Proceedings of the Midland Branch of the Incorporated Society of Medical Officers of Health

THE POSSIBLE DANGERS OF VENTILATING SEWERS. should~ ike sale of drink licenses, be renewable annually. Such a regulation in regard to slaughter-houses would ensure the success of an abattoir, as renewal of licenses could be refused. Referring to the difficultyof distinguishing dropsicaI from sound meat when in a frozen or hag-frozen condition, Mr. Territ, of the Smithfield Markets, had more than once pointed out to him that in sound meat the frezen juices form minute crystals--best seen with a pocket lens-aud resembling very finely-powdered glass; whereas in dropsical frozeu meat the crystals were very much larger spicules, which could be easily picked off, and examined as might be desired. Dr. Jo~:s said : I am a little surprised that Dr. Anderson does not anticipate any difficulty in inducing the butchers to use the Corporation slaughter-houses, for the experience of most other towns has been that they will resist removal from their own premises, however small and inconvenient they may be to themselves, or however obnoxious to their neighhours. I quite agree with Dr. Marsden, that concomitant trades~ such as tripe-boiling, should be carried on at a distance from a town; but there is one exception in gut. scraping, for if the skins are not cleaned very soon after removal, they decompose, and become not only -~ery offensive, but useless as a commercial commodity. It is better, therefore, to provide a suitable building near the slaughterhouse, with every arrangement made ~;o minimise the offensiveness,rather than have the guts cleaned in the slaughter-houses themselves, as they undoubtedly would be, even with the strictest supervision. Dr. SERCEANT thanked Dr. Anderson for his interesting paper. Dr. ANDERSON replied, and the meeting terminated. THE ordinary monthly meeting of this branch was held in the rooms of the Chemical Club, Manchester, on Friday, July i2th, at 4 p.m. The following members were present : - - D r s . Vacher (President), Adams, Anderson, Graham, Jones, Kenyon, Paget, Pilkington, Porter, Sergeant, Sidebotham, Smeeth, and Wheatley. The President, on taking the chair, referred to a loss, by the death of one of its members, which the branch had sustained since its last meeting. Dr. William Cloudson Barnish, Medical Officer of Health for Wigan, who had been for some time in failing health, and died on June 27th, in his fiftysixth year. H e joined the Society in ~878, and would be well known to most members. H e was Honorary Surgeon to the Albert Edward Infirmary, and Medical Officer to the Wigan Hospital for Infectious Diseases. The President submitted the following resolution : " T h a t the North-Western Branch of the Incorporated Society of Medical Officers of Health, takes the earliest opportunity of expressing its sense of the loss it has sustained by the death, in his prime, of Dr. Barnish, who had been a member of the Society for nearly seventeen years, and was beloved and esteemed by all who knew him." This motion was seconded and passed unanimously. The minutes of the last meeting were read and confirmed. The recommendation of the Committee that Drs. Paget and Anderson should represent the

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branch on the Council of the Society, was carried unanimously. Dr. Livy, who was nominated at the last meeting, was duly elected an associate. A paper was then read by Dr. Porter, which will be published in the September number of PUBLIC HEALTH.

PROCEEDINGS OF THE MIDLAND BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. T~E Midland Branch held a meeting at CheItenham on Thursday, July 4th, to meet the Members of the West of England and South Wales Branch. There were present Dr. l~ianley (President), Drs. Fenton, Barwise, Bostock Hill, May, Reid, Garrett, Underhill; also Drs. Davies, Heaven, Dowson, Partridge, Crossman, Cresswell, Bond, and Johnstone, and Councillor Griffiths, Mr. Bridges (Town Clerk), and Mr. Hall (Borough Surveyor). After a brief meeting for private business (Messrs. Bostock Hill and Manley being elected branch representatives), the joint meeting was held, and proceedings commenced with a paper by Dr. Bostock Hill (Sutton Coldfietd). THE POSSIBLE DANGERS OF CERTAIN METHODS OF VENTILATING SEWERS. By PROFESSOR BOSTOCK HILL, M.D., D.P.H. Camb.

The subject of the ventilation of sewers and house drains is one that is constantly coming under the notice of the medical officer of health, though it belongs perhaps more particularly to the department of the surveyor or engineer. In London and some other large towns few complaints are made of nuisance arising from sewer ventilators, wherever fixed, but I feel sure it must be within the experience of many officers of health of smatl towns and rural districts, particularly when recently sewered, that one of their greatest difficulties is caused by malodorous emanations coming generally from gratings in the centre of the road. So great is the nmsance caused occasionally in this way, that it has been found necessary in many places to endeavour to remedy the evil, and as a consequence many plans have been tried : in some districts the sewer ventilators in the road have been stopped up, and the sewers left practically unventilated; in others shafts have been erected, either by the side of the road or up against the houses near, with or without the closing of all or some of the gratings in the road, through which the odours arise ; in other districts the plan of sterilizing the sewer air by passing it over plates heated by gas has been strongly recomm e n d e d ; but there seems little doubt that of all these, the one that has hitherto found most favour is that of closing most of the road ventilators, and ventilating the sewers by means of shafts, either up houses, or on the roads themselves.

