SANITATION AT CALAIS.

280 not prove this. They alone show that he was aware of the travelling up the drain pipes into the houses. The sewers well-known invading character of scirrhus, and was familiar ventilate into the open streets. The new sewers are also with the lengthened prolongations spreading outwards from very useful in preventing the floods that frequently occurred the more localised mass, a condition so frequently found, in some parts of the town. The greater portion of the but one entirely aside from the subject of the papers. Also, sewers built since 1889 have their outfall in the tidal basin the primary origin of scirrhus in outlying parts of the breast of the port; but some of the sewage falls into the canal was not under discussion. Shortly before reading my paper near the citadel. There it is locked in until such time as I heard of Heidenhain’s work, but had not had an oppor- the condition of the tide admits of the canal water being tunity of referring to it. His observations and the con- run out into the harbour. To drain into a harbour is bad ,dusions which he arrived at are apparently much the same enough, but to drain into a canal is infinitely worse. as those to which I was led. My friend Mr. Johnson did Monsieur A. Dagniault, the town engineer, explained that refer to Heidenhain’s observations on the pectoral fascia. I it was impossible to manage otherwise. A great portion of take this opportunity to correct an obvious printer’s error Calais being below the level of the sea, it was not possible Of course what in your report in THE LANCET on page 90-viz., oedema for to obtain a fall in other directions. is needed is a pumping station to raise the sewage, and adenoma. I am, Sirs, yours truly, thus to artificially create the necessary fall. The new CECIL F. BEADLES. Calais, which includes St. Pierre, is surrounded by fortifi. cations and a moat. The old Calais is surrounded by huge docks and by canals, and to construct a main sewer through this double series of obstacles is no easy matter. When the new fortifications and the new docks were built, no one SANITATION AT CALAIS. spems to have thought of making any sort of provision for the drainage of Calais ; yet it might have been foreseen (FROM OUR SPECIAL CORRESPONDENT.) that as the population increased, as the knowledge of sanitation spread, objections to draining into the port would ABOUT three hundred thousand travellers cross the become more and more emphatic. For the moment, however, the population of Calais is ,Channel and pass through the town of Calais during the In the year 1889, in consequence of not increasing ; on the contrary, there has been a notable - course of the year. the Paris Universal Exhibition, the actual number of decrease in the number of inhabitants. This is due to the termination of the greater part of the works for the building .passengers who availed themselves of the Calais route of the fortifications, new harbour, and docks. Also, the amounted to 332,230 during the first eleven months of that tulle manufactories not having prospered of late, a great year. This enormous figure suggested the advisability of many of the hands have had to seek work elsewhere. some inquiry as to the sanitary condition of Calais. In A large proportion of these artisans have obtained employTHE LANCET of Dec. 21st, 1889, the result of the in- ment in Poland, principally in the neighbourhood of Warsaw, where certainly they will not find better sanitavestigations made at that time were published. Two years tion than at Calais. According to the census taken on have now elapsed, and on again going over the same May 31st, 1886, there were 58,969 inhabitants at Calais .ground I am pleased to be able to report progress. The and Sb, Pierre. The census taken on April 1st, 1891, ’articles published by THE LANCET were carefully trans- showed that the population then amounted to only lated into French by an official of the Calais munici- 56,867. This is a falling off of 2102 persons ; but, as during the last two years there have been 1206 more births pality, and read and studied by the local authorities, with the than conclude that at least 3300 persons death, we result that the work of sanitary improvement has been have left Calais may in that lapse of time. Many of them pressed forward with considerable energy. Ib may be were Italian navvies whose labour at the new port was no remembered that, writing from Calais at the end of the year longer required. For a town so sparsely populated-all the 889, I described how the old historic town of Calais had new streets are broad, the houses low, and many of the been united to the new industrial suburb of St. Pierre, streets mapped out are not yet builb upon-the death-rate ’where are situated the celebrated tulle manufactories. The is high. lo amounted to about 22-2 per 1000 in 1889 and total population was 58,000, of whom 44,000 belonged to 22 9 per 1000 in 1890. Calais is healthily situated, con’St. Pierre. Of these, 5000 were foreigners, comprising some stantly exposed to the fresh sea breeze, swept and purified 1500 British subjects, who are residents permanently esta- by the four winds of the heavens ; still Calais has a deathblishedin Calais. The town is provided with pure though some- rate much higher than London, notwithstanding the overwhat calcareous water from Guines, but a certain number of crowding, the vice, the misery, and the fearful fogs of our private wells still exist ; and I must repeat to-day what I great metropolis. -said two years ago-namely, that the authorities should be Calais, moreover, retains cesspools. These are emptied with armed with power to close allmch private wells. Fortunately, some care by pneumatic suction. This is not produced by a however, Calais is so low-some portions of the town being portable steam engine, as in Paris, but by a hand-pump. In below the level of the sea-that the water in these private Paris the air escaping from the cesspool is passed through wells is often brackish ; it can, therefore, only be used for the fire of the engine and thus rendered innocuous. At Calais a special fire is lit in the street in a very simple con. - cleaning purposes. The general aspect of Calais and St. Pierre has greatly trivance the shape of a handbell or of an inverted wineimproved. Formerly there were hardly any sewers. The glass. The bell part is put on a smooth piece of ground - slop water from the houses flowed into the streets ; if there or pavement. An aperture in the centre enables a pipe to be screwed on which joins the pipe that is laid from was a sufficient fall, and the gutter was not blocked, it gradually found its way into the port, but very often the the portable tank to the cesspool. The upper part of the slop water stagnated in the streets, formed pools of fer- apparatus, which I might call the handle of the bell, is a menting matter, and gave off objectionable odours. Some circular metallic tube about four inches in diameter and a foot long, perforated on all sides with small holes. At the sewers had, however, been constructed of late years, amounting in 1889 in total length to 6320 metres. Since bottom there is a little grate. This pipe is filled with char,then-that is to say, in the brief space of two years—sewers coal, and when the charcoal burns it consumes the air to the extent of 4540 metres have been added. This is escaping from the cesspool by the pipe which brings it a notable improvement, and brings the total length of I to the bell portion of the apparatus beneath the fire. In ’the Calais sewers up to the respectable figure of 10,860 this way a cesspool can be emptied in the daytime without metres. Most of these sewers are eighty centimetres in causing a nuisance. The contents of the cesspool are then width, and made of compressed concrete. At distances conveyed to tank-barges, which, by canal, travel to Belgium, not greater than fifby metres one from the other, and I where there are large works for the manufacture of human on both sides of the streets, are openings from the guano. Needless to observe, the emptying of the cessgutters to the sewers. The slop water from the houses ’i pools costs each householder a certain sum, which sum, still runs into the gutters, but it soon finds its way ’, paid as a tax for seweis, would probably suffice to to the sewer, and no longer stagnates in the street. cover the interest on a loan levied to carry out a proper and This is in one sense preferable to draining into ihe complete scheme of drainage. There must be some lowsewer, for there is no direct communication from the lying district where a sewage farm could be established or houses to the sewers, and no danger of the sewer air a point on the coast where the sewage outfall could be

