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SEWER GAS AND HEALTH.
DEDICATED
TO
SIR THOMAS WRIGHT,
TO WHOSE FORETHOUGHT, WISE COUNSEL, AND PERSEVERANCE
THE TOWN OF LEICESTER IS INDEBTED FOR MANY SANITARY
AND OTHER IMPROVEMENTS, AND WHO HAS FOR A GREAT
NUMBER OF YEARS GIVEN FREELY OF HIS VALUABLE TIME
FOR THE BENEFIT OF HIS FELLOW-CITIZENS.
AS A MARK OF HIS VERY HIGH ESTEEM AND REGARD.
THE AUTHOR.
SEWER GAS
INFLUENCE UPON HEALTH
TI^E-A-TISE
BY
H.^^'^FKED ROECHLING. C.E.,
ASSOCIATE MEMBER OF THE INSTITUTION OF CIVIL ENGINEERS ;
MEMBER OF THE SANITARY INSTITUTE;
FELLOW OF THE ROYAL STATISTICAL SOCIETY ;
FELLOW OF THE IMPERIAL INSTITUTE ;
MEMBER OF THE SOCIETY OF ARTS ;
MEMBER OF THE ROYAL AGRICULTURAL SOCIETY J . , .
MEMBER OF THE AMERICAN ACADEMY OF POLITICAL AND aOCML kl^NCF j
ETC., ETC. / ^,*'*''^ 4 ' ''N *^ '//
l<^'\ ' r , ]r^
London :
Biggs and Co., 139-140, Salisbury Court, Fleet Street, E.C.
\To^t^ •5'!
Although a great deal has been written at one time or another about
the influence sewer gas exerts upon health, yet, in the author's
opinion, the published information has dealt invariably only with one
or two aspects of this question, and not with the whole, and the
student of sanitary science was left to grope his way in the dark, as
it were, and without guide through this apparent chaos, emerging
therefrom probably after having formed a very one-sided opinion.
This state of things the author has endeavoured to remedy in the
treatise before the reader, and although he is fully aware that great
gaps still exist in our knowledge concerning the subject, he hopes he
has succeeded in shedding some light upon it, and upon the way that
will lead to its ultimate elucidation.
Questions affecting Nature and the processes by which she works
her marvellous changes should, in the author's opinion, not be looked
upon from one standpoint only, but ought to be viewed in their
entirety and with their surroundings, otherwise one is apt to
exaggerate the importance of one or more symptoms and leave
others — equally important, or perhaps more so-^altogether unobserved.
It is therefore to the harmonious working together of a number of
specialists — such as the chemist, the medical man, the bacteriologist,
botanist, and engineer — that the author looks for the true answer
concerning a number of questions affecting the health of individuals
and communities.
In the search for material wealth this age has at times apparently
forgotten scientific research, which did not promise some immediate
material return ; but there are hopeful indications that such temporary
neglect is passing away, and that in future the scientific side of many
practical sanitary questions will receive due consideration. It is then
to be hoped that full light will be thrown upon many subjects at the
present still shrouded in mystery.
Since writing the treatise the author's attention has been drawn to
two explosions which have occurred in the "septic tank" at Exeter.
In the first, the City Surveyor of Belfast narrowly escaped ; and in the
second, the City Surveyor of York is said to have received severe burns,
and such a shock to his nervous system, that he has been obliged to keep
to his bed at an Exeter hotel for some days.
As the "septic tank" is, like its predecessor in title, "the old cess-
pool," a place for the manufacture of rank sewer gas on a large scale,
containing considerable quantities of hydrocarbons, such as marsh gas,
one cannot be surprised to hear of explosions, but it is sincerely to be
hoped that the practical demonstrations of the dangerous character
of the gases forming in the septic tank will not be lost sight of, and
that the lessons thereby learnt will be utilised in future to prevent loss
of life.
To all those who have been kind enough to supply him with informa-
tion and particulars, the author wishes to express at this place his best
thanks. He hopes he may continue to receive information on the
influence of sewer gas upon health from those interested in the subject,
with a view to making a second edition more complete than the first.
If in the opinion of some he has not dealt fully enough with the
subject in places, the author hopes this may be excused ; but the leisure
at his command for this work was limited, and only obtainable at
intervals that were often very far between.
H. AlFBED RoECHIilNQ.
Leicester,
January, 1898.
^e)4-y^
SYNOPSIS OF CONTENTS.
PAGE.
Dedication „ iii.
Preface vii.
PART I.
General Considerations.
Pages 1 to 29.
CHAPTEK I.— Introductory Remarks 1 to 3
Importance of Subject — Additions to our Knowledge during
the last Five Years— No Comprehensive Treatise on the
Influence of Sewer Gas on Health up to now in existence in
any modern language.
CHAPTER II.— History OF Sewer-Gas Controversy 4 to 13
History of Controversy in England — Murchison's Theory —
Budd's Theory and Present Views — Diseases attributed to
Sewer Gas — Phases through which Scientific Questions pass
in Foreign Countries must be studied with a view to a com-
plete understanding— History of Sewer-Gas Controversy in
Germany — Views expressed there — Opinions held in America,
France, and Italy.
CHAPTER III.— Definition of Terms Used 14 to 15
Explanation of the terms Putrid Gases, Sewer Air, Sewer Gas,
Cesspit Air — Cesspit Gas— Privy Gas— Decomposition and
Putrefaction.
CHAPTER IV.— The Present State of our Knowledge of
THE Changes F;ecal Matters Undergo after Evacuation... 16 to 19
Our Knowledge of these Changes still very limited —
Aerobes, Anaerobes and Facultative Anaerobes — Decom-
position — Putrefaction — Nitrification - Micro-Organisms
found in Human Excreta — Aim of all True Sanitation.
CHAPTER V. — The Conservancy and the Water - Carriage
System 20 to 25
Conservancy Methods and their Disadvantages — Pails and
Typhoid Fever — Water- Carriage System and its Advantages
when properly carried out.
CHAPTER VI. — Notes on the Etiology and Epidemiology of
Typhoid Fever 26 to 29
Former Views as to the Causation of Typhoid Fever — Present
Views— The Typhoid Bacillus (bacillus typhi) of Eberth
and Gaffky — Microbes of Infectious Diseases appear to be
Specific Germs which spring from their like, and only create
their like— Behaviour of Typhoid Bacillus under Different
Conditions.
X SYNOPSIS OF CONTENTS.
PART II.
Observed Cases of Injury to Health from Sewer Gas.
Pages 80 to 43. page.
CHAPTER I— Casks in which Outbreaks of Typhoid Fever
HAVE BEEN TRACED TO SeWER Ga8 30 tO 31
Buchanan's Classical Investigations— Other Investigations in
England and Germany.
CHAPTER II. — Notes on the Coincidence between Typhoid
Fever and Faulty Drains as Demonstrated by the Smoke
AND other Tests 32to33
Experience at Leicester, Bristol, Hornsey, and Leeds.
CHAPTER III.— BiBMiNGHAM Sbweb-Gas Cask 34
CHAPTER IV.— Mephitic Poisoning through Sewer Gas 35 to 37
Mild Form of Poisoning — Severe Form — Various Cases Men-
tioned.
CHAPTER v.— Health OF Sewermen 38 to 39
Scanty Information — No Proper Records Kept — Munich
Experience — Asphyxia — Sore Throats— Rheumatic Affec-
tions— Typhoid Fever.
CHAPTER VL— Septic Poisoning through Sewer Gas 40 to 42
Sutton Coldfield Case — Contamination of Soup by Sewage —
Meat- Poisoning at Coventry.
CHAPTER VII.— Explosions in Sewers and Cesspits 43
Coal Gas — Presence of Hydro-Carbons such as Marsh Gas.
PART III.
Contents of Sewer Air.
Pages 44 to 58.
CHAPTER I. — Poisonous Gases Contained in Sewer Air 44 to 48
Carbonic Acid— Ammonia— Sulphuretted Hydrogen —Hydro-
Carbons— Volatile Fatty Acids — Examinations of Air in
Old and Modern Sewers— East Ham Sewer Fatality, 1st
July, 1896.
CHAPTER II.— Micro- Organisms in Sewer Air 49 to 58
Methods of Air Examination still imperfect — Examinations
of Air in the Sewers of Paris, Berlin, Sydney, Dundee,
Bristol, and London — Sewer Air under Ordinary Conditions-
Bursting of Bubbles— Splashing— Slimy Skin of Sewers —
Results obtained by Different Observers Practically Agree —
It is possible but not very probable that Sewer Gas carries
the Typhoid Germ — Difficulty of Detecting the Bacillus
Typhi in Sewer Air and Sewage very great.
SYNOPSIS OF CONTENTS. XI.
PART IV.
Experiments on Animals with Sewer Air,
Pages 59 to 69. page.
CHAPTER I. — EXPEKIMENTAL RESEARCHES INTO THE GaUSAL
Relations between Sewer Air and Typhoid Fever 59 to G9
Typhoid Fever and the Lower Animals— Inoculating Animals
with Large Doses of Bacillus Typhi— Protective Forces
of the System — Dr. T. H. Barker's Experiments with
Three Dogs and One Mouse — Dr. G. Alessi's Experiments
with 408 Animals in Rome — Contentions against Dr. Alessi's
Experiments and Conclusions.
PART V.
Conclusions as to the Influence of Sewer Gas upon Health.
Pages 70 to 73.
CHAPTER I.— Influence of Sewer Gas upon Health 70 to 73
Conclusions from the previous Observations — Action of Sewer
Gas apparently two-fold — Direct or Mephitic Action —
Indirect or Predisposing Action — Foetid Smells on Sewage
Farms Harmless — Immunity of Sewermen.
PART VI.
Allied Subjects.
Pages 74 to 86.
CHAPTER I. — Difference between Waterworks and Sewerage
Works in their Influence upon the Public Health 74 to 79
Buchanan's Classical Investigations in 1866 — Improvement in
Death-rates consequent on and subsequent to a Systematic
Water Supply and Sewerage is now a Sanitary Axiom —
Sewerage Works contribute to this Improvement in a more
marked degree than Waterworks.
CHAPTER II. — The Dilution of Sewer Gas and its Escape in
the Centre of Roads and Streets 80 to 83
It is better to allow Sewer Gas to escape in our Streets and
Public Places than to force it into the Interior of our
Houses — Leicester Experience.
CHAPTER III.— Concluding Remarks 84 to 86
Effect of Sewer-Gas Theory upon Advances in House and
General Sanitation — Building-up and Maintenance of
Protective Forces of the Human System.
XIL SYNOPSIS OF CONTENTS.
APPENDIX I. PAGE.
Index to the Literature upon the Subject of Sewer Gas
AND ITS Influence upon Health (including Allied
Subjects) in the English, German, French, and Other
Languages— 180 Books, Papers, etc., Enumerated 87 to 99
APPENDIX II.
Three Tables giving the Composition of Sewer Air or Sewer
Gas, the Gases Dissolved in Kaw Sewaue, and the Mephitio
Vapours Found in Disused and Unventilated Cellar
Dwellings 100 to 101
APPENDIX III.
Pages 102 to 118.
Micro- Organisms in Sewer Air, Experimental Results.
1. M icro-Orgauisms in the Air of the Paris Sewers 102
2. Micro-Organisms in the Air of the Berlin Sewers 103
3. Uffelmann's Observations 103
4. Micro-Organisms in the Air of the Sydney Sewers 103
5. Carnelley and Haldane's Observations 104
6. Laws and Andrewes' Experiments in the London Sewers 105
APPENDIX IV.
Pages 119 to 130.
Experimental Researches into the Causal Relations of Sewer Gas and
Typhoid Fever.
1. Experiment by Dr. T. H. Barker 119
2. Researches by Dr. G. Alessi in Rome 120
APPENDIX V.
Pages 131 to 133.
Explosions in Sewers and Cesspits.
1. Explosion in one of the London Sewers 131
2. Explosion in a Cesspit at Mayence 131
3. Explosion in a New Sewer at Burton-on-Trent 132
SYNOPSIS OF CONTENTS. xiii.
APPENDIX VI.
Pages 134 to 137.
Health of Sewermen. page.
1. General Remarks 134
2. Opinion of the late Dr. E. A. Parkes 1,84
3. Cases reported by Gaultier de Claubry 135
4. Observations of Hankel 135
5. Sewermen at Munich 136
6. Sewermen at Wiesbaden 136
7. Health of London Sewermen .. 136
APPENDIX VII.
Pages 138 to 148.
Some Authentic Oases op Mephitic Poisoning through Sewer Gas.
1. Poisoning Case at Clapham 138
2. Deaths of Four Men in a Sewer in the City of London 138
3. Case reported by Gaultier de Claubry 138
4. Case reported by Halle 139
5. Chevalier, Blumenstock, and Thierling mention Similar
Cases of Mephitic Poisoning 139
6. Case reported by Caspar 139
7. See also Item 4, "Health of Sewermen" (page 135) 139
8. Accident in the Paris Sewers 139
9. Case reported by Finkelnburg 139
10. Fatality in a New Sewer at Bast Ham, near London 140
11. Observations by Dr. Hankel 143
A. The Mild Form 143
B. The Fairly Severe Form 144
C. The Severe Form 144
D. The Qhronic Form 144
12. Case reported by Hankel 145
13. Death in London Sewers 146
14. Death of Three Men in a Sewer at Widnes 146
15. Death of Five Men from Sulphuretted Hydrogen at the
Tynemouth Gasworks 147
16. Death of One Man in a Sewer at Harpurhey , near Manchester. . 147
APPENDIX VIII.
Pages 149 to 155.
Cases of Septic Poisoning through Sewer Gas.
1. Case of Poisoning at Sutton Coldfield 149
2. Cases reported by Dr. Fenton 165
XIV. SYNOPSIS OF CONTENTS.
APPENDIX IX.
Pages 15«) to 1G4.
Casks whrrk Outbreaks of Typhoid Fkver nAVE brkn Traced to
Sewer Gas.
PAGE.
1. Buchanan's Historical Cases 156
2. Cases reported by Dr. Blaxall 15H
3. Case reported by Dr. Airey 158
4. Great Number of other Cases 158
5. Enteric Fever at the FoundlinLj Hospital, 1891, reported
by Dr. J. F. J. Sykes 159
6. Outbreak of Typhoid Fever at a Fever Hospital at Leeds... 160
7. Case reported by H. Alfred Roechling 163
8. Cases reported on the Continent 164
APPENDIX IXa.
Pages 165 to 185.
Other Effects of Sewer and Cesspit Gas not previously
referred to.
1. Case of Blood-Poisoning at Birmingham through Sewer Gas... 165
2. Case of Diphtheria attributed to Cesspit Gas 185
APPENDIX X.
Pages 186 to 194.
Influence of Sanitary Works upon the Mortality from Typhoid
Fever.
1. Investigations by the late Sir George Buchanan 186
2. Cases quoted by Soyka 187
3. Investigations by Baron 188
4. Typhoid Fever at Berlin 189
5. Other Cases 194
APPENDIX XI.
Pages 195 to 198.
NoTE.s ON the Coincidence between Typhoid Fever and Faulty Drains
AS Demonstrated by the Smoke and Other Tests.
1. Experience at Leicester 195
2. Experience at Bristol 1 95
3. Experience at Hornsey 196
4. Experience at Leeds 196
5. General Remarks on Smoke-Testing Drains 198
SYNOPSIS OF CONTENTS. XV.
APPENDIX XII.
Pages 199 to 209.
Notes on the Typhoid Mobtality and the Ventilation op the Sewers in
Leicester.
Detailed Index of Names and Subjects.
Pages 211 to 224.
INFLUENCE OF SEWER GAS UPON
HEALTH.
PART I.
General Considerations.
CHAPTEE I.
Introductoby Eemarks.
The subject chosen by the author for his treatise has
been very hotly discussed for years past, both in
scientific assemblies and in the public Press, and many
and various are the opinions which have been expressed
upon it in this country as well as abroad. In fact,
perhaps it is not too much to say that the subject
has been clothed in many forms, some of them of an
almost mysterious construction, and that it has created
a great deal of confusion in the public mind.
To those who are more intimately acquainted with
the matter, this can, perhaps, not be surprising, as the^
cause of it is undoubtedly to be found in our imperfect
knowledge up to the present time of sewer gas and its
influence upon health. Both those who strongly main-
tained the pathogenic character of sewer gas and those
who as strongly opposed it were unable to support their
belief with scientific proof, for want of sufficient know-
ledge of these matters. But within the last four years
further light has been thrown upon this abstruse subject,
and the author thought that it might not be out of
place to critically review it in the light of our increased
knowledge, with a view, if possible, of clearing up the
1
2 SEWER GAS AND HEALTH.
question, and lifting the veil somewhat behind which
it has been hidden up to now.
Our century is fast sinking into its grave, and it
must be our aim to do what lies in our power to
disentangle questions of great public importance, and
hand them over to the next century in a clear shape,
so that they may be easily understood by all.
Apart from these considerations, it has appeared to
the author that a rather one-sided interpretation has
been given in this country to the very able reports of
Messrs. Laws and Andrewes for the London County
Council, which have been published within the last four
years. But, as will be shown later on, these reports
must be accepted with certain reservations, the chief
amongst them being that they do not cover the whole
subject of sewer gas and its influence upon health ;
that, on the contrary, they only deal, as it were, with
one phase of it — viz., the microbes. If, therefore,
these limitations are lost sight of, there is the danger
that the conclusions drawn from these researches are
one-sided also, if not altogether wrong.
With a view to avoid such a mistake being made,
the author intends, amongst others, to draw attention
in the treatise to the very painstaking investigations
made about four years ago by Dr. G. Alessi, in
Italy, into the question of putrid gases as predisposing
causes of typhoid infection. As he considered these
researches of the greatest importance, he had them
translated ; and the Sanitary Institute, sharing his views,
was good enough to publish this translation in its
volume for 1895. These investigations supplement those
of Messrs. Laws and Andrewes, and ought to be carefully
studied with them in order to get a complete insight
into the whole question.
SEWER GAS AND HEALTH. 3
There is yet another reason why the author ventures
to think that the bringing forward of the question in
^he form of a short treatise may not be inopportune.
When suggesting on the Continent various alterations
in the house-drainage arrangements, he had to run the
gauntlet of a fairly hot opposition in reference to the
injurious character of sewer gas, and when trying to
refresh his memory by reference to the published infor-
mation, he found the greatest difficulty in doing so, as
it is scattered about in many places and not easily avail-
:able. He thought, therefore, it might be a considerable
advantage to put the subject into such a shape as would
; afford an easy reference even by those members of his
profession with whom to live means work and to work
life. With a view to attaining this end, he has attached
to the review several appendices, in which he has given
some of the information contained in a great many
• different sources and reported in different languages.
The public mind lends itself as easily to an unlimited
rsense of security as to a gross and unreasoning panic,
but in the judgment of the author either of these should
be avoided, and those who make and control public
opinion in hygienic matters should not err in the direction
■ of either extreme, as sooner or later a collapse or a
reaction is sure to set in, which will sweep everything
clean before it, and tend to make the pendulum swing
to the other extreme of its amplitude. But by such a
-course nothing is gained, and the words of Ovidius
.('* Medio tutissimus ibis") seem to indicate to the author
.the right course to be adopted in this question.
4 SEWER GAS AND HEALTH.
CHAPTEK II.
History of the Sewer-Gas Controversy.
Before entering upon the subject in detail, it might
be convenient to give a general outline of the history of
this question, which has caused many a severe conflict
of opinion.
The opinion that filth and disease go hand in hand
is practically as old as the hills, and might be
said to underlie the Mosaic Law. From it, no doubt,
in times long gone by sprang the conviction that the
emanations rising from filth, especially from decomposing
organic waste matters, were capable of producing certain
diseases, but it was not till about the middle of the
present century that this doctrine was applied to the
putrid exhalations proceeding from our sewers, cesspits,
privies, etc.
It had been noticed by various observers that typhoid
fever frequently broke out in houses, the air of which
had been rendered impure through the emanations from
sewers and cesspools, and this gave rise to the theory
that this disease was the result of a putrid process, and
caused directly by these emanations. In this theory,
which was called the " pythogenic theory," it was
endeavoured to establish the self-produced, or spontaneous
generation, of typhoid fever, and amongst its chief sup-
porters were men such as Murchison (see A-45, Appendix
I.) and Kiecke.
It was not long, however, before men like Budd (see
A-17, Appendix I.), and others, assailed it. Whilst
admitting the facts observed by Murchison, Budd main-
tained that the disease was not spontaneously generated ,„
SEWER GAS AND HEALTH. 5
l)ut that putrid substances were only capable of producing
iyphoid fever in the presence of a specific contagion.
Each school of thought endeavoured to support its own
theory by advancing facts observed, and the controversy
raged at one time somewhat fiercely, without, however,
apparently clearing the air. As time went on, the list of
diseases observed to have been caused by emanations
from cesspits or sewers increased, and at the present
time nearly all the zymotic diseases, and several others
besides, are attributed to this cause, such as typhoid or
enteric fever, diarrhoea, dysentery, diphtheria, scarlet fever,
^erysipelas, cholera, malaria, yellow fever, puerperal fever,
hospital gangrene, inflammation of the lungs, gastro-
'Cnteritis, etc. Without expressing any opinion at this
point, it cannot be denied that this is a very formidable
list, and at any rate goes to show how widespread the
mischief from sewer air, etc., is supposed to be.
In our day, when the daily Press takes a deep interest
in the doings and sayings of scientific men, it cannot be
surprising that it endeavoured to place before the general
public the opinions entertained amongst professional men
in reference to sewer gas — hence the great interest taken
generally in this question. This interest has not always
been a well-defined one, and as the connection between
sewer gas and disease was somewhat shrouded in mystery,
it cannot be surprising to find that the general public
has come to look upon any smell proceeding from cesspits
or sewers as dangerous to health and poisonous. No
doubt this conviction in the public mind of the dangerous
•character of sewer gas has at times given rise to
exaggerated fears, but at any rate it has had the good
-effect, by bringing pressure to bear upon our sanitary
^authorities, of vastly improving the hygienic conditions
;and surroundings of our houses and towns. In fact, it
b SEWER GAS AND HEALTH.
has been stated — and in the author's opinion very
properly — that this conviction has attributed more to-
the advance in the sanitation of our houses and towns
than any other theory or cause.
But the history of the sewer -gas controversy would
not be complete without a short reference to the stages-
through which it has passed in foreign countries..
Fortunately, the laws of Nature do not follow arbitrary
political lines, but are the same, with but slight local
modifications, throughout the globe ; hence, he who wants-
to understand the importance of any question connected
with them must be able to follow its various phases in
the various countries of the civilised world. This, no-
doubt, entails a great amount of labour, as it frequently
happens that simultaneously investigations into the same
subject are carried on in three or four countries, whicb
are afterwards reported in the various scientific,
periodicals.
Notably has this been the case of late with the newly-
founded science of bacteriology, where observers seem to-
have sprung up like mushrooms in nearly every part
.of the civilised world, and practically showered their
frequently most contradictory observations upon the
scientific public to such an extent that it was almost,
impossible to keep pace with them. In the general
interest and in the interest of this science itself, it is-
sincerely to be hoped that this pace will considerably
slacken in future, and that every observer will only
publish his results after the most careful scrutiny.
In Germany, the sewer-gas theory was utilised by those
who were opposed to the water-carriage system for faecal
matters as an argument against it. According to them,,
a system from which these dangerous emanations arose
could not but be a standing danger to the public health —
SEWER GAS AND HEALTH. 7
hence it ought not to be carried out ; and in its place was
recommended one form or other of the conservancy
system. In their zeal against the water-carriage system,
these advocates of the conservancy system forgot entirely
that putrid gases are perhaps more easily formed in
cesspits, tubs, privies, etc., which, owing to their con-
centrated nature, are more injurious to health than
those formed in sewers, and that in this country, to
which frequent reference was made, the conviction that
the putrid gases rising from sewers were dangerous did
not lead to the abolition of the water-carriage system
at all, but to its perfection by causing sanitary engineers
to be doubly careful in excluding these gases from our
houses.
This controversy was hotly fought out in many towns,
but perhaps in none more so than in Munich, where,
on the advice of Prof. Pettenkofer, the late Joseph
Gordon had been asked to prepare a combined drainage
scheme. It would lead much too far to go into details,
as whole volumes have been filled with this controversy;
it must suffice to say that the advocates of the water-
carriage system made light of the sewer -gas theory,
and endeavoured to show that sewer gas had not the
influence assigned to it in this country. Such a course
was, perhaps, but very natural, as the causal relations
between sewer gas and typhoid fever, for instance, could
not be proved ; and the conviction had grown amongst
professional men and others that the water-carriage
principle was greatly to be preferred to the conservancy
methods.
The German Association of Public Health convened
in September, 1881 (see B-55, Appendix I.), with a
view to settling this question, a congress at Vienna, at
which the late Prof. Soyka read a paper on the influence
8 SEWER GAS AND HEALTH.
of sewer gas upon health, and submitted the following
resolutions to the meeting, which it would appear,
however, were not accepted by the same :
1. The positive proof of the connection between sewer
gas and the spread of epidemic disease has not
been established.
2. The investigations made up to the present time
admit, on the contrary, in the majority of cases,
the conclusion that the spreading of epidemic
diseases takes place quite independently of sewer
gas, and that towns have better mortality figures
after the carrying out of sewerage works than
they had before. The same difference has been
observed between the sewered and non-sewered
parts of one and the same town.
Soyka tried to prove these resolutions with the aid
of experimental facts and epidemiological data taken
from a number of typhoid fever outbreaks, including
the Croydon outbreak in 1875.
In 1882 Prof. Eenk published a pamphlet (see B-46,
Appendix I.) in which he sums up his remarks on the
hygienic importance of sewer gas as follows :
"We summarise our opinion on the importance of
sewer gas by stating that we look upon it as
one of the factors which cause the pollution of
air in our houses, and hold it responsible for
the effects of this pollution.
** We cannot, however, admit that it exerts a special
influence upon the distribution of infectious
diseases, or that it predisposes the constitution
for them, but consider that its injurious influence
upon health consists in the nauseating effect
which it produces in the whole nervous sj^stem.
SEWER GAS AND HEALTH. 9
^'Although we make these reservations, we consider
the keeping of sewer gas out of our houses an
important task. . . ."
According to Soyka and Eenk, then, sewer gas has
no epidemiological importance; and, further, according
to the latter observer, the influence of sewer gas upon
health must be considered from the point of general
hygiene.
For at a certain concentration the gases contained in
sewers form a most poisonous combination, and numerous
fits observed amongst sewer-men lead one to suppose
that it is a question of the noxious influence produced
by ammonia and sulphuretted hydrogen. The prolonged
action of these gases gives rise to a chronic poisoning,
which is accompanied by disturbances of the organs of
digestion and nutrition, and in the end leads to attenua-
tion, and physical and intellectual weakness. When
the air is very impure and saturated with ammoniacal
vapours, it obstructs breathing, and violently irritates
the mucous membrane of the eyes and nostrils.
If these conclusions of Kenk were correct, it would
follow that the longer these gases are breathed the more
would the constitution become undermined, until in the
end collapse would take ^place. However, against this
hypothesis the observations of facts and daily experience
bear witness ; these teach us that sewer-men, tanners,
manufacturers of glue, labourers in manure works, and
other workmen, who are forced to live for the greater
part of the day in foul air, end by not feeling its noxious
influence at all. Instead of getting weaker and weaker,
these workmen seem to become gradually immune to
the influence of putrid gases ; and to this extent, at
:any rate, Kenk's theory cannot be correct.
As is frequently the case, those who shared the views
10 SEWER GAS AND HEALTH.
of Soyka and Kenk went a great deal farther than their
authors, and freely stated that sewer gas is perfectly^
harmless. In this opinion they were supported by the
bacteriological results obtained so far, which seem to
be against the probability that sewer air carries the
germs of infectious diseases such as typhoid fever.
In September, 1894, the author was invited to read a
paper before the German Association of Public Health
at Magdeburg, on the ** water supply and drainage of
houses," in which he very shortly referred to the dangerous
character of sewer gas. This gave rise to a discussion,,
and the impetus given to this question by the author's
paper led the council of the association to set the subject
down again for discussion at the next yearly meeting at
Stuttgart, in September, 1895. The title of the subject
was somewhat altered to " Injurious Character of Sewer
Gas, and how to keep it out of our Houses"; and two
gentlemen (Dr. Kirchner, professor of hygiene at Hanover,
and Mr. Lindley, late borough surveyor of Frankfort-on-
the-Maine) expounded then* theories, which were some-
what similar to those of Soyka and Eenk.
The author opened the discussion, which extended over-
several hours ; but in the end the resolutions proposed ta
the meeting by Messrs. Kirchner and Lindley, and which
were as follows, were not accepted by the same :
1. The theory that sewer gas causes such epidemic
diseases as typhoid, cholera, and diphtheria, is
not in keeping with our present knowledge of
pathogenic germs.
2. However, the putrid gases, which are formed in
street sewers and house drains, are dangerous to-
health, not so much directly as indirectly,
especially during long exposure, as they cause
nausea and tend; to lower the general vitality,.
SEWER GAS AND HEALTH. 11
and with this reduce the power of resistance of
the body against disease.
3. The formation of these gases and their accumula-
tion in the sewers can be reduced to a minimum
through proper arrangements, such as regular
flushing, cleansing, and sufficient ventilation.
4. Therefore, neither foul water nor air ought to be
allowed to stagnate in the public or private sewers,
nor should suspended matters be allowed to collect
in them.
5. In order to avoid the entrance of noxious gases-
from the sewers and drains into the air of the
subsoil and of our houses, it is necessary that all
drains and pipes in, under, and by the side of
our houses should be perfectly air and water tighty
and that all water-closets, sinks, etc., should be
provided with proper traps which are protected
against anti-syphonage and evaporation.
6. House drains can only remain permanently efficient
if the whole arrangement is simple and can easily
be inspected.
7. For these reasons the direct connection of house-
drains and street sewers is preferable to the dis-
connecting system, because the latter makes the
flushing and ventilation very difficult, necessitates
very complicated ventilating arrangements, and
causes the accumulation of decomposing matters
in the immediate vicinity of our houses.
It will be observed from these resolutions that the
meeting was asked to pronounce against disconnecting
traps in house drains.
Looking back upon the result of these two years'"
discussions, the author is of opinion that the conviction
is gaining more and more ground on the Continent that
12 SEWER GAS AND HEALTH.
the gas formed in the sewers must be excluded from our
houses on account of its injurious influence upon health.
In America similar views to those held in this country
have always prevailed, and though at times opinions
have been expressed that there is no connection between
sewer gas and infectious disease, they have not been
generally accepted.
The author is not very intimately acquainted with
the views generally held in France concerning putrid
gases, but he may point out in this place that after
very careful consideration, extending over a number of
years, the city of Paris has decided to abandon the
conservancy methods so far in vogue, and to make a
change to the water-carriage principle, and that further,
by the new by-laws which came in force on the 8th
day of August, 1894, the disconnecting trap has been
made compulsory for all houses. Article 15 of these
.by-laws is as follows :
"Each drain, before it passes out of the house, is to
be provided with a disconnecting syphon, the
seal of which shall not be less than 2*75in., so
as to ensure a permanent and air-tight barrier
between the house drainage and the street sewer.
•** Each disconnecting syphon is to be provided above
the bend with an inspection pipe with air-tight
cover.
** The models of these syphons and apparatus are to
be submitted to the authorities for their approval."
It may be inferred from this by-law that sewer gas
is, in Paris, considered injurious to health.
Concerning Italy, the author has already mentioned
that Dr. Alessi has made some very interesting researches
(see A-4 and D-2, Appendix I.) into the causal relation
hetween sewer gas and typhoid fever. After a very
SEWER GAS AND HEALTH 13
painstaking enquiry, this observer has arrived at the
conclusion that these gases predispose the constitution
for the reception of this disease; but as full particulars
of these investigations will be given later on, nothing,
further need be said at this point.
i4 SEWER GAS AND HEALTH.
CHAPTEK III.
Definition of Terms Used.
It might not be out of place to explain here shortly
the meaning of the terms used in this treatise. Such
s. course might prevent misunderstandings.
The general term of " Putrid Gases " includes all
gases arising during the process of putrefaction of
■organic matters ; it therefore includes all the gases
forming in sewers, cesspits, vaults, privies, privy
middens, ashpits, etc. — in fact, it is the collective
description of all gases and combination of gases
forming in the decomposition of the matters of the
animal and vegetable kingdom which have served for
the food and sustenance of man.
The terms "Sewer Air" and '* Sewer Gas" are taken
in this paper as identical expressions, and denote the
air and the gas in sewers or drains. Various writers,
and especially some of those who have endeavoured to
prove the harmless nature of sewer gas, have made
distinctions between these terms, using the term " sewer
air" for the air when it is devoid of smell, and the
term " sewer gas " for the air when it is charged with
noxious smells. Such a distinction is, however, in the
author's opinion somewhat arbitrary, as the difference
between the two, if it exists at all, is at the best one
•of degree only. Of course, there is a great deal of
difference in this sense between sewer air and sewer
gas as far as our nasal organs are concerned, but
whether the same difference exists as far as our health
is concerned is, to say the least, by no means certain,
SEWER GAS AND HEALTH. 15
the weight of the evidence collected so far being
apparently against any difference.
The terms ''Cesspit Air," "Cesspit Gas," "Privy
^Gas," etc., will not be much referred to in this treatise,
but where they occur they will be used as identical
expressions denoting the air in cesspits, privies, etc.,
which is always more or less charged with gaseous
<;ompounds.
The term "Decomposition" shall be generally used
only in reference to the process of complete oxydation
or mineralisation — that is, that process in which the
organic matter in the presence of an ample supply of
oxygen is converted into such products as water, carbonic
acid, nitrous and nitric acids, without the creation of
foul smells.
The term " Putrefaction " shall generally be applied
only to the process of incomplete oxydation — that is,
that process in which, in the absence of oxygen, the
albuminoid bodies are first peptonised, and then split
up into a great number of chemical substances, notably
fatty acids, trimethylamine, ammonia, ammonium sul-
phide, sulphuretted hydrogen, indol, scatol, etc., and
under certain conditions also into poisonous alkaloids
(ptomaines). This process mostly gives rise to very
foul smells which poison the atmosphere.
A rough-and-ready distinction between decomposition
and putrefaction is, therefore, the absence or presence
■of foul smells, although, strictly speaking, it is not quite
^correct.
16 SEWER GAS AND HEALTH.
CHAPTEK IV.
The Present State of our Knowledge of the Changes
FiECAL Matters Undergo After Evacuation.
Before considering the causal relations between sewer
gas and health, it might be opportune to describe
shortly the changes faecal matters undergo after leaving
the body.
It is to be greatly regretted that our knowledge of
these changes is still very limited; we know that they
ultimately become mineralised through bacterial activity,
but we know very little as to the progress and the various
stages of this change, as to the kind of bacteria
at work, and their life products. This oxydation or
mineralisation proceeds quicker and at a more active
rate in the pores of the soil than in water, owing,
most probably, to the more abundant supply of air,
especially in very porous subsoil; and, in fact, all the
investigations made so far seem to prove that the
amount of oxygen available during decomposition is
the most important factor in this process.
In the processes of decomposition and putrefaction of
organic matters three different kinds of bacteria may be
distinguished, which are subject again to further sub-
division— viz. :
1. The aerobes, or those bacteria which, as their name
expresses, can only exist and work in the presence
of oxygen.
2. The facultative anaerobes, or those bacteria which
exist and work in the presence of oxygen, but da
not altogether cease work in the absence of this-
gas; and
L
SEWER GAS AND HEALTH. 17
3. The anaerobes, or those bacteria which, as their
name expresses, can only exist and work in the
absence of oxygen.
It will be seen from this enumeration that the facul-
tative anaerobes form the connective link between the
aerobes and the anaerobes ; and it might be said that
the former are the bacteria of decomposition, the latter
those of putrefaction.
Concerning the products of activity of these different,
forms, it is now generally supposed that those formed
by the aerobes are more or less harmless, being products
of complete oxydation, whereas those formed by the^
anaerobes frequently contain ammonia, sulphuretted
hydrogen, and strong poisons of an alkaloidal nature^
being products of incomplete oxydation.
Probably the following is a picture of the process of
decomposition, followed eventually by putrefaction : At
first the aerobes, assisted to some extent by the
facultative anaerobes, carry on the work satisfactorily
until the oxygen of the medium becomes more and
more consumed, when such products as carbonic acid,
water, nitrous and nitric acids, are formed. In this
way, the amount of oxygen available is still further
reduced, and, if not supplied afresh, the aerobes must
cease their work. At this stage decomposition proper
ends and putrefaction sets in, fr-equently accompanied by
very foul and injurious smells when the decaying matters
are invaded by the hordes of anaerobes, which commence
at once their dangerous activity, and continue it until
they finally perish in the ever-increasing quantities of
carbonic acid, or in other substances of their own making.^
Then this process may be said to have come to an end.
^For particulars of the products of incomplete oxydation see th©
remarks made in the definition of the processes of putrefaction.
2
18 SEWER GAS AND HEALTH.
Such, then, is in very general outline a probable
picture of the processes which take place when the
waste matters of the animal and vegetable kingdom are
reduced and split up through bacterial activity. But
before it will be possible to give a complete and accurate
description, much more will have to be ascertained,
and a great many gaps in our knowledge will require
to be filled up. Although this is the case, it ought,
on the other hand, to be acknowledged with pride that
within the last few years much has been done to make
■us better acquainted with the processes of decomposition
and putrefaction ; and the knowledge gained, that in the
same bacteria play a very important part, has to some
extent lifted the veil which covered so long this phase
of the cycle which Nature in her marvellous wisdom
has ordained for the benefit of mankind.
In passing, it might be remarked that it has lately
been established that the process of nitrification in the
soil is the work of two separate microbes, of which the
first converts ammonia into nitrous acid, whilst the
second transforms the nitrous acid into nitric acid.
So far, no mention has been made of the swarms of
bacteria which are found in the dejecta even in a fresh
condition, their number in the case of a grown-up male
having been calculated at 34,000 millions.
Some of these, and perhaps by far the greater portion,
do not seem inimical to life, but there are also others
which appear of a doubtful nature, and finally those
to which a pathogenic character has been attributed.
Amongst the latter may be mentioned Koch's comma
bacillus (the bacillus of Asiatic cholera) and the bacillus
of typhoid fever, which are always found in the stools
of those suffering from these diseases. What becomes
of these in the process of decomposition has not yet
SEWER GAS AND HEALTH. 19
iDeen fully elucidated, but it is frequently held that, by
the law of the survival of the fittest, the pathogenic
germs, being of a more delicate nature, succumb after a
while in the struggle for existence with the swarms of
other microbes. How long these pathogenic germs retain
their power for mischief is not clearly established, and
the most contradictory statements have been made in
this respect, but the observations seem to point in this
■ direction, that for about a week or ten days, when
in sewage, they may exert their baneful influences.^
Even if the products formed by the aerobes should
eventually be proved to be perfectly harmless, it will be
clear from the foregoing remarks that it must be the
aim of all true sanitation to remove these waste products
.as quickly and as completely from our surroundings as
possible, so that even in the absence of pathogenic
germs putrefaction may not take place in the vicinity of
our dwellings, with all its attendant evils in the form
of dangerous gases, ptomaines, etc. Experience has over
;.and over again proved the wisdom of such a course.
See also tne remarks in Chapter VI.
20 SEWER GAS AND HEALTH.
CHAPTER V.
The Conservancy and the Water- Carriage System.
In these days, when the sanitary advantages — not to*
mention the pecuniary and administrative advantages — of
the water-carriage system over any other system appear
to be almost universally recognised, it might seem sheer
waste of time to compare it — even though it be but very
briefly — with the conservancy methods ; but as voices are
still heard from time to time in ardent support of the^
latter, it may not be out of place to make here a few
remarks concerning this subject.
In the conservancy methods all faecal matters remain.
in the house or on the premises for more or less time,
during which they have a chance to do mischief, and.
undoubtedly putrefactive changes have set up in them,
before they are removed. But it has been shown above
that it is just those changes which we ought to avoid
taking place in our surroundings, and that the excreta
ought to be removed from our houses, as soon as possible
after evacuation, in a fresh condition.
