 8 days of notice Wilfully ringing Not complying with notice to r* nuisance m Guilty of riotous or indecent behaviour Eefusal or neglect of chairman or other responsible person to conduct legally Eefusal or neglect of persons acting under chairman or other responsible person to conduct legally Penalty Not exceeding 405. for every offence, and a continuing penalty of not more than 205. a day Not exceeding 205. Gruilty of a misdemeanour Not exceeding 405., or imprisonment for any term not exceeding 3 months Not exceeding 5^. Not exceeding bl. Not exceeding 405., or imprisonment not ex- ceeding 14 days Not exceeding 405., or imprisonment not ex- ceeding 14 days Not exceeding 405., or imprisonment not ex- ceeding 14 days Not exceeding 405. Not exceeding 405., or imprisonment for any term not exceeding 14 days A continuing penalty of 105. a day Not exceeding 405., for every offence, or im- prisonment for a term not exceeding 7 days Not exceeding 50^. Not exceeding 51, 172 INDEX TO PENALTIES UNDER THE SANITARY ACTS Statute 10 & 11 Vict, c. 34. s. 81 10 & 11 Vict, c. 34. s. 82 10 & 11 Vict. C.34.S.108 27 & 28 Vict, c. 48. s. 4 9 & 10 Vict, c. 74. s. 39 ll&l2Vict. 0.63. s. 38 10 & 11 Vict, c. 34. s. 80 10 & 11 Vict, c. 89. s. 28 lO&ll Vict, c. 89. s. 28 11 & 12 Vict. c. 63. s. 63 18 & 19 Vict. C.121.S.26 10 & 11 Vict. c. 89. S.28 10 & 11 Vict, c. 89. s. 28 10 & 11 Vict, c. 89. s. 28 23 & 24 Vict. C.77.S.8 Subject Excava- tions Excava- tions Factories, &c. Factory . Fees Fees Fences Firearms . Flower- pot Fooi Food Footway . Footway Footway Fountains Offence Not lighting, fencing, or enclosing Continuing an un- reasonable time in streets Fireplaces of not con- suming their own smoke Not keeping well cleansed and venti- lated Taking of by Com- missioners or officers beyond their salaries Improperly taking by officers, &c. Not setting up while repairing buildings Wilful discharge of in street Fixing in upper win- dow without suffi- ciently guarding the same "When unfit, exposing for sale When unfit, exposing for sale Placing any kind of goods on, or placing any blind, &c., less than eight feet in height from the ground Hanging up goods which project into, and obstruct pas- sage of persons Rolling or carrying any cask, &c.,on, ex- cept for purpose of loading or unload- ing any carriage or of crossing the foot- way Wilful damage to Penalty Not exceeding 5^., and a continuing penalty not exceeding 405. Not exceeding 5^., and a continuing penalty of 405. A continuing penalty of 405. Not exceeding 10^. nor less than M. 501, 501. Not exceeding 51., and a continuing penalty of 405. . Not exceeding 40s., or imprisonment for any term not exceeding 14 days Not exceeding 405., or imprisonment for any term not exceeding 14 Not exceeding 10^. Not exceeding 20^. Not exceeding 405., or imprisonment for any term not exceeding 14 Not exceeding 405., or imprisonment for any term not exceeding 14 days Not exceeding 405., or imprisonment for any term not exceeding 14 days Not exceeding 51., and a continuing penalty of 205. INDEX TO PENAL7IES UNDER THE SANITARY ACTS 173 statute 18 & 19 Vict. c. 121. ss. 23, 25 10 &U Vict. c. 89. s. 52 10 & 11 Vict. c. 89. s. 53 10 & 11 Vict. c. 89. s. 53 10 & 11 Vict. c. 89. s. 55 10 & 11 Vict. c. 89. s. 56 10 & 11 Vict, c. 89.S. 57 10 & 11 Vict. c. 89. s. 58 10 & 11 Vict. c.89. s. 59 10 & 11 Vict, c. 89.S.60 10 & 11 Vict, c. 89. s. 61 10 & 11 Vict. c. 89. s. 62 10 & 11 Vict. c.89. s. 63 10 & 11 Vict. c. 89. s. 66 10 & 11 Vict. c. 89. s. 67 10 & 11 Vict. c. 89. s. 40 10 & 11 Vict, c. 89. s. 41 10 & 11 Vict, c. 89. s. 45 Subject Gas-waeh- ings Hackney- carriage Hackney- carriage Hackney carriage Hackney carriage Hackney carriage Hackney- carriage Hackney carriage Hackney carriage Hackney carriage Hackney carriage Hackney carriage Hackney carriage Hackney carriage Hackney carriage Hackney carriages Hackney carriages Hackney carriages Offence Pollution of water by Proprietor of, refusing to carry the pre- scribed number Driver of, refusing to drive Demanding more than sum agreed upon for, though less than legal fare Driver of exacting more than legal fare Not carrying the proper distance for a sum agreed upon Driver of refusing, to wait or to account for deposit Proprietor or driver of, overcharging Proprietor or driver of, permitting persons to ride without con- sent of the hirer Acting as driver of, without consent of the proprietor Driver of, misbe- haviour of Leaving unattended at places of public resort Damage done by driver of Kefusing to pay the fare to driver of Damaging of On application for license, fraudulently framing requisition Proprietor of, not giving notice of change of abode Proprietor of, plying for hire without a license Penalty Not exceeding 200^., and a continuing penalty of 20/. Not exceeding 405. Not exceeding 405. Not exceeding 40^. Not exceeding 405. Not exceeding 40s. Not exceeding 405. Not exceeding 405. Not exceeding 205. Not exceeding 405. Not exceeding 5/., and in default of payment imprisonment for any term not exceeding 2 months Not exceeding 205. Not exceeding bl. Recovery of fare, to- gether with cost of ap- plication before justice Not exceeding 61. Not exceeding lOZ. Not exceeding 405. Not exceeding 405. 174 INDEX TO PENALTIES UNDER THE SANITARY ACTS Statute lO&ll c. 89. lO&ll c. 89. Vict, s. 47 Vict, s. 48 lO&ll c. 89. lO&ll c. 89. Vict, s. 64 Vict. S.28 10 & 11 Vict, c. 89. s. 28 11 & 12 Vict, c. 63. s. 49 11 & 12 Vict. c. 63. s. 60 18 & 19 Vict. e.l21.s.29 29 & 30 Vict. C.90.S. 22 29 & 30 Vict. c. 90. s. 39 21 & 22 Vict. c.98.s.32(2) 21 & 22 Vict. c.98.s.32(2) 10 & 11 Vict. c. 34. s. 64 IQ&ll Vict. c. 34. s. 65 10 & 11 Vict. c. 34. s. 69 lO&ll Vict, c. 89. s.28 29 & 30 Vict, c. 90. s. 25 Subject Hackney carriages Hackney carriages Hackney carriages Horse, &c. Horse, &c. House House House House House House refuse House refuse Houses . Houses . Houses . Indecency Infectious disorder Offence Drivers, acting as, and without license Proprietor of, neglect- ing to retain license of drivers in his em- ploy or refusing to produce the same when summoned Improper standing of Kiding or driving upon footway of any street, &c. Furious driving of Eebuilding without drains, &c. Neglect of notice to cleanse Overcrowding . Not cleansing and dis- infecting Letting of when in- fected Kemoval of or obstruct- ing the authority in removing by any person not being the occupier of a house Kemoval of orobstruct- ing the authority in removing by the oc- cupier (except when produced on pre- mises) Pulling down or de- facing number of Non-renewal of num- bers by occupiers Refusal on notice to remove within 14 days projection of Exposure of person so as to be an Entering public con- veyance when suf- fering from Penalty Not exceeding 205. Not exceeding 405. Not exceeding 205. Not exceeding 405., or imprisonment for any term not exceeding 14 Not exceeding 405,, or to imprisonment not exceeding 14 days Not exceeding 50/. Continuing penalty of 1 05. Not exceeding 405. A continuing penalty of not less than l5., or more than 10s. a day Not exceeding 20/. Not exceeding 5L Not exceeding 405. 405. for each offence. Not exceeding 40s. Not exceeding 405. Not exceeding 405., or im- prisonment for a term not exceeding 14 days Not exceeding 5/. INDEX TO PENALTIES UNDER THE SANITARY ACTS 175 Statute Subject Offence Penalty zy OC OU V ict. iniectious interierence witn. Not exceeding bl. c. yu. s. ^y disorder rules, enforcing re- moval of persons brought by ships, suffering from zy oc oU Vict. infectious Persons suffering from, Not exceeding bl. c. yU. s. oo disorder exposure of zy oc ou V icu. Infectious Letting of houses in Not exceeding 20^, c. yu. s. oy disorder which there has been • OOOC OO Vict. infectious Breach of rules made Not exceeding 50^. c. /y. s. oz disorder uncier s. oz oi zy oc Qn Vir»f n QA q cs i-r\ OU V ICL. c. yu. as to treatment of per- sons on board ships seized with 11 oc iz Vict. inspector. Disobeying summons Not exceeding bl. C Oo. b. 1 Zl to appear before 1 U OC 1 1 V ict. inspector Obstruction to enter- Not exceeding ol. L. Cx. o. lol of nui- ing into slaughter- ZO Oil I V ICl. Inspector Obstruction to enter- JMot exceeding ol. 1 1 7 c ^ C. 1 1 / . S. O of nui- ing into slaughter- JiUUotJo, 060. lUoC 11 Vict. li-ites Flying of , JNot exceeding 405., or _ on <-i oo c. by. S. ZO imprisonment for a term not exceeding 14 days 1 U Oo 1 1 V ICL. ijlglltS . Jc or removing wiien Not exceeding bl% c. o*. s. /y placed at night m streets undergoing alterations or re- pairs oD 05 oO Vict. T ijOCal (jrO- Neglecting orders of JNot exceeding oOo. n 7Q c ^^9 vern- ment Board zy OC oU V ict. Lodging JNot obeying regula- XT *. ^A ^ JNot exceeding 405. lor c. yu. s. 60 houses tions as to every offence, and a continuing penalty of not more than 205. a day ^ 90 J?-r Qn "\7^/^^- zy oc ou Vict. TIT Manure m Keiusal or neglect to A continuing penalty of c. yu. s. Oo mews, remove accumula- OHc ZU5. occ. tions of 1 U V ICL, C. 1 1 lVrQ-r>Tr£if iviarKeL Selling elsewhere than JNot exceeding 405. s. 13 m lOVict.c.14. Market or Selling or exposing for Not exceeding bl. s. 15 fair sale unwholesome meat in, &c. lOVict.c.14. Market or Inspector of provisions Not exceeding bl. s. 15 fair obstruction of 176 INDEX TO PENALTIES UNDER THE SANITARY ACTS Statute 10 Vict. C.14. s. 16 10 Vict. 0.14. s. 22 10 Vict. c.14. s. 23 10Vict.c.l4. s. 26 10 Vict. c.14. s. 27 10 Vict. c.14. s. 28 10 Vict. c.14. s. 29 10 Vict. c.14. s. 30 10 Vict. c.14. s. 37 10 Vict. c.14. s. 40 11 & 12 Vict, c. 63. s. 19 11 & 12 Vict. C.63.S.111 18 & 19 Vict. C.121.S.14 18&19Vict. C.121.S.14 18& 19 Vict. c. 121.S.27 26 & 27 Vict, c. 117. s. 2 Subject Market or fair Market or fair Markets or fairs Markets or fairs Markets or fairs Markets or fairs Markets or fairs Markets or fairs Markets or fairs Markets or fairs Member . Mortgages Nuisances Nuisances Nuisances Nuisance . Offence Keeper of, obstruction of Eefusal to weigh ar- ticles for sale in on request of the buyer Eefusal by persons ap- pointed to weigh articles for sale Eefusal of drivers in to take carts to be weighed Drivers of carts, &c., in committing frauds in weighing Buyers or sellers in committing frauds in weighing Frauds committed by the machine-keeper Frauds committed by other persons as to weighing goods Taking a greater toll than authorised in Collector of rents, &c., in, obstruction of Acting when disquali- fied as, of local boards of health Eefusal to allow in- spection of register of Contravention of order of abatement of Contravention of order of prohibition of Arising in cases of noxious trades, busi- nesses, processes, or manufactures Penalty Not exceeding 40^. Not exceeding 405. Not exceeding 405. Not exceeding 205. Not exceeding 51. for each offence Not exceeding 5/. Exposing for sale dis- eased and unwhole- some meat, &c., so as to be a Not exceeding bl, in cer- tain specified cases Not exceeding bl. Not exceeding 405. Not exceeding 405. 50^. Not exceeding U. A continuing penalty of not more than IO5. a day A continuing penalty of not more than 205. On first conviction not more than 5^., nor less than 405. On second conviction 10^., and for each subsequent con- viction a sum double the amount of the penalty imposed for the last preceding con- viction, but in no case to exceed 200^. Not exceeding 20/. for every animal, &c., or imprisonment for not more than three months INDEX TO PENALTIES UNDER THE 8ANITAEY ACTS 177 statute 18 & 19 Vict. C.121.S.36 11 & 12 Vict. C.63.S.148 18 & 19 Vict. C.121.S.37 31 & 32 Vict. C.130.S.36 11 & 12 Vict. C.63.S.148 11 & 12 Vict. c. 63. s. 64 9 & 10 Vict. c. 74. S.39 11 & 12 Vict, c. 63.S. 38 11 & 12 Vict, c. 63. s. 39 11 & 12 Vict, c. 63.S.148 26 & 27 Vict. c. 40. s. 6 26 & 27 Vict. C.117.S.3. 31&32 Vict. C.130.S.35 11 & 12 Vict. c. 63. s. 28 18 & 19 Vict. 0.121,8.36 31 & 32 Vict. C.130.S.36 18&19 Vict. C.121.S.14 18 & 19 Vict. C.121.S.14 Subject Nuisances removal Occupier. Occupier . Occupier . Occupiers Offensive trades Officers . Officers Officer Officers Officer Officer of health Officer of health Officer, re- turning Officer Officer of health Order of abate- ment. (See nui- sances) Order of prohibi- tion. (See nui- sances) Offence Obstruction of execu- tion of Act Refusal to permit owner to execute necessary works Obstructing owner from entering on premises to execute necessary works Obstructing owner from carrying Act into execution Refusal to disclose owners' names Establishment of Taking fees beyond salaries, or inte- rested in salaries Contracts when inte- rested in or under colour of employ- ment exacting fees Failing to account Obstruction of in exe outing of Public Health Act, 1848 Inspection of bake- houses, obstruction of Obstructing him from entering slaughter- house, &c. Obstruction of . Neglecting to comply with provisions of Act Wilfully obstructing Obstruction of when executing Act Contravention of Contravention of Penalty Not exceeding 5/. Not exceeding bl. A continuing penalty not exceeding bl. A continuing penalty of 20^. Not exceeding bl. bOl.j and a continuing penalty of AOs, Not exceeding 50^. 50^. Distress for amount or imprisonment for three months Not exceeding bl. Not exceeding 20/. Not exceeding bl. Not exceeding 20/. Not exceeding 50/. Not exceeding 5/. Not exceeding 20/. A continuing penalty of not more than lOs. A continuing penalty of not more than 20^. 178 ind:ex TO PENALTIES UNDER THE SANITARY ACTS statute 18 & 19 Vict. C.121.S.29 7 & 8 Vict. c. 101. S.33. 11 & 12 Vict. c. 63. s. 68 9 & 10 Vict. c. 74. s. 40 11 & 12 Vict. C.63.S. 123 11 & 12 Vict. C.63.S. 123 14 & 15 Vict. c. 28. s. 16 21 & 22 Vict. c. 98. s. 67 lO&ll Vict. c. 89. s. 28 21 & 22 Vict. c. 98. s. 56 29 & 30 Vict. c. 113. s. 7 lO&ll Vict. c. 89. s. 28 11 & 12 Vict. c. 63.S.100 30&31 Vict. C.113.S.18 11 & 12 Vict, c. 63. s. 80 11 & 12 Vict, c. 63. s. 80 11 & 12 Vict, c. 63. S.47 29 & 30 Vict, c. 90. s. 29 Subject Over- crowd ing Overseers . Pavement Penalties , Penalty . Penalty . Penalties Penalties Pigstye . Poor rate books Poor-rate books Prostitu- tion Rates Rates Reservoir Reservoir Sewers, drains, &c. Ships Offence House, so as to be dangerous to health Refusing to attend audit Displacing Application of Recovery of, 'must be within 6 months Application of Recovery of, under Common Lodging- House Act In corporate boroughs Keeping in front of street Refusal by officer to allow inspection of Refusal by officer to allow inspection of Loitering in streets and importuning passengers for pur- poses of Refusal to allow in- spection of Non-payment of by overseers Fouling water in Gas manufacturer, fouling by Unauthorized commu- nication with Interference with rules empoweringremoval to hospital of per- sons suffering from infectious disorder brought by Penalty Not exceeding 405. Not exceeding 40^. Not exceeding 5L, and 5s. per sq. ft. displaced Residue of in borough to borough fund,in parish to rate for relief of the poor One half to informer, one half to Local Board Payable to district fund account Not exceeding 40^., or imprisonment for any term not exceeding three months Not exceeding 51, Not exceeding 51, Not exceeding 405., or imprisonment for any term not exceeding 14 Not exceeding 5/. Amount or so much in arrear raised by dis- tress and sale of goods Not exceeding 51, and a continuing penalty of 55. Not exceeding 200^., and after 24 hours' notice, 20/. a day 5/., and a further con- tinuing penalty of 405. a day Not exceeding 51. INDEX TO PENALTIES UNDER THE SANITARY ACTS 179 statute 10 & 11 Vict, c. 89. s. 28 10 & 11 Vict, c. 34.S.126 10 & 11 Vict. C.34.S.127 10 & 11 Vict. C.34.S.128 10 & 11 Vict. C.34.S.130 10 & 11 Vict. c. 34.S.131 10 & 11 Vict. C.34.S.131 10 & 11 Vict. c. 89. s. 28 80 & 31 Vict. c. 84. s. 32 10 & 11 Vict. c. 89. s. 28 10 & 11 Vict. c. 89. s. 21 10 «& 11 Vict. c. 89. s. 28 10 & 11 Vict, c. 34. s. 64 11 & 12 Vict, c. 63. s. 68 11 & 12 Vict. c. 63. s. 59 18 & 19 Vict, c. 121.S.27 11 & 12 Vict. c. 63. s. 37 30 & 31 Vict. c. 84. s. 29 30 & 31 Vict. c. 84. 8. 30 Subject Slate Slaughter- houses Slaughter- houses Slaughter- houses Slaughter- Slaughter- houses,&c. Slaughter- houses,&c. Slide Small pox Stones Streets Street Streets Streets . Swine, &c. Trades, noxious Treasurer Vaccina- tion Vaccina- tion Offence Throwing into street from roof or any part of any house Erecting without a license. Using existing houses without registration Breach of bye-laws for regulation of During suspension of license slaughtering cattle in Keeping cattle, &c., which are diseased Obstruction of In- spector of Making of in street upon ice or snow Person inoculating with Throwing or laying down in streets Obstruction in during public processions,&c. Placing line, cord, or pole across Pulling down or de- facing name of Displacement of materials of Keeping of in im- proper situations Nuisance, arising from Holding office of clerk to Local Board Parent not procuring, of child Vaccination, and pa- rent neglecting to forward certificate N 2 Penalty Not exceeding 40s., or im- prisonment for any term not exceeding 14 days Not exceeding bl., and a continuing penalty of bl. a day Not exceeding 5^., and a continuing penalty of 105. Not exceeding 5/., and a continuing penalty of 105. Not exceeding 51., and a continuing penalty of bl Not exceeding 10^. for every animal Not exceeding 5^. Not exceeding 405., or imprisonment for any term not exceeding 14 days Imprisonment for one month Not exceeding 40#., or imprisonment for any term not exceeding 14 days Not exceeding 405. Not exceeding 405., or imprisonment for any term not exceeding 14 days 405. for each oflfence 5^., and a continuing penalty of 55. 405., and a continuing penalty of 55. a day Not exceeding 5^., and a continuing penalty of 405., with double pe- nalty for each new offence 100^. 205. 205. 180 INDEX TO PENALTIES UNDEB THE SANITARY ACTS statute 30 & 31 Vict. c. 84. s. 30 34 & 35 Vict. c. 98. s. 7 34 & 35 Vict. c. 98. s. 7 34 & 35 Vict, c. 98. s. 10 34 & 35 Vict. c. 98. s. 11 10 & 11 Vict. c. 89. s. 28 21 & 22 Vict. c.98.s.l3(5) 11 & 12 Vict. c. 63. s. 59 11 & 12 Vict. c. 63. s. 80 11& 12Vict. c. 63. s. 80 11& 12Vict. c. 63. s. 80 11 & 12 Vict. c. 63. s. 94 18 & 19 Vict. C.121.S.23 23 & 24 Vict. c.77. s. 8 11 & 12 Vict, c. 63. s. 51 11 & 12 Vict, c. 63. s. 52 Subject Vaccina- tion Vaccina- tion Vaccina- tion Vaccina- tion Vaccina- tion Vault Voting papers Waste water Water Water Water Water Water Water Water- closets, &c. Water- closets Offence Signing false certifi- cate Certificate of, non- transmission of Certificate of, wrongly- signing, &e. Preventing public vaccinator from taking lymph from any child Parent failing to pro- duce child Leaving open Forging, &e., of Allowing to remain in cellars, &c. Fouling of by gas of proprietors of gas works Fouling of Fouling of by pro- prietors of gas works, &c. Cutting off, by Local Board Corruption of by gas washings Fouling of Omission to provide in houses Omission to provide in factories after notice Penalty Gruilty of misdemeanour Not exceeding 205. G-uilty of a misde- meanour, and liable to imprisonment, with or without hard labour, not exceeding 2 years Not exceeding 205. Not exceeding 20^. Not exceeding 405., or imprisonment for any term not exceeding 3 months Imprisonment on convic- tion before two jus- tices in the common gaol or house of cor- rection for any period not exceeding 3 months with or without hard labour 405., and a continuing penalty of 55. Not exceeding 20/., and a continuing penalty of 10/. Not exceeding 5?., and a continuing penalty of 20s. a day 200/., and a continuing penalty of 20/. Not to affect penalties or liabilities 200/., and a continuing penalty of 20/. Not exceeding 5/., and a continuing penalty not exceeding 20s. a day 20/. 20/., and a continuing penalty of 405. INDEX TO PENALTIES UNDER THE SANITARY ACTS 181 Statute Subject Offence ■ ' ■" Penalty 10 & 11 Vict. Water- Not affixing to houses, A continuing penalty not c. 34. s. 74 spouts &c. within 7 days exceeding 405. after service of order 11 & 12 Vict. Water- Injury to, or diverting Not exceeding bl., and a c. 63. s. 79 works, streams, or wasting continuing penalty of &c. water 20^. 10& 11 Vict. Window . Allowing person in Not exceeding 405. or c. 89. s. 28 service to stand on the sill of, unless such window be in the sink or base- ment storey imprisonment for any term not exceeding 3 months 21 & 22 Vict. Works,&c. Injury to belonging to Not exceeding bl. c. 98. s. 66 Local Boards 29 & 30Vict. Works Wilful damage to be- Not exceeding bl. c. 90. s. 45 longing to sanitary authorities 30&3lVict. Work- Kefusal of admission Not exceeding 20^. c. 146. s. 9 shops of authorised officer to enter 30 & 31 Vict. Work- Obstruction of in- Not exceeding 20/. C.146.S. 10 shops spector from enter- ing to inspect con- dition thereof PAET II. 185 CHAPTER I. ROUTINE DUTIES. The duties of the Metropolitan Medical Officers of Health Duties of were originally defined by the Metropolis Local Manage- poutan ment Act (18 and 19 Vict., cap. 120, sec. 132), as follows : ^' ^' ^' — *To inspect and report periodically upon the sanitary condition of their parish or district, to ascertain the exist- ence of diseases, more especially epidemics, increasing the rate of mortality, and to point out the existence of any nuisance or other local causes, which are likely to originate and maintain such diseases, and injuriously affect the health of the inhabitants, and to take cognisance of the fact of the existence of any contagious or epidemic dis- eases, and to point out the most efficacious mode of check- ing or preventing the spread of such diseases, and also to point out the most efficient modes for the ventilation of churches, chapels, schools, lodging-houses, and other public edifices within the parish or district, and to perform any other duties of a like nature which may be required of him or them ; ' and those of inspectors of nuisances, by the Duties of next section * to superintend and enforce the due execution NuSances.^ of all duties to be performed by the scavengers ' — to en- quire into complaints made by inhabitants about infringe- ments of the provisions of the Act, or about the existence of nuisances ; to report the result of such enquiry to the Vestry or Local Board, and to institute, * subject to the direction of the Vestry or Board,' legal proceedings for the punishment of offenders against the provisions of the Act. The Public Health Act of 1872, under which Medical Officers of Health and Inspectors of Nuisances are now being appointed outside of the metropolis, makes no at- 186 MANUAL OF PUBLIC MEDICINE Duties of district M. 0. H. To advise Sanitary Authority. Epidemic diseases. tempt at defining their duties, wliicli has, however, since been done by the orders of the Local Government Board : Duties of Medical Officer of Health, " The following shall be the duties of the medical officer of health in respect of the district for which he is appointed ; or if he shall be appointed for more than one district, then in respect of each of such districts : — (1.) He shall inform himself as far as practicable respect- ing all influences afiecting or threatening to affect inju- riously the public health within the district. (2.) He shall inquire into and ascertain by such means as are at his disposal the causes, origin, and distribution of diseases within the district, and ascertain to what extent the same have depended on conditions capable of removal or mitigation. (3.) He shall by inspection of the district, both syste- matically at certain periods, and at intervals as occasion may require, keep himself informed of the conditions in- jurious to health existing therein. (4.) He shall be prepared to advise the sanitary au- thority on all matters affecting the health of the district, and on all sanitary points involved in the action of the sanitary authority or authorities ; and in cases requiring it, he shall certify, for the guidance of the sanitary au- thority or of the justices, as to any matter in respect of which the certificate of a medical officer of health or a medical practitioner is required as the basis or in aid of sanitary action. (5.) He shall advise the sanitary authority on any ques- tion relating to health involved in the framing and sub- sequent working of such byelaws and regulations as they may have power to make. (6.) On receiving information of the outbreak of any contagious, infectious, or epidemic disease of a dangerous character within the district, he shall visit the spot with- out delay and inquire into the causes and circumstances of such outbreak, and advise the persons competent to act as to the measures which may appear to him to be required to prevent the extension of the disease, and, so far as he BOUTINE DUTIES 187 may be lawfully authorized, assist in the execution of the same. (7.) On receiving information from the inspector of nui- ^^^^^^^wd sances that his intervention is required in consequence of the existence of any nuisance injurious to health, or of any overcrowding in a house, he shall, as early as prac- ticable, take such steps authorized by the statutes in that behalf as the circumstances of the case may justify and require. (8.) In any case in which it may appear to him to be inspection necessary or advisable, or in which he shall be so directed by the sanitary authority,", he shall himself inspect and examine any animal, carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, or flour, exposed for sale, or deposited for the purpose of sale or of preparation for sale, . and intended for the food of man, which is deemed to be diseased, or unsound, or unwholesome, or unfit for the food of man ; and if he finds that such animal or article is diseased, or unsound, or unwholesome, or unfit for the food of man, he shall give such directions as may be necessary for causing the same to be seized, taken, and carried away, in order to be dealt with by a justice accord- ing to the provisions of the statutes applicable to the case. (9.) He shall perform all the duties imposed upon him by any byelaws and regulations of the sanitary authority, duly confirmed, in respect of any matter afiecting the public health, and touching which they are authorized to frame byelaws and regulations. (10.) He shall inquire into any offensive process of trade Offensive carried on within the district, and report on the appropriate ^ means for the prevention of any nuisance or injury to health therefrom. (11.) He shall attend at the office of the sanitary autho- rity, or at some other appointed place, at such stated times as they may direct. (12.) He shall from time to time report, in writing, to Report, the sanitary authority, his proceedings, and the measures which may require to be adopted for the improvement or protection of the public health in the district. He shall in like manner report with respect to the sickness and mor- 188 MANUAL OF PUBLIC MEDICINE tality within the district, so far as he has been enabled to ascertain the same. Books. (13.) He shall keep a book or books, to be provided by the sanitary authority, in which he shall make an entry of his visits, and notes of his observations and instructions thereon, and also the date and nature of applications made to him, the date and result of the action taken thereon and of any action taken on previous reports, and shall produce such book or books, whenever required, to the sanitary authority. Annual (1^-) He shall also prepare an annual report, to be made report. December in each year, comprising tabular statements of the sickness and mortality within the dis- trict, classified according to diseases, ages, and localities, and a summary of the action taken during the year for preventing the spread of disease. The report shall also contain an account of the proceedings in which he has taken part or advised under the Sanitary Acts, so far as such proceedings relate to conditions daDgerous or injurious to health, and also an account of the supervision exercised by him, or on his advice, for sanitary purposes over places and houses that the sanitary authority has power to regu- late, with the nature and results of any proceedings which may have been so required and taken in respect of the same during the year. It shall also record the action taken by him, or on his advice, during the year, in regard to offen- sive trades, bakehouses and workshops. Relation to (1^-) shall give immediate information to the Local Government Grovernment Board of any outbreak of dangerous epidemic Board. disease within the district, and shall transmit to the board, on forms to be provided by them, a quarterly return of the sickness and deaths within the district, and also a copy of each annual and of any special report. (16.) In matters not specifically provided for in this order, he shall observe and execute the instructions of the Local Government Board on the duties of medical officers of health, and all the lawful orders and directions of the sanitary authority applicable to his office. (17,) Whenever the Diseases Prevention Act of 1855 is in force within the district, he shall observe the direc- BOUTINE DUTIES 189 tions and regulations issued under that Act by the Local Government Board, so far as the same relate to or concern his office." Duties of the Inspector of Nuisances, Duties of district In- " The following shall be the duties of the inspect oro f spector. nuisances in respect of the district for which he is appointed, or if he shall be appointed for more than one district, then in respect of each of such districts : — (1.) He shall perform, either under the special directions of the sanitary authority, or (so far as authorized by the sanitary authority) under the directions of the medical officer of health, or in cases where no such directions are required, without such directions, all the duties specially imposed upon an inspector of nuisances by the Sanitary Acts, or by the orders of the Local Government Board. (2.) He shall attend all meetings of the sanitary authority when so required. (3.) He shall by inspection of the district, both syste- inspections, matically at certain periods, and at intervals as occasion may require, keep himself informed in respect of the nuisances existing therein that require abatement under the Sanitary Acts. (4.) On receiving notice of the existence of any nuisance within the district, or of the breach of any byelaws or regu- lations made by the sanitary authority for the suppression of nuisances, he shall, as early as practicable, visit the spot, and inquire into such alleged nuisance or breach of byelaws or regulations. (5.) He shall report to the sanitary authority any noxious or offensive businesses, trades, or manufactories established within the district, and the breach or non-observance of any byelaws or regulations made in respect of the same. (6.) He shall report to the sanitary authority any damage Water done to any works of water supply, or other works belong- ing to them, and also any case of wilful or negligent waste of water suppHed by them, or any fouling by gas, filth, or otherwise, of water used for domestic purposes. (7.) He shall from time to time, and forthwith upon com- plaint, visit and inspect the shops and places kept or used 190 MANUAL OF PUBLIC MEDICINE Inspection for the Sale of butchers' meat, poultry, fish, fruit, vegetables, corn, bread, or flour ; or as a slaughter-house, and examine any animal, carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, or flour which may be therein ; and in case any such article appear to him to be intended for the food of man, and to be unfit for such food, he shall cause the same to be seized, and take such other proceedings as may be necessary in order to have the same dealt with by a justice. Provided that in case of any doubt arising under this clause, he shall report the matter to the medical officer of health, with the view of obtaining his advice thereon. To procure (g.) He shall, when and as directed by the sanitary autho- samples for ^ ^ ' ^ »' analysis. rity, procure and submit samples of food or drink, and drugs suspected to be adulterated, to be analyzed by the analyst appointed under the Adulteration of Food Act, 1872, and upon receiving a certificate stating that the articles of food or drink, or drugs, are adulterated, cause a complaint to be made, and take the other proceedings prescribed by that Act. ^pidemic (9.) He shall give immediate notice to the medical officer &c., &c.' of health of the occurrence within his district of any con- tagious, infectious, or epidemic disease of a dangerous charac- ter ; and whenever it appears to him that the intervention of such officer is necessary in consequence of the existence of any nuisance injurious to health, or of any overcrowding in a house, he shall forthwith inform the medical officer thereof. (10.) He shall, subject in all respects to the directions of the sanitary authority, attend to the instructions of the medical officer of health with respect to any measures which can be lawfully taken by him under the Sanitary Acts, for preventing the spread of any contagious, infec- tious, or epidemic disease of a dangerous character. Books. (11-) He shall enter from day to day, in a book to be provided by the sanitary authority, particulars of his in- spections and of the action taken by him in the execution of his duties. He sball also keep a book or books, to be provided by the sanitary authority, so arranged as to form, as far as possible, a continuous record of the sanitary con- dition of each of the premises in respect of which any action has been taken under the Sanitary Acts, and shall BOUIINE DUTIES 191 keep any other systematic records that the sanitary author- ity may require. (12.) He shall at all reasonable times, when applied to by the medical officer of health, produce to him his books, or any of them, and render to him such information as he may be able to furnish with respect to any matter to which the duties of inspector of nuisances relate. (13.) He shall, if directed by the sanitary authority to superintend do so, superintend and see to the due execution of all works which may be undertaken under their direction for the suppression or removal of nuisances within the district. ' (14.) In matters not specifically provided for in this order, he shall observe and execute all the lawful orders and directions of the sanitary authority, and the orders of the Local Government Board which may be hereafter issued, applicable to his office." The essential duties, then, of the Medical Officer of Health are to inspect the sanitary condition of his district, and to report periodically upon it. He is to take special notice of special at- the spread of epidemics, or of the means of checking them, epidemics. But it should be observed at once that it is not his duty, but the duty of the Inspector of Nuisances, under his direc- tion, to investigate complaints of nuisances. It is his duty, on receiving notice from any source, of the existence of conditions dangerous to health, or of the existence of infec- investiga- tions diseases, to instruct the Inspector of Nuisances to plaints, visit such locality and report to him upon the conditions existing there. As a matter of fact, and in practice, the Inspector of Nuisances, on finding that an undoubted nui- sance exists, at once gives a verbal notice to the owner or verbal occupier of the premises to remove such nuisance forth- with ; indicating (in ordinary cases only) the best way in which this may be done. If, on visiting the place a few days afterwards, he finds that the notice has not been com- plied with, he fills up a printed notice in compliance with the 21st section of the Sanitary Act, 1866, stating what alterations, if any, are required, and takes it to the Vestry printed Clerk (or other officer) to be signed by him : this notice is ^°*^^^^* either served upon the owner or occupier, or, when he cannot be found, posted on the premises. It is to be re- 192 MANUAL OF PUBLIC MEDICINE Issued by- Inspector. Consulta- tion with M. 0. H. Disregard of notice. Applica- tion for summons. marked that it is not necessary that the name of the owner or occupier should be mentioned in the notice. It is usual for the Inspector to issue such notices, and, in fact, the majority of such notices are issued by him, without any consultation with the Medical Officer of Health. It is obviously sufficient, in the great majority of instances, that the opinion of the Medical Officer of Health that such and such a condition of things constitutes a nuisance injurious to health, be given once for all, and in such cases the In- spector of Nuisances may and ought to act on this opinion without any further consultation with his chief ; but in all cases where there is the slightest doubt as to whether the notice so served could be followed up by legal proceedings with a reasonable prospect of success, he should make a point of consulting with the Medical Officer of Health as to whether a notice should be issued or not. It is to be remembered that it is not, as a rule, a good practice to allow the Inspector to issue notices for alterations that you do not mean to insist on having carried out, although it is true that in a great number of cases you may get desirable alterations effected by issuing notices that you may not think fit to follow up afterwards by legal proceedings if disregarded. If the notice served by the Inspector or Officer appointed to this duty, be not attended to within the time specified therein — which will of course vary with the extent of the work which is required to be carried out, and which in the great majority of sanitary notices is well expressed by the word "forthwith" — the Inspector notifies the fact to the Medical Officer, who then visits the place in company with the Inspector, in order to see whether he is in a position to advise the Sanitary Authority to give permission to the Inspector to apply to a Justice of the Peace for a summons against the owner or occupier of such premises. When this permission is obtained, the work required is often done without any further trouble. The Inspector, it will be remembered, has no right to apply for a summons without the instructions of the Sanitary Authority (which is often represented by a special Sanitary Committee) to do so. Such instructions are very seldom given except under the advice BOUTINE DUTIES 193 of the Medical Officer of Healtli, who is then responsible for the result of his recommendation. Another object of his visiting the place is that he should be able, if called upon, to give evidence in a Court of Justice that a nuisance ^^^^^'^^ injurious to health exists there. It must be pointed out at once that it is not his duty either to take legal proceed- ings or to appear in Court to support them. He may have to be, and usually is, called upon to give evidence in these cases, and some Justices even insist upon his being called as a witness. It is the practice of some Medical Officers of Health to conduct cases in Court themselves. They Conduct of are however taking upon themselves by so doing, a re- sponsibility which is not properly theirs ; and, in case of failure to obtain from a Justice the order required, it is plain that they are open to the charge of not having pro- perly conducted the case. Still less is it advisable that the Inspector of ^^uisances should conduct cases himself, although it is his duty to institute proceedings in the first instance. It is plainly advisable, to say the least of it, that ^ec^ai ad- the Vestry Clerk, or some legal adviser of the Sanitary Authority, be present to conduct the case. The persons summoned often get legally advised, and are represented by their solicitors, and it is obviously too great a responsi- bility for either the Medical Officer of Health, or the Inspector of Nuisances, to take upon himself to conduct cases without legal assistance. It is necessary to mention -^^^^ ^^^^ in the summons the date at which the nuisance, which is tioi^ed. objected to, existed, and it is advisable that the date men- tioned should be that of the day on which the Medical Officer visited the place ; and it must also be remembered that the plea that the nuisance has been removed since that date, is of no avail. It is sufficient to prove, to the satisfaction of the Justices, that it existed on that date. In all cases an order should be prepared beforehand by Order ready, the Medical Officer of Health, stating precisely the struc- tural alterations, if any, that are necessary for the abate- ment of the nuisance ; and the Justices should be asked to make this order. Of course, in some cases, although issuing an order, they alter the wording of the one that is submitted to them, or omit parts of it when they do not 0 194 MANUAL OF PUBLIC MEDICINE consider that the necessity for all the alterations has been satisfactorily proved ; but, in the majority of instances, the Medical Officer will not allow any order to be submitted to them for approval that cannot be shown to be necessary ; and so, as a matter of fact, when the order is made at all, it is usually the order submitted to the Justices by the Terms of representative of the Sanitary Authority. This order order. should be for the removal or abatement of the nuisance, which existed at the date mentioned in the summons, within a certain reasonable time ; and the Justices almost invariably rely upon the opinion of the Medical Officer of Health, or of the Inspector, as to the time that they con- sider reasonable in each case. If the nuisance is likely to be repeated, the order should be what is known as a ' Eecurring' ' recurring ' order, in accordance with section 13 of 18 and 19 Victoria, cap. 121, which provides as follows: — ' If the Justices are of opinion that such or the like nuis- ance is likely to I'ecur, the Justices may further prohibit the recurrence of it and direct the works necessary to prevent such recurrence as the case may in the judgment of the Justices require ; ' and if they are satisfied that the nuisance existing renders the house or building unfit for habitation, they may, if they think fit, prohibit its use for habitation until it is rendered fit for such use. Of course, when an order is made by the Justices, the representa- Costs. ^^^^ Sanitary Authority asks for the costs of the case, which, if granted, have to be paid by the person summoned.* Where, however, the Justices do not consider the case proved against the person summoned, the Sanitary Authority will have to pay at any rate its own costs. Neglect to If the Order which has been made by the Justices is dis- order.