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THE POISON OF SEWER EMANATIONS.
750 views on the subject. He thinka it unnecessary to discuss with sensible people the existence of clairvoyance. Nobody in his right mind, he holds, can believe that Fiaulein Salomon while under hypnotic influence displayed medical knowledge of which she was ignorant in her natural state. He does not believe that the young lady died in a hypnotic trance. It is said that the body of Fräulein Salomon has been exhumed, so there is some prospect that the truth of this strange affair may be made clear. Whatever may have been the precise circumstances of the unfortunate young Hungarian lady’s end, it is impossible to regard these sensational displays without grave disapprobation. That any good end is achieved by them, or that information can be gained in this way that is inaccessible by the ordinary channels, is, in our judgment, impossible. These displays seem simply to minister to a craving for notoriety, or to a morbid curiosity about certain psychological phenomena which are best studied apart from hysterical girls. The time may be near at hand when it will be imperative for the Legislature to consider whether the practice of hypnotism should be any longer permitted to unqualified and irresponsible persons. We are indebted to the Times report for most ofthe above facts.
THE
POISON OF SEWER EMANATIONS.
THE fatal case of poisoning by sewer air, notes on which Dr. Webber contributed to our columns last week, while presenting several features of clinical interest, affords also further evidence, which accumulates every day, of the obscure toxic nature of sewer emanations. Experiments which have been rather freely made of late seem to have established that the poisonous nature of sewer air is not to be traced to microorganisms, and indeed careful bacteriological examination has shown that sewer air is remarkably free from microbes, and superior even in this respect to the atmosphere of the common breathing level. Moreover, it is doubtful whether currents of gases are ever able to detach microbes from the sticky and slimy contents of the sewer. In the light of these results, therefore, we may refer the toxic symptoms which are produced by the inhalation of sewer air not to the direct action of organisms, but to the toxic substances which, it may be, they are concerned in producing from or evolving out of faecal matter. In other words, it is not improbable that the poison of sewer air is a The precise nature of the poisonous gaseous ptomaine. action of this substance is by no means understood, but, as is well known, it in many instances proves the forerunner of various maladies in different persons. Thus, according to circumstances, in one it may lead ultimately to diphtheria, in another to typhoid fever, in another to scarlet fever, and, as illustrated in the fatal case which Dr. Webber records, even to anæmia of a distinctly profound degree. Sewer poison acts undoubtedly by lowering the general vitality of the system which reduces almost to vanishing point its powers of resistance against the invasion of disease. ’Whatever chemistry or bacteriology may or may not have to offer in explanation of the poisonous effects of sewer air, man has been led intuitively to avoid it and to exclude it his surroundings ; indeed, he as far as possible from has instinctively accepted as a hygienic axiom, so to speak, that sewer gas must be avoided if health is to be preserved. That sewer gas is a serious and powerful factor in the production of disease, although per se it is not responsible for the direct production of specific diseases like typhoid fever, diphtheria, &c., but rather reducing the subject to a condition of low vitality which predisposes him to such, is strikingly illustrated in a series of experiments instituted a few months ago by Dr. Alessi.l This investigator after inocu1
Nature, May 3rd, 1894.
lating several animals including rats, rabbits, and guineapigs, with a small dose of an almost harmless growth of the typhoid bacillus exposed one set to ordinary conditions of environment, while another set was placed in a box communicating with the sewers. Of forty-one rats, which, although infected with the typhoid bacillus, had not inhaled sewer air, only three died. On the other hand the rats exposed to the air of drains soon lost their vivacity, grew thin, although they ate voraciously, and of the forty-nine inoculated, thirtyseven died exhibiting the typical symptoms of typhoid infection. Precisely the same thing happened to guinea-pigs when similarly treated and placed under similar environment, while of eleven inoculated rabbits exposed to sewer air, every one died, but not one of the inoculated animals kept in ordinary surroundings succumbed. Rapidly fatal results were produced also when a similar experiment in which a small dose of a weak culture was made, This of the bacillus coli communis was substituted. led Dr. Alessi to observe extremely interesting investigation that it was during the first two weeks of exposure to the noxious gases of the sewer that the animals were most easily predisposed to typhoidal infection, for no less than 90 per cent. of the animals inoculated died during the first fortnight, whilst 76 per cent. succumbed in the third week. This may partly explain, says Dr. Alessi, how it is that some people who habitually breathe contaminated air do not appear to suffer any evil results, having gradually in course of time become accustomed to it, whilst a stranger exposed to the same condition without previous experience may suffer seriously. Different people, however, enjoy varying degrees of immunity. More striking and conclusive experimental evidence than the foregoing of the seriously important rôle which sewer air plays in the production of disease could not, we imagine, be obtained, and the results should lead all concerned in improved sanitation to redouble their efforts to prevent the inhalation ofsewer emanations. Already we have indicated the measures which civilised countries have instinctively been led to adopt to avoid as far as possible the contamination of air with sewer air, and Dr. Alessi’s experiments show the prudence of such precautions, and should teach us to shun sewer emanations as we would a powerful poison. Recently the improved ventilation of sewers has received a large share of attention, and it is obviously desirable that not only that ventilation may be secured, but also that steps should be taken whereby the destruction of sewer gases by cremation or by efficient disinfection should also be effected. THE
ROLE OF SURGERY.