Further, it is frequently found that the various forms
of application of the conservancy system, especially such
as cesspits, vaults, privies, and privy middens, were
constructed a great many years ago — long before the
sanitary importance of these arrangements was fully
understood — and are consequently very defective; hence
they afford frequently readier means for the systematic
pollution of soil, air, and water than drains and sewers, .
which are, comparatively speaking, of more recent date.
However, it might be said that the forms of the-
conservancy systems just mentioned — cesspits, vaults,.
SEWER GAS AND HEALTH. 21
privies, and privy middens — are happily dying out, and
that against the only form remaining in this country —
viz., the tubs or pails — no such accusation could be
sustained. In support of this, comparisons might and
have been made between the death rates in towns with
the tub and in those with the water-carriage system,
and conclusions drawn therefrom that, so far as the
public health is concerned, no difference exists between
the two systems. But in the author's opinion such
comparisons between towns and towns ought only to
be undertaken with the greatest care — otherwise, owing
to the many points of difference between them, the
conclusions will be worse than useless and only mis-
leading, and it will generally be better and more reliable
to compare with each other different parts of one and
the same town where tubs and sewers exist. This has
lately been done, and, for instance, in Leicester, New-
castle-upon-Tyne, and Birmingham, observations have
been made as to the bearing of tubs and water-closets
upon the prevalence and spread of typhoid fever.
For Leicester 1 it has been shown that the number
of typhoid-infected houses is greater in those districts
where the faecal matters are collected in tubs than in
the sewered portions of the town. Further, during a
local epidemic in Navigation-street in 1894 the number
of typhoid-infected houses with tubs was five times as
large as the number of infected houses with water-closets.
Similar experiences are reported by the medical
officer for Birmingham, ^ who states that in 1894 the
typhoid incidence was IJ times as great in houses with
3)ails as in houses with water-closets, and that, as
regards second cases, one occurred in every 14 houses
1 See "Public Health " for May, 1895, pages 280 to 285.
^ See " Public Health " for May, 1895, pages 280 to 285.
22 SEWER GAS AND HEALTH.
with pails, but only in every 22 houses with water-
closets.
Dr. H. E. Armstrong mentions that in 1894 enteric
fever was twice as prevalent in Newcastle-upon-Tyne^ in.
households on the pail-closet system as in households
on the water-closet system.
The author does not know whether similar facts have
been observed in other towns, but at any rate it will
not be disputed that these figures cannot be quoted in.
recommendation of the last remaining form of the =
conservancy system.
Apart from this, it ought not to be forgotten that
nearly all towns in which this system is still in vogue
are experiencing the greatest difficulties with the disposal
of the excreta, and that these difficulties have become
so accentuated in the last few years, that towns
like Glasgow, Manchester, Birmingham, Nottingham,.
Leicester, etc., have decided to abandon the pail system
altogether, and establish the water-carriage principle
pure and simple, although they had previously expended
great sums of money in introducing the former.
In passing, the author would also mention here that,,
in a report lately issued by the medical officer of
health for Nottingham, and which deals with 78 towns,,
the following passage occurs (see "Eeport on the Con-
servancy and Water- Carriage Systems," by P. Boobyer) r.
"One note of encouragement to us at the present
juncture, running through almost all the answers
I have received, is the very general and growing
discontent with the so-called conservancy systems,,
from whatever standpoint they are viewed. In.
only four of the towns on my list (78 towns in.
1 See *' Public Health " for May, 1895, pages 280 to 285.
SEWER GAS AND HEALTH. 23
all) — Hull, Eochdale, Warrington, and Darwen —
is their continuance openly advocated in any
form."
If attention is now directed to the water-carriage
system, it has been stated that it does not completely
remove the faecal matters, but deposits portions of
them on the sides and bottom of the sewers and drains,
and that especially house drains are great offenders
in this respect. In fact, it was stated on the Continent two
years ago with great pertinacity, as an argument against
disconnecting traps, that house drains were, as a rule,
in a much fouler condition than the public sewers in
the streets.
The author's own experience is opposed to this state-
ment concerning house drains ; and although he has
known foul house drains, yet in the majority of cases,
where they were of modern construction and under
rational and intelligent supervision, he has frequently
found them entirely devoid of smell and deposit.
Apart from the consideration that the quantity of faecal
and other matters passing through house drains is con-
siderably smaller than that carried away in a main sewer,
it needs no great effort to see that house drains can be
kept in a clean and sanitary condition with much less
trouble than street sewers. There are, further, plenty
of means to attain this end, amongst which a systematic
ventilation, a good automatic flush from water-closets,
and a careful supervision, may be mentioned.
There would, therefore, appear to be no reason why
house drains should still be permitted to remain in a
very foul condition, and the author cannot help thinking
that where this state of things — which perhaps might be
called antiquated — still is the order of the day, the
authorities have been somewhat soundly asleep, and
24 SEWER GAS AND HEALTH.
require waking up a little in reference to house-
•drainage requirements.
Concerning street sewers, it cannot be gainsaid that*
•especially in the early days of sewering, great mistakes
were committed, as it was sometimes thought that
anything in the nature of a hollow underground passage
would do ; but, thanks to the untiring and well-directed
efiforts of Sir Kobert Kawlinson, such ideas have long
been abandoned, and in a system of sewers constructed
according to modern notions but comparatively little
chance is given to the faecal matters to deposit in the
sewers and gradually fill them up.
However, this must not be misunderstood as if it was
impossible for gases to form in modern sewers. All those
intimately acquainted with the subject know, of course,
that it is not possible to prevent the formation of gas
altogether, and that all that can be done is to reduce
the chances favourable to these formations to a minimum.
A very sad instance of the truth of this happened on
July 1, 1895 (see A- 25, Appendix I., and 10, Appendix
VII.), at East Ham, near London. In this case five
men lost their lives in a sewer which, as the surveyor
stated at the inquest, had not been at work for more
than 3^- years, the sewerage of the district having only
recently been carried out.
Although the formation of dangerous gases cannot be
altogether avoided in modern systems of sewers, there is
absolutely no need for the gases when formed to enter
our houses, as we possess plenty of means to prevent
this, perhaps the most effective of them being the
keeping of each house drain clean and sweet, and its
disconnection from the street sewer.
It will be clear from all the foregoing remarks that
the water-carriage principle possesses a great many
SEWER GAS AND HEALTH. 25
advantages over the conservancy methods; and, further,
it may safely be concluded that the gases formed in
privies, cesspits, etc., are, owing to their concentrated
nature, considerably more dangerous than those formed
in street sewers, especially if the latter are well ventilated.
26 SEWER GAS AND HEALTH.
CHAPTEE VI.
Notes on the Etiology and Epidemiology of Typhoid-
Fever.
It may not be out of place before going further to
make a few remarks at this point concerning the causation
of typhoid fever.
Although, as previously stated, a great many
diseases have at one time or other been traced to sewer
gas as their cause, such as typhoid or enteric fever,
diarrhoea, dysentery, diphtheria, scarlet fever, erysipelas,
cholera, malaria, yellow fever, puerperal fever, hospital
gangrene, inflammation of the lungs, gastro - enteritis,
etc., it will not here be necessary to refer to any other
but typhoid or enteric fever, as the connection between
sewer gas and the other diseases is not sufficiently
elucidated.
It will not be attempted in the following notes to deal
minutely with the etiology and epidemiology of typhoid
fever, as such a course would be out of place in this
treatise, and would also lead too far, this being a question
on which volumes and volumes have been written. Con-
flicting opinions have been put forward and defended
with great pertinacity, and the fight around them has
frequently been very severe. To those who were not in
the front line of battle, it has not always been an easy
task to wade through a very voluminous literature,
especially as not only the conclusions but also the
observations leading to them have been challenged and
contradicted by each opposing side. What is received
with exultation to-day is to-morrow put into shade
through a new investigation; and although the severe
SEWER GAS AND HEALTH. 2T
fight has this advantage that it is conducted on all
sides with great skill and astuteness, which in the end
is sure to lead to the full truth being found out, yet it
seems that at the present time we are still far from
that goal.
It has already been stated on a previous page that
about the middle of the present century abdominal
typhoid was considered to be the result of a putrid
process. Murchison and others held that putrefying
substances were the specific cause of this disease, and
that it could be generated spontaneously by their emana-
tions, such as sewer gas.
A little later the idea was gradually gaining groundl
that infectious diseases were caused through a specific
contagium animatum of a parasitical nature, and it
cannot be surprising, therefore, that Murchison's theory
was strongly assailed by Budd, who maintained that
putrid gases were capable only of producing typhoid
fever in the presence of a specific exciting cause.
It was then suggested that this specific contagion or
germ was probably spontaneously generated in putrid
gases, which were afterwards able to spread this disease..
A host of other theories were propounded, but it would
lead too far to mention them here; suffice it to say that
it required a great deal of very skilful labour to prove
that William Harvey's great word, " omne vivum ex:
ovo," was as true for the world of large animals and
plants as for the world of the most minute beings.
Although by no means universally accepted, it is now
generally held that the typhoid- exciting cause is the
bacillus typhosus, a microbe which was discovered probably
by Eberth, Koch, Meyer, and Gaffky.
Another theory has also been advanced, according:
to which the bacillus typhosus is not the cause, but
•28 SEWER GAS AND HEALTH.
ihe product, of the disease, the latter having converted
•the harmless bacterium coli into the pathogenic typhoid
germ ; but it would appear as if this theory was not
supported by the results of bacteriological investigations
up to the present time, which seem to show that the
microbes of infectious diseases are specific germs which
spring from their like and only create their like. At
:any rate, for the purposes of this treatise, it shall be
assumed that the exciting cause of typhoid or enteric
fever is the typhoid bacillus of E berth and Gaffky.
A great deal has been written about this bacillus, and
ihe most contradictory opinions concerning it have been
advanced by different observers, which is no doubt due
to the fact that the identification of the bacillus
typhosus is a matter of some considerable difficulty,
.as there are other bacilli, such as the bacillus coli
communis, a normal inhabitant of the intestines, which
are very much like it, and which have often been
erroneously taken for it. Therefore the published results
must be received with caution. But allowing for this,
the following facts appear to be somewhere near the
truth.
The bacillus typhosus is found in the stools and
urine of typhoid patients, and retains its vitality in
them for a considerable time— according to Uffelmann,
several months. But sewage does not appear to be
quite such a favourable medium, as it would seem that
this bacillus loses in it its power of mischief after a
period ranging probably from one to two weeks. The
■experiments concerning the vitality of the germ in well
and river water have given very different results, but
it would appear that it may live in these media for
:several months. It appears to be less sensitive to acids
ihan to alkalies, and Liborius has shown that it can exist
SEWER GAS AND HEALTH. 29^
without oxygen. It seems to perish tolerably quickly
under ihe influence of direct sunlight, but retains its
virulence in soil for some considerable time. A tempera-
ture of 60° C. = 140° F. will kill it within 10 minutes,
but it seems to be able to withstand a temperature of
— 10° C. = 14° F. for a considerable time even during
alternate melting and freezing. Dunbar states in refer-
ence to the tenacity of the typhoid bacillus, that it.
does not make great demands on its nutritive medium;
and that even without forming lasting spores, it manages
to maintain itself in our climate outside the human
body and to survive the winter.
Concerning the media through which this bacillus is
disseminated, it seems now established that it may be
carried in the air in fine dust particles, in the water,,
and milk. Other means of distribution are linen,-
clothes, dirty hands, instruments, etc.
Before proceeding to investigate the composition of
sewer air and the germs contained in the same, the
author thinks it will be more convenient to mention
first some of the forms in which sewer gas has exerted
an injurious influence upon health. In doing so,,
frequent references will be made to the appendices, in.
which full particulars of the various cases mentioned
are given, as such a course will be more convenient
than to have embodied these latter in the treatise-
itself.
.^0 SEWER GAS AND HEALTH.
PART II.
Observed Cases of Injury to Health from Sewer Gas.
CHAPTER I.
Cases in which Outbreaks of Typhoid Fever have been
Traced to Sewer Gas.
(See also Appendix IX.)
In Appendix IX. the author has mentioned first
Buchanan's historical cases at Worthing in 1865, in
Caius College, Cambridge, in 1874, and at Croydon in
1875, and has then given a number of other cases, such as
the outbreak in 1880 at Melton Mowbray, in Sherborne
in 1882, and in York in 1884, all of which have, after
careful examination, been held to have been caused by
the emanations from the sewers.
Further interesting cases are the outbreaks of enteric
fever at the Foundling Hospital, St. Pancras, in 1891,
which was very carefully investigated and reported upon
by the medical officer of health for St. Pancras (Dr.
J. F. J. Sykes), and at the Leeds Fever Hospital.
In Germany, too, several outbreaks of typhoid fever
have been attributed to sewer gas, and the late Dr.
Uffelmann, professor of hygiene at Rostock (B-60,
Appendix I.), perhaps one of the most careful and
painstaking observers and investigators, maintained that
houses into which sewer gas entered periodically were
frequently visited by diphtheria, malaria, and typhoid
fever. At the meeting of the German Association
of Public Health in 1895, the late Dr. Goepel (B-23,
Appendix I.) reported a very interesting case from
SEWER GAS AND HEALTH. 31
Frankfort-on-the-Oder, where in a house the typhoid
fever ceased after the pipe through which the sewer
gas entered it had been seen to. Dr. Lissaur (see B-36,
Appendix I.) also reports an interesting case of typhoid
fever from Dantzic.
A great many other cases might have been quoted,
as there is no lack of them, but the author does not
consider it necessary to go beyond a few typical instances.
Those who deny the existence of a connection between
sewer gas and typhoid fever are bound to assume that
all the numberless trained and untrained observers,
who have pronounced in favour of this connection, have
made serious mistakes both in their observations and
conclusions.
In some of the outbreaks mentioned above, those who
investigated them attributed the cause to the inhalation
of sewer gas, whereas in others it was thought that sewer
gas polluted the water supply, and thus brought about
the epidemic.
It will not be attempted here to explain the relation
between sewer gas and typhoid fever, as there will be a
special opportunity for this later on, but it might be
pointed out that the sewer-gas theory has been taken
advantage of to such an extent as to bring it practically
into miscredit. It has been attempted to explain cases
by it in which sewer gas seems to have played no part
whatever, and this over-zeal on the part of some indiscreet
advocates has been utilised by the opponents to hold the
whole theory up to public scorn and ridicule. But be
ihat as it may, the fact is now generally admitted, even
by those who look upon sewer gas as comparatively
harmless, that putrid gases and typhoid fever are
frequently found side by side, and it is important to
clearly bear this in mind in the future remarks.
32 SEWER GAS AND HEALTH.
CHAPTEE II.
Notes on the Coincidence between Typhoid Fever and-
Faulty Drains, as Demonstrated by the Smoke and-
Other Tests.
(See also Appendix XI.)
In support of the facts just mentioned, it might not
be out of place to refer here shortly to the experience
gained in several towns as to the relation between
defective drainage and typhoid fever.
Formerly it was not always possible to prove the
entrance of sewer gas into our houses, but now, since
the introduction of the smoke, hydraulic, and sceni
tests, such a proof is, comparatively speaking, an easy
matter.
In this connection the author would like to point out
that the smoke test is not under all circumstances a
completely reliable test, as there are cases, especially of
underground leakage, which can only be demonstrated
by the hydraulic test. In his own experience the author
has had cases where, suspecting defects, he could not
discover them with smoke, although he made repeated
trials, and where he only succeeded in localising them
after the application of the hydraulic test. It would,
therefore, be incorrect to conclude that in all cases
where the smoke test has shown no defects, sewer gas
could not possibly find its way into the interior of the
house, and in such a case, if necessary, recourse should
be had to the water test.
In Appendix XI. the author has given the observations
made at Leicester, Bristol, Hornsey, and Leeds. He would
SEWER GAS AND HEALTH. 35
have been glad to have been able to add to these those
made in other towns, but they were not in his possession.
In Leicester the percentage of all typhoid-infected
houses with defective drainage, as ascertained by the
smoke test, was 31*25 per cent, in 1893, and 45*18 per
cent, in 1894.
For Bristol reports the medical officer of health that
during the ^Ye years 1890 to 1894, 29*38 per cent, of
548 typhoid-infected houses showed drainage defects on.
the application of the smoke test.
In Hornsey, there were nine typhoid-infected houses
tested with smoke between 10th August and 30th
December, 1893, all of which showed drainage defects.
In 1894 the number of typhoid-infected houses with
drainage defects was 19.
Particular mention deserve the interesting observations-
made by Dr. J. Spottiswoode Cameron, the medical officer
for Leeds, in connection with the testing of the drains of
1,121 houses in which typhoid or diphtheritic disease was^
supposed to be present, and 30*51 per cent, of which were
found to have faulty drainage arrangements. For full,
particulars see 4 of Appendix XI.
The author is of opinion that the statistics just quoted
support the statement previously made, that putrid gases
and typhoid fever are frequently found in close proximity.
k
34 SEWER GAS AND HEALTH.
CHAPTER III.
Birmingham Sewer-GtAS Case.
(See also Appendix IXa.)
A case of blood-poisoning by sewer gas was tried in
August, 1896, at Birmingham before Mr. Justice Collins,
and as it contains many interesting points, the full
report of the trial, together with two sketches taken
from the Contract Journal^ are given in Appendix IXa.
The executors of the late T. H. Smith brought an
action against the King's Norton Urban District Council
for damages for his death, caused, as they alleged, by
sewer gas, and the judge gave judgment for ^02,875
against the District Council.
A case of diphtheria attributed to cesspit gas, in which
damages to the extent of £50 were awarded by Mr.
Justice Wills, is also given in the appendix above
referred to.
SEWER GAS AND HEALTH. 35
CHAPTEK IV.
Mephitic Poisoning through Sewer Gas.
(See also Appendix VII.)
It is well known that gases such as ammonia, carbonic
oxide, carbonic acid, and sulphuretted hydrogen — which
are frequently found in sewer air — are highly poisonous,
and have, in consequence, when inhaled, an injurious
influence upon health, the degree of which seems to
depend on the amount so taken into the system. If
the dose is small, then the poisoning is of a mild form ;
but if the dose is large, then the poisoning is frequently
very acute, and instantaneous death may be the result.
It will not be necessary here to dwell upon the nature
of this injurious influence ; it will suffice to say that
this influence is universally admitted.
In the further remarks, therefore, the mild form of
poisoning will be distinguished from the severe or acute
form.
A. Mild Form of Mephitic Poisonhig through Sewer
Gas.
The effect which the breathing of small doses of sewer
gas has upon the constitution varies considerably. It is
generally more marked in persons of weak health, in
persons suffering or recovering from illness, in women
and children than in men. The following disorders
have been attributed to this cause: languor, loss of
appetite, vomiting, diarrhoea, colic, [ prostration, head-
ache, malaise, insomnia, and feverishness. Children seem
to feel the effects of the inhalation of sewer air most —
3*
36 se^^i:r gas and health.
they lose appetite, become pale and languid, and suffer
from diarrhoea.
If the inspiration of sewer gas is allowed to continue-
for some time it may lead to the chronic derangement-
of the digestive and nutritive systems, to ansemiay
nervousness, neuralgia, etc., and, by lowering the vitality,
will reduce the power of resistance of the body to
injurious influences from outside. In this way the
prolonged action of sewer gas tends to render the
constitution more perceptible to the entrance of patho-
genic germs ; and the causal relation between sewer
gas and typhoid fever has been explained in this way;,
but the author is inclined to think that such an
explanation is only partially correct.
This action of sewer gas has frequently been-
attributed to carbonic oxide, carbonic acid, ammonia,,
and sulphuretted hydrogen ; but as this subject will later
on be referred to in detail, it will not be necessary to-
say more at the present stage.
Further particulars concerning the mild form of
mephitic poisoning are given in Appendix VII. -11, where,
according to Hankel, the mild form, the fairly severe
form, the severe form, and the chronic form are
distinguished.
B. Severe Cases of Mephitic Poisoning through Sewer
Gas.
There are a great number of cases of acute poisoning.;
through sewer gas on record, but as they are scattered
about in the literature of several countries, the author
has given some of them (10) in Appendix VII. for
convenience of reference. It must, however, be borne
in mind that the cases mentioned do not by any
means comprise all those reported in the papers, as^-
SEWER GAS AND HEALTH, 37
■probably the yearly number of deaths from this cause
in all countries is Considerable.
In most cases of acute mephitic poisoning death is
practically instantaneous, the victim perishing through
asphyxia. Some observers have attributed this to the
presence of carbonic acid, others to that of sulphuretted
hydrogen in sewer air.
A very severe and at the same time very sad case
•of mephitic poisoning happened on the 1st July, 1895,
at East Ham, near London, in which five sewermen
lost their lives. (Appendix VII.) The widow of one of
the men brought an action against the Urban District
Council, and at the second trial — the Court of Appeal
having granted a fresh hearing of the case, as Mr.
Justice Cave had non-suited the plaintiff in the first
trial — judgment was given for the plaintiff, with ^225
damages.
Another recent case is that mentioned by Hankel,
where a plumber perished in thawing up a frozen water-
<}loset. (Appendix VII.-12.)
It is very disappointing that the post-mortem
•examination in both cases was not able to throw
further light upon the cause of death.
38 SEWER GAS AND HEALTH.
CHAPTEK V.
Health of Sewermen.
(See also Appendix VI.)
In connection with this subject it will be necessarjr
to make a few remarks about the health of sewermen^
as they have frequently been quoted in support of the^
harmless character of sewer air. (See Appendix VI.)
It is greatly to be regretted that the statistical
information concerning the health of sewermen is
generally very incomplete. No proper continuous
records appear to have been kept anywhere, and, when
required, facts and figures have had to be collected
probably years after the dates to which they refer,
and that, too, in a somewhat haphazard manner. The
results of such enquiries are therefore in most cases-
not based upon a proper system of notification, and
must be received with a certain amount of caution.
Further, the information generally only deals with.
the workmen whilst employed in the sewers, but gives^
no clue as to their health after leaving this employ-
ment, which, of course, is a point of the greatest
importance when considering the influence of sewer gas.
upon health.
The information in most cases also refers only to-
the days lost through sickness, but does not give any
idea as to the state of the health of sewermen before
actually becoming unfit for work.
In the case of the Munich sewermen, for instance,
the information collected by Prausnitz (see Appendix.
VI.-5) goes to show that out of the total number of 421
SEWER GAS AND HEALTH. 39
men so employed, 48 per cent, remained on an average
only 20 months in the sewers. It would have been very
interesting to ascertain the cause of this, and whether
their state of health compelled the workmen to leave
this work.
With these reservations the author agrees with the
generally expressed opinion that workmen connected
with fairly well ventilated sewers do not show any
excess of sickness. The same can, however, not be
said of those who have to work in ill- ventilated sewers,
as they seem, according to Gaultier de Claubry and
Hankel (Appendix VI. -3 and 4 and Appendix VII. -11), to
suffer in their health from the evil effects of the gases
they encounter, asphyxia being a common disease
amongst them.
Complaints of sore throats and rheumatic affections
seem to be pretty common amongst sewermen, but the
opinion of Murchison and Peacock, that typhoid fever
was not uncommon among them, does not seem to be
supported by the experience of other observers.
Further particulars concerning the health of sewermen
are given in Appendix VI.
40 SEWER GAS AND HEALTH.
CHAPTEE VI.
Septio Poisoning through Shwer Gas.
(See also Appendix VIII.)
Cases have from time to time been reported in which
food that had been exposed to sewer gas has caused
illness in those who have partaken of it.
A very remarkable and interesting case of this kind
has quite lately been reported by the medical officer
of health for Sutton Coldfield, near Birmingham, full
particulars of which are given in Appendix VIII. -1.
In this instance, soup, which had been gratuitously
distributed, appears to have caused a sudden outbreak
of poisoning amongst about 100 persons at the end of
1894. Dr. Bostock Hill in vain endeavoured to trace
the poison in the soup and its source, and finally,
after one patient had died, he sent a portion of it to
Dr. Klein for bacteriological examination, who summed
up his report as follows :
"In conclusion, from the foregoing observations, the
following conclusions can be drawn :
"1. The soup contained microbes which were derived
from sewage, and it is thereupon highly probable
that the soup had been polluted with sewage.
Amongst the microbes present in the soup, the
bacillus mentioned as a variety of the bacillus
coli is possessed of virulent properties on account
of its extremely rapid multiplication at the body
temperature, and the poisonous substance it elabo-
rates. It is most probable that this microbe
caused the consumers of the soup the ill effects
SEWER GAS AND HEALTH. 41
and the disease. This bacillus, it will be
remembered from the foregoing paragraph, was
present in the soup in enormous numbers."
The soup had been prepared in an outhouse of an
hotel in an iron boiler, which was under the same roof
as a stable, and only separated from it by a wooden
partition in which there was a door. On the floor of
the stable there was a drain grating, and at the end
of the outhouse, near the boiler, ran up the ventilating
pipe of the house drain, while about 20ft. away and
up the side of the hotel itself, there was a large venti-
lating shaft connected directly with the main road
sewer. This latter sewer was notoriously a very
stinking one, and to obviate the nuisance caused by it
to residents and to those travelling along the road, the
crown ventilator at this point had been stopped up, and,
by permission, a large 6in. ventilating shaft erected
against the wall of the hotel. Dr. Bostock Hill relates
that offensive gases had been given off by this ventilating
shaft, and the proprietress of the hotel had complained
that foul smells had been noticed in a room close to
where it was fixed.
The soup had been allowed to stand in the boiler for
about 18 hours, including one night, and it is just
possible that during this time or in the operation of its
distribution to the poor it became polluted by sewage,
either by handling it with dirty fingers or in some other
way ; but Dr. Hill is evidently not of this opinion, as he
sums up his interesting report as follows :
*'I have previously remarked that the night was a.
cold one, so that the sewer gas coming from the
top of this shaft would become heavier as it
cooled, and would thus tend to sink lower in the
atmosphere ; and my belief is that this sewer gas
42 SEWER GAS AND HEALTH.
in question did gain access to the outhouse hy
way of the chimney, and that in this way the
soup was contaminated with those micro-organisms
which were found by Dr. Klein. I do not by
any means lay this down dogmatically, but after
a very careful consideration of all the local
circumstances, I see no method more likely of
contamination of the soup with the micro-
organisms of sewage."
It is by no means an uncommon thing that the
gases escaping from the top of a ventilating shaft
descend again, and the author has frequently made
the same observation when testing drains with smoke.
The medical officer of health for Coventry also
reports two similar cases of poisoning.
Further particulars will be found in Appendix VIII.
SEWER GAS AND HEALTH. 4^
CHAPTEK VII.
Explosions in Sewers and Cesspits.
(See also Appendix V.)
Now and again cases are reported in which explosions-
are said to have happened in sewers and cesspits, and
the author has mentioned three such cases in Appendix V.
There is but little doubt that in some of these coal
gas was the cause of the explosion, but in others the
presence of hydrocarbons, such as marsh gas, which
are formed in the decomposition of organic matters,
may account for it.
After having now dealt with the effects sewer gas has
upon health, it becomes necessary to examine into the^
cause of this.
44 SEWER GAS AND HEALTH.
PART III.
Gonte7its of Sewer Air,
•
CHAPTER I.
Poisonous Gases Contained in Sewer Air.
(See also Appendix II.)
The quantity of gas that can be formed by a given
^quantity of faecal liquid has been variously calculated
by different observers.
Concerning the air in cesspits, Levy (see C-3a,
Appendix I.) mentions an analysis, which shows a
reduction of oxygen by 2 per cent, and an increase of
carbonic acid by 4 per cent, over the normal state.
Erismann made experiments in the Hygienic Institute
at Munich, and came to the conclusion that 1,000
gallons of cesspit contents, consisting of human dejecta
and urine, were capable of developing the following
quantities of gas in 24 hours:
Table I. — Poisonous Gases in Cesspits.
Carbonic acid ...
315-0
gallons,
or about 43,376
Ammonia
149 0
, )
},
7.912
: Sulphuretted hydrogen
1-2
)i
t>
140
Hydrocarbons and volatile
fatty acids
579-0
n
}i
29,124
Total quantity of poisonous
gases
1,044-2
,,
M
80,552
Equal
, say, ll-51b.
It will not be denied that these are very considerable
-quantities of some highly poisonous substances.
Parent Duchatelet found the air in a choked-up sewer
in Paris to contain in 10,000 volumes only 1,379 volumes
SEWER GAS AND HEALTH. 45»
of oxygen, and as much as 299 volumes of sulphuretted/
hydrogen.
Gaultier de Claubry, who also examined the Paris
sewers, states that the minimum amount of oxygen in
10,000 volumes of sewer air was 1,740 volumes. On an
average he found that sewer air contained in 10,000^
volumes 230 volumes of carbonic acid and 81 volumes
of sulphuretted hydrogen, whilst the greatest amounts
met were 340 volumes of carbonic acid and 125 volumes
of sulphuretted hydrogen.
It may fairly be assumed that the foregoing analytical,
results were chiefly obtained in old sewers, which, perhaps,
had not been constructed according to proper principles.
At any rate the analysis of the air in sewers of more
recent date do not show such an alarming amount of
poisonous gases.
Letheby, who examined the air in some of the London
sewers, states that it contained 53*2 volumes of carbonic
acid in 10,000 volumes, a considerable amount of
ammonia, and traces of marsh gas and sulphuretted
hydrogen ; he also calculated that a gallon of sewage
containing 128*8 grains of organic matter, when excluded
from air, gave in " nine weeks 1*2 cubic inches of gas
per hour, consisting of 73*833 per cent, of marsh gas,.
15*899 per cent, of carbonic acid, 10*187 per cent,
of nitrogen, and 0*081 per cent, of sulphuretted
hydrogen."
Eussell, who also analysed the air of some sewers in
Paddington, found it to contain 51 volumes of carbonic
acid, 2,070 volumes of oxygen, and 7,880 volumes of
nitrogen.
Carnelley and Haldane state that the air in the sewers
at Dundee and Westminster Palace contains on an
average only 7*5 volumes of carbonic acid in 10,000
46 SEWER GAS AND HEALTH.
volumes, but in the Bristol sewers this amount ranged
from 9-1 to 20*7.
Laws, who in 1892 made a series of analyses of
London sewer air, states that in a normal state it con-
tained on an average in 10,000 volumes 8*95 volumes
•of carbonic acid ; in the case of the Fulham-road sewer,
however, this amount reached the abnormally high figure
of 93*10 volumes.
The Munich sewers contain, according to Beetz, on
an average in 10,000 volumes of air 31*4 volumes of
carbonic acid and 2*2 volumes of ammonia.
Levy and Miquel, who now periodically examine the
air in the Paris sewers, state that on an average of
their observations between 1891 and 1893 it contained
in 10,000 volumes only 4*8 volumes of carboni« acid
and 1*2 volumes of ammonia.
Further particulars are given in Appendix II., where
also, for convenience of reference, some analyses of the
gases dissolved in raw sewage and of the vapours in
disused and unventilated cellar dwellings are given.
From these analyses it is clear that the air in
modern, well-constructed, and well-ventilated sewers does
not contain the same amounts of poisonous gaseous
substances as that in old and foul sewers. It is clear
therefore that to a very large extent the state of the
air in any one particular sewer depends on the state
this sewer is in. If it contains no deposits and is well
ventilated, we may very properly assume that in most
cases the air contained in it will also be comparatively
free from gas ; but if, on the other hand, it is very
foul and badly ventilated, then most probably its air
contains a very high percentage of these dangerous
mixtures. Hence it must be the aim of all those who
design and superintend sewers to see that ample provision
SEWER GAS AND HEALTH. 47
is made for the fulfilment of these two essential con-
ditions : no deposits and an ample supply of fresh air;
for it will not be denied by anyone that in the absence
of deposits the formation of gases in them will
not be great, and that the safety against the nefarious
influence of gaseous mixtures lies in their ample dilution.
How these two requirements can best be carried out in
a sewerage system is outside the scope of this treatise,
but the author is afraid of late a tendency has set in
not to provide for the dilution of the gaseous mixtures,
but only for their escape in cases of need, overlooking
at the same time that under pressure these gases will
escape at the point of least resistance, whether that
be through the appointed channels or through house
drains, water seal of traps, etc. The author has lately
examined a system of new sewers in which the provi-
sion for ventilation was totally inadequate, hence each
manhole, forming, as it were, a dead end for the
accumulation of gas, emitted a most horrible stench
of sulphuretted hydrogen on the cover being removed.
In considering this subject it is necessary to bear
in mind that normal atmospheric air contains on an
average in 10,000 volumes only three volumes of carbonic
acid, 2,090 volumes of oxygen, and 7,910 volumes of
nitrogen, and that in the case of sulphuretted hydrogen,
from 10 to 12 volumes of this gas in 10,000 have been
considered a rapidly fatal dose.
The question of the organic vapour in sewer air need
not be discussed here, as it will be referred to later
on in connection with the experimental researches of
Dr. Alessi.
These few remarks must suffice to show that the
gaseous mixtures in sewer air are of a highly poisonous
nature, which will exert a powerful influence upon
48 SEWER GAS AND HEALTH.
health if they are allowed to accumulate; and there can
be little doubt that the cases of mephitic poisoning
mentioned in a previous paragraph (see also Appendices
VI. and VII.) were due to this cause. Although in
modern sewers with good supervision the formation of
such gases as carbonic oxide, carbonic acid, sulphuretted
hydrogen, ammonia, volatile hydro-carbons, and fatty
acids may be to a very large extent avoided, it ought
not to be assumed that their formation is altogether
an impossibility, as the sad case at East Ham on the
1st July, 1895, painfully demonstrates ; even their
entrance under pressure into our houses is by no
means excluded, as the sad case reported from Glauchau
by Hankel on the 18th January, 1895, proves.
SEWER GAS AND HEALTH. 4&
CHAPTER II.
Micro-Organisms in Sewer Air.
(See also Appendix III.)
The introduction of methods enabling us to study
the micro-organic life in air is of comparative recent
date, hence it follows almost as a corollary that they
are still somewhat crude, and that our knowledge
concerning these micro-organisms is still far from perfect.
The author is far from wishing to underrate the value
of the present methods for the examination of air, but,,
on the other hand, as it is by no means an uncommon
thing to hear opinions expressed in a way as if these
methods were infallible, he thinks it is but right to call
attention to their comparative primitive character. In
support of this the almost daily improvements may be
quoted which tend towards the exclusion of accidental
errors and errors inherent to former methods, and
which entitle us to the hope that ultimately we may
ascertain the true state of the air around us and in
our sewers. But how soon this goal will be reached,
or how near we are to it, is impossible to say ; some-
times it seems a long way off yet.
It is necessary, therefore, in dealing with the subject
of the micro-organic life in sewer air, to make due
allowance both for our imperfect methods of investiga-
tion and our incomplete knowledge.
So far as known to the author, about six sets of
investigations into the bacterial flora of sewer air have
within recent years been made in various towns, as
is shown in the following table :
4
50 SEWER GAS AND HEALTH.
Table II. — Investigations into the Micro-organic Life in Sewer Air.
Sewers in which
Year of
Investigations.
No.
Name of Observer.
Investigations were
made.
1
L6vy and Miquel .-
Paris sewers.
Periodical investiga-
tions commenced in
1891, and continued
since.
2
Petri
Berlin sewers.
—
3
Uflfelmann ...
—
—
4
Smith
Sydney sewers.
1893.
5
Carnelley and Hal-
Sewers at Dundee,
1887.
dane
Westminster Palace,
and Bristol.
6
Laws and Andrewes
London sewers.
1892-1894.
In Appendix III. full particulars of each set of investi-
gations are given, and on reference to this place it will
be seen that in the main points the various observers
practically agree. These for convenience of reference
may be stated as follows :
1. The number of germs in sewer air is small and
less than in outside air. Whereas outside air
contains on an average 15 germs per litre, sewer
air has not more than from two to nine germs
per litre. Only in the case of the Sydney sewers
was a considerably higher number found, ranging
from 7 to 2,260 germs per litre.^
2. The micro-organisms of sewer air are related to
the micro-organisms in the air outside the sewers,
but not to the micro-organisms of the sewage.
3. The only pathogenic germ found up to the present
in sewer air is the staphylococcus pyogenes aureus,
the cause of suppuration, which was identified
by Uffelmann B-30, Appendix I.)
The results of their investigations having so far,
1 1 litre = 1,000 cubic centimetres (ccm.) ; 1 ccm. of sewage contains
frequently 5,000,000 germs, and at this rate 1 litre of sewage would
contain 5,000,000,000 germs.
SEWER GAS AND HEALTH. 51
apparently, demonstrated the absence of pathogenic
germs, with the exception of the germ of suppuration,
various observers endeavoured to find out experimentally
whether there was a possibility of the pathogenic germs
being separated from the liquid, and then carried away
by the air currents prevailing in sewers.
They therefore tried to ascertain whether these germs
could pass into the air from the liquid under the
following conditions :
a. Under ordinary circumstances ;
h. Through the bursting of bubbles ;
c. Through splashing; and
d. From the slimy surface of the sewers ;
and whether the germs, after passing into the air, could
remain suspended there for some time and be carried
away by the current.
Naegeli has shown that it is not very likely that germs
pass under ordinary circumstances from a wet surface
into the air B-39, Appendix I.)
Prof. Frankland (A-28, Appendix I.) has shown that
the bursting of bubbles disseminated particles of lithia
solution, and, therefore, presumably micro-organisms.
Carnelley and Haldane made laboratory experiments
which completely justified Frankland's inference; and
the possibility, therefore, exists that germs can thus
pass from the sewage into the air. But it is urged
that in those places in the sewers where, through the
formation of gas, bubbles rise to the surface of the liquid
and burst, it is hardly likely, that pathogenic germs,
even if they are present, will retain their virulence for
any length of time, as it may safely be assumed that
here the sewage swarms with immense numbers of
saprophytes, and that in the struggle for existence
with these the pathogenic germs will soon perish.
4*
52 SEWER GAS AND HEALTH.
Hence the probability that germs could thus hey
disseminated could not be considered great.
Concerning splashing, Carnelley and Haldane have
observed in several cases in sewers that it disseminates
germs from the sewage. These results were corroborated
by their laboratory experiments, and they therefore came
to the conclusion that large numbers of germs may be
thrown into the air in this way. Laws states that it
has been shown by some observers "that if the splashing
is sufficiently violent to produce a very fine state of
division of the sewage, organisms will be carried some
distance, even 50 to 60 yards." He concludes therefore
that splashing, such as is caused by a house drain,
discharging its contents into a sewer through an opening
in its crown, should not be permitted. From his own
experiments it would follow that sewage, falling from a
branch drain into an egg-shaped sewer lift, high by
9ft. wide from about the middle of its height, produces
practically no effect upon the number of micro-organisms
in the sewer air.
It has been stated that the slimy skin, which is practi-
cally a thin layer of bacteria, and which lines the inner
walls of a sewer, cannot give off germs, as it cannot
get sufficiently dry owing to the moisture contained in
sewer air, the latter being always for its temperature
sufficiently saturated with aqueous vapour. This seems
to be supported by the experiments of Laws in London
and Ficker in Breslau. Laws made his experiments on
an experimental 9in. sewer of 80ft. in length, but, of
course, it might have been that the period allowed for
his observations was not long enough to form a skin of
the same thickness and consistency as is formed in
sewers which have been at work for 20 years and more-
At any rate he states :
SEWER GAS AND HEALTH. 53
"^^ It is really remarkable to find that no organisms
are given off from the walls of a sewer which has
been empty and open to the air at both ends for
such a lengthened period as 12 days. The sewage
with which the sewer had been kept full for several
periods of 24 hours would contain no less than
three to four million organisms per cubic centi-
metre, and immense numbers of these must of
necessity have been clinging to the walls of the
sewer. . . . The velocity of the air current
used in the above experiments was 5ft. and 15ft.
per second respectively, the latter being far in
excess of any current that would normally obtain
in a sewer."
Ficker remarks that in his experiments in the Hygienic
Institute at Breslau a current of air, with a velocity of
several metres per second, was not able to lift up specific
germs from half-moist soil, and that a current of the
same strength was not capable of carrying away germs
which had dried on several substances and adhered to
them.
Various experiments have been made with a view to
;ascertain how far germs can be carried away by
:air currents in pipes and sewers. Hesse, who first
investigated this point, took a 2in. glass tube about
one yard long, the inside of which he had covered
with a layer of nutritive gelatine, and sucked air
t-hrough it at a slow rate. When examining the tube
afterwards he found that a large number of bacteria
had settled in its first fourth, that that number
was somewhat less in the second fourth, that it
«till further decreased in the third fourth, and that
no bacteria at all had settled in the last fourth. In
these experiments, therefore, the bacteria were not even
54 SEWER GAS AND HEALTH.
carried the distance of one yard. But against any
conclusions drawn from these investigations might be^
urged that the tube employed was far too small tO'
provide for the proper passage of germs through it.