^^* regarded, the person so ofiending may be summoned again for neglecting to carry it out, and he is then liable, by section 14 of the Act just quoted, unless he can * satisfy the Justices that he has used all due diligence to carry out * Such costs include the expense of procuring the summons, of serving it (if any), of making the order, the fee of the medical officer of health or other medical witness, and the costs and time-re- muneration of the other witnesses who may be summoned to give eyidence. ROUTINE DUTIES 195 sucli order to a penalty of not more tlian ten shillings per day during his default,' and it is, more- over, provided by the same section that ' any person knowingly and wilfully acting contrary to the said order of prohibition shall be liable for every such offence to a penalty not exceeding twenty shillings per day during such contrary action.' In certain cases the Inspector of Nuisances, or even the Po\wev ©f _ , entry. Medical Officer of Health, is refused admission into houses where be has ground for suspicion of the existence of a nuisance ; it is then the duty of the Medical Officer of Health to apply to the Sanitary Authority for permission to be given to the Inspector to procure a Magistrate's order for forcible entry on the premises. So also, where an order for abatement of a nuisance has been made out and has not been attended to, the local authority is given power to enter such premises ^ and remove or abate the nuisance condemned or prohibited, and do whatever may be necessary in the execution of such order, and charge the cost to the person on whom the order is made.' Each Inspector should be provided with two books at inspector's least ; one of these he should always carry with him, and in this he should make rough notes of his daily work ; the other should be kept in the office, and in this he should make a careful entry of the premises inspected^ with the date, the names of the owners, the kind of nuisance found, the action taken, and the results. There should also be a book in the office for the entry of complaints, with all particulars, and another ' so arranged as to form, as far as possible, a continuous record of the sanitary condition of each of the premises in respect of which any action has been taken under the Sanitary Acts.' There may also be, with advantage, a separate book for Notice the entry of complaints about the non-removal of dust ; and a notice book, in which a list should be made of the premises from which dust requires to be removed, this list being entered twice over on each leaf, so that half of the leaf may be sent to the contractor, while the other half, containing the duplicate list, remains in the book at the office. The notice forms for the removal or abatement of o 2 books. 196 MANUAL OF PUBLIC MEDICINE Medical Of. ficer's note book. Eeports. Mortality table. Classifica- tion of deaths. nuisances are often kept loose, but are mucli better bound in a book, tbe form being printed twice on each leaf; each half is then filled up similarly, and the one torn out, signed, and served, while the other remains in the book, * These books should be always kept at the office, and are best placed in the care of the Chief Inspector, where there is such an officer. The Medical Officer of Health will of course keep his private note book, in which he will enter the date and par- ticulars of inspections made by him, with the orders given, etc., and this book will be of especial use to him, both in compiling his reports and also in preparing his evidence when he is called upon to give it ; moreover, he is required by the order of the Local Government Board (before quoted) to keep such a book or books. The Medical Officer of Health is also required to report periodically to the Sanitary Authority the results of the work that has been carried out by himself and his Inspectors. By the 25 and 26 Victoria, cap. 102, section 43, the Metropolitan Medical Officers are required to present an annual report in the month of June ; by the order of the Local Government Board the report for other districts is to be made at the end of December : but it is very desirable that the Medical Officer of Health should present a quarterly, or even a monthly statistical report of the mor- tality of his district. This report should be on the plan of the Registrar- General's weekly reports. It should be ac- companied by a table of deaths compiled either from the local registrar's returns — which are, in London at any rate, sent to the Medical Officers by the Registrar- General, after he has used them in compiling his returns — or obtained directly from the local registrars by some special arrange- ment. In this table the deaths may be classed in vertical columns according to (1) diseases ; (2) ages ; (3) divisions of the district ; (4) hospitals or other public institutions, as workhouses, etc. ; and under this head a distinction should be made between persons belonging to the district, or inhahitants, and strangers ; and (5) sexes : lastly a vertical column of totals. Convenient divisions of the ages are (1) under 1 year ; (2) 1 and under 5 ; (3)5 and under 20 ; (4) 20 ROUTINE DUTm'8 197 and under 40 ; (5) 40 and under 60 ; (6) 60 and under 80 ; (7) 80 and upwards. Along with the headings of ' Districts ' should be placed the population of each at the last census ; the average number of inmates of public institutions should also be stated ; and the numbers of the sexes at the last census. In preparing this report each month, at least two blank forms will be necessary. In the first one each death ^^pi^^tion as it is taken out from the original return should be entered by making a line or dot opposite to the name of the disease certified, and in the column indicating the age ; another in the column headed by the name of the district —unless the death happens to have taken place in a hospital or public institution, when the line or dot should be in the special column devoted to that institution (under the heading * Inhabitants ' or ' Strangers,' as the case may be) ; a third line or dot in the column headed by the name of the sex ; and a fourth in the column of totals. This course must be pursued for each of the deaths separately in the returns of all the districts for one week. Every fifth death in the same category, that is to say, belonging to the same disease and also to the same vertical column, is conveniently indicated by a line drawn through the four preceding dots or lines, as then, in counting up the totals, the matter is much simplified. As soon as the deaths for one week are tabu- Each week*s lated, the number in each column should be added up and checked the totals checked ; and when one is satisfied that no mis- ^^p^^^^^^* take has been made in the first week, one may proceed to the second, either on the same blank form, or, especially if there be a considerable number of deaths, much preferably on a second blank form, and the totals must then again be checked, so that a mistake may be discovered at the stage at which it is committed. For all the weeks that are to be reported upon, which in the case of monthly reports are either four or five (five weeks being taken for the months of March, June, September, and December), the table must be made up by placing numbers instead of lines or dots in the corresponding columns and lines of another blank form. The grand totals should then be cast up and again checked. It is convenient to enter these totals, and also those that Entry of . totals. are about to be mentioned, in red ink, as then they are 198 MANUAL OF PUBLIC MEDICINE easily distinguislied from tlie other numbers. Then the numbers under each order should be cast up and their totals placed opposite to the name of the order, and in the proper columns, and, in cases where there is only one disease mentioned in an order, this should also be done. It is, too, convenient to consider the headings (generally the last two in the table) viz., * sudden deaths (cause un- certain,) ' and ' cases not specified or ill defined,' as equivalent to orders, and to enter the numbers of deaths under those headings as totals in red ink. Then all the totals of the different orders should be cast up, and the results ought obviously to be the same as the original Information Casting up of the Separate diseases. It is from the totals totSs! ^ of diseases under the different orders, that the most im- portant information is derived with regard to the kinds of diseases which are prevalent at different times. If it be thought useful, the orders may be again cast up in each class, and those totals placed against the names of the classes. It will, however, be found that this latter proceeding is of very little practical utility, as orders grouped under each class do not include diseases which are brought about by similar causes, and, indeed, in some cases the same may also be said of diseases included in the several Births. orders. The table should also contain a statement of the number of births registered during the time to which it relates, divided according to the districts and according to sexes, and, if possible, a statement of the average total number of births and deaths recorded during the corre- sponding weeks of previous years. If the report is printed, the totals in the table of mortality (written in red ink) may conveniently be printed in block type. If sickness Sickness re- j i ^ r ^ turns. returns can be got from the Poor Law medical ofi&cers, from public institutions, or in any other way regularly, there may be a supplementary table to include them. This, however, should be short, and contain only the piincipal prevalent diseases, and should be looked upon as merely supplementary to the more important table just described. It must be remembered that it can only be very incomplete until we have a general registration of sickness, and there- fore its value is, at the best, but small. The monthly ROUTINE DUTIES 199 report itself should be, as we have said, in the main statis- Report itself, tical, and should state, in the first place, the death rate per thousand per annum, during the period referred to, calculated from the total number of recorded deaths of persons belonging to the district, and upon the estimated population of the district at the middle of the current year. This is approximately found by the method pursued by the Registrar- General — that is to say, by adding to the population, as enumerated at the last census, a tenth of the difference between that number and the number ob- tained at the previous census for each year that has elapsed since the last census ; and a fortieth of that difference for each odd quarter. Thus the population of the district at the pop^^^tkm middle of 1873 is estimated, by adding to the enumerated population in April 1871, a fifth of the difference between the enumerated population in 1871 and 1861, for the two years which have elapsed up to April 1873, and a fortieth of that difference for the quarter between April 1873 and Midsummer 1873 ; and this estimated population should be used in calculating the death rate all through the year 1873. If the deaths of stransrers are not excessive in i^eathsof c5 ^ strangers, number they may fairly be included in calculating the death rate, and may be considered to represent the deaths of those persons belonging to the district who died else- where. The rate thus found should then be compared with the usual death rate of the district, with that of the surrounding districts, or with some larger area in which Companson the district is included, and also, if the district be a large districts; one, with the general death rate of England, or of the United Kingdom, during the same period, and any excess or defect in it explained, if possible, by appropriate remarks. Next, the total number of deaths (especially of preventable diseases) in the various orders should be examined, and if the necessary materials exist, compared with the corres- ponding totals for corresponding periods of previous years ; this will show at once the prevalence or otherwise of any Prevalent particular order, or orders, of disease ; and then the disease or diseases, which are unusually prevalent, or the reverse, must be noticed, and an account given of the variations in the mortality from such diseases. This is of course diseases. 200 MANUAL OF PUBLIC MEDICINE especially important in the case of epidemic diseases. Sucli explanations as can be given of their fluctuations maybe added, accompanied with suitable caution or advice us to the methods which all may use for the prevention of the spread of such diseases, and any special defects in household sanitary arrangements that have been recently brought to light may be mentioned, and the modes of remedying them described. The influence of the weather upon the death-rate should be noticed, and the diseases most liable to be affected by it pointed out ; appeal being made to the table to prove the truth of the assertions. It is sometimes usual to include in this report a short account of the sanitary improvements that have been effected during the month or quarter, including the number of disinfections which have been carried out. This however is rather a matter which should be left for a special informal report to the Sanitary Committee, or other repre- sentative of the general Sanitary Authority, as it is only at their meetings that such matters can be considered in detail. The report just described, whether monthly or quarterly, ought in all cases to be printed, and the Me- dical Officer should urge upon the Vestry or Local Board the advisability of having this done, as it is only in this way that information of prevalent diseases, or sanitary advice concerning them, can be widely spread. Such a printed report, or the substance of it at any rate, will be copied into the local newspapers, and will so reach the hands of a great number of people who would otherwise perhaps never gain access to it. (See specimen table.) The annual Report should be prepared on the same plan as the monthly or quarterly ones, but should contain a more detailed account of the Sanitary work effected, and a statement of the improvements required, with a concise history of any epidemics that may have occurred during the year. This report must, in the case of the metro- politan parishes, be printed and appended to the annual report of the Vestry or district board (25 & 26 Vict. c. 102 sec. 43). But in carrying out the actual business of his office the Medical Officer is required to attend all or some meetings BOUTINE DUTIES 201 of tlie Committee whose duty it is to attend to the sanitary wants of the district. If there is a Committee assigned to this business alone, as in most large districts there will be, he will probably be required to attend all their meetings, which will be usually either fortnightly or monthly. If the sanitary administration is carried on by some general Committee, which has other business to attend to, he will only be required to attend occasionally but regularly, say once a month, unless there should be some special business demanding his attention and that of the Committee in the interval. At these meeting^s he will in the first place read Business a 1 . o itVmt committee nis formal report, already described, previously to its being meetings, printed ; if, however, as is generally the case, the printing of this report is a matter of course, and does not require a special permission, it may be read to the committee after having been pnnted, or, if they choose, be considered as read. He will then be prepared with a list of matters which he wishes to bring under the notice of the Com- mittee ; and a short account of the work carried on by the Inspectors ; the number of inspections made, of orders given, of disinfections carried out, &c. (which will be prepared for him by the chief Inspector or Clerk, from the Inspectors' books) ; and with any report which he may have been re- quired to make on any particular class of dwellings, or any special trade nuisances or other matters which may be ground for complaint at the moment. Amongst the matters Neglect of which he will have to bring under the notice of the Com- mittee will be also the cases in which notices for the re- moval of nuisances have been neglected, and it will then be his duty to ask the Committee to give authority to the Inspector to apply for a summons against the offending person or persons. He will of course be required to explain accurately the nature of the nuisance complained of, and also the evil likely to arise if such nuisance be not removed or abated. The Committee will then, unless they see any Proceedings ground for believing that the complaint has been made mittee. from any personal motive, or unless they are not perfectly satisfied that the nuisance is of such a character as to warrant the institution of legal proceedings (in which case they will probably appoint a sub- committee to view the place 202 MANUAL OF PUBLIC MEDICINE Position of the Medical Officer. Complaints to be made to Inspec- tors. Special dayts for Inspec- tions. Mutual con- fidence ne- cessary. and decide upon the course of action to be taken) grant the request. The Medical Officer should make a point, at this meeting, of receiving the instructions of the Committee with regard to any unusual steps that he may be about to take, as, for instance, the abolition of a class of nuisances that has not hitherto been made war against. He should never take up a new line without the sanction of the Sani- tary Authority. If he does so he will only have himself to blame, if he finds his doings are not approved of. He must remember that he is the adviser of the authority, and not the authority itself. If his advice is not taken that is not his fault. He will never be blamed for not assuming to himself a power which he does not properly possess. On the other hand he may bring upon himself considerable obloquy by attempting to carry out reforms without first consulting those whose duty it is to manage the sanitary afi'airs of the district. With regard to complaints, the Medical Officer should never encourage persons to make them to him. They should be made in the first instance, as a general rule, to the Inspectors, who should attend to them and get the remedy applied if possible without troubling the Medical Officer. They should, however, always feel that he can at any time be consulted, whenever they are in doubt, or whenever their authority is disputed. If there is a chief Inspector it is convenient for the sub-inspectors to refer matters in the first place to him, and he, if he thinks it ne- cessary, should consult with the Medical Officer. It will save much trouble and considerable uncertainty to all con- cerned if the Medical Officer appoints a particular day or days each week for making tours of inspection with the Inspectors to investigate such matters as they may think it necessary to bring under his notice. Of course specially urgent matters will continually arise to which his attention will have to be directed at once, but it will always happen that the great majority of cases can be postponed for a day or two, so that they can all be attended to on the day devoted by the Medical Officer to that purpose. Mutual confidence between the Medical Officer and his subordinates is absolutely essential to successful sanitary EOUTISE DUTIES 203 work ; although he must accept the responsibility of every- thing that is done, he will of necessity have to trust them to a very considerable extent, and they should strive to show themselves worthy of his confidence ; he, on the other hand, should be able and willing to assist them in their difficulties, and should endeavour to show them and his employers that his object is to do his utmost to improve the condition of the population placed under his charge and to prevent the spread of disease amongst them. 204 MANUAL OF PUBLIC MEDICINE CHAPTER II. REFUSE MATTERS. — CONSERVANCY PLANS. Introduc- tory. Local con- ditions. Importance of removal of refuse matters. The Medical Officer's object must then be to find out the causes of the diseases which prevail in his district, and to inquire into all the conditions which are likely to affect the health of the inhabitants injuriously, whether by favouring the spread of special diseases, or by lowering the general health of the population, and so facilitating the contraction of diseases of any sort. He must not merely turn his atten- tion to the prevention of the spread of epidemic diseases, although this will occupy a considerable portion of his time during the periods when they are prevalent, and may then perhaps fill up the whole of it to the exclusion of general sanitary work. But at other times there must be a con- tinual contest going on with the conditions of the locality, whether natural or artificial, which favour endemic diseases, as well as, in many cases, the spread of epidemics. Such conditions we shall next proceed to consider in detail. It might seem reasonable to begin, first, with the natural con- ditions of the district, and to describe the efiects of different soils, and different potable waters, upon the health of the inhabitants ; but a little reflection will show that there is one condition necessary for the conservation of a healthy state in all communities, which overrides all other condi- tions, and thrusts itself into an importance of the first order. It is only a matter of secondary consideration whether a town is situated on a porous gravelly soil, or upon an impervious clay. We must first ask the question, applic- able to all communities, — how does it get rid of its refuse matters ? Indeed a moment's consideration will show that the very fact of a town's being situated on a porous soil, REFUSE MATTERS.— CONSERVANCY PLANS 205 of itself a condition favourable to health, may, if the refuse matters are not satisfactorily got rid of, become a reason for the pollution of its water and the poisoning of its inhabitants by their own refuse matters. The refuse of a Kinds of town consists of (1) the fouled water, which may be taken as at least equal to the water supply, and which must neces- sarily be got rid of, whatever be done with the other refuse matters which we come to mention next : (2) The excretal matters, consisting of the fasces and urine of human beings and of domestic animals, of which, however, the greater part is in all cases turned into the waste v/ater : and (3) what is known as * dust,' which contains, besides ashes, a quantity of kitchen refuse of various kinds, including much vegetable and even animal matter, which putrifies, rendering it necessary that this kind of refuse should be removed from the vicinity of habitations as soon as possible. Almost all Eesem- collections of human beings then agree in one point, and different that is in the removal of a large portion of their refuse matter, including the greater part of the urine, along with the foul water, which is generally turned into the nearest stream, but they differ as to the mode of disposing of the remaining excretal refuse. Two things have long been recognised — 1, that these matters are valuable as manure, and 2, that they pollute the water of streams into which they are turned. But it is not even now generally under- stood that the method of their disposal determines to a very great extent the state of health, and the death-rate of a community. It may be said that there are two methods for the disposal of these matters, which proceed on totally dif- Opposite ferent principles — one on that of conservation^ and the other p^^^^^^^^' on that of riddance. Now assuming for the moment that the refuse excretal matters are dangerous to health when kept in and about houses, there can hardly be two opinions as to which of these principles is the correct one, and all plans for the conservation of these and other refuse matters among a population, whether in a crude condition or mixed with substances which are supposed to render them h aimless or to prevent their decomposition, not only depend upon an erroneous principle, but also leave the main question, which is the disposal of the foul water, containing, as it must in all 206 MANUAL OF PUBLIC MEDICINE Right one. Abolition of Conser- vancy. Results of riddance. cases, far the larger proportion of tlie valuable refuse matters of towns, untouched; and there can be no question whatever that the right principle to go upon is that of riddance. The sooner we can get the refuse matters away from the vicinity of habitations, so that they shall not undergo putrid decom- position among us, poisoning the air we breathe, the better will it be for the community : it is the duty of every medical officer of health to oppose with all his might all sj'stems which have for their object the conservation of refuse, especially of excretal, matters in crowded localities, and it is therefore his duty to advise the sanitary authority not only to insist on the abolition of cess-pits, dumb- wells, and other such receptacles, but to oppose the introduction of middens and closets of every description, in which earth, ashes, or other substances are mixed with the excretal refuse, with the object of deodorising it, and to advocate the substi- tution for them, wherever possible, of one or other kind of water-closet communicating with the sewers by impervious pipes. It is right here to mention that * the construction of an earth- closet or other place for the reception and de- odorisation of faecal matters, made and used in accordance with any regulation from time to time issued by the Local Authority, shall be held to satisfy the Acts requiring the construction of a water closet.' (San. Act 1868.) In proof of these statements we may refer to the 9th Report of the Medical Officer of the Privy Council, where we shall find that in almost every instance, where the water-carriage system has been carried out, with the aboli- tion of midden-heaps and cesspools, the general death rate has been lowered, often very considerably, indeed as much as 32 per cent, in two instances, and that a considerable reduction has also taken place in the death rate due to special diseases which we know to be communicated by means of excretal refuse — to wit cholera and typhoid fever. Of the first we are told that, ' cholera epidemics appear to have been rendered practically harmless in the towns examined ; ' towns which had mortalities of from 18 to 26 per thousand during the epidemics of 1848-49, were either not touched at all, or suffered to a very slight extent (e.g. a mortality of 1 to 2 per thousand) during succeeding epide- EFFUSE MATTERS.— CONSERVANCY PLANS 207 mics, and, to show that it is not merely a coincidence, it must be stated that there is no exception to this rule. In No ex- ^ . ception. all cases where pains have been taken to get rid of the excretal matters, which without doubt contain the poison of the disease, at once, that is to say before they begin to decompose, the reward has been that the epidemics have been ' rendered practically harmless.' In the case of enteric (typhoid) fever the same result has been attained. There is no doubt that this fever is propagated mainly if not entirely by the poisoning of the air we breathe and the water we drink by excretal matters which contain the evacuations of persons suffering from that disease. In all towns where enteric fever is prevalent there is found to be Enteric either pollution of water or of air by the decomposition of excretal matters, and in many country towns and villages where this fever is endemic, the drinking water is derived from the soil into which are sunk pervious dumb wells for the reception of the excretal matters of the population, in some instances so near to the wells that they may be said to supply them with water. It is not to be wondered at therefore that where those poisonous matters have been removed from towns before there is any chance of their Diminution .. ' n 1 n death decomposition, the death rate from enteric fever, and of rate, course also the number of cases of this disease, have, like those of cholera, been diminished ; and to a very remarkable degree ; at one place the diminution has been no less than 75 per cent., at ten others it has been from 33 to 50 per cent., and at some others to a smaller extent. There would doubtless have been no exception to this rule had there Exceptions, been in all cases a free outlet for the sewage at the outfall ; but in certain towns the outfall of the sewer opens into a tank from which the sewage has to be pumped, and in those instances it is backed up in the main sewers, and the pro- ducts of its decomposition collect, and, ascending the pipes, distribute themselves in various ways into the interior of the houses, taking with them in many instances the poison of the disease in question ; so that in a few cases, especially where sewer ventilation has not been properly provided causes of. for, the death rate from enteric fever has not decreased coincidentally with the sanitary improvements ; and in two 208 MAIiUAL OF PUBLIC MEDICINE cases there wai5 even a slight increase, while the increase Want of has been marked only in one instance. That in this latter S6WGr TGll- tilation. case the absence of any ventilation of the sewers (the outfall being into a pumping well), was the cause of a severe outbreak of fever, * appears to reach positive demon- stration, when it is added that the fever almost exclusively attacked well-to-do houses on the higher levels, where the water-closets were inside the houses ; and almost entirely spared the houses, mostly of a much poorer sort, situated on lower levels, where the closet was placed outside the house. It was not so in the times of cesspools ; then these lowlying poor houses were far more attacked with fever than the others. Moreover, the fever subsided as soon as openings were made into the sewers, from certain houses where it before maintained itself for months. (9th Report, M. 0 .P. C . , page 45.) In another place where the outfall is below the level of the river, during floods, in which case ' the sewage is backed up the main sewer for four to five hundred yards ' we are told that ' occasional outbreaks of typhoid had followed times of flood, when the outfall sewer had Causes of been underwater.' Although other improvements have fever. accompanied the more speedy removal of excretal matters, it is certainly this improvement especially which has caused the diminution in the death rate from enteric fever. Any one who has investigated enteric fever cases one by one knows perfectly well that it very seldom happens that a case occurs without his being able to put his finger at once upon some sanitary defect in the arrangement of the house, almost invariably connecbed with the apparatus which deals with the excretal matters. Such persons will hardly require to be told that although — ' many of the public im- provements have coincided with the reduction of typhoid . . . it is however the purification of the atmosphere from decomposing organic matters, that has been most uniformly followed by a fall in the prevalence of typhoid.' BEFUSE MATTEB8.^C0N8EBVANCY PLANS 209 Improved Conservancy Plans, We have then decided against all methods for the conser- vation of refuse matters, bnt still it will be found that in many places where these methods have been at work more or less completely for a considerable time, it is difficult, if not impossible, on account of the prejudices of the inhabi- conservaney tants, and even of the local authorities, to get them removed, fatne/^ and indeed in certain places, as at Manchester, for example, one or other of these systems is resorted to with the belief that it affords a safer and more economical way of treating the refuse matters. Hence we are obliged to consider the methods that may be employed for the rendering of cess- pools and middens as little objectionable as they can be, and the medical officer should make it his business to be acquainted with the various devices that are practised to this end. Cesspools originally were merely holes in the Cesspools, earth into which the excreta were conveyed, or in which they were directly deposited. They were known as dumb wells, and they are still to be found in many towns and villages in this country. The liquid part of the excretal matters soaks into the surrounding soil, and in fact such & cesspool allows of free percolation into or out of it as the case may be. In several places these pits were made with the distinct object of allowing the foul matters contained therein to percolate as freely as possible into the sur- rounding soil. At some towns they were made and closed, practically speaking, for ever. At others it was usual to dig down to a water course, and allow the refuse matter to be carried away in this manner. Of course the sub-soil in which these pits were dug usually afforded the water supply water sup- of the locality, and so the latter became inevitably contami- nateT.^*^^^ nated with organic refuse ; and this still happens, for the same reasons, in many localities. The first improvement on this state of things was makins: the cesspools impervious by lining them with cement. Ai some places the cesspool was constructed so as to contain both the liquid and the solid excreta, and this is the system practised in Paris and some other continental cities and towns. In others it was drained, so as to leave the solid p 210 MANUAL OF PUBLIC MEDICINE Improve- ments. Drainage of Valuable part still in sewage. Effects of cesspool Methods of emptying. excreta more or less dry. In the foriner case the manure obtained is mncli more valuable, as it contains the urine, which in the latter is entirely lost, with the addition of any matters that it may dissolve out of the solid portions of the excreta. There can be no doubt that, from a sanitary point of view, drained cesspools are much better than undrained ones, and the contents of a cesspool in a tolerably dry condition are much less offensive than if the liquids are mixed with them. As Dr. Trench says : — ' The perfect drainage of middens and cesspools was a great sanitary improvement. It lessened materially, though it did not entirely remove, the evils of the existing system.' If cess- pools are not drained there is also a far greater chance of the sub- soil of the town becoming contaminated with the refuse matters from such cesspools as may leak or overflow. On the other hand, if cesspools are drained into the sewers it is obvious that the principle of conservation is given up, because the more valuable part is lost, and the sewage from a town containing drained cesspools is no more fit to be turned into a river than that from one provided with water- closets. It is indeed, as a fact, often much more offensive. Where these pits are very large, as in Paris, they require to be provided with ventilating shafts reaching to the top of the house, above the eaves, or else foul air accumulates in them ; and there have been many instances of night-men having been killed, suffocated by the gases, especially the sulphuretted hydrogen, contained in the air of these places. The French name for this suffocation is Le Plomb — doubtless from the manner in which persons fall when taken with it. Men who work in such atmospheres are also liable to a kind of ophthalmia (La mitte of the French authors) ; but of course the main reason why these pits require ventilating is that the foul air which collects in them will of a certainty rise through the discharge pipes and through crevices, and find its way somehow or other into the dwelling. In most continental towns they are emptied with considerable precautions. In the first place some disinfecting fluid is thrown down one of the discharge pipes, and then the pit is emptied, by a pump, or by means of hose leading into a partially exhausted barrel or tmneaic. EFFUSE MATTFES.— CONSERVANCY PLANS 211 This is all done at night. Notwithstanding that the whole of the apparatus is supposed to be air-tight, the nuisance caused by this method, is, as may be expected, very consi- derable, A street in which it is being carried on is almost impassable for a considerable time. Still there can be no doubt that this is an immense improvement upon the old plan still in vogue in many places, of emptying large cess- pools by hand and bucket. A great improvement which has been introduced abroad consists in having the cesspool Stparatews. divided into two or more chambers with porous partitions between them, and so arranged that the solid refuse matters remain, comparatively speaking, dry in the one chamber, while the urine and other fluids are collected in one or more of the others — each of these chambers being provided with a ventilating shaft. In this case very little odour is to be observed in them, and also the removal and after treatment of the contents is much facilitated, Of course the soil pipes which descend from the closets to these cesspools and also the waste-pipes of sinks, &c., require to be trapped. They should descend as vertically as possible, and if they pass, as Descent they generally will, inside the house, should be syphon trapped at the lower end w^iere they empty themselves into the upper part of the cesspool ; otherwise, if they are defective in any part, the air from the cesspool will be drawn into the house. At each closet there should be either a syphon-trap or any simple contrivance for keeping the air of the soil-pipe out of the house, and below this, if the top of the soil-pipe be not carried up to the roof of the house and left open (which is the best plan) there should be inserted a small ventilating pipe. This is, however, not done in towns on the Continent where the system is in vogue ; we shall refer to it further when we come to treat of water-closets. A variety of the cesspool system has been proposed by Captain Liernur, and is called the pneumatic Liernur's system. The cesspool, instead of being lined with cement, ^^^^^"^ and placed underneath the courtyard of the house, or underneath the house itself, is made of cast iron, is air- tight, and is placed underneath the street where two streets cross one another, being connected with all the houses of several streets by iron pipes. The closets are made of as p2 212 MANUAL OF PUBLIC MEDICINE simple a construction as possible, and it is considered that no extra snpply of water is necessary for them — the liquid refuse of the house being sufficient to keep them in order — the cesspool is emptied daily by being ^connected with an air-tight barrel in which a partial vacuum has been created — ^the end of the hose not being dipped into the contents of the cesspool, but being fastened on to the latter with an Disposal of air-tight joint. The barrels containing the manure are sent directly to the farms requiring it, and are placed upon a plough of special construction, so arranged that the manure is discharged from the bung-hole of the barrel through a hollow foot behind the plough- share, while a shovel, which trails behind, closes the earth over it. This plan of applying liquid manure is worth the attention of towns where excretal refuse is collected unmixed, apart from Captain Liernur's process, which is itself only an improvement (although a considerable one) upon the cesspool system. As the emptying of cesspools is an expensive process, it is obviously advantageous to construct them as large as possible for the sake of economy, so that they only require to be emptied at considerable intervals of time, and this is, of "Course, a great objection to the system, as, indeed, to all systems which require remova.1 by cartage. Importance As frequent removal is of the first importance from a sani- rem?vai!^* tary point of view, th^ most obvious improvement upon the large permanent cesspool was the provision of small Fosses Mo- moveable ones — the Fosses Mobilles of Paris, -and the pails ' * and tubs of some of our own towns. These temporary cesspools have been carried to considerable perfection abroad, the plan being to have one descent pipe into which the closets (which are of the simplest construction imagin- able) empty th^ir contents by means of connecting pipes. The descent pipe is straight. At the upper end is fixed a ventilating pipe, on the top of which a revolving vane, or Archimedean screw, is sometimes placed, and at the lower end the last joint rests on a slab of stone, through which the pipe is continued by means of a sliding joint made of wrought copper — the descent pipe itself being made of glazed stoneware. This sliding copper pipe fits into an aperture in the covering of the barrel (tonneau or tinette), REFUSE MATTERS.