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I have for some time thought that this method of discharging sewer air, either close to the fronts of houses, or more particularly immediately above them, by shafts erected against them, is one not without danger to the health of those in the neighbourhood ; but it was not until last Christmas that I had the opportunity of investigating a case which apw-ars to give point to the objections that can be urged against this system. I propose shortly, then, to calI your attention to the main points of this case, and then to consider why a system which appears to be gaining ground in certain districts among surveyors must not be regarded from the point of view of sanitation as entirely free from danger. My attention was called on the ist of January to au outbreak of poisoning among certain of the inhabitants of Wylde Green Ward, Sutton Coldfield, which was locally attributed to the consumption of soup which had been gratuitously distributed by the proprietress of the Wylde Green Hotel. Some of the soup was given to the inspector of nuisances, who submitted it to my inspection, together with some of the meat from which it had been made, and some pearl barley which had also been used in its preparation. Peaflour and vegetables were also contained in it. I made a toxicological examination of the soup and other articles to discover if arsenic or other mineral irritant was contained therein, but the results were entirely negative: I then investigated the outbreak on the spot, and found that about one hundred persons, all of whom had partaken of the soup, had been affected. There is not the slightest doubt that the poisoning was due entirely to the soup. On inquiry, I found thaL the soup was made from a large piece of salted beef, which had been boiled to make the stock, to which the other ingredients had been added. The broth in which a rabbit had been boiled was also added, but the rabbit was eaten at the hotel for dinner on the previous day without any symptoms of poisoning. It was first suggested that arsenic had accidentally found its way into the soup, but its absence, and that of other metallic poison, disproved this theory. It was also stated that the poisoning had been caused by the soup having been made in a " copper" which was not clean. The so-called copper was made of iron, and as far as inquiries can show, it had been used previously for boiling clean water only. It was rumoured that a hare which was high had been put into the soup, but I am assured by the landlady that this was not the case, and as a matter of fact she had not had a hare in the house for months. The symptoms were also ascribed to the fact that saItpetre had been used too freely in making the brine, but in my opinion this is absolutely untenable, because the quantity required to be toxic in eighteen gallons of soup would be several pounds at least, and the supposition that this was present is absurd; be-

?,,IIDLAND B R A N C H . sides, other pieces of beef were pickled at the same time in the same brine, and no symptoms of poisoning have been reported by the consumers of these. As was to be expected, a great number of other theories to account for the outbreak were propounded, b u t only one, for which I am indebted to a gentleman who took the trouble to write to me on tl?e matter, is worth consideration. H e called my attention to the fact that three outbreaks of poisoning among horses had come to light, due to the presence among peas of the Indian vetch (Lathyrus sativus), and suggesting the possibility of the peaflour used to thicken the soup containing this. On inquiry, I found that the peaflour was not home-made, but was bought in packets at a neighbouring shop, and as no other similar attacks occurred in the neighbourhood it is very unlikely that it was the cause of the outbreak. In addition to this, while, as far as I know, no cases in human beings of such poisoning have been reported, in the case of horses the symptoms are not those of gastro-intestinal irritation, but are referable rather to the nervous system. When the soup was submitted there was no sign of decomposition, w h i l e I found that the cold beef, which appeared of the finest quality, was being eaten for at least ten days after the soup was made, without any symptoms of poisoning. I am indebted to Dr. Donovan of Erdington, and to 1V~r. Fosbroke Hobbes of Sutton, for a description of the symptoms they observed, while I myself also visited and made inquiries from a large number of the sufferers. The chief symptoms were pain, swelling of the abdomen, and purging, followed in some instances by vomiting. The purging generally lasted a considerable time, in some instances many days, despite medical treatment. Great coldness with pains in the limbs (said to be in the bones by the patients) were complained of in many instances, and in one case a child, nine years old, was unable to use his legs sufficiently to walk for many days after the onset of the first symptoms. I found that the symptoms in nearly all cases did mot come on for many hours, in some as long as thirty, after taking the soup, and this, in my opinion, contraindicates the presence of any form of mineral poisoning. Experience of simiIar outbreaks led me to believe early in the case that the effects observed were due to the presence of ptomaines, or other substances generated from animal matter. I found the sanitary arrangements of the hotel good, the water being supplied from the mains of the South Staffordshire Waterworks Company, while the place is drained into the public sewer, the work being carried out under the supervision of the Borough Officials. A careful consideration of all the circumstances appeared to point to the fact that the soup had become toxic independent of the meat from which it had been made, and on inquiry I found that the soup was prepared on the