Similar experiments with similar results were made by
Carnelley and Haldane. As already stated, Laws reports
that former experiments have shown **that if the splash-
ing (in a sewer) is sufficiently violent to produce a very
fine state of division of the sewage, organisms will be
carried some distance, even 50 to 60 yards."
Ficker used for his experiments a 4in. tube, which
he placed upright, and at the bottom of which he
caused bubbles of a liquid highly charged with specific
germs to burst. Then, forcing air through it at the-
rate of 0*196in. per second, he found that the germs
had been carried as high as 23ft. into the air.
It cannot, however, be said that any of the experi-
ments mentioned in the last series afforded conclusive-
evidence against the possibility of germs remaining
suspended in air for some time and being carried away
by the currents.
It may not be out of place to summarise now the-
various results obtained.
1. It is held that all pathogenic germs which reach the
sewers in the faeces, urine, sputa^ in the water from
baths and lavatories, in the house refuse, in the rain-
water from streets, etc., meet with conditions there that
are not favourable to them, and prevent their propagation.
2. Amongst these unfavourable conditions is perhaps
the struggle for existence with the myriads of other
germs that crowd the sewage, and ending in the survival
of the fittest — the most unfavourable one. Hence the
life of pathogenic germs in sewage is of comparatively
short duration, and the death being a gradual one they
SEWER GAS AND HEALTH. 55
lose their virulence — i.e., their power of mischief — some
time before this event actually takes place.
3. It is further held that pathogenic germs, like other
germs, cannot rise from liquids and moist surfaces under
ordinary circumstances, and that although they may
become disseminated in sewer air through the bursting
of bubbles and through splashing, they cannot be
carried very far by the air currents, but, following the
law of gravitation, soon fall back into the sewage.
Hence it is not all likely that pathogenic germs are
carried about suspended in sewer air.
4. The experimental results then, so it is argued, go
to explain the cause of the comparative absence of germs
from sewer air, and confirm the conclusions drawn
from its examination.
5. Further, it is argued that the air is but seldom
the carrier of infectious germs.
Therefore concludes Kirchner (B-30, Appendix I.)
a passage in his paper on the injurious influence of
sewer gas, "we are entitled to say with a probability
bordering on certainty that presumably pathogenic
germs will never be found in sewer air."
But where the cause is absent — it is here assumed
that there can be no typhoid fever without the typhoid
bacillus — the effect will also be absent, hence sewer air
or sewer gas is not capable of producing typhoid fever.
Against these conclusions, however, it has been urged
by those who support the theory that sewer gas is
capable of propagating typhoid fever, that it is by
no means conclusively established that the bacillus
typhosus is the vera causa of typhoid or enteric fever ;
further, as has already been stated, that our methods
of investigation are still very imperfect and admit of
a great many errors, and, finally, that the chances of
56 SEWER GAS AND HEALTH.
finding the typhoid germ in such a vast labyrinth of
underground conduits as the London system of sewers
is, are practically nil.
Assuming for the sake of argument that the bacillus
typhosus is the true cause of typhoid fever, it must
not be thought that it is present in every litre of sewer
air, but being only an occasional and periodical
inhabitant of it, it will be found only in isolated
places. It is, therefore, a mere accident if the
experimenter happens to take his samples of air in a
locality where the typhoid germs are and just at the
time they are passing his place of observation in an
air current ; the next moment they might be wafted
away and beyond his reach. Further, in a large sewer
they might pass round his instruments, and so escape
him. It is clear therefore that their chances of not
being taken in isolated samples of sewer air are
innumerable, and the chances of catching them
extremely remote.
These or similar circumstances may account for the
fact that only one observer (Uffelmann) has up to the
present been able to discover the pathogenic germ of
suppuration in sewer air.
How very difficult it is to catch the typhoid germ
even in sewage is clear from the report of Messrs.
Laws and Andrewes. Although these experimenters
employed the greatest care, they were not able to find
this germ once in ordinary London sewage. They then
tried the drain that takes the sewage from the typhoid-
fever block of the Eastern Hospital at Homer ton at
a point inside the hospital grounds, and although this
sewage must have contained a vast number of typhoid
germs at the time, they were only able to find two:
colonies of it. Later on they tried the sewer which.
'&
SEWER GAS AND HEALTH. 57
takes the drainage of the hospital at a point about a
quarter of a mile below this institution, and did not
find a single colony of the bacillus typhosus. Therefore,
in spite of all their most painstaking investigations,
Messrs. Laws and Andrewes found only two colonies of
the typhoid germ in London sewage.
Further, it is by no means a new thing to attribute
an outbreak of cholera or typhoid fever to water without
having been able to discover the specific germs of these
diseases therein. For instance, the late severe cholera
epidemic at Hamburg in 1892 was traced to the water
supply although no cholera germs were found in it.
Likewise were two typhoid epidemics at Berlin in 1889
and 1893 attributed to the water without the bacillus
typhosus having been found therein. On the contrary,
there are only a few cases on record where this specific
germ has been found in water in connection with an
outbreak of typhoid fever, and it was considered a feat
worthy to be recorded when, at Berlin, where perhaps
the most elaborate and painstaking searches have been
and are still being made for this germ, it was found
for the first time in the public water supply by Loesener
on the 27th February, 1894. Therefore those who look
upon sewer air as capable of carrying the typhoid germ
are in no worse position than those that hold the
water responsible for some outbreaks of typhoid fever.
It will not be denied that arguments such as these
in favour of the sewer-gas theory cannot in the present
state of our knowledge be fully contradicted by those
who are opposed to it, but, looking at the whole case
and making all due allowances, it appears to the author
that the chances of typhoid fever being brought about
through the conveyance of the bacillus typhosus in
«ewer air are somewhat remote.
58 SEWER GAS AND HEALTH.
What then is the connection between sewer air and
typhoid fever ? This question the author will endeavour
to answer in the following paragraph.
SEWER GAS AND HEALTH. 59:
PART IV.
Experiments on Animals with Sewer Air.
CHAPTEK I.
BXPEEIMENTAL KeSEARCHES INTO THE CaUSAL EeLATIONS-
BETWEEN Sewer Air and Typhoid Fever.
(See also Appendix IV.)
As it had frequently been observed that domestic
animals which are exposed to typhoid infection in
almost the same degree as human beings never showed
symptoms of illness during or after a typhoid epidemic,
or even pathologic-anatomical changes, which could be
considered at all identical with those found in typhoid
fever, ^the opinion gained ground that the lower animals
do not suffer from typhoid fever in the sense in which
it is recognised in man. "When, therefore, the bacillus
typhosus was discovered, various experimenters at once
set to work with a view to ascertain whether it could
produce typhoid fever in the lower animals.
Gaffky, who was perhaps the first to carefully and
methodically investigate this matter, was not fortunate
in settling it, as all his numerous experiments on 5
monkeys, 1 calf, 16 rabbits, 13 guinea-pigs, 7 rats,
white and grey mice, pigeons, and fowls led in no
case to illness or even to changes which could
have been attributed without doubt to the infection.
Shortly after him, however, Fraenkel and Simmonds
were able to report that they had succeeded in pro-
ducing an acute fatal disease in guinea-pigs, grey house
•60 SEWER GAS AND HEALTH.
mice, and rabbits by injecting large quantities of the
typhoid bacillus (from 1 to 2 ccm. of broth culture and
more) into them. Since then numerous other observers
have been able to observe the same results after inoculating
animals with large doses of the bacillus typhosus, and
it can, therefore, no longer be doubted that this bacillus
<5an produce very acute illness and death in animals
provided the doses given are large enough ; in many
•cases death took place within from three to four hours
after the inoculation. But this disease — and here all
observers practically agree — is not of a specific nature,
and does not resemble in its clinical and anatomical
appearances those observed in typhoid fever in man ;
moreover, it can be brought about by the injection of
various other microbes.
In passing, it may not be out of place to quote here
what Stern says in reference to the action of the typhoid
bacillus upon animals :
*'We must imagine that the animals experimented
upon can withstand, if the injected quantities of
culture are below a certain standard, which latter
varies according to the virulence of the bacilli,
the amount of poisonous matter introduced at the
same time, and have still strength left to deal
successfully with the bacilli themselves. If, how-
ever, the injected quantities of culture are above
this standard, then the great amount of poisonous
matter tends on the one hand to reduce the power
of resistance of the body against the injected
bacilli, and on the other hand the greater number
of the latter will be able to break down all the
quicker the protective forces of the body which
oppose their growth. Then follows the secondary
Augmentation of the bacilli, which, of course, can
SEWER GAS AND HEALTH. 611
attribute very essentially, through the production
of more poisonous substances alone, to the fatal
issue."
What these protective forces of the body are, whether
they are the leucocytes of Metchnikoff or not, and why
the acute disease produced in the body of the animals-
through the injection of large quantities of typhoid-
bacilli is not of a specific nature and cannot be compared
with typhoid fever in man, are questions which are outside
the scope of this treatise. Suffice it to say that before
they are solved our investigations will have to be pushed
a great deal farther, so as to obtain full explanations
of a great number of other processes which at present
are still shrouded in mystery. For our purposes, there-
fore, it will be sufficient to bear in mind that under
ordinary circumstances small doses of the typhoid bacillus-
will not produce ill effects in animals, but that large
doses cause very acute disease and rapid death.
After this slight detour it will be necessary to return,
to our subject and consider some of the investigations
which have been made with a view to ascertain, through,
experiments on animals, the causal relations between,
sewer gas and typhoid fever.
Dr. Parkes reports in his " Manual of Practical
Hygiene" that Dr. H. Barker exposed three dogs and
one mouse to the influence of sewer gas. The animals
were put into a box and lowered down over a cesspit,,
so that they were forced to breathe the gases formed
through the decomposition of organic matters. The
mouse died on the fifth day, and all the dogs suffered
from vomiting, purging, and a febrile condition, which
Dr. Barker says " resembled the milder forms of continued,
fever common to the dirty and ill-ventilated homes of
the lower classes of the community." But the effects-
^62
SEWER GAS AND HEALTH.
required some time and much gas for their production.
Dr. Barker attributes the results, not to the organic
matter, but to the mixture of carbonic acid, hydrogen
sulphide, and ammonium sulphide, and specially to the
latter two.
The best and by far the most elaborate researches
into this question have been made in Italy in the
Hygienic Institute of the University of Eome, by Dr.
Alessi (see A-4 and D-2, Appendix I.), full particulars
of which are given in Appendix IV. Alessi experimented
in all on 408 animals, as is shown in the following
table :
Table III.— Particulars and Numbers of Animals Experimented on by
Dr. Alessi.
Treatment of Animals.
Rats.
Guinea-
pigs.
Rabbits.
Totals.
Putrid gases (^Xexto^edto ::
Special mixture/ Exposed to
of gases \ Not exposed to ...
Totals
49
41
48
34
Ill
79
8
6
19
13
179
133
56
40
172
204
32
408
The plan which he adopted in conducting his researches
was the following:
He exposed 49 rats, 111 guinea-pigs, and 19 rabbits
to putrid gases, including sewer gas, for a time, then
injected into them small doses of attenuated typhoid
bacilli and bacterium coli, carefully noted the results
of this operation, and after death made searching post-
mortem examinations. At the same time he kept as
a control of the foregoing experiments 41 rats, 79 guinea-
pigs, and 13 rabbits under ordinary conditions and
injected into them exactly the same doses of typhoid
bacilli as before, so as to have all the conditions
SEWER GAS AND HEALTH. 63
the same save the exposure to sewer gas. This formed
the first set of his experiments.
With a view to ascertain now whether the result of
his first set of observations was brought about by the
action of those chemical substances which are commonly
given out in the form of gas from putrid fermentations,
he started a second set of experiments. Taking in all
48 rats and 8 guinea pigs, he exposed them to such
substances as retilindol,* ammonia, sulphuretted hydrogen,
methyl sulphide, carbonic acid, carbonic oxide, and ammo-
nium sulphide, and after a time injected doses of typhoid
bacilli into them. As a control of the foregoing experi-
ments he injected the same doses of typhoid bacilli into
34 rats and 6 guinea pigs, which had been kept under
ordinary circumstances. These two sets of experiments
enabled him to arrive at certain final conclusions which
are given later on.
Concerning the doses of typhoid bacilli injected into
the various animals, it ought to be stated that they
were very small, amounting only to from 0*25 to
0*50 ccm. Other observers, in order to bring about
fatal results, had been obliged to use doses as large
as from 2 to 4 ccm., and above that; therefore, their
doses were from four to eight times larger than
Alessi's maximum dose.
Further, the cultures used by Alessi were far from
being virulent. Concerning his culture A he says : " its
virulence might be considered almost nil,^' and concern-
ing his culture B he states that *' it had a certain
virulence."
The exposure to putrid gases was made in the follow-
ing manner : The rats were put into a box with a wire
* Rebilindol (Scatol) is a strongjly smelling product of putrefaction of
albuminous substances, and is, therefore, easily found in the intestines.
64 SEWER GAS AND HEALTH.
bottom, which was so placed over an untrapped water-
closet that it closed its aperture. The rabbits and
guinea-pigs were likewise placed into a box with a wire
bottom, but the latter was placed over a vessel which
contained excrementitious substances.
In reference to the bacterium coli commune which
Alessi used for some of his inoculations, it might not
be out of place to state that it is now considered a
harmless inhabitant of the intestines. It is very much
like the typhoid bacillus, and has frequently been mis-
taken for this pathogenic germ ; some observers call
it bacillus coli communis. It is always found in faecal
matters, and consequently in sewage, hence its presence
in a liquid indicates contamination by sewage.
The experiments throughout were conducted with the
greatest care, and cannot fail to carry conviction to all
those who read them ; certainly Dr. Alessi appears to
have spared no pains to arrive at reliable conclusions.
The results obtained in the first set of experiments
are given in Tables I., II., III., and IV. of Appendix
IV., from which it is clear that from 75 to 100 per
cent, of all animals inoculated with small doses of
attenuated typhoid bacilli and bacterium coli after
exposure to sewer gas perished, whilst practically not
one of the animals which had been kept under normal
conditions succumbed to the inoculation. These figures
are highly significant, and speak for themselves.
It is not necessary here to dwell on the changes
brought about by the inoculation in the organs and
tissues of the animals as revealed in the post-mortem
examinations ; it will suffice to say that bacteriological
research was able to prove the almost exclusive presence
of large numbers of typhoid bacilli in the organs and
tissues in every case excepting those animals of course
SEWER GAS AND HEALTH. 65
into which the bacterium coli had been injected, where
this latter germ alone was found. In reference to this
point Alessi remarks : " By the distribution then of the
typhoid bacilli in the various tissues, and by the altera-
tions which they have caused in them, I am justified
in concluding that they have caused death in these
animals following upon the predispositions which the
latter had acquired by breathing putrid gases."
From these experiments it is clear that through the
exposure to putrid gases, including sewer gas, the animals
experimented on lost their natural immunity to small
doses of the typhoid bacillus, and acquired a pre-
disposition to the pathogenic action of this germ tO'
such an extent that they succumbed to small doses
of attenuated typhoid bacilli in periods ranging on an
average from 23 hours to 5 days and 3 hours. How
very great the influence was which the breathing of
putrid gases exercised on the animal organism is further
demonstrated by the fact that even the harmless
bacterium coli was capable of killing 83 per cent, of
the animals into the bodies of which it had been
injected.
The period in which this predisposition or great
susceptibility to the pathogenic action of the bacillus
typhosus was obtained by the animals varied on an
average from 3 days to 22 days, and was also different
for the different species, rats showing a greater
resistance than guinea - pigs, and guinea - pigs than
rabbits. Alessi remarks: "It appears that generally
the animals acquire the predisposition to infection more
easily during the first two weeks than after that time.
In fact, 90 per cent, of the animals inoculated in
the first two weeks died, and only 76 per cent, of those
inoculated in the following weeks. This fact may in a
5
66 SEWER GAS AND HEALTH.
certain degree explain how it is that some individuals
who habitually breath air from sewers or in whatever
way corrupted, end by becoming habituated to it, and
are no longer attacked by intestinal infections."
After having studied the predisposing action of
putrid gases taken in their entirety, Alessi set to work
to ascertain whether the chemical substances which
are commonly given out in the form of gas from putrid
fermentations can also exercise separately a similar
influence on the animal organism.
The number of animals and the various substances
used in these experiments have already been stated.
It will only be necessary to add here that both
the gases and the animals were placed inside a
bell glass, which was closed in such a manner as to
make change of air impossible. It is of course well
known that the substances employed are of a highly
poisonous nature to man and animal, and produce
very rapid deleterious effects. Alessi therefore only used
very small quantities, certainly smaller than the minimum
fatal dose.
The results of this second set of experiments are
given in Table V. of Appendiv IV., from which it follows
that out of a total number of 56 animals which had
breathed the various gases and gaseous mixtures only
three in all died, and, as Alessi remarks, these three
died from other causes, which it was impossible for
him to define. He therefore comes to the conclusion
that neither the gases taken separately nor in mixtures,
exercise a predisposing influence over the animal organism.
** For which reason," Alessi continues, " I may be allowed
to suppose that both the exhalations arising from faecal
matter and the exhalations arising from organic matter
in putrefaction, are not composed of simple mixtures,
SEWER GAS AND HEALTH. 67
but are much more complicated than might be believed.
And the predisposing cause might also have its seat in
those foetid substances of neutral character which it is
impossible either to understand or determine, whether
from their small quantity, the insufficiency of analytical
methods, or from the imperfection of those which we
already have. In any case, from my experiments can
be drawn this useful lesson that the above-mentioned
gases or vapours can be breathed in small doses without
their predisposing to typhoid infection."
The final conclusions at which Alessi arrived are the
following :
"1. The inspiration of putrid gases predisposes the
animals (rabbits, guinea-pigs, and rats) to the
pathogenic action of even attenuated typhoid
bacilli and of bacterium coli.
" 2. This predisposition is due to the combination of
gases given out by putrid fermentations, and not
to anyone separately; and
'* 3. It is probable that this experimental predisposition
is diminished by prolonged breathing of the said
It can, perhaps, not be surprising that those who con-
sider sewer gas comparatively harmless have endeavoured
to find fault not only with the conclusions derived from
Alessi's experiments, but also with the way in which
they have been carried out. According to them these
researches cannot be applied to human beings, as in the
first instance these will never be exposed to such strong
doses of sewer gas as were applied by Alessi to his
animals. Those whose good or bad fortune it has ever
been to have to examine the ramifications of house
drains that have been laid more than 20 years ago
will know from their own experience whether this
68 SEWER GAS AND HEALTH.
objection is true or not; at any rate, so far as the-
author is concerned, he has met with cases in whicb
the escape of sewer gas was in every way as bad as
in these experiments, and where the doses inhaled,
cannot have been much less. But even granted that
in the generality of cases, though the amount of
sewer gas escaping through faulty places or untrapped
water - closets, etc., may be as great as in Alessi's
researches, the exposure to these gases is not as con-
tinuous as in them, this will only make a difference as
to the time in which this predisposition is acquired,
not to the predisposition itself. At any rate Alessi's
experiments show very clearly what a powerful influence
putrid gases, including sewer gas, can exert upon the
animal organism under unfavourable circumstances ; and
who shall say in so important a matter as health what
the dose is an individual may inhale without detriment,
and for what length of time ! Social hygiene has too
often and too painfully shown that some constitutions
are quickly affected by sewer gas, whereas others are
more slowly but none the less surely conquered by it.
In the author's opinion, therefore, this first objection to
Alessi's experiments springs from an under-estimation.
of the real condition of things.
Further, it has been urged that the fatal disease
produced by Alessi in his animals does not correspond
to typhoid fever in man, and that therefore it is wrong
to conclude from the predisposition to this disease in
animals a predisposition to typhoid fever in man.
through the breathing of sewer gas. Let us see
whether or no this objection carries more weight than,
the former.
The author has shown that rodents and all lower
animals are immune to small doses of the typhoid.
SEWER GAS AND HEALTH. 69
1)acillus. He has further shown that in Alessi's experi-
ments the animals after inhaling putrid gases for a
greater or less time lost this immunity, and became
so susceptible to the action of the typhoid bacillus
and even the harmless bacterium coli that small doses
of attenuated typhoid bacilli and of bacterium coli were
•capable to set up rapidly fatal disease. He has finally
mentioned that in the organs and tissues of the dead
animals only the bacillus typhosus and in one experi-
ment the bacterium coli was found, so that there
<}annot be a doubt but that these germs caused the
•death of the animals. This being so it matters not for
the purposes of this treatise whether or no the patho-
genic action of the typhoid bacillus is the same in
animals as in human beings, the only point of import-
a^nce being the fact that the breathing of sewer gas
did render the animals more susceptible, or in other
words, predisposed them, to the pathogenic action of
"this germ. Therefore, if from experiments on animals
we may form opinions as to the effects on human
-beings — and this will hardly be denied — we are entitled
to conclude that the breathing of sewer gas will
predispose human beings as well to the pathogenic
action of the bacillus typhosus. Hence, in the author's
opinion this second objection cannot be maintained.
Alessi^s experiments then offer an explanation of the
causal connection between sewer gas and typhoid fever,
a connection which, though foreseen epidemiologically by
:Some observers, had been disputed by others, and which
social hygiene has practically and painfully confirmed
in many instances.
SEWER GAS AND HEALTH.
PART V.
Conclusions as to the Influence of Sewer Gas upon Healths
CHAPTEE I.
Influence of Sewer Gas upon Health.
Conclusions from the foregoing Chapters.
It will now be necessary to summarise shortly the^
influence which sewer gas exerts upon health.
It has been shown in the foregoing remarks that,
broadly speaking, sewer gas is able to cause instantaneous
death through asphyxia, and to predispose the constitution
to the action of the typhoid bacillus. Therefore, although-
such a classification is not entirely correct, we may for
convenience of reference distinguish between a direct
and indirect action of sewer gas upon health.
Concerning the direct action, it is highly probable that
this is • brought about through such gases as carbonic
oxide, carbonic acid, and sulphuretted hydrogen acting
either in combination or separately, as they are known
to be highly poisonous substances. If the quantity of
sewer gas inhaled contains large doses of these gases,.
then the severe form of mephitic poisoning will be the
result — viz., instantaneous death through asphyxia ; if,
on the contrary, these gases are only present in small
quantities, then the mild form of mephitic poisoning will
take place, which, if the exposure to sewer gas is continued
for some time, will lead to derangements in the digestive
and nutritive organs. This direct action has, therefore^
sometimes been called the mephitic action of sewer gas^
SEWER GAS AND HEALTH. 71
The cause of the indirect action of sewer gas is still
shrouded in mystery, as we do not know the nature
of the poison which renders the constitution susceptible
to the pathogenic action of the typhoid bacillus.
Whether it be the combination of gases given off by
putrifying organic matters, or whether it be a mixture
of some of them, or whether it be one of them only
which has been called organic vapour, or whether this
cause has its seat in those fetid substances of neutral
character which it is impossible at the present time
either to understand or determine, we are powerless
in the present state of our knowledge to ascertain.
But, nevertheless, the fact remains that this pre-
disposition exists, and must not be overlooked, as has
been done by those who, for want of being able to
specify the cause, have disputed the effect. This indirect
action has by some been called the predisposing action.
We have therefore the direct or mephitic action and
the indirect or predisposing action of sewer gas, and
though these definitions are, strictly speaking, not quite
correct, they admit at any rate of an easy reference.
Whether or no it will eventually be found that they
both spring from one and the same cause is a matter
of mere speculation at the present time, and therefore
outside the sphere of practical consideration.
Concerning the direct infective action of sewer
gas, the author has already pointed out that,
in his opinion, the chances of typhoid fever being
brought about through the conveyance of the bacillus
typhosus in sewer air are somewhat remote, and for
this reason he has not taken any note of it in the
previous remarks.
Up to the present time the point whether the pre-
disposing action of sewer gas extends to other zymotic
72 SEWER GAS AND HEALTH.
diseases as well has, so far as the author is aware,
not been investigated experimentally, but if such a
predisposition should be proved eventually it would
afford an easy explanation for the connection which has
been observed by various observers to exist between
sewer gas and such diseases as diarrhcea, cholera,
erysipelas, puerperal fever, etc.
It has frequently been stated that if sewer gas was
capable of exercising a predisposing influence to typhoid
infection, this influence ought to make itself strongly
felt on sewage farms, where the sewage is spread over
large tracts of land, but as the latter was not the case,
sewer gas could not possess the power of rendering the
system susceptible to the action of the bacillus typhosus.
In the author's opinion such a conclusion is not correct,
as the reason of this fortunate state of things is to be
found in the nature of the predisposing poison, and not
in its absence from sewer air. If this poison were an
organised one, or if sewer air did carry a large
number of typhoid germs, then one might expect that
an epidemic in town would be followed by an outbreak
on the sewage farm, but as the predisposing poison does
not appear to be an organised one (probably a chemical
one) it becomes diluted with air to such an extent on
the farm that it loses its powers of mischief. Hence
this objection cannot be maintained.
In passing, the author would like to remark that the
•experience of all well - conducted sewage farms goes to
show that they do not act injuriously to the public
health, and that, for instance, the epidemic of typhoid
fever which visited the city of Berlin in 1889 was not
followed by an outbreak on the very large sewage farms.
Against the predisposing action of sewer gas has
further been advanced that sewermen do not suffer to
SEWER GAS AND HEALTH. 73
:any extent from typhoid fever, but are practically
immune to it. The author has already pointed out that
the statistical material available for the consideration of
this question is very meagre, and requires care in using.
But even granted that such is the case, it does not
appear to militate against the theory of predisposition,
for Alessi's experiments make it probable that with a
prolonged exposure to sewer gas the predisposition
becomes diminished. Hence the experience with sewer-
men appears to show that it is possible to become
immune to the predisposing influence of sewer gas, but
not that sewer gas has no such predisposing influence.
It is greatly to be regretted that this subject has not
been more fully and systematically investigated, as it
would be of considerable interest to ascertain what
are the conditions and particulars under which this
immunity is obtained.
Concerning the cases of septic poisoning through
sewer gas which have been mentioned by the author
(see also Appendix VIII.) , it is difficult to offer any
explanation, as we know too little about them. In the
case quoted by Dr. Hill from Sutton Coldfield it
appears that the poison was an organised one, and
it is possible that it was carried in sewer air.
Before concluding this treatise the author thinks it
might not be out of place to draw attention to one or
two further points of interest which, in his opinion,
bear intimately on the connection between sewer gas
.and health.
74 SEWER GAS AND HEALTH.
PART VI
Allied Subjects.
CHAPTER I.
Difference between Waterworks and Sewerage Works-
IN their Influence upon the Public Health.
(See also Appendix X.)
If, as has been stated, there is no connection between
putrid gases and typhoid fever, then it would undoubtedly
be correct to assume that the carrying out of sanitary
improvements, which aim at the prevention of the
formation of these gases and their exclusion from our
houses, such as a systematic sewerage of a town,
combined with a rational house drainage, would not
affect the mortality from typhoid fever. But that
such a conclusion is opposed to the universally observed
facts will be known to all those who have given this
matter some consideration however small.
Ever since the memorable and classical report of the
late Sir George Buchanan in 1866 on the influence of
sanitary works upon the health of towns, in which this
original and skilled investigator for the first time drew
public attention to the fact that in a large number of
English towns the typhoid mortality had considerably
decreased since the carrying out of water and sewerage
works, this lowering of the typhoid rates, coincident
with, and consequent on, the introduction of a syste-
matic water supply and sewerage, has been but
universally observed not only in this country, but
SEWER GAS AND HEALTH. 75"
practically in all other countries, so that we have now
come to look upon it almost in the light of an axiom.
How far this reduction in . the typhoid rates is due
to the execution of works for the supply of good water
and how far to the carrying out of proper sewerage
works had been decided by Buchanan in favour of
sewerage works, and from his and further careful
investigations by Continental observers it may safely
be concluded that sewerage works contribute to it in a
more prominent degree than waterworks.
Besides the researches of Soyka (B-55, Appendix 1.)
it may not be out of place to mention here the
investigations by P. Baron (B-2, Appendix I.) in 1886.
After selecting for his purposes 10 towns which in his
opinion were comparatively free from objections, and
after examining the statistical material in reference-
to them. Baron states : *' We are therefore not entitled
to attribute the reduction of the typhoid mortality in the
10 towns above enumerated to the introduction of the
water supply."
Very striking is the difference in this respect between.
the water supply and drainage works in the case o£
Berlin, of which full particulars are given in Appendix X..
It appears that the waterworks were opened in 1856,,
and the operations for the sewerage of the city com-
menced in 1875, or 19 years later. In Table I. and
Diagram I. of Appendix X. can be studied the movement
of the typhoid-fever rates since 1854, and from these it is
clear that, whereas these rates very gradually declined in
the first 19 years since the introduction of a public water
supply, they take a very remarkable leap downwards from
the year 1875, in which the sewerage of the city was-
started. The same downward movement since the year
1875 may be observed in Diagram II., which deals with
76 SEWER GAS AND HEALTH.
the general death-rates of Berlin, although, as was to be
•expected, it is not so marked in this case.
Therefore, in the case of Berlin, the introduction of
a public water supply has not been accompanied by
the same beneficial results to the public health as
the commencement of the sewerage works, which has
been followed by a most marked improvement in the
death-rates.
It is, of course, not contended here that to this state
of things only the sewerage works of a town have con-
tributed— far from it, as undoubtedly a great many other
factors have helped to lower the death-rates ; but what
is maintained is this, that so far as we can judge from
the death-rates, especially from those of typhoid fever,
sewerage works have had as a rule a more decided
influence upon their reduction than waterworks.
After having thus settled the question of the reduction
of the typhoid rates in favour of sewerage works,
Baron goes on to mention several towns, such as
Berlin, Dantzig, and Hamburg, where the introduction of
Si systematic sewerage has been followed by a great
reduction in the typhoid mortality, and finally compares
the typhoid rates for nine years in 46 towns with good
-drainage, with those in 37 towns without drainage.
His conclusions are as follows :
1. The heaviest typhoid mortality occurred in towns
without drainage ;
2. Average rates occurred more frequently in non-
sewered than in sewered towns ; and
3. The lowest typhoid rates were by far more frequently
observed in sewered towns.
Baron then further sub-divides the towns into those
with the highest and those with the lowest typhoid rates
Sbud finds :
SE\\^R GAS AND HEALTH. 7T
4. Out of 70 towns with the highest yearly rates, 51,
or 73 per cent., were not sewered ; and
5. Out of 51 towns with the lowest yearly rates, 36,.
or 70 per cent., were sewered.
Summarising all his results, Baron concludes : The-
lowest yearly typhoid rates occurred in 36, or 78 per
cent., of the 46 sewered towns, and only in 15, or 40 per
cent., of the 37 towns without sewerage.
Hueppe (B-27, Appendix I.), who investigated the same
subject, came to similar conclusions as Baron.
The foregoing facts then can only be interpreted as-
follows : Towns with a systematic sewerage have as a.
rule lower typhoid rates than towns which are not
sewered at all ; and, further, the systematic sewerage of
a town is generally accompanied by a corresponding,
reduction of the typhoid rates.
This being so, it may well be asked in what manner
does the carrying out of drainage works beneficially
influence the public health ?
This question, in the author's opinion, admits in the-
main of but one answer — viz., by preventing the
systematic pollution of the air under our houses-
and in their vicinity through decaying organic waste
matters. No doubt this answer could be extended
by including such factors as the permanent lowering,
of the subsoil water, etc., but for our purposes such a
course need not be adopted.
In the days of cesspits, vaults, middens, privy middens,,
pails, large uncovered ashpits, etc., the air in the vicinity
of our houses was methodically polluted through putrid
gases rising from the stored-up putrefying organic waste
matters; hence people were forced to inhale continually
strong doses of these gases, and became more or less pre-
disposed to the action of the typhoid germ, which thenu
5 SEWER GAS AND HEALTH.
found the ground already prepared for its destructive
work. This state of things was, however, altered with
the introduction of a systematic sewerage, the main aim
•of which is to carry away from our houses as quickly
and as completely as possible such organic waste matters
as excreta and all refuse waters, which are always
more or less charged with organic matter, The systematic
pollution of the air through putrid gases being thus
prevented, a reduction of the typhoid rates followed as
the natural consequence.
As an instance of the gradual decline in the typhoid
rates coincident with, and consequent upon, the carrying
out of various sanitary improvements aiming at the
prevention of the formation of putrid gases and their
exclusion from our houses, might be mentioned the
town of Munich. From the particulars given in item 2
of Appendix X. the reduction of the typhoid rate can
be traced step by step coincident with the carrying out
of various sanitary improvements, with this result, that,
whereas it stood at 24*20 per 10,000 inhabitants in the
period 1852-59, it had gone down to 1*75 in the years
1881-1885. It will not be disputed that this is a very
marked and large decrease.
These facts then, which are derived from daily
observation and common experience, go to show that
there exists in nature, as apart from experimental
results, a connection between putrid gases and typhoid
fever, and they further show that the conditions pre-
vailing in the conservancy methods are more favourable
to this disease than those brought about by the water-
carriage system, which is an undoubted improvement in
this respect.
Those observers therefore who dispute the connection
between putrid gases, including sewer gas, and typhoid
SEWER GAS AND HEALTH. 79
fever, either overlook the facts just enumerated altogether,
or endeavour to explain them away in a manner that
cannot inspire great confidence.
But perhaps the most remarkable statement has lately
been made by an opponent who, after mentioning the
conclusions at which Baron arrived and admitting their
correctness, goes on to say that if there was a connection
between sewer gas and typhoid fever such a state of
things could not exist, as then with the introduction of
a sewerage scheme typhoid fever would increase instead
of decrease. It will hardly be necessary to deal seriously
with such a statement, as it springs (firstly) from a gross
exaggeration of this influence, and (secondly) from a sad
want of knowledge of the state of things previous to the
introduction of the water-carriage principle and of this
principle itself.
80 SEWER GAS AND HEALTH.
CHAPTER II.
The Dilution of Sewer Gas and its Escape in the
Centre of Roads and Streets.
(See also Appendix XII.
It may not be out of place to make here a few remarks
concerning the dilution of sewer gas, as the question of
noxious smells from manhole covers has considerably
agitated the public mind and has caused sanitary com-
mittees in various towns to adopt such measures as the
closing of the open street ventilators, the ultimate
sanitary effects of which are to say the least very
doubtful.
Without entering into details concerning the ventilation
of the sewers, it has been stated that if we wish to reduce
the injurious effect of sewer gas upon health we must
take care that it is absolutely excluded from the interior
of our houses, and that at those places where it is
allowed to escape it becomes at once diluted with large
volumes of fresh air, if indeed it is not already diluted
within the sewers themselves. This appears to be a
wise rule, and is certainly based on general experience
and universally observed facts; for sewer gas, like other
poisonous gases, loses its injurious effect upon health in
the ratio of its dilution with fresh air.
Acting upon this principle, the gases forming in our
sewers were prevented from passing into private house
drains through a disconnecting trap, and allowed up to
now to escape through the open manhole and lamphole
covers in the crown of streets and roads. However,
owing, no doubt, to the complaints in the public Press
and elsewhere about noxious smells from these covers,
SEWER GAS AND HEALTH. 81
a movement has lately set in to close the open street
ventilators and replace them wherever possible by venti-
lating pipes up the sides of houses.
So far as the author is aware, no attempt has yet been
made to prove that such a change is beneficial to the
public health, and as it is, of course, of the greatest
importance to know whether this is so or not, it may
not be out of place to put here on record the observations
made in Leicester, as they are perhaps somewhat unique.
For this purpose the author has compiled Appendix XII.,
where full particulars concerning these points are given*.
On reference to it, it will be seen that, so far as the
ventilation of the Leicester public sewers is concerned,
three periods may be distinguished — viz. :
1. The period before the year 1881, when the sewers
were very foul and not ventilated ;
2. The period from 1881 to 1886, in which a great
length of the old sewers was cleaned out and
ventilated by open covers at street level ; and
8. The period since 1886, in which practically two-
thirds of the open covers at street level were
closed, about 300 ventilating shafts erected, and
the old main sewers replaced by larger and better
constructed ones.
If we now compare the typhoid rates in these three
periods as shown in Table I. and Diagrams I. and 11.
we find that the average rate for the second period
was practically only half that of the first period, but
that this decline was not continued in the third period,,
the average rate for it being, on the contrary, somewhat
higher again than that of the second period. The same
upward movement in the third period can be observed
in the diagram showing the number of typhoid certifi-
cates received.
6
82 SEWER GAS AND HEALTH.
This rise in the typhoid death-rates since 1886, the
year in which the closing of the open street covers was
commenced, is all the more remarkable, as since that
year the new main sewers (their cost, including pumping
station and sewage farm, amounted up to 31 st March,
1895, to nearly £330,000) and a large number of other
sanitary improvements have been carried out in Leicester,
not to mention the general advance in the knowledge
and treatment of infectious diseases ; and if we look
for an explanation of this remarkable fact, the thought
suggests itself that probably sewer air had something
to do with it.
In the first period undoubtedly sewer air or sewer
gas would find its way into the interior of the houses;
in the second period it escaped largely through the
open covers at street level, hence the numerous com-
plaints; and in the third period it is possible that with
the closing of these open covers, sewer air gradually
found its way back again into the interior of the houses.
In connection herewith it is interesting to observe that
the medical officer of health, as has previously been
stated, reports that in 1893, out of all typhoid-infected
houses, 31*25 per cent, had defective drains, as shown
through the smoke test, and that in 1894 this percentage
had increased to 45*18. In passing, it might be remarked
that the smoke test is not altogether reliable in cases
of underground leakage.
The author is of course perfectly well aware that a
variety of causes are at work in the propagation of
infectious disease, and that the three periods under
review are not very long ones ; but whatever our opinions
may be on this point, the fact remains that, in spite of
a large expenditure on sanitary works, the typhoid rate
has not decreased since the commencement of the closing
SEWER GAS AND HEALTH. 83
of the open covers at street level, but has, on the
contrary, slightly increased, and this fact alone is, he
thinks, of sufficient importance to be noted down very
carefully by all those who give these questions their
.anxious consideration.
b
84 SEWER GAS AND HEALTH.
CHAPTEK III.
Concluding Eemarks.
When the history of the sanitary progress during the-
present century, which is now fast sinking into its
grave, comes to be written, a very important place will
have to be assigned to what has been termed the sewer-
gas theory, as it has exerted a most powerful influence
for good in the matter of house and general sanitation ;.
indeed, it has been stated that the results which the
conviction that sewer air or sewer gas is dangerous to
health has brought about surpass in brightness, excel-
lence, and importance the results achieved by any
other sanitary doctrine.
If we enquire into the causes which were capable of
producing such weighty effects, we shall probably find
that they are largely due to the very great interest
the general public has taken in this question, as is
evidenced by the controversy to which it gave rise in
the public Press and elsewhere. That during the same
the most divergent opinions should have been expressed
cannot be surprising.
On the one hand, it was asserted that the influence
which sewer gas exerts on health was practically un-
limited and almost mysterious, and, on the other hand,,
sewer gas was said to be practically harmless. In the
author's opinion the truth lies probably in the middle
between these extremes, and whilst considering the
chances of sewer air acting directly infective, or in
other words, of sewer air, per se, producing typhoid fever
somewhat remote, he is clearly of opinion that apart
from its direct or mephitic action, which is admitted-
SEWER GAS AND HEALTH. 85
Ijj everyone, sewer air or sewer gas (synonymous terms)
has the power of predisposing the constitution to typhoid
(and probably also to other) infection, so that if the
typhoid bacillus is introduced into the system in some
way or other after exposure to sewer gas, it finds there
a favourable soil for committing its ravages. How
/large the dose of sewer gas must be before this pre-
disposing influence is felt depends probably on a variety
of circumstances, which in the present state of our
knowledge we have no means of ascertaining correctly.
If, in his endeavour to survey the whole question,
the author appears to have been too detailed in some
places, he hopes he may be excused, as the subject is
a most important one, and it was his wish to give the
fullest information possible concerning it.
