180 THE ROYAL SANITARY INSTITUTE.

THE ROYAL SANITARY INSTITUTE.

THE twenty-third Congress of the Royal Sanitary Institutewas held at Bristol from July 9th to 14th. The inauguraladdress was delivered by the President, Sir EDWARD FRY.

SECTION OF SANITARY SCIENCE AND PREVENTIVEMEDICINE.

The President of this section, Sir WILLIAM J. COLLINS,being unavoidably absent, the address was read for him byDr. R. SHINGLETON SMITH. The gist of the address will befound in THE LANCET of July 14th, p. 106.

The Spread of Diphtheria.Dr. F. T. BOND (Gloucestershire) read a paper on the

Spread of Diphtheria, especially in rural districts, and thedifficulties that the medical officer of health encountered inhis efforts to suppress the outbreaks. Dismissing as absolutelyimaginary the notion of any connexion between " drains anddiphtheria," he traced the story of rural epidemics from thealighting of some bacillus in the requisite stage of specificityon the mucous membrane of the congested tonsils or fauces ofsome child in perhaps an elevated and sanitary locality andthe spread of the infection from child to child in the schooluntil the outbreak assumed the proportions of an epidemic,according to the number of scholars and overcrowdingof the - school. What, he asked, should then be done?Closure was a clumsy atd ineffective procedure andshould rarely be resorted to. He told how in two adjoiningvillages with a combined school population of 470, after along succession of notifications extending over severalmonths, he obtained swabs from the throats and noses ofall, with the result that more or less characteristic bacilliwere found in the throat only in 16 cases, in the nose in149, and in both in 230, while only 83 gave negative results.The preponderance of nasal infection was thus well seen.His subsequent procedure, to some extent experimental, was Ito have the noses and throats of all the children sprayedtwice daily with a 10 per cent. solution of carbolic acid,with the result that in the next six months there wereonly five cases, three of them being in one house. Butwhat was notifiable diphtheria ? This was easy to answer40 years ago, but they knew now that they might havewell-marked membrane without diphtheria and diphtheriawith no membrane. Only by bacterioscopy could the

question of diagnosis be decided and it was doubtfulwhether, and from whom, the medical officer of healthcould look for remuneration. If he could pronounce thechild to be suffering from diphtheria, as he might in evenslight cases showing abundant growths of Klebs-Löfflerbacilli, the sanitary authority-i.e., the ratepayers-couldbe called on ; but the wider questions, the inspection of an.entire school and subsequent preventive sprayings ought tobe defrayed by the Board of Education. Then as regardsantitoxins. Legally they could supply them gratuitously onlyto patients in the hospital, and to no other persons save bya pious fiction, charging it to the expenses of the hospital.A board of guardians might supply it to paupers, indoor oroutdoor, and to them only. But an urban council withouta hospital could not supply antitoxin at all.

Dr. J. FLETCHER, representing the Metropolitan AsylumsBoard, as Dr. Bond did a county mainly agricultural,repudiated, too, any connexion of diphtheria with sewer

gases or insanitary conditions. In his paper he confined hisattention to the form known as post-scarlatinal, of which inthe years 1896-1901 inclusive the Board had had in itshospitals an attack-rate of 4’4 per cent. among 81,245scarlet fever patients, though owing to the extending useof antitoxin the fatality-rate had sunk from 43’ 3 per cent.in 1892 to 2’ 5. By far the greater proportion of thesecases arose from infection from persons who, though withoutany clinical symptoms, harboured the bacilli in their throatsor noses, " carriers as they were called. Members of the staffmight act thus, indeed he knew one case of a nurse suffer-ing from mild pharyngeal diphtheria infecting 16 scarlatinalconvalescents, six of whom died. He gave very fully detailsof a series of cases of post-scarlatinal diphtheria at HamGreen Hospital whence he concluded that the bacilli, how-ever introduced, lurked in the mucous membrane of thenares and fauces of scarlatinal patients in a dormant state,springing into activity when, as was often the case betweenthe fourth and sixth week of convalescence, a rhinorrhcea setin and swabs taken then from the nose would give almost

