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On the operations of the sanitary committee (Manchester) in regard to insanitary dwellings
INSANITARY DWELLINGS I N MANCHESTER. A suitable apparatus is made in England by Messrs. Defries and Sons, of x47, Houndsditch, London, and when the difficulty as to the disinfection of the houses infected by small-pox arose, I communicated with Mr. Wolf Defries, a member of the firm, and he was good enough to place at my disposal one of the Equifex Sprayers, and the houses were disinfected with it. The disinfectant used was the mercury per-chloride, one per thousand, acidulated with three per thousand hydrochloric acid. The first disinfections were carried out personally by myself, in order to instruct my sanitary inspectors in the use of the apparatus. It answered most admirably, and no case of small-pox occurred in any house that had been disinfected b y this means. Indeed, i attribute the limited nature of the outbreak to the perfect disinfection that was secured by the use of the Equifex Sprayer, and I expressed the very great obligations which I, and two of my District Councils, were under to Messrs. Defries for their exceeding courtesy to us under the emergency that arose. I now propose to give a brief outline of the action of this apparatus, and show what it has done as regards disinfection both here and abroad. The Equifex Sprayer consists essentially of a .strong metal reservoir ; a hand-pump, by which air is compressed above the disinfectant; and extension tubes (which may be of any length)for projecting the spray against the surface to be disinfected. The formation and the delivery of the spray is characterised by means for independently and separately controlling the fineness of division and the force of projection. For this purpose the channel for the disinfectant is so arranged as to reduce the velocity of the liquid at the point of delivery to a rate which is very small, and capable of being exactly controlled by the turning of a tap. The force of projection, regulated by another tap, is determined by the velocity of the air, which depends upon the pressure to which the pump is worked, and by the extent to which the air-tap is open. The importance of a fine division of the liquid disinfectant rests on the fact that it enables the work to be done with a minimum useful amount of disinfectant~ and the saving of the expense and inconvenience of waste liquid. The experience derived from the use of the Equifex Sprayer in other countries for some years has shown that it does e2~ciently and with the minimum of inconvenience what sulphur fumigation has been finally shown to be incapable of doing. These sprayers have been substituted b ~ the Paris Municipality for fumigations. The experience 0f that body is of the greater value, inasmuch as it deals with a relatively large number o f cases. In I893 , for instance, the number of houses in which spray disinfection was practised by the municipal sanitary authorities was 3 4 , 8 ~ ; in x894, 37,915 ;
65
and in i895 , 38,646, as stated by the Medical Officer of Health for Paris, Dr. Martin, in the last number of the Annales de Aficrogra#Me. The results are most satisfactory. The recurrence of house epidemics in Paris has practically ceased through the prompt and rigid use of this method, and epidemics are got under and arrested in a considerably shorter period than has previously been possible. As far as this country is concerned, I understand that the Equifex Sprayer has been adopted with great success by the health authorities in the Port of London ; also in Dublin, Edinburgh, Keswick, Crewe, Barnsley, and other towns. It may be thought that I have gone into this subject at some unnecessary length. Considering, however, the very important bearing which it has upon the check of infectious disease, there is, I think, ample justification for discussing the question so fully. I believe it is no exaggeration to state that nine out of every ten cases of the recurrence of zymotic disease in houses previously infected are the result of the inefficient disinfection of rooms, bedding, and clothing. Of course, with regard to the two latter, the only method of purifying them is by steam or else destruction by fire ; and every sanitary authority should possess a steam disinfector. With regard, to houses, it cannot be too clearly understood that we have at our command a method upon which health authorities can safely rely for the effectual purification of infected dwellings within their district, as opposed to the obsolete and useless sulphur fumigation.
O N T H E O P E R A T I O N S O F T H E SANIT A R Y C O M M I T T E E ( M A N C H E S T E R ) IN REGARD TO INSANITARY DWELLINGS. BY
Mr. A. W. LAWSON,of the City Surveyor's Department,*
IN dealing with the back-to-back houses in the City, the Sanitary Committee have had in view so to alter these houses where possible as to give to the occupants a sufficient supply of fresh air and light, whiIe putting them under conditions favourable to the easy maintenance of cleanliness both inside and outside the houses. Where it has been found impossible, by any alterations, to attain these elementary requirements of healthy existence, or where the houses were in a hopeless state of dilapidation, they have been permanently closed. I n pursuing the object of obtaining pure airs light, and cleanliness for the altered houses, the Committee have had to vary considerably the plans on which alterations could be effected. Generally these objects, especially with wide streets at the front and back of the houses, are best attained by removing the two From Dr. Niven's Annual Report for 1895. F
66
R E P O R T S OF M E D I C A L OFFICERS OF H E A L T H .
