ball-rooms, in theatres, in churches and chapels to hear popular preachers,
where no adequate ventilation is carried on, propagates zymotic diseases. Im-
pure water is the cause of several deaths; but the companies have of late years
supplied water infinitely superior in quality to the water which they drew pre-
viously from the parts of the Thames, now admitted by everybody, even their
retained chemists, to be offensive. The impurity of the air was unquestion-
ably the cause of a large number of the 293 deaths. This impurity is most
noxious in the houses where the people sleep. The cesspools are still nume-
rous; half a million water-closets and sinks discharge large quantities of im-
pure air into the 353,326 inhabited houses. This incommodity is lessened in
London by the system of drains, which, however, are badly constructed, and
emit their volatile impurities under the faces of the people. The drains again
pour their contents into the Thames; from which, in its course through Lon-
don in ordinary times, more than four million gallons of water are evaporated
daily, carrying with the vapor, and diffusing all over the town, impurities
which are breathed by the whole population."

ART. 7.-On the production of Pulmonary Consumption in persons who work in
a close and confined atmosphere. By Dr. Guy, Physician to King's College
Hospital.

(Dr. Beale's Archiv. of Med., No. II, 1858.)

The Report on the Sanitary Condition of the Army' recently published
proves that our soldiers, but especially the infantry of the line and foot guards,
are subject to a very high mortality, a great part of which is attributed to pul
monary consumption. It is assumed in the report that this excess of mortality
from consumption is traceable, at least in part, to the narrow space allotted to
the soldier in the barrack and guard-rooms: but as no proof of the dependence
of pulmonary consumption on this cause is given in the report, it may be useful
to republish, from my evidence laid before the Health of Towns Commission
in 1844, the following table, based upon measurements of the offices of letter-
press printers, and the number of compositors working in them, together with
the answers given to certain simple questions addressed to the men them-
selves.

104 men having less than 500 cubic feet of air to breathe
115 men having from 500 to 600 cubic feet of air to breathe
101 men having more than 600 cubic feet of air to breathe

Number per cent. subject to
Spitting of Blood. Catarrh.

. It is scarcely necessary to add that the number of compositors who answered
the question, Had they ever spit blood? in the affirmative, would correspond
very closely to the number actually suffering under consumption; just as the
number stating that they were subject to colds would afford a good indication
of the number in the three classes who were predisposed by the same close and
confined atmosphere to suffer by exposure to the common causes of diseases of
the chest.

ART. 8.-Effects of Arsenite of Copper upon paper-stainers.
By Dr. Guy, Physician to King's College Hospital.

(Dr. Beale's Archiv. of Med., No. II, 1858.)

In the correspondence which has lately taken place in the medical journals
and in the newspapers, on the effect produced upon the health of persons living
in rooms covered with arsenite of copper paper, nothing has as yet been said
on the more important question of the effect produced upon the health of the
men engaged in the manufacture of the paper itself.

The coloring matter is mixed with size, and kept in a proper state for use by
the heat of warm water. It is laid on to the paper with brushes, and suspended
in the warm room to dry. When a bright green color is to be produced, the
arsenite of copper is used alone; but the lighter tints of green, down to the
very palest, are obtained by mixing the arsenite with oxide of zinc or porcelain

ABSTRACT OF THE MEDICAL SCIENCES,

&c. &c.

PART I.

PRACTICAL MEDICINE, PATHOLOGY, AND

THERAPEUTICS..

SECT. I.-GENERAL QUESTIONS IN MEDICINE.

(A) HYGIENE.

ART. 1.—An instance of the salutary effects of simple Sanitary Measures. By the REGISTRAR-GENERAL.

(Quarterly Return of the Registrar-General, Oct. 28th.)

