544 



NATURE 



\OcL 21, 1875 



important public places. It has an ambulance always ready to 

 be sent out to bring any injured persons to the institution. The 

 ambulance drives straight into the hospital, where a bed of the 

 same height on silent wheels, so that it can be moved without 

 vibration into a ward, receives the patient. 



The kitchens, laundries, and laboratories are in a separate 

 block at the back of the institution, but are connected with it by 

 the central corridor. The kitchen and laundries are at the top 

 of this building, the laboratories below. The disinfecting-room 

 is close to the engine-room, and superheated steam, which the 

 engine supplies, is used for disinfection. 



The out-patient department, which is apart from the body of 

 the hospital, resembles that of the Queen's Hospital, Birming- 

 ham : the first out-patient department, as far as I am aware, that 

 ever deserved to be seen by a generous public. The patients 

 waiting for advice are seated in a large hall, warmed at all 

 seasons to a proper heat, lighted from the top through a glass 

 roof, and perlectly ventilated. The infectious cases are separated 

 carefully from the rest. The consulting rooms of the medical 

 staff are comfortably fitted, the dispensary is thoroughly officered, 

 and the order that prevails is so effective that a sick person, who 

 is punctual to time, has never to wait. 



The medical officers attached to the hospital in our model 

 city are allowed to hold but one appointment at the same time, 

 and that for a limited period. Thus every medical m:'>n in the 

 city obtains the equal advantage of hospital practice, and the 

 value of the best medical and surgical skill is fairly equalised 

 through the whole community. 



In addition to the hospital building is a separate block, fur- 

 nished with wards, constructed in the same way as the general 

 wards, for the reception of children suffering from any of the 

 infectious diseases. These wards are so planned that the people, 

 generally, send sick members of their own family into them for 

 treatment, and pay for the privilege. 



Supplementary to the hospital are certain other institutions of 

 a kindred character. To check the terrible course of infantile 

 mortality of other large cities — the 76 in the 1,000 of mortality 

 under five years of age, homes for little children arc abundant. 

 In these the destitute young are carefully tended by intelligent 

 nurses ; and mothers, while following their daily callings, are 

 enabled to leave their children under efficient care. 



In a city from which that grand source of wild mirth, hope- 

 less sorrow and confirmed madness, alcohol, has been expelled, 

 it could hardly be expected that much insanity would be found . 

 The few who are insane are placed in houses licensed as asylums, 

 but not different in appearance to other houses in the city. Here 

 they live, in small communities, under proper medical super- 

 vision, with their own gardens and pastimes. 



The houses of the helpless and aged are, like the asylums, the 

 same as the houses of the rest of the town. No large building 

 for the poor of pretentious style uprears itself ; no men badged 

 and badgered as paupers walk the place. Those poor who are 

 really, from physical causes, unable to work, are maintained in a 

 manner showing that they possess yet the dignity of human 

 kind ; that, being worth preservation, they are therefore worthy 

 of respectful tenderness. The rest, those who can work, are 

 employed in useful labours which pay for their board. If they 

 cannot find work, and are deserving, they may lodge in the 

 house and earn their subsistence ; or they may live from the 

 house and receive pay for work done. If they will not work, 

 they, as vagrants, find a home in prison, where they are com- 

 pelled to share the common lot of mankind. 



Our model city is of course well furnished with baths, swim- 

 ming baths, Turkish baths, playgrounds, gymnasia, libraries, 

 board schools, fine art schools, lecture halls, and places of in- 

 structive amusement In every board school drill forms part of 

 the programme. I need not dwell on these subjects, but must 

 pass to the sanitary officers and offices. 



There is in the city one principal sanitary officer, a duly 

 qualified medical man elected by the Municipal Council, whose 

 sole duty it is to watch over the sanitary welfare of the place. 

 Under him as sanitary officers are all the medical men who 

 form the poor-law medical staff. To him these make their re- 

 ports on vaccination and every matter of htalth pertaining to 

 their respective districts ; to him every registrar of births and 

 deaths forwards copies of his registration returns ; and to his 

 office are sent, by the medical men generally, registered returns 

 of the cases of sickness prevailing in the district. His in- 

 spectors likewise make careful returns of all the known pre- 

 vaiUng diseases of the lower animals and of plants. To his 

 office are forwarded, for examination and analysis, specimens of 



foods and drinks suspected to be adulterated, impure, or other- 

 wise unfitted for use. For the conduction of these researches 

 the sanitary superintendent is allowed a competent chemical 

 staff. Thus, under this central supervision, every death and 

 every disease of the living world in that district, and every 

 assumable cause of disease, comes to light and is subjected, if 

 need be, to inquiry. 