centre houses (one at the front and one at the back) in every three pairs of houses, and converting the space thus obtained into yards. In some cases, at the ends of blocks, two houses, both back and front, are added together to form double houses, and the third pair demolished to provide the requisite yard space for such double houses. At the same time a water-closet is erected in the yard of a simple but efficient character, with the cistern inside the house. An ashbox is also provided. In this way the filthy condition of the privies and ashpits is done away with, and the yards being so constructed as to be easily cleaned, the tenants are enabled to maintain them in a satisfactory condition. The cases of back-to-back houses surrounded by narrow streets are dealt with by the entire removal of one row on the most suitable side of the block, and the open space so formed is utilised for yards. A similar alteration to this, provided the width of streets and size of houses admit, is effected by the removal of a portion only, transversely, of the houses on one side of the block, the remaining portion being added to the houses left standing, to form sculleries with bedrooms over. In places where one row of a block of houses fronts to a court or private street of sufficient area, a n d providing there are no conflicting interests, alterations are effected by adding the back-to-back houses together in pairs to form " t h r o u g h " houses, and separate yards made (by absorbing a portion of the street or court) together with a passage not less than nine feet wide. By the removal of an entire block of dwellings an arrangement of the site is sometimes obtainable by which back streets and yards for the surrounding houses are secured without any very large structural alterations to the houses. Where alterations are not allowed, the owners are, as far as possible, induced to demolish the houses, provided the position renders such a course desirable. Should an owner decide to build new houses upon the site, or deal with the buildings in any way, except by altering for improved dwellings, the bye-laws for new streets and buildings come in force. All houses coming under the notice of the Unhealthy Dwellings Committee, besides being structurally altered as is found necessary, are required to be thoroughly repaired, cleaned, papered, and painted, both inside and out, before being re-occupied or the closing orders be rescinded. Every house has also to be supplied internally with a service of water over a slopstone. It may be remarked that it is the practice not to serve the closing orders in those cases where the owners make arrangements to alter within a reasonable time after the passing of the order, it being the object to cause as little inconvenience as possible either to owner or tenant. Wherever houses are demolished to form yards,
passages, or open spaces, which are of general benefit to' the adjoining houses, the Committee make an allowance towards the expense of flagging and other work for each house removed. During the year under review 481 houses were ordered to be closed, but as the negotiations for and execution of the alterations take a very considerable time (in most cases, mortgagees, trustees, or beneficiaries have to be consulted), only a small proportion of this number have at the end of the year been reported as altered or demolished. Since the end of the year, however, a very considerable number of the above houses have been completed or are now approaching completion. From the commencement of the Committee's operations in x885, the premises in fully half of the cases dealt with have been structurally altered in • satisfactory manner. The provision of adequate yards, air space, and the admission of light for every portion of the houses, together with through ventilation, necessarily makes an improvement in the health and habits of the tenants. They attaina higher standard of self-respect,and take greaterpride in keeping their houses clean and attractive. The effect,generally, upon the whole community must be for the better. REPORTS
OF
MEDICAL OFFICERS HEALTH.
OF
MANCHESTER.
Bacte~olo~cal Examinations in D~M~ria.m Dr. Niven describes the organisation for the examination of throat material from supposed diphtheria cases, started in February, 1896 : In a short time, medical men having every facilitygiven them, and recognising the value to them of the examination, began to send material from nearly every case that could be got to furnish it,and a bacteriological diagnosis is now made of nearly every living case, and occasionally of cases in which death has occurred. The information so obtained throws considerable light on the previous history of the disease. Of IO6 cases examined since February 6th, 69 have yielded no diphtheria bacilli; two have given intermediate results; and thus only in 35 out of the lO6 have positive results been obtained. In a large proportion of the cases it has been possible, of late, to say beforehand from the description obtained by the Inspectors what the bacteriological examination would yield. This is a matter of much importance, since the majority of the cases which are not diphtheria are scarlet fever, and require quite as much attention as the disease for which they are taken. It is thus of moment, when the bacteriological examination is made the ground for not removing a case to the hospital, to know that we are not incurring as great a danger as we are leaving. Given this security, however, and the
65
and in i895 , 38,646, as stated by the Medical Officer of Health for Paris, Dr. Martin, in the last number of the Annales de Aficrogra#Me. The results are most satisfactory. The recurrence of house epidemics in Paris has practically ceased through the prompt and rigid use of this method, and epidemics are got under and arrested in a considerably shorter period than has previously been possible. As far as this country is concerned, I understand that the Equifex Sprayer has been adopted with great success by the health authorities in the Port of London ; also in Dublin, Edinburgh, Keswick, Crewe, Barnsley, and other towns. It may be thought that I have gone into this subject at some unnecessary length. Considering, however, the very important bearing which it has upon the check of infectious disease, there is, I think, ample justification for discussing the question so fully. I believe it is no exaggeration to state that nine out of every ten cases of the recurrence of zymotic disease in houses previously infected are the result of the inefficient disinfection of rooms, bedding, and clothing. Of course, with regard to the two latter, the only method of purifying them is by steam or else destruction by fire ; and every sanitary authority should possess a steam disinfector. With regard, to houses, it cannot be too clearly understood that we have at our command a method upon which health authorities can safely rely for the effectual purification of infected dwellings within their district, as opposed to the obsolete and useless sulphur fumigation.