T H E POSSIBLE D A N G E R S OF V E N T I L A T I N G SEWERS. Friday afternoon, and left standing in the boiler, loosely covered, till about eleven o'clock on Saturday morning. This boiler is placed in an outhouse, which is under the same roof as a stable, and separated from it by a wooden partition, in which there is a door. On the floor of the stable there is a drain grating. It is possible therefore the contamination of the soup with foul air may have occurred in this way. I also observed that the ventilating pipe of the house drain runs up the end of the outhouse, near the boiler in which the soup remained all night, while about twenty feet away, and up the side of the hotel itself, there is a large ventilating shaft connected directly with the main road sewer. • It is a well-known fact that under certain conditions there is a risk of sewer-gas from a ventilator near a chimney being conveyed down the chimney into the interior of the house. I have heard of one case in the borough, i.e., Sutton Coldfield, where the tenant of a house, up which a sewer ventilator is carried, complains of the smell coming down the chimney, so much so, that he has stopped up the flue ; while in my own house, on two occasions during the present winter, I have noticed smoke from another chimney coming by a down-draught into a room in which there was no fire, in each case in the evening, although the chimney had a good draught when there was a fire burning in the room. These facts, then, may, I think, throw some light on the matter. It is quite likely that on the Friday night sewer-gas was discharged from the sewer ventilators, and as this became colder, it would become heavier, and therefore fail if not rapidly diffused. This being so, it is highly probable that some descended the chimney of the outhouse, and gained access to the soup in the boiler, and in this way started septic change. It is, of course, impossible definitely to say that this was the case ; but bearing in mind that the symptoms point to the poison being septic, or of animal origin, I cannot at the present time discover a cause more likely to have produced the outbreak. After I had brought to light the foregoing facts, owing to one of the sufferers having died, an inquest was held, and a portion of the soup which had been kept was forwarded to Dr. Klein for bacteriological examination. His report was as follows : - - " On January 24th, I received a glass jar of fluid material, tied with a membrane. The material in the jar had, on opening, a sour smell, and gave a strong acid reaction. It was a thick film, containing various vegetables, fat, and bits of flesh. Under the microscope, besides these substances, there was seen a muItitude of microbes; in fact, the whole material was crowded with them. Amongst these could be recognised various forms of bacilli differing from one another in length, and numerous yeast cells. Cultivations were at once made, so as to isolate the microbe. These culti-

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vations yielded the following microbes in colonies : (i) Torula or yeast, very copiously present; (2) A short non.mobile baciIIus, not liquefying geJatine, fairly abundant ; (3) A bacillus, which proved on sub-culture to be closely related to the typical bacillus cell--this microbe is the normal inhabitant of man and animals, and is a prominent microbe in sewage; in the soup it was present in considerable numbers; (4) A bacillus which also proved on sub-culture to be closely related to the bacillus coli, but must be Considered as a variety of the typical bacillus coli. It is also a normal inhabitant of sewage, and was present in enormous numbers in the soup. Experiments were made with the soup and with the cultivations obtained from it:--(a) Feeding mice with the soup produced no ill-effect ; this result does not prove much, since the time that had elapsed since the consumption by human beings at Wylde Green and the experiment made here was considerable, and as it is known that organic substances, poisonous at one time, lose their action when exposed to fermentative changes ; (b) Inoculations of guinea pigs with cultures of the microbes (3) and (4), bacillus coli and variety, proved these microbes to be virulent, particularly microbe (4), which is highly virulent ; (c) Inoculation of guinea pigs with microbe (i) and (2) had no ill-effect; (d) Microbe (4) multiplies extremely rapidly in beef-broth kept at body temperature, that is, about 37 dogs. C., which turned the broth very turbid in twenty-four hours, the broth being fllh d with microbes. In addition, there are present by this time numerous flocculi entirely made up of the bacilli. If the broth culture is subjected to filtration by which these bacilli are separated from the fluid, and this latter is. injected in small quantities (0"5 c.c.) into guinea pigs, it is found that they die in from six to eight hours under symptoms of acute poisoning. From this it is then clear that this microbe is capable cf rapidly forming in the broth a poisonous chemical substance. In conclusion, from the foregoing observations the following conclusions can be drawn. (I) The soup contained microbes which were derived from sewage, and it is thereupon highly probable that the soup had been polluted with sewage. Amongst the microbes present in the soup the bacilIus mentioned as a variety of the bacillus coli is possessed of virulent properties on account of its extremely rapid multiplication at the body temperature, and the poisonous substance it elaborates. It is most probable that this microbe caused the consumers of the soup the ill effects and the disease. This bacillus, it will be remembered from the foregoing paragraph, was present in the soup in enormous numbers." This report of Dr. Klein's was not made public for over a month after I had made my investigations, and had reported upon them to the authority and to the Local Government Board, and it certainly seemed to give some amount of proof to the theory which

