170 



NATURE 



[August 20, 1891 



'I'hanks to the above-mentioned measures, it now stands at 

 from one-third to one-tenth of its former rates. 



(2) The influence of improved drainage has been shown by 

 Dr. Buchanan, in his table of towns, contrasting the mortality 

 by phthisis and other diseases before and after the introduction 

 of improvements in this direction ; and lastly, by the reduction 

 of the general phthisis rate of the country from 2500 per 

 1,000,000 in 1867, to 1500 per 1,000,000 in 1889. 



My own observation in Manchester and Salford, and those 

 of Dr. Irwin in Oldham, and of Dr. Flick in Philadelphia, 

 point to the existence in towns of tubercular areas and infected 

 houses. 



Under these circumstances it seems to me that the duty of 

 sanitary authorities is clear. They should regard phthis^is as a 

 disease to be dealt with on precisely the same lines as the 

 analogous diseases, typhoid fever, cholera, and leprosy— diseases, 

 namely, which are slightly, if at all, directly contagious, but 

 which spread by material thrown off from the bodies of the 

 patients. The means to be employed to this end would also be 

 very similar : (1) notification of cases; (2) disinfection; (3) 

 ■ hospital accommodation ; and (4) general sanitary nfeasures, 

 such as ventilation, drainage, and reconstruction of unhealthy 

 areas. 



(i) Nolijication. — At first it may sound somewhat novel to 

 demand that a slowly progressing ailment like phthisis should 

 be notified as if it were liable to become an epidemic disease ; 

 but, after all, we may fairly inquire whether the purpose of 

 notification is not the prevention of any disease that could be 

 arrested by tarly intelligence of its existence being sent to the 

 health officer, nor would there be much difficulty in obtaining 

 the notification of phthisis. Although phthisis is not directly 

 contagious, there would be nothing unreasonable in classing it 

 with other diseases that need special measures to prevent its 

 spread. 



(2) Disinfection. — After receiving notice of a case of tubercu- 

 losis, the next step to be taken by a local authority would be to 

 ascertain whether proper care is or can be taken to prevent 

 injury to the public health. In the case of well-to-do persons 

 the information given by the medical attendant would be suf- 

 ficient, but where the case is that of a poor person it should be 

 visited, and the local authority should see to the regular cleans- 

 ing and whitewashing of the premises, and to the disposal of 

 excretions, especially of the expectorated matter. If necessary, 

 disinfection by sulphur and the steaming of clothes should be 

 carried out. Paper spittoons that can be burnt should be in- 

 sisted upon. After death, also, measures should be taken for 

 the cleansing and disinfection of house, bedding, and clothes. 



(3) Hospital Accommodation. — There would next come the 

 question of the propriety or possibility of removing the sick 

 person to hospital. So long as he (or she) could work, and so 

 long as he would consent to use the necessary means for destroy- 

 ing the infective material, it would be unnecessary to do more 

 than I have already indicated ; but when the patient becomes 

 unable to follow his employment, and the family are obliged to 

 seek for assistance from the parish, he has a claim to be received 

 into the workhouse hospital, and such an asylum should be 

 offered him, and should be made as little humiliating and as free 

 from ignominy as possible. 



(4) But it is probably to general sanitary measures that we 

 must look for any large reduction in the rate of mortality from 

 tubercle. It has been found that deep and thorough drainage 

 of the subsoil w ill greatly diminish this mortality. In the case 

 of Salisbury, as you are probably aware, it was reduced by one- 

 half, and similar reports have come from other towns ; and 

 though the same result has not always been obtained elsewhere, 

 there can be no doubt as to the importance both of draining 

 and concreting the foundations of dwelling-houses, so as to 

 prevent organic vapours from rising along with the ground air 

 into living-rpoms. 



It is for this reason that I have ventured to suggest that where 

 consumption is prevalent there must exist some special nutri- 

 ment which either (l) serves to prolong the li(e of the bacillus 

 of tubercle, or (2) which may even increase its virulent proper- 

 ties, this special element in foul air being either the organic 

 matter exhaled from human bodies, or the emanations from 

 polluted ground air from badly drained subsoils. I should 

 imagine that either of these hypotheses might account for the 

 result, and certainly in the few experiments which I have 

 carried out to find the conditions that modify the virulence of 

 the bacillus it was proved that foul air caused the organism to 



NO. II 38, VOL. 44] 



retain its power for evil much longer than when it was exposed 

 to some fresh air and light. 



