297 day, April 16th. The examinations will begin on April 17th, at 9.30 A.M. ____ THE vestry of St. George’s, Hanover-square, have recently decided upon carrying the Workshop Regulation Act into effect, and have instructed the Medical Officer of Health (Dr. Aldis) and the Inspector of Nuisances to commence operations. THE contest for the office of Assistant-Physician at the West- minster Hospital on Tuesday last terminated in the election of Dr. Octavius Sturges by a considerable majority of votes, the numbers being for Dr. Sturges 117, for Dr. Cavafy 55. WE desire to call the attention of practitioners to the new vaccination rules passed by the Privy Council on the 18th instant, and which will be found in another part of our impression. ____ ABOUT thirty new cases of small-pox are recorded as having occurred amongst the paupers in the Woolwich district during the last week. THE FEVER IN THE MAURITIUS. THANKS to the Epidemiological Society, the scientific ques- tions arising out of the recent terrible visitation of pernicious fever in Mauritius are now very fairly elucidated. At the meeting in December, Dr. Edwards, the general sanitary in- spector of the island, related his experience and opinions con- cerning the outbreak; and a paper on the subject was read from Mr. Stone, one of the assistant-surgeons of the Civil Hospital there. At the recent meeting, Dr. Barraut, the health officer for Port Louis, gave a description of the topo- graphy of the island, and the circumstances preceding and accompanying the outbreak; and a paper was read on the irruption by Dr. Rogers, the senior assistant-surgeon of the Civil Hospital. These four papers, each singularly able, and treating of the visitation from different points of view, furnished a complete account of the nature of the desolating disease, and of the causes which determined ics development. The papers of Dr. Edwards and Mr. Stone have been already considered in these pages (THE LANCET, Dec. 7, 1867). We propose now briefly to review the additional facts and conclusions fur- nished by Dr. Barraut, and the conclusions of Dr. Rogers. Dr. Barraut’s paper was very elaborate, and threw much light upon a point which has provoked considerable doubt in this country. It has been commonly supposed that the so- called "bilious-remittent" " or "Bombay fever," presumed to be endemic in Mauritius, was the malarious disease familiar in the Indian peninsula. True bilious remittent fever is endemic in the marshy and malaria-breeding districts of Mauritius; but Dr. Barraut shows that the disease popularly known as the ,, "Bombay fever" is a contagious malady, which is developed under conditions precisely similar to those in which typhus occurs. This malady first appeared among, if it was not im- ported by, recently arrived detachments of coolies, as far back as 1808. The disease runs a certain course (fifteen and twenty- two days), is of continuous type, spreads unquestionably by contagion, as is shown by the manner of its dissemination in Indian camps, gaols, and shops, and its introduction into Reunion ; it prevails equally in the cold months (when mala- rious disease is less rife) as in the sultry, and is entirely un- affected in its course by quinine. The prevalence of this disease owned altogether different causes to those which deter- mined the outbreak of pernicious fever. The latter malady was entirely new to the island. Dr. Barraut vividly described the telluric and climatic changes which had taken place of late years in Mauritius, and the aggravation of circumstances pro- ductive of malaria as a consequence,-particularly the gradual rise of the coral reefs, diminished scour of the tides, and con- sequent decreasing Hushing of the pestiferous lagoons and em- bouchures of streams near inhabited districts. He showed, also, how a period of intense heat had given peculiar vigour to malarial emanations; and that this period had concurred with a time of commercial crisis, and high price of provisions, en- tailing much privation among the poor Indians. At the outset of 1867 the sources of malaria were more rife than they had been at any previous period in Mauritius ; and the population was in a state less able than at any former time to resist the pernicious influence of paludal emanations. Under these conditions the outbreak occurred. Dr. Barraut, bearing well in mind Dr. Salisbury’s researches on the connexion of intermittent fever with certain species of palmellæ, made several observations on the subject. In the foggy air about marshy land and humid ground near Port Louis he discovered an immense variety of zoosporoid cells, animalcular bodies, algid cells, filaments and fungoids; but he did not find either these cells or the species of palmellea described by Dr. Salis- bury in the secretions or urine of patients affected with perni- cious fever. Dr. Barraut, however, while stating this fact, does not wish too great importance to be attached to his neces- sarily somewhat limited and imperfect observations during the terrible pressure of the outbreak. Dr. Rogers’s paper