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I formed as to the poisoning being due to contamination with gas from the main sewer ventilating shaft ; but it. must be borne in mind that the report recently made to the London County Council by Parry Laws and F. W. Andrewes seemed to negative the possibility of micro-organisrh~ which are found plentifully in sewage being also found in sewer-gas emanating from manholes or other forms of ventilation. With this in my mind, I made further investigations therefrom into the possibility of pollution of the soup with liquid sewage, either intentionally by some evil-disposed person, or accidentally by leakage from some pipe or otherwise. It will be remembered that the soup was left standing in a kitchen boiler for about eighteen hours, and I found that everybody in the house who had access to this outhouse had suffered considerably from symptoms of poisoning; therefore it is very unlikely that any of these persons had contaminated wilfully the soup with sewage matter. The position of the boiler, the top of which is four feet from the ground, renders it unlikely that it would have been accidentally polIuted with such matter ; while the fact that there is no room above it, and no pipe conveying sewage above it, seems to render it impossible that pollution would have been effected accidentally in that way. "Further, a consideration of the report of Messrs. Laws and Andrewes, while instructive as to the absence of microbes in the sewer air which they investigated, is by no means instructive as to the condition to be found in the sewer at Wylde Green. More than twenty years ago Frankland and others have pointed out that liquids running smoothly in channels give off very little solid matter in the air in contact with them, but on the other hand if there be any obstruction caused, so that bubbling results, or if fermentation causes the formation of gas and the disengagement thereof, then by this process solid particles in the liquid are conveyed into the atmosphere above it. It is quite, therefore, in accordance with what one would expect, that the air of London sewers should be particularly free from microbe life, because the sewers run smoothly, the quantity of liquid is large, and the sewers are free from deposits. But what are the conditions to be found in a comparatively small pipe sewer at a very low gradient, and which generally gives forth emanations of an offensive kind? To fully answer this question, it will be desirable to consider why a sewer gives out smell. It is a well-known fact that fresh sewage has practically no odour, and it is only when it has become stale, or in other words, putrescence has become advanced, that unpleasant odours are noticed. When, therefore, a sewer smells, it is a sign that it is not conveying what it was intended to convey, viz., fresh sewage, and that the odours are produced by putrescence, the result of stagnation

MIDLAND BRANCH. and deposition of offensive matter. This condition is likewise accompanied by a disengagement of gases, the result of decomposition and fermentation ; so that providing we have a stinking sewer, we appear to have just those conditions which are capable of giving to the atmosphere of the sewer solid matter, including micro-organisms with which the sewage teems. The sewer at Wylde Green has been for years notoriously a stinking one. To obviate the nuisance caused to residents and those travelling along the road, the crown ventilator at this part of it was stopped up, and by permission a large six-inch shaft was erected against the wall of the hotel. That gases of an offensive kind were given off from this I know to be the case, because nuisance had been complained of by the proprietress of the hotel in one of the rooms close to where it was fixed ; and to obviate this nuisance a register grate had been put in, so that the evil smelling gas might be shut out from the room. I have previously remarked that the night was a cold one, so that the sewer-gas coming from the top of this shaft would become heavier as it cooled~ and would thus tend to sink lower in the atmosphere, and my belief is that this sewer-gas in question did gain access to the outhouse by way of the chimney, and that in this way the soup was contaminated with those micro-organisms which were found by Dr. Klein. I do not by any means lay this down dogmatically, but after a very careful consideration of all the local conditions, I see no method more likely of contamination of the soup with the micro-organisms of sewage. If my supposition be the correct one, then it points strongly to the possible danger to health from the shafts which are now, especially in sparsely populated districts, being erected close to dwellings. Under certain conditions, I admit that the engineer is justified in endeavouring to prevent the nuisance, against which the ratepayers cry out ; but I also affirm that the method of doing it is wrong in principle, and possibly dangerous in practice. It is wrong in principle, because no one should be called upon to discharge on to his own private ground gases from the public sewers, which are a common nuisance; and I think it may also be quite rightly objected to this method of procedure under ordinary circumstances, because instead of remedying a sanitary defect, such as a stinking sewer must always be, attempts are instead made to palliate, and continue the nuisance. When a sewer stinks it is a sign that there is something wrong; it is a sign that the sewer is one of deposit and is not self-cleansing; it is a warning to the Sanitary Authorities to alter the conditions existing ; and I maintain that it is the duty, under all such circumstances, for the engineer to discover and remedy the cause of the evil, rather than to take measures which, while preventing nuisance to the nose being evident, tend to perpetuate a grave