281

brought without injury to bathing. Of course it will be difficult to urge the abolition of cesspools and to propose ’, direct drainage into the sewers while these latter have their outfalls either among the shipping in the port or in the stagnant water of the canals. In the old inner port, known as the Basin du Paradis, - close to the ancient but now abandoned town railway station, there is a sewer outfall. When the tide runs out a ’filthy, greasy, black mud is exposed, which gives off foul odours. Here are a great number of fishing smacks. The owners of these vessels still continue to look with favour on the filth by which they are surrounded; it makes a soft bed for their boats to rest upon when there is no water in the port. The town authorities more than two years ago had offered to send in a deredger to remove these sewer deposits ; the fishermen refused the offer, so that the dirt remains, much to the annoyance of all visitors to Calais. The fishermen’s quarter near the lighthouse, called the Courgain, rematns in the same picturesque and insanitary condition as when I described it last. The houses are still devoid of any sort of sanitary convenience, and utensils containing night soil are brought out every morning into the streets and emptied into a large drain in the middle of a somewhat elegant kiosk. A scavenger flushes this place once a day, and all that has been emptied into it flows into the port among the shipping. On the other hand, this, the slum of Calais, is a marvellous picture of cleanliness. The fishwives, with their neat hand-knitted woollen stocking?, thick, short, clean skirts, their wooden clogs, and caps of apotless white, are ever engaged scrubbing the floors of their little houses, washing down the walls, and sweeping the narrow street. On the whole, the quarter is healthy in spite of the total absence of drainage. The wonderful meatness, order, and cleanliness of the inhabitants compensate in a great measure for the smallness of the houses, the narrowness of the streets, and absence of closets or drains. Now that the fortifications are finished, that the heaviest work and expenditure for the new port and docks are also completed, perhaps more thought will be devoted to sanitary improvements. The fact that in two years the sewers have been augmented in length from 6320 metres to K),860 metres is evidence of good intentions. There is, I have shown, still much to be done, but what has been achieved during the last two years gives good promise for the future. BIRMINGHAM. (FROM OUR OWN CORRESPONDENT.)