O N T H E O P E R A T I O N S O F T H E SANIT A R Y C O M M I T T E E ( M A N C H E S T E R ) IN REGARD TO INSANITARY DWELLINGS. BY
Mr. A. W. LAWSON,of the City Surveyor's Department,*
IN dealing with the back-to-back houses in the City, the Sanitary Committee have had in view so to alter these houses where possible as to give to the occupants a sufficient supply of fresh air and light, whiIe putting them under conditions favourable to the easy maintenance of cleanliness both inside and outside the houses. Where it has been found impossible, by any alterations, to attain these elementary requirements of healthy existence, or where the houses were in a hopeless state of dilapidation, they have been permanently closed. I n pursuing the object of obtaining pure airs light, and cleanliness for the altered houses, the Committee have had to vary considerably the plans on which alterations could be effected. Generally these objects, especially with wide streets at the front and back of the houses, are best attained by removing the two From Dr. Niven's Annual Report for 1895. F
66
R E P O R T S OF M E D I C A L OFFICERS OF H E A L T H .
centre houses (one at the front and one at the back) in every three pairs of houses, and converting the space thus obtained into yards. In some cases, at the ends of blocks, two houses, both back and front, are added together to form double houses, and the third pair demolished to provide the requisite yard space for such double houses. At the same time a water-closet is erected in the yard of a simple but efficient character, with the cistern inside the house. An ashbox is also provided. In this way the filthy condition of the privies and ashpits is done away with, and the yards being so constructed as to be easily cleaned, the tenants are enabled to maintain them in a satisfactory condition. The cases of back-to-back houses surrounded by narrow streets are dealt with by the entire removal of one row on the most suitable side of the block, and the open space so formed is utilised for yards. A similar alteration to this, provided the width of streets and size of houses admit, is effected by the removal of a portion only, transversely, of the houses on one side of the block, the remaining portion being added to the houses left standing, to form sculleries with bedrooms over. In places where one row of a block of houses fronts to a court or private street of sufficient area, a n d providing there are no conflicting interests, alterations are effected by adding the back-to-back houses together in pairs to form " t h r o u g h " houses, and separate yards made (by absorbing a portion of the street or court) together with a passage not less than nine feet wide. By the removal of an entire block of dwellings an arrangement of the site is sometimes obtainable by which back streets and yards for the surrounding houses are secured without any very large structural alterations to the houses. Where alterations are not allowed, the owners are, as far as possible, induced to demolish the houses, provided the position renders such a course desirable. Should an owner decide to build new houses upon the site, or deal with the buildings in any way, except by altering for improved dwellings, the bye-laws for new streets and buildings come in force. All houses coming under the notice of the Unhealthy Dwellings Committee, besides being structurally altered as is found necessary, are required to be thoroughly repaired, cleaned, papered, and painted, both inside and out, before being re-occupied or the closing orders be rescinded. Every house has also to be supplied internally with a service of water over a slopstone. It may be remarked that it is the practice not to serve the closing orders in those cases where the owners make arrangements to alter within a reasonable time after the passing of the order, it being the object to cause as little inconvenience as possible either to owner or tenant. Wherever houses are demolished to form yards,
passages, or open spaces, which are of general benefit to' the adjoining houses, the Committee make an allowance towards the expense of flagging and other work for each house removed. During the year under review 481 houses were ordered to be closed, but as the negotiations for and execution of the alterations take a very considerable time (in most cases, mortgagees, trustees, or beneficiaries have to be consulted), only a small proportion of this number have at the end of the year been reported as altered or demolished. Since the end of the year, however, a very considerable number of the above houses have been completed or are now approaching completion. From the commencement of the Committee's operations in x885, the premises in fully half of the cases dealt with have been structurally altered in • satisfactory manner. The provision of adequate yards, air space, and the admission of light for every portion of the houses, together with through ventilation, necessarily makes an improvement in the health and habits of the tenants. They attaina higher standard of self-respect,and take greaterpride in keeping their houses clean and attractive. The effect,generally, upon the whole community must be for the better. REPORTS
OF
MEDICAL OFFICERS HEALTH.
OF
MANCHESTER.
Bacte~olo~cal Examinations in D~M~ria.m Dr. Niven describes the organisation for the examination of throat material from supposed diphtheria cases, started in February, 1896 : In a short time, medical men having every facilitygiven them, and recognising the value to them of the examination, began to send material from nearly every case that could be got to furnish it,and a bacteriological diagnosis is now made of nearly every living case, and occasionally of cases in which death has occurred. The information so obtained throws considerable light on the previous history of the disease. Of IO6 cases examined since February 6th, 69 have yielded no diphtheria bacilli; two have given intermediate results; and thus only in 35 out of the lO6 have positive results been obtained. In a large proportion of the cases it has been possible, of late, to say beforehand from the description obtained by the Inspectors what the bacteriological examination would yield. This is a matter of much importance, since the majority of the cases which are not diphtheria are scarlet fever, and require quite as much attention as the disease for which they are taken. It is thus of moment, when the bacteriological examination is made the ground for not removing a case to the hospital, to know that we are not incurring as great a danger as we are leaving. Given this security, however, and the