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d a n g e r to health. I n some instances, n o t a b l y m S u t t o n Coldfield, owing to t h e fact t h a t t h e outfall sewer is a long o n e a n d t h e g r a d i e n t necessarily low, it is essential that s o m e t h i n g s h o u l d be d o n e to p r e v e n t the n u i s a n c e to t h e public, a n d u n d e r these c i r c u m s t a n c e s I think, as a t e m p o r a r y measure, t h a t it is perhaps desirable to erect shafts at certain places a n d in certain positions, care b e i n g t a k e n to see t h a t t h e d i s c h a r g e o f t h e sewer gas from t h e m will n o t jeopardize t h e public health. I n saying this, I wish distinctly to a c c e n t u a t e t h e position I take up, t h a t this should only b e a t e m p o r a r y m e a s u r e , t i l l there is a sufficient q u a n t i t y of flow in t h e sewers to r e n d e r t h e m self-cleansing, a n d therefore sweet. I t c a n only apply to certain newly-sewered districts, while it c a n n e v e r do a n y t h i n g b u t h a r m in the large sewers of towns, where t h e r e is n o reason why t h e sewer a t m o s p h e r e s h o u l d n o t practically b e as sweet as t h a t of the air above. As regards o t h e r alternative forms of dealing with m a l o d o r o u s sewer gas, every o t h e r system, such as has yet b e e n suggested, o f b u r n i n g or sterilizing this o n a large scale, m u s t b e c o n s i d e r e d absolutely impracticable. DISCUSSION. The President ha~ing briefly invited discussion, Dr. BAr,WISE (Derby County) said that while he admitted the possibility of preventing sewage odonrs by proper flushing, it was not likely in village communities that, With the small amount of water per head used, a sufficient flush could be obtained. In some places there neither was, nor ever could be, a public water supply, as natural difficulties and expense were both fatal to such an undertaking, and consequently manhole ventiIation was boand to be offensive and objectionable. He thought iron-shaft ventilators should be galvanized, as had been done in India, to prevent the constant accumulation of rust which he had himself noticed in many instances. With regard to the bacilli in the soup, he felt that great risks were run by insufficient attention to personal cleanliness on the part of domestic servants, especially after delineation, and suggested this as a po..sible means of transit for the bacillus coil communis. Dr. DAvlRs (Bristol) said that it was true, as the President had remarked, that the Bristol sewers were unventilated, and that their engineer did not regard it as necessary. The sewers varied up to six feet in the long diameter, and evenupwards, and carried storm water as well as sewage. The manholes were lightly closed, and there were no shafts to vemilate the sewer proper ; every soil pipe, of course, had its own ventilatorD but that did not aflect the sewer. He could not find in the sickness and mortality statistics of the city that any evil arose from this want of ventilation; indeed, Mr. Haldane, when visiting Bristol, examined the sewer air at the oulfall and in the ~ewers, and found no offensive odour, while the number of mlcro-organisms compared favourably with those in the outside air. He was not quite convinced of the correctness of Dr. Hill's hypoIhesis, but inclined rather to the suggestion of Dr. Barw~se, as he had traced the origin of typhoid in hospital nurses to inattention to personal cleanliness alter dealing ~ith typhoid dejects. Dr. A. UNDERmLL (Tipton) agreed with the last speaker, and commented .upon" typhoid arising from badly-placed sewer ventilators. He had known rain water down spouts acting as sewer ventilators to produce an outbreak of typhoid m a hospital ward. He considered that ground air and sewer-gas were both dangerous, and calculated to produce such diseases as typhoid and diphtheria~ and quoted an

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experience in connection with subsidences accompanying the laying down of a new sewer. Dr. FENTON (Coventry), recalled some of the classical eases of meat poisoning, e.g., \¥elbeck, and related two within his own knowledge--one where green salted pork had been exposed in a pantry over an untrapped drain and had produced choleraic symptoms, although nothing could be found by Dr. Klein ; and another where beef exposed to sewer-gas had produced severe alkaloidal poisoning in those to whom it had been given. He considered ventilators in narrow streets not only offensive but dangerous, and even capable of producing typhoid. Factory chimneys had been tried in Coventry, but their effect did not extend to a sufficient distance to be of any value. Dr. GARRETT (Cheltenham), agreed that fresh sewage was odourless and not a nuisance while we regard a system of ventilation as merely designed to dilute the emanations° Cheltenham could not put up ventilating shafts, as no one would give permission, and would be still less likely to do so if they read the remarks of Dr. Hill. He did not find any serious pressure of sewer-gas, in spite of their want of ventilation, in Chelter~ham, but he had had experience of the down draught of chimneys. Dr. BOND said that whatever might be the ideal system, it would never be the combination of shafts and manholes in which a reverse current could be set up. He alluded to the question of the proximity of the stable to the soup, and asked if the copper was covered. (Dr. Hill: ' ' Yes, but imperfectly.") Dr. HILL replied, and remarked inter alia that to obviate a smell at a particular place did not of necessity obviate the dangers to which he had alluded. His hypothesis commended itsetfto the Local Government Board Inspector who came down.