— CONSERVANCY PLANS 213 so that the refuse matters fall down the pipe directly into the barrel, and by these means the pipe is kept compara- tively clear, as no accumulation can take place in any part. The barrel is placed upon a small cart with wheels, which Kemovai of run on rails, and can be easily moved from beneath the descent pipe when full. When this is to be done, the copper pipe is slipped up a little, a cap is fitted to the end of it, another covering without an aperture placed securely on the top of the barrel, and the former one fixed on to the empty barrel which is to take its place — the whole process occupying only a few minutes. Frequently sepa- rators are placed in the interior of these barrels, and then the liquid part is sometimes carried away by a small pipe into a sewer. By this method much manure is lost ; but on the other hand the barrel does not require to be moved nearly so often. Chesshire's intercepting tank is a variety of this chesshire's system ; by it the solid matters are retained, while the Tan^r^*^^^ liquids flow away into the sewer ; Dr. Hewlett looks upon it as 'a better form of cesspool.' A simpler plan than this, in which no descent pipe is necessary, is described in a report by Dr. Buchanan and Mr. RadclifFe, published in the twelfth report of the Medical Officer of the Privy Council. In this plan the pail or tub is placed immediately Pails and beneath the seat of the closet. At some places disinfectants are placed at the bottom of the tubs with the view of re- tarding decomposition and preventing offensive smells. At Rochdale, the pails are made from disused paraffin casks — each cask being cut into two. They are fitted with iron handles and tightly-fitting lids, and cost only Ss. 4 however, it will be quite sufficient to allow this water to run away Q 226 MANUAL OF PUBLIC MEDICINE into the sewer, and then to charge the trough again with a small quantity of water. This is known as the " Trough water-closet," and has been perfectly successful in the poorer parts of large towns, and notably of Liverpool. Another form of closet suitable for collections of people is known as the " Tumbler water-closet." In this case there is a trough, as before described, in permanent connection with the sewer at the lower end, while at the upper end, in a special compartment, the water is allowed to drip from a tap by means of which the amount can be regulated ac- curately, into a swinging basin, which is so arranged that as soon as it is filled up to a certain point it tips over and empties its contents into the trough, thus washing it out. The supply of water to it can be regulated so that it shall upset at any interval of time that may be thought desirable, and it may be made to capsize at dijSTerent intervals during different periods of the day, according to the frequency of the use of the closets during such periods. In both these cases the special compartment containing the water-trap and other apparatus must be under the control of a single responsible person. The more complicated kinds of water-closet are very varied in the details of their construction. It is only necessary here to describe the one in most general use to show its defects and the way of remedying them. It consists, like the simpler form already described, of a china or earthen- ware pan, which is usually conical, but is now made of several shapes, one of the best being that in which it is a kind of basin. The sides of conical pans always allow a certain amount of soil to accumulate upon them, and re- quire a greater flushing power of water to clean them. This pan is not, as in the former case, connected with a syphon, but it opens into a large iron vessel called the container," and it is inside this " container " that the basin which closes the extremity of the pan, and retains a certain amount of water in it, usually from three to four inches in depth, swings. The container, in its turn, opens by a vertical pipe from its lower part into a contrivance known as the D trap, so called from its resemblance to the letter D placed thus O. From the upper part of this D WATER'CABBIAGE SYSTEM 227 trap, at one end, the leaden connecting-pipe passes, and joins it with the soil-pipe of the house, and the vertical pipe from the container passes through the flat top of the D trap down to a couple of inches or so below the level of the last-mentioned pipe. It is clear, by this description, its action, that the D trap must necessarily hold water up to the level of the discharge pipe at the upper part of it, and that the vertical pipe from the container must end beneath the surface of this water, so that air coming from the soil- pipe into this trap is prevented by the water from getting into the container above. Now, this is on the whole a very good contrivance, but several precautions require to be taken with regard to it, and several additions require to be made to it in order to render it unobjectionable. When these precautions are taken and these additions made, it is a contrivance that can be placed with perfect safety, and almost without the possibility of a nuisance, in any part of a house, and even in the most confined situations. We do not for a moment advise this to be done as a matter of choice. The first precaution has been already mentioned. Precautions, that the soil-pipe with which this apparatus is connected be, if possible, open at the top. If it is not open, and in the majority of instances it is not, then it is necessary, and absolutely necessary, that from the point at which the connectine^-pipe from the D trap enters the soil-pipe, a i^esuits of . . . on . . ^ant of ven- leaden ventilating pipe of from one to two inches in tiiation. diameter be carried up to the top of the house, ending, as before mentioned, above the eaves. If this is not done, although there is little fear of the pressure of air in the sewer forcing it past the water of the D trap into the container, what happens is that the putrescent organic matter contained in the air of the soil-pipe is absorbed by the water in the D trap, which is thus rendered fouler than ever, and gives ofi* foetid gases into the container. These collect under pressure and escape into the house as soon as the pull-up apparatus by which the basin is re- moved from the base of the pan is set to work, and thus a Further pre- nuisance is created each time the closet is used. But even this precaution may be taken and, especially if the closet be in a confined situation, a certain amount of nuisance Q 2 228 MANUAL OF PUBLIC MEDICINE will arise from it, and this happens in the following way : When the pnll-up apparatus is set at work, after the use of the closet, the water held up bj the basin and the excretal matters contained therein fall into the D trap, and it is seldom that suflB^cient water is allowed to pass through the apparatus to flush out sufficiently this D trap. Consequently, foul water remains in it. This foul water fills the container above it with offensive gases which escape as soon as the basin is Ventilation movcd. To obviatc this difficulty, the container itself must be ventilated, and this is done by having a hole made in the top of it, and soldering a half-inch lead pipe into it, which is carried out and made to end in any convenient manner. It has been recommended to attach two such pipes to each container, making the one end immediately outside the wall, and carrying the other up to a greater height, the object being the establishment of a continuous current of air through the container. There can be no doubt of the efficiency of this method ; but we have found, as a matter of fact, that a single ventilating pipe answers the purpose perfectly well, the object being, the provision of a free escape for any foul air that may collect in the container, and the consequent prevention of its collecting under pressure therein. When this is done it is clear that on pulling up the handle, and discharging the water from the pan, there is a rush of air down after the water into the container, instead of, as in the former case, the escape of gases confined under pressure in this latter. In the improved forms of closet, instead of a basin, a plug is used, which fits the opening at the apex of the pan with an air-tight joint, the Air-tigh\i chief advantages being that the large container with plugs. j^g collection of foul air is no longer wanted and that paper, etc., is not caught up by the plug, as it some- times is by the edges of the basin, and wedged in at the top of the container. It is frequently the practice to make the waste-pipe of the cistern, which supplies the closet with water, end in some part of the water-closet apparatus. It cannot, as in the simpler form of closet, be made to end in the pipe which supplies the pan, for in this case the waste water would find no means of escape, and, filling the pan, Waste pipe, would flood the place. This pipe is therefore made to end, as WATEB-CARRIAGE SYSTEM 229 a general rule, in the D trap below the surface of the water, so that it is trapped at this point, and this is the least ob- jectionable place for it, if it is connected with the closet apparatus at all. Sometimes, however, it is made to end in the connecting-pipe between the D trap and the soil-pipe, or in the soil-pipe itself — a most objectionable proceeding, as in this case it becomes the ventilator of the soil-pipe, perhaps- of the house- sewer, and perhaps of the main in the street. If the same cistern supplies the drinking-water of the house (as is frequently the case), these plans become still more objectionable, and it ought to be insisted upon, that the waste-pipes of all drinking-water cisterns should end in the open, air, and should on no account be connected should end with any part of a water-closet apparatus, or directly con- ^^^^ nected with a drain or sewer. The violation of this principle is, we are persuaded from manifold experience, the cause of a great part of the diseases due to the poisoning of drink- ing water by sewer air, and not only so, but we believe that the production of these diseases directly by the inhala- tion of sewer air is comparatively rare in comparison with their production by the imbibition of water poisoned in the way just described. Case after case of enteric (typhoid) Enteric fever we have traced directly to this cause ; and in one dian-hoea. instance, where a whole household was stricken with diarrhoea, it was found upon examination that the waste pipe of the drinking water cistern communicated with the soil pipe of the house, and although the cistern was out- side the house, the air inside it between the covering and the water was foul to a degree (being in effect the air that had risen up from the partially stopped sewer) while the water was little better, and was, without doubt, the cause of the outbreak. If the cistern is not used for the supply of drinking water, or of water for domestic purposes, it is still advisable wherever it can be done, to make the waste pipe end outside, over a roof or yard, or in a rain water pipe which is not connected with the sewer, or in any convenient manner, as then there is no chance of foul air getting up it and so into the house, because it must be remembered, that although the water is not used for drinking, still the cistern is, as a rule, inside the house, and so it is advisable 230 MANUAL OF PUBLIC MEDICINE Closets above each other. Wastes of baths. Sink-pipes. Bell-traps. that foetid air should not be permitted to get into it. Where closets in a large house are one above another, and open into the same soil-pipe, there is another reason for the ventilation of the soil-pipe, and in such cases it ought always to be left wide open at the top. If this is not done, it frequently happens that when the lower closet is used the rush of water down the soil-pipe will draw much of the water out of the D trap and perhaps out of the basin of the upper closet. This will also happen if any larger body of water is suddenly turned into the soil-pipe of a house. The wastes of baths form an example of this : if the water is discharged suddenly from a large bath into a soil-pipe the same thing happens. It is not advisable that the waste- pipes of baths should end in soil pipes ; the only advantage is the washing of these latter by the water ; where they do so end it is absolutely necessary that they should be so small that the water can only run in a small stream. This must be securely trapped with a strong syphon bend, and (a point often overlooked) the overflow pipe from such baths must be made to end in the waste-pipe above this syphon trap. It frequently happens that this precaution is not taken, and that the bath-room of a house in consequence becomes a nuisance. A much better plan, and one that is to be recommended for the wastes of baths and sinks is, that they should, like those of cisterns, not be connected with the soil pipe at all, but that their water should get into the house sewer in another way. Sinks should be placed on the outer walls of houses, so that their discharge- pipes may be carried out through the wall into the yard or area. Where a sink is not so placed, its discharge-pipe is frequently made to descend straight into the sewer, a bell- trap being placed on the top of it. A bell-trap consists merely of an inverted cup or bell attached to a perforated plate. The plate fits into a place cut into the stone, and the inverted bell covers the mouth of the discharge- pipe, its rim dipping about half an inch into a little water con- tained in a groove around the end of the discharge-pipe. This contrivance is one of the most dangerous that can be imagined, as in the first place the small amount of water is (if the trap does not happen to be used frequently) WATEB'CABBIAGE SYSTEM 231 evaporated and a free passage for the sewer air is esta- blished into the house. In the next place, the soapsuds, &c., do not easily run through the perforated plate, the result being that the servant takes it off, bell and all, to allow the water to run off the sink. Of course it is frequently- left off perhaps for a whole night, or even longer, and the sewer directly ventilated into the house. Cases of disease and even of death have frequently been traced to this cause. Bell traps, then, ought to be abolished, whether inside houses or in the yards. Another plan is to make a strong syphon bend upon the discharge-pipe of the ^^^Jg"" sink. The objections to this plan are that the syphon does not hold much water and may become dry, and that it fre- quently gets stopped up. Where such a syphon is used, it is, therefore, advisable to have a contrivance for opening into it at the lowest part of the bend so as to clean it out. The best plan, whether the sink pipe can be carried out- side or not, is to make it end over a large earthenware syphon trap. These syphon traps hold a considerable ^^^p^^^^^^'^^'^ quantity of water, so that they do not easily get dry. They traps, are cleaned with the greatest facility, being large enough to admit the hand. They have a loose top of earthenware with four or five holes in it, and their advantage is, that if this top is taken off the trap itself is not interfered with. These traps are now constructed with a hole in the side, above the level of the water, so that a sink-pipe or a waste pipe of any sort can be made to end in them below the perforated top, and yet above the water in the trap, and this is how such wastes should be made to end if the End of sink- trap is inside the house, and how they may be made to end in any case. In this way the water is discharged by the waste-pipe independently of the perforated top of the trap, which may at any*given time be accidentally stopped up, and so a flooding of the basement or of the yard is prevented. D traps are frequently used in such situations, and although far superior to bell-traps, in that they cannot easily be Comparison tampered with, they are, in our opinion, not so reliable as these large earthenware syphons, for they only contain a comparatively small quantity of water, and thf^y are easily stopped up. Or, ordinary dip-stone traps, which are fre- pipes. with D traps. 232 MANUAL OF PUBLIC MEBICUm quently used on brick- drains and for gullies, may be placed in yards : they consist of a rectangular pit, deeper than the invert or bottom of the sewer or drain, and partially divided into two parts by a stone placed vertically, which is long enough to dip two or three inches into the water and yet leave a sufficient interval between its lower edge and the bottom of the pit. The half of the pit from which the drain passes is covered by a stone slab cemented down, while the other half has a perforated plate or stone over it. The pit requires to be carefully built in and lined with cement. When the trap is placed on the course of a sewer or drain, the bottom should be curved so that the descent into the trap is abrupt and the ascent into the sewer on the other side of the dip-stone easy ; while the dip-stone should not be vertical, but should incline in the direction of the flow ; thus sediment will be less likely to remain in Rain-water the trap. Rain water pipes should as a rule be made to end on the surface of the yard or area, and should not descend directly into the sewer, unless, as before stated, they are specially constructed and allowed to act as venti- lators to the sewer. It is plain, that where they end ^ver the surface of the yard they may be conveniently used for the discharge of the wastes of cisterns, &c. Where Soil pipe. soil-pipe passes through the house instead of outside it, it is usual to trap it at the bottom so that it may not ventilate the house sewer through the house ; but then there is all the greater necessity that it should itself be ventilated at its highest point by a special pipe, and the house-sewer will then need ventilating separately. The best plan is to carry a special pipe from the house- sewer to the highest possible point. It is the practice in some towns to pro- Archime- vide the top of this pipe with an Archimedean screw, with the view of creating an upward current in it ; Drs. Parkes and Sanderson, however, in their report on the Sanitary arrangements of Liverpool, state that they do not find that these screws make any difference to the pressure of the air in the sewers, and the great object of ventilating pipes being to prevent the jDOSsibility of any undue pressure of air in the house-sewer, it is plain that it is sufficient to leave them open at the top. The objection to using the WATER-CARRIAGE SYSTEM 233 ventilating pipe as a rain-water pipe or vice versa, even if in the latter case the rain-water pipe is specially jointed for the purpose, is, that during heavy storms, when there is a considerable pressure of air in the sewer, the pipe no longer acts as a ventilator. The plan is then to allow no pipe either inside or outside the house to be connected with the sewer, except the soil-pipe, which should descend out- side the house directly into it and should be wide open at the top, and no pipes but the discharge pipes of the water- closets themselves should be allowed to be connected with the soil-pipe, while neither the waste-pipes of cisterns, sinks or baths, should, if it can be avoided, be directly connected with any part of the water-closet apparatus, soil-pipe, or sewer. The more freely water-closets communicate with the open air the better. They may be ventilated in an infinite variety of ways, but the principle in all cases must be the provision of two openings between which a current will be established in one direction or the other. If possible, there should be a double door between them and the staircase of the house, the space between the two doors being venti- lated to the open air. The best form of window for a water-closet is one that swings on a horizontal axis situated half-way between the top and bottom. M'Kinnell's venti- lator is a very useful one for closets which have nothing above them, and its action is accelerated by placing the jet of gas which serves as a light at night beneath the exit shaft. This ventilator, it may be observed, consists of two shafts — one inside the other, the inside one rising into the open air to a higher level than the outside one, and having at its lower end (that is, in the room) a broad rim, between which and the ceiling a small space is left, communicating, of course, with the interval between the two pipes, so that air goes into the closet or room between the ceiling and the rim of the inner pipe, while air escapes by the inner pipe. In many cases, a single shaft may be taken either up through the roof or horizontally, or in any convenient direction, out into the open air, so that a current may be established between the window and such shaft. This shaft must be protected at the top with a wire gauze to Conclusions about pipes. Ventilation of W. C-"s. M'Kinneirs ventilator. Shafts. 234 MANUAL OF PUBLIC MEDICINE keep out the birds, and it may have pieces of wood or of zinc fastened to its sides inside, and inclined upwards (in a vertical shaft) so as to form receptacles for the blacks, &c., that would otherwise be brought into the closet. Divided by a Where there is no window, this shaft may be divided by a partition, in which case a current of air will pass up one side of it and down the other, and each partition may have these shelves to catch the blacks placed alternately on one side and the other, so that the air is obliged to descend in waves. The action of such double shafts is very much promoted by making the two divisions end at different levels in the open air, and they may be even made to end at different places in the closet itself by prolonging one or other of them, and the one that is intended to act as an Action of. exit, that is to say, the one that is made to end externally at a higher point than the other — may have an upward current of air caused in it by placing the gas-jet or other light below it. In this way, closets in the most confined situations, without any window whatever, may be venti- lated satisfactorily, and in these cases it is sometimes con- venient to carry the small leaden pipe which ventilates the container out through the exit pipe of the ventilating shaft, of course making it end at some distance above the Cover of latter. The shaft itself will require to be covered over by same slanting top projecting over the apertures which lead into it, so that rain may be kept out of it. With out-of- door closets it is a very good plan to have holes bored along the top of the door, or even to have a piece cut off it all along the top ; but with in-door closets every pre- caution should be taken to prevent the possibility of the introduction of air into the staircase from the closets. Of course, this precaution is still more necessary when the closet opens, as it frequently does, into a room. It is well. Doors of indeed, to have springs on the doors of closets, to keep them always shut, and draught-preventers fastened along the posts and lintels to prevent air getting from the closet into the house. The first principle of the ventilation of a water-closet must be that it be entirely separate from that of the house. The necessity for taking these precautions is, however, WATEB-CABEIAGE SYSTEM 235 of course less, as the ventilation of the closet apparatus and house- sewer is more complete, and, in a perfectly arranged water-closet, there is very little necessity for them, if the pan and the water in it are kept always clean. In houses where many people are gathered together, as model lodging-houses, for example, and where the closets Model lodg- are each used by large numbers of people, they should be placed either externally to the building itself, being con- nected with it by passages from each floor, roofed, but not closed in at the sides, or they must be placed at the ends of the corridors, so as to project from the main building, in order that a cross draught may be established by having opposite windows in the corridor, between the main building and the water-closets. It is necessary that someone should be appointed to attend to them, or it will be nobody's business, and the persons using them may be required to take this duty in turn. Urinals. Urinals are best made with slabs of slate, or with glazed Urinais, stoneware, but however they are constructed they will necessarily become a nuisance, unless they are well su23plied with water, and they are much better supplied by a small amount continuously, than by an occasional flushing with a larger one. The reason that they become foul if they are not kept constantly clean, is that the urea contained in the small quantity left on the slab, or in the basin, becomes changed into carbonate of ammonia, thus rendering the film of liquid alkaline, the result being that the phosphates and lithates are ]io longer held in solution, and are precipitated along with organic matters contained in the urine. These Offensive latter soon putrefy, giving off* an odour, which, combined with that of the ammoniacal salt, constitutes the offensive smell of urinals. In public places, it is sufficient that they should be well trapped, and connected with a ventilated sewer. In houses their discharge-pipe should be trapped in some way or other Discharge- as soon as possible, as the pipe itself is very liable to be- come lined internally by a,n offensive deposit, and urinals that have even a sma]\ length of pipe communicating freely 236 MANUAL OF PUBLIC MEDICINE with the basin are sure to be a nuisance for this reason ; and on the other hand, the discharge-pipe must not open into any pipe, as a waste-pipe or sink-pipe, communicating with some other part of the house, or an offensive smell will rise up this latter pipe ; the discharge-pipe in question may be made to end below the surface of the- water in the D trap of a closet, or in a ventilated soil-pipe or sewer, or still better in the open air over a trapped grating. The forms of urinals are almost infinite in variety, the most cleanly, especially for public places, being those which consist essentially of a trough filled with water, which is continually escaping into the sewer, and being re- supplied from a cistern. Disinfection. A little crudc carbolic acid is sometimes placed in the water supplied to a urinal (a practice now carried out at some railway stations), and other disinfectants maybe used, provided they are such as keep up an acid reaction. Animal charcoal is also sometimes placed in urinals with the view of keeping them sweet. Drainage. It has been long known that upon the dryness or wetness of the soil upon which habitations are built, the sanitary condition of a population to a great extent depends, but it is only within the last few years that it has been ascertained by the researches of Dr. Buchanan on the results of sewer- age and drainage upon the health of certain towns (see Ninth Report of the Medical OflB.cer of the Privy Council) Phthisis. that one of the great causes of phthisis in a population is the dampness of the soil upon which it lives, and on the other hand we have Dr. Pettenkofer, of Munich, asserting that the distribution of cholera in a country depends entirely upon certain conditions in the level of the subsoil water. In all towns which have been so sewered that their sewers act also as drains, and are, as we have called Decrease them, ' drain sewers,' whereby the subsoil water of the town subsoir^^^^^ has been lowered, the death-rate from phthisis has decreased, water. sometimes to a very remarkable extent ; in one case, that of Salisbury, the decrease having been as much as fifty per cent. : while in other towns which have been so sewered with impervious pipes throughout, that the level of their WATEB-CARRIAGE SYSTEM 237 subsoil water has not been lowered, the death-rate from phthisis has not decreased, but, ou the contrary, has in some cases increased. This shows us, in the first place, otherwise . not so. that brick sewers (the invert only being constructed with cement) do, as a matter of fact, act as drains, and do lower the level of the subsoil water beneath the houses ; and, in the second place, that where pipes are used for mains this result is not effected, so that wherever pipes are used throughout a system of sewerage it is absolutely necessary in the majority of instances that drains should also be provided for the drying of the subsoil. It has indeed been proposed by Mr. Menzies to separate in all cases the sewage, properly so called, from the surface waters. He proposes to have a Separate double system, consisting of impervious sewers to carry off the refuse water and excretal matters of the population, and superficial drains to carry the surface waters into the nearest water course ; but this plan does not provide for the drying of the subsoil, and although it is advisable, for several reasons we need not discuss here, to keep as much extraneous water as possible out of the sewers (reserving, however, always the power of turning it into them if necessary), yet for the sake of this we must not sacrifice the drainage of the subsoil. There can be little doubt that, besides phthisis, other diseases, especially scrofula and other rheumatism, are favoured by the dampness of the soil, although according to Dr. Buchanan's researches, no such influence was noticed upon lung diseases (other than consumption). It is necessary to mention that Dr. Petten- kofer considers that the spread of cholera can only take place in localities where there is a porous subsoil, contain- ing putrescent organic matters, with a subsoil water which is liable to fluctuations of level, and that he is of opinion that enteric fever is subject to similar conditions. This makes the drainage of the subsoil a still more important consideration. Note. — Whatever be the state of the subsoil, the basement of each house should be rendered as dry as possible ; there should be an air space between the basement floor and the ground, which should be ventilated by means of air bricks in the walls ; it is a great advantage to have a layer of con- 238 MANUAL OF PUBLIC MEDICINE Crete three or four inches thick spread over the ground beneath the house, and when a new house is built a damp- proof course should be inserted in the walls near to the ground to prevent the rising of moisture up the walls ; these latter are however matters upon which the medical officer has at present only the power to tender his advice ; he has, practically speaking, no control whatever over the erection of dwelling houses. Outfall Seiuers and Treatment of Seiuage. The outlet of the main sewer of a town, called the ' outfall,' is of essential importance with regard to the health of a community ; the first rule about it is, that it should be 2^ifcCainarge large enough to allow all the sewage which can ever be discharged from the place to pass easily through it ; the next point, which is of still greater importance, is, that it should be perfectly free. In many instances, especially in towns on the seaside, or at the mouths of tidal rivers, and in other cases, the outfall is so low, that for some reason or another, sewage is blocked up in the main sewers at certain times. "When outlets are made into the sea, the tide rises into them and backs the sewage up in the mains, and even occasionally into the cellars of houses. If, as is usually the case, a flap be placed at the outfall, then the sewage during the rise of the tide is collected in the outfall and main sewers, and the gases which rise from it pass upwards into If not free, the town. The same is the case when sewers emptv them- sewage . . ■'••^ backed up. selves mto rivers below the water line, and the same, too, is frequently the case when the outfall is into a tank, out of which the sewage has to be pumped to be got rid of; for in the latter case the pump or pumps may be out of order, or may not be sufficiently powerful to keep the sewage below the level of the outfall, when, as in wet weather, there is an excessive discharge. In all these cases, then, the freest ventilation of the main sewer in the town is more than ever necessary. Where there is an impediment offered to the escape of' sewage from the mains, the sewering of towns has not been accompanied by the usual diminution of the death-rate tever. from enteric (typhoid) fever, or there has even been an WATER'CABBIAGE SYSTEM 239 increase in the death-rate from this disease, especially if in addition to this defect, the sewers have not been properly ventilated. Thus, at Chelmsford there was a slight increase in the death-rate of enteric fever after the execution of the sewerage works, and also an appearance of diptheria in the town ; but the sewage is delivered into a tank by an out- fall sewer which enters some six feet below ground ; the result being that it occasionally accumulates in the main sewers, although precautions are taken to prevent its doing so, and is even forced up into the cellars. At Worthing:, instances of \ . . ° ' faulty out- there was a very considerable increase in the death-rate fails. from enteric fever after the sewerage arrangements were carried out. The sewage is there received into pumping works in a similar manner, and, moreover, no provision for the ventilation of the mains was at first provided, and it was observed that the fever especially attacked persons living in houses high up in the town which had the most direct com- munication with the sewers, and that it subsided as soon as proper ventilation of the main sewers was provided. It is, then, the duty of the medical officer to point out the danger that arises from want of free ventilation of the sewers — and also from the confinement of sewage in the outfall sewer in either of the ways just mentioned. The outfall of most towns is made to discharge the sewage either into the sea or into a river, and thus a great deal of fertilising material is thrown away. It is not our purpose Waste of here to discuss in detail the different methods which have been proposed for utilising the valuable matters contained in sewage — it is, however, worth while to mention that the annual value of the sewage of London has never been estimated at less than a million sterling, and that this is all thrown away — but it is with the results of this method of riddance that we have to deal. Where sewage is turned into the sea (provided the outfall is at a sufficient distance Dischareed from the town, and that currents do not set towards the latter), no nuisance is likely to be experienced, but when, as in many cases, the sewage is discharged close to the town, or over the beach in front of the houses, the nuisance becomes considerable, and the danger great. Where, on into rivers: the other hand, sewage is discharged into rivers, even with 240 MANUAL OF PUBLIC MEDICINE due provision to prevent backing up in the mains, two kinds of danger arise : — the one, the formation of banks of sewage- mnd in the course of the river, which help to block up its channel, and which, when left high and dry (as in the case- of a tidal river), give out pestilent emanations ; and the Mud-banks other, from the pollution of the water itself. The banks so formed. \ ^ ^ deposited, in the case of tidal rivers, may be formed above the outfall of the sewage, and this is the case in the Thames. A report issued in 1867 showed that even 2,000 feet above the northern outfall a considerable depth of mud had been deposited, which, from its situation, certainly came from the sewage, the thickness, in some places, of this mud being seven feet ; and, since 1867, there is evidence to show that the amount of it in certain places has increased, while experiments on this head leave no doubt as to the fact, that the tide carries up the suspended matters of the sewage and deposits them considerably above the point at which they are discharged into the estuary. It is therefore plain, that in the case of a tidal river, the outfall, if into it at all, must be so far below the town that there is no chance of the sewage being brought back into the town again by the Pollution of risins: tide. But the next point, the pollution of rivers by rivers. , ^ , . . their admixture with town sewage, requires more careful attention. The danger, of course, increases the smaller the bulk of the river is in comparison with that of the sewage. Small rivers may be, and frequently are, converted into open sewers, from the discharge of sewage and other refuse matters into them, and although it is difficult to determine the effect of emanations from such open sewers upon the health of a population, on account of the numerous other sources of disease among crowded populations, still there can be no doubt that the effect is bad. It is, however, when we come to consider the fact that most towns derive their supply water-supply in the present day from the rivers upon which they stand, that the importance of not allowing these rivers to be polluted comes into prominence, and when the medical officer is called upon to advise as to the best means of dealing with the refuse matters of a community, although it is his duty to advise in the first place that they be got rid of as speedily and as effectually as possible, it is also his WATER-CARRIAGE SYSTEM 241 ceeds slowly. duty to insist upon this being done without detriment to other towns. It has been frequently stated, and is still maintained by many, that organic matters are so speedily oxidised when broue:ht in contact with the oxyo^en dissolved Oxidation , , "l^ , during flow. in river water that they are destroyed, or rather converted into innocuous substances, after a flow of a comparatively short distance. There can be no doubt that such is the case to a very great extent, but we are perfectly sure that such is not the case to the extent to which it has been stated to be so. It is impossible for us to be satisfied that all the organic matters in sewage, which may include the poisons of special diseases, are destroyed in a river, whatever be its length. We know, from Dr. Frankland's experiments, that the re- moval of such organic matters in this way is much slower oniy pro- and much less perfect than is generally supposed, and the conclusion that he came to was, that ' there is no river in the United Kingdom long enough to eflPect the destruction of sewage by oxidation.' It is quite clear that unless we were perfectly sure that all organic matter discharged into a river in this way was perfectly oxidised after a short flow, we should not be justified in recommending water which had been so contaminated to be used as a supply for domestic purposes. We find, from Mr. Simon's report, that the cholera, during the epidemics of London, in 1848-49, and cholera and 1853-54, was most prevalent in those places which had questionable sources of water-supply, and that the death- rate from it was lowered in places where the improved water-supply was secured. There can be no doubt what- ever, that his dictum, ' it ought to be made an absolute condition for a public water-supply that it should be un- contaminable by drainage,' or, as we should say, by sewage, is the correct guide to take. It is obviously absurd to pollute water first and then resort to filtration and other expedients to make it presumably fit for drinking afterwards, yet this is what is continually done, and there is one instance of a town which turns its own sewage into the river at a particular point, and derives its water-supply from the same river a mile lower down. But if we can no longer allow sewage to be got rid of in this way, accompanied as it is both by waste and R polluted ^vater. 242 MANUAL OF PUBLIC MEDICINE Treatment of sewage. Inefficiency of precipita- tion methods. Filtration and irriga- tion. Intermittent downward filtration. danger to the health of the communities, what is to be recommended as the best plan to deal with it ? All the attempts to prepare a solid manure out of it, whether by merely straining off the suspended matters, or precipitating these together with certain of the dissolved matters by means of some other substances, and then letting the so far purified water into a stream, have only to be mentioned to be condemned as inefficient for the purpose, from both the economical and sanitary points of view. By them the valuable materials are not and cannot be utilised (the sus- pended matters in themselves being of very little value, and the matters which can be precipitated from solution being small in amount), while in several of these processes, either valuable materials contained in the substances added are in part lost, or worthless materials added in such quantity that the manure, such as it is, is of very little value ; and, on the other hand, the water that is allowed to run into the river contains by far the greater part of the soluble matters of the sewage, and is certainly not freed from the dangerous polluting properties that the sewage originally possessed. If then it is useless, as it appears to be, to attempt by chemical or mechanical methods, or by both combined, to render sewage sufficiently pure to be turned into water- courses which are afterwards to be used for the supply of water for domestic purposes, the only thing that remains is either to filter it through some large mass of porous ma- terial, or to turn it on to the land and use it directly as manure. The latter method has been employed for a very considerable time at various places with tolerably good results. The former one has lately come prominently into notice through the experiments of Dr. Frankland, the re- sults of which are published in the first report of the Rivers' Pollution Commissioners (1870). The results of these experiments show that if sewage be passed down- wards through filter beds of sand or soil of various kinds, the process being conducted intermittently, it is satis- factorily purified. It was moreover found that the nitro- gen which existed in the original sewage, either in organic matter or as ammonia, was found in the effluent water in the form of nitrates and nitrites ; that is to say, that oxi- WATEB-CARBIAGE SYSTEM 243 dation took place during the passage through the filter. It was also shown that the process of upward filtration through the same materials did not cause such purification. The success, then, of filtration depends upon its being downward and intermittent — that is to say, ample time must be left for the introduction of air into the pores of the filtering material to ensure the oxidation of the organic matters and ammonia contained in the sewage. This plan has been applied practically on a large scale at Merthyr Tydfil, where an area of about 20 acres has been laid out Practically . . ^ ^- « applied. in square beds and pipe-drained at a depth of about 7 feet, so as to be used as a filtering bed. It consists (according to the Fourth Heport of the British Association Sewage Committee, read at Brighton in 1872) ' of a deep bed of gravel (probably the former bed of the River Taff, which is embanked upon the east side, and is raised above the valley), composed of rounded pebble of the old red sand- stone and coal-measure formations, interspersed with some loam and beds of sand, forming an extremely porous deposit, and having a vegetable mould on the surface.' ' The sewage before being turned on to the filtering-bed is screened through a bed of slag, which arrests the coarser matters. It is applied to the land intermittently, for, the area being divided into four plots or beds, it is turned on to each one for six hours at a time, leaving an interval of 18 hours for rest. The surface land was cultivated to a depth of from 16 to 18 inches, and laid up in ridges, in order that the sewage might run down the furrows, while the ridges were planted with cabbages and other vegetables.' Thus, it will be seen, that, in this case, the surface of the filtering-bed Surface of has been turned into a sewage-farm. The results of the utmsed. examinations of the process, as carried out there, made by the Rivers' Pollution Commissioners, and by the British Association Committee, have been very satisfactory, so far as the purification of the dilute sewage there treated is con- cerned, and this is all that can be expected of the process ; nevertheless, the fact that the surface of filtering-beds may be planted with vegetables, which will materially assist in the purification of the sewage, is a very important one, and shows, that although it cannot be said that this is a B 2 244 MANUAL OF PUBLIC MEDICINE Manure not all wasted. Extension of area. Saturation principle. Essentially wrong. process for the utilisation of tlie manure, yet it is not en- tirely wasted. The British Association Committee show, from the results of their analyses, that the efflu-ent water from these filters contains, chiefly as nitrates and nitrites, the same amount of nitrogen that the original sewage had in solution, as organic nitrogen and ammonia, so that the amount retained by the filtering-beds and by the crops is approximately equal to the amount contained in the sus- pended matters of the sewage. They also state that during the winter the purification was more efficient than during the summer, but, that even during the summer, four- fifths of the nitroo'en in the effluent water was in the form of nitrates and o nitrites. It is clear, then, that if sewage can be satisfactorily purified by being passed through the soil, so that the effluent water is sufficiently pure to be allowed to flow into water- courses, the more the area of the soil is extended the greater chance will there be of more perfect purification. But in order that this may take place, it is obviously essential that the sewage should pass through the soil, and not merely over it, and it is also plainly as essential that unless the natural drainage of the land be quite sufficient, recourse must be had to artificial drainage, in order that the soil may not become saturated with water ; for we have seen that it is necessary for filter-beds (and irrigation farms ought to be nothing more nor less than filter-beds on a very large scale) to be aerated, in order to ensure a satisfactory purification of the effluent water. Many farms have, how- ever, been laid out upon what the British Association Com- mittee call ' the saturation principle.' They are not under- drained. The sewage is turned on to the land at the highest point, and is allowed to flow downwards by gravitation over the surface, which it can only do as soon as it has sufficiently saturated to a certain depth the soil with which it first comes in contact. In these cases, with a sufficiently luxurious vegetation, the effiuent water may be satisfactorily purified, but at other times, and especially in winter when growth is at a minimum, such is not the case, and the effluent water from farms constructed on this principle is little better than diluted sewage, and, indeed, the British Association in their Third Report mention an instance in which the water which WATER-CABBIAGE SYSTEM 245 had passed over one field was actually rendered more im- pure, as regards the amount of organic matter and total solid constituents it contained, by passage over a second field. It is obvious that, by this saturation plan, the prin- ciple of filtration through aerated soil is entirely given up. The sewage-farm is converted, for the time being, into an area saturated with foul water, reliance being placed for its purification entirely upon the amount of vegetable growth. It is found that the purification effected where sewage is Comparison passed through a sufficient depth of soil into drains, as at plans. Breton's farm, near Romford, is as great in the winter, » without the aid of vegetation, as it is in the summer with it. On the other hand, it has been satisfactorily shown that purification is only very partially effected in winter, where the sewage is not made to pass through the soil. The soil must then be porous, and, if not originally so, it must be made so by the aid of ashes, &c., and, as the Com- mittee before mentioned remark in their Third Report, ' if Necessity of drainage is necessary where no water is artificially supplied to the soil, it cannot be less necessary after an addition to the rainfall of 100 or 200 per cent.' But a great deal has been urged against the general introduction of sewage farms from a sanitary point of view, and the medical officer may very probably be required to Sanitary give his opinion upon the advisability of treating sewage in tkms.