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SANITATION IN MASSACHUSETTS

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Page 1: SANITATION IN MASSACHUSETTS

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Sate control and made, as in their bright mediaevalforetime, autonomous. In other words, the "sencuy com-munis" of the whole University body, including students aswell as teachers, must give tone and law to its life andworking. So long as that power was retained the well-conducted majority of the students made short work of theirriotous fellows, and, in concert with the professorial or

governing body, purged their ranks of the rowdy element.Far otherwise is it with the Italian universities as they havesince degenerated. Under State control they ar.- now

dominated by political ideas, and no student, however in-subordinate, is without the consciousness that he can findsome friend in the Chamber of Deputies to make an inter-pellation in his behalf. Successive Ministers of PublicInstruction, in fact, have, especially of late years,been hampered in every way by the power possessed byundergraduate organisation to get the ear of Parlia-ment and make their grievances or claims " Statequestions." Under this system students are almostinvited to become politicians, at an age, however,when their one and only concern should be their pre-paration for professional life. Concentration of thcughtand work is thus made next to impossible for all but thosewho have the moral strength to resist the surroundingcontagion. All this Dr. Baccelli aspires to put an end toby a return to the condition of things which prevailed atBologna, Pisa, Padua, and such like centres of academicculture at, and immediately after, the Renaissance. Letthere be two distinct spheres of inflaence " dominating thestudent’s career. Let there be the examination for gradua-tion, in which only the University shall have a voice.Secondary to that, let there be the examination by theState giving the right to practice. The former grants thejus dooendi, the latter the exerceat. Full liberty to teach it isfor the University to confer; but when it comes to bringingthat teaching en rapport with the public-in other words,when the practitioner.is brought into relation with the citizen-let the State see that the public have a duly qualified func-tionary, be he medical man or lawyer or engineer. By thattime the University shall have done its work. The body ofgraduates, long past the stage at which youthful insubordi-nation occurs, will, with a view to professional practice, besubjected to government examiners, who shall migratefrom one university to another, and grant qualificationsimpartially and judiciously only after due cognisance offitness has been taken. Such is Dr. Baccelli’s ideal embodiedin the rubric, "Torniamo alle antiche tradizioni " (let usreturn to the old traditions) ; and when his Bill, alreadyformed, shall have passed into law we hope towitness a salutary reform in Italian academic life, underwhich such riots as have lately discredited it will becomeimpossible, and such Draconian measures as that just appliedto Naples a thing of the past.

SANITATION IN MASSACHUSETTS.

THE twenty-fifth annual report of the State Board ofHealth of Massachusetts, which refers to the year 1893, is a

production of no mean size, and the subject matter of whichit treats is dealt with in a thoroughly scientific spirit. The

volume comprises 784 pages, exclusive of an excellent index,and amongst its valuable contents may be mentionedexhaustive reports on Water-supply and Sewerage, the

Analysis and Filtration of Water, and an elaborate report onInfectious Disease Hospitals. The volume also contains aninteresting’ account of a series of experiments made byDr. Thomas Drown, chemist to the Board, on the Amountand Character of Organic Matter in Soils and its Bearingon the Storage of Water in Reservoirs. These investiga-tions were carried on more especially in reference to theproposed storage reservoir for the c’ty of Boston, as

it was deemed exp3dient prior to forming the reservoirto obtain a thorough knowledge of the character of thesoil so as to be in a position to determine how muchsoil it would be necessary to remove in order to procurea clean bottom and sides free from organic matter. Theresults obtained were, as was to be expected, somewhatirregular, but it was found generally that there was a rapiddiminution in the amount of organic matter below a dep’hof nine to eleven inches, and at a depth of three feet the

amount of organic matter was, as a rule, below 1 per cent.In order to render the observations more complete, samples ofthe soil were treated with water and the filtrates from the-solution analysed. The watershed from which the severalsamples were taken was but sparsely populated, and the-organ;c matter present mainly of vegetable origin. As a resultof a very thorough examination of the effect of water uponthe soils experimented with, Dr. Drown has provisionally fixed1-5 to 2 per cent. of organic matter, as determined by the losson ignition of the sample dried at 100° C., as the permissiblelimit of organic matter that may be allowed to remain onthe bottom and sides of a reservoir. It is not possible for us.here to deal in any way exhaustively with the Massachusettsreport, but we may say that it does honour to thosewho compiled it, and we can conscientiously commend itto the notice of all students of sanitary science. There isone special feature which distinguishes this as well as allthe later Massachusetts reports, and that is the completenesswith which the writers deal with the statistical side of altsuch subjects which can be approached from a statisticalstandpoint. The notification of infectious disease wasstarted at an early date in Massachusetts ; indeed, it appearsfrom the report before us that as far back as 1792 house-holders were required to report cases of dangerous in-fectious disease to the local authority, while in 1827 dualo+-,ification came into operation. An Act of 1893 hasspecified the diseases "dangerous to the public health," andthese include measles, yellow fever, cerebro-spinal meningitis,hydrophobia, malignant pustule, leprosy, and trichinosis,in addition to most of the diseases required by our ownNotification Act to be notified. We observe, however, thaterysipelas and puerperal fever are not included among thediseases "dangerous to the public health." The reportupon infectious disease hospitals, to which we have alreadyreferred, was compiled by Dr. S. W. Abbott, Secretary to theBoard of Health, owing to oft-repeated demands on the partof local authorities for information upon the subject. Dr.Abbott points out how the increasing tendency of thepopulation to congregate in cities favours the spread ofinfectious disease, and he shows that in 1840 the urbanpopulation of Massachusetts was but 27’1 per cent. of thepopulation of the State, while in 1880 it was 58 4 per cent.,and in 1890 69’9 per cent. As an illustration of the relationof this tendency to the mortality and in all probability to the.prevalence of infectious disease the following very interestingtable is given. The term "Dense" refers to districts where