Dr. GARRETT r e a d a p a p e r o n the necessity for P u b l i c Abattoirs. ON PUBLIC AND PRIVATE SLAUGHTER-HOUSES. B y J . H. GARRI~'I~ M.D., D.P.H. Camb., etc., M.O.H. of Cheltenham. T h e r e does not a p p e a r to h a v e b e e n any general law for t h e regulation o f private slaughterh o u s e s in E n g l a n d , prior to the T o w n s I m p r o v e m e n t Clauses C o n s o l i d a t i o n Act, I847. The object of this A c t was to b r i n g together t h e powers t h a t h a d b e e n conferred in n u m e r o u s private Acts o b t a i n e d by different towns, a n d it c o n t a i n s sections w h i c h m a k e provisions for t h e following objects : - ~. T o give power to a governing body to license slaughter-houses. 2. T o p r e v e n t t h e e s t a b l i s h m e n t of slaughterhouses, except u n d e r license. 3. T o cause all existing slaughter-houses to be registered. 4. T o give powers to g o v e r n i n g bodies to m a k e bye-laws for the regulation of slaughter-houses. 5. T o give to justices of t h e p e a c e power to s u s p e n d t h e license of a slaughter-house for b r e a c h o f bye-laws, etc., a n d m a k e a penalty for slaughtering d u r i n g the t i m e the license is suspended. 6. T o give power to the m e d i c a l officer of h e a l t h a n d i n s p e c t o r o f nuisances to e n t e r at all r e a s o n a b l e hours, to inspect, a n d to seize m e a t , T h i s A c t is a curious piece of legislation, t h e sections as to slaughter-houses all b e i n g d e p e n d e n t

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upon the prospective supposition that a " special" Act will be passed later on, which shall embody these sections, and does not in itself establish the sections as absolute law. They only became taw in different towns at different times, according as special local Acts were passed in which they were adopted, or did not become law at alI until the passing of the Public Health Act, I875. In Section ~69 of the Public Health Act, x875, we read : " F o r the purpose of enabling any urban authority to regulate slaughter-houses within their district, the provisions of the Towns Improvement Clauses Act, I847, with respect to slaughter-houses shall be incorporated with this Act." As these provisions are not quoted in the Public Health Act, I875, many people must be at a loss to know what they are, as it is not everyone who is possessed of the old and otherwise useless Towns Improvement Clauses Act. The Public Health Act of I848 embodied some of the above-mentioned provisions, but this Act appears to have had a very limited application, the mode prescribed for its administration being undoubtedly the cause of this in great measure. In Cheltenham, a Special Act was obtained in I852 , which adopted the sections from the Public Health Act, 1848 , relating to slaughter-houses. The licensing of private slaughter-houses began with us at that date, and since then we have had the two classes of private slaughter-houses--those that existed before licensing began and which were at that time registered, there being no limit put upon the length of time during which they should continue to be used ; and those which, having been established since ~852 , were licensed for a definite period, the minimum period of such a license having been fixed in our case at one year by powers obtained by a private Act in ~889. Similar powers for the limitation of the license are also contained in the Public Health Acts Amendment Act, i89% for such as like to adopt them. In most urban districts the conditions are now as in Cheltenham. There are registered slaughter-houses--registered practically in perpetuity, and licensed slaughterhouses, the license being renewable at a definite period. The relative proportion of registered to licensed places varies in one town and another according as it is a town of ancient or more modern growth. Thus, in Cheltenham there have always been many more registered than licensed places, whereas in Blackpool, which is a town that has rapidly increased in recent years, there are only two or three registered places, the greater number being licensed for a short period, and consequently much more closely controlled by the governing body. The section of the Public Health Act referred to above applies to urban authorities alone, and why rural authorities should have been excluded so rigorously is not clear. Most rural districts include several small towns, or large villages par-

MIDLAND BRANCH. taking of the character of towns, in a greater or lesser degree, and from every point of view it is important that the slaughter-houses in these, or for that matter those in the smallest villages, should be placed under regulations similar to the regulations in force in districts governed by urban authorities. The mischief of having regulations for slaughterhouses that apply to urban and not to rural districts becomes apparent when one finds that, in order to evade the laws and bye-laws in force in the town, butchers will set up slaughtering just outside the borough boundary. By Section 159 of the Public Health Act, ~875 , power is given to any urban sanitary authority to provide, if such authority, shall see fir, a slaughterhouse, and make bye-laws for its regulation. No power is given, however, in that Act which would cause a butcher, already possessed of a registered slaughter-house, to use such a public abattoir if built. Not only, therefore, is this provision of the Public Health Act permissive, where it might well be compulsory ; but it is only halfa measure and of little practical use as it stands. Acting upon the suggestion contained in this Secticn, a small public abattoir has been erected by the Cheltenham Town Council, upon a site that allows of ample room for extension ; and although by withdrawing some of the annual licenses, a few of the least important of the private slaughter-houses have been closed, and the public abattoir is used to a limited extent; not one of the o!d registered slaughter-houses has been relinquished, and it was with the idea of abolishing many of these olcl unsuitable places in particular that public money was expended in building the abattoir. By the simple fact of registration in ~852 , a certain vaIue was gratuitously placed upon a number of old hovels which were used for slaughter-houses, although quite unfit for the purpose~ and the inordinate care at that time displayed for individual as against public rights is likely to cost a large sum of public money for its redemption in the immediate future. The man who has held a slaughter-house under license for the last forty years desires to be informed why the owner of the slaughter-house registered in ~852 should be granted compensation for giving up his place, whilst the owner of the place licensed in I853 and every year since gets no compensation. It is difficult to find him an answer, as the equity of the matter is obscure. Powers by private Act of Parliament have been obtained by severat towns, to compel the owners of the registered places to give them up in favour of a public abattoir, when one has been provided; but always hitherto provision has been at the same time made for the owner of the registered slaughter-house to receive compensation at the hands of the Sanitary Authority. On making inquiry of the Local Government Board, as to what powers could be obtained for