^^^^" this manner. It is, therefore, well that we should examine a little into the evidence on this head. There can be no doubt, in the first place, that if sewage farms are made into marshes, as is the case about Milan, and as is also the case to a certain extent where the saturation principle before spoken of is adopted, the endemic diseases peculiar to marshy places may be expected to arise, and we conse- quently find it reported by the Sewage Commissioners that near to Milan ' the population who lived in the midst of and close upon irrigated lands are subject to the same diseases as are common wherever extensive tracts of vegetation are ^^^^i ^^^^ ^je alternately covered with water, and then exposed, when ^^^^^iies. comparatively dry, to the action of the atmosphere under a hot sun.' The same is true, as we all know, with rice and maize plantations, which are freely irrigated with 246 MANUAL OF PUBLIC MEDICINE Cholera and enteric fever. Results of saturation system. "Water of a brook polluted. water, and it has nothing whatever to do with the water being sewage water ; that is to say, it occurs equally, so far as can be ascertained, where ordinary river water is used in the same way. These marsh diseases are strictly endemic, and do not extend from such irrigated meadows to the towns near. On the other hand, the evidence with regard to the probability of the spread of cholera, enteric fever, and other diseases, the poisons of which are known to be contained in human excrement, is as conclusive as possible. It was found at Milan that these diseases were not one whit more prevalent on the irrigated lands than anywhere else, and that even during three epidemics of cholera in the town and neighbourhood no case occurred upon the irrigated meadows ; that is to say that diseases that we should expect might possibly be spread abroad by such a method of disposing of sewage are not spread in this way at all. Similar evidence can be produced from Edin- burgh and from other places where irrigation has been practised for some time, and often not in so satisfactory a manner as could be wished. It is clear, however, that if it be so carried out, either by too much sewage being turned on to the land for too long a time, or by the sewage being allowed to flow over saturated land, as is too often done, the effluent water is but little better than sewage. The noxious organic matters contained in it not having been oxidised, danger will arise when such water is admitted into streams from which supplies of drinking water are taken, and thus we find, quite recently, that some cases of enteric fever occurred among some people near Northampton, who drank water out of a brook that had been polluted in this way ; but Dr. Buchanan reported that ' out of 120 people at work upon the sewage farm itself there is no single case that can be affirmed to be fever, and the only case of illness that can be heard of is a case of diarrhoea and, he adds, * there is nothing to tell of mischief done by the sewage farm itself, even to persons who were themselves employed on the farm under excep- tionally favourable conditions for breathing exhalations from the sewage.* Now, there can be no doubt that this ought not to have happened at all, and that it would not WATER-CARRIAGE SYSTEM 247 have happened had the sewage all passed through soil Necessity of before being turned into the stream. Of course, if sewage containing the poison of enteric fever is turned into a stream and people drink the water of that stream after- wards, they will be liable to get enteric fever, and for this purpose it can make no dijfference whether the sewage is turned directly into the stream or allowed to run into it off saturated land. This case, it is hoped, will be especially ^^^^^ useful in preventing the establishment of irrigation farms upon a false and dangerous principle. The passage of sewage through soil seems to be the most effectual way of destroying the poisons of such diseases contained in it ; and it cannot be doubted that drainage improves the condition of the farm from an agricultural point of view. Indeed, in the Fourth Report of the British Association Committee, a case is given in which, on the South Farm at Tunbridge Wells, ' a field of beans was noticed, one portion of the crop being very heavy and healthy-looking, and the other very poor and stunted. On inquiry, it was ascertained that the Advantage . ^ of drainage. whole field had been equally se waged, but that the portion where the crop was so good had been drained four feet deep during last winter, the other portion being left undrained,' so that we have now sufficient evidence, both economical and sanitary, to insist that sewage-farms shall be constructed as large filter-beds. The nuisance, if any, caused in the im- mediate vicinity of these farms is produced entirely by the suspended matters in the sewage, which ought to be Nuisance separated, in some way or other, before the latter is turned sul^nded on to the land. This is usually done by allowing them to deposit in settling-tanks, which tanks also serve for the Tanks, storage of any inordinate supply of sewage during wet weather, and the sludge which forms at the bottom of these tanks, together with the crust at the top, may cause a con- siderable nuisance, especially during its removal. It is desirable that this sludge should be de-odorised by the Deodorisa- addition to the sewage itself of some substance which will not injuriously afiect it as a manure, that is to say, if the tanks are so placed that anyone is likely to be afiected by the nuisance caused during the cleaning of them. Some one or more of the precipitation processes may, perhaps, be found tion. 248 MANUAL OF PUBLIC MEDICINE General Scott's pro- cess. Effluent waters and cement. Cattle diseases. Entozoa. Suggested danger. to answer this purpose satisfactorily. The only one we need mention, is one that only professes to deal with these suspended matters — that invented by General Scott, which consists in the addition to the sewage in the sewers in the town, of a mixture of clay and lime. The result is, that the sewage is de-odorised while in the sewers, and the precipitate which forms in the tanks contains a large excess of clay and lime, with sufficient organic matters precipitated from the sewage to burn itself into cement when placed in a kiln, the fire under it being merely started by a few coals — the process causing no nuisance, and the effluent water passing off in a condition eminently fitted to be applied to the land. The cement prepared, may also (General Scott suggests) be used as manure for land which requires the use of lime, containing, as it does, a considerable proportion of phosphoric acid. In other places it may be used as cement. It has been also stated, in the first place, that cattle will not eat the produce grown upon sewage-farms — a state- ment which we think will hardly be repeated ; and the same may be said of the allegation, that diseases of cattle, such as the rinderpest, and the foot and mouth disease, are pro- pagaj^ed in the same way. Evidence to the contrary has been produced, but it is not our place to discuss it here ; a more important point for us, is the suggestion that entozoic diseases will be propagated to a great extent directly in cattle, and indirectly in men, through the spread of sewage over the land, by means of sewage irrigation. The original suggestion of Dr. Cobbold, that the Bilharzia hcematohia, a parasite common in certain parts of Africa, and especially prevalent in the summer months, can be introduced and brought into this country in such a manner, we may dismiss at once, as Dr. Cobbold himself has shown that the embryos of this parasite are destroyed in a very short time in im- pure water, as ascertained by experiments, which, he says, as regards this parasite, at any rate, ' undoubtedly appear to favour the notion that little harm can result from sewage distribution, so far at least as parasitism is concerned.' But with regard to parasites to which we know that herbi- vorous animals are subject in this country, the question WATER-CAREIAGE SYSTEM 249 becomes a more serious one, the suggestion being, that the ova of these parasites contained in the sewage are distributed on to the land and eaten by the cattle with their food, undergo a stage of development in them, and a still further stage in the human subject when the meat of such cattle is eaten without being properly cooked. The first question which naturally arises is, w^hat facts are there to show that such diseases have been propagated in this way ? The answer from all hands being, that there are none. Irrigation has been practised, as before stated, for many years near Edin- ^J^^^^y f^cts burgh, and Professor Christison asserts that he has not been able to trace a single case of parasitic disease to this source. But we are told that entozoic diseases, especially in cattle, are not usually recognised at all, and that if they were looked for, they would, no doubt, be found. The answer to this is, that we do know in what countries entozoic diseases are particularly prevalent, and that if any such re- sult had taken place upon any sewage-farm in the country it would undoubtedly have been found out by the farmers, or by the medical practitioners in the neighbourhood, as public attention has been now drawn to the subject for several years. But more than this, the British Association Com- mittee instituted two kinds of experiments. The one con- Experiments sisted in examining the slime and mud from the bottom and ^int!^ sides of some sewage- carriers at the Earlswood farm. It was found that although these matters contained a consider- able amount of animal life there were no ova of entozoa among them. As Dr. Cobbold says, ' the flaky vegetable tufts collected by me from the sides of the furrows occupied by sewage-currents consisted chiefly of Batrachospermum Negative re- moniliforme, in the filaments of which were numerous active free nematodes, but no ova of any true entozoon,' and more than this, the carcase of an ox, which had been fed for 22 months upon sewaged produce grown at Breton's farm, was examined by Dr. Cobbold, Professor Marshall, and the writer, in the presence of several members of the Committee? the result being, that no trace of parasitic disease could be found in any part of the body by the most careful examin- ation. Dr. Cobbold also points out, that upon these farms Absence of there is a remarkable absence of those molluscan and insect &c.^^"^^^' 250 MANUAL OF PUBLIC MEDICINE Destruction of wire- VitaHty of ova. Comparison with usual mode of dis- tribution. forms of life which frequently play the part of intermediary bearers to the larvse of entozoa — a very important point, as if these creatures are killed, or driven away, by the sewage, it is plain that many of the parasitic diseases can- not possibly be propagated by means of sewage-farms. Moreover, we have evidence to show that certain creatures, which are very destructive to crops, may be killed by irri- gating the land with sewage. Thus, in the third report of the British Association Committee, we are told that a crop of American oats ' was seriously damaged, and in danger of being destroyed by the ravages of the Oscinis vastator, one of the smallest but most destructive of those * grubs ' and *wire worms,' which at times cause such injury to cereal crops in this country. The remedial effects of sewage irri- gation under similar circumstances having been previously observed elsewhere, two heavy dressings of sewage were applied to this bed during two successive days, the result being that the grubs were entirely destroyed, and the greater part of the crop was saved.' Whether this effect would have been produced by clean water, as well as by the foul water, we do not at present know. Again we are not sure that the impregnated ova of intestinal worms ever get alive on to the sewage-farm ; being naturally inhabitants of acid excretions, they are turned into a liquid alkaline from excess of ammoniacal salts, and are churned about in it during its passage along sewers for a considerable distance : a great proportion of them is, no doubt, deposited with the sludge in the sewage-tanks ; and such as do get on to the land, if the sewage is made to pass through the soil, as it ought to be, are carried down into the pores of the soil, and so disposed of. There is no need that cattle should graze on sewaged meadows, although they do so with avidity, and no evil consequences have been traced to this procedure ; but with grass cut and carried to the stalls it is hardly pos- sible to imagine any danger arising. Indeed, if human excrement is to be used at all as manure, it is obviously better, from this entozoal point of view, so to speak, that it should be distributed on the ground itself, by means of water, than that it should be spread abroad over meadow- land after the fashion in which farm-yard manure is WATER-CARRIAGE SYSTEM 251 ordinarily distributed. But even taking the worst point of Advantages T . . . % • i • T from worst View, and supposing a certain increase oi parasitic diseases point of from the use of sewage in this way ; is not this an evil which would be far more than counterbalanced by the enormous gain to the community, especially from a sanitary point of view, which is acquired by the removal and satis- factory purification and utilisation of their most offensive refuse matters ? Dust. ^ Under this head we include the house refuse that accumu- lates in places where any system for the removal of excretal matters other than the midden and ash-pit plan is at work. This refuse consists in the main of ashes and cinders, but if this were all it would not be of great importance from a sanitary point of view. The dust-bin is, however, a con- Contents of venient receptacle for all kinds oi refuse — vegetable and animal. Everything that is not wanted in the kitchen is thrown into the dust- bin, and so these receptacles become a source of nuisance. This might be altogether prevented if people would have such refuse matters as are likely to produce offence burned. In places where much brick -making is going on, this Value of dust is valuable, and contractors pay for the privilege of varialief removing it, and then the scavenging is well done ; but in places where, as in London at present, nothing can be got for the dust, and the contractor has, perhaps, even to pay for being allowed to shoot it at a particular place, it is plainly to his interest to collect as little as he can, and so the scavenging is, as a rule, very inefficiently performed, and the sanitary authority has to investigate cases of neglect or refusal to remove the dust and fine the contractor from time to time for not acting up to the provisions of his contract. As an example of this state of things, we may instance of take the case of the parish of Islington, with about 27,000 inhabited houses. For the removal of dust from June 1866 to June 1867, the vestry received from contractors the sum of 2,200?., and from June 1871 to June 1872, the vestry paid to the contractors the sum of 4,05 7Z. That is to say that from the fact that the dust had become worth- less the loss to the parish for 1871-2 as compared with 252 MANUAL OF PUBLIC MEDICINE 1866-7 was no less than 6,25 7Z. A plan was adopted which it would be well to adopt in all similar cases. It was •D' cards, as follows : — Cards with the letter * D ' printed on one side of them, and directions on the back, were sent to the inhabitants, who were instriicted to place them in a con- spicnons place in the front of the house — as in the window of the ground floor — whenever they wanted their dust removed, and the contractors were held liable to penalties for not removing the dust from hocuses inwhichthe ' D 'had been properly exhibited for a certain number of days. Another advantage of these ' D's ' was that the sanitary inspectors took notice of such of them as happened to be exhibited in the streets through which they passed, and reported them daily. This, however, not being foand to be sufficient, a Inspector special inspector of dust was appointed, in addition to the three sanitary inspectors — at first temporarily and after- wards permanently ; the investigation of the complaints about the non-removal of dust, and the business of seeing that the contractors carried out their work according to the contracts, and removed at the earliest opportunity dust from houses about which they received special orders, being found fully sufficient to occupy one man's time. To Working of work such a system as this requires a regular set of books system. very careful management. On a complaint being received at the office that the dust requires removing from a particular house, or on the dust inspector, or one of the sanitary inspectors, reporting that such is the case, an entry is made with the date, and at the end of the day a lis-t of such places is sent to the contractor, being written on one half of a leaf of a book kept for the purpose. Upon the other half of the leaf which remains in the book is written a counterpart of this list. The scavenger is then bound to remove the dust from these houses within a certain short time — say two days — and it is the business of the inspector to report when this is done, so that the same may be duly entered and the contractor fined, if it be thought necessary, in cases of neglect. The contractor should be bound to Public dust remove the dust from public dust bins at certain intervals bins. — twice a week — and to clean out all courts and alleys once a week, and this without a special notice, a general WATEB'CABRIAGE SYSTEM 253 receptacles. one giyen once for all being sufficient. There may also be public institutions, about which there is a general notice given for removal at certain stated intervals, and it is a finable offence to neglect any of these places. He is also visiting of ^ . streets. bound to send a cart or carts with his name and a number upon each along every street at least once a week ; the men in charge of the cart being required to cry ' dust.' Like all receptacles for refuse matters, dust bins should be as small as possible, so that no large collection can accumulate in them ; and it would be a great improve- ment if they were done away with altogether, and the dust, &c., of each house placed outside in a portable re- Portable ceptacle of some sort for the scavenger to remove every morning. The Paris plan is certainly better than ours in this respect, for the people, late at night, simply shoot their dust into the street in front of their houses. It is well picked over during the night by the chiffoniers, and is all carried away early in the morning by the scavengers, who are bound to keep the streets clear of it. The value of dust consists, in the first place, of articles vaiue and of value that are found in it, and have got there acci- of^ust!*^^^ dentally ; then pickings and sortings of various sorts, such as pieces of old iron, rags, paper, bones, old bottles, &c. In the third place, what is termed * hard core,' which is made up of broken china and earthenware, together with a quantity of miscellaneous refuse which has no special value. This is used for the making of roads. Cinders, which are used in the burning of bricks, and finer ash ; and lastly, ' soft core,' consisting of the intestines of animals, and all kinds of animal and vegetable refuse matter. To show the magnitude of this work, we may add that in Magnitude the parish alluded to, from June 1871 to June 1872 the con- tractors were required in writing from the sanitary office to remove the dust from no less than 27,814 premises, and out of these orders 14,841 were in consequence of appli- cations from parishioners. It is worth while noticing here that it has been decided ciinkers to that 'clinker,' or refuse from fuel used in manufactures and trades, is not a trade refuse, and that the contractor is bound to remove it as dust. of the work. be removed as dust. 254 MANUAL OF PUBLIC MEDICINE Difficulty when dust is valueless. Midden system worse. The upshot of all this is, that when dust is valuable, nothing is easier than to get it removed satisfactorily by contractors, and they will even prosecute persons for not giving up to them the article for which they have paid — for using it on their gardens, for instance ; but when dust is worthless, and especially when it becomes a cost, it is, practically speaking, impossible to get it properly removed in this way, and the sanitary authority will do well to take the matter into its own hands, and employ its own ser- vants to remove the dust. It will thus be done cheaper and more effectually. This has already been done in certain parishes with very good effect. The midden system and other similar plans solve the difficulty by mixing the ashes with the excrement and re- moving them both together — that is to say, they convert the ash-pit or dust-hole (which is bad in itself, and which we wish to get done away with) into a midden heap, which is ten times worse. Such a plan ought not, and we hope will not, be long tolerated anywhere. WATEB SUPPLY 255 CHAPTER IV. WATER SUPPLY. Although in many places the medical officer of health will have nothing to do with the sources of water supply, or rather will have less direct control over this than over any other part of the sanitary arrangements of the community, still in many instances it will be his duty to advise the Medical discontinuance of certain supplies or the adoption of new ad^sea^to ones, and besides this, he will have to combat the various ^^p^^^* sources of pollution to which water is exposed when it gets into the town and into the houses. With regard to the sources of water, a few general points may be laid down. Rain is the original source of all water supplies, but the water is collected in very different ways. In the first place, wells in the subsoil of weii water towns ought not to be used to supply water for drinking, ^^^p^re. Although it may not contain a large amount of organic matter, such water always contains the results of the oxidation of organic matter, viz., nitrates and carbonates, and may at certain times, and perhaps frequently, become noxious from the passage into it of unoxidised putrescibJe organic matters. In towns where there are midden heaps Especially and cesspools, this caution against the use of subsoil middens water is still more necessary, as these often, to a great pooiJ.^^" extent, supply the wells. In one instance which came under our notice during the investigation of an outbreak of enteric (typhoid) fever, the use of a particular pump had been pretty generally discontinued by the neighbourhood because the water became green and offensive. Shortly afterwards, when a portion of the wall behind the pump fell down, it was discovered that a midden pit, nearly full 256 MANUAL OF PUBLIC MEDICINE But also where faulty- sewers. Artesian borings. Source of their water. Lower greens and water. Softening by Clark's of semi- liquid excretal and other filth, was just on the other side of the wall, and, in fact, directly over the well from which the pump drew. But this caution is also necessary in towns that are sewered, because what with old brick drains, cesspools not yet abolished, sewers faulty in construction or accidentally damaged, leakages of gas, and a thousand other sources of impurity, the subsoil waters of a large town cannot be sufficiently pure to be safely used for domestic purposes. But if) instead of superficial wells (which may indeed go to a considerable depth in the subsoil without the cha- racter of their water being much improved), we have wells specially constructed so as to keep out the subsoil water — that is to say, lined with masonry constructed in cement, and at the bottom of these wells borings through imper- vious strata into water-bearing strata beneath — the cir- cumstances of the case are quite altered. These, which are known as * artesian wells,' often afford a very large supply of excellent water, which rises through the boring into the well, and either overflows or has to be pumped out of it. This water is derived from the rainfall of districts at some distance, where the outcrop of the water-bearing stratum tapped appears — that is to say, where this stratum comes to the surface ; the water percolating through the pervious rock is confined within it when this rock is covered by an impervious stratum of clay. It is the water falling on the outcrop of the lower green sand around the London basin which descends beneath the Gault clay, and when tapped round London by borings which pass through this latter and the strata above it, will rise in these borings to a height which depends, of course, upon the height of the country from which it has come. In the same way the chalk water may be got at, and is got at, by borings through the London clay into the chalk rocks below it. Such waters are often very hard, containing a large amount of carbonate of lime dissolved in excess of car- bonic acid, but they may be easily softened on a large scale by Clark's process, which consists in the addition of sufficient milk of lime to combine with the carbonic acid WATEE SUPPLY 257 dissolved in the water ; the carbonate of lime which is formed being deposited, together with that formerly held in solution. Thus the water obtained by boring into the chalk has 17 or 18 degrees of total hardness on Clark's scale ; whereas, after the application of this process, its hardness is only 2 or 3 degrees. Similar borings have been made into the Kew Red Sandstone in various parts of the country, but the water so obtained is occasionally brackish, as there are large deposits of rock salt in this formation. A method, which ought to be resorted to more than it is, for obtaining supplies of water, is that of collecting it from a gathering ground at some distance from the place to be Gathering supplied, in a large impounding reservoir and conveying it s^^^^^^- to the town from this by pipes. Its quality in this case will, of course, depend upon that of the water of the springs and streams which supply the reservoir, and this again mainly on the rocks through which they pass, and on the nature of the surface of the gathering ground. It is necessary that water, which is to be used for drinking, should, if collected even at some distance from large towns, be made to percolate through soil before it is used. Dr. Angus Smith tells us that if it were possible to collect rain Necessity of from the clouds in large quantities it would not be pure ^^^^^^i^u. enough to be drunk without being filtered through soil. The primitive and metamorphic rocks afford the purest sources of water. Compact limestone rocks (as the mountain comparison limestone) also afford a good supply, but of much harder sources, water. The same may be said of many looser limestone and sandstone formations, while the water that comes from fissures in clays often contains a large amount of organic matter, and, having also as a rule a high degree of per- manent hardness due to the amount of sulphate of lime that it contains, is generally unwholesome ; as a matter of course water derived from peaty or marshy districts con- tains a large amount of organic matter, and is very unwholesome. As special impurities in waters derived from particular Special strata, we may mention, in the first place, magnesian salts magnesian' — especially the sulphate, chloride, and carbonate — which salts. 258 MANUAL OF PUBLIC MEDICINE Snlpliate of lime. are found in waters from tlie dolomite^ or magnesian lime- stone rocks, or from serpentine and rocks of its class, and in Italy from the sub-Apennine strata ; and, in the next place, sulphate of lime, which is, as before said, contained in water coming from clays, some of which, as the London, Kimmeridge, Oxford, and Lower Lias clays, afford con- siderable quantities of it, or in water coming from localities where there are large deposits of gypsum, as at Montmartre, near Paris. The effects of the habitual use of water con- taining these salts will be mentioned in another section. This plan of collections from gathering grounds is a variety • of one that has been long used in the East, and that was Komanpian. generally practised by the Romans. They simply tapped natural springs at a sufficient height above the place to be supplied, and brought the water in admirably- constructed aqueducts to distributing resorvoirs in the town. !N"ow we come to the method far too generally adopted, Elver water, which is that of taking river water just above the town but often below other towns — water which we know has been polluted — filtering it, so as to purify it to a certain extent, and distributing it to the houses. It is only in places where there is a sufficiently large and swift stream that has not been previously polluted, that this plan is defensible. We are told that the water supplied to towns by this method, is, practically speaking, a pure drinking water, but it is perfectly obvious that the plan of taking water which we know has been polluted, and then attempting to purify it, is radically wrong and entirely at variance with the principle laid down by Mr. Simon. Since, however, this is the plan so frequently adopted, it should be insisted on, in the first place, that the water be filtered on the large scale. The passage of impure water through filtering beds of gravel and sand not only frees it from sus- pended impurities, but also, if performed intermittently (time being allowed for the filtering bed to become aerated) converts a large proportion of the dissolved organic matters into innocuous substances. Distributing reservoirs, no matter how the water is supplied to them, require to be covered and well ventilated, besides being very frequently cleaned, as they afford the first opportunity for the water Wrong principle. Filtration. Reservoirs WATEB SUPPLY 259 to be rendered impure in the town itself: their overflow pipes must end freely in the open air. Distribtttion, Water may be distributed to the houses either on the Two system of constant service or on that of intermittent distribution, service. In the former case the mains are always full, and as much water as is required can be obtained at any time in the houses. In the latter case the water is only turned on for a certain time — say a few hours during the day — and so it has to be stored on the premises, in cisterns, butts, intermittent and other contrivances. Of the two systems there can be advantages, no doubt that from a sanitary point of view the constant system is far the best. The great disadvantage of the system usually adopted — the intermittent system — is that the water is exposed to sources of impurity in the cisterns and other receptacles in which it is kept. These require (of whatever material they are constructed) to be very fre- quently and thoroughly cleansed. They should be covered Service over, and those best constructed are of slate with supply- pipes of wrought iron, for Mr. Hawlinson tells us that ' wrought iron service-pipes are cheaper, stronger, and more easily fitted than service-pipes of lead.' But it must be added that leaden pipes and cisterns are not dangerous to the extent that is generally stated, for they become soon covered with a coating of carbonate and oxide of lead, which effectually prevents them from the further action of the water. This happens even with soft waters. We have already stated that the destination of the waste Waste pipes pipe of the drinking water cistern is one of the most important c^^*^^^^*- points to be looked to in examining the sanitary condition of a house. With the system of constant supply there is no need of cisterns, except perhaps for the supply of water closets. The water is drawn from taps placed on the rising mains, and there should be one for each storey of the house. These should be so placed that any leakage from them would cause considerable inconvenience to the inhabitants, and in the poorer parts of towns, the taps for this reason should be placed inside the houses and not out- side of them. By these means and with proper inspection s 2 260 MANUAL OF PUBLIC MEDICINE Less waste with constant system. Quantity required. of fittings there is less waste of water with the constant system than with the intermittent system of supply. Where greater waste has been found to take place with the constant system, it Las been when it has been adopted instead of the intermittent system with the same pipes and fittings. A difficulty which has occasionally arisen with the constant system is that the supply runs short in the upper parts of houses at a high level. This must be obviated by the use of high level cisterns in the upper storeys of these houses. They should be pi'ovided with ^ warning pipes,' ending in the open air. With regard to the amount to be supplied, we have chiefly to deal with the smallest quantity that can be con- sidered sufficient. According to Professor Rankine ' the supply of water to towns ranges in extreme cases from about 2 gallons to 600 gallons per inhabitant per day;' and he gives the following table as containing fair estimates of the average daily consumption : Gallons per Day. Least. Average. Greatest. Used for domestic purposes 7 10 15 Washing streets, extinguishing fires, 1 3 3 3 supplying fountains, «&c. . J Trades and Manufactures , 7 7 7 Total usefully consumed 17 20 25 Waste under careful regulation, say . 2 2 2| Total demand . 19 22 27i Least amount. The least amount, then, that should be allowed is, say 20 gallons a day, and it is well to aim at a more copious supply, especially as the waste is almost always much greater than that allowed for in the table. "We may add here that the system of collecting rain water from the roofs and utilising it for the water closets, or for washing, ought to be carried out much more fully than it is, and might certainly be very easily adopted. WATER SUPPLY 261 Effects of Livpure Water. Several of the more importaiit diseases connnunicatecL by Hard v. soft the use of impure water for drinking have been already mentioned. In the first place, there can be little doubt that a hard water is less wholesome, generally speaking, than a soft one. Besides being more unwholesome, it oc- casions a considerable waste of soap — each degree of hard- ness being equivalent to the waste of 2^ ounces of soap for every 100 gallons of water used, and it is also not nearly so advantageous for other domestic purposes, as making Carbonate tea, boiling vegetables, &c. Perhaps the least hurtful ^^^^* mineral substances are the carbonates. Dr. Parkes says : ' Carbonate of lime, when not exceeding 12 to 16 grains per gallon, is not usually considered unwholesome, though it remains to be seen whether a more careful inquiry will not indicate some efiect on digestion or assimilation to be produced by the constant use of such a water.' But there other salts can be no doubt, and there is no difference of opinion about ^^^^ ' ^ ^ magnesian the fact that salts which cause the permanent hardness in salts, water are injurious. To quote Dr. Parkes again : ' Symp- toms which may be referred to the convenient term dys- pepsia, and which consist in some loss of appetite, vague uneasiness or actual pains at the epigastrium, and slight nausea, and constipation, with occasional diarrhoea, are caused by water containing any quantity of sulphate of lime, chloride of calcium, and the magnesian salts.' Besides this, there is considerable evidence to show that Goitre and the habitual drinking of hard waters containing magnesian salts is the cause of goitre in the localities where it is pre- valent, a disease associated in many places with the fearful form of idiocy known as cretinism. (See ' Aitken's Science and Practice of Medicine,' vol. i.) As a rule, then, soft waters are to be preferred to hard ones, and hard water should be softened, as far as it can be by Clark's process, before being distributed ; while per- manently hard water should be avoided. Suspended substances, whether mineral or organic, are Suspended liable to produce diarrhoea, sometimes of a severe kind, and the mountain dysentery of some parts of India has been 262 MANUAL OF PUBLIC MEDICIlSlE Dissolved organic matters Marsh water Leaden pipes. Entozoa traced to the use of water containing very fine particles of" mica in suspension. Such, waters, when filtered, may be quite fit to drink. Water containing dissolved organic matters (especially of animal origin) in a state of putrid decomposition is liable to produce diarrhoea, and may, in certain instances, contain the poison of special diseases, as cholera, enteric fever, and, in hot climates, dysentery. One of the commonest sources of animal impurity in water is the absorption of decom- posing organic matters from foul air, as before described. Water containing dissolved vegetable matters dops not, it is said, produce diarrhoea, but it frequently comes from marshy districts, and has then been accused of affording one of the ways in which intermittent fever, and, in tropi- cal climates yellow fever, are produced ; such water should always be avoided. The presence of more than a small amount of nitrates and nitrites in water raises a suspicion that the water has been contaminated, and one which is strength ened if salts of ammonia and chlorides are found in excess also ; but the mere presence of nitrates is not a sufficient reason for the condemnation of a water as a source of supply ; it should only induce a more careful search after possible sources of recent contamination. Certain waters, especially soft waters, and more particu- larly such as contain nitrates and nitrites, dissolve enough lead from leaden pipes and cisterns, or from zinc pipes con- taining lead, to produce toxic ejQfects ; it is, however, certain that it is very rare that water supplied for drinking has any such effect on leaden pipes and cisterns. The solution of other metals, as copper, is a purely accidental occurrence. It remains to be added that drinking waters afford the means for the introduction into the body of certain entozoa. The ones that may be especially mentioned are the Ascaris Lumhricoides, the BotliriocepJiahts Lahts, and the Oxiuris Vermicularls, But the ova and embryos of these creatures are mostly swallowed when some manifestly impure water is drunk, in which cases leeches, tadpoles, and like creatures may be swallowed. Dr. Parkes states that * in a march of' the French near Oran, in Algiers, more than 400 men were at one time in hospital from swallowing leeches.'' WATEB SUPPLY 2G3 The embryos of the common tapeworms (tcenice) enter the body chiefly by means of the food. Purification of Water, The water supplied to a collection of people ought not to require purification ; in other words, water should be got which has not been fouled ; as this is, however, seldom- the case, some kind of purification has to be resorted to. In settling tanks, a good deal of the suspended matters are deposited, and the Romans found that such tanks were necessary even with the spring water with which they supplied their towns. For river water slow filtration through beds of gravel and sand must be resorted to, the result being not only the separation of the suspended Filter beds, matters, but the oxidation of a great part of the dissolved organic matters. Hard waters may be purified to a con- siderable extent by Clark's process, as already mentioned. On the small scale water may be rendered purer by filtration through animal charcoal, silicated carbon, or magnetic carbide filters, which may be placed in the cis- tern, or attached to the delivery pipe, or filled by hand. Boiling also afibrds an excellent means for purifying water, and very impure waters may be drunk with impunity if previously boiled, especially if with a few tea leaves so as Boiling, to make a weak decoction, according to the plan practised in China ; this should always be done during the prevalence of cholera or of enteric fever. Various substances have been proposed to be added to drinking water in order to purify it, and a little Condy's fluid may be occasionally used with advantage ; but it is needless to enlarge on this subject, as impure supplies must be abandoned, and as it is much more essential to see that Avoid con- the water is not rendered impure, as is far too often the case, in the cistern ; it is ridiculous to allow the water to be contaminated first, and then seek to purify it by filters or by other contrivances, and the medical of&cer will chiefly have to do with the prevention of the contamina- tion of water, whether on a large or small scale. 