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NATIONAL ASSOCIATIONFOR

THE PROMOTION OF SOCIAL SCIENCE.CONGRESS OF 1862.

PUBLIC HEALTH DEPARTMENT.

THE annual meeting of the Congress has been conductedwith great energy and ability on the part of its managers; theplace of meeting has been well selected, and the papers readwere numerous and interesting. It is to be regretted, however,that the attendance at the scientific day meetings has not beenproportionate to that of the evening social gatherings.The inaugural oration of the venerable Lord Brougham was

of course listened to with profound attention by a numerousauditory. The physical weakness of this illustrious savan con-trasted strongly with the intellectual vigour displayed in hisaddress. He touched but slightly, however, on subjects in-teresting to the medical profession; noticing only the newLunacy Kegulation Bill, in order strongly to condemn its testi-mony clauses and the limitation of evidence.

FRIDAY, JUNE 6TH.This department met in the Court of Queen’s Bench, and

was very well attended, amongst those present being-Dr.Holland, Dr. W. Lewis, Mr. Hawlinson, Dr. Letheby, Dr.Ellis. Dr. Lankester, Dr. Bollard, Mr. Simon, Miss Nightingale,Dr. Farre, Sir Joshua Jebh, &c.W. FAIRBAIRN, Esq., President, said there was no depart-

ment of social science of greater importance to a nation thanthe public health, and the development of measures calculatedto confer this benefit could not be too highly appreciated byGovernments, and those whose object was to promote and in-crease the physical as well as the moral condition of the people.In all ages and in all countries this duty had not escaped thenotice of governors, philanthropists, and legislators. TheGovernment of this country, as well as the public at large, aretoo sensibly alive to the advantages of good drainage, water-supply, ventilation, &c., for the purification of large towns, tobe content with anything short of large and comprehensivemeasures for the attainment of those objects. In water-supplymuch had already been done for large and populous towns,but much had yet to be accomplished in extending its benefitsto the smaller towns, and there was probably no gift so great,and none so conducive to health and cleanliness, as a copiousand well-regulated supply of pure water. The metropolis wasprobably worse off for water than many other towns ; but hehad recently seen the outline of a gigantic project in prepara-tion by Mr. Bateman, the engineer of the Manchester andGlasgow Loch Katrine Waterworks, to supply London fromWales, by the construction of reservoirs, and the formation ofaqueducts on a scale far beyond anything that ever was beforeaccomplished in ancient or modern times. This scheme wasnot problematical, as he believed the engineer was prepared toshow, from actual surveys, that 100,000,000 gallons per daycould be delivered in London, and works constructed for theconveyance of double that quantity, for a sum not exceedingX7,000,000. To London that would not be a large sum, if

they considered the immense benefits it would confer on a

population of nearly three millions of souls-and that with aquality of pure soft water which for washing purposes andother branches of domestic economy was calculated to effect a

saving of £400,000 per annum. Next to water, an elementwhich largely contributed to the public health was food, whichwas often depreciated, and sometimes seriously injured, byadulteration. Other conditions besides good food and purewater entered into the catalogue of wants for the sustenance oilife and the maintenance of vigorous health ; and those were,that people should be well housed and comfortably clothed. ThE

subject of dwelling-houses was therefore of the greatest importance. The draining of land was beneficial in every point.as it improved the crops, improved health, and carried off thtsuperfluous waters not required for the growth of plants.Having referred to the metropolitan drainage works in detail,Mr. Fairb,,irn said his greatly enlarged system of drainagewas of the first importance to the health of the metropolis. H(next alluded to the noxious effects of chemical and alkalworks, which polluted the atmosphere into which they wendischarged. He then enlarged on the necessity of an improve(

system of warming and ventilating dwellings ; and he said ithad been found that a full-grown man required at least tencubic feet of pure air per minute for respiration ; but in closerooms, in order to retain the atmosphere in a wholesome state,double that quantity is not too much. He might, he said,enlarge on other topics involving considerations in connexionwith the public health; but, having occupied a good deal oftime, it only remained for him to direct attention to the dif-ferent subjects as classified and arranged in the programme forthe consideration of the members of this department. In thosewould be found abundant matter for discussion ; and, confidingin the good sense of the meeting over which he had the honourto preside, he ventured to look forward to results calculated toimprove the moral and physical condition of the community.