It is greatly to be regretted that we are not yet able
to assign for every specific effect a specific cause, and
there is good reason to fear that it may yet be a long
while before this ideal state is reached; but this must
not prevent us in matters of public and private health
to carefully obey those preventive rules and laws which
we have been able up to the present time, even though
it were but imperfectly, to discern.
We probably only stand to-day on the threshold of the
knowledge of health and disease, of life and death, and
before us lies a vast tract of unknown land which has
only been explored on its circumference, but into which
no solitary traveller has yet penetrated. Therefore it
behoves all those who interest themselves with matters
of public and private health, always to fully bear in mind
-that health is the greatest blessing we enjoy, and that
when once it has escaped our grasp it may probably
snever return to it. Hence it is far better to prevent an
illness than to cure a disease.
86 SEWER GAS AND HEALTH.
What the protective forces within our system are,,
whether or no they are represented by the leucocytes,,
we do not know, but the aim and end of every true
sanitation must be to carefully nurse, build up, and
strengthen them and then protect them from injury, so-
that they stand us in good stead in the hour of our
greatest need, when we are assailed by swarms of hostile
germs, and gain a splendid victory in the life and death,
struggle that then ensues.
This then is the direction in which true sanitation
must proceed, and if the author has succeeded in shedding
further light upon this goal and the way that leads ta-
it, all his labours will have been well repaid.
SEWER GAS AND HEALTH. — APPENDIX I. 87
APPENDIX I.
A. English Liteeature.
A-L— Abbott, A. G., "The Effects of the Gaseous
Products of Decomposition upon the Health
and Resistance to Infection of Certain Animals
that are forced to respire them." Transactions
of American Physicians, 1895.
A-2. — Acland, " Reports on Fevers in Agricultural
Districts."
A.3.— Airy, ''Enteric Fever at York." 1884.
A-4. — Alessi, G., '' On Putrid Gases as Predisposing^
Causes of Typhoid Infection." Translated from
the Italian. Journal of the Sanitary Institute,
Vol. XVI., 1895, page 487.
A-5.— "Army Medical Report for 1861," page 486.
A-6.— Barker, T. H., " Malaria and Miasmata." 1863.
A-7. — Berkart, J. B., British Medical Journal, 25th
November, 1893.
A-8.— Billings, J. S., " Ventilation and Heating." 1893,
Page 99.
A-9.— Blaxall, "Enteric Fever at Melton Mowbray."
Report M.O.L.G.B. 1881.
A-10.— Blaxall, "Enteric Fever at Sherborne, 1873."
Report M.O.P.C. and L.G.B., No. 2. 1874.
A-11.— Blaxall, "Enteric Fever at Sherborne, 1882."^
Report M.O.L.G.B. 1882.
A-12.—Blyth, A. Wynter, " Manual of Public Health.'^
Recent publication.
A-13. — Buchanan, Sir G. "Epidemic of Enteric Fever
at Worthing, 1865." Ninth report, M.O.P.C.
A-14. — Buchanan, Sir G., " Influence of Sanitary Works
upon Health of Towns." Ninth report,.
M.O.P.C, 1866. London, 1867.
A-15. — Buchanan, Sir G., "Enteric Fever at Caius-
College, Cambridge, 1874." Report, M.O.P.C.
and L.G.B., No. 2. 1874.
88 SEWER (JAS AND HEALTH. — APPENDIX I.
A- 16. — Buchanan, Sir G., " Epidemic of Enteric Fever
at Croydon in 1875." Appendix to Keport,
M.O.P.C. and L.G.B. New Series, No. VII.
1876.
A-16A. — Burton, Ashby and Coalville Guardian^ 14th
November, 1896. " Explosion in a New Sewer
at Burton-on-Trent."
A-17. — Budd, '' Observations on Typhoid or Intestinal
Fever — the ' Pythogenic ' Theory." British
Medical Journal, 1861.
A-17a. — Cameron, J. Spottiswoode, " On the Dissemi-
nation of Typhoid Fever." Surveyor, 29th
October, 1897.
A-17b. — Cameron, J. Spottiswoode, " Drain Testing :
Some Facts Eevealed by Testing the Drains of
1,121 Houses in Leeds." Journal Sanitary
Institute, Vol. XVIII. 1897.
A-18. — Christison, E., "A Treatise on Poisons."
A-19.— Clark, F. W., '' Keport on the Ventilation and
Flushing of Sewers." June, 1894.
A-20. — Clinton, A., " Keport to Chief Inspector of the
New York Health Department." Kecent report.
A-20a. — " Coal-Gas Poisoning." Papers by J. Haldane,
J. K. Davison, A. Scott, S. Lockie, J. L. Smith,
and T. W. Parry. British Medical Journal,
3rd October, 1896.
A-21.— CoUins, J., '' The Necessity for Efficient Ventila-
tion of Sewers." Tra7isactions of the Sanitary
Institute of Great Britain, Vol. VI., page 259.
1884-85.
A-21a. — Contract Journal, 12th August, 26th August,
and 7th October, 1896. " Important Case of
Poisoning through Sewer Gas at Birmingham."
A-22. — Corfield and Parkes, '' Treatment and Utilisation
of Sewage." Kecent publication.
A-22a. — Corfield, W. H., '' Disease and Defective House
Sanitation." London, 1896. H. K. Lewis.
A-23. — Davies, S., "Ventilation of Sewers." Sanitary
Engineer, 14th September, 1894.
A-24.— Dodd, J., '' Sewer Gas and its Effects." 1879.
SEWER GAS AND HEALTH. — APPENDIX I. 89
A-25, — " East Ham Sewer Fatality." Stratford Express,
6th, 13th, and 20th July, and Times, 8th August,
1895.
A-25A. — Fanning, F. W. Burton, " Sewer-Air Poisoning."
Lancet, 24th October, 1896.
A-26. — Fenton, Public Health, August, 1895.
A-27. — Fergus, G., "The Sewage Question with reference
to Traps and Pipes." Glasgow, 1874.
A-28.— Frankland, Sir E., " The Transport of Solid and
Liquid Particles in Sewer Gases." Proceedings
of the Eoyal Society, April, 1877.
A-29. — Guy, Journal of the Statistical Society, 1848.
A-30.— Haldane, J. S., "The Air of Buildings and
Sewers." Vol. IX., Transactions of the Sanitary
Institute of Great Britain, 1887. See also
Transactions, Eoyal Society, Vol. 178 (1887) B
and Proceedings of the Eoyal Society for 12th
June, 1887, on "The Pathology of Coal-Gas
Poisoning." Laiicet, 3rd October, 1896.
A-30a. — Hargreaves, J., " Sewage and Zymotic Poisons."
Industries and Iron, 6th March, 1896.
A-31.— " Health of Town's Eeport," Vol. I. Old publica-
tion.
A-32. — Herring, E., Eeport on the Eesults of an
Examination made in 1880 of several Sewerage
Works in Europe. Appendix IV. to Annual
Eeport of the National Board of Health, 1881.
Contains on page 200 an elaborate Index to the
Literature on Sewerage Works, etc.
A-33. — Hill, Bostock, " The Possible Dangers of Certain
Methods of Ventilating Sewers." Public
Health, August, 1895.
A-34.— Hun, H., Medical News, 20th August, 1887.
A-35. — International Congress of Hygiene and Demo-
graphy, Vol. VII., page 45. London, 1891.
A-36. — Jacobi, A., " The Production of Diseases
by Sewer Air." Sanitary Engineer, 28th
September, 1894.
A-37.— Latham, B., " Sanitary Engineering," 1878.
90 SEWER GAS AND HEALTH. — APPENDIX I.
A-88. — Laws, J. Parry, Keports on Sewer-Air Investiga-
tions. London County Council, No. 1'26. 1893.
A-39. — Laws, J. Parry, and Andrewes, F. W. Eeport
on the Result of Investigations on the Micro-
organisms of Sewage. Parts I. and II., London
County Council, No. 21(3. 1894.
A-40. — Letheby. Various Eeports. Old publications.
A-40a. — Manchester Guardian, 28rd September, 1896.
" Death of a Man in a Sewer near Manchester."
A-41.-McClellan, ** The Sewer Gases Question." New
York, 1890.
A-42. — Meade, T. de Courcy, '' Fatal Accident in London
Sewers." Vol. XX. Incorporated Association of
Municipal and County Engineers, page 190.
k.A^,— Medical Times, February, 1861. " Death of Four
Labourers in the City of London Sewers."
KA^.— Medical Times, July, 1861. ''Explosion in the
City of London Sewers."
A-45.— Murchison, " A Treatise on the Continued Fevers-
of Great Britain." London, 1862.
A-46. — ''Observations on Typhoid or Intestinal Fever —
the Pythogenic Theory." British Medical
Journal, 1861.
A-47. — Paget, C. E. : Some Lectures by Sir George Paget.
Eecent publication.
A-48.— Page, Army Medical Report. Vol. XV.
A-49.— Parkes, Louis C, " Hygiene and Public Health."
Eecent publication.
A-50. — Parkes, E. A., " A Manual of Practical Hygiene."
Eecent publication.
A-51.— Eafter, G. W., and Baker, M. N., " Sewage Dis-
posal in the United States." 1894.
A-52. — Eead, E., " Gloucester Sewers and their Ventila-
tion." 1884.
A-52A.— Eoechling, H. Alfred, " Bacteria and their
Importance in the Household of Nature."
Leicester, 1896.
A-52B.— EoechHng, H. Alfred, "Life in Sewers.'*'
Leicester, 1897.
SEWER GAS AND HEALTH.— APPENDIX I. 91
A-52c. — Eoechling, H. Alfred, " Dissemination of
Typhoid Fever." Surveyor, 15th October, 1897.
A-52D.— Eoechling, H. Alfred, ''A Case of Typhoid
Fever in a House with Faulty Drainage ; with
Plan of Premises." Journal Sanitary Institute,
Vol. XVIII. 1897.
A-53. — Eoscoe, Sir H., and Lund, Transactions of the
Eoyal Society. 1892.
A-54. — Eowan, Thomas, " Disease and Putrescent Air
and the Ventilation of Sewers."
A-55. — Eussell, Hon. Eollo, *' Epidemics, Plagues, and
Fevers." Eecent publication.
A-56. — Sharp, Gordon, and Summerskill, W., Lancet,
9th December, 1893.
A-57. — Smith, J. McGarvie, " Air in the Sewers of
Sydney." Sixth Annual Eeport of the Metro-
politan Board of Water Supply and Sewerage,
1893, page 32.
A-57A. — Smith and others versus the King's Norton-
Urban District Council. Contract Journal, 12th'
August, 1896.
A-58.— Stevens, F. J. H., *' Health of Sewer Men."
'' Deutsche Vierteljahrschrift flir oeffentliche
Gesundheitspflege," Vol. XXVII., page 404.
1895.
A-59. — Stevenson and Murphy, '' Hygiene and Public
Health," Vol. II., page 333. 1894.
A-60.— Style, Mark, Lancet, 19th October, 1889.
A-61.— Sykes, John F. J., ''Public Health Problems."
Eecent publication.
A-62.— Sykes, John F. J., '' Outbreak of Enteric Fever
at the Foundling Hospital." 1891.
A-63.— Thackrah, '' The Effects of Arts, Trades, and
Professions on Health." 1832.
A-63a. — Tichborne, E. C, "On the Dissemination of
Micro-organisms and the Best Methods of
Destroying Germ Emanations from Sewer
Gas." Journal of State Medicine, August, 1897.
A-64. — Transactions of the Epidemiological Society.
'92 SEWER GAS AND HEALTH. — APPENDIX I.
A-65. — " Treatise on the Continued Fevers of Great
Britain." London, 1862.
A-65A. — *'Tvnemouth Gasworks Accident." Shields
Daily News, 21st and 23rd January and
4th February, 1896.
A-66.— Wallace, Army Medical Keport, Vol. XVII.
A-67. — Whitelegge, B. Arthur, '* Hygiene and Public
Health." Kecent publication.
A-67A. — Widnes Sewer Accident. Bwicorn Guardian,
29th January and 8th February, 1896.
A-68.— Woodhead, W. C, '' The Dangers of Sewer
Gas in our Dwellings."
B. German Literature.
B-1. — "Andelfingen, die Epidemie." In ''Deutsches
Archiv fiir klinische Medicin," Bd. III., 1867,
page 223.
B-2. — Baron, P., " Einfluss von Wasserleitungen und
Tiefcanalisationen auf die Typhusfrequenz
in deutschen Stadten." " Centralblatt fiir
allgemeine Gesundheitspflege," V., page 335,
1886.
B-3. — Baumeister, E., in " Handbuch der Baukunde."
Abth. III., Heft 3, page 284. 1890.
B-4. — " Berichte ueber die Verhandlungen und Arbeiten
fiir Wasserversorgung Canalisation und Abfuhr
in Miinchen." 1880.
B-5. — Betz, " Jahresberichte von Virchow und Hirsch,"
1868, page 302.
B-6.--Biefel und Poleck, '* Zeitschrift fiir Biologie,"
XVI., 3, page 279.
B-7. — Blumenstock, " Vierteljahrschrift fiir gerichtliche
Medizin,'' N. F. XVIII., page 295.
B-8. — Bockendahl, J., "General Berichte ueber das
oeffentliche Gesundheitswesen der Provinz
Schleswig-Holstein.
B-9. — Brix, in " Bekiimpfung der Infectionskrankheiten
von Behring." " Hygienischer Theil," page
309. 1894.
SEWER GAS AND HEALTH. — APPENDIX I 93-
B-10. — Buesing, F. W., in '' Handbuch der Hygiene/'
von Weyl, 2ter Band, Iste Abtheilung, page
229. 1895.
B-11. — Caspar, " Handbuch der gerichtlichen Medizin,"
II., page 598.
B-12. — ''Deutsches Archiv fiir klinische Medicin," Band
IX." 1872.
B-L3.— ''Deutsche Bauzeitung," 27 Februar, 1895. " Ex-
plosion of Sewer Gas in a Cesspit at Mayence."
B-14. — Dunbar, W. P., Typhus in " Ergebnisse der
allgemeinen Pathologie und pathologischen
Anatomie des Menschen und der Thiere." Con-
tains a complete index of 206 numbers to the
literature on typhoid fever. 1896.
B-15. — Dunbar, W. P., Cholera in the same book as
above. Contains a complete index of 282 num-
bers to the literature on cholera. 1896.
B-16. — Emminghaus, " Memorabilien," XIV., Lief 1.
1869.
B-17. — Erisman, F., " Gesundheitslehre fiir Gebildete
aller Stande Miinchen," 1885, page 110.
B-18. — Erisman, F., *' Ventilation der Siele, Canalgase."
In " Handbuch der Hygiene und Gewerbe-
krankheiten." von Pettenkofer und Ziemssen.
Leipzig, 1882.
B-19. — Eulenberg, " Vierteljahrschrift fiir gerichtliche
Medicin." N. F. XXV., page 209.
B-19a. — Ficker, " Schadlichkeit der Canalgase." Referat
von M. Kirchner und W. H. Lindley, " Deutsche
Vierteljahrschrift fiir oeffentliche Gesundheits-
pflege." Band XXVIII-1. 1896.
B-20. — Finkelnburg, *' Vierteljahrschrift fiir gericht-
liche Medizin," N. F. XX., page 301.
B-21. — Fraenkel, E., *' Zur Lehrevon der Aetiologie der
Complicationen im Abdominal Typhus." ** Jahr-
biicher der Hamburgischen Staats Kranken-
anstalten." 1890.
B-22. — Fruehling, A., in "Handbuch der Ingenieur-
Wissenchaften." Leipzig, 1893. III. Band,.
Iste Abtheilung, 2te Halfte, page 462.
94 SEWER GAS AND HEALTH. — APPENDIX I.
B.23.— Goepel, H., "Ein Fall von Typhus in Frankfurt-
an-der-Oder." ** Deutsche Vierteljahrschrift fiir
oeffentliche Gesundheitspflege, Vol. XXVIII.-l.
1896.
B-24. — Hankel, Ernst, *' Ein Todesfall durch Einathmen
von Cloakengas." '* Vierteljahrschrift fiir
gerichtliche Medizin und oeffentliches Sanitiits-
wesen. 1895.
B-24a. — Heunner, M., *' Experiment elle Studien iiber
die Wirkung faulender Stoffe auf den thier-
ischen Organismus." Munchen, 1866, pages 82,
87, and 88.
B-25. — Hesse, " Quantitative Bestimmung der in der Luft
enthaltenen Mikro - organismen." Mittheil-
ungen aus dem Kaiserlichen Gesundheitsamt.
1884.
B-26. — Hesse, " Bemerkungen zur quantitativen Bestim-
mung der Mikro-organismen der Luft." " Zeit-
schrift fiir Hygiene." 1886, IV.
B-27. — Hiippe, " Journal fiir Gas beleuchtung." 1887.
B.28.— Karlinski, " Fortschritte der Medicin," n. 18.
1889.
B-29. — Kaufmann and Kosenthal, " Archiv fiir Anatomie
und Physiologie," 1865, page 659.
B.30._Kirchner, M., and Lindley, W. H., " Schad-
lickeith der Canalgase und Sicherung unsrer
Wohnraume gegen dieselben." Heft I., Band
XXVIII., "Deutsche Vierteljahrschrift fiir
oeffentliche Gesundheitspflege." 1896.
B-31. — Kohler, " Handbuch der speciellen Therapie.'*
B-32.— Kruegkula, " Wiener Med. Wochenschrift," 1877,
page 1,068.
g.33. — Lebert, " Handbuch der praktischen Medicin."
B-34.— Lehmann, " Archiv fiir Hygiene," XIV., Heft II.
g,35. — Liernur, C. T., "Archiv fiir rationelle Stadteent-
wasserung," V. Heft, page 307. 1887.
B-36. — Lissauer, " Ueber das Eindringen von Canalgasen
in die Wohnraume." " Vierteljarschrift fiir
oeffentliche Gesundheitspflege," 13ter Band.
1881.
SEWER GAS AND HEALTH.— APPENDIX I. 95
B-37.--Mori, " Ueber pathogene Bakterien im Carial-
wasser." " Zeitschrift fiir Hygiene," 4 Band.
B-38. — Naegeli, "Uebergang von Spaltpilzen in die
Luft." Centralblatt fiir die medizinischen
Wissenschaften." 1882.
B-S9. — Naegeli, " Die niederen Pilze," page 108.
Miinchen, 1877.
B-39A.— Panum, '' Virchow's Archiv," Bd. XV., Hefte 5
und 6, page 441.
B-40. — Pettenkofer, Max v., " Vortraege ueber Canalisa-
tion und Abfuhr. Miinchen," 1876.
B-41. — Pettenkofer, "Die Choleraepidemie des Jahres,
1865, in Gibraltar." " Zeitschrift fur Bioiogie."
Band VI., page 95.
B-42.— Port, "Zeitschrift fiir Bioiogie." Band XI.,
page 487.
B-43. — Prausnitz, W., " Der Gesundheitszustand der
Miinchener Canalarbeiter." " Archiv fiir
Hygiene." Kecent publication.
B-44. — " Keinigung und Entwasserung Berlins." Berlin,
1870.
B-45. — " Keinigung und Entwasserung der Stadt
Heidelberg." Heidelberg, 1870.
B-46.— Kenk, Fr., " Die Canalgase." Muncben. 1882.
B-47. — Seuss, A., " Officielle Berichte von Staats und
Stadtbehorden ueber das Liernur'sche Canal-
isationssystem, 1877 Wiirzburg," page 75.
B-48. — Koechling, H. A. " Technische Einrichtungen fiir
Wasserversorgung und Canalisation in Wohn-
hausern." Heft 1, Band XXVII. "Deutsche
Vierteljahrschrift fur oeffentliche Gesundheits-
pflege." 1894.
B-49. — Eoechling, H. A., " Schadlichkeit der Canalgase
uud Sicherung unserer Wohnraume gegen
dieselben." Heft 1, Band XXVIII. " Deutsche
Vierteljahrschrift fiir oeffentliche Gesundheits-
pflege." 1895.
B-50. — Koechling, H. A., " Tonnen u. Spiilaborte in
ihrem Verb alt en zu Typhus abdominalis."
" Gesundheitsingenieur." 15th September, 1895.
96 SEWER GAS AND HEALTH.— APPENDIX I,
B-51. — Eozsahegyi, ** Ueber die Luftbewegung inj den-
Miinchener Sielen.'* *' Zeitschrift fiir Biologie,"
Bd. XXV., 1881, page 23.
B-51a. — Schmidt, C, '' Charakteristik der epidemischen-
Cholera."
B-52. — Senator, ** Berhner klinische Wochenschrift,"
1872, page 254.
B-53. — Siegfried, *' Viertelsjahrschrift fiir gerichtUche
Medizin," N. F. XXI., page 338.
B-54. — Spiess, A., ** Repertorium der in deutschen
und auslandischen Zeitschriften erschienenen
Aufstiize ueber oeffentHche Gesundheitspflege,'^
see each volume of the '' Deutsche Vierteljahr-
schrift fiir oeffentliche Gesundheitspflege."
B-55. — Soyka, Rozsahegyi, and Renk, " Ueber Canalgase
als Verbreiter epidemischer Krankheiten."
** Vierteljahrschrift fiir oeffentliche Gesund-
heitspflege," 14 Band. 1881.
B-56. — Soyka, J., *' Untersuchungen zur Canalisation."
1885.
B-57. — Soyka, J., " Zeitschrift fiir Biologic," Heft 3,
Band XVII.
B-58. — Soyka, J., "Kritik der gegen die Schwemm-
canalisation erhobenen Einwande, Miinchen.'*"
1880.
B-58A. — Thiersch, " Infections Versuche an Thieren
mit dem Inhalte des Cholera Darmes."
Miinchen. 1856.
B-59. — Thierling, " Ueber Vergiftung durch Cloakengas
Breslau." 1879.
B-60. — Uffelmann, J., " Wiener medicinische Presse."
1893. No. 47.
B-61. — Uffelmann, J., " Berliner klinische Wochen-^
schrift." 1893. No. 26.
B-62.— Uffelmann, J., ''Archiv fiir Hygiene," VoL
VIII., page 338.
B-63. — Varrentrapp, " Deutsche Vierteljahrschrift fiir
oeffentHche Gesundheitspflege," XII., page
558. 1880.
SEWER GAS AND HEALTH. — APPENDIX I. 97
B-64. — Virchow, " Generalbericht, page 163. Canalisa-
tion und Abfuhr." Berlin. 1872.
B-65. Virchow, " Gesammelte Abhandlungen aus dem
Gebiet der oelfentlichen Medicin und der
Seuchenlehre," Band 2, page 285.
B-66. — Welz, A., "Typhus auf der Veste Marienberg."
" Aerztliches Intelligenzblatt," 1878, page 61.
B-67. — Wernich, " Die Luft als Tragerin entwicke-
lungsfiihiger Keime." " Virchow^s Archiv,"
Band LXIX., page 424.
B-68. — Weyl, Th., "Die Einwirkung Hygieni&cher
Werke auf die Gesundheit der Stadte mit
besonderer Kiicksicht auf Berlin." 1893.
B-69. — Winterhalter, L., " Zur Canalisation von
Miinchen." 1880.
C. Fkench Liteeatuee.
C-1. — Bechmann, G., " Service de Tassainissement de
Paris en 1893."
C-2. — Chevalier, " Asphyxie double par le vidange d'une
fosse d'aisance." " Annal. d'hyg.," 1875, II.,
Ser XLIII., page 430.
C-3. — Gaultier de Claubry, " Annal. d'hygiene et de Med."
Leg. II., 82.
C-3a. — Levy, " Traite d'hygiene." Tome I., page 636.
C-3b. — Magendie, " Kemarques sur la notice precedente,
avec quelques experiences sur les effets des
substances en putrefaction." Journ. de
Physiologie, etc., January, 1823, tome III.
•C-4. — Miquel, "Etude generale sur les bacteries de
I'atmosphere." " Annuaire de Montsouris,"
1881, page 40.
•C-5. — Miquel, "Les organismes vivants de I'atmo-
sphere." Paris, 1883.
>C-6. — Miquel, "Etude sur les poussieres organiques
de I'atmosphere." "Compt rend. hebd. de
I'academie des sciences," 1878.
7
98 sewi<:r gas and health.— appendix i.
C-7. — Miquel, ** Septieme memoire sur les organismes
microscopiques de I'air et del'eau." " Annuaires
de Montsouris," 1885.
C-8.— Nitter, " Soc. Medic, des Hopitaux," 6th March,
1891.
C-9.— Parent-Duchatelet, *' Hygiene publique," 1836.
C-10. — Poincarre, " Etude sur les circumstances qui
peuvent faire varier la richesse des egouts en
microbes." "Kevue d'hygiene," 1889.
C-11. — Kapports et Avis de la Commission de I'assainisse-
ment de Paris instituee par M. le Ministre de
I'Agriculture et du Commerce. Paris, 1881,
page 88.
C-12.— *' Eevue d'hygiene," 1881, page 648.
C-13.— Sanarello, " Annales de Flnstitut Pasteur," 1892,.
page 721.
0-14.— Vedi, " Journal d'hygiene," 1881, page 10. " La
revue d'hygiene," 1882, pages 12, 316, 428.
C-15. — Vidal, *' Annales de I'lnstitut Pasteur," 1892, page
755.
C-16.— Vincent, " Soc. Med. des Hopitaux," 13th Novem-
ber, 1891, and " Annales de I'lnstitut Pasteur,"
1893, page 141.
C-17. — Zuber, " Des gaz d'egout et de leur influence
sur la sante publique." " Kevue d'hygiene,"
1881.
C-18. — Zuber, *' De I'influence pathogenique des gaz
d'egout." "Eevue d'hygiene," 1882.
D. LiTEEATUEE OF OtHEE LANGUAGES.
D-1. — Agro, " Annali dell' Istituto d'Igiene di Koma,"
1893, page 477.
D-2.— Alessi, G., " Sui Gas Putridi." '' Annali deir
Istituto d'Igiene sperimentale della E. Universita
di Eoma." Vol. IV., Fasc. 1. See also the
translation of this treatise in the Journal of
the Sanitary Institute, Vol. XVI- (A-4 of this^
list).
SEWER GAS AND HEALTH. — APPENDIX I. 9^
Summary of Literature referred to :
84 English works,
papers, etc,
74 German ,,
ii >t
20 French
If a
2 Itahan „
a a
180 works, etc., in all.
100
SEWER QAS AND HEALTH. — APPENDIX II.
APPENDIX II.
Table I. — Composition of Sewer Air.
Gases in 10,000 Volumes
oxidise
tter in
f Air.
Micro-
i
of Air.
organisms
(per litre).
^
2i:.
^^
s
Author.
Locality of
Sewer.
■
c
<
"o
B
s
'Z
3
S
<
•id
6
.2 .
Is
IS"
si
■a M
Quo
c
o
>>
X
o
o
03
1
1
i
&
1
Claubry
(G. de)
Paris, choked ...
201
299
1379
8121
2
jj
„ old, 1829..
340
125
3
1 >
)| •!
19
230
81
4
Levy and
Miquel
„ 1891-93....
4-8
1-2
3-63
5
Letheby
London, 1857-58.
53-2
i'^
traces
1951
7996
6
Miller
„ 1867....
18
10-6
ciean and well-ventilated sewer.
7
6
30-7
tide-locked and ill-ventilated sewer.
8
Russel
Paddington
51
2070
7880
9
R. Nichols
Boston, January
31
8-65
10
a
„ Feb. ...
44
8-16
11
,, March...
47
11-53
12
,,
., April ...
12
10-75
13
if
June....
8
27-52
14
„ July
8
21-92
15
»»
August .
8
23-95
16
Beetz
Munich, soil-
pipes to cesspits
6
42-37
•0004
traces
17
,,
Munich, sewers..
8
31-4
2-2
18
Haldane
Dundee, West-
minster, and
Bristol
32
7-5
7-2
8-9
19
"
Bristol, Clifton
outlet
2
20-2
20
20
1 1
,, second outlet
2
11-6
8-5
21
Smith
Sydney
20
225
22
cremating- shaft
(before gas)
4
30
23
))
,, (after gas)
2
25
24
Laws
London, normal.
8
8-95
5-04
106
610
25
1 1
,, splashing...
3
12-87
2-04
1-15
3-19
26
„ disinfectmg
8
9-88
0-10
0-65
0-75
27
Pimlico (vent) ...
5
16-36
0-60
1-59
2-15
28
»»
E xperimental
small sewer
9
1 90
1-46
3 -.36
29
) )
Stagnant sewer. .
6
11-24
3-46
1-59
5 05
30
t>
Fulham-road ...
3
69-28
0-10
1-15
125
31
«)
,1 1 J • • •
1
93-10
32
f Average
\ atmo
composition of )
spheric air /
300
2090
7910
15
SEWER GAS AND HEALTH. — APPENDIX II. 101
Table II.— Sewer Gases (W. H. Collins).
Gages Dissolved in Raw Sewage.
The Results are stated in C.C. per Litre. Averages 100 Samples.
No.
Carbon
Dioxide.
Carbu-
retted
Nitrogen.
Sulphu-
retted
Oxygen.
Ammonia.
Hydrogen.
Hydrogen.
1
2-69
5-01
16-2
0-60
1-21
0-004
2
11-04
3-27
19-4
1-37
3-06
0-006
3
7-32
1-56
15-8
4-02
2-51
0-006
4
4-06
6-72
17-9
2-49
1-04
0-004
5
17-49
2-04
20-6
3-06
3-23
0-004
Table III. — Analysis of Mephitic Vapours (W. H. Collins).
From Disused and Unventilated Cellar Dwellings.
Results are stated in Volumes per cent.
No.
Oxygen.
Carbon
Dioxide.
Ammonia.
Ammonia
Albu-
menised.
Sulphu-
retted
Hydro-
gen.
Nitro-
gen.
Marsh
Gas.
1
2
3
4
I
20-83
20-85
20-73
20-71
20-65
20-62
0-58
0-64
0-59
0-49
0-92
0-95
0-086
0-088
0-084
0-087
0-085
0-084
0-142
0-139
0-144
0-153
0-136
0-146
0-26
1-02
0-56
0-64
0-72
1-13
0-313
0-206
0-564
0-606
0-217
0-393
See also A-21, Appendix I., for Tables II. and III.
102 SEWER GAS AND HEALTH. — APPENDIX III.
APPENDIX III.
Micro-organisms in Sewer Air. — Experimental Kesults.
1. Micro-organisms in the Air of the Paris Sewers (see
also page 26 of C-1 and also C-4, 5, 6, and 7,
App. L).
Analyses of the air in the Paris sewers are regularly
made by Messrs. Albert Levy and Dr. Miquel, who have
charge of the municipal observatory of Montsouris. For
this purpose an observing station has been established
in the intercepting sewer " Sebastopol," not far from the
point where it crosses under the rue Eambuteau, which
is provided with the necessary instruments.
These examinations, which were commenced in 1891
and have since been regularly continued, have so far
given the following results. The air of the Paris sewers
contains on an average a little more carbonic acid than
street air, from three to four times as much ammoniacal
nitrogen, but only half the number of germs. The.
actual figures are as follows:
Sewer Air. Street Air.
Carbonic acid .... 4'8 3*0 in 10,000 vols, of air.
Ammoniacal nitrogen ... 1*2 0*3 „ ,,
Bacteria 3*630 6760 per litre.
It might not be uninteresting to mention here that
there exists in the sewers of Paris another observing
station, which has been established since 1893, in the
intercepting sewer '* Kivoli," and where the temperature,
the humidity of the air, the evaporation, and the tem-
perature of the sewage are recorded. These observations
have led to the following results :
SEWER GAS AND HEALTH. — APPENDIX III. 103
a. The variations of the temperature of the air and
sewage are less perceptible in the sewers than in
outside air ; and
h. The humidity in the sewers is great, and practi-
cally constant-
's. Micro-organisms in the Air of the Berlin Sewers
(see also page 159 of B-30, App. I.).
Petri found that the air of the Berlin sewers con-
tained only a very small number of micro-organisms.
3. Uffelma7in's Observations (see also page 159 of B-30,
App. I., and B-60, 61, and 62 of App. I.).
Uffelmann examined the air in house drains and
public sewers, and reports that in house drains he
could not find more than from 0 to 0*5 germs in one
litter. He endeavoured to classify the various micro-
organisms found, and distinguished the following kinds :
hacillus subtilis, bacillus butyricus, bacillus proteus
vulgaris, bacillus candicans, bacillus liquefaciens viridis
lacteus, and staphylococcus pyogenes aureus. The latter
germ produces suppuration, and is a pathogenic micro-
organism. It is important to bear this in mind (see
ipage 159 of B-30, App. I.).
4. Micro-organisms iji the Sydney Sewers (see also
page 32 of A-57, App. I.).
Smith examined the air of the Sydney sewers, and
found on an average of 20 determinations 225 germs
per litre, comprising bacilli, micrococci, torulse, sarcinae,
streptococci, and mould fungi, some colonies liquefying
gelatine. He distinguished the following kinds: bacillus
fluorescens, micrococcus rosaceus, yellow bacterium,
yellow sarcina, mycoides, orange sarcina, micrococcus
/cinnabareus, pink torula. The maximum number of
104 SEWER GAS AND HEALTH. — APPENDIX III.
germs found in 1 litre of sewer air was 2,260, and the
minimum 7.
Concerning the slimy skin frequently found in badly-
ventilated sewers. Smith remarks :
*'As noted in diary, cultivations from the slime on
the top and sides of sewer proved in every case
to be a compact mass of micro-organisms. When
recently flushed there was less slime, and when
dry the roof was in places covered with mould,
fungi."
See page 32 of A- 57, App. I.
5. Carnelley and Haldane's Observations (see also'
page 12 of A-30, App. I.).
Haldane and Carnelley experimented on the sewers of
Dundee, Westminster, and Bristol, and the conclusions
they arrived at may be summarised as follows :
a. The number of germs in sewer air is on an*
average very small. It amounted on an average
of all experiments to only 8*9 germs per litre.
h. Sewer air is, as far as germs are concerned, purer
than outside air. The latter contained on anj
average 15 '9 germs per litre.
c. The bursting of bubbles in a sewer will disseminate-
germs. Sir Edward Frankland arrived at the
same conclusion from his experiments on bubbles -
bursting in a lithia solution (A-28).
d. With an increase in carbonic acid, the number of
germs decreases.
This, expressed in other words, means that the-
fouler the sewer, the less is the number of germs..
e. As the draught in a sewer decreases, so alsO'
decreases the number of germs.
SEWER GAS AND HEALTH. — APPENDIX III. 10^'
/, A decrease in the number of micro-organisms in
fresh air is followed by a decrease of micro-
organisms in the < sewer air.
g. The germs in sewer air are as a rule derived
from the outside air, and not from those con-
tained in sewage.
Their experiments on the air of the Bristol sewers
are particularly interesting, as these sewers are not
ventilated at all and only accessible in two places, but,
generally speaking, the results obtained are in keeping,
with those obtained at Dundee and Westminster. As
far as I know, no attempt was made to classify and
distinguish the different micro-organisms found.
6. Laics and Andrewes' Experiments for the London
County Council (see also A-38 and 39, App. I.).
Perhaps the most recent, and, so far as the English
language is concerned, the most careful and elaborate
experiments on sewer air were made for the London
County Council by J. Parry Laws, his first report being
dated May, 1892, and his second 7th December, 1893.
After these two reports had appeared, the London
County Council further instructed him to make, in
conjunction with F. W. Andrewes, investigations into
the micro-organisms of sewage. Their joint report,
which is dated 13th December, 1894, is divided into
two parts : the first dealing with the micro-organisms
of sewage and their relation to those in sewer air, and
the second with the bacillus of typhoid fewer and its
relation to sewage.
As these experiments have been freely discussed in
scientific papers and periodicals and have given rise to-
many expressions of opinions, some of which cannot be
said to be in any way derived from them, I will deal
106 SEWER GAS AND HEALTH.— APPENDIX III.
with them here more fully, and consider the conclusions
at which Messrs. Laws and Andrewes have arrived.
In his first report on sewer air, Mr. P. Laws arrives
.at the following results:
a. Sewer air contains a smaller number of bacteria
than outside air, but from two to ten times as
much carbonic acid. No sulphuretted hydrogen
was found.
6. " The micro-organisms in the sewer air are related
to the micro-organisms in the air outside, and
not to the micro-organisms of the sewage."
c. "In the air both within and without the sewer,
the forms of micro-organisms present are almost
exclusively moulds and micrococci ; on the contrary,
the micro-organisms of sewage are for the most
part bacilli. Of the latter sometimes as many
as 25 per cent, very rapidly liquefy the gelatine
on which they grow, whereas in the whole course
of my experiments with fresh air and sewer air
I only met with one colony, and that a micro-
coccus rapidly liquefying gelatine."
>d. "Moderate splashing carried out so as to imitate
the inflow of a lateral drain or house sewer
produces no variation in the sewer air even
within such a short radius as 4ft. from the
disturbance."
s. The mixing of deodorants with sewage or their
distribution in sewer air produces no effect on
the latter ''beyond the removal of, in most cases,
the disagreeable smell. In some instances, how-
ever, the deodorants when added to the sewage
had a marked effect upon the sewage itself,
reducing very considerably the number of bacteria
present." Of all the chemicals experimented on
SEWER GAS AND HEALTH.— APPENDIX III. 107
with a view to ascertaining their deodorising
powers, manganate of soda and sulphuric acid
and carbolic acid were the most efficient; and
setting aside the question of relative cost, the
former is decidedly preferable for the reason
stated above.
From his second report on sewer air, Mr. Laws
draws the following conclusions:
/. A considerable increase in the velocity of the
current in a sewer does not produce a concomitant
increase in the number of micro-organisms.
g. The conditions in large sewers, so far as the
micro-organisms in sewer air are concerned,
appear to be the same as in small sewers, in
which the sewage is intermittent and the velocity
of the air current variable.
h. Stagnant and highly putrescent sewage has no
influence upon the number of micro-organisms in
sewer air.
^. The results of further investigations strengthen the
conclusion arrived at from previous experiments
(see conclusion h above), that the micro-organisms
in the sewer air are related to the micro-organ-
isms in the air outside, and not to the micro-
organisms of the sewage.
Mr. Laws has gone to the trouble to classify some of
the germs found in fresh air and sewer air, and his
results are given in the following statement :
A. — Micro-organisms in Fresh Air.
1. Micrococci.
Sarcina lutea.
Micrococcus aurantiacus.
Micrococcus candicans.
108 SEWER GAS AND HEALTH. — APPENDIX III.
Diplococcus citreus conglomeratus.
Diplococcus roseus.
Sarcina rosea.
Pediococcus acidi lactici.
Micrococcus acidi lactici.
Micrococcus flavus desidens.
Diplococcus flavus liquefaciens tardus,
2. Moulds,
Pencillium glaucum.
Aspergillus glaucus.
Aspergillus albus.
Aspergillus repens.
Aspergillus nigrescens.
Aspergillus nidulans.
Brown mould.
3. Bacilli,
Bacillus subtilis.
Bacillus fluorsecens liquefaciens.
Bacillus ochraceus.
Bacillus mesentericus fuscus.
Bacillus arbore^cens.
4. TorulcB.
Pink torula.
Black torula.
White torula.
5. Cladothrices.
Cladothrix dichotoma.
Cladothrix rubra.
B. — Micro-organisms in Sewer Air,
1. Micrococci.
Sarcina lutea.
Sarcina aurantiaca.
Micrococcus candicans.
b
SEWER GAS AND HEALTH. — APPENDIX III. 109
Diplococcus citreus conglomeratus.
Pediococcus cerevisiae.
Staphylococcus cereus albus.
Micrococcus cremoides.
Staphylococcus cereus flavus.
•2. Moulds.
Pencillium glaucum.
Aspergillus glaucus.
Aspergillus albus.
Aspergillus repens.
Aspergillus nigrescens.
Aspergillus nidulans.
Brown mould.
3. Bacilli.
Bacillus subtilis.
Bacillus aureus.
Bacillus arborescens.
Bacillus acidi lactici.
Bacillus helvolus.
Bacillus nigrescens.
4. TorulcB.
None.
5. Cladothrices.
Cladothrix dichotoma.
The second report concludes as follows :
** Although one is led almost irresistibly to the con-
clusion that the organisms found in sewer air
probably do not constitute any source of danger,
it is impossible to ignore the evidence, though it
be only circumstantial, that sewer air in some
instances has had some causal relation to
zymotic disease. It is quite conceivable, though
at present no evidence is forthcoming, that the
danger of sewer air causing disease is an indirect
110 sewi:r gas and health. — appendix hi.
one ; it may contain some highly poisonous
chemical substance — possibly of an alkaloidal
nature — which, though present in but minute
quantities, may nevertheless produce, in con-
junction with the large excess of carbonic acid,
a profound effect upon the general vitality."