"FOLLOWING the waters of the hills of Buckinghamshire down through the fens, we arrive at Ely. Here a remarkable example is found of the salutary effects of simple sanitary measures, of which every town in the kingdom may have the advantage. Ely stands, with its lofty cathedral, on one of the old fen islands. It is a small city of 6176 inhabitants (in 1851), and is in the neighborhood of the low lands, where the great systems of modern embankments and draining were commenced by Vermuyden, one of Cromwell's colonels of horse. The Bishop of Ely in ancient times went in his boat to Cambridge. And the country around, like all our old marshes, is still imperfectly drained. The atmosphere has therefore no natural advantages. The Public Health Act was introduced in 1851. The Ely Board of Health was founded. They set on foot two great works; one for supplying the town with water, the other for carrying off that water through every house clear out of the town. The public works were completed at the end of 1854; and the houses were gradually connected with the public sewers, leaving, however, at the end of 1857, 200 in 1200 houses out of connection. Mr. Marshall, the superintendent-registrar of the district, in an able paper shows the result of this great experiment. In the seven years (1843-49) before the Public Health Act was in operation the mortality was at the rate of 26 deaths annually to every 1000 living; in the seven subsequent years (1851-57), when the sanitary measures were only partially carried out, the mortality fell down to the rate of 19 deaths annually to every 1000 living. The mortality in the last two years (1856-57) was at the rate of 17 in 1000. In the same periods the surrounding rural parishes underwent some improvement; but the improvement of the city has advanced so much more rapidly that its mortality was in the last two years 4 in 1000 less than the mortality of the surrounding country. The young people under the age of 35 have enjoyed remarkable immunities from disease, and the benefit will be transmitted to succeeding generations. The two chief sanitary works which have been completed are the introduction of water taken from the river of inferior quality, and the destruction of 4000 cubic yards of cesspools-nearly four yards to each house. The surveyor, Mr. Burns, exclaims, with justifiable pride, There is still a number of cesspools remaining, and the sooner they are done away with the better. After this is done, I may truly say that I found Ely a city of cesspools, filth, and sickness; but I shall leave it a city of drains, health, and cleanliness, and that is something to be proud of.' Yes, Mr. Burns, you may well be proud of your work. Pau, in the Pyrenees, to which British in

PART XXVIII.

2

valids still resort for health, experienced a mortality of 28 and 23, when you had reduced the mortality of Ely to 17 in 1000.

"The citizens of Ely have sunk 15,000l. on their sanitary works, which appear to have been conducted in something like the same determined spirit as animated Cromwell's colonel of horse. Certain rate-payers who enjoy the benefits complain of the burthen of the rates.

'We may now turn from this small resolute city in an agricultural district to Liverpool, the second city of the kingdom, where the great work of sanitary improvement is also advancing.

66

Liverpool lies on the shore of the fresh, deep, wide Mersey, which is lined by her magnificent docks, and the houses rise from the river over the red sand. stone heights in long stretching lines. Lancashire and Cheshire cover the plains and hills behind the queenly town; before her are Ireland, America, and the ocean which her ships ride over, carrying foreign produce or the manufactures of the north to and from the various regions of the world. The place is well chosen for health; and in 'Gough's Camden' (ed. 1806) Liverpool is said to be celebrated for her beauty and populousness.' Yet it was found and published in the first Registration Report that the mortality of the population of this district was in the latter half of 1837 at the rate of 39 in 1000 annually; while the population of West Derby, containing, with other parishes, the outlying parts of the borough, died at the rate of 25 in 1000. The strong contrast between the contiguous places and the subsequent discovery that Liverpool was one of the unhealthiest parishes in the kingdom, excited surprise as well as regret in the public mind. A local association was formed of some of the best people; and the causes of the mortality were investigated, and were afterwards made known by Dr. Sutherland in a series of lucid papers. Little, however, was done; the prophets had been crying in the desert; and in 1846 the mortality grew still more threatening. Cholera raged fearfully in the borough in 1849. Steps were now taken to carry out sanitary measures, under the direction of Dr. Duncan and the other able officers of the town. The sanitary school of Liverpool subsequently furnished some of the most efficient members of the commission which did good service in the East. Still it is to be regretted that the health of the great bulk of the population has improved but slowly. Liverpool has a good supply of water; but it is still infested by cesspools, including under this name the filthy Lancashire midden; and the drains pour their contents into the dock basins, which exhale a malarious sickly air over the people. The mortality in the borough of Liverpool was at the rate of 29 in 1000 in the year 1857. Much good, therefore, has been done since 1857; thousands of lives have been saved. Still Liverpool has not yet, like Ely, taken the bull by the horns. Or why should not the mortality be as low as 19 or even 17 in 1000? What natural advantages has Ely, taking one thing with another, over Liverpool? If Ely has had thousands of cubic yards of dirt removed, Liverpool has hundreds of thousands of cubic yards to deal with; but her means are commensurate with her duty. Mr. Newlands can do for Liverpool what Mr. Burns has done for Ely. The cesspool, the midden, or call it what they may, for it is still the same, is the chief destroyer of the Lancashire population. Crowded dwellings, vice, want, do a part of the mischief; but in Liverpool the cesspool destroyed a large proportion of the 6418 people who last year perished in excess of the numbers who would have died at the rates prevailing in country districts. The tender-hearted may shed natural tears over them as they lie in the cemetery. Abolish the cesspools of Liverpool, and you immediately save the lives of thousands of people. Yet the parties who have exerted themselves to put a stop to capital punishments have not been roused by the ruthless destruction of men; and no Beccaria has written on these, crime, and punishments. A living poet, in one of his last poems, exclaims