Mr. G. GODWIN moved the thanks of the department to Mr.Fairbairn for his valuable address ; and the PRESIDENT acknow.ledged the honour conferred upon him.

BENJAMIN ScoTT, Esq., Chamberlain of the City of London,read a paper on the "Ancient Water Conduits and ModernDrinking Fountains of London," which, at length, explainedthe value of those means of preserving the health of the people.

Mr. Rawlinson, Mr. Godwin, Mr. Bateman, Dr. Lankester,Dr. Holland, and other gentlemen having addressed the de-partment, thanks were voted to Mr. Scott for his paper.

Dr. LETHEBY read a paper " On the Necessary Qualifications

of a Medical Officer of Health," in which he enforced the neces-sity of the person appointed devoting his whole time to his

duties.Dr. WALLER LEWIS read a paper " On the Health, past andpresent, of the Working Classes of the General Post-office."

After remarks upon it from Dr. Edward Smith, Dr. Milroy,Mr. James Heywood, Mr. E. Chadwick, Mr. Ackroyd, Dr.Warren, and Mr. Bracebridge, thanks were given to Dr.Lewis for his paper.The department adjourned shortly before four o’clock.

SATURDAY, JUNE 7TH.The Section resumed business at eleven o’clock, W. Fair.

bairn, Esq., F.R.S., the president of the department, in thechair.

Mr. A. E. DURHAM read a paper " On the ComparativeHygienic Arrangements of the French and English Hospitals."He produced several statistical tables for the purpose of show-ing that the average general mortality was much greater in theFrench than in the English hospitals ; and, in the first place,that the proportionate mortality in all cases in both coun-tries was greater in the medical than in the surgical cases.In the Parisian hospitals a very much larger number ofmedical than surgical cases were fatal. The mortality percent. in the Parisian hospitals was as follows :-St.Louis, 11’98 ; Maison de Sante, 12’72; Lariboisstere, 15-32;Necker, J5’70; St. Antoine, 16-49; Beaujon, 17-14; Pitie,

17.56 ; Cochin, 18.17; Hôtel Dieu, 21 °64 ; Clinique, 27 ’37 ;Charite, 35-27; Hôpital des Enfants Malades, 18 9. The

mortality in the London Hospitals, on the other hand, was asfollows :-St. Bartholomew’s, 10-72; Guy’s, 9’4 ; St. Thomas’s,9 70 ; King’s, 10 -73 ; University, 11-19; bt. Mary’s, 10-11;Westminster, 9-6 ; London, 84; Charing cross, 8-3; St.George’s, &-34. He said shat all applicants were admitted in-discriminately into the French hospitals, but in the Londonhospitals only the most urgent and severe cases were selectedfrom multitudes. The consequence was that in London hos-

pitals they had a much larger proportion of acute diseases andof severe chronic cases approaching their termination ; while inthe French hospitals there was a much larger proportion oftrifling cases which required only a fdw days’ rest, or some ofthose slight operations which were done every day in the out-patient rooms of the London hospitals. He referred also tost,atistical tables in reference to the amputations for disease,and showed, by comparison, that the r-tte of mortality fromthem was much greater in the Parisian than in the Londonhospitals. Taking a st-ries of years, the results in the principalhospitals of both capitals were as follows : -London-Deaths,22 ; cures, 103. Paris-Deaths, 176 ; cures, 168. He wentat some length into an examination of the arrangements of thehospitals, both as to ventilation and dietary ; and, in conclu.sion, said he had pointed out very hastily many of the differ-ences in the hygienic arrangements of the hospitals, and hehoped he had said enough to call earnest attention both to the’ warnings and examples afforded by the present state of the. French hospitals., Mr. GEORGE GODWIN, while acknowledging the value of thepaper, as showing the disastrous state of the French hospitals,

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hoped it would not be put forward in consequence that therewas no necessity for making any change in Eng!i8h hospitals.

