744

SANITATION IN THE BAKEHOUSE ANDTHE RESTAURANT KITCHEN.

IT was at the end of 1889 and the beginning of 1890 thatwe published a series of reports on "Bakeries and Bread-making." We first described the dangerous filth existing inunderground bakeries not only in poor quarters but notablyin the establishments of some fashionable London We&t-endconfectioner and bakers. Then we alluded to the unhealthynature of the work imposed on the journeymen bakers,the night work, the long hours, and the diseases prevalentamong this section of the population. These details were

followed by a description of the bakery in the Rue

.Scipion which provides all the bread consumed in the

hospitals and which belongs to the Paris Municipality. Herethere are no night work, no excessive work, good pay, andold age pensions. The bread is pure and cheap and it doesnot entail any expense on the ratepayer but, on the contrary,saves the public purse by providing the hospitals with whole-some food at something like cost price. We also gave anaccount of the cooperative bakeries of Vooruit, of Ghent, andof the Maison du Peuple of Brussels where model conditionsprevail in regard to cheapness, purity, and sanitary surround-ings in the making of the bread. There journeymen bakershave the eight hours day, no night work, plenty of light andventilation, and better pay than in the ordinary bakehouses,and there is consequently much less sickness. This informa-tion gradually filtered through from our columns to the tradepapers and the general press. It ultimately found an echoin proposals and speeches made in the House of Commonsand the greater rigour shown in dealing with undergroundbakeries under the Factory and Workshop Act of 1901. Thenthe Factory Act of 1895 was passed forbidding the using ofa " place underground " as a bakehouse unless it was so usedbefore the passing of the Act and numerous by-laws havebeen issued by local authorities rendering the supervision of<such places more and more severe. So there has been some

improvement and the publicity which we gave to the subjectbas helped to bring this about.

After dealing with bread-making we published an articleon Sanitation in the Kitchen,l in which we described thecegulations issued by the Paris Municipality in regard to therestaurant kitchens. We also related how Dr. Regeard hadtaken action on behalf of the professonal cooks. The greatprevalence of disease among them is the direct consequence<of the unwholesome conditions under which they work andthis was denounced by Dr. Regeard. Now to-day we findthat Dr. W. Collingridge, as medical officer of health of theCity of London, has issued a special report coupled withimportant and practical proposals in regard to the restaurantkitchens and the bakehouses of the City. The suggestionis that such establishments shculd have certificates given tothem if their premises are in a satisfactory state. There is

nothing new in the proposal. Silver is "hall-marked" andin many seaside places or other health resorts certificates aregiven to lodging-house keepers as to the condition of theirdrains, &c. Many owners of restaurants in the City havebeen called upon to carry out alterations and repairs andthey feel that they should reap some benefit from suchoutlay. If they could exhibit a certificate it might attractcustomer. To he public, also, it would be a greatadvantage to know that the kitchens where the food whichthey eat is cooked have been examined by experts and putin order. Dr. Collingridge proposes that all the owners ofkitchens and above-ground bakehouses should be told whatare the requirements that would meet the necessities of thecase and that if they complied with the specifications pre-pared by the corporation a sanitary certificate would begranted. But this is evidently not sufficient, for a placethat is in a perfect state to-day may soon degenerate andbecome unwholesome. The inspections should be repeatedfrom time to time and fresh certificates should be issued. ItM thought that under this system the restaurant keepers andsize bakers would be much more willing to carry out the

requirements of the sanitary authorities and would devotemore time and attention to the proper maintenance of the

necessary standard of sanitary perfection. A somewhatsimilar way of proceeding has worked well in regard to

1 THE LANCET, April 26th, 1890, p. 934.

houses let out as cheap tenements. These are exemptedfrom the payment of inhabited house duty if the medicalofficer of health certifies that the tenements are kept up tothe model sanitary standard established.The sanitary requirements of tenements are, however, better

I known than those of bakehouses or restaurant kitchens.It will be, therefore, of practical interest to see what arethe rules it is proposed to apply to the City bakehouses andrestaurants. Now, in this respect, the first object is to scourand thoroughly to wash out the place. Therefore the wallsand ceiling should be finished off with a hard, smooth surfacemade of impervious material so that it can be washed. Thefloor, for the same reason, should not be absolutely level butshould slant slightly so that the water may easily drain away.The method suggested for dealing with damp walls is some-what stringent. Another inner wall is to be built at leasthalf a brick thick and separated from the damp wall byan open space also at least half a brick wide. This spaceis to be ventilated and drained. But such a supple-mentarv wall would make the interior of the bakehousesmaller and the cost of space in the City will cause