THE Students’ Number of Guy’s Hospital Gazette contains a reissue of a lecture delivered to the students by Mr. Thomas Bryant ten years ago on the " Art and The observations may be read Practice of Surgery." with as much profit now as then by all students about to travel along "the rough, difficult, and possibly dangerous " road of surgery. Mr. Bryant defines a trustworthy suras not geon merely a man with a surgical diploma, but a man who practises for the good of those who entrust their healths to him and who finds his personal interests identified with those of his patients. For the proper study of the subject lectures and text-books must be supplemented by a study of the larger book of nature, and this must be begun early in the professional career of the student. Mr. Bryant points out that from the scientific point of view no distinction can be drawn between medicine and surgery, the separation between the two being entirely arbitrary, and rather accidentally anatomical than pathological ; and he brings this forcibly home by his words of warning against the attachment of over-importance to
‘
THE
POISON OF SEWER EMANATIONS.
THE fatal case of poisoning by sewer air, notes on which Dr. Webber contributed to our columns last week, while presenting several features of clinical interest, affords also further evidence, which accumulates every day, of the obscure toxic nature of sewer emanations. Experiments which have been rather freely made of late seem to have established that the poisonous nature of sewer air is not to be traced to microorganisms, and indeed careful bacteriological examination has shown that sewer air is remarkably free from microbes, and superior even in this respect to the atmosphere of the common breathing level. Moreover, it is doubtful whether currents of gases are ever able to detach microbes from the sticky and slimy contents of the sewer. In the light of these results, therefore, we may refer the toxic symptoms which are produced by the inhalation of sewer air not to the direct action of organisms, but to the toxic substances which, it may be, they are concerned in producing from or evolving out of faecal matter. In other words, it is not improbable that the poison of sewer air is a The precise nature of the poisonous gaseous ptomaine. action of this substance is by no means understood, but, as is well known, it in many instances proves the forerunner of various maladies in different persons. Thus, according to circumstances, in one it may lead ultimately to diphtheria, in another to typhoid fever, in another to scarlet fever, and, as illustrated in the fatal case which Dr. Webber records, even to anæmia of a distinctly profound degree. Sewer poison acts undoubtedly by lowering the general vitality of the system which reduces almost to vanishing point its powers of resistance against the invasion of disease. ’Whatever chemistry or bacteriology may or may not have to offer in explanation of the poisonous effects of sewer air, man has been led intuitively to avoid it and to exclude it his surroundings ; indeed, he as far as possible from has instinctively accepted as a hygienic axiom, so to speak, that sewer gas must be avoided if health is to be preserved. That sewer gas is a serious and powerful factor in the production of disease, although per se it is not responsible for the direct production of specific diseases like typhoid fever, diphtheria, &c., but rather reducing the subject to a condition of low vitality which predisposes him to such, is strikingly illustrated in a series of experiments instituted a few months ago by Dr. Alessi.l This investigator after inocu1
Nature, May 3rd, 1894.
lating several animals including rats, rabbits, and guineapigs, with a small dose of an almost harmless growth of the typhoid bacillus exposed one set to ordinary conditions of environment, while another set was placed in a box communicating with the sewers. Of forty-one rats, which, although infected with the typhoid bacillus, had not inhaled sewer air, only three died. On the other hand the rats exposed to the air of drains soon lost their vivacity, grew thin, although they ate voraciously, and of the forty-nine inoculated, thirtyseven died exhibiting the typical symptoms of typhoid infection. Precisely the same thing happened to guinea-pigs when similarly treated and placed under similar environment, while of eleven inoculated rabbits exposed to sewer air, every one died, but not one of the inoculated animals kept in ordinary surroundings succumbed. Rapidly fatal results were produced also when a similar experiment in which a small dose of a weak culture was made, This of the bacillus coli communis was substituted. led Dr. Alessi to observe extremely interesting investigation that it was during the first two weeks of exposure to the noxious gases of the sewer that the animals were most easily predisposed to typhoidal infection, for no less than 90 per cent. of the animals inoculated died during the first fortnight, whilst 76 per cent. succumbed in the third week. This may partly explain, says Dr. Alessi, how it is that some people who habitually breathe contaminated air do not appear to suffer any evil results, having gradually in course of time become accustomed to it, whilst a stranger exposed to the same condition without previous experience may suffer seriously. Different people, however, enjoy varying degrees of immunity. More striking and conclusive experimental evidence than the foregoing of the seriously important rôle which sewer air plays in the production of disease could not, we imagine, be obtained, and the results should lead all concerned in improved sanitation to redouble their efforts to prevent the inhalation ofsewer emanations. Already we have indicated the measures which civilised countries have instinctively been led to adopt to avoid as far as possible the contamination of air with sewer air, and Dr. Alessi’s experiments show the prudence of such precautions, and should teach us to shun sewer emanations as we would a powerful poison. Recently the improved ventilation of sewers has received a large share of attention, and it is obviously desirable that not only that ventilation may be secured, but also that steps should be taken whereby the destruction of sewer gases by cremation or by efficient disinfection should also be effected. THE
ROLE OF SURGERY.
THE Students’ Number of Guy’s Hospital Gazette contains a reissue of a lecture delivered to the students by Mr. Thomas Bryant ten years ago on the " Art and The observations may be read Practice of Surgery." with as much profit now as then by all students about to travel along "the rough, difficult, and possibly dangerous " road of surgery. Mr. Bryant defines a trustworthy suras not geon merely a man with a surgical diploma, but a man who practises for the good of those who entrust their healths to him and who finds his personal interests identified with those of his patients. For the proper study of the subject lectures and text-books must be supplemented by a study of the larger book of nature, and this must be begun early in the professional career of the student. Mr. Bryant points out that from the scientific point of view no distinction can be drawn between medicine and surgery, the separation between the two being entirely arbitrary, and rather accidentally anatomical than pathological ; and he brings this forcibly home by his words of warning against the attachment of over-importance to
‘