Mr. CHARLES HAWKINS agreed with Mr. Godwin that theyshould not relax in their exertions to improve the Londonhospitals.

1 ord TALBOT DE MALAHIDE said some years ago he hadvisited the Paris hospitals, but he could not agree with Mr.Durham that the Paris hospitals were better situated thanthose of London, as most of them were in very crowded situa-tions, and particularly the Hotel Dieu. The extra mortalityin some of these hospitals might also be accounted for. in con-seqnence of a large number of very critical cases which wereseut ftom considerable tlistances to have the advantage of theexcellent medical staff to be found in those particular hospitals.That particularly applied to the Hôpital de la Charite. An-other point might have some effect on these statistics, on

account of the different system upon which the Parisian hos-pitals were conducted as compared with those in London, inas-much as a variety of cases were treated in separate hospitalsin Paris which were combined in London hospitals.

After a few remarks trom Dr. Guy and Mr. Simon,Mr. PAWLINSON, C.E , said that when the British army was

sent to the Crimea the hospitals there were in a notoriouslybad state, for in the ano:zth of March the burials were at therate of from fifty to seventy a day, but within three monthsfrom the commencement of the sanitary arrangements thosedeaths were reduced to about five per week, which he believedhad been arrived at by reducing the numbers in the wards, im- Iproving the ventilation, and cleansing the sewers. He stronglyurged that there should be a perfect ventilation, that thereshould be no stagnation of air in the wards of an hospital, andat no time of day or night should the means of obtaining freshair be stopped or closed.

Mr. DURHAM having replied, thanks were voted to him forhis paper.

Sir JOSHUA J ERB read a paper on the appropriation of theNightingale Funcl, which stated that out of the surplus of theCrimean fund fifteen young women had p-isse(i their proba-tionary examination at St. Thomas’s Hospital a.s nurses, nineof that number having obtained appointments at other hos.pitals, at salaries of X25 a year ; but owing to the impendingremoval of St. Thomas’s Hospital, the authorities had beenobliged to suspend for the present their probationary examina-tions.Thanks were voted to the author of the paper.The Section, soon after four o’clock, adjourned until Monday.

MONDAY, JUNE 9TH.This section re-assembled, Lord Talbot de Malahide in the

chair.Mr. RAWLINSON, C. E., read the first paper on "The Prin-

ciples of House Drainage and Town Sewerage." In treatingupon this subject, he said there were many difficulties to over-come in executing works of town sewerage, and one of themost formidable difficulties at present was the outlet and per-manent disposal of the sewage, so as not to be a cause of nui-sance and injury to streams, rivers, and property. In a shorttime he believed that fluid sewage would be applied directto land for agricultural uses, so as to relieve towns and housesfrom that which caused disease and give life and fettility tothe land.A paper by Mr. Spooner Tili, being "A Report on the

Sewers and Sewage of Birmingham," was also read by Mr.Rawlinson.

Dr. MILROY read a paper bv Mr. Green, on "The Healthand Mortality of Birmingham."

Mr. E. CHADWICK. adverting to the necessity of sanitaryregulations, instanced the case of the town of Ely, where, in

consequence of the improvements in drainage, which were car-ried out under the direction. of the late Dr. Peacock, Dean ofEly, the deaths had been reduced to one-!hircl, so that it was

equal to this happy state of things-that every third year therewould be no deaths.

