1268 THE DRAINAGE OF RANGOON.

is required. It does not suffice to beat about or stir up theair. The hot and vitiated atmosphere has to be driven outand fresh air admitted in the necessary volume, and yet so- equably as not to occasion draughts.The male ambulance station was in charge of a party of

the Volunteer Medical Staff Corps-in the afternoon ftir-nished by No. 1 University College Company, Surgeon-’’Captain V. Matthews; in the evening by No. 5 City ofLondon Company, Surgeon-Captain J. Squire-and was Ialso made use of for minor casualties.Accidents which occurred to the soldiers in the arena

were attended to in an army hospital fully equipped withall the hospital armamentaria from Aldershob. This hos-pital was under the charge of Surgeon-Captain F. J. Gceig- from Aldershot, who was assisted by Surgeon-Captain J. B.Beach from the same station. Fortunately the services ofthese gentlemen were not called into requisition except toattend to a trooper who received a subcoracoid dislocationof the humerus during the Balaclava mêlée. The disloca-tion was reduced in the army hospital, under chloroform,and next day the patient was sent by ambulance waggon tothe Guards’ Hnspital in Rochester Row. Besides theabove-mentioned officers, twelve men and three non-com-missioned officers of the Medical Staff Corps were in,1J,ttendance.

The sanitary arrangements had received considerableattention. Latrines were provided by the Sanitas Com-pany, and several of Moule’s earth closets were erected.The sanitary appliances for the soldiers had likewise

received attention from those in charge of the tournament.Water was plentiful, and ablutions could be performedwith comparative comfort. Objection, however, must betaken to the sleeping accommodation provided for thesoldiers. Tents had been erected in an upstairs portion.of the building. It may be that this is the readiest mode<of providing the men with a " local habitation," but tentsunder such circumstances are not sufficiently airy andventilated to be occupied at night, and can hardly be takento illustrate, even from a spectacular point of view, theexigencies of life in a military camp. That British soldiersshould be sweltering in a small, ill-ventilated tent in theupper room of a building, the air of which has been vitiated’by its having been occupied for many hours by vastmumbers of men and horses, is scarcely in harmony witharmy hygiene or complimentary to those who made thearrangements. It seems to us that it would have beenan easy and preferable arrangement to provide the re-

quired accommodation in the shape of extemporisedcubicles.

____________

THE DRAINAGE OF RANGOON.

THE municipal authorities of Rangoon have courageouslygrappled with the drainage problem, and this is the more<creditable as local circumstances rendered the question oneof exceptional difficulty. Rangoon is situated at a distance.of thirty-five miles from the sea, on very low-lying ground.It was occupied by the British troops from 1824 to 1827,but did not become definitively an English possession till1852. At that time it was but a collection of. bamboo andplank houses and huts built on piles that bad been sunkinto a swamp which was periodically flooded by spring andother high tides. Yeb, historically, the town is veryancient, having been founded, according to popular belief,by the brothers Pov and Tapaw, B.C. 585. Thus the swampy ’,ground on which Rangoon stands has had ample time to be ’contaminated by its inhabitants. i

Though annexed by the English forty years ago noattempt was made to deal with the sewage before 1873.’The population had greatly increased. It was only 86GO in1826, but it rose to 61,138 in 1863, and 98,745 in 1872. Thecesspools with which the town was provided leaked fre-quently, and in 1873 they were abolished; but the pailsystem, instituted in their stead, was only a partialimprovement. These pails were conveyed in carts to the.jetties on the river bank, and there emptied into the water.Thus the air of Rangoon was polluted throughout the nightby the horrible stench caused by the emptying and washingof the pails. For many years, however, no better plan couldbe devised. To build ordinary sewers was a matter of excep-tional difficulty, as the ground was too flat and too unstable.Then there was the question of the rainfall, which is equal .

to 100 inches per annum ; but as this rain comes down inthe course of six months, the sewers would have to dealwith what in England we should consider as equivalent toan annual rainfall of 200 inches. At Rangoon rain fallssometimes to the amount of 5-5 inches in one single hour.The soil becomes softer and softer and more unstable the

deeper the trenches for sewers are dug. It was therefore

impossible to build sewers large enough to deal with such arainfall. Under these circumstances the Shone systemseemed well suited to solve these special local difficulties ifapplied as a separate system, the rain being left to flow tothe river in the ordinary manner. The gravitating sewers ofthis system are only 6 inches in diameter, and the largestsealed main 21 inches. Such small sewers, even in the driestseasons, are easily and efficaciously flushed. The fallgiven to the gravitating sewer is always sufficient, even in soflat a town as Rangoon; for it is never less than 1 in 200 fora 6-ineh pipe. This advantage has been secured bydividing Rangoon into twenty-two sections or districts. Eachof these districts has its ejector station, where there are

two ejectors of 200 gallons capacity each. This means thatRangoon has twenty-two outfalls, situated where they aremost needed--that is, at the lowest levels. These ejectorscan be placed anywhere, even in the most crowded part of atown. Their construction need not be minutely described,as the system is now so well known, having been applied tothe Houses of Parliament at Westminster and the towns ofEastbourne, Henley -on- Thames, Lowestoft, Southampton,and many other places being drained in this manner.