was principally occupied with a descrip- tion of the pernicious disease. He concludes (1) that it was of malarial origin ; (2) that it was infectious-a conclusion ex- plained, doubtless, by Dr. Barraut’s observations, and the co- existence of the typhous disease with the malarial ; (3) that the outbreak was occasioned primarily by the extensive de- nudation of land which had been going on for several years, and to a succession of droughts consequent on a marked de- crease in the amount of rainfall; (4) and secondarily to the inundation of 1865, the enormous increase of population in Port Louis of late years, and the abominable insanitary state of the town and native camps. Finally, Dr. Rogers expresses the belief that pernicious fever will become endemic in the island unless sweeping and radical sanitary measures are car. ried out. THE SEWAGE DIFFICULTY. AMONGST the papers which came before the Leamington Sewage Congress was one contributed by Mr. Bannehr, of Exeter, having, as its main object, a plan for the interception and utilisation of the fluid as distinguished from the solid excreta of the population. In point of commercial value chemical authorities have assigned the relative proportion of fertilising ingredients in the urine as compared with the faeces to be 5 to 1 ; and, as the great bulk of excreta is voided in a fluid state, it is obvious that any practicable solution of the difficulty of disposal of that fluid would go far to settle the whole sewage question. In May, 1863, Dr. Thudichum read a paper before the Society of Arts* entering very fully into the nature and value of excrementitious matter, and laying down the position that regard should be had to the ways and objects of nature, which separates the two excretions by propelling them in directions diverging at an angle of 45 degrees, and assigns to each its distinct chemical peculiarity. " Nature, then, by ordaining the discharge of urine at frequent intervals quite independent of defecation, and by restricting the quantity discharged with defecation to less than one-sixth part of the total quantity discharged, has imposed a kind of compulsion upon man to collect this excretion in a separate vessel." To accomplish this object, Dr. Thudichum proposed that every householder should collect, in proper vessels, the valuable fluid excreted in his house for removal, by a collecting system, at daily or other intervals, receiving in return for his produce at the rate of 10s. per head per annum as the value of the urine for manurial purposes. An essential point is to keep the urine uncontami- nated by water, slops, or other impurities, the admixture of which engenders the ammoniacal decomposition so offensive to health. Allowing for the variation in quantity and value of the fluid excretion at different ages, and in the two sexes, Dr. Thudichum estimated the daily urine passed in London to be * Journal of the Society of Arts, May 15, 1863.
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297
day, April 16th. The examinations will begin on April 17th,at 9.30 A.M.
____
THE vestry of St. George’s, Hanover-square, have recentlydecided upon carrying the Workshop Regulation Act intoeffect, and have instructed the Medical Officer of Health (Dr.Aldis) and the Inspector of Nuisances to commence operations.
THE contest for the office of Assistant-Physician at the West-minster Hospital on Tuesday last terminated in the election ofDr. Octavius Sturges by a considerable majority of votes, thenumbers being for Dr. Sturges 117, for Dr. Cavafy 55.
WE desire to call the attention of practitioners to the newvaccination rules passed by the Privy Council on the 18th
instant, and which will be found in another part of our
impression. ____
ABOUT thirty new cases of small-pox are recorded as havingoccurred amongst the paupers in the Woolwich district duringthe last week.
THE FEVER IN THE MAURITIUS.
THANKS to the Epidemiological Society, the scientific ques-tions arising out of the recent terrible visitation of perniciousfever in Mauritius are now very fairly elucidated. At the
meeting in December, Dr. Edwards, the general sanitary in-spector of the island, related his experience and opinions con-cerning the outbreak; and a paper on the subject was readfrom Mr. Stone, one of the assistant-surgeons of the CivilHospital there. At the recent meeting, Dr. Barraut, thehealth officer for Port Louis, gave a description of the topo-graphy of the island, and the circumstances preceding andaccompanying the outbreak; and a paper was read on the
irruption by Dr. Rogers, the senior assistant-surgeon of theCivil Hospital. These four papers, each singularly able, andtreating of the visitation from different points of view, furnisheda complete account of the nature of the desolating disease, and ofthe causes which determined ics development. The papers ofDr. Edwards and Mr. Stone have been already considered inthese pages (THE LANCET, Dec. 7, 1867). We propose now
briefly to review the additional facts and conclusions fur-nished by Dr. Barraut, and the conclusions of Dr. Rogers.
