Second Annual Report of the State Board of Health of Massachusetts
RECENT LITERATURE.
January, 1871.
Boston.
THIS Report contains the results of special investigations made under direction of the Board of Health, and it abounds in matter interesting to the general reader, and worthy of careful study by the medical profession.
Probably the most attractive paper in the Report is that of the president describing his walk at night among the homes of the poor in London and Boston, and contrasting the condition of the two cities in this respect, — not always to our advantage. The president also contributes a very able and entertaining article on the question of sewerage, and the utilization of the refuse of cities.
The inquiries as to the use of leaden water-pipes confirm the commonly received opinion that the safe or unsafe use of such conduits depends upon the kind of water supplied, and this can be determined by experiment only. The water from Lake Cochituate has been supplied through leaden service-pipes for more than twenty years, without, so far as known, developing any new disease or modifying any old one ; it may, therefore, be considered safe ; and yet this water contains to the U. S. gallon two or three hundredths of a grain of lead derived from the service-pipes or the leaden joinings of the mains. The animal system has the power, within certain limits, of adaptation to slight modifications in the surrounding physical agents, by which they become as it were normal. Otherwise air and water, which contain a little of almost everything, would be poisonous. Fears are sometimes entertained lest the solder of tinned iron cooking utensils should prove poisonous, but the solder is an alloy of tin and lead, and is almost insoluble even in acidulated water. The use of zinc or “galvanized iron ” waterpipes is alluded to, and the opinion given, — a correct one, we think, — that under ordinary circumstances they are safe. The carbonate of zinc, the condition in which the metal is usually found, in drinking-water, is a gentle tonic.
The trichina, or pork disease, has been discovered in two localities in the State. Its effects upon the muscular system are described; they are the same that have been observed elsewhere. In one case the disease came from eating dried fresh pork insufficiently cooked, in the other from eating smoked ham cut in thin slices raw. There seems hardly any excuse for the disease in those who know that it is fully demonstrated that the parasite producing all the trouble cannot exist after being subjected to a boiling heat, or even fifty degrees less.
The article on Health of Towns brings out the important fact that consumption and diseases of the respiratory organs are more than twice as frequent as all other diseases noted. Another important fact is noticed ; four hundred and eighty-seven fatal cases of cholera infantum occurred in Suffolk County, while outside the city limits in an equal population the number of deaths was one hundred. The same proportion holds with regard to other bowel complaints of children, — a most decided indication of the advantage of a country summer residence for young children, even after making allowance for the fact that the above numbers must have contained the deaths among the very poor.
The article on Typhoid Fever is one of the most interesting in the Report. The facts collected (page 167) do not lend much support to the theory that it is caused by the water ordinarily supplied from wells, — a theory strongly urged by some European hygienists. The city of Boston, for the past twenty years, has been supplied with water from a pure source more than twenty miles distant, and yet the number of cases of fever is not materially less than when it was supplied by thousands of wells within the city limits, exposed, many of them, to contaminations which are supposed to be most potent causes of disease. Nor, indeed, has the vast improvement in sewerage consequent upon the introduction of a plentiful supply of water produced a marked effect upon the frequency or severity of the disease. The observation that fever is most rife when the water in the wells is low has certainly been repeated during the past autumn. The surface of the country has seldom been so dry, or the water in the wells so low, or an epidemic of typhoid fever so wide-spread in New England, as during the autumn of 1870.
Facts concerning the effects of intoxicating drinks are sought from one hundred and sixty-four correspondents. The answers, as may be supposed, are rather contradictory. In the midst of all these contradictions we shall not be far from the truth if we assume that, as a beverage, alconoiic stimulants to the young and middle-aged are worse than useless ; they are fraught with danger; to the old they are valuable helps ; and as a remedy in disease they are so important that the art of medicine without them would be halt and maimed. •
The chapter on Ventilation of Schoolhouses contains a short description of the causes of the vitiation of the air in occupied rooms ; the quantity of fresh air required for removing such vitiation is assumed to be fifteen or twenty cubic feet for each individual a minute. The ways of producing the required change of air arc then considered. One of these, the vacuum method, is thus explained, page 375 : “ A volume of air
heated from the freezing-point to the boiling-point of water (barometer at 30 in.), expands .375 [according to Rudberg and Regnault more accurately .366], or about three eighths of its volume, or .002 for each degree of Fahr. (Gay-Lussac’s law. ”) The following is given as an example of the method of calculating the expansion of air : “ If the temperature of the air in a schoolroom is 20° higher than that of the exterior air, its volume has been increased .002 x 20 = .04 or ; consequently it is lighter than the exterior air, and tends to rise.” This answer is not exact (though perhaps sufficiently so for this purpose), except when the exterior air is at 320 and the interior air at 52°, because air expands .002 of its volume for each degree of Fahr. only when that volume is taken at 320. The air thus expanded is pressed upward through the proper ducts by the colder and heavier air from without. It is recommended that the vitiated air should leave the room at the floor. This we think objectionable. The expired air is usually 25° warmer than the air of the room, and the products of combustion from lights still warmer ; they therefore rise and must be forced downwards by a current of air with a velocity often objectionable, even if it did not require a constant moving power without which all ventilation in this direction at once ceases. In the British Houses of Parliament, —perhaps the best ventilated buildings in the world, — after experiments extending through many years, the opposite or upward plan has been adopted as both better and more economical. In the Massachusetts State House downward ventilation is used, but it can hardly be deemed a success. New determinations have been made of the amount of carbonic acid in the air in the country, in the city, and in various halls and school-rooms with the following results. In Boston in the spring, there were three hundred and eighty-five parts of carbonic acid in a million ; in Cambridge in winter, three hundred and thirty-seven parts of carbonic acid in a million ; in the school-rooms the highest was nineteen hundred and ninetythree and the lowest seven hundred and seventy-three parts in a million. Mr. Stodder’s microscopic examination of dust shows some of the difficulties in the way of those who investigate the “germ theory of disease ” and of those who are studying “ spontaneous generation,”and mistaking the socalled brownian movements for evidences of animal life.
As many of the statistics set forth in the Report have been obtained from the replies to circulars sent to persons in various places, it is quite important that the questions should be clearly stated. Question No. 1, page 118, reads thus : “ Have you observed a difference in the prevalence of this disease [typhoid fever] between houses supplied with water from wells about the premises, and houses supplied with water conveyed from springs or from ponds of unquestionable purity ?“ To this twenty-three reply “ Yes,” but whether the difference is in favor of water from the wells or springs is not stated ; and yet this we suppose to be the pith of the question.