The point to note is that when once the small andcomparatively short 6 inch sewer has reached the nearestejector, a distance which rarely exceeds 400 yards, thesewage is locked up, and has no further communicationwith the outer air.When the ejector is full the pressure of the sewage on

the air confined in a bell or cup, situated in the top of theejector, forces open a valve, and then there is a rush ofcompressed air into the ejector. The force of this air issufficient to lift the sewage out of the ejector up to ahigher level, and into a sealed main. The compressedair is distributed to the various ejectors with the samefacility and in the same manner as coal gas for lightingpurposes. As the motive power consists of compressedair, it causes but little friction and practically no wearand tear. The sewage being forced out from the bottomof the ejector, the whole of the sewage-includingsolids, sludge, grit, &c.-brought down the sewer, is dis-charged out of the ejector. Therefore no screening or

straining of sewage is necessary, as is the case with pumps,and the nuisance caused by the cleaning of pumps isavoided. Then the sudden rush of the whole contents ofthe ejector into the sealed main forms a good flush.Finally, each ejector acts as a trap, which completely dis-connects the house drains of each district from the otherdistricts and from the main outfall sewer. This main out-fall is made of iron, and as it receives the sewage fromthe twenty-two ejectors it is always full and under pressure.The sewage has no time or space to generate sewer gas, norcould such gas escape and pollute the town, for the pipemain is air-tight. Its outfall is in the Rangoon river(which is much larger than the Thames), and is placed threefeet below the lowest tide.Each 6-inch gravitating sewer pipe has an automatic

flush tank of 200 gallons. As these pipes are short and thefall ample, the sewage from the farthest house cannot takemore than five or six minutes to reach the ejector, andthere it is, as it were, locked up and put out of harm’sway. To further ensure the perfect cleanliness of thesepipe sewers, and so that all sewage, when in certain partsof the day the quantity is very slight, should not remainany length of time in the ejectors, there is an automaticdischarge of 200 gallons of clean water from the flush tanks.In a 6-inch sewer, where sewage travels the whole dis-tance in a few minutes, there is not time or spacefor the generation and accumulation of sewer gas. Also,as the volume of air in the pipe is very small, theflow of sewage and the regular flushing are more likelyto be a sufficient motive power to replenish the air withinthe pipe. By smallness in diameter and shortness in lengthof the pipes, the volume of water and of air required tothoroughly flush and ventilate is reduced to a minimum.Financially the great cosb of deep cuttings is avoided, and itis not necessary to provide for more than the district actuallyrequiring drainage. The system can afterwards be easily

1269THE MEDICAL COUNCIL AND THE UNQUALIFIED ASSISTANTS.

extended according to the increase of population. The air-compressing station built near the fire brigade stationsupplies the motive power capable of raising 3300 gallonsper minute, or 4,750,000 gallons of sewage or water per dayto a height of sixty-two feet. All the machinery and all

, the pipes had to be sent out from England, and the cost ofskilled labour at Rangoon is about double what it would bein England; and yet the outlay on sewage works for thetown proper only amounted to &pound;155,377, or f2 5s. perhead of the population. There are towns in Englandwhich have cost as much as f8 per head for their sewageworks. But there has been an extension of the originalscheme at Rangoon, increasing the total cost to &pound;162,573.As, however, this embraces a population of 77,196, the costper head is reduced to jE2 2s. 4d.Such, briefly, are the main features of the drainage works

successfully accomplished at Rangoon. They seem to havegiven the greatest satisfaction. Major R. C. Temple, Pre-sident of the Rangoon Municipality, in speaking on thesubject at the International Congress of Hygiene andDemography of 1891, said :-’c Most exhaustive trials havebeen made of the works, which have now been in operationnearly two years, and the result has placed beyond doubtthat the favourable estimate originally formed of the Shonesystem has been completely justified by the result of itsworking. Rangoon is now the only city in the Indianempire which can boast of a scientific system of drainagewhich fulfils all the requirements of sanitarians."

Ib is nevertheless regrettable that at Rangoon the outfallsewer should pour all the sewage into the river. The volumeof water in the river is estimated roughly at 150,000times the volume of sewage, but in any case there is awaste of useful fertilising material. Then again, howeversatisfactory the Shone system may be in itself, thecoupling of the houses to this system has not yet beenfully accomplished ; and where the connexion is esbab-lished the workmanship has not always been of a satis.factory character. These are points on which the muni.cipality should enact very severe by-laws and exercise astrict supervision. We have little doubt that this willultimately be successfully accomplished, and hope that theexample afforded by the town of Rangoon will stirall thegreatmunicipalities of India to similar useful sanitary action.

THE MEDICAL COUNCIL AND UNQUALI-FIED ASSISTANTS.

THE following resolution of the Council and Report ofthe Executive Committee should be in the possession ofpractitioners who employ unqualified assistants.