Dr. Barraut’s paper was very elaborate, and threw muchlight upon a point which has provoked considerable doubt inthis country. It has been commonly supposed that the so-called "bilious-remittent" " or "Bombay fever," presumed tobe endemic in Mauritius, was the malarious disease familiar inthe Indian peninsula. True bilious remittent fever is endemicin the marshy and malaria-breeding districts of Mauritius; butDr. Barraut shows that the disease popularly known as the ,,
"Bombay fever" is a contagious malady, which is developedunder conditions precisely similar to those in which typhusoccurs. This malady first appeared among, if it was not im-ported by, recently arrived detachments of coolies, as far backas 1808. The disease runs a certain course (fifteen and twenty-two days), is of continuous type, spreads unquestionably bycontagion, as is shown by the manner of its dissemination inIndian camps, gaols, and shops, and its introduction into
Reunion ; it prevails equally in the cold months (when mala-rious disease is less rife) as in the sultry, and is entirely un-affected in its course by quinine. The prevalence of thisdisease owned altogether different causes to those which deter-mined the outbreak of pernicious fever. The latter maladywas entirely new to the island. Dr. Barraut vividly describedthe telluric and climatic changes which had taken place of lateyears in Mauritius, and the aggravation of circumstances pro-ductive of malaria as a consequence,-particularly the gradualrise of the coral reefs, diminished scour of the tides, and con-
sequent decreasing Hushing of the pestiferous lagoons and em-bouchures of streams near inhabited districts. He showed,also, how a period of intense heat had given peculiar vigour tomalarial emanations; and that this period had concurred witha time of commercial crisis, and high price of provisions, en-tailing much privation among the poor Indians.At the outset of 1867 the sources of malaria were more rife
than they had been at any previous period in Mauritius ; andthe population was in a state less able than at any former timeto resist the pernicious influence of paludal emanations. Underthese conditions the outbreak occurred. Dr. Barraut, bearingwell in mind Dr. Salisbury’s researches on the connexion ofintermittent fever with certain species of palmellæ, madeseveral observations on the subject. In the foggy air aboutmarshy land and humid ground near Port Louis he discoveredan immense variety of zoosporoid cells, animalcular bodies,algid cells, filaments and fungoids; but he did not find eitherthese cells or the species of palmellea described by Dr. Salis-bury in the secretions or urine of patients affected with perni-cious fever. Dr. Barraut, however, while stating this fact,does not wish too great importance to be attached to his neces-sarily somewhat limited and imperfect observations during theterrible pressure of the outbreak.
Dr. Rogers’s paper was principally occupied with a descrip-tion of the pernicious disease. He concludes (1) that it wasof malarial origin ; (2) that it was infectious-a conclusion ex-plained, doubtless, by Dr. Barraut’s observations, and the co-existence of the typhous disease with the malarial ; (3) thatthe outbreak was occasioned primarily by the extensive de-nudation of land which had been going on for several years,and to a succession of droughts consequent on a marked de-crease in the amount of rainfall; (4) and secondarily to theinundation of 1865, the enormous increase of population inPort Louis of late years, and the abominable insanitary stateof the town and native camps. Finally, Dr. Rogers expressesthe belief that pernicious fever will become endemic in theisland unless sweeping and radical sanitary measures are car.ried out.
THE SEWAGE DIFFICULTY.