pure cultures of Loffler’s bacillus. On one occasion several

patients had been admitted suffering from a certain amountof nasal catarrh but no notice was taken of the factuntil the slow progress which they were making led to anexamination of their nasal mucus, when out of 29 elevenshowed Löffler’s and six Hoffmann’s bacilli, 12 beingnegative. These last were removed to the convalescentwards where one after another developed clinical symptomsof diphtheria and communicated it to others previouslyadmitted until prophylactic doses of 2000 units of antitoxinpromptly arrested the further progress of the disease.

Dr. SYMES (Bristol), after ten years’ experience of bacterialexamination, attached little value to it. On one occasion50 per cent. of the children attending a skin hospital showeddiphtheria bacilli in their noses or throats and he wouldpoint out that they could never sterilise throats. In one

place all cases of bacterial diphtheria were sent to hospitalwhere.nearly every one developed clinical diphtheria. Itwas well worth consideration that post-scarlatinal diph-theria was practically confined to hospitals and was almostunknown in private practice.

’

There followed a short passage of arms between Dr.SYMES and Mr. HERBERT JONES, who thought that it wassuperfluous to look for bacteria in the presence of clinicalsymptoms, while Dr. SYMES believing that the bacteriawithout symptoms were harmless now employed examinationin clinical cases only with a view to verify their specificcharacter.

Sir CHARLES A. CAMERON (Dublin) held that sore-throatswere certainly connected with bad drains and might pre.dispose to diphtheria. In Dublin with improved seweragesore-throats had become much less prevalent, but the diminu-tion of diphtheria was less marked in consequence of theovercrowding of the population, 37 per cent. of whom livedin single rooms, though fairly large ones.

Dr. E. M. SMITH (York) raised an earnest protest againstthe growing belief in the harmlessness of sewer air and baddrains, against which there was a mass of evidence thatcould not be lightly ignored.

Preventian of the Growth of Algae in Open Reservoirs.Dr. S. RIDEAL, F. 1. C. (London), read a paper on the Em-

ployment of Copper Sulphate and of Chlorine Evolved in theElectrolysis of Common Salt Solutions. The earliest experi-ments with the copper salt were made in America by Dr.G. T. Moore of the United States Agricultural Department,who found that the various orders of algæ were destroyedby copper sulphate in dilutions of from 1 in 8,000,000 partsto 1 in 1,000,000, but up to last year its employment had notbeen sanctioned by the Board of Health of Massachusetts.Mr. Reid, engineer to the Gloucester waterworks, hadused it in the proportion of 1 in 3,000,000 with mostsatisfactory results, a single application in early springinhibiting the growth of the chara for the remainder of theseason. For 24 hours after the addition of the sulphatethe water gave off bubbles of a strongly fishy odourbut was then bright and clear and after another24 hours not a trace of copper was discoverable bythe cyanide test, the metal having combined withthe organic sediment, and the filters required far less

cleaning than previously. The only objection was the

popular prejudice against the employment of copper in anyform in connexion with articles of food or drink and thoughin this case the danger was imaginary it provided an

argument in favour of the substitution of the alternative ofnascent chlorine. Chlorine evolved by the electrolysis ofsea water or of solutions of common salt had proved verysuccessful in the purification of sewage effluents and Dr.Rideal believed that it would be found equallyapplicable to potable waters. It was true that a

special electrolytic plant was required but the Digbyhypochlorite apparatus could be installed at a costnot exceeding £1OO and the requisite power was availablewherever pumping operations were carried on, while thematerial, common salt, was considerably cheaper thancopper sulphate at £ 28 per ton, though this at 1 part per1,000,000 worked out at no more than 2s. 6d. for each1,000,000 gallons of water treated. Chlorine was mosteffective with algæ of the convervoid type ; dermids anddiatoms were more resistant and entomostraca were notkilled even by the largest quantities required by the algseor permissible in potable waters. The "available chlorine" "

consumed by these rarely exceeded 0’ 5 part per 1,000,000,and by lake waters 1 or 1’ 2, but these quantities