RESOLUTION OF THE COUNCIL, APRIL 21st, 1883.That the Council record on its Minutes for the inf orma-

tion of those whom it may concern that charges of grossmisconduct in the employment of unqualified assistants, andcharges of dishonest collusion with unqualified practitionersin respect of the signing of medical certificates required forthe purposes of any law or lawful contract, are, if broughtbefore the Council, regarded by the Council as charges ofinfamous conduct under the Medical Act."REPORT OF THE EXECUTIVE COMMITTEE ON THE

USE OF UNQUALIFIED ASSISTANTS.-MINUTES,MAY 22ND, 1888.

The Executive Committee, without attempting to makea formal definition of the misconduct in question, reportsto the General Council that, in its opinion, " a registeredmedical practitioner would render himself liable to thecensure of the Medical Council in case of the employmentof an unqualified assistant in the practice of medicine,surgery, or midwifery on behalf and for the benefit of suchregistered practitioner, either in complete substitution forhis own services or under circumstances in which due per-sonal supervision and control are not, or cannot be, exercisedby the said registered practitioner." "The Executive Com-mittee furthermore takes this opportunity of stating, inreference to the proceeding known as covering,’ that in itsview a registered practitioner covers an unregistered personwhen he does, or assists in doing, or is party to, any actwhich enables such unqualified person to practise as if hewere duly qualified."

ANNUAL MEETING OF THE BRITISHMEDICAL TEMPERANCE

ASSOCIATION.

THE sixteenth annual meeting of the British MedicalTemperance Association was held on Tuesday last in therooms of the Royal Medical and Chirurgical Society,20, Hanover-square, W. The President, Dr. B. W. Richard.son, took the chair at 5 P. M. The annual report was read bythe hon. secretary, Dr. Ridge, and showed the total numberof members in the United Kingdom to be 415, and of associateseighty-one, the latter being medical students. Thirty-eighbnew members had joined during the year, hub there hadbeen some losses by death (including Dr. Alfred Carpenter,Dr. Maclagan, and Rev. Mr. Lowe) and by resignationo-The balance-sheet showed a debt of E8 to the treasurer. Arule was added to admit lay associates interested inscience, under certain conditions, wibhout vote. Mr. Moir

subsequently read extracts from a lecture on Alcohol de-livered in 1837 by Dr. H. W. Dawhursb, who took up anadvanced position with regard to the evils resulting fromthe use of intoxicating liquors. r

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6444 birthsand 3797 deaths were registered during the week endingMay 28th. The annual rate of mortality in these towns,which had been 20-4 and 19-3 per 1000 in the precedingtwo weeks, rose last week to 19’4 In London the ratewas 18’8 per 1000, while it averaged 19.9 in the thirty-twoprovincial towns. The lowest rates in these towns were8’7 in Derby, 13-0 in Brighton, 13’4 in Portsmouth, and13-8 in Croydon ; the highest rates were 240 in Liver.pool, 25’2 in Manchester, 25’6 in Wolverhampton,and 27-5 in Sanderland. The 3797 deaths included 478.which were referred to the principal zymotic diseases,against numbers declining from 542 to 469 in the precedingthree weeks; of these, 203 resulted from measles, 113 fromwhooping-cough, 51 from diphtheria, 49 from scarlet fever,44 from diarrhoea, 17 from "fever" (principally enteric),and 1 from small-pox. No fatal case of any of thesediseases occurred last week in Derby or in Gateshead ; inthe other towns they caused the lowest rates in Hudders-field, Newcastle-upon-Tyne, Plymouth, and Leeds, and thehighest rates in Bristol, Manchester, Sunderland, Wolver-hampton, and Halifax. The greatest mortality from measlesoccurred in Birmingham, Sheffield, London, Liverpool, Man-chester, and Halifax; from scarlet fever in Cardiff; fromwhooping-cough in Burnley, Blackburn, WolverhamptonBristol, and Sunderland ; and from diarrhoea in Wolver-hampton and Bolton. The mortality from "fever " showedno marked excess in any of the large towns. The 51 deathsfrom diphtheria included 39 in London, 3 in Birmingham, 2 inPortsmouth, 2 in West Ham, and 2 in Oldham. One fatalcase of small-pox was registered in London, bat not one inany of the thirty-two large provincial towns; 96 cases of thisdisease were under treatment in the Metropolitan AsylumHospitals, and 12 in the Highgate Small-pox Hospital, onSaturday last. The number of scarlet fever patients in theMetropolitan Asylum Hospitals and in the London FeverHospital at the end of the week was 1741, againstnumbers increasing from 1226 to 1677 on the preceding nineSaturdays ; 202 new cases were admitted during the week,against 232 and 226 in the previous two weeks. The deathsreferred to diseases of the respiratory organs in London,which had been 304 and 292 in the preceding two weeks,further declined to 285 last week, and were 25 below thecorrected average. The causes of 51, or 1-3 per cent., ofthe deaths in the thirty-three towns were not certifiedeither by a registered medical practitioner or by a coroner.All the causes of death were duly certified in West Ham,Bristol, Leicester, Leeds, Newcastle-upon-Tyne, and inseven other smaller towns; the largest proportions of un.certified deaths were registered in Birmingham, Halifax,and Hull.