Dr. BADCOCK condemned the practice of servants beingallowed to sleep in the basement of houses, which he con-sidered to be most unwholesome, and ought to be at once

given up.Dr. FINCH remarked that there could not be a doubt as to

the value of house drainage, and the question was not as to thadvantages or disadvantages of drainage, but as to the carryingit out on the right principle.The PRESIDENT said it, was not to he taken as sufficient that

ever was always to be attributed to bad drainage. These re.

sults were not always to be traced to sufficient causes, and insome they could not be at all accounted for. In travelling inItaly, in certain parts of it a malarious fever always prevailed;and medioa) men had for ages been puzzled to a count for it,especially as towns in the most, elevated and dnest situationswere the mos’ exposed to it. Equally strange was it, and uponwhich he coulrl speak from experience, that in those districtsof Ireland which were wet with bogs and their exhalationsfever was almost unknown.

Dr. MARKHAM did not think that there was a sufficientdistinction drawn in the case of fevers arising from decompo-sition of animal and vegetable matter and that which arosefrom crowded dwellings. That which was called typhoid feverhad lately become much known to them, on account of the melan.choly death of the Prince Consort, which took place in WindsorC.,sde last December; but having, as house surgeon in Edin-burgh, seen cases where hundreds had died of fever, he couldsay distinctly there was not one case of typhoid fever amongstthem, but they had died of typhus fever. Typhoid fever,as he had srid, arose from the decomposition of animal andvegetable matter, and typhus fever from overcrowding; andwitti respect to the deatli which had taken place at Windsor,if the truth were told, he believed it would be found thatthe death of the illustrious Prince had arisen from defectivedrainage.Mr. RAWLINSON replied, and remarked that the fashionable

district oi Belgravia was as flat as a pancake ; the sewers werefull of deposit, and as to what was called the " trapping ofdrains," that was a complete mockery, a delusion, and asnare; and, were it not fur the escape of exhalations fromsewers in the streets, he predicted a fearful and raging epi-demic.The thanks of the department were given to the authors of the

papers.A paper was read by lir. G. Godwin on " The Evils of Over-

crowding Houses."The section adjourned at four o’clock.

TUESDAY, JUNE lOTH.Mr. G. Godwin read a paper "On Overcrowding in London. "Dr. Miller read a paper " On Some of the Disadvantages

which Affect the Insane Poor."Mr. REYNOLDS said he was surprised that in the paper no

reference had been made to the causes of insanity. Sir GeorgeStrickland stated that insanity increased with the consumptionof tobacco, and the same view was held at the Social ScienceCongress at Glasgow last year. He concluded by expressinghis firm conviction that insanity was owing in a great measureto the consumption of tobacco.

Dr. MARTIN (of Warrington), quite agreed with Mr. Rey.nolds upon the injurious effects of tobacco.

Dr. LANKESTER sticl he felt sure that no medical man wouldat once come to the conclusion that the moderate use of tobaccowas the cause of insanity. He stated on his professional repu-tation that of all narcotic substances that were used, tobaccowas the least injurious.

Dr. RAKDALL said there was no foundation for the state-ment that tobacco wa,s the cause of insanity, although it mightproduce indigestion, as it led to diseases of the stomach andnot of the brain.

After a few remarks from Dr. MILLER, thanks were votedto him for his able paper.

Mr. Rawlinson, C E., read a paper by W. Rullar, M.D.,Physician to the Royal South Hants Infirmary, "On theDangers, from Sanitary Defaults, to Travellers in Search ofHealth." At two o’clock other litisiiiess of this department was sus-

pended for a meeting of the Ladies’ Sanitary Association. TheLord Mayor was in the chair.The section was most numerously attended by ladies.In the evening a meeting was held at Burlington House, for

the purpose of discussing the effects of occupation on health.Mr. Simon presided.