181ROYAL COLLEGE OF SURGEONS OF ENGLAND.

disappeared in five hours, and even 11’ 2 in a lake water, J

far in excess of its requirements, had been resolved into chlorides and oxygen after a few days ; in fact, the rapidity with which the hypochlorites broke up somewhat militatedagainst their action. The resultant effect on London water after treatment with 0’44 part per 1,000,000 of "available chlorine " was a reduction of the oxygen con-sumed and an increase of the chlorides from 2’ 1 to 2 ’ 4 per 100,000.

International Notification of Infectious Diseases. ’

Dr. E. WALFORD (Cardiff) read a paper in which he dwelton the futility of the existing practice of granting cleanbills of health by our Consuls at foreign ports to homeward-bound vessels and the urgent need for an internationalorganisation or bureau for the collection and circulation ofinformation as to the existence of such diseases in ports inevery land. At the Sanitary Conference held at Paris in1903 the proposal, first made at the Vienna Congress in 1874,was formulated and strongly pressed by M. Barrere, whovery properly insisted that it should be strictly inter-national and wherever located, whether as he natur-

ally desired at Paris or elsewhere, the local governmentshould exercise no controlling influence over it. The Britishdelegates, for reasons that Dr. Walford could not under-stand, had opposed it, maintaining that their Governmenthad already all the information that they required or couldexpect to obtain by means of such an office, but factscoming under the almost daily observation of our portofficers showed that such was far from bping the case. The

only valid objection was the loss and annoyance that mightbe inflicted by the authorities of countries which, like Spain,adhered to antiquated beliefs and practices by refusingadmission to vessels coming from, say, Liverpool or

Hamburg simply because the presence of a few casesof small-pox had been reported as existing in thosetowns, though instances of such hardship were not un-known at present, and official information of the presenceof disease in any port would be a better ground than thatobtained from newspaper paragraphs for the guidance of thehealth officers of other ports in the inspection of vesselscoming from the infected port and therefore liable to haveinfection on board. Medical inspection of shipping on

arrival was far from satisfactory ; it was compulsory inrespect of cholera, plague, and yellow fever only and in thesmaller ports could not be said to exist. Many cases ofdisease, especially ambulant small-pox, were concealed or

ignored, partly through the ignorance and want of diagnostic power of the masters and partly through wiltul misapprehen- sion of their responsibility. Deaths on the voyage weremisdescribed or not reported and legal technicalities aidedthe deception. A ship arrived from Antwerp with a case ofsmall-pox ; she had a clean bill from the Consul andthe captain declared that no illness had occurred on the

voyage, which was technically correct, since she was a trampwhose voyage ended at Antwerp, whence she returned inballast, the patient sickening after leaving that port.Sometimes the concealment admitted of no extenuation, aswhen a steamer having had several cases of small-pox onboard in the course of her voyage from the East Indieslanded five of them at a continental port where they weresent to the hospital and proceeded homewards with a cleanbill of health endorsed by the British Consul. Fortunately,Dr. Walford had had unofficial information of her historyand disregarding the clean bill he inspected the crew, with theresult of finding two more cases, one convalescent but stillinfectious and the other in an early stage of the eruption.The Registrar-General, as Dr. Walford observed, did reportcertain outbreaks of infectious diseases in foreign countries,but the nearest approach to a universal notification is, webelieve, to be found in the weekly bulletins of the GermanImperial Board of Health in which the occurrence of out-breaks or the continued presence of any of the principalinfectious diseases in the more important seaports in everypart of the world are reported week by week, presumablyfrom information afforded by the consular service.