the sum of £ 7500, this amount being generously given by Miss Stokes, the object being to establish a convalescent home in connexion with the fund. It is intended that the sum of .10,000 per annum shall be given to the hospitals for the gratuitous work they do, and that the remainder of the money shall be devoted to the maintenance of the home. Some interesting figures were given by Mr. Smedley, the secretary, with whom the idea originated of making this departure, of such vast importance to the working classes of the city. He showed that the sum contributed by the working classes to the hospitals in 1867 was ;f500, in 1890 it was fl9,000, and he believed that it would be still years went on. Some very significant figures were also given with regard to the sources of the subscriptions. Thus between 19,000 to £20,000 came from working men, J.:12,000 from private subscriptions, £4000 from country subscriptions, and about 4000 from Hospital Saturday. The total income of the hospitals in 1890 was f:55,373, of which E5667 came from legacies, donations, and investments. The incidence of this new departure will bear strongly on the provident principle, and will have an important effect on the present working of the hospital

greater as

system.

Changes in Appointments.

Suckling has resigned the post of physician to the Workhouse Infirmary. The salary is JE200 a year. Dr. G. F. Crooke, pathologist to the Queen’s Hospital, is a candidate for the appointment. Mr. Augustus Clay has resigned the post of casualty surgeon to the Qaeen’s Hospital. The promotion of Mr. Haslam to the honorary staff of the General Dr.

Hospital

has left

vacancy for

a

an

assistant surgeon.

Among the candidates are the present house surgeon, Mr. Albert Lucas, Dr. Felix Vinrace, and Dr. B. F. Jordan. The

appointment will be made on Feb. 5th. The Children’s Hospital. The annual meeting of this charity was held at the Medical Institute on the 25tb inst. Mr. H. Wiggin, M.P., presided. The thirty-first annual report was presented, and showed that the number of in-patients for the year was 841, out-patients 11,999, casualties 832, and home patients 22. The detention rate was 21’3 days, the death-rate 10’4 per cent., the cost of maintenance of patients 2s. 9d. per week,

and of officers 8s. 3d. per week. The accounts showed that the income was :C80 less than the expenditure. The magnificent gifo of a convalescent home at Moseley by Mr. Cadbury will allow of twenty beds being always at the disposal of the hospitals. The usual votes of thanks were passed. Birmingham, Jan. 29th.

LIVERPOOL. CORRESPONDENT.)

(FROM Health of the City. UNDOUBTEDLY the late severe weather is responsible for Influenza. a large increase in the number of affections, so THERE have been many cases of influenza in and around much so that the death-rate rose last week from 19’4 to 26’6. Only six deaths were certified as due to influenza, as the city, and when it has been followed by pneumonia or compared with seven in the preceding week, facts which other chest complications it has been very frequently fatal. show that this dire disease is not as yet present in an In the majority of cases recovery follows, but the incon’epidemic form among us. At the same time there is a venience arising from its prevalence is very great, especially liarge amount of sickness generally, many practitioners among large bodies of men like the police and postal being sorely overworked by the exceptional strain. For officials. The weather has been somewhat milder during instance, the parish authorities report that the out-door the past week, which will probably have some effecb in medical relief has gone up 35 per cent. above the average. diminishing the more serious complications. The Health Committee have printed and circulated a handbill among householders, detailing the symptoms, treat- One Year’s Result of the Infectious Diseases Notification Act. At the last ordinary meeting of the Medical Institution ment, and means of prevention of influenza. The most important part of the advice given is, "Send for the Dr. E. W. Hope, the assistant medical officer of health, doctor without delay," a common-sense view which com. recounted the results of the working of the Notification of Infectious Diseases Act in Liverpool from its first adoption on mends itself to most intelligent minds. Sept. lst, 1890, to Sept. 1st, 1891. Liverpool was slow to Hospital Saturday F1.tnd. adopt the Act, and local practitioners had grave misgivings The first meeting of the Board of Delegates for the as to its working, which, however, have been dispelled. administration of the Birmingham Hospital Saturday Fund Simultaneously with the adoption of the Act a small subwas held at the Council-house on the 25th insb. under the committee of the Medical Institution was appointed to confer presidency of the Mayor (Councillor Lawley Parker). A with the medical officer of health as to the most suitable form sketch of the history of this movement for the past nineteen of certificate by which the notification could be made. This years was given, and it was pointed out that in 1891 a form was usefully designed to enable the certifying praclegal constitution became necessary for the purpose of titioner to supplement the notification with additional .carrying out the new plans, and that the association was information, which supplemented form, when filled up, registered on Dec. 29th as a company. The purchase of a obviated much inconvenience and irritation. Arrange. property at Tyn-y-coed, near Llandudno, was effected for ments have been made between the medical departOUR OWN

pulmonary