26 i MANUAL OF PUBLIC MEDICINE CHAPTER y. EPIDEMIC DISEASES. Two classes. First class fatal to children. Apparent exception. Typhus and relapsing fevers. Practically speaking, the diseases under this head, of which the medical officer will take cognizance, may be divided into two classes : the first comprising small pox, scarlet fever, diphtheria, typhus and relapsing fevers, and occasionally, perhaps, measles and whooping cough ; and the second one, cholera, enteric fever, and diarrhoea. In the first class the most important point in the consideration of the spread of the disease is the isolation of the patient — all these diseases being highly contagious : while, with regard to those of the second class, ' the quality of infec- tiveness,' as Mr. Simon says of cholera, ' belongs particu- larly, if not exclusively, to the matters which the patient discharges by purging and vomiting from his intestinal canal.' Diseases of the first class especially attack children, although they may, any of them, attack persons of any age, and the number of deaths of children from them, as compared with those of adults, is very large indeed, with the single exception of small-pox. This exception is, however, only an apparent one, and is due to the influence which the vaccination of infants has had over the disease, for small-pox, although attacking adults more readily than the fevers to which it is alHed, still is, apart from vaccu nation^ more fatal to children than to adults. Sixty-one per cent, of all unvaccinated children attacked under five years of age died during the late epidemic, as against less than forty-one per cent, of unvaccinated adults. Of these eminently contagious diseases, typhus and relapsing fevers are propagated especially in places where EPIDEMIC DISEASES 265 tliere is want of air, want of food, and want of cleanliness ; in tlie over-crowded, ill- ventilated sleeping-rooms, in- habited by badly fed, half-starved, unwashed people, who breathe over and over again air saturated with fetid cutaneous, and pulmonary (not to mention any other) excretions. Small-pox, scarlet fever, and the remaining diseases of the first class are always more or less amongst us, but become epidemic at certain times from causes with Epidemics, which we are not acquainted. When we see a disease like small -pox, which is never totally absent from among the population, suddenly take on a character of eminent con- tagiousness, and spread like wildfire among the people, as illustrated by the late severe epidemic, it is plain that there is either some factor of epidemicity, which may have something to do with special meteorological or electrical conditions, but about which we know absolutely nothing, or that the poison of the disease has been reintroduced from elsewhere with somewhat difierent properties, being not necessarily more virulent than the poison of the preceding epidemic which has spent itself, so to speak, but being of a suffi- ciently difierent character to flourish in a population acclimatised, as it were, to the other one. The propagation Necessity of of these diseases is aided by want of ventilation ; scarlet fever, for instance, always spreads most in houses where there are no windows at the back. This fever has been known to travel up one side of a street from house to house until it came to a cross street, that is to say, to a. place where there was free ventilation, and then to go no further. All these diseases are propagated more than any- where else at schools, and during epidemics the greatest schools, precautions ought to be taken in sending children to schools, especially as there is every probability that some of these diseases, if not all of them, are contagious during the period of incubation. With measles and whooping cough the medical officer Measles and of health has, generally speaking, little to do. Disinfec- ^^g^if^^^ tion is not usually carried out after them. Where, how- ever, this is undertaken, it should be carried out in the manner to be presently described for the other contagious fevers. These diseases often cause a considerable mortality 266 MANUAL OF PUBLIC MEDICINE among cliilclren ; not directly but indirectly. Tliey pre- dispose to lung diseases, especially broncHtis and pneumonia, of which, the children die, and the fatality from these diseases accompanies in a very striking manner the fluctu- ations of the mortality from diseases of the respiratory organs. They are diseases which are commonly looked upon as necessary diseases of childhood ; like the other diseases of the same class, they are eminently communicable by means of infected air or clothing, and in the case of Generally mcasles by means of the contagious discharges. As a attack?^ general rule, one attack protects during the rest of life, and the same is true of the other diseases of this class, and also of enteric fever ; but it must be remembered that there are exceptions to this rule, and that there are even persons who appear to be especially predisposed to diseases of this class. Second attacks of one or other of these diseases are not very uncommon, and third attacks are not unknown. As in the majority of instances a person is only attacked by . any one of these diseases once during life, it is commonly thought a good thing for children to take measles and whooping cough and have done with them, though as no one is bound to have any one of these diseases during his life, the logic of this theory is not very clear. Prevention of the Spread of Epidemic Diseases. — Disinfection, The first great preventive of the spread of these diseases Fresh air. is to be found in a plentiful supply of fresh air. It is at any rate plain that it is especially necessary during the preva- lence of any epidemic disease to reinove from the vicinity of habitations all those refuse matters that are liable to produce an impure state of the atmosphere which is known to favour the spread of these diseases. Infected rooms containing articles of clothing of various sorts, have in many cases to Disinfection be inhabited almost continuously, and then it is necessary to of rooms, &c. . « . n -i resort to some special plans for the disinfection of such rooms and of the articles they contain. We do not propose here to enter into a scientific discussion on the relative value of different substances for this purpose, nor to adopt any one of the numerous classifications which have been proposed for EPIDEMIC DISEASES 267 them, but simply to point out practical methods wliicli have succeeded where they have been systematically carried out. In the first place persons attacked with one of these dis- eases (especially with a disease belonging to the first class), should be separated as completely as possible from other isolation, persons, and especially from persons who have not already sufiered from the same disease, and sanitary authorities are empowered by the 37th section of the Sanitary Act, 1866, to provide " hospitals or temporary places for the reception of the sick." The sick room should contain as few articles as possible. It should be kept sweet by having a current of air passing through it, and this may generally be effected by keeping up a small fire and opening a window a little at ^^^^^^^^^^^ the top, care being taken that the patient is not exposed to room, a draught. The room selected should be as distinct from the rest of the house as possible — that is to say, where a room can be selected at all — and should if possible not be a papered room. It is well to hang a sheet over the doorway and to keep this moistened with carbolic acid. In many cases instead of opening the window the door may be left open, and then the supply of air for the sick chamber may be forced to come from the rest of the house, the staircase into which the room opens being freely supplied with fresh air. Carbolic acid in solution or some Macdougall's powder, carbolic (carbolates of lime and magnesia) may be sprinkled about ^^^* the floor. All linen that has been used by the patient should be at once placed in a vessel containing water mixed with some Condy's fluid or carbolic acid, and should afterwards be thoroughly well boiled. All the excretions from the Excretions body of the patient must be efi'ectually disinfected. Thus ^^^^^^^^t^^- for wiping the mouth and nose rags should be used and then immediately burnt. In cases of such diseases as are accom- panied with skin eruptions (and this is especially applicable to small-pox and scarlet fever), the infection of the air and of articles of clothing, &c. may be very much diminished by rubbing the patient's body with olive oil, which may advan- Use of oil. tageously be impregnated with carbolic acid. This is not only useful from the point of view we are now considering but is a rehef to the patient. Vessels used for receiving excretions should contain a small quantity of some powerful 268 MANUAL OF PUBLIC MEDICINE Glasses, cups, &c. Carbolic soap. Dresses of attendants. Washing of skin. Medical of- ficer little control over snch matters. Removal to hospital. disinfectant, as crude carbolic acid or a solution of green vitriol (the proto- sulphate of iron — ferrous sulphate), or some Burnett's fluid. This applies to the vessel in which the expectorations are received as well as to that used for the excretions from the bowels and kidneys. It is impor- tant that the disinfectant be placed in tbe vessel before it is used. All glasses, cups, spoons, &c., used in the room re- quire to be most carefully cleaned before being used by other persons, and a basin of water containing a little carbolic acid, or Condy's fluid, should be always ready for the attendants to wash their hands in before leaving the room. Carbolic acid soap may be used with advantage. Dresses of atten- dants should be made of some glazed material which will allow as little dust as possible to adhere to it. As soon as the patient is considered well, whether the external application of water has been resorted to by the medical attendant during the course of the disease, or not, the whole surface of the body should be well washed, carbolic acid soap being used, and this should be repeated for several days ; but even for a longer period all contact witb uninfected persons should (especially in the case of diseases accompanied with skin eruptions) be avoided as much as possible. With the foregoing part of the preventive measures to be adopted, the medical oflB.cer of health has unfortunately, only occasionally anything to do, and this is one of the reasons why, when, diseases take on an epidemic form they spread more rapidly and more extensively among the people than they might do if suf&ciently careful isolation of infected persons and places were generally carried out. The medical officer of health under the present regime only hears of the deaths that have occurred from these diseases, and, of a certain number, it is to be feared a very small proportion, of the cases of sickness from them, and it is only now and then (except during severe epidemics) that he is able to get patients removed from unsuitable localities, such as from rooms in which several persons are living, to the permanent or temporary fever hospital. It would be well if this could be done very much more frequently, a special conveyance being provided by the sanitary authority for the purpose — (Sanitary Act 1866, section 24). It may here be remarked that it is the EPIDEMIC DISEASES 269 duty of the medical officer to investigate into the circum- stances under which persons snfferingfrom infectious diseases are allowed, or even in certain cases forced, to expose them- Exposure in . T • • 1 T public selves in the public streets and even m public conveyances ; places, being sent away, as frequently happens in the case of ser- vants, from the places at which they have contracted the disease, to their homes at a considerable distance — per- haps in another part of the country — carrying with them the infection, and spreading it abroad along the whole line of their route. Such cases should then be diligently investi- gated and the offenders (if the charge can be brought home to them) summoned under the 25th section of the Sanitary Act. Of course if the persons so exposing themselves have been warned that by so doing they are committing an illegal act, then the blame rests with them. It now remains for us to describe the methods to be used for the disinfection of the house or room and the infected articles contained in it : and in the first place Formal as to the formal mode of procedure* : — A notice must ^^^^^^^^^^ be given by the inspector of nuisances that the infected rooms, &c. are to be disinfected within a certain time, or Certificate of • iT'p n 1 a medical forthwith. It IS formally necessary m this case that a practitioner, certificate be obtained from a legally qualified medical practitioner stating that in his opinion the cleansing and disinfecting of such house or part thereof and of any articles therein likely to retain infection "would tend to prevent or check infectious or contagious disease,'' and it is of course advisable to have this where no death has occurred, as in case of non-compliance with the order a certificate must be produced during the legal proceedings which may ensue. In cases, however, where death has been certified, it is plain that the medical officer has sufficient evidence to go upon, and then such certificate need not be made out unless there is any likelihood that the order for disinfection will not be attended to, in which case he can write the certificate him- self. When the notice is disregarded, the 22nd section * Such thorough disinfection should be insisted on in all cases where a room has been occupied even for a short time by a person suffering from small-pox, scarlet fever (including rubeola) or typhus fever, even when the attack has been a mild one ; no distinction should be drawn. 270 MANUAL OF PUBLIC MEDICINE Non-com- pliance with notice. Powers of nuisance authority. Entry of pre- mises. Dead body. Disinfection •of clothes, <&c. of the Sanitary Act, 186G, provides as follows: — " If the person to whom notice is so given fail to comply therewith within the time specified in the notice, he shall be liable to a penalty of not less than one shilling and not exceeding ten shillings for every day during which he continues to make default ; and the Nuisance Authority shall cause such house or part thereof to be cleansed and disinfected, and may recover the expenses incurred from the owner or occu- pier in default in a summary manner," — and it is further provided under the same section that if the person upon whom the notice has been served be unable to carry out the requirements, the Nuisance Authority may do so at its own expense. (Note. — It is a strange omission in this section that power is not given to the nuisance authority to disin- fect infected articles of clothing &c., and to recover the expense of so doing from the defaulter. This provision is only made with regard to the "house or part thereof.") As the word "nuisance" under the Nuisances Removal Acts includes " premises in such a state as to be injurious to health," the powers of entry given by these Acts may be enforced, if necessary, where the Inspector has reason to suppose that the disinfection has not been carried out ac- cording to the notice (for it is well that the notice should be accompanied with a description of the way in which satisfactory disinfection may be effected.) Where death has occurred, the interior of the cof&n and the body itself should be well sprinkled with Macdougall's powder or with a solution of carbolic acid, and the lid firmly screwed down. The body must be looked upon as infectious and should be buried as soon as possible ; not only so, but it should be insisted that no such dead body be kept in a room where persons live or sleep, and the 27th section of the Sanitary Act (1866), which provides for removal of bodies which are in such a condition as to be a nuisance, to a mortuary (where there is one), should be strictly enforced. If a proper place has been provided under the 23rd section of the Sanitary Act " for the disinfection of woollen articles, clothing, or bedding which have become in- fected," such articles should be sent for by the Sanitary EPIDEMIC DISEASES 271 Inspector and disinfected. This is usually done by placing Hot air them in a hot air chamber, a large iron box which can bo ^^^^^^*^* heated by means of a furnace, or still better by gas, until the temperature of the air in it is raised to about 240° Fahrenheit. The articles are placed on shelves or rails inside this box and are there subjected for several hours to the above temperature, when they may be considered to be sufficiently disinfected. It is well however that all articles which have been much soiled by infectious discharges, especially bedding, should be burned, a.nd where this is ordered to be done by the Sanitary Authority, in the case of poor persons, such articles must be replaced at the public expense. Where a hot air disinfecting chamber has not been provided by the Sanitary Authority, all infected articles which can be boiled should be boiled in water (to Boiling, which some disinfectant may be added) for a considerable time, and other articles, such as bedding, &c., be disinfected by leaving them in the infected room (undoing the ticks and spreading about the contents in the case of bedding and mattresses) during the carrying out of the process em- ployed for its disinfection, now to be described. For disinfecting the air of a room, and to a certain extent Disinfection the things contained in it and the walls, it is necessary that ^ some gaseous disinfectant be generated in considerable quantities in the room, and kept therein for a certain time. In order to do this all the doors bat one must be tightly closed and the crevices pasted over with brown paper. Sulphurous acid, chlorine, nitrous acid, and similar disin- Snirimrons fectants have each had their defenders, but there is no doubt '^^^ that for general practical purposes, especially on a large scale, sulphurous acid as generated by the burning of sulphur, is the one which is the cheapest, simplest, and most effectual. The immense advantage which sulphur possesses by being in the solid form, and by the fact that it is not requisite to use any acid with it, can hardly be over-rated, and the ease with which disinfection by sulphurous acid is managed affords another excellent reason for its general adoption. The chimney must be also stopped up, either by pushing a bag up it, or by pasting paper over the fire- place. One or more iron vessels must then be placed in 272 MANUAL OF PUBLIC MEDICINE Method of procedure. Room shut up and left. Infection hangs to wall papers. They must be stripped off and burnt. the room, either standing on tiles on the floor, or, still better, supported over buckets of water by means of stair rods, or pairs of tongs, or other convenient metal rods. Common roll sulphur broken into small pieces is to be placed in these, in the proportion of about one pound to every 600 cubic feet of space, and then lighted, either by moistening it with alcohol and setting fire to it with a match, or by throwing two or three live coals upon it from a shovel. The remaining door is then to be closed and the crevices on the outside pasted over with brown paper, so that the room is as completely shat up as possible. The sulphur burns rapidly with the oxygen of the air in the room, forming sulphurous acid gas in large quantities, and there is a considerable amount of evidence to show that this gas is capable of destroying the poisons of infectious diseases. The room should be left closed for six hours, if possible, or even longer. It should not be left shut all night on account of the possibility of accidents. The door or doors should then be opened, and as soon as it is possible to enter the room the windows should be unfastened and thrown wide open. The room cannot yet be considered to be thoroughly dis- infected. The infectious particles, especially from such of those diseases as are accompanied with skin eruptions, settle about with the dust in diflPerent parts of the room and especially adhere to the wall-paper, and there are plenty of instances of paper-hangers who, having proceeded to pull down old papers from the walls of rooms before re- papering them, have been attacked by various kinds of infectious diseases. In every case then in which a papered room has become infected it must be considered absolutely necessary, after it has been fumigated with sulphur, that the paper be thoroughly well washed with a solution of crude carbolic acid in water (some recommend chloralum for this purpose) and stripped off the walls and burnt : with regard, however, to varnished papers, which can be washed without being injured, the case is different, and they may be treated like an ordinary painted wall ; that is to say, thoroughly well washed with a solution of carbolic acid : they need not be stripped off the walls. Then the EPIDEMIC DISEASES 273 walls, ceiling, woodwork of the floor, and articles of furniture must be thoroughly well scrubbed with the same solution : for all these purposes the crude carbolic acid is the cheapest as well as the most efi'ectual disinfectant. The ceilino: and walls are then to be lime-whited, and the room ^^^}}^^. o ' ^ walls lime- left unoccupied and freely open to the external air for whited. a fortnight, if possible. Very frequently, however, the room has to be re- occupied on the same day. IvTotwith- standing this we have never known a single case in which fever has again broken out in a room which has been so disinfected. Small-pox. — Vaccination. The above directions hold good for small-pox, one of the most infectious of diseases," as well as for the other diseases mentioned : but in its case we have what we have not in other cases, viz., an almost infallible preventive. As Mr. Simon says, in one of his memoranda, "It is the neglect of vaccination that renders the occurrence of con- Vaccination, siderable epidemics of small-pox possible ; and it is by vaccination that the spread of small-pox can most effectu- ally be prevented or restrained." And again in another (No. 41) :— Be-vaccination. — Memorandum of Privy Council. "By vaccination in infancy, if thoroughly well performed and successful, most people are completely insured, for their whole lifetime, against an attack of small-pox ; and in the proportionately few cases where the protection is less com- plete, small-pox, if it be caught, will*, in consequence of the vaccination, generally be so mild a disease as not to threaten death or disfigurement. If, however, the vaccination in early life have been but imperfectly performed, or have imperfect from any other cause been but imperfectly successful, the protection against small-pox is much less satisfactory ; neither lasting so long, nor while it lasts being nearly so complete, as the protection which first-rate vaccination gives. Hitherto, unfortunately, there has always been a very large quantity of imperfect vaccination ; and in con- sequence the population always contains very many per- sons who, though nominally vaccinated and believing T 274 MANUAL OF PUBLIC MEDICINE themselves to be protected against small-pox, are really liable to infection, and may in some cases contract as severe forms of small-pox as if they bad never been vacci- nated. Partly because of the existence of this large number of imperfectly vaccinated persons, and partly because also even the best infantine vaccination sometimes in process of time loses more or less of its effect, it is advisable " that all persons who have heen vaccinated in infancy Necessity of should, as they approach adult life, undergo ee-vaccination. tion. Generally speaking, the best time of life for re- vaccination is about the time when growth is completing itself, say from 15 to 18 years of age ; and persons in that period of life ought not to delay their re- vaccination till times when there shall be special alarm of small-pox. In proportion, however, as there is prevalence of small-pox in any neigh- bourhood, or as individuals are from personal circumstances likely to meet chances of infection, the age of 15 need not be waited for ; especially not by young persons whose marks of previous vaccination are unsatisfactory. In cir- cumstances of special danger, everyone past childhood, on whom re-vaccination has not before heen successfully per- formed, ouyht without delay to he re-vaccinated. Does not re- " Rc-vaccination, once properly and successfully per- qu^e repeti- f^^^^^^ ^^^^ ^^j. appear BVCT to require repetition. The nurses and other servants of the Small-Pox Hospital, when they enter the service, are invariably submitted to vaccination, which in their case generally is re- vaccination, and is never afterwards repeated ; and so perfect is the protection, that though the nurses live in the closest and most constant attendance on small-pox patients and though also the other servants are in various ways exposed to special chances of infection, the resident Surgeon of the hospital, during his thirty-four years of office there, has never known small-pox affect any one of these nurses or servants. ProTisionfor " Legal provisions for re- vaccination are made in the 8th tionr^^'^^' Section of the Vaccination Act, 1867, and in Section IV. of the Regulations which the Lords of the Council under authority of the Act issued in their order in February 18th, 1868. Under these provisions, re-vaccination is now per- formed hy all puhlic vaccinators at their respective vacci- EPIDEMIC DISEASES 275 nating stations; and, so far as is not inconsistent with the more imperative claims for primary vaccination, any jperson ivJio ought to., he re-vaccinated may, on apphjing to the public station: of. the district in which he resides, obtain re- vaccination at. the public expense.'^ It is also necessary to insert in fall the " Memorandum on the STEPS specially requisite to be taken by Boards of Guardians under the Vaccination Act, 1869, in towns in which SMALL- POX is epidemic. " I. — Special Instructions to Vaccination Officers, "1. At times when small-pox is epidemic, the ofiicer appointed by the Guardians to see that the provisions of the Vaccination Act are duly observed should give his first and special attention to the particular localities in which the infection exists. " 2. In order that for this purpose he may have the earliest possible information of the occurrence of cases of the dis- ease, the Guardians should instruct their district medical officers to give him immediate notice of every fresh case of Notice of small-pox which comes under their treatment, and should also instruct the registrars of deaths to forward to him notice of each death registered from small-pox on the day on which it is registered. For convenience of transmitting such notices, each district medical officer and registrar should be supplied with forms duly stamped for post ; or with post-cards adapted for the purpose. Private medical practitioners should also be invited to give similar infor- mation. " 3. In each locality in which the infection exists, the vaccination vaccination officer should proceed with the utmost possible children, dispatch to personally ascertain what children are unpro- tected by vaccination, and should use his utmost exertions to obtain the prompt vaccination of all such children. Generally speaking, he must be guided by his own judg- ment and by his knowledge of the locality as to the manner in which his inquiries can best be made ; but in infected courts or alleys, as well as in certain kinds of streets, inquiries from house to house, and, in tenemented houses, from room to room, will be indispensable. T 2 276 MANUAL OB FUBLIC MEDICINE Unvac- 4. Where any child is found illegally unyaccinated (be- chiidren. tween the ages of three months and 14 years) the vaccina- tion officer should give a notice requiring the vaccination to be done within a specified time. This time, when there is small-pox in the house, or other special risk of exposure to the contagion, should not exceed 24 hours ; but in other cases some days, not exceeding a week, may be allowed. A second visit from the vaccination officer will, of course, afterwards be necessary, in order to see that his notice has been complied with. " With regard to unvaccinated children, not yet three months old, who may be in infected localities, the vaccina- tion officer should advise the parents not to incur the un- necessary risk of waiting for the child to complete that age before having its vaccination performed ; for vaccination is performed with perfect safety on children even immediately after birth. In no house in which there is small-pox ought a child, however young, on any account to remain unvacci- nated, unless on medical examination it be pronounced unfit to be vaccinated. Ee- vaccina- "5. The vaccination officer should make it well known in infected localities that the public vaccinator is at liberty to re- vaccinate grown-up and young persons (not under 12 years of age) who have not before been successfully re- vaccinated, and who apply to him for that purpose ; and that persons not vaccinated since childhood, who are likely to be exposed to contagion, ought to be re-vaccinated without delay. Above all, this is necessary for persons whose original marks of vaccination are imperfect. "6. All notices given and representations made as above, should be accompanied with information of the provision for public vaccination in the district. If any case requiring prompt vaccination by the public vaccinator cannot, in the judgment of the vaccination officer, properly be taken to the station or residence of the public vaccinator, the vacci- nation officer should give to tho public vaccinator im- mediate information of the case. " 7. Besides the above- described special proceedings in infected localities, every means should be taken, generally throughout the Union or Parish, to ensure that the infan- EPIDEMIC DISEASES 277 tine Yaccination is as complete as possible. The vaccination officer should make frequent examination of the registrars' vaccination books, and should deal with each default which he finds as speedily as possible after it has arisen. " JI. — Special arrangements for the iniblic Vaccination of cases of emergency. " 1. Besides the ordinary attendances for the performance special at- of vaccination at the appointed station in each vaccination tendances, district, special attendances should, during the continuance of the epidemic, be given at a fixed hour daily for the vaccination of cases of emergency. "2. Under the regulations of the Privy Council, Guar- dians, where small-pox is prevailing, are at liberty, without special authorization, to order such exceptional attend- ances. But as regards the place where the special daily attendance should be given, if, in the case of any district where the vaccinator's surgery or residence is not a vacci- nation station, the Guardians are of opinion that the ordi- nary vaccinating station would be less convenient for the special purpose than such surgery or residence would be, they should at once apply to the Privy Council to sanction, for a limited time, the exceptional use of the surgerj or residence. "3. The special provision for daily attendance is designed ^or cases of only to meet cases of emergency ; and all other cases should emergency, be reserved for the usual vaccinating day. It is on the latter regular attendance at the station that reliance must be placed, not only to maintain the usual performance of primary vaccination from arm to arm, but also to furnish the supply of lymph required for cases of re-vaccination, and for use in the special attendances ; and former epide- mics of small-pox have shown that to attempt at such times an indiscriminate daily performance of vaccination leads only to difficulties and disadvantages. Adherence to sys- tematic arrangements (with exception only for special cases) is indeed of the utmost consequence at such periods ; — first, because it is then of supreme importance that each J)rimary vaccination should be done under conditions which scarcely admit of failure ; and secondly, because without 278 MANUAL OF PUBLIC MEDICINE system it is not possible properly to meet the large demands for re- vaccination which, at such times are sure to arise, and which, unless under very particular circumstances, must always be reserved for the weekly vaccinating day. " III. — Isolation of the sick, and disinfection. " The isolation of the sick, and the disinfection of infected houses and things, are very important means of checking the spread of small-pox ; and in order that such measures may be enforced, the Sanitary Act, 1866, besides^imposing penalties on the exposure of infected persons, the letting of infected houses, the sale, &c., of infected things, and other acts similarly dangerous to the public health, gives in §§ 22-24, 26-28, very important powers to nuisance authorities. As the nuisance authority is in most towns a separate body from the Board of Guardians, it is not pro- posed in this memorandum to give any advice as to the way in which these powers can best be exercised ; but, so far as the destitute classes are concerned, Boards of Guardians, as poor law authorities, have through their oflB.cers opportuni- ties of securing disinfection and the isolation of the sick, of which full use should be made during an epidemic of small-pox." Whether the Medical Officer of Health be required to act as vaccination inspector or not he ought to make himself acquainted with all that has to do with the prevention of small-pox as well as of other diseases, as he is required to advise on all such matters. Few are hardy enough to deny that vaccinated people are far less subject to attacks of small-pox than un vaccinated ones, or that a greater proportion of the latter die if attacked by that disease, but it is not sufficiently generally known that re-vaccination is in most cases essential and is a far more absolute preventive than an attack of small-pox itself is ; for whereas there are many cases of second and some of third attacks of small-pox, showing that some per- sons are extraordinarily susceptible to the disease, and whereas the second attacks are frequently worse than the Small-pox -11 • L J after rc-vac- first and may kill the patient, cases of small-pox after re- ciiiation • ■ • • 7 ? i r» very rare. vaccmation are very rare inaeea, and so lar as we can ascer- EPIDEMIC DISEASES 279 tain always very mild ones : at any rate this mucli is certain, that a person who has been well re-vaccinated is far less Hkely to die from the small-pox than one who has already had the disease. As we have elsewhere pointed out, the results of the Change of ^ late epidemic show us that the compulsory vaccination of smaii-pox. infants has changed entirely the aspect of small-pox among us : the infectious diseases akin to it, as scarlet fever, measles, diphtheria, and whooping cough, are far more fatal to children than to adults ; small-pox stands alone among them (enteric fever being excluded for many obvious reasons) in being at present more fatal to adults than to children ; but if we consider only its fatality among un- vaccinated people we find that it is, like the other diseases above mentioned, more fatal to children than to adults. Dr. Guy describes it as "a disease always specially greedy of the blood of children.'* In short, to quote from a report already mentioned (" On the sanitary condition of the parish of St. Mary, Islington, during the year 1871 ") : — " We should be led to think it likely that for some reason or another, fewer, far fewer children died of small-pox than ought by analogy to die, or that it was a disease which was more fatal later in life and especially between the ages of twenty and forty. "Now there is no doubt that it is a Less fatal to disease that spares no age and therein differs in degree at no\^^^^^ any rate from the other fevers just mentioned, but from the vaccination statistics we are warranted in concluding that the comparatively small mortality among children is due to the efiect of vaccination, and that the large number of deaths between 20 and 40 points to the necessity of re- vaccination at some earlier period, preferably between 10 and 15 years of age, as that is the period when least deaths occur, in other words the deaths which might have been prevented by re-vaccination begin to be more numerous after that period is passed. " Un vaccinated children under one year old scarcely ever recover from small-pox : of unvaccinated children under 5 years of age admitted to various hospitals during the late epidemic 61*15 per cent, died, while of the vaccinated only 280 MANUAL OF PUBLIC MEDICINE 19*48 per cent, died ; of un vaccinated persons of all ages 44*8 per cent, died, of vaccinated 10'15 ; this sliows us that like the other contagious fevers, small-pox is, apart from vaccination^ more fatal to children than to adults* ; or to put : it still more obviously, out of 708 unvaccinated children under 5 years of age, 433 died, or 61*15 per cent., while out of 2,926 unvaccinated persons of all ages over 6 years, 1,195 died, or 40*84 per cent. The above facts I have gathered from the Report of a Committee of the Managers of the Metropolitan Asylum District, which has just been issued : now I also find there some very interesting Inefficient statistics showing the effect of inefficient vaccination ; vaccination. ^^^^^^ vaccinated persons the mortality varied gradually from 5*5 per cent, among those who had 5 or more vaccina- tion marks, to 15*2 per cent, among those who had only one mark, showing conclusively the desirability of vaccination being so effectively performed as to produce several per- manent cicatrices. Another very interesting fact related in the report is, that of upwards of 14,800 cases received into the hospitals only four presented proofs of having been re- vaccinated." 0 VEECB 0 WDI2sG.— VENTILA TION 281 CHAPTER VI. OVEECEOWDTNG. — VENTILATION. It is provided by* the 19th section of the Sanitary Act, 1866, that the word nuisances " imder the Nuisances E/enioval Act shall include " any house or part of a house so overcrowded as to be dangerous or prejudicial to the overcrowd- health of the inmates," and by the 35th section the ^aL^.""^'" nuisance authority is empowered to make sanitary regula- tions for lodging-houses, one of these being " for fixing the number of persons who may occupy a house, or part of a house, which is let in lodgings or occupied by members of more than one family." The Medical Officer of Health then has to decide what, in particular instances, is to be considered over-crowding. 'Now 300 cubic feet of space is the amount allowed by the Poor Law (Local Government) Board for every healthy person in dormitories, and as about 2,000 cubic feet per head per hour are required to Minimum purify the air respired by an individual, it follows ^"^^p^^®- that where only 300 cubic feet are allowed the air must be changed three times an hour at any rate. If not changed the air becomes foul from the presence in it of putrescent organic matters exhaled from the lungs and skin of the persons living in it, and it is in such an atmo- sphere that infectious diseases seem to find the most favour- impure air. able conditions for their development and spread. Such an atmosphere, too, has the most deleterious effect on the general constitutions of the persons inhabiting it, and has even, by one author, been considered the main, if not the sole, source of phthisis. Under these conditions, moreover, the amount of oxygen is decreased, and these two circumstances, aided perhaps by insufficient food, combine in producing 282 MANUAL OF PUBLIC MEDICINE that anaemic condition which, is so universal among people, especially women and children, who inhabit overcrowded rooms. Lastly, the proportion of carbonic acid and of moisture in the air is increased. The excess of carbonic acid no doubt assists in deteriorating the health of the inhabitants of overcrowded rooms, which is, however, mainly attributable to the foul organic matter, and to the diminution of oxygen in the air. Three hundred cubic feet, then, should be looked upon as the minimum sup- Measure- posed to be allowed per individual, and this amount can, space. as a matter of fact, be almost invariably insisted on. In determining the amount of cubic feet which each individual has in a given room, the Inspector has merely to employ the ordinary rules of mensuration, subtracting a reasonable amount for cupboards and furniture, adding for recesses, and subtracting three cubic feet for the space occupied by each adult, and a proportionate amount for the children. If the number left be divided by the number of persons of all ages occupying the apartment, the number of cubic feet per head will be obtained. Some Medical Officers do not Children as insist on the Same amount of cubic space for children as for adiTits.^^ adults on account of the practical difficulties sometimes found in securing such an amount. We do not think it advisable to make any such distinction, especially as the amount stated as the minimum is already very low indeed. Some special enactments have been made with regard to the inhabitation Cellar dwell- of underground rooms or cellars. These are to be found iJ^gs. section 103 of the Metropolis Local Management Act, 1855, and section 62 of the Act of 1862, and it is the duty District sur- of the District Surveyor to see that these sections are veyor's re- • port. complied with in the case of underground rooms let as separate dwellings, any room being considered to come within the provisions of the Act if there is a reasonable presumption that someone passes the night therein. Such report of the district surveyor stating the houses where cellars are inhabited, although not complying structurally with the provisions of the Act, with the names of the owners and occupiers, and the reasons for believing that such cellars are occupied separately as dwellings, is for- warded to the Medical Officer of Health of the district. 0 VEBCBOWDim.— VENTILATION 283 cases. The simplest and most obyious course then would appear to be for an inspection to be made of such places by one of the inspectors, with or without the Medical Officer, to verify the statements made in the report, and for the nuisance authority to authorise the issue of notices for discontinu- ance in all such cases unless the provisions of the Act can Different be complied with. There are, however, a multitude of differcnt reasons why such a course cannot be pursued, and these arise chiefly from the great variety of conditions under which such underground rooms are met with. Some of them are so dark and damp that it is well to advise the nuisance authority to issue an order for their discontinuance as inhabited dwellings immediately. In other cases the areas can be made broader and larger, &c., without inter- fering with the pavement in front of the houses, there being a sufficient width of private ground between the houses and the public pavement, and in such cases the advice to give is that notice shall be issued for the dis- continuance of such rooms as inhabited dwellings unless the provisions of the Act are complied with forthwith ; but in many cases it will be found that although the rooms are not so dark and damp as to induce the Medical Officer to No action in insist strongly on energetic action being taken (it being cases!^ frequently a great hardship both to the persons living in them and to the landlords to insist that such rooms shall no longer be let in the same manner as before) yet the areas do not comply with the provisions of the Act and cannot be made to do so without interfering with the public pave- ment, an interference which the local authorities will not always allow. It is usual then for such rooms, especially if they have ventilation at the back into a yard, as they sometimes have, to be left alone,^ although in all cases where the Medical Officer does not feel satisfied with such an arrangement, he should advise the contrary course, and leave it to the Sanitary Authority to accept the responsi- Closing, if bility of inaction. As different landlords may be responsible ti^ns.