PUBLIC AND PRIVATE SLAUGHTER-ItOUSES. compelling the use of a public abattoir when built, I was referred to the Local Acts, passed in favour of Torquay, Oxford, and Sheffield ; but on making further inquiry at these towns, I found that neither had yet built its public abattoir, and although each had power to compel all the butchers to use it when built, compensation was to be paid in each case respectively. Hitherto I have never been able to ascertain upon what basis, or how, and by whom such compensation has been awarded, and indeed I am not sure that any such award has yet been made. If there be anyone present to-day who knows of such compensation having been given, the relation of his experience will be of value to such as ourselves. It has been suggested by one of the butchers of this town, that in lieu of the private convenience which a butcher may be called upon to give up, the Corporation should provide him convenience at the abattoir free of charge. Where public abattoirs are elsewhere in use, however, such an income is raised by the fees charged for slaughtering animals, as to at least cover the current outlay ; and it is surely questionable whether the expense of providing appropriate places for a trade like this should be defrayed from the public purse. Judging from the tenor of the private Acts, it is probable that any general Act of Parliament which may be passed in connection with the subject will require compensation to be paid to the butchers; but it will be but fair to judge each case on its merits, and take into consideration the suitability of the place for a slaughterhouse, and its condition, in estimating the value of the interest which is supposed to be vested in the slaughter-house by virtue o f long use and registration. Let us turn for a moment to the butchers' side of the question. The butchers, for the greater part, object to the establishment of the public abattoir and the suppression of their private slaughter-houses, and several of the reasons of their objection are declared or apparent. Amongst other reasons they urge : - L That the change will entail a considerable money loss to them, as they will have to give up the places which hitherto have cost them little or nothing, and pay fees at the abattoir ; and although compensation may be paid to some--those who hold registered slaughter-houses, it wii1 not be paid to those who are only licensed. This fact, they argue, will cause a rise in the price of meat, which will be to the disadvantage of the public. 2. That the private slaughter-houses, being generally adjacent or near to the shops, are much more convenient to the butcher, and that loss of time and additional expense are caused by having to drive the animals to an abattoir and cart the meat back again to the shops, the abattoir being often a mile or two distant.

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3. That the using of any slaughter-house in common by several butchers destroys the privacy of a man's business, fosters gossip amongst the employrs that may be turned to unfair ends, and is generally to the disadvantage of the individual butcher. 4 - T h e natural disinclination on the part of butchers to have their animals and meat submitted to stringent inspection, which is sure to lead to heavy losses by destruction of unsound meat, whilst notwithstanding that the butcher may be acting in perfect good faith, no sufficient means have been adopted for compensating him for his loss. 5. That no means have been adopted to insure as stringent an inspection of imported meat as that proposed for the meat that is home-killed ; and in face of the fact that meat importation is very rapidly increasing, and that one-third of our meat supply already comes from abroad, an anomaly is created which is unfair to those dealing in English meat. On the other side it may be stated : - L That the public good is a greater consideratiort than the private interest of a class, and that our knowledge of the dangers to the public health attaching to meat renders it imperative that inspection of all cattle intended for slaughter, and all meat, should be rendered possible by the use of central abattoirs. 2. That most of the existing registered slaughterhouses are structurally unfit for the important purpose for which they are assigned. 3. That for the prevention of cruelty, as well as for the sake of sanitation, it is requisite that private slaughter-houses should be abolished. 4. That in large towns, where special inspectors of slaughter-houses and meat have been appointed, the distribution of numerous places over a wide area renders it easy for the butchers to occasionally evade the laws and bye-laws; whilst in smaller towns, where the sanitary staff is usually short of hands, the proper inspection of private slaughterhouses, and of animals brought into them at at1 hours for slaughter, becomes impossible, and the provisions of bye-laws can only he enforced with great difficulty, and are constantly evaded. The call for public abattoirs and for the abolition of private slaughter-houses is, I believe, well founded and not to be denied; but before we get the meat supply under thorough control, it is evident that other measures will have to be taken. I believe there are gentlemen present who have had a greater experience than myself in the matter of meat inspection, and as to the conditions of importation of foreign meat, and the expression of their opinions will be valuable to those who with me are seeking additional knowledge. One thing certainly appears to me to be required above all others, and that is the concerted action of all the sanitary authorities and health officers