At a distance from the town are the sanitary works, the 

 sewage pumping works, the water and gas works, the slaughter- 

 houses and the public laboratories. The sewage, which is 

 brought from the town partly by its own flow and partly by 

 pumping apparatus, is conveyed away to well-drained sewage 

 farms belonging to the city, but at a distance from it, where it 

 is utilised on Mr. Hope's plan. 



The water supply, derived from a river which flows to the 

 south-west of the city, is unpolluted by sewage or other refuse, 

 is carefully filtered, is tested twice dail}', and if found unsatis- 

 factory is supplied through a reserve tank, in which it can be 

 made to undergo forther purification. It is carried through 

 the city everywhere by iron pipes. Leaden pipes are forbidden. 



In the sanitary establishment are disinfecting rooms, a 

 mortuary, and ambulances for the conveyance of persons suffer- 

 ing from contagious disease. These are at all times open to 

 the use of the public, subject to the few and simple rules of the 

 management. 



The gas, like the water, is submitted to regular analysis by the 

 staff of the sanitary officer, and any fault he may detect which 

 indicates a departure from the standard of purity framed by the 

 Municipal Council is immediately remedied, both gas and water 

 being exclusively under the control of the local authority. 



The inspectors of the sanitary officer have under them a body 

 of scavengers. These each day, in the early morning, pass 

 through the various districts allotted to them, and remove all 

 refuse in clo-ed vans. Every portion of manure from stables, 

 streets, and yards, is in this way removed daily and transported 

 to the city farms for utilisation. 



Two additional conveniences are'supplied by the sanitary 

 scientific work of this establishment. PVom steam-works steam 

 is condensed, and a large supply of distilled water is obtained 

 and preserved in a separate tank. This is conveyed by a small 

 main into the city, and at a moderate cost distilled water can be 

 supplied for those domestic purposes for which hard water is 

 objectionable. The second sanitary convenience is a large ozone 

 generator. By this apparatus ozone can be produced in any 

 required quantity, and is made to play many useful purposes. 

 It is passed through the drinking water in the reserve reservoir 

 whenever the water shows excess of organic impurity, and it is 

 conveyed into the city for diffusion into private houses for pur- 

 poses of disinfection. 



The slaughter-houses of the city are all public, and are sepa- 

 rated by a distance of a quarter of a mile from the city. They 

 are easily removable edifices, and are under the supervision 

 of the sanitary staff. The Jewish system of inspecting every 

 carcase that is killed is rigorously carried out, with this im- 

 provement, that the inspector is a man of scientific knowledge. 



All animals used for food — cattle, fowls, swine, rabbits — are 

 subjected to examination in the slaughter-house, or in the 

 market, if they be brought into the city from other depots. 

 The slaughter-houses are so constructed that the animals killed 

 are relieved from the pain of death. They pass through a 

 narcotic chamber, and are brought to the slaughterer oblivious of 

 their fate. The slaughter-houses drain into the sewers of the 

 city, and their complete purification daily, from all offal and 

 refuse, is rigidly enforced. 



The buildings, sheds, and styes for domestic food-producing 

 animals, are removed a short distance from the city, and are 

 also under the supervision of the sanitary officer ; the food 

 and water supplied for these animals comes equally with human 

 food under proper inspection. 



One other subject only remains to be noticed in connection 

 with the arrangements of our model city, and that is the mode 

 of the disposal of the dead. The questions of cremation and 

 of burial in the earth have been considered, and there are some 

 who advocate cremation. For various reasons the process of 

 burial is still retained : firstly, because the cremation process 

 is open to serious medico-legal objections ; secondly, because, 

 by the complete resolution of the body into its elementary and 

 inodorous gases in the cremation furnace, that intervening 

 chemical link between the organic and inorganic worlds, the 

 ammonia, is destroyed, and the economy of nature is thereby 

 dangerously disturbed ; thirdly, because tire natural tendencies 