Dr. GREENHOW said he would direct his attention prin-cipally t.o pulmonary diseases. Having given the statistics ofthese diseases, he inquired what were the causes which pro-duced them. These ite classed as follows :-First, the inhalingof an atmosphere charged with dust or other mechanical im-purities. Secoudiy, the breathing in an atmosphere of dele-’I ter mu;s gases, &c. Thirdly, the inhaling of an atmosphereartificially heated, and over-dried. Fourthly, the working inrooms imperfectly ventilated ; and, fifthly, the injurious posi-tion of certain classes of operatives at work. In speaking of

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the cotton manufacture, the speaker said it was a rule carriedon under arrangements calculated to preserve he.dtb, but iusome cases it was attended by very iLjurious consequences.Having referred to the occupation of miners, potters, grinders,&c., he said the causes of the mortality were very largely pre-ventable. He concluded by moving the following resolution :-"That in the opinion of this meeting, the principle of regu-lating labour already adopted by the legislature in certainmines and factories, should be extended to all other kinds ofindustrial employment where several persons are employed inthe same factory or work-place, with the especial purpose of

endeavouring, as far as possible, to obviate conditions danger-ous to the health or safety of the employed, and that the Coun-cil of’the Association be requested to consider whether it canwith propriety and advantage represent the importance of thesubject to the legislature."Mr. CHARLES HAWKINS seconded the resolution.Dr. RICHARDSON was unfavourable to the interference of go-

vernment as recommended in the resolution.Dr. RYLAND was also opposed to the interference of the

government.Mr. HOLLAND said he would extend the Factory Act, though Inot, perhaps, so far as Dr. Greenhow. After some further discuasion,Dr. RICHARDSON moved an amendment to the effect that I

it would be expedient for the government to issue a commissionto inquire into the influence which occupations exercise onhealth.On the vote being taken, the resolution was carried by a

majority of 1. --

WEDNESDAY, JUNE 11TH.Mr. W. Fairbairn presided over this department.Dr. SYMLS PRIDEAUX read a paper "On the Pollution of the

Atmosphere by the Smoke of our Manufactories."This subject led to a discussion, in which it was stated that

the washing bill for the metropolis was, at the lowest estimate,five millions per annum; but if the use were general of im-proved grates and kitchen ranges, such as those on the Frenchand American principle, this great bill might clearly be re-duced one-half.

Dr. MILPOY read a paper " On the Health of the Army andNavy compared together." It contained the following facts inreference to the two services :-In the army, in 1·59, in theUnited Kingdom, the annual death-rate was 8’4 in 1000 ; inthe Mediterranean it was 13 ; in the West Indies, 17 ; in theAustralian colonies, 10; and in Ceylon and China, 47’1. Thedeath-ra.te in the navy was as follows for the year 1858 :-Onthe home station, 9’6 ; Mediterranean, ll’l; West Indian,20’8 ; Australian, 7 9 ; and East Indies and China, 62’5. Thedaily sick rate in the army was as follows :-United Kingdom,50 in 1000 ; Mediterranean, 48 ; West Indies, 535; Austra-lian colonies, 27 ; Ceylon and China. 99 ’5. The daily sick ratein the navy was- Home station, 53 5 ; Mediterranean, 48.7 West Indian, 66 6 ; Australian colonies, 42 ; and East Indiesand China. 92.Mr. J. N RADCLIFFE said it was worthy of notice that Lord

Clarence Paget, in moving the navy estimates, had stated thata large amount of the mortality and sickne&s in ships was be-lieved to be traceable to the want of proper ventilation betweendecks. The iron plating of ships shut out the means of venti-lation, and the temperature between the decks of the Warriorwas much higher than in any of the other war ships of thenavy now in use. He thought it was urgently required thatthe attention of the Government should be drawn to the venti-lation of the Warrior, Black Prince, Defence, and the otheriron-plated ships now building, or the mortality might provemuch greater than it was at the present time.

Mr. ERNFST HART read a paper ’’On the Sale of Poisons,and the Prevention of Accidental Poisoning." in which he recotn-mended that peculiar shaped botles should be adopted forparticular kinds of medicines, whe her poisonous or not, for external or internal application. This precaution, he believed,would be found most useful, and would have prevented manyof those accidental cases of poisoning which he enumerated,and which they had so much reason to deplore.The thanks of the sec ion were awarded to Mr. Hart for the

valuable suggestions contained in his paper.