AMONGST the papers which came before the LeamingtonSewage Congress was one contributed by Mr. Bannehr, ofExeter, having, as its main object, a plan for the interceptionand utilisation of the fluid as distinguished from the solidexcreta of the population. In point of commercial value chemicalauthorities have assigned the relative proportion of fertilisingingredients in the urine as compared with the faeces to be5 to 1 ; and, as the great bulk of excreta is voided in a fluidstate, it is obvious that any practicable solution of the difficultyof disposal of that fluid would go far to settle the whole sewagequestion.In May, 1863, Dr. Thudichum read a paper before the
Society of Arts* entering very fully into the nature and valueof excrementitious matter, and laying down the position thatregard should be had to the ways and objects of nature, whichseparates the two excretions by propelling them in directionsdiverging at an angle of 45 degrees, and assigns to each itsdistinct chemical peculiarity. " Nature, then, by ordainingthe discharge of urine at frequent intervals quite independentof defecation, and by restricting the quantity discharged withdefecation to less than one-sixth part of the total quantitydischarged, has imposed a kind of compulsion upon man tocollect this excretion in a separate vessel." To accomplish thisobject, Dr. Thudichum proposed that every householder shouldcollect, in proper vessels, the valuable fluid excreted in hishouse for removal, by a collecting system, at daily or otherintervals, receiving in return for his produce at the rate of 10s.per head per annum as the value of the urine for manurial
purposes. An essential point is to keep the urine uncontami-nated by water, slops, or other impurities, the admixture ofwhich engenders the ammoniacal decomposition so offensive tohealth. Allowing for the variation in quantity and value ofthe fluid excretion at different ages, and in the two sexes, Dr.Thudichum estimated the daily urine passed in London to be
* Journal of the Society of Arts, May 15, 1863.
298
equivalent to the product of 2, 000, 000 adult or middle-agedmales, in quantity amounting to 2900 tons, possessing an agri-cultural value of £2838. " The simplest arrangements, whichneed not exceed a few pounds in expense for every house,would enable the inhabitants of London to collect a value ofa million pounds sterling per annum, without offence to theirhealth, their noses, or even their feelings. The same holdsgood for every other town, or village, or single house ; every-where a value of 10s. per head can be collected and returnedto the land from which it was abstracted." The objectionagainst house-to-house collection might, it was explained, beobviated in towns already provided with sewers, by means ofa separate system of pipes laid in the sewers, communicatingwith the urinal of each house, and conveying the urine awayto tanks, or by conduits at once into the country.
Adopting the conclusions arrived at by Dr. Thudichum inreference to the chemical and commercial value of fluid ex-creta, Mr. Bannehr proposes to collect the urine passed duringnon-defecation by means of urinals constructed for the purpose.Portable urinals for house or other use would have the recep-tacle covered with a concave pan, in the bottom of which awater-trap inlet would be trapped with the last inflow ofurine, so as to prevent the escape of offensive air through theinlet ; the air displaced by the repeated accessions of urinewould pass from the receptacle through a small chamber con-taining a deodorant before its liberation. Public and fixedurinals would be constructed on the same principle. Theurine would be removed from the houses in close vessels tosuitable works, where it would be stored in tanks to undergodecomposition in combination with sulphate of lime; the aqueousmatter being subsequently evaporated by warm air, the result-ing dry substance would be a concentrated powder containingall the chemical manurial properties of urine in its fluid state.Mr. Bannehr claims for his process that if properly conductedit would cause no offence or annoyance whatever ’’ from thecommencement of the process of collection to the completionof the marketable article." But over and above the urinary product thus proposed to be
dealt with, there remain the solid and fluid voidings duringdefecation; and for these Mr. Bannehr would provide dryclosets, with earth, ashes, or other deodorant, the urine (eitherwholly or in part) being separately intercepted. He is, as
may be supposed, a decided opponent "of that modern mis-take, the watercloset" " on sanitary and commercial grounds,but he does not " for one moment think the inhabitants ofLondon will be induced to alter their system until they havein vain tried every expedient that promises them its con-tinuance, and until they have thrown away, probably, somescores of millions."Thus one project after another comes to bewilder and dis-
hearten the unfortunate ratepayers of this huge metropolis,who under the guidance of first one and then another set ofadvisers, find themselves periodically called upon to enter
upon a new system, which involves the loss of capitalpreviously invested in works now declared to be useless.What is the solution of the sewage difficulty ? Is thereno way of arriving at that solution other than by thetentative process which we find so unpleasantly expensiveas well as unsatisfactory? The advocates of the drysystem and the champions of the watercloset are onlyagreed on one point,-each that their own plan is the onlysound and practicable one. Why should there not be aCommission composed of men specially qualified as chemists,as sanitarians, as practical men of business, appointed to
thoroughly investigate the merits of the several schemes pro-posed for the disposal of excrementitious matter, and to decideupon their applicability under such varying conditions as
would meet the wants of our town and country populations ? :’
SMALL-POX AT HERTFORD.