SECTION OF CHEMISTRY, PHYSIOLOGY, AND BIOLOGY.The Ditst Nuisance.

Dr. PHILIP BOOBBYER (Nottingham) referred to the manyevil results of dusty occupations and especially to the dustnuisance caused by motor vehicles on dusty roads. To

mitigate this nuisance streets ought to be paved, he said, with smooth and cleanable material, the sweeping of dust

from houses and shops into the street should be forbidden,and motor- cars in urban districts should not run at a higherspeed than ten miles an hour.

Dr. A. BOSTOCK HILL (Warwickshire) protested against thehorrible practice of putting refuse from the houses in the.streets for collection. It was a practice as disgusting as itwas dangerous to health. The motor had accentuated thedust nuisance.

Professor H. R. KENWOOD (London) admitted, that thedust nuisance was a very great one, but it afflicted motorists,more than anyone else. The remedy was improved scavengingand watering and better road makers.

Dr. S. RIDEAL (London) considered that the dirt.nuisance would be greatly mitigated if the hedges were cutdown so as to give a free course for the dissemination of the-dust over the fields.

Dr. BOOBBYER, in replying to the discussion, said they hada painful picture from motorists of their sufferings for theirmisdeeds. He objected to the public also suffering. He

objected to having his front garden rendered uninhabitableon a Sunday afternoon by "road hogs" tearing along theroad at 30 miles an hour.

CONFERENCE OF MEDICAL OFFICERS OF HEALTH.

The Milk-svpply.Dr. H. RENNEY (Sunderland) referred to the pressing need<

of licensing dairies, cowsheds, and milkshops. In the shops-in the poorer parts of towns it was not uncommon to finda number of small shops in one street often quite closetogether, the proprietors of which sold from a quart to a,

gallon of milk per day. These shops were usually smallgrocers or general dealers, and on inspecting them one found,the milk contained in an earthenware vessel without anycovering standing on the counter. He had seen it kept in.a dirty zinc pail. In close proximity to the milk were

pickles, kippered herrings, onions, flour, coals, perhaps anopen tin of so-called preserved meat, and even paraffin oil.The floor was dirty with a layer of dried mud from the street,the walls and ceiling were sadly in need of cleansing, and.the place usually communicated with the living-room, wherethe stock of bread was being baked, to be afterwards sold inthe shop. He proposed that :-In consideration of the insanitary condition of the great majority

of dairies, cowsheds, and milkshops which thereby renders the milk.supplied, under such insanitary conditions, unfit for human consump-tion and dangerous to the public health this section is of the opinion thatlegislation is desirable to secure the licensing of all dairies, cowsheds,-and milkshops in lieu of registration as at present; and this sectionrecommends the council of the institute to bring the proposition under-the notice of the proper authorities.

Professor KENWOOD seconded the motion and suggestedthat the licences should be issued annually, which was.accepted.

Dr. T. EUSTACE HILL (Darlington) considered that theenforcement of regulations in small districts was intimatelybound up with the question of security of tenure of theofficial. Any dairyman could drive a coach-and-four-through the model regulations of the Local Government-Board.

Dr. H. E. ARMSTRONG (Newcastle-on-Tyne) believed thatnothing short of a combination of sanitary authorities wouldsolve the troubles between milk-sellers and consumers.The motion was unanimously adopted.

SECTION OF ENGINEERING AND ARCHITECTURE.

Water-supply.Dr. E. F. WILLOUGHBY (London) read a paper on Rural

Water Supplies and urged that the county council should beempowered to authorise, or to compel, the formation of waterboards for the supply of combined districts devoid of themeans of supplying themselves.We hope to be able to notice the interesting health

exhibition which was held in connexion with the congress ina forthcoming issue.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

ELECTION OF PRESIDENT.

A QUARTERLY meeting of the Council was held on

July 12th, Mr. JOHN TWEEDY, the President, being in thechair.

i The PRESIDENT reported the result of the recent election