"But what number of lives did the 'gallows tree' take away in 1857? 13 in all England and Wales; two only in Lancashire. And these were the lives of

murderers, who were put to death for their crimes after the most deliberate judicial inquiry. But the 6418 men, women, and children of Liverpool, were destroyed cruelly in that year without discrimination. Of the cesspool, rather than of the gallows tree, a wiser muse will sing- Sweep it from the earth.''

ART. 2.-Adulterated and unhealthy Milk. By Dr. RoUTH, Physician to the Samaritan Free Hospital for Women and Children.

(British Med. Journal, April 5, 1858.)

Cows' MILK.-This is the substitute for human milk best known in these regions. The absence of odor and its more general diffusion, are advantages in its favor. In appearance it is of a bluish-white color, almost tasteless, specific gravity varying from 1930 to 1035. Its microscopical characters are about the same as those of human milk, excepting that the milk-globules are more abundant. Now, it is clear, comparing this with woman's milk, that—1, the quantity of water is less in the cow; 2, the solid matters are in greater quantity; 3, the sugar is less in amount; 4, there is more casein; 5, and more butter; 6, the salts are also in excess.

It is quite manifest that a simple dilution of this milk will not suffice. This may be added to diminish the relative quantity of casein and butter to the normal figure it attains in human milk; but it will only reduce unduly also the amount of sugar; and thus, at the outset, we meet with a difficulty in its employment. But there are other difficulties more serious and difficult to contend with, and which tend to affect materially its quality. A few of these I will consider seriatim. They are-1, adulteration of cows' milk; 2, its acidity, dependent upon stall-feeding; 3, the effect produced upon the milk by feeding cows in a proper manner; 4, the effect upon milk of keeping cows in unhealthy sheds.

Adulteration. The most painful part of our experience in town is, that pure milk cannot be procured; it is almost always adulterated. In the excellent work of Becquerel and Vernois, the Annales d'Hygiène' (and in this respect Dr. Hassall confirms their results), it appears to be adulterated in Paris by the following substances: water, glucose, flour, starch, dextrine, infusion of amylaceous matters (rice, barley, bran), grumous matters, yolk of egg, and white of egg; sugar, gelatine, liquorice, boiled carrots, broken-down calves' brains, serum of blood, several salts, bicarbonate of soda, chalk, turmeric, emulsion of hemp or almond seeds, &c. We do not, however, find that most of these are commonly employed. The adulteration by water is, however, extensively practised in England. Dr. Hassall, out of 26 samples of milk, found that 11 were adulterated with water in the proportion of from 10 to 50 per cent. Dr. Sanderson, the medical officer of health for Paddington, found in 32 specimens of the milk examined by himself and Mr. Alfred Bernays, of St. Mary's Hospital, that in all, except one, the quantity of water was greater than what it was in pure milk. In many instances (12 times), the quantity of solid constituents was only half as great as it should be, in a few only one-fourth; many specimens containing less than 6.5 or 5.8 per cent., in a few gradually diminishing to 3.5 instead of 12.98 as in pure healthy milk.

Dr. Hillier, the medical officer of St. Pancras, examined 20 specimens of milk, and found that the quantity of water added varied from 25 to 50 per cent. That supplied to the workhouse was one of the poorest. Instead of a gallon containing nearly 9000 grains of solid matter, it contained only 5425 grains, or two-thirds the proper quantity. Dr. R. D. Thompson found in Marylebone, that the gallon of milk, in seven samples, weighed as a mean, 71,680 instead of 72,415 grains, which amounts to the withdrawal of 1.44 oz. of solid matter, well calculated to nourish the body, and substituting for it water. Dr. Hyde Salter and Mr. Hunt, from the confessions made to them by milkwomen, their patients, state the quantity of water usually added is one gallon of water to two of milk. What sort of food can this be for an infant, especially if diluted as it almost invariably is by the purchaser, and often afterwards by medical direction? Is it to be wondered at that children fed on such weak milk do not thrive?