THE frequent recurrence of outbreaks of small-pox indifferent parts of the kingdom is a very lamentable fact, andone which points to the necessity for a searching inquiry intothe causes of so unlooked-for, and in every way unfortunatea state of things. In the teeth of modern legislation, and ofthe undeniable advance of medical and sanitary knowledge, adisease, which in all its characteristics is thoroughly under-stood, and for whose prevention an effective remedy is believedto be assured by a simple process now familiar to everybody,
manifests the most erratic tendencies to increase or subsideirrespective of any efforts made to eradicate it. The officialreturns of death supply a reliable means of measuring thefluctuations in the fatality of small-pox. Thus in the year1855 the death-rate per million of the population in Englandand Wales was 136; in years following successively downto 1865 the rates were 121, 206, 335, 197, 140, 66, 81,293, 373, and 309. What the rates were in the two yearssubsequent to 1865 is not yet known, but judging from thereported prevalence of the disease in various places, it is notunlikely that the high rates of 1863-65 will be found to haveundergone little diminution when the returns are made up.The conclusion is irresistible that vaccination is either neglectedaltogether, or is most inefficiently performed to a far greaterextent than has generally been supposed ; and we shall,therefore, await with interest and anxiety the results which itis fervently to be hoped will follow on the legislative measureof last year.As a pendant to the description we have already given of
the outbreak of small-pox at Woolwich, it has been broughtto our notice that the town and neighbourhood of Hertfordhas for some months past suffered from a severe epidemic ofthe same disease. The local registrar reported in his lastquarterly return that out of 65 deaths registered in the sub-district from all causes during the last three months of 1867,no less than 20 were caused by small-pox ; and we understandthat in the first eight weeks of the present year 22 additionalfatal cases have occurred. Altogether, then, during five months,the disease has killed 42 persons out of a population of some12,000, thus giving a ratio equivalent to an annual mortalityof 8’3 per thousand inhabitants, considerably higher than thecorresponding ratio arising out of the Woolwich outbreak.Our information states that the epidemic appears to be nearlyover so far as the town of Hertford is concerned, but that ithas spread with considerable severity to the villages in theneighbourhood.
Correspondence."Audi alteram partem."
THE ANGLO-GERMAN OPHTHALMIC HOSPITAL.To the Editor of THE LANCET.
SIR,-The notice of the Sub-committee of the Anglo-German Ophthalmic Hospital has been directed to an
article which appeared in THE LANCET of February 22nd, en-titled "Anglo-German Ophthalmic Surgery," in which thefollowing statement occurs :-
i " We are authorised to state that the permission of Dr.Farre to connect his name with a German Ophthalmic Hospitalwas obtained under circumstances very different from thoseunder which this Anglo-German Hospital’ makes its appear-ance."
I am instructed to inform you that on Dr. Farre being askedto become a Vice-Patron of this institution (the Anglo-GermanOphthalmic Hospital), that gentleman placed his name andaddress, in his own handwriting, as a Vice-Patron on one ofour printed prospectuses, which is now lying at the secretary’s’office, 15, Old Cavendish-street, and is open to the inspectionof anyone who may desire to see it.
Trusting that you will publish this letter in your next issue,T rpmain. Sir. vmir obedient, -,Prvn.nt.-
W. K. R. COOMBS, Secretary.
We have also been requested by Dr. Farre to publish thefollowing letter addressed to the Committee of the ’’ Hospital;"and to state thatwhenhe permitted his name to be used, the titleof the institution in the printed circular issued by the Com-mittee was" Anglo-German Ophthalmic Hospital." This wasaltered to " Anglo-German Ophthalmic Hospital for the Treat-ment of Diseases of the Eye by a new and most successfulMethod" in the prospectus in which Dr. Farre’s name sub-sequently appeared in print, and without his knowledge.
SIR,-A prospectus of the Anglo-German Hospital has justbeen placed before me of which I so entirely disapprove thatI must request you to immediately withdraw my name from it.
I cannot help stating that the printing of my name alone as