: there is less than one acre to each inhabitant, ’’Medium " tothose having more than one but less than four to eacbI inhabitant, and where there are over four acres to eachperson the term " Sparse" is used.

l Mortality from Eight Principal Infectious and -Destruetiv6Diseases in Dense, Medium, and Sparsely &ttled Districtsin ]}Iassaclwsetts, that (Jf Dense Districts being taken as1000.

It will be seen that, with the exception of typhoid fever,there appears a direct relation between density of populationand mortality. Dr. Abbott, in dwelling on the advantages ofhospital accommodation, points out that where it obtains, theordinary duties of the household, attendance at school, andthe support of the family by the wage-earner can be carriedon without disturbance. During the twenty years 1871-1890’the deaths from measles, scarlet fever, diphtheria, croup,and typhoid fever amounted altogether to 74,597; andDr. Abbott remarks, in regard to these figures, that if the-usually observed case mortality of the several diseases wasmaintained there would have been some 700 000 cases ofthese diseases during the twenty years ; and he considersthat, had proper isolation provision been in existence from 1871, a very material proportion of this illness and mortality

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might have been prevented. In dealing with hospital con-struction and management, Dr. Abbott quotes largely fromDr. Thorne Thorne’s standard work on the "Use andInfluence of Hospitals for Infectious Disease," and it is

impossible to read without a feeling of national satisfactionthat "hospitals for infectious disease have reached their

highest type of development in Eogland." In the reportbefore us plans of pavilions both of the Boston and Cam-bridge infectious disease hospitals are given. In the formercase the arrangement differs materially from those usuallyfound in the more modern fever hospitals in England, and inboth cases there are no annexes for cutting off aerially thewaterclosets, &3., from the wards. In an appendix to hisreport Dr. Abbott reviews the practices of different countriesin regard to hospital provision, and his report generallyserves in an excellent manner the purposes for which it wasintended.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

AN ordinary meeting of the Council was held on the7th inst., the President, Mr. J. W. Hulke, F.R.S., being inthe chair.The Council approved the following resolution, which had

been adopted by the Court of Examiners on Jan. 23th, 1895,in consequence of having been called upon by the Councilto take into consideration the arrangements for admittingvisitors to the examinations :-

" The Court of Examiners, having considered the question of theadmission of visitors to the final examination for the Fellowship, are ofopinion that for the present it will be sufficient if a notice is handed to<each visitor on his arrival, in the following terms-namely, Visitorsare requested not to approach too closely to the candidates while theexaminations are in progress, and to refrain from examining patients inclose proximity to the examiners."’

"

Mr. J. McCarthy and Mr. Edmund Owen were electedmembers of the Court of Examiners’ section of the Board ofExaminers in Dental Surgery.The Council proceeded to the further consideration of the

resolution carried at the meeting of Fellows on Jan. 3rdrequesting the appointment of a conjoint committee, andresolved : "In accordance with the opinion of the legaladviser of the College the Council do not deem it expedientto accede to the resolution passed at the meeting of theFellows held on Jan. 3rd."

It was further resolved : "That a committee of the Councilbe appointed to receive deputations from the Fellows of theCollege upan the subject of the resolution of the meeting ofFellows of Jan. 3rd last and to report thereon to the Council."Copies of these resolutions were directed to be sent to themover (Mr. W. H. Bennett) and the seconder (Mr. T. Holmes)of the resolution at the meeting of Fellows.A letter was read, dated Jan. 30th, from Mr. W. G. Dickin-

son requesting by desire of the committee of the " Society ofMembers of the Royal College of Surgeons of England," thatthe following resolution might be laid before the Council-viz. :" That in the event of the Council of the College consenting to form

a joint committee, composed of Members of their own body and of thatof the Fellows, to consider the desirability of applying for a newCharter they are hereby requested to add some representatives of theMembers to the same committee."