^^"^^^' one after the other for the overcrowding of a room or house, or for the letting of an underground room as a separate dwelling, it is provided by the 36th section of the Sanitary Act, that where two convictions have been obtained under 284 MANUAL OF PUBLIC MEDICINE Lighting and warming. Ventilation. Natural and artificial. Diffusion of gases. No effect on suspended organic matters. Variations in density. such circumstances within three months, " it shall be law- ful for any two justices to direct the closing of such pre- mises for such time as they may deem necessary, and in the case of cellars occupied as aforesaid, to empower the nuisance authority to permanently close the same in such manner as they may deem fit at their own cost." After the impurities introduced into the air by persons living in it, come those produced by the combustion of sub- stances for the purposes of lighting and warming, but over this the medical officer, as such, has no special control, and the same may be said of the smoke from factories about which there are special Acts which, however, it is no longer his duty to see carried out. We have already considered the methods to be practised for the riddance and disposal of house refuse, and in the following chapter we shall treat of special trade nuisances. We have now to consider briefly the methods to be used for ensuring as far as possible the purity of the air in apartments by the simplest possible means. This can only be done effectually by providing a sufficient and continual change of air. In apartments in which persons live there should be always a large quantity of air entering at one place and escaping at another without a draught. Yentilation has been described as natural and artificial. Natural ventilation includes all the methods by which air is renewed without resorting to any apparatus which forces it in particular directions. IvTatural venti- lation depends in the first place upon the property of diffusion of gases, by which, for instance, the excess of carbonic acid which may be present in the air of a room would be gradually distributed to all parts of the room, even supposing there to be no currents of air in it : (but the organic matters which are suspended in the air are not acted upon by virtue of the law of the diffusion of gases). In the next place it depends upon move- ments produced in the air by variations in the density of the air itself, and in all successful methods of venti- lation such movements are regulated and taken ad\^ntage of. These movements are ordinarily caused in rooms by means of a fire or lamp which heating and therefore expand- ing the air causes it to rise and escape at certain openings. 0 VERCR 0 WDING,— VENTILA TION 285 while denser air comes in throngh others to take its place. Thirdly, it depends upon movements produced in large bodies of air outside of houses by the same cause operating on a large scale; these are known as ''winds," and they Winds, act in two ways — directly (if the chance is given them) by forcing the air before them and taking its place, and indi- rectly by aspiration. A wind passing over the top of a ^^^^^^ chimney (even supposing there to be no fire in the grate below), causes a diminution of pressure in it, and the result is an upward movement of air from the room with which the chimney communicates. Winds are very power- Power of ful agents of ventilation, and in the summer it is only ne- cessary to open the windows, because the slightest amount of air, almost imperceptible as a wind, suffices completely to change the air of a house. Winds have also been utilised for the ventilation of large buildings by means of a cowl turn- ing always towards the wind and communicating with a tube that descends underneath the house into a warmed chamber from which the air passes to the various parts of the house. This is known as Sylvester's plan, and by it the holds of ships are frequently ventilated. As to the methods of ventilation by which the movements of air caused by variations in its density are utiHsed, the first and most obvious is to take advantage of the fact that the impure warmed air of a room rises to the top, and to make openings for it to go out by. Such openings, whether -^^^^^ there be a fire in the room or not will have precisely the openings, contrary effect unless sufficiently large openings are made lower down in the room, and at least equally exposed, by which denser air can enter. It is perfectly impossible that this can be done either in large or small rooms unless the air is artificially warmed before being allowed to enter the room, and so it becomes a matter of practical necessity in ninety-nine cases out of a hundred to introduce air into rooms at the upper part, and either to provide special open- Entrance ings for its exit, or to allow it to get out by the chimney, op^^i^^^- and this latter plan is generally sufficient. Air may be most conveniently introduced into rooms by openings over the lintel of the door, and if these be so constructed that the cold air passes upwards to the ceiling no draught will be felt. 286 MANUAL OF PUBLIC MEDICINE Sherring- liam's valve. Simple plan. Arnott's valve. Not to be recommend- ed. In fact draughty rooms are only made inhabitable by pro- viding a special means of entrance for air from outside. A ventilator of common use and of great efl&ciency for this purpose is known as Sherringbam's valve. It is fixed in a bole in the wall at any convenient situation, but preferably bigb up in the room and opposite to the fireplace. On the outside — that is, either in the open air or in the hall or staircase from which it is proposed to supply the room with air, — the aperture is covered by a piece of wire gauze or of perforated zinc to keep dust, soot, &c. out as far as possible. On the inside is a heavy flap which falls forwards by its own weight into the room for a certain distance so that the open- ing left by it looks upwards towards the ceiling. This flap IS balanced by means of a weight hung on a string which passes over a pulley — the w^eight serving as the handle and keeping the flap in any desired position. By means of one of these ventilators a very large amount of air is continually introduced into a room (especially if there be a fire in it) quite imperceptibly. An excellent plan for introducing outer air into staircases or sleeping rooms is, to have a block of wood made to fit under the lower sash of the window so as to raise it a little ; air then enters between the sashes and is directed upwards ; no draught is felt. Staircase windows may be screwed in this position in winter. Circular glass ventilators are occasionally useful especially over entrance doors, but louvre ventilators with metal frames are liable to get out of order, especially in large towns. Among ventilators intended to provide for the exit of heated air from the top of rooms may be mentioned especially Arnott's valve, which consists essentially of a light flap balanced in an aperture made into the chimney flue high up in the room, and so arranged that any pressure of air from the inside of the room will open it without allowing of an escape of smoke into the room. The disadvantages of this ventilator are, that it is apt, especially if a little out of order, to make a clicking noise, and that a certain amount of soot generally gets through it into the room. Another is that such provision for the escape of vitiated air is not necessary in rooms with a fireplace, especially if a sufiicient amount of pure air is being continually introduced. A very simple 0 VERCROWBING.— VENTILA TION. 287 chimneys. and most excellent ventilator for rooms wliicli project from houses and have no other rooms above them, or for water closets in similar situations, is McKinnell's, which has been McKinneii's. already described. (See page 233.) Chimneys act not only in winter but also in summer as chimneys, extraction shafts if only sufficient means be provided for the entrance of fresh air into the room. A chimney, indeed, may be considered to be a kind of inserted syphon, the fact being that air will come into a room at the lowest place possible. If there be no aperture in the walls of the room for this purpose as much will come in by chinks round the door, at the joints of the window, &c. as can, and the rest will come down the chimney — one of the most frequent causes of smoky chimneys. In fact in large chimneys there is frequently an up-current and a do wn- current, the latter Smoky being produced in the way here indicated ; but if a suffi- ciently large opening be made into the room to allow dense air of the lower strata to come in, a continual current will be established up the chimney, and there will be no chance of any air coming down it. The efficiency of chimneys as ventilators is increased by narrowing their two ends so as Narrowed to produce a more rapid entrance and exit of the air, and the upper end is equally well narrowed by placing a chim- ney pot inside the top of the chimney instead of outside it, while the unsightliness of the latter proceeding is avoided. Stoves of various sorts may be used to ventilate apartments, the external air introduced into the room being warmed by contact with them, and the same plan is carried out in Galton's fire-places. A single fire may be made to ventilate stoyes and a whole house if pipes are made connecting the various rooms in the house with the ash-pit below this fire. By this means a fire (say the one in the hall), may be made to ex- tract air from all the rooms in the house, and it is only necessary in that case to provide openings by which external air can enter these rooms. It is not our purpose to discuss these plans here, as we have only to do with the simplest methods employed for ventilating rooms. We may mention however, that the first great essential is that the products of combustion shall pass directly from the apartment and not have any chance of being brought into it again. Sloping apertures. fire-places. 288 MANUAL OF PUBLIC MEDICINE Windows. windows, tliat is windows wliicli slope wlien they open, are an excellent contrivance where they can be^ conveniently placed, and double windows are especially advantageous for hospital wards. When air is to be introduced by means of them, the outer one should be opened at the bottom and the inner one at the top. buimlngs Large buildings, if at all, are usually ventilated by some artificial method, but it is not often that the numerous lights in them are utilised for the purpose of producing an outward current of air, and of removing much of the vitiated Sunlight air of such places when overcrowded. The sunlights now ventilators. yogue do this to a considerable extent. Outside the tube which carries off a certain proportion of the products of combustion is a large tube opening into the room round the lights, in which an upward current is caused by the heated air in the inner tube, and thus a large quantity of air is drawn out of the room ; a few large buildings, as theatres, are now ventilated by the chandeliers which light them, by means of small tubes which connect the different parts of the building with the extraction tube just mentioned, by which air is thus drawn from all parts. It is only neces- sary to provide a means by which slightly warmed air can enter at the lower part of a building — the pit of a theatre for example : it can be warmed by comiact t^ith coils of hot- water pipes. For descriptions of the apparatus used in the various plans for the artificial ventilation of Public Buildings, &c., and also of the arrangements of hot water pipes for warm- ing and ventilating, we must refer the reader to special treatises ; for while such matters only come very occasionally under the notice of the Medical OfiB.cer of Health, they could not be usefully described except at considerable length. Torrens's If the Medical Officer of Health is of opinion that any premises " are in a condition or state dangerous to health so as to be unfit for human habitation," he is to report (in writing) on the matter to the Sanitary Authority, who will refer the matter to the Engineer or Surveyor, and get his suggestions, whether they concern the improvement or the demolition of the premises, enforced by means of the Artizans' and Labourers' Dwellings Act (1868), if that Act applies to the place in which the premises are situated. INSPECTION OF TRADES, ETC, 289 CHAPTER VII. INSPECTION OF TRADES, ETC. Slaughter 'houses. — The places for slaughtering cattle, sheep, and pigs for human food are of two sorts : they 2iYe either ipublic abattoirs or private slaughter-houses. I cannot quote a higher authority than Tardieu to show the advantages of public over private slaughter-houses. He says (I)ictionnaire d^Hygiene Puhlique et de la Medecine Legale^ art, * Abattoir') — " We must point out that the establishment of communal Advantages and pubhc abattoirs is of capital importance as regards the abattoirs, butcher's trade and the exercise of supervision over the kind as well as the quality of the meat. Beasts intended for food are taken directly to the abattoirs^ where a special inspection, entrusted to competent men, is carried out. It is forbidden to slaughter in these public establishments animals suflPering or supposed to be suffering from conta- gious diseases, and especially from malignant pustule or entozoic disease. Animals suflPering from other diseases cannot be slaughtered without the consent of the inspectors of the slaughter-house ; nor, in case of doubt, without the previous advice of a veterinary surgeon. Animals which happen to die in the abattoirs are treated in the same way. Lastly, the meat (whether of oxen, sheep, or pigs) must be inspected after the animals are slaughtered, and seized whenever it is found to be spoiled, tainted, or unfit for food." Slaughter-houses, whether public or private, must fulfil Paving, &c. certain conditions. The pavement must be impervious, made of York paving- stone or hard bricks set in cement, or of asphalt, and laid on four or five inches of concrete ; u 290 MANUAL OF PUBLIC MEDICINE and the drains should be constructed of glazed stoneware pipes. The freest possible ventilation should be provided. The walls should be frequently lime-whited. A sufficient sup- suppiy water is, of course, absolutely necessary ; but the old plan of providing an enormous supply was faulty for several reasons ; and the modern one to be seen at work at the public abattoirs in Paris, as recommended by Bouchardat — that of allowing a comparatively small sup- ply of water, and insisting on the place being kept clean by the continuous removal of all oflPal, blood, and other refuse — is by far the best.- By it much less is wasted ; and the cleanliness of slaughter-houses conducted in this way will compare favourably with those in which the careful re- moval of putrescible matters is avoided by flooding the place with water. It need hardly be added, however, that where this plan is carried out it must be under constant authoritative super- vision, and that, where this cannot be had, the plan of insisting on the use of a very large quantity of water is the safest one ; and so in all private slaughter-houses one of the first necessities is the presence of a sufficient supply of water ; and the tap should, as a rule, project from the wall over the highest point of the floor. Blood. The blood should not be allowed to run into the drains, or it will stop them up ; and a special receptacle should be provided in every slaughter-house to receive it. In large slaughter-houses, where many animals are killed, this is always done on account of the value of the blood ; but in small ones it is sometimes allowed to run into the drains. j)Qgg^ Occasionally, butchers are in the habit of tying up dogs in the slaughter-house at night. This should never be allowed, as it is a practice which is not only filthy, but dangerous, on account of the facilities afibrded by it for the spread of entozoic disease. Licenses. Private slaughter-houses have in London to be licensed annually by the magistrates ; and the local authorities may, if they choose, and do occasionally, upon the advice of their medical officer, who makes an inspection of all the slaughter-houses once a year, oppose either the renewal of INSPECTION OF TBABES, ETC. 291 old licenses or the granting of new ones. But there are considerable difficulties in the way of refusing licenses to the proprietors of slaughter-houses which have been licensed for a number of years, but which, from their proximity to dwellings, cannot but be a nuisance, however well they are kept. Although it is admitted on all hands that a o:reat im- Private 1 PI . slaughtor- provement has taken place m the condition of the private houses, slaughter-houses in London since the introduction of inspec- tion by the Sanitary Inspectors and by the Medical Officers of Health, yet it cannot be denied that there are a large number of private slaughter-houses in London and other towns which are a nuisance to the persons living in the neighbouring houses, even if they are well kept ; and plenty more that are so because they are kept badly. In many Bad instances these slaughter-houses are placed in small back p^^^^^^^^"^' yards, with houses builfc all round, the only access to them being through the house of the butcher; so that the animals have to be driven across the pavement and through the shop, and often down steps into the yard. The impossibility of any inspection whatever of the con- Disad- dition of the animals slaughtered in private slaughter-houses is obvious. Perhaps, however, the strongest argument that can be used against them, and that can be urged in favour of their discontinuance, which it is to be hoped will be in great measure effected next year, when the Act of 1834 will come into force, is, that very few butchers in the best parts of London slaughter at all. They apply annually for Private their licenses, so that they may not lapse for this would necessary, diminish the value of the premises ; and also that they may be able, if they choose, to slaughter occasionally ; but they do not find it necessary, or even expedient, to have the animals driven up to London and to slaughter them on their own premises. Whether on the ground of public health or on that of economy, there can be no question of the superiority of public abattoirs over private slaughter-houses — a superiority acknowledged and acted upon in Paris as long ago as 1810. Cowsheds are (if the milk is sold) subject to the same u 2 292 MANUAL OF PUBLIC MEDICINE Paving channels, &:c. Ventilation. Water supply. Wells. Mangers. conditions as to licensing (in the Metropolis) as private slanghter-houses. They are visited freqnently by the san- itary inspectors, and once a year by the medical officer as well. The paving requires to be impervious, and laid on con- crete, as in the case of slanghter-houses. The channels must be well laid, so that the water runs freely off them, and does not accumulate in pools. They are best made of York paving or asphalt ; and if made of brick, require to be frequently set to rights, as they become uneven. The mangers should be lined with cement. Cowsheds must be well veatilated. It is well to insist on having a louvred window in each stall ; and, if there be a loft overhead, the floor should be taken off over the heads of the animals for about three feet all along, and the tiles of the roof should not be pointed. It is much better, however, not to have lofts over cowsheds at all. The cubic space allotted to each cow should be about 1 000 cubic feet, at least 800. The water supply is a most important consideration in connection with cowsheds. So many epidemics of enteric fever have now been traced to wells or tanks containing polluted water, in dairies and cowsheds, that it becomes a matter of necessity to insist, in all cases, that the water supply to a cowshed or dairy be unexceptionable. Under- ground tanks should not be allowed, and wells only when there is no doubt as to the purity of the water they contain. It is, however, very difficult to prevent the use of wells, unless it can be clearly proved that they actually do, on a particular day, contain water which is then unfit to drink. There are plenty of wells in London and other large towns of which this cannot be said. It is a good plan to have the mangers so constructed that they incline in the opposite direction to the channels, so that water thrown into the manger at the upper end may run down it, and, when above a certain level, overflow so as to run into the upper part of the channel and then down along it into the drain. Thus, every time that the cows are watered, the channels will be washed. The grain- pit as well as the dung-pit must be properly drained. The INSPECTION OF TBADE8, ETC. 293 manure and other refuse matters from slaughter-liouses and Manure, &c. cowsheds should be removed very frequently, every other day, or, if there be a large quantity, daily. The same is to be said about the manure from stables ; and sanitary author- ities have power, under the Sanitary Act, to insist that it shall be frequently removed from such places. Piggeries should be got rid of, if possible, whene\^er they are near to houses ; they are almost invariably a nui- sance, and ought not to be tolerated in populous districts. Neither pigs nor any other animals ought to be kept except Animals in properly paved and drained sheds, or they will necessarily be a* ^ be a nuisance to the neighbourhood, and a notice should always be served on anyone offending in this way, and followed up, if necessary, by a summons to appear before a magistrate, sufficient evidence being brought forward to prove the existence of the nuisance. Bakehouses require to be inspected frequently, and at irregular intervals. It is obviously necessary that they, and all the troughs, tables, &c., used in them, should be kept scrupulously clean ; and to this end it is provided by the 26th & 27th Vict., cap. 40, as follows :— " The inside walls and ceiling or top of every bakehouse Cleanliness, situate in any city, town, or pla<3e containing, according to the last census, a population of more than five thousand persons, and the passages and staircase leading thereto, shall either be painted with oil or be lime-washed, or partly painted and partly lime- washed ; where painted with oil there shall be three coats of paint, and the painting shall be renewed at least once in seven years, and shall be washed with hot water and soap once at least in every six months ; where lime- washed the lime-washing shall be re- newed once at least in every six months. " Every bakehouse, wherever situate, shall be kept in a cleanly state, and shall be provided with proper means for effectual ventilation, and be free from effluvia arising from any drain, privy, or other nuisance. ' ' If the occupier of any bakehouse fails to keep the same in conformity with this Section, he shall be deemed to be guilty of an offence against this Act, and to be subject in respect of such offence to a penalty not exceeding five pounds. 294 MANUAL OF PUBLIC MEDICINE Penalties for infringe- ment. Fires or explosions. Poisons. " The .Court having jurisdiction under this Act may, in addition to or instead of inflicting any penalty in respect of an offence under this Section, make an order directing that, within a certain time, to be named in such order, cer- tain means are to be adopted by the occupier for the pur- pose of bringing his bakehouse into conformity with this Section. The Court may, upon application, enlarge any time appointed for the adoption of the means directed by the order, but any non-compliance with the order of the Court shall, after the expiration of the time as originally limited, or enlarged by subsequent order, be deemed to be a continuing offence, and to be punishable by a penalty not exceeding one pound for every day that such non-compli- ance continues." And that the officer of healtb or sanitary inspector, or any other person appointed by the local authorities, may enter any bakehouse at all times during the hours of baking ; and that any person obstructing him, or refusing admission, shall, for each offence, incur a penalty not ex- ceeding 201. Dangerous or noxious trades may be divided, for public health purposes, into four classes ; — 1. Those which are especially liable to fires or explosions, as petroleum works or stores, gas works, and the like. About the propriety of insisting that such works should be as far as possible from the centre of the population, there can be no question, apart from, the fact that they frequently cause a nuisance to the neighbourhood around ; and this is especially the case with the manufactures attached to gas , works. It must be remembered also that the leaking of gasometers, by which escape of the foul water contained in them into the subsoil is allowed, has frequently been the means of polluting the wells of a whole neighbourhood. 2. Trades in which poisonous matters are given out into the air. Gas works must be again included under this head, because the possibility of accidents causing con- siderable escape must always be taken infco account ; the great advantage of the oxide of iron process for the purifi- cation of gas over the lime processes (wet and dry) from a sanitary point of view are, it is believed, acknowledged on INSPECTION OF TRADES, ETC, 295 all hands, and its employment should be insisted on : lime- kilns, which give out enormous volumes of carbonic acid, both from the limestone burnt and from the fuel employed, and which have been the cause of suflPocating persons living in the immediate neighbourhood ; and especially smelting works, ft'om which sulphurous acid, arsenious acid, &c., are liable to be allowed to escape into the air ; soda- works, where we have hydrochloric acid as a refuse product and the like, are liable to become a nuisance, especially as Dr. Angus Smith says that chlorine, hydrochloric acid, &c. are carried in the air for long distances. They are placed in France in the first class of noxious trades. In them, every precaution that can be devised should be taken to prevent Precautions, the escape of the poisonous materials. The processes should be conducted in closed vessels where practicable. Vapours, such as that of hydrochloric acid, should be absorbed by water, being made to pass through high chimneys, in which water is continually trickling, or by some other suitable method. 3. Trades in which the danger to health arises chiefly Dust to the operatives from the fine dust floating continually in the air of the premises. Such are those of marble workers and polishers of various sorts, especially those who use emery, as steel polishers. In these trades the great danger is from phthisis ; but it is seldom that they cause much nuisance to the neighbourhood, except in the case of manu- factures of artificial manures, in which the manure made by ground-up coprolites and bones, frequently mixed with a certain amount of putrid organic matter, and treated with concentrated sulphuric acid, gives off, when dry, a very fine dust, which is particularly irritating, and which, if blown out of the premises, may cause a considerable nuisance to the neighbourhood. The smoke from factory chimneys may perhaps be mentioned here : smoke consuming furnaces should be used. 4. Lastly, we have trades where the nuisance consists in organic the necessary production of foul organic vapours ; and ^^^^a- these are very numerous. Places where horses are slaugh- tered, and their carcases turned to the various uses to which they are assigned, must be mentioned first, necessi- 296 MANUAL OF PUBLIC MEDICINE tating, as they do, the works of the bone boiler, the soap maker, &c. Then those of the albumen makers, gut cleaners and preparers, and a quantity of other offensive trades. Varnish makers may also be added, for the fumes emitted by the boiling resins are very offensive. In all such cases the best plan is to insist that the vapours from the boilers (which should be provided with covers that can be easily lifted up and let down) be con- ducted into a flue which passes into the furnace of the boiler itself, so that they are effectually burnt. And this can be done in almost all cases. ISTo accumulation of offensive matters, as rags at marine- store dealers' warehouses, &c., should be allowed to remain any longer than is absolutely necessary for the purposes of the trade. It is only when a manufacturer is found to be neglecting the precautions which are considered necessary to prevent his processes becoming a nuisance that he can be interfered with, and compelled to remove his business to some other place. The inspection of articles of food exposed for sale is a matter that must be left to common sense, guided by a little practical experience. Entozoic diseases are sufficiently described in medical treatises. 297 DEATHS registered in the District of during the 13 Weehs ending March 29th, 1873. . CAUSES OF DEATH. Ages at Death. Sub-Districts & Population. Sexes. Under 1. 1 1 and under 5. 5 and under 20. 20 and under 40. 40 and under 60. 60 and under 80. 80 and above. A— 18,700. B.— 13,020. C— 58,038. Workhouse— 268. Residents. 1 [ pital 216. f2 1 Males, 38,456. 1 Females, 51,302. Total, 89,758. Class I. Zymotic Diseases. Order 1. — Miasmatic Diseases. g g IC 5 2 2 3 25 5 5 21 19 40 I I 2 3 6 4 2 6 3. Scarlet Fever (Scarlatina) . I I I 4 2 2 4 1 2 1 4 3 I 4 7. "Whooping Cough .... 1 I I Enteric (Typhoid) Fever . I 2 6 1 5 2 3 4 6 lO Simple Continued Fever . I I I 10. Puerperal Fever (Metria) . I I I 11. Pygemia I 2 I 2 2 3 I 4 15. DiarrhcEa 5 I 2 I 3 4 2 6 I I 1 2 3 Order 2.— Enthetic . . . 1 1 1 1 1 1 3 3 I I I 2. Stricture of Urethra . . . I I I I 2 2 Order 3.— Dietetic . , , 4 2 1 4 1 5 1 6 2. Want of Breast Milk . . . 3 2 2 1 3. Purpura and Scurvy . . . ..AlcohoUsm{-?„e™- I I I 3 I I 2 1 2 Order 4. — Parasitic. . , 2 2 2 2 Class II. Constittjtional Diseases Order 1.— Diathetic . . 1. Gout 2. Dropsy 3. Cancer 1 1 3 3 10 I ■ I 8 5 2 3 3 I 2 2 2 2 7 3 4 1 I 6 5 1 8 1 2 5 2 11 2 9 2 19 1 4 14 298 (JAUSlib UJb DJliATH. Ages at Death. Sub-Districts & Population. Sexes. 1 Under 1. 1 and under 5. 5 and under 20. 1 20 and under 40. 40 and under 60. 60 and under 80. 80 and above. I A.— 18,700. B.— 13,020. CO 00 0^ CO 1 Workhouse— 268. ■ Hos] —2 02 "i Dital 16. aJ Males, 38,456. | Females, 51,302. Total, 89,758. | Order 2.— Tubercular. . . 2. Tabes Mesenterica .... 4 2 4 11 OQ Zo g 36 I 2 1 4 11 34 I 2 25 59 I 2 I 23 14 3 1 6 29 I 4 II 30 22 52 I 2 I 4 I 3 4 Class III. Local Diseases. Order 1. — Nervous System . . 10 8 4 2 15 19 2 11 8 33 2 4 2 34 26 60 IP,-. I I 1 2. Apoplexy 9 12 I 4 4 4 n II 22 3. Paralysis 4 4 I 3 I 5 4 5 9 4. Insanity 2 2 2 I 3 4 2 I 3 2 3 g 5 3 2 10 3 8. Brain Disease, &c. .... 2 I ^ 3 I 4 Order 2. — Organs of Circulation. 2 7 8 15 I 3 4 19 1 5 17 15 32 2. Aneurism 2 I I 2 3 3 3. Heart Disease, (kc I 5 8 I 3 3 19 I 3 14 15 29 Order 3. — Respiratory Organs. 14 16 1 11 25 37 5 25 4 67 7 3 3 55 54 109 2 I I to ^3 14 3 18 3 45 6 I I 38 36 74 •^^ I I 1 3 >> 2 6 2 I 6 5 II 5. Asthma 2 3 2 I 5 I 5 2 7 I 2 7 3 4 I 8 I 5 9 14 Order 4. — Digestive Organs . 4 2 5 9 6 2 3 17 1 3 12 14 26 1. Gastritis I I J. 2. Enteritis 2 2 3 Peritonitis I 2 2 2 4 4. Ascites 5. Ulceration of Intestines 6. Hernia 7. Ileus and Intussusception i I I 2 I 3 I 3 2 5 10. Stomach Disease, T3T V JZjJJlISiJU xtvyJi YV Al Jlixt O Uir rJj x Sept. 25 Swanston .... •03 •10 Do. Crawley .... •01 •08 Do. Colinton .... •14 •08 Do. Comiston .... •00 •03 Sept. 18 University tap .... •00 •07 1867. Oct. 3 GrLASGOw Watee (from Loch. Katrine) . •00 •08 1871. Scarborough Water-Supply Dec. From the Pumping Station •01 •06 New Water-Supply to Guildford 1 0 TO (Surrey) Feb. 6 consisting of deep spring water ' •00 •01 1867. Water from Cold Harbour, Dorking •01 •00 ioD/. UATERHAM- W ATER alter tile application of Clark's softening process . •04 •00 1868. Five Springs in the West of England J my No. 1 (containing 26 grs.of solids per gal.) •00 •01 Do. No. 2, with 23 grains . •01 •04 Do. No. 3, with 20 grains . •00 •01 Do. No. 4, with 62 grains . •00 •01 Do. No. 5, with 20 grains . •01 •03 Three of the Thames Companies which supply London with water, supply water which does not yield more than 0*06 or 0'07 milligrammes of albuminoid ammonia per litre. This they do in summer time, and ordinarily when the river is not flooded. Occasionally, however, in winter and in flood-times the water supplied by these Companies is not so pure ; owing, no doubt, to the capacity of the filtering beds being overtaxed. y 2 324 MANUAL OF PUBLIC MEDICINE Two of the Thames Companies, viz. the Southwark and Vauxhall and the Lambeth Companies, supply impure water at all seasons ; and instead of '06 or '07 milligrammes per litre, supply water yielding on an average about '14 milligrammes of albuminoid ammonia per litre. These Companies have had defective filters, and indeed have been supplying London with water which is only slightly cleaner than the unfiltered Thames water drawn from the river at Hampton Court. Ordi- narily the water of the New River Company which is supplied to London does not give more than '06 or '07 milligrammes of albuminoid ammonia per litre. The water which is brought to Manchester, from the high ground at Woodhead, showed a similar result when it was examined. The same thing has been noted relative to the waters of Edinburgh, Chester, Scarborough, and Derby. These remarkable results have led to the assignment of the limits ' '06 or '07 milligrammes of albuminoid ammonia per litre ' as the limits which distinguish clean from unclean water. N^o town ought to be served with water which over- steps these limits. WATER 325 Tn conclusion I will give some examples of analysis of waters which are not fit to drink. Parts in a million Milligrammes per Litre. Free Albuminoid Date. Ammonia. Ammonia. 1 9.79 Feb. An * Effluent "Water ' from sewage . Waters from the Thames at London Bridge, taken at different states 16-20 0-90 OF THE TIDE J 1II16 Hign tide .... ro2 0-59 1)0. .... 1-02 0-56 Do. . . . . 1-02 0-50 At two hours flood (after filtration througli paper) . . . 1-76 0-35 1867. June Great St. Helen's Pump, Ijondon 3-75 0-18 Pu:mp in Bishopsgate Street, London 7-50 0-26 "PTTunj T"M "Tit? AT>T7T>c' TT A T T T,r»Tirlr»'n J. yj JxLtr IIN J^xviUrili Cvo J.XAXjJ^, J-iUUU.Ui-1, • 3-75 0-18 1867. Pump in Edinburgh . 0-21 0-29 1873. Well Water in Windsor (containing 60-2 grs. of solids and 6*9 grs. of chlorides per gallon) 1-20 0-08 1873. Well Water from Eton (containing 48*5 grs. of solids and 5*6 grs. of chlorides per gallon) •00 0-84 326 MANUAL OF PUBLIC MEDICINE CHAPTER II. AIR. In order to a right understanding of the subject, it will not be useless to begin with a general survey of the chemical composition of the atmosphere. The atmosphere consists mainly of the two gases, nitrogen and oxygen, which are not combined with one another, but only mixed together. The relative proportions of these gases are 79*02 volumes of nitrogen, and 20*98 volumes of oxygen. This ratio is maintained all the world over, whether we go to the top of the mountain, or to the surface of the sea, or down into the valley. Hardly is it altered by the greatest activity of our busiest and most populous towns, notwithstanding that every animal that breathes, and every fire that burns, is using up the oxygen of the air. In the air of the streets of Man- chester and of the streets of London, there is all but as high a proportion of oxygen as in the air ofi" the hill-tops in Scot- land. Vide the follov/ing table, compiled from Dr. Angus Smith's admirable book on " Air and Rain " : — SOUECE OF THE AIR. Oxygen. Percentage by volume (in dried air) Tops of Hills (Scotland) . .... 20-98 North East Sea-shore and open heath (Scotland) . 20*999 Suburb of Manchester in wet weather . . . 20"98 Do. do. ... 20-96 From Marburg (Grermany), analysis by Bunsen . . 20*92 Mean of a great number of specimens of Air from Paris (analysis by Regnault) .... 20*96 Average composition of the Air in open parts of London (by Dr. Angus Smith) .... 20*95 Average composition of Air in the worst parts of London Streets (by Dr. Angus Smith) . . . 20*857 AIR 327 Even in such places as the tunnel of the Metropolitan railway and in close rooms the fall in the oxygen is of a very trifling description, as may be judged of from the following analysis made by Dr. Angus Smith : — Oxygen. Date. Place. Percentage by volume (in dried air). 1 Q.CKQ 1 ooy. JVIeteopolitan JKailway. Nov. 12 Tunnel between Grower Street and King's Cross Stations : specimen taken at the open win- dow, first-class carriage, 10 a.m. Do. Do. 7.30 P.M. . . 20*79 Do. Tunnel, Praed Street : specimen taken at the open window, second class carriage, 10.30 a.m. 20*71 Nov. 15 Specimen taken during journey between Grower Street and King's Cross, first-class carriage, windows open, 10.15 a.m. 20*66 Do. Do. 3 P.M. .... 20-70 Do. Do. 11 P.M. .... 20-74 Average 20-70 Air taken from a sitting-room which felt close, but not excessively so . 20-89 From small room with petroleum lamp 20-84: Do. after six hours .... 20*83 About backs of houses and closets 20-70 Pit of theatre, 11.30 p.m. ..... 20-74 Gallery of theatre, 10.30 p.m. .... 20*63 From which it is abundantly evident that a lowering of oxygen to the extent of only 0*3 per cent, is all that takes place in many badly ventilated places. Now, in itself, this lowering of the oxygen is far too trifling to be of influence on the animal economy. In mines a far greater depression of the oxygen is observed than in the worst ventilated rooms. The worst in- stance of air in a mine cited by Dr. Angus Smith, is that in which the oxygen fell to 18'27. Even, however, in this ex- treme case it is not improbable that the deficiency in oxygen is in itself of no biological importance. Turning to history, it may possibly not be uninteresting to make the observation that the captives in the Black Hole in Calcutta did not perish (or even sufier) for lack of oxygen. From the foregoing it will be abundantly plain that the 828 MANUAL OF PUBLIC MEDICINE Medical Officer of Health need not trouble himself with measurements of oxygen in air, but that he must look to .other criteria. Next after oxygen in abundance in the atmosphere, comes aqueous vapour. This forms, on an average about one per cent, of the volume of the atmosphere, and is by far its most variable constituent. It will not, however, occupy our attention. Leaving the nitrogen, oxygen, and water, which make np the great mass of the atmosphere, we now pass on to those constituents which exist in the air in minute proportions, but which determine the differences between different atmospheres, and form the subject of air-analyses for sanitary purposes. Next in abundance after aqueous vapour comes the carbonic acid, which forms 0*037 volume in 100* volumes of air. In point of quantity, the carbonic acid of the atmosphere may be likened to the soHd residue in water ; and, curiously enough, the proportion by volume of carbonic acid in the atmosphere is very nearly that of the weight of the solid residue to the weight of the London water which yields it. Thus 100,000 volumes of air contain 37 volumes of carbonic acid, and 100,000 parts (by weight) of Thames' water, as supplied to London, contain 30 parts (by weight) of dissolved solids. This parallel may serve to give an idea of the scale on which atmospheric impurity actually occurs in nature. The follow- ing table (compiled from Dr. Angus Smith's book) shows the range of variation actually to be met with in the open air. Volume of Carbonic Acid in 100 vols, of Air. Lake of Greneva (by Saussure) years 1826 to 1829 (mean) '0439 Chambeisy (by Saussure) years 1826 to 1829 (mean) . '0460 Munich (by Pettenkofer) mean .... '050 Suburbs of Manchester (by Angus Smith) year 1864 (mean) '0369 Open parts of London (by Angus Smith) mean . . '0301 Surface of the Thames (by Angus Smith) mean . , -0343 In the Steeets of London : — Cheapside ....... -0352 Do. ...... . -0337 Outside the Exchange ..... -0398 Newgate Street ...... -0413 Oxford Street ...... '0344 AIR 329 Volume of Carbonic Acid in 100 vols, of Air. Lower Thames Street ..... -0428 Small Alley, Smithfield ..... -0337 Small Court, Lambeth ..... -0382 New Cut ....... -0413 Top of Monument . ..... '0398 Showing that the air of London streets is hardly appre- ciably richer in carbonic acid than the air of the country. Even in close rooms the rise in the carbonic acid is very slight, vide the following : — Volume of Carbonic Acid in 100 vols, of Air, Close Places in London : — Chancery Court, shut . . . . .0*193 Do. do. .... . -203 Do. open ..... -0507 Do. do. .... . -045 Strand Theatre, gallery, 10 p.m. . . . . 'lOl Surrey Theatre, boxes, 10.3 p.m. . . . . 'Ill Do. do. 12 P.M. . . . . -218 Olympic, 11.30 P.M. ..... -0817 Do. 11.55 p.m. . . , . . -1014 Victoria Theatre, . . . . . '126 Pavillion, 10.11 P.M., Whitechapel . . . '152 City of London Theatre, pit, 11.15 P.M. . . . '252 Standard Theatre, pit, 11 P.M. .... '320 Metropolitan Kailway . , . . , '078 Do. ..... -338 It is hardly necessary to call attention to the fact that in the worst of all these instances, the cajrbonic acid has not risen to a dangerous height. It is indeed not improbable that the mere rise in the carbonic acid from 0'037 to 0*338 vol., is in itself of no consequence whatever ; and it is certain that the feeling of closeness is not due to this rise. We are in great darkness as to the real cause of foulness of atmosphere. Cer- tainly the action of animals on a confined atmosphere fouls that atmosphere; apparently too the burning of lamps and candles contributes to do so — but the fouling is not in virtue of the abstraction of oxygen and generation of carbonic acid, but is due to something else, which is not yet understood. 