THE OPHTHALMOSCOPE IN THE DIAGNOSIS OF 1’lE;stTGITIS.-M. Bouchut for the first time has employed the ophrhalmoscope in the diagnosis of tubercular meningitis, with thmost satisfactory results.-G’az. des H4pitaux.

Correspondence.

PROPOSED OPERATION FOR THE REMOVALOF EMBOLON IN ACCESSIBLE ARTERIES.

THOMAS WILLIAMS, M.D., F.R.S.,Physician to the Swansea Infirmary.

"Audi elteram partem:’

To the Editor of THE L.ANCET.

SIR,-Two interesting cases of embolon in the femoral arteryare published in your " Mirror " of last week: one under thecare of Mr. Prescott Hewett, at St. George’s, and the otherunder that of Mr. Erichsen, at University College Hospital.In both, death by gangrene took place. In the former, ampu-tation of the limb was contem platpd, but not adopted ; in theletter it was actually put in practice. A similar case cameunder my notice some time since, in which we felt certain thata plug of fibrin had become impacted in the femoral artery ata short diS’ance below Poupart’s ligament. To my friend whowas with me in attendance 1 proposed that the following opera-tirm for the removal and extraction of the embolon should bepractised :-

Ope?-cotio)i.-L-,3t the trunk of the artery at the point at whichthe pulsation ceases be laid bare to the linear extent of abouttwo inches ; then, by means of sharp-cutting scissors (takingcare that the point of the instrument does not displace theplug), let a straight longitudinal incision of the required lengthbe made through the coats of the vessel-thus laying open thetubular channel of the artery and exposing the plug, whichnow may be removed by aid of a property constructed forceps.This being accomplished, the ed_ es of the incision in the coatsof the vessel should be accurately brought into contact, andheld in apposition by means of an appropriately contrivedsuture of silver wire.

In our case, however, the friends would not consent to anoperation. The patient recovered.

I am not aware that the proposed operation has been thoughtof by any surgeon. I suggest it as worthy of trial in these andsuch cases in which the artery is accessible, and the locality ofthe embolon can be determined with fair certainty. It recom-mends itself as a harmless measure; and offers to the surgeona feasible mode of restoring the tubular continuity of the vessel,and therefore of the current of the circulation. It is my beliefthat an incision made parallel with the axis of the vessel, pro-vided the edges be carefully brought into apposition, would notbe followed by hœmorrhage. If surgeons reflect on the terrible-ness of the consequences which now follow upon the pluggingof an artery-amputation and gangrene-they will admit thatthe operation as explained is not ouly justifiable, but strong inits claims to practical adoption.

I am. Sir. vour obedient servant.

Swansea, June, 1862.

ROYAL COLLEGE OF SURGEONS.—ELECTIONOF COUNCILLORS.

To the Editor of THE LANCET.

SIR,-I beg leave respectfully to quote your words in THELANCET of the 31st ult., and with your permission to make afew comments upon them. You remark : " It is desirable inevery point of view that country surgeons should be representedin the Council. The reasons for this are so obvious, that it isunnecessary to enlarge upon them. The interests of the pro-fession demand that no cxclusive principles should be in theascendant " Allow me. as a country Fellow, senior to some ofthe candidates who are laudably ambitious to fill the honourablepost of Councillor, to express my entire dissent from the spiritof your proposition-the antagonism between London and pro-vincial Councillors. I eoincifie in the correctness of your pre-vious remark, "That the College of Surgeons is no longer aLondon College but the College of England." I contend thatthe history of the College shows that it has regard alike to thewants and claims of town and country; it is essentially one andundivided. To attempt, therefore, to array one section ofCouncillors against another, on the plea that rural and urbanCouncillors have clashing interests to uphold, is to assume amyth or a fiction which is most mischievous to the unity offeeling ]in,, and action which are essential to the well-being of theColl, ee.

Whatever individual views on a given subject a Councillor