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throughout the country. It is clear that whilst we have one code of regulation within the borough boundary and another immediately beyond, our endeavours to ensure a constant supply of sound meat to our districts are liable to be frustrated. The system of local duties in vogue in the towns upon the other side of the Channel is doubtless useful in checking the importation of some unsound food, but as we are not in the least likely to copy our neighbours by adopting such a troublesome and, to Englishmen, objectionable system as that, we must look to the powers that be to help us in the difficulty, and in regard to rural districts we naturally look to the County Council. Dr. DAvIEsparticularlyadmired the conciseway in which the paper stated both sides of the case. In Bristolmhe had special]g reported upon the slaughter-houses,some sixty in number most of which, though kept cleanj were absolutely unfit structurallyfor the purpose, and evenused as living rooms on other days. Without an abattoir efficientinspection of meat was quite impossible. Bristol had only one meat inspector,who couldnot see everything; indeed, the Board of Agriculture complainedthat they never received any information as to swine fever from Bristol as compared with, say, Liverpool. Further, giventhe abattoir, how to compel its use? He knew one instance where the trade objection had been broken down by getting large consumers to insist upon having their meat prepared at the abattoir. He felt, however, that recent investigations into tuberculosis would lead to reform in these matters. Dr. MAY (Astou Manor) remarked upon the difficulty of dealing with vested interests and trades, and the inadequate character of the law dealing with this question. Dr. MANLEYbriefly sketched out the present statutory powers, laying stress upon the '~ continuous use" (Towns Improvement Clauses Act, 1847, Sec. 126, upon which, unfortunately, Glen gives no comment), and upon methods of abolishing old slaughter-houses. Mr. BRIDGES(Town Clerk of Cheltenham) delivered an admirable address upon the law of the subject and the experienceof Cheltenham, pointing out the need for an overhauling and consotldation of the law rein,lug to public health, and the evils of "adoptive" legislation, and further showinghow the possessionof a good private Act sometimes militated against the adoption of powers conferredby recent legislation. The Act of 189o was confessedlyconstructed out of private Acts. Dr. Bond, Dr. Fenton, Dr. Barwise~ and Dr. Reid also spoke briefly with respect to the difficulties alluded to, and Dr. Garrett replied. The members then drove (under Dr. Garrett's guidance) past the Delancy Hospital, up Leekhampton Hill, from which a splendid view was enjoyed, and thence to inspect the destructor, etc. Here, on one area, the Borough possesses a destructor (four-celled), disinfecting station, sewage precipitation tanks, and electric lighting generator. The site adjoins the Midland Railway, and is well removed from the town. They then drove to the abattoir, where slaughtering was going on, and thence returned to the Queen's Hotel, where some fifteen, including the Mayor, sat down to dinner. The thanks of the Branch are due to Dr. Garrett for one of the most enjoyable meetings ever held under its auspices.

P R O C E E D I NGS OF THE SOUTHERN BRANCH OF T H E I N C O R P O R A T E D SOCIETY OF MEDICAL OFFICERS OF HEALTh. A MEETING of the Southern Branch was held at Eastbourne, on July 5th. There were present : Dr. C. Kelly (President of the Branch), Dr. S. R. Lovett (President of the Incorporated Society), Drs. P. W. G. Nunn, A. Pern, W. G. Willoughby, and B. H. Mumby, Hon. Sec. The following officers were elected to come into office on October ~st next, viz. :--President (J. Groves, M.B., J.P.), Vice-Presidents (Drs. N u n n and Kelly), Council (Drs. Newsholme, B. Browning and W. G. Willoughby), Treasurer (Dr. A. Wellesley Harris), Secretary (Dr. B. H . Mumby), Representatives on the Council of the Society (Dr. Kelly and Dr. B. H. Mumby). Drs. A. Ransom, J. Turton, and A. G. Mossop were elected members of the Branch. DR. WILLOUGHBYread a paper on the "Etiology of recent Diphtheria in the Borough of Eastbourne," after which Drs. Kelly, Nunn, Lovett, and Mumby took part in the discussion. Before the meeting the members visited the Isolation Hospital, where they were entertained at lunch by the Sanitary Committee. The members were met by the Town Clerk, and the water-works pumping station was explained to them by Mr. G. A. Wallis, whilst at the ejector works Mr. R. M. Gloyne, the Borough Surveyor, explained points of interest. After the meeting the members dined together at the Gildridge Hotel, Eastbourne, where theywere joined by the Mayor of Eastbourne. SUMMARY OF PAPER ON DIPHTHERIA IN THE BOROUGH OF EASTBOURNE. By W. G. WILLOUGHBY, ~¢LD. Lond.~ M.O.tt. of Eastbournc. Dr. Willoughby presented an analysis of 8e7 notified cases of so-called diphtheria, of which records had been kept. The numbers were steadily diminishing year by year, and now a genuine case is a rarity in the Borough ; but an epidemic had occurred in I889-9o, hence the material used. The various possible factors in the causation of these cases were discussed, more particularly those which might be considered special to the Borough of Eastbourne. The age incidence and the sex incidence presented nothing notable: female cases preponderated, and the ages of incidence were chiefly those from 3--35 inclusive. The 827 Cases occurred in 584 different houses, giving an average of x'4 cases to each house affected. After i892 more care was taken in the isolation of case~ and in the disinfection, and since then the average number of cases per house affected has been reduced to I"~. As regarded the effect of