In the first portion of the third, or joint report,
Messrs. Laws and Andrewes deal with the micro-
organisms contained in the sewage itself, with a view
to comparing them with those in sewer air, and thus
to elucidate this subject still further. It will not be
necessary, however, to follow them into the details ; it
will suffice to say that they found on an average from
about one million to five million colonies in 1 ccm.
of sewage, of which they were able to classify
only a very small number, given in the following
statement :
Bacteria Found in London Sewage.
1. Moulds (only 0*4 per cent, of the colonies examined
were moulds).
Pencillium glaucum.
A mould of a dark-brown colour and identical with
the species found in sewer air.
2. TorulcB.
A white torula allied to common yeast (S. cerevisias)*
A pink torula liquefying gelatine.
8. Micrococci.
Small streptococcus, in large numbers.
Micrococcus ochroleucus.
Micrococcus luteus.
Micrococcus flavus liquefaciens.
Micrococcus aurora.
A citron-coloured micrococcus.
\
SEWER GAS AND HEALTH.— APPENDIX III. Ill
Pediococcus albus (doubtful).
Sarcina colonies of yellow colour, amongst them
being :
Sarcina flava, in large numbers.
Sarcina aurantiaca.
Staphylococcus cereus albus.
Staphylococcus pyogenes citreus, in large numbers.
Staphylococcus pyogenes aureus, pathogenic.
A yellow staphylococcus.
Diplococcus albicans tardissimus, in large numbers.
Diplococcus roseus.
4. Bacilli.
Bacillus coli communis, in large numbers.
A bacillus -very much like the bac. coli communis,
in large numbers.
Bacillus typhosus (twice), pathogenic.
Bacillus fluorescens liquefaciens, in large numbers.
Bacillus fluorescens stercoralis, in large numbers.
Bacillus mesentericus ruber.
Bacillus aureus.
Bacillus janthinus, a brilliant violet species.
Bacillus albus putidus, in large numbers.
Bacillus subflavus (doubtful).
Bacillus fluorescens aureus (doubtful).
Bacillus mycoides, in large numbers.
Bacillus cloacae fluorescens, in large numbers.
A dark-orange brown bacillus.
A bacillus resembling bacillus aquatilis sulcatus.-
A bacillus resembling diphtheria bacillus.
Proteus Zenkeri, in large number.
Proteus cloacinus, in large numbers.
5. Gladothrices.
Cladothrix dichotoma.
For convenience of reference, I will give here the list
112 SEWER GAS AND HEALTH. — APPENDIX III.
•of bacteria found by Jordan in the Lawrence sewage
•(see report of the Massachusetts State Board of Health,
1890, page 821) :
Bacillus ubiquitus.
Bacillus circulans.
Bacillus cyanogenus.
Bacillus superficialis.
Bacillus reticularis.
Bacillus rubescens.
Bacillus hyalinus.
Bacillus cloacae.
Bacillus delicatulus.
Bacillus violaceus laurentius.
Proteus Zenkeri.
Bacillus janthinus.
Messrs. Laws and Andrewes then contrast the micro-
organisms which they found in the air of some of the
London sewers with those found by them in the metro-
politan sewage, and call attention to the following main
points of difference :
A. Moulds.
Whereas moulds abound in sewer air, they are prac-
tically absent from sewage. In sewer air 64*33 per cent,
of the total colonies found were moulds ; in sewage, on
the contrary, only 0*4 per cent, of all the colonies
examined were moulds, the actual number found being
seven, of which only one colony was allied to the
common species existing in sewer air.
B. Micrococci and Bacilli.
The bacterial flora of sewer air consists mainly of
micrococci, bacilli forming but a small proportion of the
itotal species found. In sewage, on the contrary, bacilli
SEWER GAS AND HEALTH. — APPENDIX III. 113
preponderate over micrococci probably in actual numbers,
certainly in the number of species present.
C, Bacillus Coli Communis.
Although bacillus coli communis (from 20,000 to
"200,000 germs per cubic centimetre) and its allied species
abound in sewage, they were never found in sewer air.
B, SarcincB.
Although enormous numbers of sarcina — in one case
over 300,000 germs per cubic centimetre — were found in
sewage, not one single colony of Sarcina lutea, so
common in sewer air and fresh air, was ever discovered
in it.
E. — Bacteria Liquefying G-elatine.
In sewer air, organisms rapidly liquefying gelatine
were found to be practically absent, whereas in sewage
these kinds of bacteria form so large a proportion as
to make gelatine an impossible medium to employ in
estimating their numbers.
F. — The Number of Micro-organisms in Sewer Air is
Dependent on the Number of Micro-organisms in
Fresh Air.
*' The number of micro-organisms existing in sewer
air appears to be entirely dependent upon the number
of micro-organisms existing in the fresh air at the
same time and in the same vicinity. With the advance
of the colder weather, and consequent rapid decrease
in the number of micro-organisms in fresh air, we find
:a corresponding decrease in the number of the micro-
organisms of sewer air, although the temperature of
the sewer air and sewage suffers but a comparatively
slight variation."
8
114 SEWER GAS AND HEALTH. — APPENDIX III.
The concluding sentences of Part I. are as follows :
*'If the organisms existing in sewer air were derived'
from those existing in sewage, then the flora of sewer
air should bear a very close resemblance to the flora
of sewage. When, however, we compare the organisms
which have hitherto been isolated from sewer air with
those species which we have found to be predominant
in sewage, it is at once evident that they bear no
resemblance whatever to one another — indeed, we may
go even further, and state that, so far as we are aware,
not a single colony of any of those species which we
have found predominant in sewage has been isolated
from sewer air. We consider, therefore, that the study
of the sewage bacteria on which we have been engaged
fully confirms the conclusion previously arrived at from
the study of the micro-organisms of sewer air — viz.,
that there is no relationship between the organisms of
sewer air and sewage."
"It is possible that some of the ill - effects which
have been erroneously ascribed to sewer air may be due
to subsoil air derived from soil polluted by constant
infiltration of excremental matter through a leaky drain.
It is a well-recognised fact that subsoil air does at
times gain access to our dwellings, either through the
pressure of the wind on the surface of the ground or
from currents induced by wide differences between the
exterior and interior temperatures. Under such con-
ditions it is possible that sewage may gradually
extend through a permeable soil until its outer margin
becomes sufficiently dry to give off micro-organisms to
the subsoil air. Whatever the danger arising from this
cause may be, it would in all probability be strictly
limited in its effect."
Part II. of the third or joint report is devoted to an
SEWER GAS AND HEALTH — APPENDIX III. 115
investigation of the bacillus of typhoid fever and its
relation to sewage.
After stating that the micro-organisms contained in
the London sewage are derived from the water used for
drinking purposes, from the air, from the superficial
layers of the soil, from the organic matter in the
soil, and, lastly, from putrescible organic matters,
Messrs. Laws and Andrewes dwell on the changes
which the micro-organic life in sewage undergoes in
the sewers. Various causes are here at work :
a. The sewage is a favourable medium for some
germs, whilst others quickly perish in it.
h. Through the activity of the microbial life, chemical
changes are brought about in the sewers which
favour some species and destroy others.
c. In the struggle for existence, the healthier and
stronger forms survive, the weaker ones perish.
Thus it is brought about that the sewage flora of the
Barking and Crossness outfalls is very different from
that of fresh sewage originally delivered into the house
drains, etc. This being so, it is of the utmost import-
ance to ascertain the fate of the pathogenic germs in
the sewers.
Amongst the diseases which have been attributed to
the contamination of drinking water with sewage, two
stand very prominently in the foreground — viz., cholera
asiatica and typhoid fever. Some observers have also
held sewer air responsible for diphtheria, but it would
appear that but a small part in the dissemination of
this disease can be played by this cause.
As cholera asiatica was absent from London at the
time of these experiments, Messrs. Laws and Andrewea
were not able to discover Koch's comma bacillus in the
8*
116 SEWER GAS AND HEALTH. — APPENDIX III.
London sewage. They were, further, unable to find the
diphtheria bacillus in it, though a careful look-out was
kept for this organism.
Concerning typhoid fever, Messrs. Laws and Andrewes
state there is no question that the specific poison of
the "disease believed on very good grounds to be the
bacillus typhosus of E berth and Gaffky passes from the
body with the faeces, and that the excreta of typhoid
patients constitute the main channel of infection in this
disease." They, therefore, searched for it very carefully
in the ordinary sewage of London, taken at various
places, but were never able to find it. They then came
to the conclusion that the mathematical chances of
ever detecting it in the ordinary London sewage were
but extremely remote, as from an estimate of the
reported cases of typhoid fever at the time of the
experiments the sewage from the typhoid-fever patients
could not form more than 1 -250,000th part of the whole
sewage.
In consequence of this they determined to analyse the
sewage from the Eastern Hospital at Homerton, where
there were at the time 40 cases of typhoid fever, many
being acute cases suffering from diarrhoea. Here the drains
are accessible at various places through manholes and
inspection chambers, and the sewage, after its disinfec-
tion had ceased for two days, was taken at a manhole
before it leaves the hospital. One would have expected
that numerous colonies of bacillus typhosus were found
in this sewage ; but after very careful and most
elaborate investigations, Messrs. Laws and Andrewes
only found two solitary colonies. This is very remark-
able, as undoubtedly there must have been a vast
number of typhoid bacilli in the sewage when taken.
In connection with this, it is stated in the report : ** So
SEWER GAS AND HEALTH. — APPENDIX III. 117
far as we are aware, this important fact (that in the
sewage from a typhoid block the typhoid bacillus can
be found) has never previously been demonstrated."
After this result had been obtained, Messrs. Laws
and Andrewes took a sample of sewage a quarter of
a mile below the Eastern Hospital at Homerton, but
were unable to find a single colony of bacillus typhosus
in it. We must, therefore, conclude, that even in
sewage, where according to our notions a great number
of typhoid bacilli must exist, their detection is a
matter of the extremest difficulty.
After making various experiments with a view to
ascertaining the vitality of the bacillus typhosus in
sewage, the authors conclude as follows :
" These preliminary experiments are necessarily very
incomplete, and afford only an indication of the pro-
bable fate of typhoid bacilli which gain access in a
living condition to sewage. It seems, however, clear
that the sewage does not form a medium in which
much, if any, growth is possible for them under natural
conditions, and their death is probably only a matter
of a few days, or at most one or two weeks. But this
degree of resistance may, nevertheless, be sufficient to
allow of their being carried in the sewage to remote
distances, and of their being able to reproduce disas-
trous results should they gain access to any water
supply. As our knowledge accumulates, it becomes more
and more evident that water supply and, as an inci-
dental result, our milk supply constitute the chief
channels of infection by which typhoid fever is com-
municated, and this is true also of cholera, and possibly
of other infectious diseases. It is, therefore, of the
first importance to determine in an exhaustive manner
how far sewage is a possible soil for the growth of
118 SEWER GAS AND HEALTH. — APPENDIX III.
these and other disease germs which admittedly gain
access to it, and also to determine what precise
influence their non-pathogenic companions may exert
on them."
** In the conclusions to Part I. of this report we
endeavoured to show that sewer air has no power of
taking up bacteria from the sewage with which it is in
contact. A strong argument in favour of this view is
the fact that the very organisms which are most
abundant in sewage are precisely those which are absent
from sewer air. In the course of previous experiments
on sewer air, the nature of the organisms in some
1,200 litres of sewer air was carefully determined.
Not once was bacillus coli communis or any of the
predominant organisms of sewage found, though we have
shown above that the former is present in sewage in
numbers varying from 20,000 to 200,000 per cubic
centimetre. If this be so, how infinitely improbable
becomes the existence of the typhoid bacillus in the air
of our sewers. That sewage is a common medium for
the dissemination of typhoid is certain ; that sewage-
polluted soil may give up germs to subsoil air is
possible ; but that the air of sewers themselves should
play any part in the conveyance of typhoid fever appears
to us, as the results of our investigations, in the highest
degree unlikely."
SEWER GAS AND HEALTH. — APPENDIX IV. 119
APPENDIX IV.
lExPERIMENTAL KeSEARCHES INTO THE CaUSAL RELATIONS OF
Sewer Gas and Typhoid Fever.
1. Experiment by Dr. T. H. Barker (see also A-6
and A-50, App. I.).
The late Dr. Parkes reports in his " Manual of
Practical Hygiene " an experiment made by Dr. H.
Barker, as follows :
"Dr. Herbert Barker has attempted to submit this
question to experiment by conducting the air of a
cesspool into a box where animals were confined.
The analysis of the air showed the presence of
CO2, hydrogen sulphide, and ammonium sulphide.
The reaction of the gas was usually neutral —
sometimes alkaline. The gas was sometimes
offensive, so that organic vapours were probably
present ; but no analysis appears to have been
made on this point. Three dogs and a mouse
were experimented on ; the latter was let down
over the cesspit and died on the fifth day. The
three dogs were confined in the box ; they all
suffered from vomiting, purging, and a febrile
condition, which, Dr. Barker says, 'resembled
the milder forms of continued fever common to
the dirty and ill-ventilated homes of the lower
classes of the community.' But the effects
required some time and much gas for their
production. Dr. Barker attributes the results,
not to the organic matter, but to the mixture of
-the three gases, and specially to the latter two."
120 SEWER GAS AND HEALTH. — APPENDIX IV.
2. Besearches of Dr. G. Alessi (see also A-4 and D-2^
App. L).
Perhaps the most careful investigations which have
ever been made into the causal relations between putrid
gases, including sewer air, and typhoid fever, are those
conducted by Dr. Alessi in the Hygienic Institute of the
University of Kome, and reported by him in the AnnaU
of this institute for the year 1894. As I consider them
of great importance, I had them translated, and the
Sanitary Institute, sharing my views, was good enough
to publish them in the Journal for 1895. I can in this
place only give the outlines of these researches, but all
those who wish to consult them more carefully can do
so in the Journal just mentioned.
Alessi states at the commencement of his investiga-
tions :
" The fact (which with English sanitarians is a.
dogma of practical hygiene) that infectious
diseases, and especially typhoid fever, are con-
nected with bad exhalations is most important.
The English hygienists, therefore, consider as
injurious to health and life the emanations which
may escape into houses through defective construc-
tion of sewers and closets, from accidental flaws
in waste-pipes, or from any other imperfections
in the system of the pipes for carrying away the
refuse. And it is precisely this idea which has
brought about the good hygienic arrangement in.
houses in England, to which also sanitary legis-
lation has contributed, and the diffusion in a.
popular form of the rules necessary to protect
houses from any putrid exhalations. This idea,
of the J English hygienists having been carried.
SEWER GAS AND HEALTH. — APPENDIX IV. 121
out, has given the most magnificent results;
therefore it is useful to see if it has any experi-
mental scientific basis, and this is what forms
the subject of this paper."
The plan on which Dr. Alessi conducted his experi-
ments was as follows:
He took rats, guinea-pigs, and rabbits, exposed a
certain number of them to the influence of putrid
gases, including sewer gas; whereas the rest, as a con-
trol experiment, he kept under normal conditions, and
after a while inoculated all of them with the bacillus
of typhoid fever and the bacterium coli commune
(called by some bacillus coli communis). He then most
carefully observed and recorded the different results
which this inoculation produced in both sets of animals,
made sections of them as soon as possible after death,
and besides instituting a very careful examination of
the organs to reveal the macroscopic changes, he made
cultures of them on gelatine plates, and took out
anatomical pieces for the microscopic research of the
bacilli, ixo^
After having thus completed the first part of his
researches, he started a second set of experiments with
a view to ascertain *' whether the chemical substances
which are commonly given out in a state of gas from
putrid fermentations can also exercise separately a
similar influence on the animal organism."
Concerning the way in which Dr. Alessi exposed the
animals to the putrid gases it might be stated that the
rats were placed in a box, the wire bottom of which
closed the aperture of an untrapped water-closet; they
were, therefore, exposed to the direct influence of sewer
gas. The guinea-pigs and the rabbits were placed in
122 SEWER GAS AND HEALTH. — APPENDIX IV.
a box, the wire bottom of which rested on a vessel
containing excrementitious substances.
It is not stated whether these excrementitious matters
were in a dry or liquid state, so that it is not
possible to form an opinion whether in his experi-
ments with rats Dr. Alessi wished to imitate the con-
ditions prevailing in the water-carriage system of faecal
matters, and in his experiments with guinea-pigs and
rabbits the conditions existing in conservancy systems ;
but be that as it may, no distinction is made between
these two kinds of putrid gases in the report, and,
indeed, the results obtained would not have warranted
such a course.
The experiments throughout were conducted with the
greatest care and precaution, and cannot fail to carry
conviction to all those who read them ; certainly. Dr.
Alessi appears to have spared no pains to arrive at
reliable conclusions.
For the inoculation with typhoid bacilli, he used two
cultures, which he called A and B ; culture A being
derived from the laboratory of Prof. Koch, of Berlin,
since 1889, and culture B coming from the collection of
the Institute of Rome, where it was cultivated since 1887.
It would lead too far to follow Dr. Alessi into the
details of his elaborate researches; sufi&ce it to say that
in his experiments with rats he used the A culture
alone, of which he says its virulence might be con-
sidered almost nil, and that in his experiments with
guinea-pigs and rabbits he used both typhoid cultures A
and B. With bacterium coli cultures of attenuated
virulence, he inoculated only guinea-pigs.
Looking at the whole of the experiments, it may be
said that the virulence of the cultures and the doses
used for inoculation were small.
SEWER GAS AND HEALTH. — APPENDIX IV. 123
It might not be out of place to mention here that
the bacterium coli commune (called by some bacillus coli
■communis) is always found in sewage in large numbers,
and is a common inhabitant of the bowels of human
beings. It has frequently been mistaken for the typhoid
bacillus, but is now generally considered harmless.
Dr. Alessi gives 14 tables in his report, from which
I have compiled Tables I. to V., given at the end of this
appendix on pages 127 to 180.
Table I.^ gives the number of animals experimented
on, and the results of the inoculation. For convenience
of reference, I have in Table III.^ summarised the
mortality returns of all animals. On reference to these
tables, it will be seen that from 75 to 100 per cent, of
all the animals exposed to the putrid gases died after
i;he inoculation, and that of all the animals not exposed
to sewer gas, only 7 per cent, of the rats succumbed
after this process. The figures are highly significant,
and speak for themselves. It is further interesting to
observe that rabbits appear to be less able to withstand
the combined effects of sewer gas and inoculation than
guinea-pigs and rats.
In the second table-^ I have given the time which has
elapsed before the animals experimented on lost their
natural immunity to typhoid infection and acquired the
predisposition. From the facts there enumerated it
would appear that again rabbits have a smaller resisting
power than guinea-pigs and rats. Dr. Alessi observes :
'* It appears that generally the animals acquire the
predisposition to infection more easily during the
first two weeks than after that time. In fact,
90 per cent, of the animals inoculated in the first
two weeks died, and only 76 per cent, of those
inoculated in the following weeks."
i Page 127. - Page 128. ^"Pagel^s!
124 SEWER GAS AND HEALTH. — APPENDIX IV.
" This fact may, in a certain degree, explain how
it is that some individuals who habitually
breathe air from sewers, or in whatever way
corrupted, end by becoming habituated ta
it and are no longer attacked by intestinal
infections."
Table IV.^ gives the time that has elapsed between
the inoculation and the death of the animals which
had been exposed to putrid gases. No special order
can be observed here, except, perhaps, that the rats
after once they had lost their natural immunity ta
typhoid fell quickest a prey to the poison.
Table V.^ contains the second set of experiments
which Dr. Alessi made — after having studied the pre-
disposing action of putrid gases taken in their entirety —
with a view to ascertain whether the chemical sub-
stances which are commonly given out in a state of gas
from putrid fermentations can also exercise separately
a similar influence on the animal organism.
"It is known that 18 cubic metres of excrementaL
matter can give out in 24 hours about 18 cubic metres
of gas, of which 10 cubic metres are of fatty acids
and hydro-carbons ; from 5 to 6 cubic metres are of
carbonic acid ; from 2 to 3 are of ammonia ; 20 litres-
of sulphuretted hydrogen."
'* These gases, considered separately, constitute for
man and animals the most poisonous substances, and
their combination produces very rapid deleterious effects..
It interested me to study their action on the animal
organism in very small doses — certainly smaller than
the minimum fatal dose — having reference to the possible
conditions of air - pollution of houses, through gases
arising from badly-constructed closets, filth, and other
causes where the doses can only be found weakened, as
1 Page 129. '^ Page 130. ~
b
SEWER GAS AND HEALTH. — APPENDIX IV. 125
even in such surroundings natural ventilation is con-
stantly diluting these gaseous productions."
The substances used for these experiments were :
Ketilindol (this is a very strong-smelling product
of the putrefaction of albuminous substances,
and can easily be found in the intestines);
Ammonia ;
Sulphuretted hydrogen ;
Methyl sulphide;
Carbonic acid;
Carbonic oxide; and
Ammonium sulphide.
These substances were put with the animals inside
a large bell-glass, which was closed in such a manner
as to make change of air impossible. After a certain
time the animals were inoculated with typhoid bacilli
in the same way as in the preceding experiments.
Dr. Alessi continues :
** Therefore the above-mentioned gases or vapours,
taken separately, do not predispose animals to
typhoid infection. In fact, in all the experiments
only three animals died, and those from other
causes which it was impossible for me to define.
And not only did the gases taken separately have
no predisposing effect, but even some of them
when mixed; for which reason I may be allowed
to suppose that both the exhalations arising from
faecal matter, and the exhalations arising from
organic matter in putrefaction, are not composed
of simple mixtures, but are much more complicated
than might be believed. And the predisposing cause
might also have its seat in those fetid [substances
of neutral character, which it is impossible either
126 SEWER GAS AND HEALTH. — APPENDIX IV.
to understand or determine, whether from their
small quantity, the insufficiency of analytical
methods, or from the imperfection of those which
we already have. In any case, from my experi-
ments can be drawn this useful lesson : that the
above-mentioned gases or vapours can be breathed
in small doses without their predisposing to typhoid
infection."
The conclusions at which Dr. Alessi arrived are stated
by him as follows :
" From my researches, taken altogether, I think I
am authorised to conclude that : ,
1. The inspiration of putrid gases predisposes the
animals (rabbits, guinea-pigs, rats) to the patho-
genic action of even attenuated typhoid bacilli,
and of bacterium coli.
2. This predisposition is due to the combination of
gases given out by putrid fermentations, and not
to any one separately.
3. It is probable that this experimental predisposition
is diminished by prolonged breathing of the said
These conclusions, then, serve to confirm what some
authors had epidemiological^ foreseen, and social
hygiene had practically and painfully confirmed.'*
SEWER GAS AND HEALTH. — APPENDIX IV.
127
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128 SEWER GAS AND HEALTH. — APPENDIX IV.
Table II. — Dr. Alessi's Researches.
First Set of Experiments.
Time necessary for the Animals to Acquire the Predisposition.
Kind of Culture
Used.
Animals Experi-
mented with.
Time necessary for the Animals
to Acquire Predisposition,
Minimum
Time.
Average
Time.
Maximum
Time.
First Series. — Ty-
phoid bacilli. Cul-
ture A.
Second Series. — Ty-
phoid bacilli. Cul-
ture B.
Third Series. — Bac-
terium coli.
1 Rats
Days.
5
I
5
0
3
Days.
22
18
5
6
3
6
Days.
72
58
18
21
6
12
-Guinea-pigs ...
Rabbits
1 Guinea-pigB ...
("Rabbits..
> Guinea-pigs ...
Table III.— Dr. Alessi's Researches.
First Set of Experiments.
Mortality Returns of all Animals.
Kind of Culture
Used.
Animals Experi-
mented with.
Percentage Mortality of all
Animals.
Animals
Exposed to
Sewer Gas.
Animals Kept as
Control under
Normal Con-
ditions.
First Series. — Ty-
phoid bacilli. Cul-
ture A.
Second Series. — Ty-
phoid bacilli. Cul-
ture B.
Third Series. — Bac-
terium coli.
1 Rats
Per cent.
75-5
79-2
100-0
77-8
87-5
83-3
Per cent.
7-3
0-0
0-0
0-0
0-0
0-0
!- Guinea-pigs ..
J Rabbits
(Guinea-pigs ...
I Rabbits
> Guinea-pigs ...
SEWER GAS AND HEALTH. — APPENDIX lA^
129*
Table IV. — Dr. Alessi's Researches.
First Set of Experiments.
Time Elapsed between the Inoculation with the Bacilli and the Death
of the Animals.
Kind of Culture
Used.
I'J'umber of Animals Exposed
to Putrid Gases.
Time Elapsed between
the Inoculation with the
Bacilli and the Death of
the Animals.
First Series.—
Typhoid bacilli.
Culture A.
Second Series.—
Typhoid bacilli.
Culture B.
Third Series.—
Bacterium coli.
i
[Rats
.. 9
... 25
... 3
12 to 24 hours
24 „
24 to 36 „
Total
Average, 23 hours.
Guinea-pigs
j>
... 18
.. 6
.. 6
., 3
.. 8
.. 8
.. 3
.. 52
24 hours
3 days
4 „
5 ,,
9 „
10 „
13 „
>i
Total
Average, 5 days 3 hours.
Rabbits
.. 3
.. 4
. 4
.. 11
2 days
3 „
4 „
Total
Average, 3 days 2 hours.
Guinea-pigs
. 15
.. 3
.. 1
.. 1
.. 1
.. 21
18 to 24 hours
30 „
2 days
5 >>
6 „
»>
j>
Total
Average, 1 day 10 hours.
Rabbits
>>
.. 1
. 3
.. 3
. 7
24 hours
2 days
3 „
Total
Average, 2 days 7 hours.
/-Guinea-pigs
.. 1
.. 3
.. 2
.. 1
.. 3
.. 10
8 hours
20 „
24 „
2 days
3 „
j>
Total
Average, 24 hours.
1
....
130 SEWER OAS AND HEALTH. — APPENDIX IV.
Table V. — Dr. Alessi's Researches.
Second Set of Experiments.
Experiments with Various Gases.
Substance Experi-
mented with.
Retilindol
Ammonia cal
hy.
vapours ...
Sulphuretted
drogen
Methyl sulphide ...
Carbonic acid
Carbonic oxide
Retilindol and
methyl sulphide...
Retilindol, methyl
sulphide, and am-
monia
Sulphide of am-
monia
Sulphide of am-
monia and methyl
sulphide
Animals
Experi-
mented
with.
Rats.
Guinea-
Rats
pigs
Guinea-pigs
Day on
which the
Experi-
ment
began.
24th May
24th „
7th July
7th „
28th ,,
16th Aug.
29th ,,'
13th Sept.
21sc ,,
6th Oct.
21st Sept.
6th Oct.
Day on
which
Typhoid
Inocula-
tions were
made.
5th June
28th „
23rd July
30th „
11th Aug.
25th „
7th Sept.
21st ,,
2nd Oct.
15th „
2nd „
15th ,,
Animals
Exposed
to
Sewer
Gas.
11
Q
Animals
Kept as
Control
under
Normal
Condi-
tions.
3t3
§1
5
0
0
0
0
0
0
0
0
3 0
SEWER GAS AND HEALTH. — APPENDIX V. 131
APPENDIX V.
Explosions in Sewers and Cesspits.
"1. Explosion in one of the London Sewers (see also A-44,
•App. L).
The Medical Times of July, 1861, reports a case which
happened in one of the London sewers. It appears some
thieves entered a sewer with a view to stealing the
stearine which had run into it in consequence of a fire
the previous night. When attempting to light a match,
an explosion occurred which not only singed them, but
also acted as a prompt warning to the police to find out
the whereabouts of these ingenious burglars.
It is surmised that with the stearine together inflam-
mable fatty gases entered the sewer, which exploded
when a naked light was applied to them.
2. Explosion in a Cesspit at Mayence (see also B-13,
App. L).
The Deutsche Bauzeitung of the 27th February, 1895,
mentions the following case :
A public-house in Clara-street, Mayence, had two
closets on the ground floor, which were connected with
an arched-over cesspit under the street. The entrance
to the latter was closed with a cast-iron asphalted cover
in the causeway, and it was ventilated by a Sin. pipe,
which higher up joined the rain-water down-pipe. Alto-
gether, a not very sanitary or satisfactory arrangement.
One evening in the middle of February, 1895, the owner
lighted his cigar in the room where one of the water-
closets is situated, and threw* the Hghted match into the
9^
133 SEWER GAS AN1> HEALTH.— APPENDIX V.
closet basin ; whereupon, immediately and without any-
warning, a serious explosion, accompanied by great noise,.
took place. The cover of the cesspit — which, no doubt,
was frozen hard to the ground — was burst open and
thrown high into the air, damaging in its ascent portions
of the cornice and roof of the building. Its contents were
forced out of the two closets, and the owner had a very
narrow escape.
The two closets had had to be thawed up every
morning — February, 1895, being an exceedingly cold
month ; and it is surmised that the rain-water ventilating
pipe was frozen up at the time the explosion took place.
At any rate, it would appear that the gases forming in.
the cesspit could not escape through it and were forced
up into the house. What their mixture and composition
was has, unfortunately, not been ascertained, but it would,
appear as if coal gas could have played no part in it,,
otherwise the smell would have betrayed it.
3. Explosion in a New Sewer at Burton-on-Trent
(see also A-16a, App. I.).
In this case an explosion took place in a new sewer
at Burton-on-Trent on the 11th day of November, 1896,
which was caused by a bricklayer, doing some pointing
in the same, lighting a match. The force of the
explosion was so great that the iron top of every manhole
in the street was uplifted, and three were displaced.
Houses were shaken, and the frightened inhabitants
rushed out thinking that an earthquake had occurred.
The following is the account of the accident as reported
in the Burton, Ashby, and Coalville Guardian of 14thu
November, 1896 :
*' People living in the vicinity of Alfred -street were-
greatly alarmed at seven o'clock on Wednesday morning.
SEWER GAS AND HEALTH. — APPENDIX V. 133
by a loud explosion of gas in the deep sewer recently
laid in that thoroughfare. It appears that a bricklayer
named John Parry, living in Albert- street, and employed
by Mr. Hodges, had descended the sewer through a
manhole for the purpose of seeing if any pointing was
required. He crawled along until he came to one of
the manholes, where there was a great accumulation of
gas, which the man evidently did not detect. He lit
a candle and held it up, but the moment the light
• came in contact with the gas there was a terrific
'explosion throughout the whole length of the street.
The force was so great that the iron top of every man-
hole in the street was uplifted, and three were displaced.
Houses were shaken, and the frightened inhabitants
rushed out thinking that an earthquake had occurred.
The unfortunate man in the sewer managed to creep
'back to the spot where he had gone down, and was
there rescued. He was almost suffocated, and was at
.once taken to the Infirmary. He was severely burnt
about the face and arms, and the back of his hair and
his whiskers had entirely disappeared. After he had
ibeen attended to by Dr. Sparks, the house surgeon, he
was sent home. A boy who had gone down with Parry
"ihad a very narrow escape, for although he was not
iouched by the flame, he was knocked down."
134 SEWER GAS AND HEALTH. — APPENDIX VU.
APPENDIX VI.
Health of Sewermen.
1. General Bemarks,
The statistical information concerning the health of
sewermen is generally very incomplete, as the facts and.
figures have frequently had to be collected years after,,
and that, too, in a somewhat haphazard manner. The
results of such enquiries are, therefore, in most cases
not based upon a proper system of notification and.
tabulation, and must be received with a certain amount
of caution.
Further, the information generally only deals with the
workmen whilst actually employed in the sewers, but
gives no clue as to the health of the workmen after
leaving this employment, which, of course, is of the
greatest importance when considering the influence of
sewer gas upon health.
The information in most cases also refers only to the
days lost through sickness, but does not give any idea
as to the state of the health of sewermen before
actually becoming unfit for work.
As to the length of time sewermen are employed in
sewers, Prausnitz's labours for Munich, for instance,,
indicate that, out of the total number of men so
employed, 43 per cent, only remain on an average 20-
months in the sewers. (B-43, Appendix I.).
2. Opinion of the late Dr. E. A, Parkes (see also^
A-50, App. I.)
The late Dr. E. A. Parkes states on page 139 of the-
sixth edition of his " Manual of Practical Hygiene" :
I
SEWER (iAS AND HEALTH. — APPENDIX VI. 135
"It does not appear, therefore, that at present the
workmen connected with fairly ventilated sewers
show any excess of disease ; at the same time it
must be allowed that the inquiry has not been
very rigorously prosecuted, and that the length of
time the men work in sewers, their average yearly
mortality, discharge from sickness, loss of time
from sickness, and the effect produced on their
exjDectation of life, have not been perfectly deter-
mined."
Parkes further mentions that whereas Guy and Parent-
Duchatelet deny that typhoid fever is more common
among sewermen than others, Murchison and Peacock
state that this disease is not uncommon among sewer-
men.
B. Cases reported by GauUier de Claubry (see also-
C-3, App. I.).
G. de Claubry mentions four cases of real asphyxia
and 20 of threatening asphyxia in 10 workmen who
had been taken to the hospital after having been at
work in the sewers for only about six months. One
workman had no less than four attacks.
4. Observations of Hankel (see also B-24, App. I. and
11, App. VII.).
Hankel reports that cases of light poisoning through
sewer gas are very common amongst the Paris sewermen.
They distinguish two kinds. The first kind they call
" la mitte " — vapour. This can last for several days,
but leaves no ill-effects behind. It consists in great
irritation of the mucous membrane of the nose, with,
decreasing secretion of the same, severe pains in the
sockets of the eyeballs reaching as far as the frontal
136 SEWER GAS AND HEALTH. — APPENDIX VI.
cavity, swelling and inflammation of the conjunctiva,
photophoby, leading sometimes to complete darkening
of the eyesight. It is probably brought about by
ammonia or sulphuretted hydrogen, or through a com-
'bination of both gases.
The second kind of poisoning is called " le plomb " —
lead — and derives its name probably from the feeling
of heaviness in the head and limbs. It is caused by
sulphuretted hydrogen.
5. Sewermen at Munich (see also B-43, App. I.).
Prausnitz examined the health of the sewermen at
Munich, and came to the conclusion that they did not
suffer more from illness than other workmen. From
the figures given by this observer the rather remarkable
circumstance can be deduced, that out of a total number
of 42 sewermen, 43 per cent, remained on an average
only 20 months in the sewers. No reason for this is
given in the report, although it would have been of the
greatest importance to ascertain whether or no the
cause of this short service in the sewers was in any
way connected with the impaired health of the men.
6. Sewermen at Wiesbaden (see also B-9, App. I.).
It has not been observed at Wiesbaden that sewermen
suffer to a larger degree than others from epidemic
diseases, but they are more subject to rheumatic com-
plaints than other men employed by the town authorities.
It should be observed here that the Wiesbaden sewers
are comparatively new, having only been in use a few
years.
7. Health of London Sewermen (see also A-58, App. I.).
Stevens mentions that the London sewermen com-
iplain about sore throats and rheumatism. He was not
SEWER GAS AND HEALTH. — APPENDIX VI. 137
able to discover that they suffered from typhoid fever,
and only found one case of diphtheria amongst them.
He is of opinion that the time lost through sickness
by them is not greater than that lost by other work-
men, that they are able to work long in the sewers,
^nd that their majority dies at an advanced age.
138 SEWER GAS AND HEALTH. — APPENDIX VII.
APPENDIX VII.
Some Authentic Cases of Mkphitic Poisoning through
Sewer Gas.
1. Poisoning Case at Clapham (see also A-18 and 31,
App. L).
In a case at Clapham the emptying of a privy produced
in 23 children violent vomiting and purging, headache,
and great prostration and convulsive twitching of the
muscles. Two died in 24 hours.
2. Deaths of Four Men in a Sewer in the City oj
London (see also A-43, App. I.).
The Medical Times of February, 1861, reports a case
in which four men perished in a sewer in the neighbour-
hood of the Thames. The post-mortem examination
revealed that three men were suffocated by carbonic acid
gas ; but the late Dr. Letheby, M.O.H. City of London,
expressed at the coroner's inquest the opinion that three
men were killed by sulphuretted hydrogen gas, and that
the fourth was drowned.
8. Case reported hy Gaultier de Claubry (see also C-3,
App. I.).
Gaultier de Claubry mentions a case where 12 workmen
who had entered a sewer uttered cries one after another,
became unconscious and asphyxial. When they were
removed from the sewer it was found that eight were
only slightly affected, and the remaining four so much
that they had to be sent to the hospital. One of the
latter died, but the other three recovered consciousness
after several hours, and could be discharged after six days.
SEWER GAS AND HEALTH. — APPENDIX VII. 139'
4. Case reported by Halle,
Halle reports that three workmen in a cesspit were
overcome by the gas and that two died before they could
be rescued.
5. Chevalier (see C-2, App. I.), BlumenstocJc (see B-7,
App. I.), and Thierling (see B-59, App. I.) mentiofi
similar cases of Mephitic Poisoning.
6. Case reported by Caspar (see also B-11, App. I.).
Caspar reports a case where 10 men, working in a
tannery, bored a hole in a tank containing hides under-
going the process of maceration. Some of the liquid
containing 13 vols, of sulphuretted hydrogen escaped,
and the workman who endeavoured to ladle it out of
the pit suddenly fell down dead. The others ran to his
rescue, but six of them died on the spot, and the rest
only recovered after having been ill for some time.
7. See also item 4 under " Health of Sewermen " in
App. VI.
8. Accident in the Paris Sewers.
Four men lost their lives in the Paris sewers about
the year 1880.
9. Case reported by Finhelnburg (see also B-20,.
App. I.).
Finkelnburg reports a case which shows how quick
and how serious the action of sewer gas can be upon
human beings.
The basement of a house of detention, which is 4ft.
below the level of the courtyard, was flooded to the
depth of several feet by the backing up of sewage from
the sewer. Not far from the rooms thus flooded,.
140 SEWER GAS AND HEALTH. — APPENDIX VII.
prisoners were at work during the day making brushes,
:and of these, 13 became so seriously ill that they had
to be taken to the hospital, whilst some of the others
did not feel the effects of the sewer gas in so decided a
manner. Most of the men fell ill on the day after the
sewage had been pumped out, during which operation a
pestilential smell pervaded the premises.
10. Fatality in a New Sewer at East Ham, near London,
1st July, 1895 (see also A^-25, App. I.).
A very sad accident happened at East Ham, near
London, on the 1st July, 1895, by which five men lost
pheir lives in one manhole.
At the point where the main outfall — a new egg-shaped
sewer, 4ft. Gin. by 3ft. — enters the pump well, screens
have been put up with a view to catch the rough,
floating matter. These screens are accessible by means
of a shaft 27ft. deep, closed with a ventilated cover.
It appears that on Monday morning, 1st July, 1895,
a man named Digby went down this shaft with a
view to clean the screens, after the cover had been
removed for about 15 minutes. When halfway down
he said he felt faint and would return to the surface
for a short time. However, on reaching nearly the top
of the ladder, he collapsed and fell down the shaft into
the sewage. King, the man on the surface of the ground
in attendance on Digby, called at once for help, when
three men — named Rutter, Mills, and Durrant — went
down the shaft and disappeared clean. The last man
to go to the rescue was Jones ; but he, too, being over-
come by the gas when reaching the bottom, fell against
the grating, and remained with his head above the sewage
perfectly still, in an apparently lifeless condition.
When the next man, Herbert Worman, descended, he
SEWER GAS AND HEALTH — APPENDIX VII. 141"
too, had to return, owing to feeling ill from inhaling the
gas. A bucket containing lighted coal was then lowered
into the well, and as this seemed to burn all right,
Worman descended again, and brought Jones to the
surface, who was then still breathing. Efforts were at once
made to revive animation, which proved so far successful
that he was removed to the West Ham Hospital, where,
however, he died on Tuesday morning.
When the other four bodies were brought up, it was
found that life was quite extinct. One poor fellow's face
and head were frightfully swollen, and various marks
about the nostrils, mouth, and eyes showed that he
had died from suffocation.
A post-mortem examination was made on the body of
Durrant, and at the inquest Dr. Smith stated that, as
the result of the autopsy, he was of opinion that Durrant
had died from asphyxia resulting from drowning.