330 MANUAL OF PUBLIC MEDICINE There is some reason for thinking that animals actually poison the atmosphere which they breathe, and that lamps and candles throw off traces of carbonic oxide, or acetyline, or other actively poisonous substance. Be this, however, as it may, certain it is that the discharge of carbonic acid is the concomitant of fouling of the air. It is highly probable that the chemist might produce an atmosphere which shall be quite salubrious, and yet richer in carbonic acid and poorer in oxygen than the air of the Standard Theatre or of the Metro- politan tunnel ; but in nature and in daily life we do not meet with such air, and we may take slight elevations of the pro- portion of carbonic acid as very trustworthy signs of defile- ment of the atmosphere. As has been said, normal air contains 0*037 per cent, (by volume) of carbonic acid. According to Pettenkofer, when the proportion of carbonic acid exceeds O'lOO per cent, (by volume) the air is too much defiled ; and if such a state of things be found in a dwelling-room, it is high time to improve the ventilation. Methods of measuring the Garhonic Acid m the Atmosphere. — Carbonic acid is absorbed by caustic alkalis, forming carbon- ates, and accordingly when air containing carbonic acid is treated with alkali the air is deprived of its carbonic acid. This fact is made use of by the chemist in the analysis of gases. If a gas containing carbonic acid be measured, then submitted to the action of alkali and finally measured after the alkali has absorbed the carbonic acid, the volume of the car- bonic acid may be found by the difference between the two measurements. This method of procedure is in common use among chemists who devote themselves to gas-analysis, and is valid when the proportion of carbonic acid is considerable. In the case of examinations of the atmosphere, it is, however, an invalid procedure ; because, the error of observation is larger than the quantity to be measured. This may be readily under- stood when it is considered that the limit of accuracy in the mjsasurement of gas is 0'0002 of the total volume. If then 100-00 volumes of air be indifferently represented as 100*00 or as 100*02, and if this error be made twice over (there are the two readings), there must be an experimental error of 0*04 AIR 331 per cent, whicli we have seen a little exeeeds the normal volume of carbonic acid in the air. Although the futility of this method of determining the carbonic acid is palpable enough when once pointed out, there is, nevertheless, in chemical literature a rather recent example of such a deter- mination of the carbonic acid in the air on the Alps by a very well-known chemist. Accurate measurements of the carbonic acid are to be made by taking advantage of the formation of the insoluble car- bonate of lime or baryta when lime-water or baryta- water is exposed to the air. De Saussure exposed 34 litres of air to the action of lime or baryta, and actually weighed the insoluble carbonate which was produced. Dalton, and after him Pettenkofer, have slightly modified this proceed- ing. Instead of weighing the carbonate, they measure the strength of the lime-water or baryta-water ; then they allow the absorption of carbonic acid to take place, and thereby a certain proportion of the alkali is neutralised, and finally they determine the alkalinity of the partly exhausted lime or baryta- water. The difference in the two strengths becomes thus the measure of the carbonic acid in the air under exami- nation. In his excellent book, to which I have so often referred, Dr. Angus Smith calls attention to the possibility of effecting simplifications in this process. Instead of adopting the plan of weighing the carbonate of lime or carbonate of baryta, and instead of adopting the differential titration just sketched out, Dr. Angus Smith proposes to go by the dej)th of turhidity. The plan which he adopts is to ascertain the volume of air requisite to produce a given degree of turbidity in a certain volume of lime or baryta- water. The smaller the volume of air required to produce the effect, the richer the air in car- bonic acid. I am inclined to believe that a somewhat different modification will be found to be more convenient in practice, and propose the following method : — A solution of carbonate of soda in water is first made as follows : — 4*74 grammes of gently ignited carbonate of soda are dissolved in one litre of water, giving a solution of such a strength that one cubic centimeter contains exactly one cubic centimeter of carbonic acid ( = 1*97 milligrammes of 332 MANUAL OF PUBLIC MEDICINE C O2). A large quantity of baryta- water (strength about 0*1 per cent.) is prepared. If now 100 cubic centimeters of clear baryta-water be treated witb one cubic centimeter of the standard solution of carbonate of soda just described, a certain degree of turbidity is produced. If two cubic centimeters of the solution be taken, another degree of turbidity is produced, and so on. If then a bottle capable of holding 2,000 cubic centimeters of air, together with 100 cubic centimeters of baryta-water, be filled with the sample of air to be tested, there will be a certain depth of turbidity produced on shaking Having got the air to exhaust itself on 100 cubic centi- meters of baryta- water, the degree is to be found by com- parison with another 100 cubic centimeters of baryta- water in which a like turbidity has been induced by means of the standard solution of carbonate. Every cubic centimeter of soda- solution counts for a cubic centimeter of carbonic acid in two litres of the air. A consumption of one cubic centi- meter will correspond to 0'05 volumes of carbonic acid per cent. Good air should accordingly not take more than one cubic centimeter of the soda solution, air which takes two cubic centimeters being already bad. In order practically to execute this determination of car- bonic acid, the following apparatus is required: — Several bottles capable of holding 2,210 cubic centimeters and well stoppered. (Failing bottles of exactly the right capacity, Winchester quart bottles will answer.) A small pair of bellows. Several colourless glass cylinders, marked at 100 cubic centimeters capacity. The Nesslerising cylinders will answer for this purpose. A graduated pipette or burette to deliver tenths of a cubic centimeter of solution. The standard solution of carbonate of soda, and the baryta- water, which may be of moderate strength. The testing is managed thus : — Winchester quart bottles having been washed clean, are rinsed with distilled water and allowed to drain a little. They are then closed with their stoppers, and are ready for use. The operator, having pro- vided himself with two or three of these bottles and a small AIB 333 pair of bellows, enters the room the air of which is to be tested. The stopper is then removed from one of the bottles, and some air of the room blown through with the bellows, and then the stopper is replaced and the bottle carried away to be tested. The testing is done by pouring into the bottle 100 cubic centimeters of clear baryta -water, shaking up for two or three minutes, and then pouring out into a cylinder of colourless glass and observing the depth of turbidity in various lights and against various backgrounds. The turbidity is to be exactly imitated by means of the standard solution of car- bonate of soda. In order to imitate the turbidity produced by a Winchester quart full of good air, only one cubic centi- meter of this solution of carbonate of soda is required. If two cubic centimeters, or more than two, are required, the air is bad, and the ventilation is defective. In place of the first cubic centimeter of solution of carbonate of soda, the carbonic acid naturally present in a Winchester quart of good average air may be used, and a little practice and intelligence will suggest the necessary precautions. In addition to carbonic acid, air contains ammonia and or- ganic nitrogenous matter in minute quantity ; and bad air has been shown to contain more of these than good air. Dr. Angus Smith's book may be referred to for further particulars relating to them. At present, however, I should recommend the medical officer to confine his attention to the carbonic acid. 334 MANUAL OF FVBLIC MEDICINE CHAPTER III. MILK, BUTTEE, AND CHEESE. Milk is a solution of milk-sugar, caseine, and certain mineral salts in water. It contains also, fat, partly in solution, but mainly in the form of globules. The fat has been said to be coated with some kind of membrane, being, at any rate, pro- tected to a great extent, from the action of ether. For the purposes of this book, we shall confine ourselves to cows' milk, which is the only kind of milk which has any commercial importance in this country. The first point to be brought out, is the great constancy of the composition of the milk of well-fed cows. According to the observations of Miiller and Eisenstiick, which were carried out for the Agricultural Society of Sweden, the milk of a herd of cows (fifteen cows of difierent breeds) contained on average 12*8 per cent, of solids, and never once, during an entire year, contained less than 11*5 per cent, of solids. The highest per- centage of solids observed on any day throughout the year was 14'08. My own observations are completely in accord with the Swedish results ; and it may be accepted as a well-estab- lished fact, that cows' milk does not contain less than 11 '5 ^er cent, of solids^ and seldom less than 12 per cent, of solids. The average composition of cows' milk, I take to be 12' 5 parts of solids, and 87*5 parts of water. According to an analysis of my own, good country milk contains : — Water ....... 87*55 Pat ....... 3-07 Caseine ....... 4'04 Milk-Sugar ...... 4-63 Ash . . . . . . 0*71 100-00 MILK, BUTTER, AND CHEESE 335 By dint of stall-feeding, healthy cows may be made to give richer milk, and in a specimen of such milk I found, solids, 14'07 parts, and water, 85*93 parts. Water Fat Caseine Milk-Sugar Ash 85-93 4- 00 5- 02 4-31 0-74 100-00 The analysis of milk may be conveniently made in the fol- lowing manner : — five grammes of milk (well stirred up, so as to get a fair proportion of cream) is weighed out and evapo- rated to dryness in a small and shallow platinum dish, heated in an appropriate water bath. From numerous experiments I find that there is no difficulty in taking the solid residue in milk with great accuracy. The heating at 212^ Fah. must be maintained for three hours ; and, that having been done, the residue vnll be found to be quite constant. I give four deter- minations of the residue in the same sample of milk, in order to show the degree of constancy which is easily attainable in work of this description. Grammes Grammes Percentage of Milk. of Solids. of Solids. Analysis I. . . 4-969 gaye 0-616 or 12'40 Do. II. . . 5-0105 do. 0-6255 or 12-48 Do. III. . . 5-007 do. 0-623 or 12-44 Do. IV. , . 5-0145 do. 0-626 or 12-48 I do not approve of the plan of mixing milk with sand (or with oxide of copper as a certain gentleman once proposed), in order to obtain the solid residue. According to my ex- perience, such admixtures are not required ; and certainly they are sources of error and uncertainty. It is, however, desirable that the analyst should be warned against operating on too large a quantity of milk. In order to obtain the mineral matter in milk (the ash as it is termed), the solid residue is carefully ignited and weighed. The results are, as given above, and very constant. For the fat, a soHd residue is exhausted with boiling ether, having been first just moistened with alcohol. The filtered ethereal ^36 MAmAL OF PUBLIC MEDICINE solution of the fat is then evaporated in the water-bath and weighed. For the milk-sugar, a solid residue from which the fat has been extracted, and which has been moistened with alcohol, is boiled with water, and the resulting solution filtered, and the filtrate evaporated to dryness in the water-bath and weighed. It must, however, not be forgotten that the common salt con- tained in milk will dissolve in the water, and that either it must be allowed for, or else the milk-sugar must be burnt, and the weight of the salt subtracted from the total weight of sugar- salt. Having, as above described, obtained the percentage of water (which is the difference between 100 and the percent- age of solids), also the percentage of fat, milk-sugar, and ash, the percentage of caseine may be found by difference. A direct determination of caseine may also be made as follows : — a known weight of milk (and for this purpose some twenty or thirty grammes of milk may be taken) is rendered slightly acid with hydrochloric acid, filtered, and the precipitated caseine washed very thoroughly with water. It is next washed with alcohol, and then washed with ether, in order to dissolve out the fat. A caution should here be given, relative to the washing with ether. The caseine must be got off the filter, and actually boiled with the ether, otherwise the removal of the fat will not be complete. It will be observed that so long as the caseine contains fat it will stick to the filter-paper, but that when the fat is removed, the caseine may very readily leave the filter-paper. As will, however, be perceived, the direct determination of caseine is not a very easy operation. Although precipitated by means of an acid, which might be expected to retain the phosphate of lime in solution, never- theless, experiment shows that the caseine is accompanied by the phosphate of lime, and that a burning of the caseine is necessary, in order that the weight of this phosphate of lime may be ascertained and subtracted. Another method of determining the percentage of caseinef is by means of 'the ammonia process,' or else by means of an elementary nitrogen - determination. Milk is diluted with 99 times its weight (or volume) of water, and the dilute milk is then distilled with alkaline so- lution of permanganate of potash, whereby every one part MILK, BUTTER, AND CHEESE 337 of caseine yields 0'065 parts of ammonia, whicli is determined by the Nessler test (vide chapter on water analysis). The percentage of ammonia obtained by this process for milk is 0*26, It is convenient to operate on -50 to 100 milli- grammes of milk by this process. (This is 5 to 10 cubic centimeters of diluted milk.) Adulterations and Sophistications of Milk. — There are two forms of wrong-doing in the milk trade, viz., the skimming of milk, either wholly or partially, and the diluting of milk with water. From an examination of more than a thousand samples of London milk, I conclude that not 10 per cent, of the milk sold in the metropolis is genuine ; that is to say, neither skimmed nor watered. This was especially and strikingly manifested in the course of an investigation of the milk supplied to workhouses and hospitals. The method of detecting fraud of this description is based upon a deter- mination of the total solids and also of the fat. Possibly I cannot do better than reproduce part of a paper published by me a short time ago, wherein this subject is fully discussed. If we consider the changes in composition which the ad- dition of water to milk will produce, it will be apparent that it must diminish the proportion of solids in the milk, whilst the effect of skimming is to diminish the proportion of fat, and to leave the proportion of ' solids not fat ' unaltered, or indeed, strictly speaking, to make a very trifling increase in the proportion of the ' solids not fat.' Treating the question quite rigidly, which I believe is the proper way of dealing with it, we arrive at the following : — Prohlem I. — Given the percentage of ' solids not fat ' ( — a), in a specimen of sophisticated milk (i.e., milk either watered or skimmed, or both), — required the number of grammes of genuine milk which was employed to form 100 grammes of it. Answer. — Multiply the percentage of 'solids not fat' by 100 and divide by 9-3. Or— 100 Prohlem II. — Given the percentage of ' solids not fat ' ( = a), also the percentage of fat (=?>) in a specimen of soj)histicated milk, — required the number of grammes of fat which have z 338 MANUAL OF PUBLIC MEDICINE been removed by skimming from the genuine milk which was employed to form 100 grammes of it. 3*2 Answer. — —a-h. In translating fat into cream, the rule is that a removal of 0*2 gramme of fat equals a removal of 1*0 gramme of cream. This rule is directly founded on experiment. I do not, however, claim a high degree of accuracy for the measure- ment of the cream. Finally, a slight refinement may be noticed. If a specimen of sophisticated milk have been produced by both skimming and watering, it will be obvious, on consideration, that the extraneous water employed in manufacturing 100 grammes of it is equal to the difference between 100 and the quantity of genuine milk employed to make 100 grammes of sophisticated milk, together with a quantity of water equal to the fat re- moved by skimming. Extraneous water = 100-^^ ci+ ^ a-h, =lQ0-100+3-2 An investigation of the different milks supplied to the different London Unions (which was made by me for the Government, at Mr. Rowsell's instance, last year, and which is published in Mr. Howsell's 'Report on the System of Supply of Provisions for the Workhouses of the Metropolis ' ) will furnish an illustration of this method of interpreting the results of milk-analysis. In column 1 is given the designation of the sample, viz., the name of the Union which furnished it, and the number of the sample. In column 2 is given the number of grammes of ' solids not fat ' contained by 100 grammes of the sample. In column 3, the fat. In column 4, the number of grammes of genuine milk which was employed in making the 100 grammes of sample (calculated) . In column 5, the number of grammes of fat removed by skimming from 100 grammes of sample (calculated). In column 6, the number of grammes of cream which had been skimmed off 100 grammes of sample (calculated). MILK, BUTTER, AND CHEESE 339 In column 7 is given the number of grammes of extra water which had been put into 100 grammes of sample (calculated). IX 100 GrRAMMES OF SAMPLE OP MiLK. Calculated. Grms. of Solids not Fat. a. . Grms. Fat. o S3 "B ^ O ICO 1 O S & i 1 O Grms. of Cream Removed ^ ^* CO lOi + 0 ICC 5 s Bethnal Green (St. Matthew) 1. 9-04 1-22 97'2 1-89 9-45 A .7 4 7 Camberwell (St. Giles) ... II. 4-38 2-08 47 1 — 0*57 — 2-85 OZ 0 I* 8-37 M4 90'0 1-74 8-70 11-7 5J ?» • • • II. 8-94 0-96 96*1 2*12 10-60 6-0 Chelsea (St. Luke) I 9-36 2-24 1 lUU 0 A. 00 u yo 4-90 " 5) II. 7'48 2-86 80-4 — 0-28 — 1-40 19*3 Fulham Union I. 9-09 1-52 y / o 1 0 1 8-05 )> II. 9-30 1-80 1000 1*40 7-00 1*4 St. George's Union I. 9-52 2-44 102*6 0*84 4-20 1 .0 — 1 0 TT 11. 9-08 2-82 97*6 0-31 1-55 2*7 St. George-in-the-East T 1. 6-55 2-32 — U Uo -0-30 ZiV 0 J) . . . TT 11. 5-92 L30 63*7 0-74 3-70 37'0 St Giles-in-thp-Fiplf]t{ Kr~\ T 1. 9*13 1-50 yo 2 1-65 8-25 3'4 St. George, Bloomsbury j II. 7-17 L96 '7 '7. 1 77 1 0-51 2-55 00 - A ZO 'I Greenwich Union I. 6-60 2-32 7 1 .A — U Uo -0-25 OQ- A j» n. 6-38 1-98 68*6 0*21 1-05 31-6 Hackney Union I. 9-09 3-50 97'8 — 0*47 -2-35 1*7 )j ...... IL 7-40 2-54 79*6 0-00 0-00 20-4 Hampstead (St. John ) ... I. 8-44 1-50 OA. 17 1-40 7-00 10*7 JJ ... II. 774 3-00 83-3 — 0-34 -1-70 16'4 Holborn Union I. 8-27 1-84 1-01 5-05 12*0 5> IL 7-64 2-40 82-1 0-23 1-15 18-1 Islington (St. Mary) I. 7-70 0-92 82-8 1*73 8-65 I8-9 97 M ... IL 7-06 1-45 75-9 0-98 4-90 25-1 Kensington (St.l I. 8-04 0-60 860 2-17 10-85 16-2 Mary Abbott) J II. 6-08 L26 65-4 0-83 4-15 35*4 Lambeth (St. Mary) I. 6-54 1-56 70-4 0-69 3-45 30-3 II. 7-08 1-22 76-1 1-22 6-10 25-1 Lewisham Union I. 6-42 0-96 58-3 0-90 4-50 42-6 )> II. 5-95 L30 64-0 0-75 3-75 36-7 London (City of) Union... I. 8-84 2-82 951 0-22 1-10 51 IL 6-26 MO 67-3 1-05 5-25 340 St. Marylebone I. 7-84 M4 84-3 1-56 7-80 17-3 II. 9-44 3-06 101-5 0-19 0-95 -1-3 Mile-End Old Town I. 9-55 1-96 102-7 1-32 6-60 -1*4 IL 8-70 1-80 93-6 l-]9 5-95 7-6 St. Olave's Union I. 7-17 1-86 77-1 0-61 3-05 23*5 >} IL 7-70 1-86 82-8 0-79 3-95 18-0 310 MANUAL OF PUBLIC MEDICINE In 100 Grammes op Sample of Milk. Calculated. i o ■§ > O 2 +3 o Is o B o ^ 1 Solids a. r-l lOS -g M) ICS S + 5 o LS. Ol 100, 3 CD c3 (2 Grm 100- O s f-i Padclington I. 7*22 1-44 77*7 1*04 5*20 23'3 11. 6-06 2-16 65-2 -0-07 — 0*35 34-7 St. Pancras I. 722 1-12 77'7 137 6*85 23-7 II. 4-94 1-64 53-1 0-09 0-45 47-0 Poplar Union I. 7'40 0-76 79-6 1*79 o 90 22-2 II. 5-96 0-90 64-1 1-06 5-30 370 St. Saviour's Union I. 6-65 2-10 71-5 0-19 0-95 28-7 II. 6-30 1-90 67-7 0-27 1-35 32-6 Shoreditch (St. Leonard) I. 9-99 1-48 107*4 1-96 9-80 -5-4 II. 9-44 2-36 101-5 0-89 4-45 -0-6 Stepney Strand Union I. 4-98 0*78 53-6 0*93 4-65 47-3 II. 5-09 0-58 54-7 1-17 5-85 46-5 I. 9-56 1-64 102-8 1-65 8-25 -1-2 II. 9-16 2-46 98-5 0-69 3-45 2-2 Wandsworth and"\ 1. 8-78 1-50 94-5 1-52 7-60 7-0 Clapham Union / II. 8-66 2-86 93-1 0-12 0-60 7-0 Whitechapel Union 5) • • • I. 5-62 0-68 60-4 0-25 1-25 39-8 II. 6-06 1-90 65-2 0-19 0-95 35-0 Inasmuch as I have submitted the analyses of these work- house milks to severe and elaborate treatment, it is right that some particulars should be recorded concerning the manner in which they were conducted. The ash of each milk was deter- mined, and in no instance was it excessive in amount, showing that no mineral had been used to adulterate the milk. For organic adulteration I made no elaborate analysis ; but no indication of such adulteration presented itself in the course of the examination; furthermore, I should add that I have never yet met with a case of adulteration of milk with organic substances, and believe it to be of very rare occurrence. The solid residue dry at 100° C. was taken with great — and I believe unprecedented — accuracy. I have made a study of the taking of milk-residues, and set down the average experimental error in the solid residue as not more than 0*02 per cent. The solid residues w^ere taken twice over, and the MILK, BUTTEB, AND CHEESE 341 mean of the two closely-agreeing determinations was employed in the construction of the table. The fats were taken with great care, but they do not pretend to so high a degree of accuracy as the total solids. It is hardly necessary to add that the numbers (designated as a) in the column headed * Grammes of Solids not Fat ' were obtained by subtracting the quantity of fat ( = h) from the quantity of total solids dry at 100° C. The calculation of the quantities of genuine milk employed in making 100 grammes of the samples is based on the assump- tion, which I believe to be warranted, that milk is tolerably uniform in strength, consisting of 9'3 parts * solids not fat/ 3 '2 parts of fat, and 87*5 parts of water. This is the composi- tion of country-fed milk. There is, however, an exceptionally rich milk given by highly stall-fed cows in town. This milk contains lO'O parts of ' solids not fat,' 4*0 parts of fat, and 86*0 per cent, of water ; but it is comparatively rare. If, in any instances in the above table, this rich stall-fed town milk have been employed instead of average country milk, then the real amount of watering and skimming in those instances is a little higher than the table exhibits. In the table there are seven examples of more than 100 grammes of genuine milk being used in making 100 grammes of the sample. Of these one appears to be an example of this towii- fed milk, the rest not being sufficiently above 100 to call for such a supposition. The example to which I refer is the Shoreditch milk, which on the first occasion yielded 9*99 per cent, of ' solids not fat,' which is a very close approximation to the ' sohds not fat ' in 100 parts of town -fed milk. When a exceeds 100 a minus- quantity will correspond to it in column 7, unless the slight correction for fat obliterate the minus-quantity of water. On calculating for town-fed instead of for country-fed milk, the minus- quantities in column 7 will disappear in every instance. The calculation for town-fed milk instead of for country-fed milk, as in the table, is simple, viz., substitute 10a for a ; substitute 0*4 a for The occurrence of minus- quantities in the column headed * Fat Removed ' requires a word of explanation. These minus- 342 MANUAL OF PUBLIC MEDICINE quantities have a real and substantial meaning. They are the quantities of fat which have been the reverse of removed, — that is to say, which have been added to the milk. Whenever one of these minus- quantities occurs in the ' Fat Removed ' column, one of three things has happened : — either the minus- quantity is within the limits of experimental error, as is the case with three of them (viz., -0*06, -0*05, and -0*07), or the milk was town milk, or the milk had through imperfect mixing received an undue share of the cream. There are only four cases of the kind in the table, viz., -0*57, -0*28, -0'47, and Chemical News, 18th Oct., 1872. It used to be the fashion to attempt to distinguish between genuine milk and watered milk by the specific gravity. Milk has a specific gravity of 1*029 ; but rich milk is lighter, and if specific gravity alone were depended upon it might be mis- taken for watered milk. There is a still further source of uncertainty in the circumstance that by skimming the specific gravity is raised, whilst by watering it is lowered, and that therefore, by alternately skimming and watering the original specific gravity m^iy be restored. The notion that such cases may be dealt with by supplementing the determination of specific gravity by a reading of the amount of cream is illusory, inasmuch as there is a more perfect rising of cream from watered than unwatered milk. I believe one of the soundest pieces of advice which can be given to those who are engaged in the testing of milk is to abandon the use of the lactometer. Besides skimming and watering there appears to be very little adulteration in the milk-trade. I have specially sought for mineral adulteration (such as chalk and salt) in more than a hundred instances, and in every case had positive proof that no mineral adulteration had been practised. I^^othing is easier that to ascertain whether or not milk has been adulterated in this manner. All that has to be done is to take the ash, and if this be not excessive then there can be no mineral adulteration. I have never met with a case of organic adulteration of milk, and do not believe that they are common. When anything of the sort is suspected it is to be dealt with by making a com- plete analysis of the sample in the manner described above. Butter. — This is the fat of milk which, as need hardly be MILK, BUTTEB, AND CHEESE 343 said, is extracted either from cream or from milk by a mechani- cal process. Mr. Way has found in ordinary butter — in its ordinary condition, as actually employed — Fat ....... 82-70 Caseine ....... 2*45 Water and a little Salt ..... __14-8o TOO^Q I have found in good fresh butter — A. B. Fat ...... 82-7 82-1 Salt . . . . . . 1-1 1-8 Water and trace of organic matter . .16-2 16'1 100-0 100-0 A was a sample of Devonshire fresh butter ; B was a sample of Normandy butter. There ought to be 82 to 83 per cent, of real butter-fat in genuine butter. Butter is a very dear and valuable article, costing from one to two shillings per pound. Manifestly, therefore, there is a temptation to make a partial substitution of water or salt and water for butter-fat. In a variety of butter which is in the market under the name of Bosch, I found — Fat ... . . . . 69-4 Salt ....... 3-3 Water and trace of organic matter . . . 27*3 100-0 In another sort of butter known as Hamboro' re-packs I found — Fat ....... 62-8 Salt ....... 7*5 Water, &c. . . . . . . 29-7 100^ In an investigation of the butters supplied to the workhouses of the metropolis, which I was instructed by Mr. Bowsell to make for the Government, I found abundant examples of this description of practice. The examination of butter is carried ou thus : — A quantity — one or two grammes — is weighed out into a shallow platinum 344 MANUAL OF PUBLIC MEDICINE dish and dried in the water-bath at 100° C, until it ceases to lose in weight. The loss in weight is the water contained in the sample of butter. The dry residue may next be burnt over the lamp, and the residual ash (which is salt) weighed. Another portion of butter (say five grammes) should be weighed out, partially dried at 100° C, and then treated with ether ; the ethereal solution of the fat filtered, and the filtrate carefully evaporated to dryness in the water-bath and weighed. This gives the percentage of fat. If, now, the per- centage of water, ash (or salt) and fat be added together, and the sum be subtracted from 100, the difference is the per- centage of * organic matter not fat ' in the butter. This, in unsophisticated butter, is always very small. Even in bad butters it is rarely high — and, indeed, among a great number of bad butters I did not find a single instance of high ' solids not fat.'' Should a case in point be encountered by the Public Analyst he will do well to test for starch, by means of solution of iodine ; for one of the alleged frauds in the butter trade is said to be the putting mashed potatoes into the butter. Gelatine, also, is alleged. This will, of course, be recognised as a nitrogenous substance, and by gelatinising with water, and by the formation of the well-known precipitate with infusion of gallnuts. Granting, then, that the sample of butter contain not too much water — not too much ash — not too much ' organic matter not fat ' — is it necessarily genuine butter ? No, it may be partly butter-fat and partly extraneous fat. Butter-fat is not one chemical compound but a mixture of compounds. It contains a number of the ethers of glycerine, including some of the commonest and most widely diffused descriptions of fat. It contains stearin (stearate of glycerine C3H5O3 (C 1811350)3. It contains olein and palmitin which are likewise well-known ethers of glycerine. In addition to these there are a variety of other fats in butter, such as, for instance, butyrate of glycerine. Although, doubtless, if a chemist were to take the trouble to investigate butter with that especial object he could hardly fail to come upon good tests to distinguish between a genuine butter-fat and a spurious one, there is at present no known method of doing so. Butter, as is well-known, fuses at high temperatures a little MILK, BUTTER, AND CHEESE 345 higher than the average atmospheric temperature in this country. A sample of fat, purporting to be butter, must not be too hard to melt, otherwise some such fat as tallow may be suspected ; neither must it be too easily melted. Genuine butter is moreover dissolved by 28 parts of boiling alcohol, of a specific gravity of 0*82. Butter is apt to become rancid, — a change consisting in the decomposition of traces of its fats into fatty acid and gly- cerine. Rancidity may be, to some extent, abated by the employment of a little alkali ; and by the short application of a high temperature to the butter. During the siege of Paris, the practice of heating butter and other fats for the purpose of sweetening them is said to have been largely in vogue. CHEESE. This substance consists of casein e and fat in variable pro- portions ; also of water (and by no means little of it) and of mineral matter, mainly phosphate of lime. There is very great diversity in the composition of difierent cheeses, as the following analyses by Pay en show : — Percentages. Water. Fat. Nitrogen. Ash. Cheshire Cheese 30-4 25-4 5-6 4-8 Brie .... 540 24-1 2-4 5-6 Neufchatel 61-9 18-7 2-3 4-2 Marolles 40-1 28-7 3-7 6-0 Roquefort 26-6 32-3 5-1 4-4 Holland .... 41-4 25-1 4-1 6-2 Gruyeres 32-0 28-4 6-4 4-8 Parmesano 30-3 21-7 5-5 7-1 As is well known, cheese is coloured with annatto, which is a vegetable colouring matter. In Accum's book, a curious instance is related of alleged poisoning with oxide of lead, which was said to have been used to adulterate the vermilion which was said to have been employed to adulterate the annatto used to colour a Gloucester cheese. The instance is rather doubtful. It may be noted, in passing, that cheese- rind is to be looked upon with suspicion. I have nothing to add concerning the actual adulteration of cheese 316 MANUAL OF PUBLIC MEDICINE CHAPTER IV. FLOUR AND BREAD. Fine wlieaten flour contains — Water . . . . . . .16-5 Ash ...... . 074 Fat ....... 1-2 Sugar, Gum, and Dextrin . . . . . 3'3 Albuminous matters (Gluten, &c.) . . . 12-0 Starch ....... 66*3 The water is determined by weighing out some flour in a platinum dish, and exposing it to a temperature of 130° C, until it ceases to lose in weight. In a sample of fine flour (price 2^ pence per lb.) I found 16*5 percent, of water. In a sample of ' seconds ' flour (price 2^ pence per lb.) I found 15*7 per cent, of water. In other samples of flour, drying, however, at a lower temperature, viz., 110° C. and 115*6, I have ob- tained 14-0 per cent, and 14*4 per cent, of water. The Ash, which is a most important datum in the chemical examination of flour, is obtained by igniting a weighed quantity of the flour in a platinum crucible, and subsequently weighing the residue, which persistently refuses to burn away. About one gramme of flour is a convenient quantity to take for a determination of ash. At first, at the commencement of the ignition, the flour burns rapidly, but soon forms a hard coke, which burns slowly. On continuing the application of a red heat, with free access of air, and stirring with a platinum wire, the coke will burn completely away and leave an ash which seems to shrink up almost to nothing, and which is very * I quote an analysis made recently in my own laboratory, and giving results in accordance with standard authorities. FLOUR AND BREAD 347 constant in amount. In three different samples of fiiJe flour I found respectively 073, 075, and 074 per cent, of ash. In a specimen of ' seconds ' flour I found 0*82 per cent, of ash. The chemical composition of the ash of flour is mainly phos- phate of potash, phosphate of magnesia, and phosphate of lime. Of these three the first mentioned forms considerably more than half of the entire ash, and next in abundance comes the phosphate of magnesia. If it be required to find out whether or not plaster of Paris has been used to adulterate a sample of flour, a determination of ash may be resorted to. With the object of testing the working of this method I adulterated a sample of flour with about 6 per cent, of plaster of Paris, and then determined the ash. The result was striking and satisfactory. The only caution to be given is not to mistake the coke yielded by flour in common with most organic nitrogenous substances, for the ash. Re -ignition will diminish the coke, but not a genuine ash. If, therefore, a sample of fine wheaten flour yield sensibly more than 07 or 0*8 per cent, of residue, which does not burn away on repeated ignition, there must be something wrong with the flour. Every case of replacement of flour by a mineral material cheaper than flour would be most satisfactorily dealt with by the incineration test. We have next to consider an adulteration to which much attention has been directed, viz., the adulteration of flour and bread with alum. In order to understand the nature of this peculiar case, it is necessary to remark that neither miller nor baker puts alum into flour or bread on account of the difierence in cost between alum and flour. Flour or bread to which enough alum had been added to render the replacement of flour by alum financially success- ful would be absolutely unsaleable. What the miller or baker really does is to mix a very minute proportion of alum with the flour in order to improve the quality of the bread ; in order to enable inferior flour to make fairly good bread. This practice is at least fifty years old. According to Accum, whose book on ' Culinary Poisons ' was published in 1822, the proportion of alum employed is about one or two parts of alum in a thousand parts of flour. This is apparent from the following quotations : — ^ From three to four ounces to a sack 848 MANUAL OF PUBLIC MEDICINE of flour, weighing 240 pounds,' and ' Five bushels of flour ' (i.e., 240 pounds) ' eight ounces of alum, four pounds of salt, half a gallon of yeast, mixed with about three gallons of water.' Inasmuch as crystals of alum contain nearly half their weight of water, and inasmuch as a pound of flour makes more than a pound of bread (by reason of the higher percentage of water in bread than in flour) the actual proportion of dry- alum in bread must be considerably lower than one part in a thousand pounds of bread. The question may, therefore, be very fairly raised whether the use of alum in bread-making be really detrimental to health. Is it injurious to take from two to four grains of sulphate of alumina daily ? Whatever the answer may be which is returned to this question, it is, in the meantime, necessary that the public analyst should be placed in a position to say decisively whether or not a given specimen of flour or bread be aluminised. This is possible, but by no means easy ; and here I would record my opinion, that in this country at any rate, chemists have often failed to find alum when present in bread, and succeeded in finding it when originally absent. Alum is missed partly owing to the minuteness of the quantity which is present. Alum is found in its absence when the phosphate of magnesia and phosphate of lime of bread-ash, or when the alumina or silica in the reagents, are mistaken for alumina originally existing in the bread. The first point to be regarded in testing flour for alum is to operate on a sufficient quantity of the material. One gramme is far too little. 100 grammes is the right quantity. This is to be incinerated in a platinum dish, and the resulting ash treated with 0 5 cubic cents of oil of vitriol (or one gramme of oil of vitriol). The acid mass is heated till fames of sul- phuric acid escape, and then let cool, diluted with water, and filtered. To the filtrate one and a-half grammes of pure solid potash are added ; when this has dissolved, the liquid is filtered, and the fibrate mixed with about one and a-half grammes of chloride of ammonium and boiled. The formation of a white gelatinous precipitate indicates alumina. The pure potash may be potash prepared by solution in alcohol. Instead of caustic potash, caustic soda prepared by FLOUR AND BBEAB 349 dissolving a little metallic sodium in water (which must be done with care) may be used. The operator ought to make a blank testing of the reagents before trusting to them. The aluminous precipitate obtained in the manner described is phosphate of alumina. The remark need hardly be made that the same course is to be followed whether flour or bread is to be tested for alum ; only double the quantity of bread (viz., 200 grammes) should be employed. Gojpjper in Flour and Bread. — The detection of this metal is very easy and very delicate. A quantity of the flour or bread is incinerated, and the ash boiled with a few drops of strong sulphuric acid and then diluted with water. Into the solution, which is contained in a platinum crucible, a piece of iron or zinc is placed ; whereupon the copper (if there be any) will be deposited on the surface of the platinum crucible. The test is very delicate, and one part of sulphate of copper may be readily detected in ten thousand of bread. The Fat in flour is yellow in colour and solid at ordinary temperatures, but fusing to a clear bright oil when heated somewhat. It is totally soluble in alcohol of 95 per cent. ; soluble also, as a matter of course, in ether. As given above, there is 1'2 per cent, of fat in fine wheaten flour. According to some analyses quoted in Watts' s Dictionary of Chemistry, oats and maize contain much more fat than wheat, viz., some 6 per cent. ; whilst rice is very poor in fat, viz., 0*1 or 0*2 per cent. The fact of this deficiency in rice may possibly be available as an analytical distinction. Sugar, Gum, and Dextrin. — When flour is stirred up with cold water, it undergoes a considerable alteration in appear- ance. The major part of the albuminous constituents (viz., the gluten) does not dissolve in the water, but absorbs water, becoming gluey ; whilst a small proportion of the albuminous matter, viz.; the vegetable albumen, enters into complete so- lution. The starch does not dissolve, but is mechanically separable from the gluten. The sugar, gum, and dextrin, and also the phosphate of potash, dissolve. In a cold water extract of flour there is accordingly — Grammes. Sugar, Gum, and Dextrin ..... 3'33 Vegetable Albumen ..... 0*92 Phosphate of Potash ..... 0*44 ¥69 350 MANUAL OF PUBLIC MEDICINE The numbers are the numbers of grammes of the re- spective matters yielded by one hundred grammes of fine flour in an experiment recently made in my laboratory. The analytical characters presented by the cold water ex- tract of flour are that it coagulates on boiling (owing to the presence of the vegetable albumen), and that it reduces oxide of copper to sub- oxide, owing to the presence of the sugar and dextrin. Evaporated down to dryness, it leaves an or- ganic residue, which burns with the well-known burnt-bread smell and leaves an ash. The determination of the amount of sugar, gum, and dextrin in flour is of considerable im- portance, inasmuch as unsoundness in flour is marked by an increase in the proportion of these matters. This determi- nation may be made very simply as follows : — 100 grammes of flour is well stirred up with water, and diluted with water (being also thoroughly mixed), until it occupies exactly 500 cubic centimeters. It is then thrown upon a filter, and 60 cubic centimeters of the filtrate are taken and evaporated down to dryness in the water bath. This 50 cubic centimeters will, of course, contain one- tenth of the total quantity which the 100 grammes of flour yields. The weight of the residue, dry at 100° C, should not exceed 0*469 grammes, whereof 0*092 grammes are vegetable albumen and 0*044 grammes are ash. The Albuminous matters in flour consist of a number of distinct chemical substances. First, there is vegetable albumen, which, as already mentioned, dissolves in cold water, and is therefore found in the cold water extract. This substance is very like animal albumen (possibly being identical with it). Its cold- watery solution coagulates on being warmed. Boiled with alkaline solution of perman- ganate of potash, it yields ammonia ; and indeed the readiest way of ascertaining how much of it is present in the aqueous solution is by distilling with alkaline permanganate, and esti- mating the ammonia which is produced. Ten times the weight of the ammonia is the weight of the albumen which yields it. According to my experiments, flour contains about one per cent, of vegetable albumen. The other albuminous matters in flour, which are insoluble in water, are much more abundant, and are known as gluten. FLOUR AND BBEAD 351 A rough and ready estimation of the gluten in a sample of flour is effected by an almost mechanical process. A con- siderable quantity of flour (500 grammes or a pound) is worked well in contact with water, when the gluten coheres in the form of a tenacious mass, whilst the starch is pulveru- lent, and may be washed away. In this way a mass of gluten is obtained. It is washed, dried, and weighed. This process cannot have very high pretensions to accuracy. Operating on average flour, from 9 to 12 per cent, of gluten is obtainable. Gluten is not a single substance. When treated with v^eak alcohol, part of it is dissolved and part remains insoluble. (Absolute alcohol, or even alcohol of 95 per cent., hardly dissolves a trace.) The substance insoluble in weak alcohol has received the name of vegetable fibrin. The substances soluble in the alcohol are mucin, or vegetable casein, and glutin, which is also termed gliadin, or vegetable gelatin. In place of making the determination of gluten in flour by the process described, there are great advantages in making determinations of the nitrogen and using them as measures of the albuminous substances. The percentage of nitrogen in flour appears to be about 2*0, and is, no doubt, subject to considerable variation. I am, however, inclined to recommend determinations of albuminoid ammonia, that is, determina- tions of the amount of ammonia generated by the action of boiling solution of alkaline permanganate. These are very easy to make, and especially so in laboratories where the ammonia-process of water analysis is in use. The method is the following. Into a retort containing half a litre of water (either distilled water, or fair tap water), 50 cubic centimeters of the alkaline permanganate solution, described under water fanalysis {vide p. 317), are introduced. 