It is possible that these may be regarded as somewhat strong 

 proposals, but at least they have the merit that they may all be 

 put in force without any material increase in the powers now 

 possessed by local authorities. The only thing needed to enable 

 them to be carried out in their entirety is a powerful public 

 opinion to back them up. When people generally, and espe- 

 cially the working classes, realize that a large part of their sick- 

 ness and consequent loss of time and money is due to their 

 neglect, they will unquestionably be on our side. The under- 

 taking possesses, moreover, the further merit that not only 

 will all this sanitary improvement prevent consumption and 

 other tubercular diseases by doing away with the sources 

 of infection, but it will also prevent them by raising the 

 general standard of health amongst town dwellers. It 

 will so strengthen those who are already predisposed to 

 the disease that they will more readily throw off any stray germs 

 of tubercle that may find an entrance into their bodies. It will 

 conduce to spontaneous cure, will prevent recurrence of ihe 

 disease, and will ward off attacks from those who are now 

 healthy. 



Prof. Finkelnburg, of Bonn, read a paper " On the Influence 

 of Soil on the Spread of Tuberculous Diseases." 



He showed on a large map of Germany that the localities w here 

 phthisis was most prevalent were those in which there was a 

 moory soil with stagnating and high-standing ground water ; 

 such as some districts in the north-western provinces, in the 

 Rhenish province, in Upper Bavaria, and in some parts of 

 Silesia. These facts agree with the conclusions of Bowditch 

 and Buchanan. Overcrowding did not appear to have much 

 influence on the spread of phthisis. 



Dr. J. Edward Squire, of London, read a paper entitled, 

 "To what extent can Legislation assist in diminishing the 

 Prevalence of Consumption and other Tubercular Diseases." 



Dr. Squire considered that the danger of infection increased 

 with the close crowdirg of the sick and healthy, and with defi- 

 cient ventilation ; and that by sanitary improvements this danger 

 might be obviated. There ought also to be a proper supervision 

 of food (meat and milk) obtained from tuberculous cattle. Trades 

 in relation to phthisis were also discussed. 



Dr. Gibert, of Havre, followed with a paper entitled " De la 

 distribution geographique de la Phthisic pulmonaire dans la 

 ville de Havre : Rapports de la Phthisic avec la densite de la 

 population, avec I'alcoolismc, et avec la misere." Dr. Gibert 

 thought from his observations that overcrowding was a great 

 factor in the etiology of phthisis : but that alcoholism played a 

 much greater part, and poverty was also a factor. He showed 

 on a map the distribution of phthisis in Havre. 



Sir John Banks, of Dublin, who spoke in the discussion, 

 mentioned that the sanitary improvements undertaken in Dublin 

 had produced a great diminution of disease. Practice both in 

 hospital and private had demonstrated this to him. 



Mr. Weaver, of London, and Dr. B. O'Connor also took 

 part in the discussion. 



LETTERS TO THE EDITOR. 



\7'he Editor aces not hold himself responsible for opinions ex- 

 pressed by his correspondents. Neither can he undertake 

 10 return, or to correspond with the tvriters of, rejected 

 manusci'ipts intended for this or atty other part of 'Natvrk. 

 No notice is taken of anonymous cotnmunications. ] 



Aerial Roots of the Mangrove. 



In }our note on a recent meeting of the Royal Botanic Society 

 (July 30, p. 304), it is stated that the only explanation yet offered 

 of the erect aerial roots of Avicennia nivca is that ot detaining 

 the debris and preventing the soil from being washed away. 

 Without in any way detracting from the ingenuity and prob- 

 ability of Mr. Sowerby's explanation, it can hardly be admitted 

 that this is the only explanation that has as yet been proposed. 

 The peculiarities, both structural and physiological, of the man- 

 grove-vegetation of the swamps of the Malayan Archipelago 

 have been, during recent years, a special subject of investigation 

 by botanists located at the Botanical Laboratory at Buitenzorg ; 

 the most recent and most important addition to its literature 

 being comprised in the 22nd Heft of Luerssen and Haenlein's 