Concerning the man Jones who, as already mentioned,
died after admission to the hospital, the following report
of the inquest is taken from the Tiines of the 8th August,
1895:
*' The adjourned inquest on the body of Frederick
David Jones, age 28, who died in the West Ham
Hospital on the morning of July 2nd, took place
at the King's Head, Church-street, West Ham,
yesterday evening. Jones was one of the five
men who went down a manhole at the East Ham
sewage works, and there became unconscious
through meeting with foul gas. When they were
extricated, four of the men were dead, having
been drowned. Jones was unconscious when
taken out, he having fallen on the top of a
grating. Charles King, labourer in the employ
of the East Ham District Council, was called^
k
142 SEWER GAS AND HEALTH. — APPENDIX VII.
and the evidence he gave at the other enquiry
was read over. He detailed how the men went
down the manhole and disappeared. Dr. Stuart
Kyall Blake, house surgeon at West Ham Hospital,
deposed that after the deceased was brought to
the hospital artificial respiration was resorted to
for 2 J hours, while brandy was administered and
the stomach-pump used. He never recovered
consciousness, and died the next morning.
Witness was of opinion that he died from
poisoning by sulphuretted hydrogen. Mr. W. H.
Savage, surveyor to the East Ham District
Council, stated that since the accident a cradle
had been obtained, and it was lowered with
the men, so that they could be taken up at a
moment's notice. In addition, acting on the
advice of Dr. Haldane, a mouse or a bird had
been lowered each time the men went down, and
no foul gas had been discovered. The Council
had also determined not to have any part of the
manhole covered up, and had also provided a
respirator which would enable men to go down
amongst any noxious gas. The jury returned a
verdict that death was due to suffocation by
sewer gas."
The widow of the man W. T. Digby brought an
-action against the East Ham Urban District Council for
damages for the loss of her husband. The following is
the account of the second trial as taken from the
Standard of 25th May, 1897 :
^* Digby v. East Ham XJrhayi Council. — In this case
Mrs. Esther Martha Digby, the widow of the late
W. T. Digby, sued the East Ham Urban Council
to recover damages on behalf of herself and her
SEWER GAS AND HEALTH. — APPENDIX VII. U3
•children for the loss of her husband. The deceased
was in the employment of the defendants, and in
July, 1895, went down a manhole on their sewage
works, when he was suffocated in consequence of
-an escape of noxious gas. The plaintiff's case was
that his death was caused by the defective condition
of the defendants' works, or through their negligence,
or the negligence of those engaged by them in super-
intendence. The defendants denied the plaintiff's
statements, and a good deal of scientific evidence was
called on both sides. This was the second time the
'Case had been tried, as Mr. Justice Cave non-suited the
plaintiff, and the Court of Appeal granted a new trial^
Altogether five men died from the gas, and this was a
test case. Mr. Euegg, Q.C., Mr. J. D. Crawford, and
Mr. Edmond appeared for the plaintiff ; and Mr. Dickens,
Q.C., and Mr. W. ElHs Hill for the defendants. The
jury found a verdict for the plaintiff for £^25. Judgment
accordingly."
11. Observations by Dr. Hankel (see also B-24, App. I.).
Hankel states that in human beings four different forms
of poisoning by sewer gas can be distinguished — viz., the
mild form, the fairly severe form, the severe form, and
the chronic form.
A. The Mild Form. — In the mildest cases the feeling
of a heavy load upon head and chest is experienced.
This feeling is well known amongst sewermen. If the
case becomes more severe, other symptoms, such as
vomiting, severe pains in the abdomen, breaking of wind
strongly smelling of sulphuretted hydrogen, and eructa-
tion, have been observed. The pulse becomes small, the
breathing quick and laboured, the patient feels giddy and
very weak, especially in the muscular parts.
144 SEWER GAS AND HEALTH. — APPENDIX VII.
B. The Fairly Severe Form. — In fairly severe cases
the skin becomes cold and covered with cold perspiration.
The patient begins to feel sick, and frequently complains
of pains in the stomach and joints and of a feeling as
if the throat was closing up. Delirium, convulsive
twitchings of the muscles, fainting fits, singing and
talking, have frequently been observed at this stage.
The latter is so well known to the Paris sewermen that
they call it " chanter le plomb," which might be rendered
by *' the lead song."
After this follows unconsciousness and convulsions,
chiefly of a tetanic nature. The pupils of the eyes become
enlarged and the lips and the face blue and cyanotic.
C. The Severe Form. — In cases of this kind the death
of the workman is frequently instantaneous. He enters
the sewer or cesspit and collapses there all at once as
if he had been hit by a bullet. Sometimes it has also>
been observed that the workman has uttered a cry
and then had severe convulsive fits, with vomiting and
spontaneous secretion of faeces and urine ; foam covered
the mouth, and the patient either died at once or
remained unconscious for a long time.
D. The Chro7iic Form. — This form has been observed
in labourers employed in chemical works who had
drank water containing sulphuretted hydrogen, and in
miners employed in the coal mines at Auzain.
The symptoms were pronounced anaemia, pressure in
the stomach with pains, and pulse sometimes quick,
sometimes slow. The strength of the patient diminished,
the pains in the stomach gradually ceased, the skin
became yellow, and profound perspiration commenced.
The stomach became blown, and the stools contained
pus.
In the case of the miners frequently sudden death
SEWER GAS AND HEALTH. — APPENDIX VII. 145
took place, whereas in the case of the labourers of the
.chemical works furuncle or similar diseases in the neck,
face, and skin supervened.
12. Case reported hy Hanhel (see also B-24, App. I.).
A very interesting case is reported by Hankel, which
happened at Glauchau, in the kingdom of Saxony, on
the 18th January, 1895.
A plumber, 26 years old, and to all appearances in
good health, had been sent by his master to a house
to thaw up the water-closets on the ground floor
which, owing to the severe frost, had become frozen.
He was known to be a steady, sober fellow.
At 3.30 p.m., when someone had been speaking to
him, he appeared all right, and made no complaint
whatever, but at 5 p.m., when the coachman came to
look after him, he found him dead in the room with
his trousers half off. Although the coachman had left
the door open, upon entering he felt giddy and faint,
owing to the pungent and suffocating nature of the
air in it, and when, after an hour, Hankel, the
medical officer of health, examined the place, he
reports the air in the room made him feel dazed, and
caused eructation.
In the house in question, the water-closets drain
into a cesspit, and it appears that the poor fellow had
for some reason or other, after lighting a coal fire in
the room, opened the cover of a 4in. pipe which is
directly connected with the cesspit, and the only use of
which appears to be for inspecting and cleansing pur-
poses. Up this pipe the gases seemed to have found
their way from the cesspit into the water-closet room,
and it is surmised that the plumber began to feel sick
and wanted to use the water-closet, but before he could
10
146 SEWER GAS AND HEALTH. — APPENDIX VII.
do SO he fainted and fell, unfortunately, so that h
face was close to the 4in. pipe, up which the gases
ascending from the cesspit entered his mouth and nose,.
and so caused eventually his death. The seat of the
water-closet was covered with fresh excreta, and the
clothes of the plumber were soiled with vomited matter,
defaecation having taken place of its own accord. The
face was not distorted after death, and there is no reason
to assume that the poor fellow had convulsions.
Although efforts were at once made to restore life,,
and were continued for some considerable time, they
proved in the end fruitless.
Hankel then gives full details of the post-mortem
examination, which, as he says, he was able to carry
out under very favourable circumstances, and comes to
the conclusion that the cause of death was asphyxia
resulting from the inhalation of sewer gas. The autopsy
seems to have revealed very little characteristic for such
a death.
13. Death in London Sewers (see also A-42, App. I.).
Mr. T. de Courcy Meade states that in the summer
of 1894 two men lost their lives in the London sewers.
14. Death of Three Me7i in a Seiver at WidneSy
Lancashire (A-67A, App. I.).
A very sad accident happened on the 27th day of
January, 1896, at Muspratt's Chemical Works, Widnes,
Lancashire, in which three men lost their lives.
It appears that Patrick Fahey and Luke Farrell were
engaged in cleaning out a sewer, when they were over-
come by sewer gas. Their dangerous position becoming
known, Thomas Atherton pluckily descended the shaft
to rescue them. He, however, was also soon overpowered
SEWER GAS AND HEALTH. — APPENDIX VII. 14T
by the gas, and before the three men could be got up
they had perished by falKng into the hquid.
At the inquest, the medical man who saw the bodies
when they were brought up from the sewer stated it as
his opinion that the gas from the effects of which
they had died was sulphuretted hydrogen.
15. Death of Five Men from Sulphuretted Hydrogeji
at the Tynemouth Gasworks (A-65a, App. I.).
A very sad accident, in which five men perished,
happened at the Tynemouth Gasworks, North Shields,
on the 20th January, 1896. This fatality shows what a
very powerful poison sulphuretted hydrogen is and how
very quickly it acts.
In this case, it appears, the valve in front of the
purifiers had been left open by a quarter of a turn, and!
when two men descended into the tank to remove the
foul oxide of iron they were immediately and without
any warning overcome by sulphuretted hydrogen and
fell down, apparently in a fit. Three men at once went
to their rescue, but they shared the same fate, and when
removed out of the tank it was found that in every
case life was extinct.
16. Death of One Man m a Sewer at Harpurhey, near
Manchester (see also A-40a, App. I.).
In this case, a man named Charles Jones, aged 52,
was, whilst working in one of the Manchester sewers,
overcome by sewer gas, and when removed to the surface
life was found to be extinct.
The following is the account of the inquest as reportedl
in the Manchester Guardian of 24th September, 1896 :
"Mr. Smelt, the city coroner, held an inquiry yesterday
respecting the death of Charles Jones, 52, a miner,.
10*
148 SEWER GAS AND HEALTH. — APPENDIX VII.
lately living in Higher Burton - street, Queen's - road,
who was poisoned by gas whilst working in a sewer at
Harpurhey on Tuesday morning. The evidence was to
the effect that the deceased went down a shaft which
had been sunk in Henhurst-street, Queen's-road, for the
purpose of driving a heading to find an old sewer.
Jones probed with a rod in the direction of the sewer,
and an outrush of gas which came from it overpowered
him. Patrick Devine, who was at the top of the shaft,
raised an alarm, and some men who came up, at his
request, lowered him down the shaft. Just as he reached
Jones, he called out that he wanted to be pulled up.
The request was responded to, but when he had been
lifted five or six feet he fell upon his mate, being overcome
by the gas. Another labourer named Higgins then
volunteered, but he suffered in a like manner. Some
buckets of water were thrown down the shaft, after
which a man named Lewis went to the rescue of the
three workmen. He succeeded in sending up Higgins
and Devine, and Jones was brought to the surface by
another. Jones and Devine were taken to the Koyal
Infirmary. The former died from the effects of the
poisonous gas, and Devine is still an in-patient, but is
recovering. The jury returned a verdict of accidental
death. The coroner commended Higgins and the others
for their bravery, and expressed a hope that the attention
of the Corporation would be drawn to it. Mr. Miller,
from the town clerk's office, watched the proceedings
on behalf of the Corporation."
SEWER GAS AND HEALTH.— APPENDIX VIII. 149
APPENDIX VIII.
Cases of Septic Poisoning through Sewer Gas.
1. Case of Poisoning at Sutton Coldfield (see also
A-33, App. I.).
The medical officer for Sutton Coldfield, Warwickshire,
Prof. Bostock Hill, reports in the August number
of " Public Health " for 1895 a very interesting case,,
in which he comes to the conclusion that very probably
the septic poison was introduced through sewer gas. It
might not be out of place to give here a short descrip-
tion of the leading features of the case.
The proprietress of the Wylde Green Hotel, at Sutton
Coldfield, had during Christmas, 1894, cooked a soup, and
gratuitously distributed the same in the neighbourhood
for the benefit of the poor. This soup was prepared
from a large piece of salted beef, pearl barley, peaflour,
and vegetables, to which the broth in which a rabbit
had been boiled was added, the rabbit itself having
been eaten at the hotel for dinner the previous day
without any symptoms of poisoning.
The soup was boiled in a large iron boiler in an out-
house of the hotel on Friday afternoon, the 28th
December, 1894, and left standing in the same, loosely
covered, till the next day, Saturday morning, about
11 o'clock, or about 18 hours, when it was distributed.
On the 1st January the attention of Prof. Hill wa&
called to an outbreak of poisoning in the neighbour-
hood of this hotel, which was locally attributed to the
consumption of this soup, and which affected about ]00
150 SEWER GAS AND HEALTH. — APPENDIX VIII.
persons, all of them having partaken of it. He describes
the symptoms of the illness as follows :
** The chief symptoms were pain, swelling of the
abdomen, and purging, followed in some cases by
vomiting. The purging generally lasted a con-
siderable time, in some instances many days,
despite medical treatment. Great coldness, with
pains in the limbs (said to be in the bones by the
patients), were complained of in many instances,
and in one case a child nine years old was unable
to use his legs sufficiently to walk for many days
after the onset of the first symptoms. I found
that the symptoms in nearly all cases did not
come on for many hours, in some cases as long
as 30, after taking the soup, and this, in my
opinion, contra-indicates the presence of any form
of mineral poisoning."
Unfortunately, one patient died.
Dr. Hill, who is at the same time professor of hygiene
and public health and lecturer on toxicology at the
Mason College, Birmingham, examined the soup and its
constituents to see whether it contained arsenic or
another mineral irritant, but found no such poison in it.
No suspicion could be attached to the water from which
the soup was made, as this was taken from the mains
of the company which supply the district, the sanitary
arrangements of the hotel were good, and after a very
careful consideration of all circumstances it appeared
that the soup had become toxic independent of the meat
from which it had been made, and that the outbreak of
poisoning was due to the presence in the soup of ptomaines
or other substances generated from animal matter.
The boiler, which was said to have been used for the
boiling of clean water only, is fixed, as already mentioned.
SEWER GAS AND HEALTH. — APPENDIX VIII. 151
in an outhouse, which is under the same roof as a stable
and separated from it by a wooden partition, in which
there is a door. On the floor of the stable there is a
drain grating, and at the end of the outhouse near the
boiler runs up the ventilating pipe of the house drain,
while about 20ft. away, and up the side of the hotel
itself, there is a large ventilating shaft connected directly
with the main road sewer.
Concerning the state of the public sewer in the neigh-
^bourhood of the hotel. Prof. Hill remarks :
'' The sewer at Wylde Green has been for years
notoriously a stinking one. To obviate the nuisance
caused to residents and those travelling along the
road, the crown ventilator at this part of it was
stopped up, and by permission a large 6in. shaft
was erected against the wall of the hotel. That
gases of an offensive kind were given off from this,
I know to be the case, because nuisance had been
complained of by the proprietress of the hotel in
one of the rooms close to where it was fixed ; and
to obviate this nuisance a register grate had been
put in, so that the evil-smelling gas might be
shut out from the room "
•^* These facts may, I think, throw some light on the
matter. It is quite likely that on the Friday
night sewer gas was discharged from the sewer
ventilators, and as this became colder it would
become heavier, and therefore fall if not rapidly
diffused. This being so, it is highly probable that
some descended the chimney of the outhouse,
,and gained access to the soup in the boiler, and
in this way started septic change. It is, of course,
impossible definitely to say that this was the case,
ibut bearing in mind that the symptoms point to
152 SEWJ:R gas and health.— appendix VIII.
the poison being septic, or of animal origin, I
cannot at the present time discover a cause more
likely to have produced the outbreak."
That the gases escaping at the top of a soil-pipe some-
times descend again is, 1 believe, an admitted fact, and
I have repeatedly observed it when smoke- testing the.
drains of a house. In support of this. Prof. Hill quotes
his experience on two occasions in the winter of 1895,.
when he observed in his own house smoke from another
chimney descending and entering a room in which there
was no fire. This happened each time in the evening,
and although the cold chimney through which the smoke
descended had a good draught when there was a fire in it.
Whilst the medical officer was engaged in these inves-
tigations one of the patients died, and in consequence a
portion of the soup was forwarded to Dr. Klein for
bacteriological examination. It is to be very greatly
regretted that this course was not at once adopted after
the outbreak, as the soup was nearly three weeks old
before Dr. Klein could examine it ; and although January
was a cold month, it is clear from Dr. Klein's report
that fermentative changes had taken place in it.
As this report is of considerable importance, I will give
it here in full, as follows :
*' On January 24th, I received a glass jar of fluid,
material, tied with a membrane. The material in
the jar had, on opening, a sour smell, and gave a.
strong acid reaction. It was a thick film, con-
taining various vegetables, fat, and bits of flesh.
Under the microscope, besides these substances,,
there was seen a multitude of microbes ; in
fact, the whole material was crowded with them.
Amongst these could be recognised various forms
of bacilli, differing from one another in lengthy
SEWER C4AS AND HEALTH. — APPENDIX VIII. 15^
and numerous yeast cells. Cultivations were at
once made, so as to isolate the microbe. These
cultivations yielded the following microbes in.
colonies : (1) torula, or yeast, very copiously
present ; (2) a short non-mobile bacillus, not
liquefying gelatine, fairly abundant; (3) a bacillus
which proved on sub-culture to be closely related
to the typical bacillus coli — this microbe is the
normal inhabitant of man and animals, and is
a prominent microbe in sewage: in the soup it
was present in considerable numbers; (4) a bacillus
which also proved on sub-culture to be closely
related to the bacillus coli, but must be con-
sidered as a variety of the typical bacillus coli —
it is also a normal inhabitant of sewage, and
was present in enormous numbers in the soup..
Experiments were made with the soup and with
the cultivations obtained from it : (a) feeding
mice with the soup produced no ill-effect; this
result does not prove much, since the time that
had clasped since the consumption by human
beings at Wylde Green and the experiment
made here was considerable, and as it is known,
that organic substances, poisonous at one time,
lose their action when exposed to fermentative
changes ; (b) inoculations of guinea-pigs with
cultures of the microbes (3) and (4) bacillus coli
and variety proved these microbes to be virulent,,
particularly microbe (4), which is highly virulent ;.
(c) inoculation of guinea-pigs with microbe (1>
and (2) had no ill-effect ; (d) microbe (4) multi-
plies extremely rapidly in beef-broth kept at a
body temperature — that is, about 37deg. C. —
which turned the broth very turbid in 24 hours,.
164 SEWER GAS AND HEALTH. — APPENDIX VIII.
the broth being filled with microbes. In addition,
there are present by this time numerous flocculi
entirely made up of the bacilli. If the broth
culture is subjected to filtration by which these
bacilli are separated from the fluid, and this
latter is injected in small quantities (0*5 c. c.)
into guinea-pigs, it is found that they die in
from six to eight hours under symptoms of acute
poisoning. From this it is then clear that this
microbe is capable of rapidly forming in the
broth a poisonous chemical substance. In con-
<3lusion, from the foregoing observations the
following conclusions can be drawn : (1) the soup
<iontained microbes which were derived from
sewage, and it is thereupon highly probable
that the soup had been polluted with sewage.
Amongst the microbes present in the soup, the
bacillus mentioned as a variety of the bacillus
coli is possessed of virulent properties on account
of its extremely rapid multiplication at the body
temperature, and the poisonous substance it
elaborates. It is most probable that this microbe
caused the consumers of the soup the ill-effects
and the disease. This bacillus, it will be
remembered from the foregoing paragraph, was
present in the soup in enormous numbers."
After making further investigations into the possibility
of the pollution of the soup with liquid sewage, either
intentionally by some evil-disposed person or accidentally
by leakage from some pipe or otherwise. Prof. Hill
•concludes : [v i,
" I have previously remarked that the night was a
cold one, so that the sewer gas coming from the
top of this shaft would become heavier as it cooled,
SEWER GAS AND HEALTH. — APPENDIX VIII. 155
rand would thus tend to sink lower in the atmo-
sphere ; and my belief is that this sewer gas in
question did gain access to the outhouse by way
of the chimney, and that in this way the soup
was contaminated with those micro - organisms
which were found by Dr. Klein. I do not by
any means lay this down dogmatically, but after
a very careful consideration of all the local
circumstances, I see no method more likely of
contamination of the soup with the micro-organisms
of sewage."
2. Cases reported by Dr. Fenton (see also A-26, App. I.).
In the discussion on Dr. B. Hill's paper, given above,
Dr. Fenton, the medical officer of health for Coventry,
related two cases of meat-poisoning which had occurred
within his own knowledge.
In the first case, a piece of green salted pork had
been exposed in a pantry over an untrapped drain, and
had produced choleraic symptoms, although nothing could
be found by Dr. Klein.
In the second case, beef exposed to sewer gas had
produced severe alkaloidal poisoning in those who had
partaken of it.
156 SEWER GAS AND HEALTH. — APPENDIX IX.
APPENDIX IX.
Cases where Outbreaks of Typhoid Fever have been.
Traced to Sewer Gas.
1. Buchanan's Historical Gases (see also A-13 to 16,.
App. L).
It is not contended that the late Sir George Buchanan
was the first to trace outbreaks of typhoid fever to-
emanations from the sewers, but it is perhaps correct to-
say that he was the first to systematically investigate
several such outbreaks, and to attribute them to this
cause as a result of his researches. It would lead toa
far to give particulars of his classical investigations, and
such a course would be further hardly necessary, as
they are well known. I will, therefore, only mention
that in the epidemics of typhoid fever at Worthing in
1865 (Ninth Eeport Medical Officer of the Privy Council),
and at Croydon in 1875 (Appendix to Keport Medical
Officer of the Privy Council and Local Government
Board, New Series, No. VII.), Buchanan came to the
conclusion that sewer gas had entered the interior of
the houses and thus brought about the outbreak, whereas
in the local epidemic of typhoid fever at Caius College,.
Cambridge, in 1874 (Eeport Medical Officer of Privy
Council and Local Government Board, No. II., 1874),.
he was of opinion that sewer gas entered the water-
supply pipes, and thus brought about its pollution.
Concerning the Worthing epidemic, Buchanan remarks-
that, in his opinion, the absence of any attempt to>
ventilate the sewers, and the fact that sewer gas had.
SEWER GAS AND HEALTH. — APPENDIX IX. 157
been forced up into the houses through the water-traps
of sinks and water-closets was the cause of the outbreak.
As a positive demonstration of this he mentions the
following facts :
"The fever almost exclusively attacked well-to-do
houses on the higher levels, where the water-
closets were inside the houses, and almost
entirely spared the houses, mostly of a much
poorer sort, situated on lower levels, where the
closet was put outside the house. It was not so
in the times of cesspools ; then these low-lying
poor houses were far more attacked with fever
than the others. Moreover, the fever subsided as
soon as openings were made into the sewers,
from certain houses where it before maintained
itself for months." (Quoted by L. Parkes in " Is
Sewer Air a Source of Disease?")
In reference to the epidemic in Croydon in 1875,
Buchanan remarks (quoted by L. Parkes in the same
place) :
" Where sewers are small and ill-ventilated they con-
stitute perfectly sufficient means for the rapid
distribution of fever infection ; and places having
such sewers may not only show fever rates main-
tained as high as before the sewers were made,
but they may show as smart outbursts of fever
as are witnessed where conveyance through water
or milk is in question. Croydon itself, after it
had made its sewers and before it attempted to
ventilate them, had this experience. So in other
instances that have come under my personal
knowledge, fever has maintained itself after pipe
sewers, ill - ventilated, had been made, as in
Eugby, in Carlisle, in Chelmsford, in Penzance,
158 SEWER GAS AND HEALTH. — APPENDIX IX.
in Worthing; in the last two places breaking^
out in severe, sudden, and diffused epidemics,
without there being any question of other dis-
tribution than by sewers."
2. Cases reported by Dr. Blaxall (see also A-9 to 11,.
App. L).
An outbreak of enteric fever at Melton Mowbray in
1880 was traced by Dr. Blaxall to the occurrence of floods,
which caused the backing up of sewage specifically
infected by typhoid evacuations in the flat sewers, and
thus forced the sewer air to enter the houses through
untrapped drain inlets and dry water-closet traps.
The same observer reports an outbreak of enteric-
fever at Sherborne in 1882, which, in his opinion, was
caused through the contamination of the water-mains
by sewer air, the water-closets of houses being in direct
communication with the water-supply pipes.
3. Case reported by Dr. Airey (see also A-3, App. I.).
An outbreak of enteric or typhoid fever at York in
1884 was traced by Dr. Airey, of the Local G-overnment
Board, to '^ the exhalations from the ill- ventilated sewers
under the influence of a very dry and warm season."
4. Great Number of Other Cases.
A very large number of other cases could be quoted —
in fact, it is not too much to say that every year fresh
cases are reported by medical officers of health and
general practitioners in which the cause of an outbreak
of typhoid fever is attributed to sewer gas ; but, although
some of them have been investigated with great care,
it would lead too far to mention them here separately.
It must suffice to say that in this country it is almost
SEWER GAS AND HEALTH. — APPENDIX IX. 159'
a doctrine of practical faith that there exists a causal
relation between sewer gas and typhoid fever, and that
this doctrine is supported by strong evidence. Those
who wish to study this question more in detail will find
ample material in the reports of the medical inspectors
of the Local Government Board and in the annual reports
of the medical officers of health, not to mention the cases
which are from time to time reported in the medical and
other periodicals {Lancet, British Medical Journal,.
Health, etc.),
I will only quote two more cases, which have happened
within the last few years.
5. Enteric Fever at the Foundling Hospital, 1891,
reported by Dr. John F. J. Sykes (see also A-61,
App. I.).
In this case, Dr. Sykes proved that excreta were
backwatered into the main grease-trap of the hospital,
situated near the kitchen, which was connected with
the coppers in which the food for the inmates was
prepared, and he concludes that in this way typhoid
stools got into the grease-trap, which would undoubtedly
form a very good incubation chamber, whence, borne
by the sewer air, the typhoid germs found their way
through the coppers into the kitchen and house. During
cooking, the taps in the pipes leading from the coppers
to the grease- trap would, of course, be closed, and the
typhoid germs in the coppers destroyed through the heat
necessary for this process. After the food had been
served and consumed, the taps in the coppers would
be opened for cleansing, and it was probably the steri-
lisation that saved the food supplies from infecting the
; whole of the residents in the institution.
a 60
SEWER GAS AND HEALTH — APPENDIX IX.
The report contains many points of interest, and is
well worth a careful study.
6. Outbreak of Typhoid Fever at a Fever Hospital
at Leeds (see also A-17a, App. I.).
In the Surveyor of the 29th October, 1897, the
medical officer of health for Leeds, Dr. J. Spottiswoode
•Cameron, reports the following case :
■ " The hospital buildings consisted of three blocks,
roughly indicated on the diagram. Block A was a
disused township workhouse, which, along with block B,
D?x»ju«.^wymCo»vly"
:a one-storey building erected by the Guardians many
years before for ordinary hospital purposes, was pur-
chased by the Town Council for treatment of small-pox
in 1872. When the outbreak was over, these buildings
were used by the Corporation for the isolation of
other diseases. Block A, the original workhouse, was
utilised as an administration block, but occasionally
typhoid patients were admitted, generally into the room
■on the first floor marked a, less frequently into that
marked 6, and even occasionally into c and d on the
£rst floor. The motions of such patients, after disinfec-
i
SEWER GAS AND HEALTH. — APPENDIX IX. 161'
tion, were passed down the basin of a recently-constructed
long hopper water-closet on the first floor, built off a
passage which intersected the house north and south.
Eoom e on the first floor was occupied by a nurse, /
was a linen-closet, g a nurses' bedroom, and h the
matron's bedroom ; all these on the first floor. On
the ground floor under e was a bathroom, adjacent to
which, and immediately under the one on the first
floor, was a water-closet opening off the passage. The
rooms under / and g were kitchens, h was the matron's
sitting-room. The remaining rooms were only used for
storage. There was ample cellerage, chiefly under /
and g. The bathroom wastes and kitchen wastes were
disconnected from the drains, but the keeping cellar
under / had a trap in the floor. In B, the sink in the
nurses' kitchen w^as disconnected outside over a gully
in the ordinary way ; the two water-closets in B each
had a second trap ; they were then connected with the
drain coming from the one-storey washhouse, j, and
taking also the drainage from the two water-closets,,
the disconnected bath wastes, the disconnected kitchen
wastes, and the undisconnected waste from the cellar;
all from the building A. The Corporation erected a new
and separate pavilion, C, which was opened in 1881.
The drainage of this building was conducted by an
entirely separate drain to the main sewer in the street.
The water-closets in this building were entered each
through a separate cross-ventilated ante-room from the
ward ; each closet soil-pipe was doubly trapped ; the
bathroom wastes were disconnected outside, as were
also the waste from the kitchen and surgery. At the
time the limited outbreak of typhoid occurred, block B
was used for typhoid patients, block A only for
administration, block C entirely for scarlet fever..
11
162 SEWKR GAS AND HEALTH — APPENDIX TX.
Within a few days of one another (I am now speaking
from recollection) two nurses attending typhoid patients
in B, and sleeping in A, but not in any way engaged
in C, two children who had gone home from C con-
Talescent, and who had never been in B, and a day or
two later one or two other children patients in 0, sickened,
evidently with typhoid. The husband of the matron,
resident as caretaker of the establishment but livinjj;
entirely in A, had also a feverish attack, but not very
well defined. The only food common to all these
patients was. milk, some of the children in C having
had at the time of the attack no other food than milk>
and all the other patients having had milk, the care-
taker least. The first thing done was to direct that
the milk brought to the hospital should be taken to
«ach separate block. Before it had all been taken to
A, where it was kept in the cellar, /. This pre-
cautionary measure was adopted before the diagnosis
was quite certain. We then obtained from the milkman
a list of all the farms from which he got any milk.
We found no evidence of fever at any of them or among
any persons working there. Moreover, the persons
among whom the same milk dealer distributed his milk
elsewhere in the town were not specially attacked by
typhoid fever, which existed, but to no very marked
degree, in the borough, and not more among this man's
customers than among those of other dealers. It would
thus seem that if the milk were the cause of the
typhoid, it had received the infection after it reached
the hospital. No new case of typhoid occurred which
could have received the infection after the date when
the milk was delivered directly to the separate blocks.
It seemed, therefore, probable that the milk received
the infection in the cellar. I am not able to say
SEWER GAS AND HEALTH. — APPENDIX IX. 163
■whether there was any water in the trap connecting the
.small grate in the cellar floor with the drain. There
was no trap in the cellar, and it is not impossible that
the trap may have been dry. My own reading of the
^case was that through this trap the milk had been
infected by typhoid poison from the drain. It was
found afterwards that the soil-pipe from the block A
had been badly connected with the drain, and that
faecal matter had collected at the base. Three con-
•ditions seemed to have conspired to infect the milk: (1)
the actual typhoid germ ; (2) the culture medium of
filth; and (3) the opportunity for sewer gases to pass
into the milk. I use the words ' sewer gases ' as Mr.
Koechling does — to signify not only gases but solids
•carried by them. The trap was in the cellar floor. The
stone table on which the milk was kept was some 3ft.
higher. If my supposition be correct, the bacteria must
have travelled for a considerable distance through the
.air in order to reach the milk. The evidence that it
was the infection of the milk that caused the outbreak
rested principally upon the fact that some children
whose only food was milk, and who were entirely
separated from the nurses (who also drank milk, but
who did not enter the block in which these children
were), developed the disease at about the same time
as these nurses, and that no fresh case received the
infection after the milk ceased to be placed in the
•cellar."
7. Case reported by H. Alfred Boechling (see also
A-52D., App. I.).
Mr. Pioechling reports a case of typhoid fever in a
house with faulty drainage in the Journal of the
.Sanitary Institute for 1897, Vol. XVIII. The case was
IP
164 SEWER GAS AND HEALTH. — APPENDIX IX.
carefully examined by him, and is in many respects-
interesting ; it is accompanied by a plan of the
premises.
8. Gases reported on the Continent.
A number of cases in which sewer gas is said to-
have led to an outbreak of typhoid fever are reported
by German writers, and Dr. Uffelmann, who was a
prominent sanitarian and a very careful observer,,
maintained that it was an established fact, that
houses into which sewer gas entered periodically were
frequently visited by diphtheria, malaria, and typhoid
fever. At the meeting of the German Association
of Public Health in 1895, Dr. Goepel (see B-23, App. I.)
reported an interesting case from Frankfurt - on - the -
Oder, where a house was never without a typhoid-fever
case until the drainage was seen to and improved.
Further particulars will also be found in the very
interesting investigations of Dr. Lissauer (B-36, App. I.)-
at Danzig, concerning the entrance of sewage gas into«
houses.
SEWER GAS AND HEALTH. — APPENDIX IXa. 165
APPENDIX IXa.
Other Effects of Sewer and Cesspit Gas not
previously referred to.
1. Case of Blood-Poisoning through Sewer Gas (see also
A-21A, App. I.).
This is a very sad case, in which a Mr. Smith, of
Birmingham, is stated to have died through blood-
poisoning caused by sewer gas {cause celehre).
The executors of the late Mr. Smith sued the King's
Norton Kural District Council for damages for Mr. Smith's
death, and at the hearing of the action several medical
men expressed the opinion that the death was caused
through blood-poisoning brought about by sewer gas.
This was, of course, strongly contested by the other
side, but in the end the jury found for the plaintiffs,
and gave a verdict for ^3,500, which amount was after-
wards reduced to ^2,875, in consideration of the
^acceleration of the payment of some insurance money.
The following is the account of the trial as reported
in the Contract Journal of the 12th August, 1896, with
the sketches of the locality :
At the Birmingham Assizes, August, 1896, before
Mr. Justice Collins and a special jury, an action was
I tried in which the plaintiffs were Messrs. James Smith
"(the Lord Mayor of Birmingham), William Cecil Smith,
and Halliwell Eogers, executors of the late Mr. Thomas
Henry Smith, and the defendants the King's Norton
Eural District Council. The action was brought in
ihe interest of the widow and six children of the
leceased gentleman to recover damages for negligence.
166
SEWER GAS AND HEALTH. — APPENDIX IXa.
The deceased gentleman had lived at Daylesford, Wake-
Green-road, Moseley, and it was alleged on behalf of
the plaintiffs that he died from illness caused by the-
6fie»KfAsr Room
h 'i^r
defendants wrongfully breaking, and entering, and putting,.,
and continuing to maintain, a ventilating shaft from a
sewer into a chimney of Daylesford, or alternatively
SEWER GAS AND HEALTH. — APPENDIX IXa. 167
that the defendants constructed the work in a negligent
manner, or allowed the same to get into bad order,
whereby sewer gas, in or about January last, escaped
into the house, and caused the illness and death.
The defendants denied that damage had been suffered
through their negligence ; that they had been guilty of
negligence; that they carried a ventilating shaft from
the manhole into the chimney ; or that any sewer gas
escaped.
Mr. Murphy, Q.C., and Mr. Hugo Young (instructed
by Messrs. Eyland and Co.) appeared for the plaintiffs;
and Mr. Jelf, Q.C., Mr. Alfred Young, and Mr. Pritchett
(instructed by Mr. Edwin Docker) for the defendants.
In opening the case, Mr. Murphy said the enquiry
would be of an important character to both parties,
important to the executors, who claimed compensation
for the loss of a valuable life in which they were
interested, and to the defendants, because if the plaintiffs'
case was well founded there had been very great neglect,
for which they ought to be made responsible. The
late Mr. Smith had been the tenant since 1890 of
Daylesford, which fronted Wake Green-road and School-
road, Moseley. On January 9 last he disclosed symptoms
of blood-poisoning, and on April 28 he died. A post-
mortem examination showed that the view of the doctors
was correct, and that it was a case of blood-poisoning
caused by sewer gas. The defendants were the King's
Norton Eural District Council, and by the terms of a
recent Act of Parliament the responsibilities and liabilities
of the former sewer authority became vested in them.
In the month of December Mr. Smith suffered from
sore throat, which might or might not have been con-
nected with the sewer gas. On January 6, Mr. Augustus
Clay was called in. He prescribed, and his attention
168 SEWER GAS AND HEALTH. — APPENDIX IXa.
"was drawn to the possibility of the illness occurring
from the state of the drains. Upon enquiry it was
found that the drains had been examined in 1889, and
everything that was then known to be necessary was
done. At a subsequent date Dr. Carter was called in,
.^nd afterwards, in February, Sir Willoughby Wade, who
came to the conclusion that the illness was consistent
with an escape of sewer gas. The family were alarmed,
and one of the present plaintiffs, Mr. James Smith,
applied for the assistance of the sanitary inspector of
the Corporation of Birmingham to assist in finding out
what was the matter. On February 28 he communicated
with Mr. Houghton, the sanitary inspector of Moseley,
and an examination was made. In the cellar was dis-
covered an escape of some deleterious gas, which, however,
was not suJB&cient to account for the condition of the
•deceased. Subsequently a more exhaustive inspection
was made, and as the defendants would give them no
information, the parties acting for the plaintiffs made a
trench round the house, and found a pipe running from
a manhole at the corner of School-road and Wake
Green-road, which pipe was continued up the flue of
the house chimney. In its course it passed the library
in which Mr. Smith passed his evenings and the bed-
room in which he slept. The occupants of the house
knew nothing about that shaft, but Mr. Godfrey, the
chief surveyor of the defendants, knew, for the flue was
constructed to his knowledge and under his superinten-
dence in 1885. On discovery of that, a smoke test was
applied, and it was found that smoke put into the drain
at the manhole ascended into the library and the bed-
room, and when put in at the other end came out at
the manhole. The shaft was constructed in a most
negligent and slovenly manner. The joints did not fit,
SEWER GAS AND HEALTH.— APPENDIX IXa. 169
^nd in one place there was a complete aperture. There
was an imperfect obstruction at the manhole, consisting
of brickwork with the mortar still wet. Mr. Murphy
went on to say that in 1884 the land was vacant, and
permission was given to the local authority to run up
a ventilating shaft by the side of a tree. In 1885 Mr.
Gough wanted to build a house on the land, and he
submitted plans. He complained of the ventilating
shaft against the tree, and asked for its removal. Mr.
Godfrey claimed the right to keep it there, or to get
some exchange for it, and he pressed Mr. Gough to
give him a ventilating shaft to run up the chimney of
the house, and permission was given. Mr. Murphy then
indicated the extent of the deceased's business and the
pecuniary loss which his family had suffered.
The medical evidence was first taken.
Mr. Augustus Clay, surgeon, Moseley, said he attended
the late Mr. Smith during his illness, being first called
in on December 23. He had a sore throat and slight
febrile symptoms. The next day he went to his office
for a few hours. Witness did not see him again until
January 7, when he had a sore throat, fever, and
bronchial catarrh. Witness suspected some form of
blood-poisoning. On January 11 Dr. Carter was called
in in consultation, and on February 17 there was a
marked change in deceased's condition. He then had
pneumonia of the right lung, which continued until his
death. On discovering the pneumonia, there was another
consultation with Dr. Carter; and on February 27 Sir
Willoughby Wade was called in. He entirely agreed
that deceased was suffering from blood-poisoning in
some form. On March 2 deceased was removed to
witness's house. Sir Willoughby Wade said the drains
^bout Daylesford must be examined. As time progressed
170 SEWER GAS AND HEALTH. — APPENDIX IXa.
the patient became weaker, and on April 23 he diecf
very suddenly from blood-poisoning. A post-mortem
examination was made. The blood-poisoning was such
as he should expect to find in a man who had been
exposed to sewer gas.
By Mr. Jelf : From his enquiries he found that the
deceased gentleman had had pneumonia about ^Ye years
ago, and was then dangerously ill. About the end of
the second week in January witness formed the opinion
that deceased was suffering from blood-poisoning. Witness
was assured by the relatives that the drains were all
right. Besides deceased, there lived in the house Mrs.
Smith, several children, and servants. Assuming the
drains at Daylesford, apart from the ventilating shaft,
were defective, he should not think that would be
sufficient to set up the blood-poisoning; but assuming
there was pent-up sewer gas in the drains, of course
it would be very dangerous. He did not know that
the whole state of the drainage was very defective, had
been condemned, and had had to be reconstructed. He
should say deceased, who was 51 years of age, was
ordinarily a very healthy man.
Dr. Carter spoke to seeing the late Mr. Smith five
years ago, when he was ill from pneumonia. He was
then living at Daylesford. In the last illness, witness
was called in on January 11. He found deceased in
a very weak and prostrate condition, without anything:
of an obvious character to account for it. Witness
formed the opinion that the cause of the illness was
exposure to insanitary influences, and he made enquiries.