many to seek some other method of curing the damp.ness of their walls. This is the more likely as afterall the remedy only masks the evil and does not inany way remove it. Of course, there are the usual stipu-lations as to the perfect soundness of drain-pipes and thevarious ;sanitary fittings. The bakehouses are to have aminimum height of eight feet and at least 1500 cubic feet ofclear space between the ovens and any stored flour. For eachperson employed in the bakehouse there must be at least400 cubic feet. As far as possible natural light should beused and when artificial illumination is necessary it should beeither by electricity or by incandescent burners. Then we aretold that the ventilation should insure a constant and suffi-cient change of air without prcducing draughts. It wouldbe very interesting to know how this can be provided,for unless mechanical means are employed with very elabo-rate methods of delivery and extraction of the air either theventilation is insufficient or a draught is created. Neverthe-less, we are told that the temperature must not exceed 80&deg; F.except during the half hour after a batch of bread has beentaken out of the oven. It will be more easy to ventilate, asproposed, the ovens themselves, so that the heat, steam, andsulphurous gases shall be conveyed straight to the open airinstead of permeating the bakehouse, much to the injury ofthose employed there. Then the flour should not be storedin the bakehouse. There should be ample lavatoryaccom.modation, but outside and well away from the bakehouse.If there are cisterns for the storage of water they should befitted with dust-tight covers. Flour should not be put onthe ground but on shelves at least 12 inches from the

ground. All the dough troughs and heavy articles shouldstand on castors, so that they can be easily removed whenthe walls and floor are sluiced with the hose and jet whichshould be at hand. Shelves must stand out two inches fromthe wall and all unnecessary woodwork must be takenaway.

In regard to the restaurant kitchens the same regulationsapply as to the facilities for washing the floor and walls, forventilating, for lavatories away from the kitchen, for drain-ing, for the prevention of damp wolls, for the removal ofunnecessary woodwork, and so on. The minimum height ofa kitchen should be eight feet and the capacity equal to400 cubic feet for every person employed therein, and nokitchen must have less than a capacity of 1500 cubic feet.Where the kitchen is underground the inlets for ventilationmust be at least 12 inches above the footway or the groundabutting upon the kitchen. Further, it is stated that whengas is used in the process of cooking means must be pro-vided for carrying off the fumes generated and hoodsmust be placed over all stoves and ranges to carry offthe fumes and heat. Such hood, of course, must com-municate with the outer air by means of a fhaft or flue.

Naturally, also, the storage of food and all the scullery work,draining of plates, the shelves, &c., for saucepans andother utensils, should be provided for outside the kitchen.If this is not possible there should be a dwarf partition toseparate the scullery work from the cooking. Then theremust be proper bins for flour and other articles of food soplaced as not to be exposed to dirt, dust, or moisture.Enamelled stoneware sinks should be provided, especially forthe washing of vegetables. The metal bins for the receptionof refuse must have tightly fitting covers and must beemptied every day. Great care should be taken to provide

745

separately for each sex, near but outside the kitchen,wash-hand basins for personal ablutions. The kitchenwearing apparel should be hung up outside the kitchen and,in a word, every facility ought to be provided for main-taining the perfect cleanliness of both the kitchen and thecooks. n

These regulations, it will be seen, evidently contemplatethe continued existence of underground kitchens. For theCity, considering how the houses have been built, theimmense value of the land, and the extreme cost of anyradical alteration, it is presumably necessary to make thebest of the evil conditions that prevail. Undoubtedlythe late Sir B. W. Richardson was right when he urgedthat it was a fundamental mistake to place the kitchens inthe basement of houses ; the kitchens should be in thegarrets rather than in the cellars. The picture givenby the above regulations of air inlets 12 inchesabove the footway is not encouraging. In times of

epidemic it has been noticed, especially in regard tocholera, that there was a greater number of cases amongthose who were regularly employed in the cleaning ofboots. The boots worn by pedestrians are certainly more likelyto come in contact with dejecta and to become the carriers ofspecific germs. That is why Mahomed, who was an eminentsanitary reformer, would not allow, the faithful to enterhouses of prayer with their boots on. In eastern countriesit is the practice to leave the shoes or boots at the doorwhen a call is made. As a compromise in regard to thiscustom, Europeans in Constantinople generally wear golosheswhich they take off at the door when they make a call.Here, however, we have the crowded streets of theCity where thousands of feet pass and repass, ever

stirring the dust of the pavement, and within 12 inchesof all these boots and feet and of this dust are theintakes of air for the ventilation of the kitchens. This dust-laden air will pass over the dishes and the saucepans and

sprinkle them with the heavier particles of every sort of dirtbrought in from the City causeways. This street dust willthen be duly eaten by the frequenters of the restaurants. Ifit is impossible, really impossible, to abolish the undergroundkitchens then the air intakes that are on the level of thestreet should be provided with some method of filtering or ofwashing the air brought in. Otherwise these air intakesshould consist of shafts that would bring the air downfrom above the roof of the building. It is difficult to

justify the giving of a certificate for sanitary excellence ’’

to a kitchen which is ventilated with the air and dustcollected within a few inches of the pavement of a citystreet.In Paris the suspicions which it is so natural to enter-