100 cubic centimeters of water is then distilled off and thrown away. Then 20 milligrammes of the sample of flour are put into the retort and the distillation continued, the distillates being Nesslerised {vide water analysis, p. 319). From 20 milligrammes of flour 0'24 milligrammes of ammonia are obtainable (i.e., from 100 part of flour 1*2 parts of ammonia). Either the 20 milli- grammes of flour may be weighed on a bit of platinum foil and introduced bodily into the retort along with the foil ; or 852 MANUAL OF PUBLIC MEDICINE else a solution may be made containing in one cubic centi- meter of solution one milligramme of flour. Of siich a solu- tion, 10 or 20 cubic centimeters may be conveniently employed for an experiment. This process bids fair to be the readiest and best method of determining the albuminoid material in different samples of flour. A determination of ' albuminoid ammonia/ as just described, may be employed to recognise the adulteration of wheaten flour with rice, which is very much poorer than wheat in nitrogenous matter. Rice is said to contain between 7 and 8 per cent, of albuminous matter, whereas wheat contains 12. Starch. — By far the larger proportion of the solid part of wheaten flour consists of starch (vide the tabular analysis, p. 346), and indeed flour may be described as a variety of starch, which, in comparison with many other natural starches, is highly charged with albuminous substances. The composition of starch is expressed by the formula Cg Hjo O5, probably, however, the formula ought to be reduplicated several times inasmuch as starch presents all the signs of high complexity. As will be seen, it is a non-nitrogenous substance, and a member, moreover, of the so-called carbo-hydrates or sub- stances, whose ultimate composition is carbon plus exactly the elements of water in the right proportion to yield water. The original state in which starch occurs is in the form of granules, which are of different shapes and sizes, according to the origin of the starch . In its original condition starch is insoluble in ether, alcohol, and water. But if the granules be broken, or if they be distended by hot water, then it enters into solution to some extent. By means of hot water it passes into a well-known form, viz., starch paste. A well- known test of extraordinary delicacy is afforded by iodine. This strikes a deep blue colour with starch, for which it is constantly employed as a test. Reciprocally starch paste is used by the chemist as a test for iodine. In working the test it should, however, be borne in mind that only free iodine (not any iodine-compound) gives this blue colour, and that the blue colour itself (delicate test though it be) is not the colour of any stable compound of starch with iodine, but of one of the weakest of chemical compounds. By many persons it is maintained that the iodide of starch is not a chemical com- pound at all, but only a mechanical mixture. Almost every FLOUR AND BREAD 353 substance which, is capable of acting chemically on iodine will, therefore, destroy the blue colour of the iodide of starch. Sulphuretted hydrogen, sulphurous acid, and alkalis, all of them remove the colour, inasmuch as they re-act chemically on iodine and water together. Even by simple boiling water the colour may be discharged — the iodine being in that case volatilized along with the vapour of water. One of the most convenient modes of applying the iodine- test consists in having the iodine dissolved in aqueous solu- tion of iodide of potassium ; and here be it remarked that iodide of potassium, although it combines with free iodine, does not decompose iodide of starch — which is a very excep- tional and noteworthy circumstance, tending to disprove the notion that iodide of starch is absolutely a mechanical and not a chemical compound. When starch is heated to 160°C. it is converted into an isomeric modification called dextrine, from its extraordinary power of turning polarised light to the right. It differs from starch very widely. It does not blue iodine. It is soluble in cold water. It reduces black oxide of copper to red suboxide. It is, so to speak, starch on its way towards sugar. Not alone by heat, but in many other manners is starch converted into dextrine. Boiling with dilute acids effects the transformation — even dilute acetic acid does so. Strangely, however, concentrated acetic acid brings about no such change, and digestion with acetic anhydride actually forms an acetate of starch, from which veritable starch — capable of blueing iodine — may be regenerated by means of alkalis. By means of ferments of various descriptions starch is transformed into dextrine ; and especially easily by the nitrogenous matters of flour when these pass into the fermen- tative condition, or are passing into decay. We have already directed attention to the importance of ascertaining whether flour contains its starch intact or whether the starch has passed into dextrine and sugar. This, as has been said, is ascertained by making an experiment on the cold aqueous extract of flour which, if the flour be sound, will contain only little in solution ; but, if the flour be damaged, will be rich. As has been mentioned, starch-granules are of different shapes and sizes, according to their origin. Wheaten- starch differs from potato-starch, and from rice-starch in the size A A 354 MANUAL OF PUBLIC MEDICINE and shape of tlie granules, and so the aid of the microscope may be called in to distinguish between these different starches, and consequently to detect adulterations of this description. Wheat-starch is intermediate in size between potato-starch and rice-starch. Wheat-starch, moreover, is lenticular in shape. The granules of wheat-starch are 0*36 millimeter (or *0015 inch) in diameter. Vide figs. Bread. — Little need be said, in this place, of the operation of bread-making. Although physically very different from flour, bread is chemically not very much different. Flour is mainly starch — starch granules. So is bread. According to an analysis made by Vogel {vide Watts's Dictionary of Chemistry, Article, Bread) the solids in a wheaten loaf consists of 58*6 per cent, of unBltered starch ; 18*0 altered starch ; 20' 7 gluten mixed with starch ; and 3*6 of sugar. In bread-making flour is first mixed with a certain quantity of water, and afterwards in the baking of the loaf some, but by no means all, of the additional water is driven off. In comparison with flour bread is, therefore, rich in water. According to Odling, the mean percentage of water in bread is 43*4 ; — the extremes in twenty-five specimens of loaves being 38*6 and 46*7 per cent, of water. In making bread salt is added to the flour ; accordingly the mineral matter in bread is higher than in flour. Odling found it to be 1"3 on an average. The mean percentage of nitrogen was found to be 1*26 by the same authority. There are two ways in which the carbonic acid is generated which imparts to bread its peculiarly porous condition. By fermenting some of the sugar of the flour and thereby forming alcohol and carbonic acid. By charging the dough with car- bonic acid dissolved in water under pressure; in this case the sugar of bread is economised and not allowed to degenerate into carbonic acid and alcohol. A modification of the latter process at one time in use consisted in using bicarbonate of soda and dydrochloric acid, which evolved carbonic acid and produced chloride of sodium at the same time, thus salting the bread. A rather formidable objection has been raised to this method of procedure, viz., that the commercial hydro- chloric acid is liable to be contaminated with arsenic, and consequently to render the bread arsenical. Should a case of this sort come before the public analyst he will, of course, deal with it as with an ordinary case of arsenical poisoning. BEER AND WINE 355 CHAPTER V. BEER AND WINE. Beer contains alcoliol, together with extract of malt and hops, and, of course, water. There is, likewise, a little carbonic acid, a little mineral matter, and a very little acetic acid. According to recent analyses made in my laboratory. Bass's bottled bitter ale contains in 100 cubic centimeters 5*3 grms. of Alcohol. 5'52 grms. of Organic Eesidue^ 0'36 grms. of Ash. A sample of draught ale, costing twopence a pint in London, contained in 100 cubic centimeters 4*7 grms. of Alcohol. 5*8 grms. of Organic Kesidne. 0-32 grms. of Ash. In a sample of London porter, I found in 100 cubic centimeters 3'3 grms. of Alcohol. 4*45 grms. of Organic Residue. 0-30 grms. of Ash. The following table, which I quote from Watts' s Dictionary, will also serve to indicate w^hat may be expected in different varieties of beer : — 356 MANUAL OF PUBLIC MEDICINE Percentage. Alcohol. Malt Extract. London AIq for Export London Ale, ordinary .... London Porter, for Export London Porter, ordinary Brussels Lambik .... JJl Uooclo ±. OiLyj ..... Biere forte de Strasbourg Biere blanche de Paris .... Bavarian Beer ..... White beer of Berlin .... 6 to 8 4 „ 5 5 „ 6 3 „ 4 4-5 „ 6 2- 5 „ 4 4 „4-5 3- 5 „ 4 3 „ 4-5 1-8 „ 2 7 to 5 5 „ 4 7 „ 6 5 „ 4 5- 5 „ 3 5 5 „ 3 4 „ 3-5 8 „ 5 6- 5 „ 4 6-2 „ 5-7 In examining a specimen of beer, said to be adulterated, the first point to be made out is whether it is strong enough for the price at which it is sold. If it does really contain as much alcohol and malt-extract (i.e., organic extract) as it ought to do, that fact is very strongly against its being sophisticated. The amount of alcohol in beer is determined as follows. A hundred cubic centimeters of the beer are introduced into a small retort, which is connected with a Liebig's Condenser. A third of the liquid is then distilled over. The distillate then contains all the alcohol which was originally present in the beer. The distillate is to be diluted with water till it weighs exactly 50 grammes, and its specific gravity taken at 15 '6^0 (or 60° Fahrenheit). From the specific gravity the amount of alcohol is to be found by help of the annexed table. Percentage Specific Percentage Specific by Weight. Gravity. by Weight. Gravity. 0-5 . -9991 11 . . -9828 1 . . -9981 12 . . -9815 2 . . -9965 13 . . -9802 3 . . -9947 14 . . -9789 4 . . -9930 15 . . -9778 5 . . -9914 16 . . -9766 6 . . -9898 17 . . -9753 7 . . -9884 18 . . -9741 8 . . -9869 19 . . -9728 9 . . -9855 20 . . -9716 10 . . -9841 The table gives the number of grammes of absolute alcohol BEER AND TVINE 357 contained in 100 grammes of the distillate. Inasmucli as the weight of the distillate was only 50 grammes, there will be only half the number of grammes in it that there is in 100 grammes. The strength of the distillate must, therefore, be halved in order to arrive at the strength of the original beer. The following example will serve in illustration, 100 cubic centimeters of London porter yielded 50 grammes of distillate, the specific gravity of which, at 15*6° C, was found to be '9892. Therefore, the strength of the distillate (vide the table) is 6*6. Therefore, the strength of the beer is 3-3. The specific gravity is best taken by means of the specific gravity bottle, which is first weighed empty, and afterwards weighed full of water and full of the weak spirit under in- vestigation. The weight of the weak spirit divided by the weight of an equal volume of water is the specific gravity of the spirit. The Malt Extract in beer is determined very simply as follows : — Into a small platinum dish of known weight 6 cubic centi- meters of beer are measured, and then evaporated to dryness in the water bath. The dish, with its contents, is then weighed, and the weight of the dish subtracted from the weight of the whole. In this manner the total solid residue yielded by 5 cubic centimeters of beer is found. This, multi- plied by 20, is the weight of solid residue yielded by 100 cubic centimeters of beer. The solid residue is afterwards ignited in order to find the ash. In order to give an idea of the constancy of the results (and also to illustrate the method), I will cite five experiments made on the same sample of London porter : — Five cubic centimeters of porter were evaporated to dry- ness in the water bath and weighed. Weight of Eesidue from Dry Residue. 100 c. c. Exp. I. 0-238 grms. 4*76 grms. Exp. II. 0-240 „ . 4-80 „ Exp. III. . 0-236 „ 4-72 „ Exp. IV. . 0-239 „ . 4-78 „ Exp. V. 0-235 „ 4-70 „ 5) 23-76 4-75 358 MANUAL OF PUBLIC MEDICINE The mean residue yielded by 100 cubic centimeters of porter was, therefore, 4*75 grammes. The ash was found to be '015 gramme from 5 cubic centi- meters. Therefore 0*30 gramme from 100 cubic centimeters of porter. The organic extract yielded by 100 cubic centimeters of porter was, therefore, 4*45 grammes. The organic extractive matter yielded by beer consists of dextrine, sugar, lupuline, from the hop, and also of residual gluten in a more or less altered condition. The inorganic matter, the ash, consists in great part of phosphates. Adul- teration of beer by means of salt will be at once detected by means of a determination of the ash. Under such conditions, the ash would be found to be excessive. Among the organic adulterations, two are especially to be named, viz., picric acid and cocculus indicus. Picric acid may be detected by its power of colouring wool. If white wool be boiled with beer adulterated with picric acid, it will be stained yellow, the stain being permanent when the wool is washed. The detection of picrotoxin, the active principle of cocculus indicus, is not very easy. The following method is given by Herapatli : — Mix the beer with acetate of lead in excess ; filter and transmit sulphuretted hydrogen through the filtrate. Filter again, concentrate the filtrate ; treat it with animal charcoal, which has the property of absorbing the picrotoxin. The animal charcoal is subsequently washed, dried at 100° 0., and boiled with alcohol, which dissolves out the picrotoxin. From the solution in alcohol it may be got in tufts of crystals. In addition to picric acid and picrotoxin, strychnine has been talked of as an adulterant of beer. Wine is the fermented juice of the grape, and is, as a rule, stronger than beer. The different varieties of wine differ also very widely in alcoholic strength, as may be seen from the following determinations made many years ago by Christi- son : — BEEB AND WINE 359 Percentage of Absolute Alcohol. Port Wine ...... 16-20 Sherry (old) ...... 15-37 (weak) ...... 13-98 „ (strong) . . . . . .16-17 Claret (first quality) ..... 8-99 7-72 Eiidesheimer (first) . . . . .8-40 „ (inferior) ..... 6-90 There are also in wines different kinds of ethers, some being volatile, and others fixed. Aldehydes also appear to occur sometimes, and no doubt the particular kind of ether or alde- hyde exercises much influence in determining the exact quahty and value of the wine. The proportion, however, of ether or aldehyde in wines is very small, being about one part in one thousand of wine. Just as beer contains malt-extract, so wine contains grape- extract, consisting partly of grape sugar. A certain proportion of mineral matter likewise occurs in wine, which, on being evaporated to dryness, and having the residue subjected to ignition, leaves an ash containing carbonate of potash, arising from the decomposition of the cream of tartar. Small quan- tities of free acid are also to be looked for in wines. Although much labour has been expended by chemists on the examination of wines, still the chemical recognition of the differences between the different sorts of wines is very imper- fect and unsatisfactory ; and almost equally unsatisfactory is the chemical testing for some of the commonest sophistications which are avowedly practised. The alcohol found in a sample of wine may be either pro- duced by the fermentation of the grape juice, or it may have been (in part) added to the wine. Both as a matter of taste, and physiologically, wine to which no spirit has been added differs from wine to which spirit has been added ; and yet no chemical examination has hitherto distinguished between the two cases. Most probably some trace of powerful empyreu- matic material communicates the peculiarity to distilled spirit, but chemical analysis has not as yet availed to disclose the presence of such substances. One thing, however, can be told : if the percentage of alcohol exceeds a certain figure (about 14), then the wine must have been fortified with spirit. 360 MANUAL OF PUBLIC MEDICINE since fermentation is brought to a standstill by tbe presence of that amount of alcohol. Some degree of probability, too, is attached to a judgment founded on a comparison of the percentage of alcohol in the sample, and the average strength of the particular sort of wine. Thus, if in claret we should find as much alcohol as might fairly be present in genuine sherry, we should be warranted in pronouncing the claret to have been fortified with spirit. A few examples of analysis of different wines quoted from Dr. Dupre's paper (vide Jour- nal of the Chemical Society, vol. v. p. 493, et seq.) may pos- sibly be interesting. Light claret, 1865, price 15^. per dozen. Percentage by Weight. Alcohol ....... 9-05 Total dry residue, including mineral matter . .2-17 Sugar ....... 0-047 Alcohol obtainable from the ethers . . . 0 048 Free fixed Acid, expressed as Tartaric Acid . . 0*338 Free Volatile Acid, expressed as Acetic Acid . . 0-222 Rhine wine, Rauenthaler, 1864, I85. per dozen. Percentage by Weight. Alcohol ....... 7-44 Total dry residue, including mineral matter . . 2*207 Sugar ....... traces Total Alcohol present in the ethers . . . 0*043 Free Fixed Acid, expressed as Tartaric Acid . . 0*674 Free Volatile Acid, expressed as Acetic Acid . . 0*118 Rauenthaler, 1862, 545. per dozen. Percentage by Weight. Alcohol ....... 8-83 Total dry residue, including mineral matter . . 1-867 Sugar ....... 0*062 Total Alcohol present in the ethers . . . 0-046 Free fixed Acid, expressed as Tartaric Acid . . 0*445 Free Volatile Acid, expressed as Acetic Acid . . 0*178 Port wine, 1864. Percentage by Weight. Alcohol ....... 18*56 Total dry residue, including mineral matter . . 7*30 Sugar ....... 4*90 Total Alcohol in ethers ..... 0-043 Free fixed Acid as Tartaric Acid .... 0*307 Free Volatile Acid as Acetic Acid .... 0*084 BEER AND WINE 361 The percentage of mineral matter (i.e. of ash) in wine ap- pears to be very much as in beer, viz., about 0'3. The description of the analysis of beer is applicable to the analysis of wine. There is one special kind of impurity which will occasionally come before the public analyst and medical officer of health, and which is of considerable importance. Lead is sometimes present in wine. This sometimes arises from carelessness in bottling ; the shot which is employed in cleaning the bottles having been left in them. The presence of lead in wine is ascertained by evaporating a considerable quantity of wine to dryness, igniting the residue in a thin porcelain dish, treating the ash with a little hydrochloric acid, and then adding sulphuretted hydrogen water to the solution. Blackening, or darkening, indicates the presence of lead. Cider is likewise liable to be contaminated with lead, and those whose duties call them into the apple-growing counties will, doubtless, be required to test that liquor for the metal in question. 362 MANUAL OF PUBLIC MEDICINE CHAPTER VL TEA. In making a chemical examination of tea, one of the points which first attracts the attention of the chemist is the high proportion of ash which tea leaves contain. The following determinations have been made recently in my own laboratory — From a paper of Zoller's, in Liebig's Annale7i, May 1871, ib appears that a fine specimen of tea received direct from the growers, yielded 5*63 per cent, of ash. This agrees with the above ; and we may, accordingly, set down the average ash in normal tea as 5*7 per cent. The hygrometric moisture in tea was also determined by Z oiler as 4' 9 5 per cent. The tea met with in commerce is not unfrequently adul- terated with mineral matter, such as sand and even metallic iron in a state of powder. These adulterations may at once be detected by making a determination of ash in the sample. A sample which was recently examined in my laboratory yielded 14*5 per cent, of ash, of which about 9 consisted of lumps of sand. Tea burns pretty readily, and there is, con- sequently, no difficulty in taking the ash. About one gramme of tea leaves will be found to be a convenient quantity to burn for the ash. It is unnecessary to moisten the ash with nitric acid, inasmuch as the combustion is complete without it. The composition of the ash is remarkable. According to the analysis by Zoller, it contains — Percentage of Ash. Specimen of common tea Civil Service Tea Horniman's Tea Mandarin's Tea (eight shillings per pound) Orange Pekoe (five shillings per pound) . 5-63 . 5-56 . 5-99 . 5-3 . 5-84 . 6-06 ). . 5-86 Average 5*75 Green Tea (four shillings and sixpence per pound) TEA 363 Potash . Soda Magnesia Lime Oxide of Iron Protoxide of Manganese Phosphoric Acid . Sulphuric Acid . Chlorine . Silica Carbonic Acid Percentage of Ash. 39-22 0- 65 6-47 4-24 4-38 1- 03 14-55 trace 0-81 4-35 24-30 100-00 The high percentage of potash and phosphoric acid will nofe fail to be noticed. This prevails in the ash of fine tea, that is to say of young tea leaves. As the tea leaves grow older on the tea plant their mineral constituents undergo an altera- tion — the potash and phosphoric acid diminish whilst the Hme and sihca increase. By an examination of the ash a judgment may, therefore, be formed as to whether the tea be of fine or of inferior quality. Much potash and much phosphoric acid with little lime and silica denotes excellent tea ; and the contrary denotes inferior tea. Commercial tea is sometimes accused of having been used once and then dried, and sold as genuine tea. This fraud may be investigated through the ash of the tea leaves, which will be found deficient in potash in that case. The percentage of ash in spent tea leaves (dry at 100° C) was found by Zoller to be 3*06, being, as will be observed, less than in normal tea. The composition of the ash was — Potash . . . . . . 7-34 Soda Lime Oxide of Iron Protoxide of Manganese Chlorine . Phosphoric Acid . Sulphuric Acid . Silica Carbonic Acid . 0- 69 11-45 10-76 9-53 1- 97 trace 25-41 trace 7-57 25-28 10000 364 MANUAL OF PUBLIC MEDICim Low potasli and high lime in the ash left by tea are very suspicious signs. But we are not by any means confined to an examination of the ash in investigating a case of suspected sophistication of a sample of tea. An examination of the infu- sion in boiling water gives valuable information. Z oiler found that 100 parts (by weight) of tea gave 36' 26 parts of dry solid extract soluble in water. The extraction, moreover, was believed by him to have been incomplete, and was made thus : Three litres of boiling distilled water were poured on 100 grammes of tea leaves, and afterwards poured off them. A second three litres of water was used in the same manner, and the resulting six litres of infusion evaporated to dryness, and its residue dried at 100° C and weighed. Tea leaves, therefore, yield to water more than one third of their weight. It will accordingly be easily appreciated that a determination of the amount of extract is an admirable test whether or not a specimen of tea be genuine tea or spent tea. The percentage of nitrogen in tea leaves is extraordinary. Zoller found it to be 5*38 — which is more than twice as much as in wheaten flour. The nitrogen exists partly in the form of thein, but mainly as an albuminous substance which, accord- ing to Peligot, resembles casein, and which must amount to 13*7 per cent, of the tea leaves. Thein is extracted thus : Tea leaves are dried at'100° C, then poundered finely, and then covered with sulphuric acid slightly diluted with water, and placed in the water-bath for some time. The whole mass is next- to be diluted with a little water and mixed with excess of oxide of lead, which forms sulphate of lead with the sulphuric acid. The mass is then extracted with alcohol of 86 per cent., and the alcoholic extract deposits first any traces of theobromine that may be present, and afterwards a part of the thein. The alcoholic extract having been evaporated to dryness the remainder of the thein is extracted with ether. The yield of thein obtained by Zoller was 4*94 per cent. Any colour which the thein may have is removable by means of animal charcoal. Inasmuch as thein is the characteristic principle of tea, a little description of it is called for. Its formula is, Cg Hio N4 O2 + II2 0. It has shghtly basic properties, and TEA 365 forms salts wliicli, altliougli very well defined, are frequently decomposed by water. This is the case with the hydrochlorate and the sulphate. Thein from the tea plant, and caffein from coffee are one and the same chemical substance. They are beautifully crystalline, forming silk-like crystals which fuse at 178° centigrade and sublime like benzoic acid. The crystals contain 8 '4 per cent, of water, which is partly lost at 100° C, but not entirely until 150° C. They have a slightly bitter taste. Cold water and cold alcohol dissolve them to a considerable extent, and hot water dissolves them still more readily. Hydrochlorate of thein (which is got either by the action of gaseous hydrochloric acid on thein, or else with the strongest hydrochloric acid, dilution with water or alcohol being avoided) combines with bichloride of platinum, with chloride of gold, and also with corrosive sublimate, forming double salts. There is likewise a double compound of nitrate of thein and nitrate of silver. On being boiled with strong solution of potash thein gives methylamine : and with boiling permanganate of potash it yields some ammonia. With boiling nitric acid it yields a yellow liquid which assumes a purple colour on being mixed with am- monia. This latter reaction calls to mind uric acid, which, as is well known, yields purple murexide under like conditions. Thein appears to exist in the tea plant, not in the free state but as a tannate of thein. In coffee it appears to be combined with another acid, viz., chlorogenic acid. 366 MANUAL OF PUBLIC MEDICINE CHAPTER VII. SUGAR. Brown sugar and loaf sugar, whether it be derived from the sugar-cane or from beet-root, are one and the same chemical substance. This substance has received the name canie- sugar, and the formula C12 II22 On- It is in many respects most remarkable, being the heaviest organic compound which is devoid of iodine and metals and contains only the organic elements. Its specific gravity is 1*606. Its solubility in water is extraordinary. At common temperatures 100 parts of water dissolve 300 parts of sugar ; whereas 100 parts of water dissolve only some thirteen parts of common salt. In boiling water the solubility of sugar is much greater even than in cold water and is described in the books as being indefinite. The specific gravity of an aqueous solution of sugar is very high, and it is probable that no organic solution containing an equal percentage of organic matter has so high a specific gravity as a solution of cane-sugar. In weak alcohol sugar dissolves freely ; in absolute alcohol, not at all in the cold, and very sparingly at the boiling point of alcohol. In ether it is insoluble. The aqueous solution is thick and syrupy. Moreover, it acts powerfully on polarised light, rotating it to the right. It crystallises very finely under suitable conditions and when in the form of large crystals is known as sugar candy. Under the influence of dilute acids it is very easily altered : its action on polarised light being inverted and its power of crystallising destroyed. Albuminous substances also bring about this change with great rapidity ; and this circumstance constitutes the diSiculty of the sugar-factories wherein this transformation of cane-sugar into uncrystallisable sugar has to be most diligently guarded against. SUGAR 367 An aqueous solution of pure cane-sugar does not, in the slightest degree, reduce oxide of copper even when boiled for a minute or two with it in the presence of caustic potash. If, however, any uncrystallisable sugar be present ; if, for in- stance, the solution of cane-sugar have been boiled for only a few seconds with a little hydrochloric acid, then the reduction of oxide of copper to red suboxide of copper is instantaneous at the boiling point of water. The ordinary loaf-sugar of commerce is, according to observ- ations recently made in my own laboratory, an exceedingly pure substance. In the first place it is singularly devoid of mineral matter. From a number of experiments it would appear that the ash left on incinerating it does not exceed 0*01 per cent, of the sugar. It is also singularly free from nitrogenous matter. I once burnt up a considerable quantity with oxide of copper and proved the entire absence of nitrogen gas in the products of combustion ; and recently I have submitted it to the action of boiling permanganate of potash in presence of much caustic potash and proved the non-production of ammonia. It is also devoid of uncrystallisable sugar, as may be proved by adding to its aqueous solution a few drops of solution of sulphate of copper, then an excess of caustic potash (which will yield a splendid blue-purple solution), and finally boiling for a minute, when there will be no formation of yellow or red suboxide of copper. Brown sugar is not by any means so pure as loaf-sugar. It contains a certain proportion of mineral matter derived from the plant, and in different samples of brown sugar I have found 0'49, 0'61, and 0'57 per cent, of ash respectively. From this it would appear that the ash in i*aw- sugar is pretty con- stant. The detection of actual adulteration of sugar by mineral matter such as sand is therefore very simple. All that is required is to take the ash ; and any real case of adulteration of this description will be manifested by the finding of a far- higher percentage of ash than could be due to the mineral contents of the juices of the sugar-can-e or beet-root. Much has been written respecting the sugar-insect, which is sometimes found in raw-sugar, but never in refined. 368 MANUAL OF PUBLIC MEDICINE Whether the presence of this insect in a sample of sugar be of more importance than the presence of mites in cheese, I will not undertake to determine. It will, however, be obvious that in a specimen of sugar which is almost devoid of nitro- genous matter, this creature cannot flourish, and the possi- bilities of the presence of these insects may be judged of through a determination of nitrogen (or still better of albu- minoid ammonia) in the sugar. From 100 parts of moist sugar I have obtained not more than 0*2 part of albumi- noid ammonia. Microscopical examination should likewise be had recourse to where there is reason for suspecting the presence of these insects. Moist sugar is contaminated with uncrystallisable sugar, as may be very readily proved by adding to its solution some sulphate of copper and caustic potash, and boiling for a few seconds, when there will be a very abundant reduction of the copper solution. The difference between loaf-sugar and brown sugar is in this respect very striking. DISINFECTION 369 CHAPTER YIII. DISINFECTION. There are two distinct kinds of infection, viz., the propaga- tion of specific disease wliicli reproduces itself, and the engendering of disease and unhealthiness by uncleanhness and filth. The communication of small-pox by contact with a patient suffering from small-pox, or by contact with his clothes and surroundings, affords a characteristic example of the one kind of infection. The other kind is exemplified by the falling into low fever, or even into a simply weak state of health which is induced by living amidst filth. Against specific infection we are almost limited to two disinfectants ; against common infection we have many and various disinfectants which have their appropriate uses. Given a bundle of clothes from a small-pox patient, there is only one safe and practicable course to be taken, that is to bum it. We might, it is true, destroy it with corrosive chemicals, bat that would only be a more difficult and more costly way of destroying it, and unless we pushed the action of the chemicals so far as to destroy the fibre of the fabric we could have no security. The belief that dilute chlorine or dilute carbolic acid is of any avail in destroying specific infection is founded on the misconception that the action of dilute chemicals differs only in degree from the action of the same chemicals in a state of concentration. A very striking illustration of the action of the same chemical in a dilute and in a concentrated state is afforded by sulphuric acid, which when dilute transforms cane-sugar into grape-sugar susceptible of fermentation, and when concentrated turns it into a mass of black carbon. It is B B 370 MANUAL OF PUBLIC MEDICINE no doubt true that pure chlorine, aided by sunlight or heat, will destroy the infecting material of small-pox ; but there is no real reason for believing that a touch of bleaching powder introduced into the wash tub will aid in disinfecting small-pox linen. If a good washing with soap and hot water be not effectual, there is little hope that any kind of washing, which does not destroy the fibre, will render such linen safe. In fire, which is quick, and weathering^ which is slow, we have the two great natural disinfectants ; and against specific infection we have no others which are generally practicable. All clothes which are tainted with specific infecting matter, such as the matter from small-pox, scarlet fever, &c., ought to be burnt. When • plague breaks out in a crowded part of a town, there is much to be said in favour of burning down the houses where it has been rife. Failing so extreme a measure (which, however, we would most seriously commend to the at- tention of the authorities of a plague- stricken town), they should be, for a while, dismantled and freely exposed to the rain and to the wind. There is no just reason for trusting to any fumigation with chlorine, sulphurous acid, or carbolic acid in any such case. With regard to the action of fire, it consists in the destruc- tion of the infecting material, which, whether it be a germ or an organic poison, must in common with all complex organic substances be destroyed by a high temperature especially in presence of an excess of oxygen. In place of burning clothes and bedding, there is a custom of baking them : and the practice is defended on the ground that the small-pox poison is destroyed by a heat approaching to the boiling point of water. Granting, however, that the subjection of the poison to such a temperature will destroy it, there is always room for very reasonable doubt whether a mass of bedding, for instance, is raised throughout its entire substance to the required temperature, and in the present state of our knowledge on the subject we should discourage the substitution of baking for burning outright. The action of weathering is very complex. A very impor- tant element in it is dilution, with air or water. There is no chemical poison which does not lose its efficacy when it is extremely dilute : and the same holds good of germs, which DISINFECTION 371 require to be sufficiently numerous in order to be fertile. Free exposure to atmospheric changes also induces slow oxi- dation and disintegration. There is, perhaps, no other subject which has been so over- laid with absurdities as disinfection, and in this chapter an important part of our task is to point out how that which is commonly believed to be effective cannot possibly be so. By chemical means the attempt is often made to disinfect the atmosphere of a room. Occasionally even an attempt has been made to disinfect the open air of the country ; we re- member such an attempt on the part of the Cattle Plague Commissioners in the time of the panic occasioned by the cattle plague, when cloths dipped in carbolic acid were tied to the horns of cattle which were turned loose in the fields to disinfect the air of the country. Now, when it is recollected how vast is the atmosphere which covers a field, and that on the stillest of days it is being constantly renewed^ it must be obvious that to alter its com- position in any but an infinitesimal degree is a quixotic undertaking. It would be easier to alter the composition of the sea which surrounds our coasts than of the air which covers the country. A very striking illustration of our impo- tence in this direction is afforded by the researches of Dr. Angus Smith and others, which have shown that the air of London streets does not contain 0*10 per cent, of carbonic acid, and rarely 0'05 per cent. And yet every animal and every fire in London is engaged in the generation of carbonic acid, and the normal proportion of carbonic acid in the atmo- sphere is 0*038 per cent. If we cannot, even in confined streets, raise the carbonic acid from 0*04 to O'lO per cent., what chance can there be that we can rid the atmosphere of the country of anything which happens to be in it, or even sensibly diminish it ? Paradoxical as it may seem, we are, however, able to defile the air, but not to purify it. Over our manufacturing towns there floats an atmosphere which is not compatible with vegeta- tion, and which is not well adapted to the requirements of animal life. We are able to defile the air, because plants and animals are sensitive to infinitesimal change in the atmo- sphere^ because an in conceivably minute dose of certain atmo- B B 2 372 MANUAL OF PUBLIC MEDICINE spheric poisons has effect on living things. Thi3 brings us to the case of the atmosphere of a room, which it is often pro- posed to disinfect. The difficulty in dealing with the air of a room depends on the fact that an infinitesimal quantity of corrosive chemical introduced into it renders it unfit to breathe. Before anything like a tenth of the chlorine, or sulphurous acid, or carbolic acid, which could possibly purify it, has passed into the atmosphere of a room, the atmo- sphere will have become unfit to breathe ; and if, in puri- fying the air, we render it unfit to breathe, what object do we gain in purifying it ? Let any of our readers take up any of the popular prescriptions for purifying the air of a sick room. — " Take so much bleaching powder and so much acid and put them in a saucer under the bed," — and let him calculate the percentage of chlorine which will enter into the air of an ordinary bedroom and he will be astonished at the smallness of the fraction. In one of the official docu- ments relative to disinfection with sulphurous acid, there occurs a very . significant passage to the effect that if it be possible to abide in the room for a few minutes, the disin- fection is not satisfactory. Clearly in such a case the disinfec- tion cannot be for the sake of the atmosphere (which has to be sent up the chimney or out of the window) but for the sake of the walls and the furniture.^ If the atmosphere of a room be foul there is only one prac- ticable method of dealing with it, and that is to send it out and get in a fresh supply of air. We can defile, but we cannot purify the air, and our efforts must be directed towards proper ventilation and towards avoidance of defile- ment. This brings us to the consideration of the true scope and subject of artificial disinfectants. They are of use mainly in arresting putrefaction and hindering defilement of the atmo- sphere. The most important disinfectants are those whose action consists in preventing putrefaction ; the antiseptics as they are termed. This is a very large class comprising common salt, * And most clumsy, costly, and ineffectual sucli a disinfectant must be. All fumigation with chlorine and sulphurous acid are founded on a de- lusion, and ought to give place to more rational procedure. DISINFECTION 373 a great variety of metallic salts, carbolic acid, most acids, charcoal, and a great variety of substances. In selecting a disinfectant we have not so mnch to choose a powerful antiseptic, as a sujfficiently powerful antiseptic which is otherwise unobjectionable. For general use, the property of being very poisonous is an absolute bar to the employment of certain antiseptics. Arsenious acid is most powerfully antiseptic (and it is tolerably cheap), but its poisonous properties completely forbid its use as a general disinfectant and antiseptic. For a like reason corrosive sublimate and carbolic acid (though powerfully antiseptic) are not adapted for general use. One of the most powerful antiseptics and deodorisers is copperas ( proto-sulphate of iron) which has the further merit of being very cheap (£7 per ton), and of being not frightfully poisonous. It is specially adapted for use in water-closets and urinals ; but its property of staining, giving spots of basic persalt and oxide of iron, is an unpleasant quality and will prevent its coming into general use. Alum and the material which has of late come before the pubHc under the name of chloralum is an excellent antiseptic and deodoriser and does not labour under the objection which applies to proto-sulphate of iron ; it does not give rise to brown spots. There are two ways in which a disinfectant acts on a mass of putrescent matter — e. g. — putrid urine or foeces. It may stop the putrefaction in virtue of its preservative or antiseptic properties, or it may absorb the products of putrefaction, and it may do both. In carbolic acid we have an example of a substance which arrests decomposition but is absolutely powerless to absorb or to decompose the offensive products of decomposition. In proto-sulphate of iron we have a substance which both stops decomposition and absorbs the odoriferous alkaloids and sulphuretted hydrogen to which the vile smell of putrescent matter is due. In soluble permanganates (Condy's fluid) we have chemicals which destroy sulphuretted hydrogen ; but have little antiseptic power. The main causes of bad ' smells in our streets and houses are alkaloids, — stinking ammonias. In order to get rid of these smells, even vinegar is of service : the common device 374 MANUAL OF PUBLIC MEDICINE of keeping fish, steeped in vinegar owes it efficiency to tlie circumstance ihat the stink from fish, consists of an alkaloid which is neutralised by the vinegar. The main nitrogenous excretion from the population of a town is the urine, which in its fresh condition has very little smell, but in its putrid, or fermented state, is exceedingly ofiensive. According to our experience the cheapest method of dealing with it is by means of a mixture containing chloride of calcium, which is a waste product in various industrial pro- cesses. The conversion of urea into carbonate of ammonia appears to take place with extraordinary rapidity in the sewers. The postponement of this fermentation until the contents of the sewers have mingled with the water of the river into which they are discharged is one of the tasks which will have to be accomplished if our towns are to be devoid of bad smell : and this appears to be practicable by the employment of some such material as the waste chlorides of commerce. LONDON : PRINTED BY SPOTTISWOODB AND CO., NEW-STBEET SQUARE AND PARLIAMENT STREET SMITH, ELDEE & CO.'S MEDICAL PUBLICATIONS. IN THE PRESS. 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