He agreed with the symptoms described by Mr. Clay.
In his judgment death was due to blood-poisonings
which was such as would be caused by exposure to
sewer gas.
SEWER GAS AND HEALTH. — APPENDIX IXa. ITT
By Mr. Jelf : Blood-poisoning might arise quite
independently of insanitary conditions. Supposing it
turned out that Daylesford was in a shockingly insani-
tary condition, that might be amply sufficient to account
for all he found.
By Mr. Murphy : Whatever mischief there might be
locally, the connection with the sewer would aggravate it.
Sir Willoughby Wade said he was called in first on
February 27, and then, from the state of the patient's
throat and from the history of the case, he formed the
opinion that he was suffering from blood - poisoning.
Sewer-gas poisoning most frequently attacking the throat,
he formed the opinion that the illness had arisen from
a cause of that kind. His subsequent visits to the
deceased confirmed his first impression.
Mr. Hugo Young : Supposing other people in the
house suffered from carbuncles and boils, to what would
you attribute them? Sir Willoughby Wade: They might
arise from sewer gas. — That would be a symptom of
blood-poisoning from gas from a sewer ? It might be so.
Cross-examined : Sewer emanations of any kind might
produce infectious disease in the absence of any venti-
lating pipe from the main sewer. At his suggestion the
drainage about the house was examined.
Mr. Arthur Knight, son-in-law of the deceased, said that
in April, 1895, he stayed at Daylesford for some time,
and after he had been there a few weeks he suffered
from carbuncles and boils. He had never suffered from;
them before. In 1896 he was at Daylesford again, and
again had another attack of carbuncles and boils.
Cross-examined : He never noticed that the cellar, the
closets, or the bathroom were insanitary.
Miss Jessie Smith, daughter of the deceased, stated
that in November, 1894, she suffered from an abscess,..
1172 SEWER GAS AND HEALTH. — APPENDIX IXa.
and afterwards from a succession of boils. She went away
from home and soon recovered.
Dr. Melson was called to speak to an illness of deceased
about five years ago, and, in reply to Mr. Jelf, he said
the question of the condition of the drains never came
up. Mr. Smith completely recovered from that illness,
and witness considered him a strong man.
Miss Dora Smith, another daughter of deceased, also
spoke to suffering from a number of carbuncles and boils
in April, 1895. In July, last year, her mother suffered
from very much the same thing. Up to 1894 none of
them suffered from carbuncles or boils.
Dr. Katcliffe gave evidence to attending Miss Jessie
Smith in her illness. He enquired as to whether the
drains were right, because he could find no other cause
for the abscess or boils.
Mr. J. Parker, inspector of nuisances to the Birmingham
Corporation, said that on February 28 he went to Dayles-
ford, with an assistant named Keasey, and made an
inspection. He found defects, but not then sufficient to
account for the illness. On a subsequent occasion he
tested the ventilating shaft and other pipes, and found
them very defective. The fumes from a ventilating shaft
in the chimney found their way into the library and
bedroom. It was absolutely wrong to turn a ventilating
shaft into a chimney, as was done in this case.
By Mr. Jelf : In the cellar, immediately beneath the
library, there was a gully stopped up. In it there was
a quantity of what appeared to be decomposed urine.
There were three ventilating spaces in the cellar.
The walls of the cellar were damp. He did not go on
the inspection in any official capacity. He went at the
request of the Mayor, and at his expense.
Mr. Jelf : Is it usual for the officers of these different
SEWER GAS AND HEALTH. — APPENDIX IXa. 173-
bodies co go out and take part in matters against local
authorities in the neighbourhood around ?
Mr. Parker : It is not unusual. — You are the inspector
of nuisances for the city.
Mr. George Eobinson, builder's agent, having given-
evidence,
Mr. W. Martin, architect and surveyor, stated that
on March 7 he made an inspection of the house. The
smoke test was applied downwards from the shaft to
the manhole, and they saw it coming through the
"patch," covering what had been an outlet from the
drain to the manhole. The mortar was wet. The
upward test filled the library and the bedroom with
smoke. The jointing of the ventilating shaft was
defective. On March 19 he saw Mr. Godfrey, who was
very indignant, saying that the covering from the drain
to the manhole had been interfered with. The hammering
from the inside by a rod pushed down the drains would
probably displace the brickwork.
By Mr. Jelf : The house was built by a Mr. Gough,
now deceased. — Mr. Jelf: Is he a jerry builder ? Witness :
He was what is known as a respectable jerry builder.
He was one of the best of his class in Birmingham —
Not a sort of man you would entrust with any important
drainage? He was a man who would think of himself.
Witness added that he had never before heard of a
ventilating sewer in connection with a flue. — Mr. Jelf:
Do you say it is never done, when you want to ventilate
the upper part of a sewer, to take the sewage gas by a
pipe up by the side of the house? Mr. Martin: No. —
I Assuming it had been taken up in a pipe outside the
stack of chimneys, and not inside, you would not say
that was anything improper or unusual? If it is taken
high enough above the windows. — Supposing it is taken
174 SEWER GAS AND HEALTH. — APPENDIX IXa.
in a proper pipe inside a separate flue, you would say
it is the same thing ? I should want it carried to a
great height above the top of the chimney. Witness
explained that if the pipe were not carried well above
the chimney pipe, the fumes, in the event of several
chimney flues standing together, would be apt to ascend
one flue and descend another.
Mr. F. W. Martin, son of the last witness, corroborated
his father's evidence.
Other witnesses were then examined.
Mr. James Smith, Lord Mayor of Birmingham, and
brother of the late Mr. T. H. Smith, said the latter was
a very strong man. When at home his brother chiefly
used the library. His business was that of wholesale
stationer. He was in partnership with his father. By
an agreement made in 1885 deceased was entitled to
two-thirds of the profits of the business. Deceased
managed the business, his father having retired. In
order to carry on the business since his brother's death,
they had had to incur expenses to the amount of iJ389
a year. The average profits for the last three years
had been i61,672 per year. He estimated the decrease
in the future earnings owing to his brother's death at
25 per cent. — £418 per year — reducing the total to
j61,254. From that he deducted also ^6339, money paid
for extra assistance, leaving the widow's two-thirds
share at d6610, as against i61,115, or a loss of i^505.
Taking the life of the deceased at 51, and capitalising
it upon a 3 per cent, table, gave £7,035. Deceased
was insured for £2,500, and the premiums were
£88. 15s. per annum. He had passed as a first-class
life since his previous illness.
This completed the case for the plaintiffs.
Mr. Jelf, in opening the case for the defendant
SEWER GAS AND HEALTH. — APPENDIX IXa. 175
:authority, expressed their deep regret at the termination
of so valuable a life. He maintained that there was no
liability whatever, on any theory, on the part of the
defendants for anything that had happened. He
described the history of the property, and said that in
1891 Mr. Essex, the architect, asked that the exit in
the manhole should be closed up. That was the vent-
hole over which they had got to fight out the battle.
Was the opening from the manhole stopped up or not?
That was the real battle-ground. He should call Mr.
'Godfrey and Mr. Essex, and the jury would hear the
: arrangements that were made with them. He would
;also call the bricklayer who was employed to put in the
barrier, and which was done in cement, and by which
the shaft was effectively shut off. Since then several
people had seen the manhole, and the aperture had
always been closed. Mr. Jelf complained strongly that
the manhole and sewers were overhauled in the absence
•of anyone representing the defendants, and said that
amongst so many people there was no difficulty in
imagining that someone, thinking he was doing a very
clever thing, pulled out some of the brickwork and put
in other. When they were pounding away with a rod
to try and find an exit, that would naturally shake the
bricks, and might even produce dislocations. When
people went down into the manhole once and could not
find anything, and when, three days afterwards, a
beautiful patch appeared, it looked uncommonly as if
something had been done. Mr. Murphy was going to
try and put it on to his (Mr. Jelf's) clients, but they
would tell them that they knew nothing about it.
Naturally, when Mr. Godfrey, the defendants' surveyor,
discovered what had been done, he was very angry.
Which was the side that had acted perfectly above
176 SEWER GAS AND HEALTH. — APPENDIX IXa.
board ? When there were investigations, the plaintiffs^
agents took care that no one else was present, wherea&
the defendants always invited the other side to their
inspections. In the correspondence which had taken place
the defendants had called attention to certain acts of
trespass and damage by reason of the manhole having
been entered, but no answer was made to this charge.
He described it as a dirty and unhandsome thing for
the plaintiffs' agents to go to the premises unknown
to the defendants. If he was right in saying that the
opening into the manhole was bricked up in 1891,
what did it matter whether the pipe was taken up or
not ? If the bricking was effectual, as he should show
it was, then there was no case. Speaking of how the
deceased gentlemen met his death, Mr. Jelf said he did
not think there was much doubt that it was due to
something in the nature of a septic affection in the
throat — that it was something which exhibited signs of
some specific disease. A specific disease of that kind
was not contracted by being taken direct from sewer
gas. It was a thing which was apt to come from all
kinds of causes, only it was most likely to attack those
who had been predisposed to it. It was a vicious
complaint which flourished best on the soil which was
best prepared for it. In the constitution of a person
exposed to insanitary conditions, it was very likely to
have very injmrious effects. If the house was in a bad
sanitary condition in regard to its own drains — suppos-
ing it were bad enough — that would be amply sufficient
to account for the preparation of the body for the
disease which came to Mr. Smith without anything
coming from the shaft. Mr. Jelf laid stress upon the
unhealthy condition of the cellar, where, he said, there
was a gully absolutely stopped, and where decomposed
SEWER GAS AND HEALTH. — APPENDIX IXa. 177"
urine lay. This was directly under the library, and
not far from the bedroom. The boards over the cellar
and forming the library floor were so far apart that
one could see through them. The fire would be
eminently calculated to draw up exhalations from the
place below. He did not think they need go any
further than that. Deceased's illness, which might have
been caught anywhere, was aggravated by the conditions
of the house.
Mr. Godfrey (examined by Mr. Jelf) said that he
remembered Mr. Essex, the architect, calling and
stating that he was preparing plans for the erection of
certain houses. Witness, on being asked about the shaft,
said that he had no objection to the shaft being
removed from the tree if Mr. Essex would give a new
shaft up the house. Ultimately it was decided to have
the shaft in the chimney. By arrangement with Mr.
Essex he laid tapering pipes from the sewer to the
boundary of the house, Mr. Essex undertaking, on behalf
of his client, to carry the shaft up the property. The
sanitary authority had nothing to do with the ventilat-
ing shaft. In February, 1891, he was asked by Mr.
Essex to brick up the opening from the manhole into
the shaft, and he promised to do so. Up to 1895, when
the new authority came into power, the roads were in
the hands of the surveyor of highways. From 1891
until 1895, the road was repaired and raised from time
to time, with the result that the manhole became
gradually covered. In 1895 he became surveyor of the
roads, and having occasion to find the manhole he
found that someone had interfered with the brickwork,
tand that mortar had been removed.
Mr. Oliver Essex, the architect, also gave evidence as to
the negotiations. He said that he did not understand
178 SKWKR GAS AND HEALTH.— APPENDIX IXa.
Mr. Godfrey to insist on the right to maintain the tree
shaft or have a quid pro quo. Mr. Godfrey suggested
the alternative.
By Mr. Murphy : He should not like such an arrange-
ment in his own house.
Charles Brown, sewer foreman, deposed that in
February, 1891, he received orders from Mr. Godfrey
to brick up the connection between the manhole and
the shaft, and he accordingly gave instructions to
Sawyer. Witness superintended the work, which was
done with brindled bricks and Portland cement. The
work was properly done, and the cement must have
set in 20 hours. In 1895 witness saw the manhole
in the same condition as when he built it up in
1891, the bricks and cement being in good order.
In February, 1896, he examined the drainage of the
house from the outside. The syphon to the cellar
was choked and full of solids, the result, in his
opinion, being that the water from the lavatory went
hack into the cellar. Up to that time he had no
idea that there was a cellar drain. The water fall-
ing from a height under such conditions would tend
to go both ways — into the cellar and into the sewers.
The lavatory pipe, however, was cut off when it joined
the cellar drain. Such a condition of things would
render the house unhealthy. There was also a
defective soil-pipe, and altogether the house, on account
of the state of its own drainage, was an insanitary
dwelling. On March 19, under the direction of Mr.
Godfrey, he examined the manhole. At one place he
found green soft mortar. He and Mr. Webb took the
whole of the bricks out, leaving the opening as it was
early in 1891, only a little smaller. He saw something
like whitening trickling out, and also found some at the
SEWER GAS AND HEALTH. — APPENDIX IXa. 179
vDack of the bricks. Mr. Lowcock and Dr. Hollinshead
■went down. The opening was left open for about a
fortnight, and was then bricked up again. When he
met Mr. Parker and others at the house, witness had
a plan of the house, which was laid out on the
^kitchen dresser so that all present could see it. The
plan was not kept back from anybody.
Ke-examined by Mr. Jelf, Q.C. : The state of the
(house drains would fully account for all the bad smells.
He had never tried whether a rod of the kind produced
either with or without a heavy ball at the end would
• displace a piece of 4|in. brickwork.
William Henry Blundell, labourer, examined by Mr. A.
Toung, stated that under the direction of Mr. Godfrey
he took part in fixing the brickwork. He went down
;the manhole in 1895, and found the brickwork all right.
A workman named Marshall gave similar evidence as to
:the state of the brickwork in 1895. If there had been
anything wrong with it, he would have seen it.
By Mr. Murphy : He did not know anything at the
.time about the ventilating shaft.
Charles Harry Webb, assistant surveyor, examined by
"Mr. Pritchett, said that when the manhole was examined
on March 19 he found that the joints of the brickwork
liad been raked out with a knife or something of the
kind. The whitening had just oozed through, but was
not trickling down the sides of the manhole. The bricks
had been disturbed, and were set in green mortar. The
• old cement, quite hard, was still adhering to the brick-
work. That was his first knowledge of the existence of
the shaft. He had never heard of anyone connected
with the authority interfering with the brickwork, and
he did not know anything previously of the existence
of the shaft.
12*
180 SEWER GAS AND HEALTH. — APPENDIX IXa.
John Houghton, assistant inspector of nuisances, wha
took part in the examination of the manhole, examined
by Mr. A. Young, stated that there was not the slightest
sign of percolation through the brickwork. He did not
know of an}^ tampering with the brickwork on the part
of the defendants. No objection was made, as far as
witness was aware, to anyone seeing the plans.
By Mr. Murphy: He knew nothing about the ventilating
shaft previously. This was surveyor's work, and he was
inspector of nuisances. He was a party to the report
made by Mr. Brown which referred to some ''serious
defect which at present we cannot localise." That report
was made on February 28, but the inspection of the house
drains was not completed until March 3. A defect in the
junction between the iron pipe and the earthenware pipe
was discovered on February 29. This was outside the
house, but it would account for the *' serious defect,"
the discovery of which the report had anticipated.
Mr. Sydney Kichard Lowcock, of 35, Waterloo-street,
Birmingham, Associate of the Institute of Civil Engineers,
declared the house to have been extremely insanitary, quite
apart from the question of the ventilating shaft. The
drain in the cellar, which was not shown on the authorised
plan, was quite enough to account for any illness that
had arisen. There ought not to be a drain in the cellar
at all, because such a drain was likely to get dry, and
so unsealed. On any defect arising iii the connections,,
there was a danger of refuse and bad smells backing up
into the cellar. There were other defects in the drainage.
The emanations from defective house drains were likely
to be a great deal worse than those from a well-built
sewer. The connection of rainwater-pipes directly with
the drains was universally acknowledged to be a source
of danger. A gentleman sitting up late with a fire in
SEWER GAS AND HEALTH. — APPENDIX IXa. 181
his room would be very likely to breathe the foul gases
from the cellar. On March 14, attention having been
called to the existence of a ventilating shaft, he went
down the manhole. He found that the vertical joints
of the brickwork had been opened to such an extent
that Dr. Fosbrooke, who went down with him, could
push a wooden foot rule right through. If the rod
produced were pushed down the pipe, it would be quite
sufficient to displace 4 Jin. brickwork.
By Mr. Murphy : It would be quite possible, even if
the bricks were found all right in 1895. If a great
pressure could not be brought to bear with such rods
they would not do for clearing out drains, which was
what they were made for. Accumulations of soapsuds
and bath waste generally would cause emanations quite
as injurious as those from any other source. The
lavatory must have sent deleterious matter into the
drain in question.
W. Wright, formerly a clerk in the employ of the
authority, produced a wages-sheet showing that a man
was paid in 1891 for blocking up the foot of the
ventilating pipe.
Dr. Saundby expressed the opinion that the state of
things disclosed as to the house drains was sufficient
to account for Mr. Smith's illness and death. Even
supposing there were an influx of gas from the public
sewer, that was not likely to be more than a predisposing
cause of such disease.
Dr. George Fosbrooke, medical officer of health for
Worcestershire, deposed to visiting the house on March 19,
and expressed agreement with the opinions of Dr. Saundby
as to the cause of Mr. Smith's illness.
By Mr. Murphy : You would rather expose a patient
to a good blast of sewer gas than to what has been
182 SEWEK GAS AND HEALTH. — APPENDIX IXa.
described as existing in this house? I think that the
gases emanating from the drain would be worse than^
those from the sewer. — You would prefer the sewer ?'
Yes. — Would you like to have a shaft from the sewer
in your chimney ? Not unless it were tight. — In a
jerry-built house ? Not unless it were perfectly tight. —
You would be afraid of it ? Yes. — You would not like
to have your children in the house ? No.
Dr. Francis Hollinshead, medical officer of health to-
the defendant authority, also declared that the state of
the house drains fully accounted for the illness.
By Mr. Murphy : You agree with the opinions expressed
by the other doctors ? Well, not quite. There is a.
question in my mind as to whether it was true septi-
ccemia or not. It is very difficult to say where
ordinary sore throat ends and septicoemia comes in.
By Mr. Jelf : Don't you think that the gentlemen who-
saw this patient would be quite as good judges as to^
the symptoms as those who did not, if not better?.
Possibly.
This closed the case for the defence ; and counsell
on each side having addressed the Court,
His Lordship, in summing up, said that the questions-
to be decided by the jury were. Was Mr. Smith's death
caused by the escape from the sewer ventilator, and, if
so, what damages should be given? Many points arising.
in the case had been agreed upon. The case for the
plaintiff was a straightforward one. There could be no
doubt that Mr. Smith, immediately before these symptoms
appeared, was in robust health, and it was no longer
in dispute that death was caused by blood-poisoning..
Neither was it disputed that the presence of sewer ga&
would be a sufficient cause of blood-poisoning which
might result in death. If the jury found that sewer gas.
SEWER GAS AND HEALTH.— APPENDIX IXa. 185
got into the house through the ventilator, they were
confronted with another problem — namely, the alternative
raised by the defence : that the more probable cause of
the symptoms was the condition of the drains, as to
which a considerable amount of evidence had been
tendered by the defence.
The jury retired shortly before five o'clock. They
several times called for their custodian, but only to ask
for refreshment and to state that there was no prospect
of them agreeing. Ultimately the judge was sent for^
arriving at a quarter to eight.
The Foreman informed his Lordship that the jury were
unanimous as to the death being due to an escape of
sewer gas from the ventilator, and that eleven of them
were agreed as to the question of damages.
His Lordship asked the jury if he could help them
in any way. He thought it would be a pity if a.
special jury in the city of Birmingham could not
decide a question which was settled almost every day
by a sheriff's jury.
The dissentient juryman said that he thought the-
damages agreed upon by his colleagues most excessive.
His Lordship said that in assessing damages in such
a case they should take into account the time of life
at which the man died, how long he might ■ have livedo
and what he might have made for his family. From
that they would have to deduct his personal expenses;
but, on the other hand, they must take into account,
the provision of a person in his stead to manage his-
affairs.
A further consultation having proved unavailing, his.
Lordship advised the jury to look at the matter in the
spirit of compromise. It would be a public scandal if,,
after two days of assize, they failed to agree on the-
184 SEWER GAS AND HEALTH. — APPENDIX IXa.
question of damages. He must ask them to address
themselves to the question again.
After another little talk the Foreman stated that one
man seemed to have made up his mind. Practically
there was no hope of agreement unless the eleven gave
way to the one.
" The one " informed his Lordship that he had already
met his colleagues by ^61,000.
The Foreman : It is only a question of years of life
that we cannot agree upon, and there is only a difference
of two years between us.
The jury, after another short dispute, agreed upon a
verdict for £3,500.
On Thursday morning, 6th August, 1896, his Lord-
ship heard the defendants, represented by Mr. J. E.
Jelf, Q.C., Mr. Alfred Young, and Mr. Pritchett, on
the questions of law. Mr. Hugo Young appeared for
the plaintiff.
In the first place, Mr. Jelf applied for a reduction of
the damages in respect to the insurance, pointing out
that, whereas the jury had assessed the loss at d63,500
capitalised, the family would receive, with the insurance,
j66,000, which passed absolutely into their own hands.
It was submitted that an allowance should be made in
respect to the accelerated payment of the premiums,
14 years being mentioned.
Mr. Hugo Young claimed that 8J years, as the presumed
basis of the jury's finding, should guide his Lordship.
He further contended that the policy was an investment,
capable of treatment like unto that of the rest of his property.
Mr. Jelf applied that judgment should be entered for
defendants. The jury had only found on one single
fact out of all the facts involved. They had found that
flewer gas from the shaft was a cause of death.
SEWER GAS AND HEALTH. — APPENDIX IXa. 185
The Judge : The cause.
Mr. Jelf submitted not. He held there was nothing
to show that what came from the shaft was not assisted
in producing death by other causes.
Eventually the Judge allowed a reduction in the
damages of £625 for the acceleration of the payment
of the insurance money. He entered judgment for
.i'2,875 as against the District Council, and stayed
execution for 21 days. — Birmingham Post, 5th, 6th and
7th August, 1896.
2. Case of Diphtheria attributed to Cesspit Gas,
Damages Awarded £50,
The following account is taken from the Journal of
State Medici^ie for August, 1897 :
" Deaths from Diphtheria — Action for Damages. — An
action has just been tried before Mr. Justice Wills
against the owner of certain cottages at Bexley Heath
for negligence in allowing a cesspool to become a
nuisance. The plaintiff lost three children through an
attack of diphtheria, which it was alleged was caused
by the effluvium from the defective cesspool, and sued
for damages. Mr. Justice Wills held that the defendant
was liable, and gave judgment for £50 damages and
costs.
186
SEWER GAS AND HEALTH. — APPENDIX X.
APPENDIX X.
Influence of Sanitary Works upon the Mortality from
Typhoid Fever.
1. Investigations of the late Sir George Buchanan
(see also A-14, App. I.).
On page 35 of the annual report of the Medical Officer
to the Privy Council for the year 1866, the late Sir George
Buchanan gives the following classical table, which clearly
illustrates the influence of sanitary works upon the health,
of towns at that time :
Table I. —Mortality from Typhoid Fever in Various English Towns
before and after the execution of Sanitary Works.
Buchanan's Table.
Population
1861.
Towns.
Periods of
Comparison
Mortality from
Typhoid Fever per
10,000 Inhabitants.
befor
after
before
after
the Const
Sanitary
ruction of
Works.
the Const
Sanitary
ruction of
Works.
160,714
68,056
52,778
39,693
32,954
Bristol
1847-1851
1845-1851
1845-1855
1845-1857
1847-1854
1845-1850
1845-1853
1845-1852
1845-1849
1843-1853
1845-1855
1845-1853
1843 1850
1844-1852
1843-1852
1845-1852
1845-1851
1845-1852
1845-1853
1845-1851
1843-1852
1843-18.52
1845-1852
1845-1851
1862-1865
1862-1864
1862-1865
1860-1865
1859-1866
1857-1864
1858-1864
1857-1864
1860-1865
1857-1865
1859-1864
1857-1846
1856-1865
1857-1864
1855-1864
1859-1864
1855-1864
1856-1864
1860-1864
1856-1864
1856-1865
1857-1885
1856-1864
1855-1864
10-00
14-60
21-33
8-00
17-33
15-00
10-00
14-25
16-33
14-00
1900
16-00
7-50
7-50
12-00
10-40
10-00
10-00
12-50
13-50
23-50
7-50
16-50
13-50
6-50
7-75
8-66
4-66
10-50
5-50
9-75
8-50
10-33
9-00
9-00
8-33
8-00
1-75
12-66
4-50
9-00
4-50
4 00
8-66
10-25
9-25
10-00
5-75
Leicester
Merthyr Tydfil ...
Cheltenham
Cardiff
30,229
29,417
27,475
24,756
23,108
10,570
10,238
9,414
Croydon
Carlisle
Macclesfield
Newp)ort .►.
Dover
Warwick
Banbury
Penzance
9,080
Salisbury
8,664
Chelmsford
7,847
7,818
7,189
6,823
6,494
6,334
5,805
4,490
3,840
Ely
Rujjby
Penrith
Stratford-on- Avon
Alnwick
Brynmawr
Worthing
Morpeth
Ashby-de-la-Zouch
SEWER GAS AND HEALTH. — APPENDIX X.
187
2. Cases quoted by SoyJca (see also B-55, App. I.).
In his paper at the Vienna Congress of the German
Association of Public Health, in September, 1881, Soyka
quotes a number of German towns in which, after the
introduction of a proper system of sewerage, the typhoid
mortality has considerably decreased. Concerning Munich,,
he gives the following interesting table :
Table II.— Typhoid Mortality in Munich.
Periods.
Year.
Sanitary Progress.
Number of
Deaths from
Typhoid Fever
per 10,000
Living.
1
2
3
i' 5
1852-1859
1860-1865
1866-1873
1874-1880
1881-1885
No means whatever for prevent-
ing the pollution of the sub-
soil and air.
Commencement of reforms —
making of cesspits water-
tight etc.
Sewerage in parts of the town.
Continuation of the sewerage ..
Sewerage of town still further
improved.
24-20
16-80
13-30
8-90
1-75
In the first period it may well be assumed that all
the cesspits were utterly neglected, and no supervision
whatever exercised. No doubt, cesspit or sewer gas freely
circulated in the interior of the houses without let or
hindrance. Of those days it has been said that the
smell of cesspits was ever present in the taste of man,,
and houses were little better than ammonia works on
a small scale.
In the second period, cesspits were more systematically
constructed and emptied. Probably, too, the question of
the disposal of other refuse matters was more carefully
looked into, and, generally speaking, in this period the
noxious gases from the decomposition of organic matters
were more methodically treated and avoided.
188 SEWER GAS AND HEALTH. — APPENDIX X.
In the third period, no doubt all these questions were
still further examined, with the result that the town
was partially sewered, and although the sewers were
originally not intended to convey away faecal matters,
it is recorded that the overflow from the cesspits in
many cases was connected with them. At any rate,
there is no doubt but what the gases from decomposing
faecal matters were more and more excluded from the
interior of the houses. In the fourth and fifth periods,
the sanitary arrangements of the town were still further
improved.
The successive improvements in the death-rate from
typhoid fever can be clearly traced in this table.
At the present time all faecal matters are passed
direct into the sewers, and without the intervention of
cesspits.
3. Investigations by P, Baron (see also B-2, App. I.).
P. Baron examined this question for a very large
number of German towns with and without drainage,
and found that in Berlin, Danzig, and Hamburg the
typhoid mortality had considerably decreased since the
introduction of the water-carriage system.
He then compared the average typhoid mortality for
nine years in 37 towns without drainage with the
mortality in 46 towns with good drainage, and arrived
at the following conclusions :
1. The heaviest typhoid mortality occurred in towns
without drainage.
2. Average rates occurred more frequently in non-
seweraged than in seweraged towns ; and
3. The lowest typhoid rates were by far more
frequently observed in seweraged towns.
Baron further then subdivided the towns into those
SEWER GAS AND HEALTH. — APPENDIX X. 189
with the highest and those with the lowest typhoid rates,
and found :
4. Out of 70 towns with the highest yearly rates,
51, or 73 per cent., were not drained ; and
5. Out of 51 towns with the lowest yearly rates, 36,
or 70 per cent., were drained.
Summarising these results, he concludes his investiga-
tions by saying :
"The lowest yearly typhoid rates occurred in 36, or
78 per cent., of the 46 seweraged towns, and only
in 15, or 40 per cent., of the 37 towns without
drainage.
4. Typhoid Fever at Berlin (see also B-68, App. I.).
It might not be out of place to make a few remarks
here on the prevalence of typhoid fever (typhus abdo-
minalis) in Berlin before and after the systematic sewering
of the town, as the statistical material at our disposal
appears to have been collected with the greatest care.
In Table III., on the next page, I have given the
number of deaths from all causes and from typhoid fever
between the years 1854 and 1890, and with a view to
illustrate the movement of these death-rates I have
prepared Diagrams No. I. and II., on which I have
also noted the years in which various of the sanitary
improvements have been commenced or carried out.
On reference to the table and to Diagram I., which
shows the typhoid rates, it will be seen that there has
been a very steady decline in the typhoid mortality since
1856, when the waterworks were opened, but that this
decline has become considerably more rapid since the
commencement of the drainage works in 1875. In
Diagram II., which, together with Diagram I., is taken
190
SEWER GAS AND HEALTH.— APPENDIX X.
Table III.— City of Berlin.
Mortality from all Causes and from Typhoid Fever between
1854 and 1890.
Mortality
' from all
Mortality from Typhoid
Year.
Population.
Causes.
Fev
er.
Deaths in
Actual
Number of
Deaths
per 1,000
Actual
Number of
1,000 Deaths
from all
Causes.
Deaths.
Inhabitants.
Deaths.
1854
429,390
10,305
25-60
342
34-6
1855
432,685
12,328
29-99
483
42-2
*1856
442,040
10,889
26-30
397
38-2
1857
449,610
12,664
30-16
536
44-1
.1858
458,637
11,854
28-03
426
37-3
1859
474,790
12,163
•27-78
490
41-1
1860
493,400
10,988
24-34
371
34-5
1861
547,571
14,201
28-18
440
33-4
1862
567,560
14,044
26-94
467
39-0
1863
596,390
16,473
30-21
488
31-8
1864
633,279
17,848
30-99
459
27-3
1865
657,690
20,609
33-80
693
35-7
1866
665,710
26,305
41-62
599
24-9
1867
702,437
18,668
28-96
485
27-5
1868
728,590
23,531
34-69
725
31-9
1869
762,450
20,193
26-48
518
25-2
1870
760,000
22,984
30-24
596
25-9
1871
825,937
30,756
37-24
732
23-8
1872
864,300
26,635
30-82
1,208
45-4
1873
900,620
26,427
29-34
859
32-4
1874
9.32,760
27,423
29-39
691
25 -l>
tl875
966,858
31,225
32-29
805
25-8
1876
995,470
29,185
29-32
623
21-3
1877
1,010,946
29,988
29-66
612
21-0
1878
1,039,447
30,629
29-47
326
io-«
1879
1,069,782
29,545
27-62
296
10-0
1880
1,122,330
32,823
29-25
506
15-4
1881
1,138,784
31,055
27-27
340
10-9
1882
1,175,278
.30,465
25-92
355
11-7
1883
1,212,327
35,056
28-92
221
6-3
1884
1,250,895
32,932
26-33
241
7-3
1885
1,291,359
31,483
24-38
214
6-7
1886
1,337,171
34,293
25-65
181
5-2
1887
1,386,562
30,333
21-88
193
6-3
1888
1,439,618
29,294
20-35
188
6-4
1889
1,495,151
29,545
19-76
290
6-4
1890
1,548,279
.32,823
2M9
143
4-2
* 1856, opening of waterworks, f 1875, sewerage of town commenced.
SEWER GAS AND HEALTH. — APPENDIX X, 195
from Dr. Weyl's book, quoted under B-68, App. I.,
is shown the rise and fall of the general death-
rate between 1840 and 1890, and from this it would
follow that whereas since the opening of the waterworks
the general death-rate shows, if anything, a slight increase
over previous years, it at once commences to fall with
the starting of sewerage operations in the town, and has
done so more or less regularly ever since. If we compare
the results of these two diagrams, the thought forces
itself upon one's mind, that of the two great sanitary works
the sewerage has exercised the greater beneficial influence
upon the public health of Berlin. It would be very
interesting to investigate this apparent difference further,
but for this I regret there is no time.
It is by no means contended that to this reduction in
the death-rates only the water supply and drainage have
contributed. On the contrary, no doubt, a great many
other factors have added their quota, but I think we
are perfectly entitled to say that amongst the beneficial
influences at work, sewerage and water supply occupy a
most prominent position.
Dr. Weyl mentions, concerning the reduction of the
typhoid mortality in the years immediately preceding the
commencement of the sewerage and since that, out of
1,000 annual deaths, there were on an average due to
typhoid fever :
In the years 1871 to 1880, 23*05 cases.
„ 1881 to 1890, 7-18 „
This shows that in the 10 years since the partial
completion of the sewerage works the typhoid rate per
1,000 deaths from all causes was less than one- third of
what it was in the previous 10 years. The sewerage
of the town might be said to have been commenced in
1875, and has been carried on ever since.
13
194 SKWKH CAS AND HEALTH.— APPENDIX X.
5. Other Cases.
Innumerable other instances might be quoted where,
after the drainage of the place had been carried out,
the mortality from typhoid fever has year after year
•decreased, but this would lead too far.
It will suffice to say that ever since Buchanan drew
a<ttention to this connection for the first time in his
memorable report of 186G (A- 14, App. I.), such a reduction
has in almost every case been observed, not only in this
•country, but also abroad, where a place has been
systematically sewered, and that where it has not taken
place, special and local reasons have been found to exist
which prevented it. We, therefore, consider this reduc-
tion in the typhoid mortality consequent upon the
systematic sewering of a town practically in the light of
an axiom.
SEWER GAS AND HEALTH. — APPENDIX XL
195
APPENDIX XI.
TNOTES ON THE COINCIDENCE BETWEEN TyPHOID FeVER AND
Faulty Drains as Demonstrated by the Smoke and
Other Tests.
1. Experience at Leicester.
In Leicester, it has now become the rule with the
sanitary authorities to test the drainage of a house with
smoke as soon as a case of typhoid fever has been notified
from it, and as this has been systematically carried
out since the year 1893, it might not be out of place
to give the results, as ascertained from the annual
reports of the medical officer of health, in the following
table.
Table I. — Typhoid - Infected Houses with Defective Drainage in
Leicester,
Years.
■
Typhoid-Infected Houses.
Total Number of
Infected Houses.
Number of Houses
with Defective
Drainage.
Percentage of Houses
with Defective Drain-
age.
1893
]894
96
197
30
89
31 -25 per cent.
4518 per cent.
2. Experience at Bristol.
The medical officer of health for Bristol reports that
during the five years, 1890-1894, 585 cases of enteric
fever occurred in Bristol, of which 548 were single
cases — i.e.y occurred in 548 houses — and the rest of 37
cases was distributed over 11 houses. Out of the 548
houses, 161 showed drainage defects on the application
of the smoke test, so that for 29*38 per cent, of the
548 typhoid - infected houses, the possibility of the
■entrance of sewer gas has been proved.
13*
196
SEWER GAS AND HEALTH. — APPENDIX XI.
3. Experience at Hornsey.
The medical ofi&cer of health for Hornsey states in-
his report for the year 1893, on pages 11 to 14, that
nine typhoid -infected houses were examined with the
smoke test between the 10th day of August and the
30th day of December, 1893, and that in every one of
them defective drainage arrangements were discovered.
The number of typhoid - infected houses with drainage
defects was 19 in 1894.
4. Experience at Leeds.
The medical officer of Leeds, Dr. J. Spottiswoode
Cameron, gives a very interesting paper in the Journal
of the Sanitary Institute for 1897, ^ Vol. XVIII. (see
also A-17b, App. I.), on his experience with the smoke
test. All in all, the drains of 1,121 houses, in which
typhoid or diphtheritic disease was supposed to be present,,
were tested, with the result that 30*51 per cent, were
found defective. The table of particulars and the
summary are as follows :
Table II.— Showing Drain Test Findings in 1,121 Houses in which
Typhoid or Diphtheritic Disease was supposed to be present.
Houses.
Percentage.
Found Faulty.
Result Negative.
The whole group
1,121
529
592
30-51
16-26
43-24
69-49
83-74
56-76
Wastes "severed"
Wastes not " severed " ...
Convenience outside
Wastes "severed"
Wastes not "severed " ...
994
442
552
2817
11-54
41-49
71-83
88-46
58-51
Closet inside
127
87
40
48-82
40-23
67-50
5118
69-77
32-50
Wastes "severed"
Wastes not ** severed " ...
"Severed" means that every waste, other than the soil-pipe, comes-
through an outer wall and discharges in the open air outside the house.
SEWER GAS AND HEALTH. — APPENDIX XI. 197
Summary,
" So far as these figures go, it would appear that : —
1. Nearly one third of the 1,121 houses were in aerial
"Communication with their drains.
2. This fault was more than twice as common where
disconnection of wastes had not been carried out — namely,
as 43 in the non-severed to 16 in those "cut off."
3. Neglecting disconnection, a water-closet inside the
dwelling increased by four-sevenths the chances of the
entrance of drain air, raising the faulty proportion from
"28 to 49 per cent.
4. Where severance of other wastes was effected, the
risk of direct aerial connection with the sewer increased
from 12 per cent, in houses with closets outside the
dwelling to 40 per cent, where they were inside,
5. Where, on the "other hand, drain severance was
incomplete, the risk was greater whatever kind of closet
ivas in use, but rose from 41 per cent, in those without,
to 68 per cent, in those with an inside convenience.
The table appended to the paper gives the following
results :
Percentage of houses in aerial connection with their
drai7is where:
Wastes were severed and closet outside... 11'5
Wastes not severed, but closet outside ... 41*5
Wastes severed, but closet inside 40*2
Wastes not severed, closets inside 67'5
These figures may perhaps warrant some of the following
conclusions:
1. As even in houses free from the special dangers
due to the presence of a water-closet within the dwelling,
and further protected by the disconnection of all other
198 SEWER GAS AND HEALTH. — APPENDIX XI.
waste-pipes, drain testing revealed serious defects in
nearly 12 per cent, of those tested, it is obvious that
there should be a regular, systematic, and periodical
testing of all house drains.
2. This periodical examination by tests should be
three times as frequent where, though free from the
special dangers attending the inside closet, the other
waste-pipes are not "cut off " outside the house.
3. It should also be three times as frequent where,,
though all other wastes are disconnected, there is a
water-closet within or beneath the dwelling.
4. It should be six times as frequent where there is
the double danger of an inside water-closet and undis-
connected house wastes."
5. General Bemarks on Sjnohe-Testing Drains,
In connection with the testing of houses with smoke,
it should be borne in mind that there are defects in the
drainage arrangements, especially below ground - level,
which are not very easily discovered by this test; and,
in my own experience, I have had cases where, suspecting
defects, I could not discover them with smoke, though
I made repeated trials, and where I only succeeded in
localising them after I had subjected the drains to the
hydraulic test. It would, therefore, be incorrect to con-
clude that in all cases where the smoke test has shown
no defects, sewer gas could not possibly find its way
into the interior of the house, and in such a case the
more reliable hydraulic test ought, in my opinion, never
to be omitted.
SEWER GAS AND HEALTH.— APPENDIX XII. 199
APPENDIX XII.
Notes on the Typhoid Mortality and the Ventilation
or the Sewers in Leicester.
It might not be out of place to record here some of
the Leicester experiences in connection with the venti--
lation of the sewers and the mortaHty from typhoid
fever.
Leicester is supposed to have led the way in the intro-
duction of the notification of infectious diseases, as this
came in force in the borough on the 13th September,
1879, after Parliament had given its sanction 'to this
step in a private Act.
Leicester may further be said to have been amongst
the first towns to carry out a systematic drainage
scheme, as this was commenced under the late Mr.
Wicksteed in 1852. Owing to the rapid increase of
the town, however, the main sewers soon became
too small for their work, and ever since 1870 pro-
posals have been made to improve them. However,
it was not until 1886 that the late Mr. Gordon's
scheme was accepted by the Town Council, and this has
now practically been completed at a cost, up to the
81st day of March, 1895, of £191,197. 10s. 4d. Besides
this amount, the town of Leicester has also spent
since 1885 £69,867. 6s. 6d. for a new sewage pumping
station and £68,496. 10s. 5d. on the new sewage farm.