In reply, the Council directed that copies of the two resolu-tions just passed should be sent to Mr. Dickinson.A further communication was read from the Committee of

the Society of Members, giving the reasons of the Society foropposing before the Home Secretary the proposed alterationsin the bylaws.The Courcil left it to the President to determine whether

a meeting of the Council should be held in March. The dateof the quarterly meeting in April was fixed for Thursday,"1he 4th.

WE Iparn that the Eighth Universal Cookeryard Food Exhibition is to be held at the PjitmanRoom&deg;, BakEr-Street, from May 7th to lO"h inclusive. Cookery cor&ugrave;petitiolJs s"wii! be held and .E200 awarded in special prizes as we1l asr.:ne&agrave;a1s and diplomas, while half the profits of the exhibitioncvill be devoted to the providing of meals for poor children.

ST. THOMAS’S HOSPITAL.

A MEETING in aid of the special appeal fund for the

purpose of opening the closed wards in St. Thomas’s Hos-

pital was held in the Egyptian Hall of the Mansion House,London, on Wednesday, Feb. 13th. In the absence of the

Lord Mayor, Sir Joseph JRenaIs, his predecessor, Sir Stuart

Knill, K.G., presided, and was supported by H.R.H. theDuke of Connaught, president of the hospital. Amongstthose present were the Earl of Leven and Melville, the Bishopsf Southwark. Mr. Alderman and Sheriff Samuel, Mr. SheriffHand, Sir William Mac Cormac, Sir Henry Doulton (senioralmoner of the hospital), the Rev. Newman Hall, D.D., theRev. David MacEwan, Mr. A. 0. MacKellar (seniorsurgeon to the hospital), Dr. J. F. Payne, Mr. F. A.Bevan, and the treasurer, Mr. J. G. Wainwright. Lettersof apology were read from the Archbishop of Canter.bury) who referred to the growing population of SouthLondon and its dependence upon St. Thomas’s Hospital formedical aid, which day by day grew more important), theBishop of Rochester, Duke of Rutland. Lord Selborne, LordRcthschild, Duke of Devonshire, and Sir Sydney Waterlow.A sympathetic letter was also read from Miss Nightingale, inwhich she called attention to the moral effect of residence inthe wards of S*.. Thomas’s Hospital upon a patient’s life.

Sir STUART KNILL, in calling upon his Royal Highness theDuke of Connaught to propose the first resolution, said thecitizens of London looked upon St. Thomas’s Hospital asessentially their own institution, and it was their duty totake the initiative in commencing to replace that hospital inits proper position. The wards were not closed through badmanagement, but through the failing of the hospital fundsfrom the great agricultural depression.The Duke of CONNAUGHT then moved : "That this meeting

has heard with sincere regret that notwithstanding the largeincrease in the population of South London, and the con-sequent greater demand for hospital treatment, there are

several wards in St. Thomas’s Hospital lying empty and un-used owing to the income of the charity not proving sufficientto maintain a greater number of beds than those now in use(436)." In supporting his motion his Highness referred tothe appeal that he had already addressed to the public andhoped they would believe that it was thoroughly genuine,thoroughly open, and contained all the secrets connected withthis important hospital. He referred to the importantwork done in connection with St. Thomas’s hospital by MissNightingale, which had had such a wide inflaence on

nursing throughout the country, and he then brieflytraced the history of the hospital from its foundation in1551 to the present day. It was said by some people thatthey would not support the hospital because in incurricgtheir enormous expenses they had followed the fads ofthe medical men. That was not so, and he did notbelieve that the general public held such an opinion.Sinc3 1871 the population around the hospital had increasedfrom 644 000 to 961, 000 in 1891, and at the present time itwas upwards of 1 000,000. The number of patients admittedto the wards in 1894 was 5840, and they stayed on an average22 days under treatment. There were also 24032 out-

patients and 82,782 casualty patients who received attention.Out of the Samaritan Fund 670 persons were given assistanceat a cost of f:1159 128. 9d., 400 cases being sent to convalescenthomesand the remaining 270 being aided in various ways, suchas being supplied with surgical appliances, grants of moneyto redeem tools and clothing from pawn, and for travelting.He confidently looked to the public to support an institutionthat was capable of such vast work-an institution whichwas really one of the most deserving in the country.The Bishop of SOUTHWARK, who seconded the resolution,

said he believed it fundamentally better to have a few greatcentres of hospital work than a number of smaller ones.

Sir WILLIAM MAC CORMAC testified to the importart workdone by the hospital, remarking that it would be rothingshort of a national scandal if the hospital were alicwed toremain in its present state.The Rev. Dr. NBWMAN HALL supported the motion, which

was carried unanimously.On the motion of the Rul of LBVEX and MELYILLB,

in the absence of Sir Albert Rollit, M P., the followirgmotion was supported by Df. J. F. PAYNE and the Rev. DAVIDMACEw A, and earned : ’’ Teat ’t&k!ng into consideration the


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