tain in regard to the restaurant kitchen have been metby many restaurant proprietors in a very radical andeffective manner. The celebrated Duval restaurants madetheir reputation by simply placing the kitchen in therestauract itself. Just as in England the customer maywatch his teak on the silver grill, so can the much moreelaborate cooking of the Duval chefs be observed by theintending diner. Indeed, a large proportion of the cook-ing in Paris restaurants is done in the presence of thecustomers. It has often been a matter of surprise thatthere are no imitations of the Duval restaurants in thiscountry. English people, who know little about the

cilinary arts, apologise for the simplicity of their food bysaying that they like to know what they are eating. At theDuval restaurants they can see what they wish to eat beingcooked and the fact that the customer can watch the cookis a very effective guarantee for the cleanliness of thecooking.

In any case it is very urgent that all these problemsshould be taken in hand and that practical action should beattempted. Dr. Collingridge therefore is to be congratu-lated upon his initiative. As the difficulty of obtaining theservices of domestic servants grows greater and as thenumber of persons living in flats and chambers increases thetendency will be to reduce housekeeping to its simplestexpression. For this purpose dining at the restaurant mayultimately become as much the custom in London as it isin Paris. Consequently the importance of establishing aneffective control over the sanitary condition of restaurantkitchens becomes a matter of growing concern and we arEtherefore g’ad to record the measures which the City Cor-poration is now contemplating. Their successful applicatiorwill meet with general approval and will constitute a usefulexample for other local authorities.

Looking Back.FROM

THE LANCET, SATURDAY, March 11, 1826.

ST. BARTHOLOMEW’S HOSPITAL.

Exceedingly rare case of Intussusoeption, 7vherein upwards ofa yard of intestine was removed.

In every case of intussusception that has hitherto beenpublished in the Journal?, there has always been some

questionable parr, some deficiency of description connectedwith it, so as to leave a doubt whether the portion ofsubstance brought away was really intestine or a tube oflymph, secreted from the internal surface of the intestines ;and this very circumstance has led some medical men tobecome so sceptical as to question whether such an occiar.rence, as that of a loss of a portion of gut, ever happened,It is, therefore, with no little gratification that we have itin our power to remove any existing scepticism on such aninteresting and fortunately rare disease, by reporting thefollowing case:A woman about the middle period of life, had been for

some time labouring under a constipation of the bowels, andshe in consequence sent for her medical attendant, who onthe second day of his visiting her, had his attention directedto a slight protrusion which had taken place per anum.

, From the appearance which it presented on a superficial! examination, he was induced to think it was a portion of thei rectum, and as no particular swelling of the parts had as yet. supervened, the tumour was readily returned.l The constipation, however, continued, and within a day ortwo she was seized with severe symptoms of peritoneal in-l flammation ; there was pain over the abdomen, accompaniedE with a continual state of nausea and sickness, so that every1 kind of nourishment that was taken was instantly rejected. Just about this time a protrusion again recurred, and to aE greater extent than at the former period ; this induced thes surgeon more minutely to examine the condition of the parts,1 for which purpose he very gently withdrew a small portion,and finding it yield very readily, he continued in this mannere gradually withdrawing the gut, until one yard and three inchedt of intestine were brought away, and when the last portion was’1 removed, no additional force was employed. The violent

and distressing symptoms which had previously harrassed’. and tormented the patient, now, in great measure, subsided ; ;.it still, however, pain was complained of in the abdominal

d region, and there was an occasion.1 recurrence of nauseae and sickness. A dose of castor oil was given the patient bye the attendant surgeon, and to his great surprize he had they satisfaction to find on visiting her the next day that thee bowels had acted for the first time since the commencemente of the attack. On examining the evacuation it was found toc- present the appearance of a healthy and natural secretion.Lo Small doses of sulphate of magnesia in mint water, werett occasionally administered, and in a very short time theis nausea and sickness subsided. The patient went on pro-le gressively improving to the eighth day, at which time the

IY bowels had acted three or four times, and the general stateie of the patient was such as to induce a favourable prognosisi of the case to be given.tk To use the metaphorical language of John Hunter, bow-ie ever, "Nature took the alarm, conscious of her inability to

sustain the extensive injury that had taken place, she gavelS up the contest ; " and at the moment when the patientje appeared to be going on favourably, life ceased.u- Mr. Stanley assisted in examining the body, which we needie not say was done in a most careful manner. It was foundae that the detached intestine was a portion of the ileum whichne had become intussuscepted (if we might be allowed to usest such an expression) within the colon, violent strainingy attendant on the distressing symptoms under which theis patient laboured, had in all probability greatly facilitatedin the descent of the gut. And that it did n arise from thent force which was used in extracting it is abundantly proved,.re from the circumstance that the solution of continuity was)r- discoverable. An icnammatory action had taken placeon about the caput coli, which had occasioned a secretion oful lymph, thus completely agglutinating the two portions of

intestine together; and from this agglntimated part had the