Mr. Wicksteed' s sewers were practically not ventilated
at all, and in 1881 the Town Council decided to open
them up and thoroughly cleanse and ventilate them
by open covers at street - level. These operations.
-200
SEWER GAS AND HEALTH.— APPENDIX XII.
were continued up to 1886, when, owing to numerous
complaints from the inhabitants about obnoxious
smells, the Sanitary Committee decided to close the
ventilating covers where objected to, and to erect in
their places cast-iron pipes up the sides of houses
wherever the necessary permission of the house-owners
•could be obtained. In some cases, also, the sewers
were connected with factory chimneys. This policy
has since been adhered to. From a report of the
present surveyor, it would appear that in September,
1894, the following was the number of open and closed
•covers in the borough :
Table I. — Open and Closed Manhole and Lamphole Covers,
September, 1894.
Description of Sewers.
Manholes.
Lampholee.
Open.
Closed.
Total.
Open.
Closed.
Total.
Foul sewers
470
280
980
245
1,450
525
508
305
1,103
232
1,611
537
Storm- water sewers
Totals
750
1,225
1,975
813
1,335
2,148
From this statement the following figures follow :
Total number of open manhole and lamphole covers 1,563
Total number of closed manhole and lamphole covers 2,560
Grand total 4,123
The borough surveyor also reports that up to September,
1894, 255 (6in. by 4in.) ventilating pipes had been put up
•on 125i miles of foul sewers, and 52 factory chimneys
had been connected with them, mostly by Gin. pipes.
Besides the foul sewers, there were at that time in
Leicester 36J miles of surface and storm-water sewers,
a-nd nearly four miles of storm outfall sewers — making
a total of about 166 miles of all kinds of sewers.
SfCWER GAS AND HEALTH.— APPENDIX XII. 201
Bearing the above-mentioned facts in mind, three
jperiods can be distinguished :
1. The period before 1881, when the sewers were very
foul and not ventilated.
2. The period from 1881 to 1886, in which a great
length of the old sewers was cleaned out and
ventilated by open covers at street-level ; and,
:3. The period since 1886, in which practically two-
thirds of the open covers at street-level were
closed, about 300 ventilating shafts erected, and
the old main sewers replaced by larger and better
constructed ones.
In 1887, when the complaints of objectionable smells
(from the sewers became louder and louder, the author
was instructed by his chief to investigate the question
What influence the ventilation of the sewers, if any,
.had exercised on the death-rates of the town? and
his results were given in a diagram, a copy of which
.is attached to this appendix (see Diagram I.). Since
then, as has already been stated, the open covers
have largely been closed again, so that in September,
1894, out of the total number of manhole and lamphole
• covers, 62 per cent, were closed and only 38 per cent,
were open covers.
With a view to comparing the typhoid rates after 1886
with those before that year, the author has prepared
Table I.^ and Diagram II. in this appendix, in which he
has also given the number of certificates received. In
passing, it might be mentioned that the number of
' certificates received represent the number of infected
houses only, and that the number of infected persons
is probably somewhat higher.
On comparing Table 11.^ with Diagrams I. and II. on
Plates II. and III., the following facts can be observed :
^ See page 200. - See page 202.
202
SEWER GAS AND HEALTH. — APPENDIX XII.
Table II. — Borough of Leicester.
Mortality from Typhoid Fever and Number of Certificates for 22 Years-
1875 to 1894.
oid
-2 g 00
1^
|i
°P.
Typh
nbera
|s
th Ra
id Fe
>eriod
Typh
•eceiv
iber?.
Is
1 -§1
Year.
i
Population.
8 from
Fever
ual Nui
er of
ficates r
al Num
1^
Averag:e Nu
Certificat
100,000 Inh
in certain P
Death
Act
Death
Feve
Livir
Avera
from
for c<
Numb
Certi
Actu
Numb
recei'
Livin
1875
110,000
64
58
\
1876
113,581
43
38
1877
117,462
20
17
32-2
1878
119,845
31
26
1879
117,610
21
18
1880
120,325
46
38
/
245
204
1881
123,120
29
23
-16-3
179
145
1882
126,275
19
15
110
87
1883
129,483
10
8
85
• 66
100
1884
132,773
16
12
55
41
1885
136,147
36
26
216
159
1886
139,606
19
14
J
141
101
/
1887
143,153
31
22
1
222
155
-y
1888
146,790
32
22
266
181
1889
150,520
22
14
147
98
1890
154,344
24
16
165
107
1891
177,353
29
16
-17-9
178
113
131
•1892
180,066
17
9
116
64
1893
184,547
47
26
392
212
1894
189,136
27
14
215
114
1895
193,839
38
20
248
128
1896
198,659
40
20
J
283
142
^
Enlarged borough, 1st April, 1892.
Note. — The systematic ventilation of the sewers was commenced in the
year 1881, and the closing of the manhole covers, owing to com-
plaints, dates from the year 1887. The number of certificates
received represents the number of infected houses, the number of
infected persons being somewhat higher. The registration of
infectious disease came into force on the 13th September, 1879. The
reconstruction of the main drainage of Leicester was commenced*
by the late J. Gordon in 1886, and has cost up to the 3l8t March,
1895, the sum of £191,197. lOs. 4d. (capital expenditure only).
The sums spent upon main sewers, pumping station, and sewage-
farm (capital expenditure only, J. Gordon's scheme) amounted up-
to 31st March, 1897, to £3.32,687. 7s. 3d.
SEWER GAS AND HEALTH. — APPENDIX XII. 207
1. In the first period, with badly - constructed, very
foul, and ill-ventilated sewers, the typhoid death-
rate was highest — viz., 32*2 per 100,000.
"2. In the second period — of cleansing and ventilating
the sewers — the typhoid death-rate suddenly went
down very considerably, and was lowest — viz.,
16-3 per 100,000.
•3. In the third period, with new main sewers of good
construction and nearly 66 per cent, of ventilating
covers closed, the typhoid death-rate rose again,
and was higher than in the preceding period —
viz., 17*4 per 100,000, or 17-9 if the years 18.95
and 1896 are added.
4. The increase in the prevalence of typhoid fever
in the third period over the second period is still
further illustrated by the number of certificates
received, the average rate per 100,000 inhabitants
for the second period being 100 per annum, and
for the third period 130, or 131 if the years
1895 and 1896 are added. On the first day of
April, 1892, the borough of Leicester was enlarged
by taking in the outlying suburban districts which
had sprung up close to the borders of the old
borough. But as these were not so densely
populated as the old borough, and as the pre-
valence of typhoid fever in them was on the
whole not so great as in this, it is not unlikely
that the typhoid and certificate rates have been
favourably influenced by this step. No account,
has, however, been taken of this in foregoing
remarks.
This increase in the typhoid rates since 1887 is all
ihe more remarkable, as since that year the new main
sewers (their cost, including pumping station and sewage
208 SEWTCR GAS AND HEALTH. — APPENDIX XII.
farm, amounted up to 31st March, 1895, to dB329,561..
7s. 3d.) and a large number of other sanitary improve-
ments have been carried out in the town, not to mention
the general advance in the knowledge and treatment of
infectious diseases; and if we look for an explanation of
this remarkable fact, the thought suggests itself that
probably sewer gas had something to do with it.
In the first period, undoubtedly sewer gas did find its
way freely into the interior of the houses, forcing the
water seal of the traps, as it could not escape either
through ventilated manhole covers or soil-pipes.
In the second jDeriod, the sewer gas, instead of being
forced into the interior of the houses, was systematically
allowed to escape through the ventilated manhole covers-
That this actually did take place is sufficientl}^ proved
by the numerous complaints made. It must further
be noted that the typhoid death-rates in this period
decreased about 50 per cent, in spite, as it were, of the
very foul accumulations which were removed from the
sewers, and which have repeatedly been observed to
cause local outbreaks of this infectious disease.
In the third period, the sewer gas was more and
more prevented from escaping at the street-level by
the closing of the open covers, and may have gradually,
owing to insufficient ventilation, gained access again to-
the interior of the houses. In this connection, it is
very interesting to observe that the medical officer of
health reports that in 1893, out of all the typhoid-
infected houses, 31*25 per cent, had defective drains,
and that in 1894 this percentage rose to 45*18, the
defects being discovered by the smoke test. When,,
therefore, practically for one- third and one-half of the
typhoid-infected houses the possibility of the escape of
sewer gas into them has been actually proved, it^
SEWER GAS AND HEALTH.— APPENDIX XII. 209"
would be wrong to conclude that in the remaining
cases sewer gas could not have got into the houses, as
underground defects are not always brought to light by
the smoke test. It must also be borne in mind that
there are many other causes besides sewer gas which
may and undoubtedly have been at work in bringing
about the fluctuations in the typhoid rates.
Whatever our opinions on this point may be, the fact
remains that in spite of the construction of the new
main sewers, and in spite of numerous other sanitary
improvements, the typhoid rate of Leicester has, since
the commencement of the closing of the open covers at
street-level, not gone down, but has, on the contrary,
slightly increased, and this fact should not be over-
looked by every thoughtful observer.
If sewer gas is dangerous at all, one might very
properly conclude that its effects will be more seriously
felt in confined spaces and rooms than in the open
air of streets, where it is diluted at once.
In the present state of our knowledge it is quite
impossible to assign for every specific effect a specific
cause. It behoves, therefore, in the author's opinion, all
those who occupy themselves with these questions to care-
fully note all the circumstances that contribute or appear
to contribute to the rise and fall of death-rates, and to give
them their most careful consideration before embarking
upon measures the sanitary effects of which are, to say
the least, very doubtful.
14
INDEX OF NAMES AND SUBJECTS.
PAGE.
-Abuse of Sewer- Gas Theory 31
Action of Sewer Gas upon Health Two-fold 70 to 73, 114
-Acute Mephitic Poisoning through Sewer Gas 37
Advancement in House and General Sanitation, Kole played by
Sewer-Gas Theory 84, 85
Aerobes, Work of > 16, 17
Aim of True Sanitation 85, 86
Air, Ample Supply of Fresh Air in Sewers 47
Air as Carrier of the Typhoid Bacillus 29
Air Examination Methods still imperfect 49, 55
Air, Gaseous Contents of Atmospheric Air 47
Air is but seldom the Carrier of Infectious Disease Germs 55
Air, List of Micro- Organisms found in Fresh Air ^ 107, 108
Airey 158
Alessi's Experiments, Arguments against , 68, 69
Alessi's Experiments on the Influence of Sewer Gas upon Animals,
2, 12, 47, 62 to 69, 120 to 130
Allied Subjects 74 to 79
America : Views held in America concerning Sewer Gas 12
Ammonia, Presence in Sewer Gas 35, 44, 46, 125
Ammoniacal Nitrogen in Paris Sewers 102
Ammonium Sulphide 119, 125
Anasmia 36
Anaerobes, Work of 16, 17
Andrews' Investigations concerning the Typhoid Bacillus in Sewage,
see under *' Laws."
Animals, Domestic, do not suffer apparently from Typhoid Fever ... 59
Animals, Experiments with Sewer Air 59 to 69, 119 to 130
Animals, Lower, Inoculated with Typhoid Bacillus,
59, 60, 61, 120 to 130
Appendix 1 87 to 99
Appendix II 100 to 301
Appendix III 102 to 118
Appendix IV. 119 to 130
Appendix V 131 to 133
Appendix VI 134 to 137
Appendix VII 138 to 148
Appendix VIII 149 to 155
Appendix IX 156 to 164
Appendix IXa 165 to 185
Appendix X - 186 to 194
Appendix XI 195 to 198
Appendix XII « 199 to 209
Appetite, Loss of due to Sewer Gas 35
.Arguments against Alessi's Experiments 68, 69
14*
212 SEWER GAS AND HEALTH. — INDEX.
Arguments against Predisposing Action of Sewer Gas '. 73 ■
Arguments in Favour of Sewer-Gas Theory 55 to 57
Armstrong, H. E 22
Asphyxia caused by Sewer Gas 37, 39, 70, 135
B.
Bacillus Colis Communis, Experiments with 64
Bacillus Typhi, see "Typhoid Bacillus."
Bacillus Typhosus, see " Typhoid Bacillus."
Bacteria, see also "Germs," *' Microbes," and " Micro-Organisms."
Bacteriology, Advance of 6
Bacterium Coli Commune, Experiments with 64
Barker, H., Effect of Sewer Air on Animals 61. 62, 119
Baron, P., Influence of Waterworks and Sewerage Works upon
Public Health 75 to 77, 79, 188 to 189
Beetz, Munich Sewer Air „ „ 46
Berlin Sewage Farms have not Disseminated Typhoid Fever 72
Berlin Sewer Air, Micro-Organisms in 103
Berlin Sewerage Works have brought about a greater improvement
in the Public Health than the Waterworks 75, 76
Berlin Typhoid Epidemics, 1889 and 1893, no Typhoid Germs found
in Water 57
Berlin Typhoid Mortality 188 to 193
Berlin Water Supply, Discovery of Typhoid Bacillus in 57
Bexley Heath, Case of Diphtheria attributed to Cesspit Gas 185
Birmingham, Abandonment of Pail System 22
Birmingham Sewer-Gas Case, cause c4lebre 34, 165 to 185
Birmingham, T ubs or Pails and Typhoid Coincidence 21
Blaxall 158
Blood- Poisoning through Sewer Gas at Birmingham 165 to 185
Blumenstock 139
Boobyer, P., Report on Pail System 22
Bristol, Air in Sewers 46, 104, 105
Bristol, Faulty House Drains and Typhoid Fever 33, 195
Bubbles Bursting in Sewage .t 51, 52, 55
Buchanan .« 30, 74, 156 to 158, 186
Budd 4, 27
Burglars in London Sewers 131
Bursting of Bubbles in Sewage 51, 52, 55
Burton-upon-Trent, Explosion in a New Sewer 132
Caius College, Cambridge, Outbreak of Typhoid Fever, 1874 30, 156
Cameron, J. Spottiswoode, Drain Testing at Leeds 33, 160, 196
Carbonic Acid in Atmospheric Air 47
Carbonic Acid, Presence in Sewer Gas... 35, 44, 45, 46, 47, 70, 102, 119, 125
Carbonic Oxide, Presence in Sewer Gas 35, 70, 125
Carnelley 45, 50, 51, 52, 54, 104
Caspar 139
Cave, Justice 37, 143
Cellar Dwellings, Vapours in Disused and Un ventilated 46, 101
Cesspit Air and Cesspit Gas, Definition of Term 15
Cesspit, Explosions in 43, 131 to 133
SEWER GAS AND HEALTH.— INDEX. 213
•Cesspit Gas, Case of Diphtheria attributed to 185
Cesspits, see "Conservancy Systems."
Chemical Changes brought about by Bacteria in Sewage 115
Ohevalier 139
Children, Effect of Sewer Gas on 36
Cholera 5. 26, 72
Cholera Germ not found in Hamburg Water 57
Clapham, Case of Sewer-Gas Poisoning 138
• Closing of Sewer Ventilating Covers in the Centre of Koads at
Leicester 81 to 83, 199 to 209
Clothes as Carriers of Typhoid Bacillus 29
Coal Gas, Presence in Sewers 43
Colic due to Sewer Gas 35
Collins, Justice 34, 165
Composition of Sewer Air 100
Concluding Kemarks 84 to 86
Conclusions as to Existence of Pathogenic Germs in Sewage and
Sewer Air 54,55, 102 to 118
• Conclusions as to Micro-Organic Life in Sewer Air 50
Conclusions of Alessi as to the Action of Sewer Gas upon
Animals 66, 67, 123 to 126
•Connection between Sewer Gas and Typhoid Fever,
66, 67, 69, 71, 74 to 79, 114, 118
• Conservancy Methods more Favourable to Spread of Typhoid Fever
than Water-Carriage System 78, 79
Conservancy Systems and their Disadvantages 20 to 25
Contents of Sewer Air or Sewer Gas 44 to 58
•Croydon, Outbreak of Typhoid Fever, 1875 30, 156
Damages awarded for Sewer-Gas Poisoning 34, 37, 143, 165 to 185
Danzig, Influence of Sewer Gas on Health 31, 164
Darwen, Continuance of Pail System 23
Decomposition, Definition of Term 15
Decomposition, Products of 17
Dedication to Sir Thomas Wright iii.
Definition of Terms Used 14 to 15
Deposits in Sewers must be avoided 47
Diarrhoea , 5, 26, 35. 72
Difference between Micro- Organisms in Sewer Air and Sewage,
112, 113, 114
Difference between Waterworks and Sewerage Works in their
Influence upon Health 74 to 79, 186 to 194
Digestive System, Derangement of, through Sewer Gas 35
Dilution of Sewer Gas and its Escape in the Centre of Koads and
Streets 80 to 83, 199 to 209
Diphtheria 5, 26
Diphtheria, Case of , attributed to Cesspit Gas 185
Direct Infective Action of Sewer Gas probably very small 71
Direct or Mephitic Action of Sewer Gas 70 to 73
Dirty Hands as Carriers of Typhoid Bacillus 29
Disconnecting Traps in Germany 11, 23
Disconnecting Traps in Paris 12
Disease and Dirt go Hand-in-Hand 4
Diseases attributed to Sewer Gas, List of 5
214 SEWER GAS AND HEALTH. — INDEX.
Distance Micro-Organisms can be carried by Sewer Air 53^
Drains, see " House Drains."
Dunbar on Typhoid Bacillus 29
Dundee, Air in Sewers 45, 104,105
Dysentery 5, 26
E.
East Ham Sewer Fatality 24, 37, 48, 140 to 14?
Eberth, Discoverer of Typhoid Bacillus . 27,U16'
Emanations from Sewers and Cesspits and Typhoid Fever 4
Enteric Fever, see " Typhoid Fever."
Epidemiology of Typhoid Fever 26 to 29^
Erysipelas 5, 26, 72
Escape of Sewer Gas in the Centre of Roads and Streets,
80 to 83, 199 to 209
Etiology of Typhoid Fever 26 to 29^
Examinations of Air, Methods for, still imperfect 49
Excreta, Human, see " Faecal Matters."
Experimental Researches into the Causal Relations between Sewer
Air and Typhoid Fever 59 to 69, 119 to 130-
Experimental Results on Sewer Air agree with its Actual State in
Sewers 65-
Experiments on Animals with Sewer Air 59 to 69, 119 to 130
Experiments on Sewer Air ... 49 to 58, 102 to 118
Experiments with Sewage 51 to 58, 115 to 11&
Explosions in Sewers and Cesspits 43, 131 to 133
F.
Facultative Anaerobes, Work of 16, 17'
FsBcal Matters can develop Poisonous Gases 44'
Faecal Matters, Changes of, after Evacuation 16 to 19*^
Faecal Matters, Number of Bacteria in Fresh Faecal Matters 18
Fatty Acids, Volatile, Presence in Sewer Gas 44
Faulty House Drains and Typhoid Fever 32, 33, 195 to 198
Fenton 155
Feverishness due to Sewer Gas 35-
Ficker, Experiments on Sewer Air 52, 53, 54
Filth and Disease go Hand-in-Hand 4'
Finkelnburg 139-
Fraenkel 59^
France, Views held in France concerning Sewer Gas 12
Frankfort on-the-Oder, Case of Typhoid Fever due to Sewer Gas, 31, 164
Frankland, Bursting of Lithia Bubbles 51
Gaffky, Discoverer of Typhoid Bacillus 27, 59, 116
Gases Dissolved in Sewage 46, 101.
SEWER GAS AND HEALTH. — INDEX. 215
Gases Formed in Conservancy Methods more Dangerous than those
formed in the Water-Carriage System 7, 25
Gases Formed in Conservancy Methods, see "Cesspit Gas " and ** Privy
Gas."
Gases Formed in Sewers, see " Sewer Gas."
Gastro-Enteritis „ 5, 2&
Gaultier de Claubry 39, 45, 135, 138
German Association of Public Health, Magdeburg Meeting, 1894 ... 10
German Association of Public Health, Stuttgart Meeting, 1895 10
German Association of Public Health, Vienna Meeting, 1881 7,187
Gernian Towns, Typhoid Mortality in, after Baron 188 to 18^
Germany, Opinion of Sewer-Gas Theory in .. 6tol2
Germany, Outbreaks of Typhoid Fever attributed to Sewer Gas . . 30
Germany, Sewer-Gas and Typhoid-Fever Cases 164
Germs, see also "Bacteria," "Microbes," "Micro-Organisms."
Glasgow, Abandonment of Pail System 22
Glauchau, Case of Sewer-Gas Poisoning ....48, 145 to 146
Goepel, Case of Typhoid Fever due to Sewer Gas 31, 164
Gordon, Joseph 199
Gordon, Joseph, Designs the Sewerage of Munich 7
Guy, Health of Sewermen 135
H.
Haldane 45, 50, 51, 52, 54, 105
Halle 139
Hamburg Cholera Epidemic, 1892, no Cholera Germs found in
Water 57
Hankel 36, 48, 135, 136, 143, 144, 145, 146
Harpurhey, Death of One Man in a Sewer 147
Harvey, W 27
Headache due to Sewer Gas 35
Health, Sewer Gas and its Influence upon Public Health ; Literature
in the English, German, French, and other languages ,..,. ...87 to 99
Health, Influence on, by Sewer Gas 70 to 73
Health of Sewermen 38, 39, 134 to 137
Health, see also " Public Health."
Hesse, Distance Micro-Organisms can be carried by Sewer Air 53, 54
Hill, Bostock, Case of Septic Poisoning at Sutton Coldfield
40 to 42, 73, 149 to 155
History of Sewer-Gas Controversy 4 to 13
Homerton Fever Hospital, Difiiculty of Finding Typhoid Bacillus in
Drains 56,57,116
Hornsey, Faulty House Drains and Typhoid Fever 33, 196
Hospital Gangrene 5, 26
House Drains, Faulty, and Typhoid Fever 32, 33, 195 to 198
House Drains if Systematically Laid and Used should not be in a
Foul Condition 23
House Drains, Micro-Organisms in Air of House Drains 50, 10^
House Drains, Testing of 32, 33, 198
Hueppe, Influence of Waterworks and Sewerage Works upon Public
Health - 77
Hull, Continuance of Pail System 2S
Humidity in Paris Sewers 105
Hydrocarbons, Presence in Sewer Air 43, 44
Hydrogen Sulphide 11^
216 SEWER GAS AND HEALTH. — INDEX.
I.
Identification of Typhoid Bacillus very difficult 28, 56, 116
Illustration. Leeds Fever Hospital, in which an Outbreak of Typhoid
Fever occurred 160
Illustration of Locality in which a Case of Blood-Poison ing through
Sewer Gasoccurred 166
Indirect or Predisposing Action of Sewer Gas 70 to 73
Infectious Diseases caused by Specific Contagia Animata 27
Infectious Diseases, Microbes of, are Specific Germs which spring
from their like and only create their like 28
Infective Action of Sewer Gas 71
Inflammation of the Lungs 5,26
Influence of Sanitary Works upon the Mortality from Typhoid
Fever 74 to 79. 186 to 194
Influence of Sewer Gas upon Health 70 to 73, 114, 118
Injury to Health from Sewer Gas, Observed Cases ... 30 to 31, 156 to 164
Inoculation of Lower Animala with Typhoid Bacillus 59 to 60, 120 to 130
Insomnia due to Sewer Gas 35
Instruments as Carriers of Typhoid Bacillus 29
Introductory Remarks 1 to 3
Italy, Views held in Italy concerning Sewer Gas 12
J.
Jordan 112
Justice Cave 37, 143
Justice Collins 34, 165
Justice Wills 34, 185
King's Norton Urban District Council 34, 165 to 185
Kirchner, M., Opinion on Sewer Gas 10, 55
Klein, Report on Contamination of Soup through Sewage,
40 to 42, 152 to 155
Knowledge of Micro-Organisms of Sewer Air still limited 49
Koch, R., Typhoid Bacillus 27
L.
Languor due to Sewer-Gas Inhalation 35
Lawrence Sewage, List of Micro-Organisms in 112
Laws and Andrews' Experiments in London Sewers, etc.,
2, 49 to 58, 105 to 118
Laws, Conclusions as to Micro-Organisms in Sewer Air 106, 107
Laws, Difficulty of Finding Typhoid Bacillus in London Sewage,
56, 57, 116, 117
Laws, Distance Micro-Organisms are carried by Sewer Air 54
Laws, Gaseous Contents of London Sewer Air 46
Laws, Micro-Organisms in London Sewer Air 50, 105 to 118
Laws, Slimy Skin of Sewer Walls does not give off Germs 52, 53
Laws, Splashing in Sewers 52, 106
SEWER GAS AND HEALTH. — INDEX. 217
Leeds, Faulty House Drains and Typhoid Fever 33, 196 to 198
Leeds, Outbreak of Typhoid Fever in a Fever Hospital 160 to 163
Leicester, Abandonment of Pail System 22
Leicester, Experience as to Closing of Sewer Ventilating Covers in
the Centre of Roads 81 to 88, 199 to 209
Leicester, Faulty House Drains and Typhoid Fever 33, 82, 195
Leicester, Tubs or Pails and Typhoid Coincidence 21
Leicester, Typhoid Mortality and the Ventilation of Sewers ...199 to 209
Letheby, Air of London Sewers 45, 101
Leucocytes ^ 61, 86
Levy, Air in Paris Sewers 46, 50, 102
Liborius, Typhoid Bacillus can live without Oxygen 29
Linen as Carriers of Typhoid Bacillus 29
Lindley, W. H., Opinions on Sewer Gas 10
Lissauer, Influence of Sewer Gas on Health 31, 164
List of Micro- Organisms found in Lawrence Sewage 112
List of Micro- Organisms found in London Sewage 110, 111, 112
List of Micro-Organisms found in London Sewer Air 108, 109, 110
Literature, Index to Literature in the English, German, French, and
other languages on the subject of Sewer Gas and its Influence
upon Healthy and allied subjects 87 to 99
Loesener 57
London Sewage, List of Micro-Organisms in 110, 111, 112
London Sewer Air, Gaseous Contents 45, 46
London Sewer Air, Micro-Organisms in 50, 105 to 118
London Sewermen, Health of 136
London Sewers, Case of Mephitic Poisoning in 138, 146
London Sewers, Explosion in 131
M.
"Malaise due to Sewer Gas 35
Malaria 6, 26
Manchester, Abandonment of Pail System 22
Marsh Gas, Presence in Sewer Air 43, 45
Mayence, Explosion in a Cesspit at Mayence 131
Meat Poisoned through Sewer Gas 42
Media through which Typhoid Bacillus is disseminated 29
Melton Mowbray, Outbreak of Typhoid Fever in 1880 30, 158
Mephitic or Direct Action of Sewer Gas 70 to 73, 84
Mephitic Poisoning Mild Form 35, 143
Mephitic Poisoning, Severe Form 38, 144
Mephitic Poisoning through Sewer Gas 35 to 37, 70, 71, 138 to 148
Metchnikoff 61
Methane, see " Marsh Gas."
Methods for the Examination of Air still imperfect 49, 55
Methyl Sulphide 125
Meyer, Discoverer of Typhoid Bacillus ,.. 27
Microbes and Micro-Organisms, see also " Bacteria," *' Germs."
Micro- Organic Life in Sewage brings about Chemical Changes 115
Micro-Organisms, Distance they are carried by Sewer Air 63, 54
Micro-Organisms do not rise from Wet Surfaces ^ 51
Micro-Organisms in Air of House Drains 50, 103
Micro-Organisms in Berlin Sewer Air 60, 103
Micro-Organisms in Bristol Sewer Air 50, 103
Micro-Organisms in Dundee Sewer Air 50, 103
218 SEWER GAS AND HEALTH. — INDEX.
Micro-Organisms in London Sewer Air 50, 105 to IIS
Micro-Organisms in Paris Sewer Air 50, 102
Micro-Organisms in Sydney Sewer Air 50, 103
Micro-Organisms in Westminster Palace Sewer Air 50, 103
Micro-Organisms in Sewer Air 49 to 58, 102 to 118
Micro-Organisms in Sewer Air and Sewage, Difference 112, 113, 114
Micro-Organisms in Sewer Air related to those in Atmospheric Air
outside Sewers, but not to those in Sewage 50, 114
Micro-Organisms in Sewer Air, Knowledge of, still limited 49
Micro-Organisms, Number of, in Fresh Human Dejecta « 18
Micro-Organisms, List of, in Fresh Atmospheric Air ., 107, 108
Micro-Organisms, List of, in Lawrence Sewage 112
Micro-Organisms, List of, in London Sewage 110 to 112
Milk as Carrier of Typhoid Bacillus 29
Mineralisation of Organic Matters in Soil and Water 16
Miquel, Air in Paris Sewers 46, 50, 102
Mixture of Gases, Experiments with, by Alessi 66, 125
Mortality from Typhoid Fever, see " Typhoid Mortality."
Mosaic Law 4
Munich, Decline of Typhoid Fever with Improvements in Sewerage,
78, 187 to 188
Munich Sewermen 38, 136
Munich Sewers, Gaseous Contents of Air in 46, lOO
Murchison 4, 27, 39, 135
N.
Naegeli, Germs do not Rise from Wet Surfaces 51
Nervousness 35
Neuralgia 35
Newcastle-upon-Tyne, Tubs or Pails and Typhoid Coincidence 22
New Sewer, Explosion in a New Sewer at Burton-upon- Trent 132
New Sewers, Systematically-Constructed, Air in 45, 46, 47
Nitrogen in A-tmospheric Air 47
Nitrogen, Presence in Sewer Gas 45
Nottingham, Abandonment of Pail System 22
Nottingham, Keport on Pail or Tub System 22
Number of Micro-Organisms in Sewer Air 50
Nutritive System, Derangement of, through Sewer Gas 36
o.
Observed Cases of Injury to Health from Sewer Gas... 30 to 31, 156 to 164
Observing Stations in Paris Sewers 102
Old Sewers, Air in 45, 46-
Omne Vivum ex ovo, W. Harvey 27
Organic Vapour in Sewer Air 47
Outbreaks of Typhoid Fever attributed to Sewer Gas, 30 to 31, 156 to 164
Oxidation, Complete and Incomplete 17
Oxidation of Organic Matters in Soil and Water 16-
Oxygen, Importance of Oxygen in Decomposition of Organic Waste
Matters 16, 17
Oxygen in Atmospheric Air 47
Oxygen, Keduction of , in Sewer Air 44, 45
Oxygen, Typhoid Bacillus can live without it 29-
SEWER GAS AND HEALTH.— INDEX. 219*
Paddington Sewer Air, Gaseous Contents 46-
Pails, see " Conservancy Methods."
Parent Duchatelet, Health of Sewermen , 135
Paris Sewers, Accidents in 139'
Paris Sewer Air, Gaseous Contents 45, 46, 100
Paris Sewer, Micro-Organisms in 102
Parkes, Manual of Practical Hygiene 61, 134
Pathogenic Germs are but seldom carried by Air 55
Pathogenic Germs are Specific Germs which spring from their like
and only create their like 28
Pathogenic Germs do not Rise from "Wet Surfaces 55
Pathogenic Germs, It is possible, but not very probable, that they
are carried about by Sewer Air 55, 57
Pathogenic Germs more delicate than other forms 19, 51, 54
Pathogenic Germ, The only one, found [up to the present in Sewer
Air 50,56'
Peacock, Typhoid Fever amongst Sewermen 89, 135-
Petri, Micro-Organisms in Berlin Sewer Air 50, 103
Pettenkof er in Favour of Water-Carriage System , . 7
Plan of Leeds Fever Hospital in which Typhoid Fever broke out 160 '
Plan of Locality at Birmingham (Mr. T. H. Smith's House) where a
Case of Blood-poisoning was attributed to an Escape of Sewer Gas 166 •
Plate I.— Diagram I. : Typhoid Mortality in Berlin, 1854 to 1890,
TO FACE PAGE 190
Plate I. — Diagram II. : Mortality from all Causes in Berlin, 1840 to
1890 .„ TO FACE PAGE 190
Plate II. — Diagram I. : Sanitary State of Leicester during the years
1875 to 1886, before and after the Introduction of the Systematic
Ventilation of the Public Sewers to face page 202-
Plate III.— Diagram II. : Typhoid Fever in Leicester for 20 years,
1875 to 1894, before and during the Ventilation of the Sewers at
Street Level, and since the closing of about two-thirds of the
Open Covers to face page 202
Poisonous Gases contained in Sewer Air or Sewer Gas... 44 to 48, 100
Prausnitz 136-
Predisposing Action of Sewer Gas,. 65, 70 to 73, 85'
Predisposing Action of Sewer Gas, Argument against 7^
Preface vii.
Present State of our Knowledge of the Changes Faecal Matters
Undergo after Evacuation 16 to 19^
Press, Daily, takes great interest in Scientific Questions 5-
Privies and Privy Middens, see "Conservancy Methods."
Privy Gas, Definition of Term 15'
Prostration due to Sewer Gas 35
Protective Forces of the System .. 60, 61, 86-
Public Health, Influence of Waterworks and Sewerage Works upon,
74 to 79, 186 to 194
Public Health, Interest of Public in Sewer-Gas Controversy 5-
Puerperal Fever 5, 26, 72
Putrefaction, Definition of Term 15
Putrefaction, Products of 17
Putrid Gases, Definition of Term 14
Pythogenic Theory ^-
■520 SEWER GAS AND HEALTH. — INDEX.
R.
Keference to the Subject of the Influence of Sewer Gas upon Health
difficult up to the present 3
Relations, Causal, between Sewer Air and Typhoid Fever,
59 to 69, 119 to 130
Renk, Views on Sewer-Gas Theory 8
Retilindol 125
Rheumatic Affections amongst Sewermen .^ ..39, 136
Riecke 4
Roads, Escape of Sewer Gas in the Centre of Roads ...80 to 83, 199 to 209
Rochdale, Continuance of i*ail System 23
Roechling, H. Alfred, Typhoid Fever in a House with Faulty
Drainage 163 to 164
Roechling, H. Alfred, Water Supply and Drainage of Houses 10
Russel, Contents of Paddington Sewer Air 45
S.
Sanitary Works, Influence of, upon Public Health ... 74 to 79, 186 to 194
Sanitation, Advancement in House and General Sanitation, Role
played by Sewer-Gas Theory 84, 85
Sanitation, Aims of True Sanitation 19, 85, 86
Scarlet Fever 5, 26
Septic Poisoning through Sewer Gas 40 to 42, 73, 149 to 155
Sewage, Bubbles Bursting in 51, 52
Sewage, Difficulty of finding Typhoid Bacillus in 56, 57, 116
Sewage, Experiments with 51 to 58, 115 to 118
Sewage Farms do not spread Typhoid Fever 72
Sewage, Gases Dissolved in 46, 101
Sewage, List of Micro-Organisms in Lawrence Sewage 112
Sewage, List of Micro-Organisms in London Sewage 110, 111, 112
Sewage not a Favourable Medium for Pathogenic Germs 54, 117
Sewage, Splashing in. Disseminates Micro-Organisms 51, 52
Sewage, Vitality of Typhoid Bacillus in Sewage 28, 117
Sewerage Works contribute in a more marked degree to Improve-
ment of Public Health than Waterworks 75, 186 to 194
Sewerage Works, Influence upon Public Health 74 to 79, 186 to 194
Sewer Air and Sewer Gas Synonymous Terms 14
Sewer Air and Typhoid Fever, Experimental Researches into their
Causal Relation 59 to 69, 119 to 130
Sewer Air, Composition of 100
Sewer Air, Distance Micro-Organisms are carried by ,. 53, 54
Sewer Air, Experiments on 49 to 58, 102 to 118
Sewer Air, Experiments with, on Animals 59 to 69, 119 to 130
Sewer Air, It is possible, but not very probable, that it carries about
Pathogenic Germs 57
Sewer Air, Micro-Organisms in 49 to 58, 102 to 118
Sewer Air, Micro-Organisms in Sewer Air differ from those in
Sewage 112, 113, 114
Sewer Air or Sewer Gas, Contents of 44 to 58, 100
Sewers, Explosion in 43, 131 to 133
Sewer Gas and its Influence upon Public Health ; index to literature
in the English, German, French, and other languages 87 to 99
Sewer Gas, Connection between Sewer Gas and Typhoid Fever ...74 to 79
uSewer Gas, Contamination of Meat 42
SEWER GAS AND HEALTH. — INDEX. 221'
Sewer-Gas Controversy, History of 4 to 13
Sewer Gas, Dilution of, and its Escape in the Centre of Eoads and
Streets 80 to 83, 199 to 209
Sewer Gas, Diseases attributed to it 5
Sewer Gas, Effect of Sewer Gas on Children 36
Sewer Gas, Influence on Health 70 to 73
Sewer Gas in Presence of Specific Contagion cause of Typhoid
Fever 27
Sewer Gas, Mephitic Poisoning through 35 to 37, 138 to 148
Sewer Gas not the Cause of Typhoid Fever 55
Sewer Gas, Outbreaks of Typhoid Fever attributed to Sewer Gas,
30 to 31, 156 to 164
Sewer Gas, per se, Cause of Typhoid Fever 27
Sewer-Gas Poisoning at Birmingham 34, 165 to 185
Sewer Gas Predisposes the System to the Pathogenic Action of the
Typhoid Bacillus 65, 66, 70, 85
Sewer Gas, Predisposing Action to other Infectious Diseases not
sufficiently investigated 71,72
Sewer Gas, Septic Poisoning through 40 to 42, 73, 149 to 155
Sewer-Gas Theory, Abuse of 31
Sewer-Gas Theory, Arguments in Favour of 55 to 57
Sewer-Gas Theory has played an important part in the Advance-
ment of House and General Sanitation 84, 85
Sewermen at Munich 38, 136
Sewermen, Health of 38,39, 134 to 137
Sewermen, Immunity to Typhoid Fever 73
Sewers must not be Sewers of Deposit, and ought to contain an
ample supply of Fresh Air 47
Sewers, Slimy Surface of Sewer Walls, Dissemination of Micro-
organisms , 51, 52
Sewers, Ventilating Covers in the Centre of Streets, Closing of at
Leicester, and Typhoid Fever 81 to 83, 199 to 209
Sherborne, Outbreak of Typhoid Fever, 1882 30, 158
Simmonds 59
Slimy Surface of Sewer Walls, Dissemination of Micro-Organisms...51, 52
Smith, Micro- Organisms in Sydney Sewers 50, 103
Smith, T. H., Case of Sewer-Gas Poisoning 34, 165 to 185
Smoke Testing of Drains 32, 33, 82, 195 to 198
Sore Throats amongst Sewermen 39, 136
Soup, Contamination of, through Sewage 40 to 42, 149 to 155
Soyka, Views on Sewer-Gas Theory 7, 75, 187
Specific Contagia Animata cause Infectious Diseases 27
Specific Germs 28
Splashing in Sewage, Dissemination of Micro- Organisms 51, 52, 55
Spores of Typhoid Bacillus 29
Stern 60
Stevens 136
St. Pancras, Outbreak of Typhoid Fever in Foundling Hospital... 30, 159
Street Sewers, Formation of Gases in Old and Modern Sewers ... 24
Struggle for Existence amongst Germs in Sewage 51, 54, 115
Sulphuretted Hydrogen, Death of Five Men from Sulphuretted
Hydrogen at the Tynemouth Gasworks 147
Sulphuretted Hydrogen, Fatal Dose 47
Sulphuretted Hydrogen, Presence in Sewer Gas... 35, 44, 45, 47, 70, 125
Sunlight Destroys Typhoid Bacillus 2^
Survival of the Fittest as regards Bacterial Life 19, 51, 54, 115
Sutton Coldfield, Case of Septic Poisoning, 1894 40 to 42, 73, 149 to 155
\222 SEWER GAS AND HEALTH. — INDEX.
/Sydney Sewers, Micro- Organisms in Sewer Air 50, 103
.Sykes, J. F. J 30, 159
T.
Table, Berlin Mortality from all Causes and from Typhoid Fever
between 1854 and 1890 190
Table, Buchanan's Table of Mortality from Typhoid Fever in
various English towns before and after the Execution of Sanitary
Works 186
Table, Composition of Sewer Air 100
Table, Dr. Alessi's Experiments with Various Gases 130
Table, Dr. Alessi's Experiments, Influence of Putrid Gases upon the
Animals experimented with 127
Table, Dr. Alessi's Experiments, Mortality Keturn of all Animals ... 128
Table, Dr Alessi's Experiments. Time elapsed between the Inocula-
tion with the Bacilli and the Death of the Animals 129
Table, Dr. Alessi's Experiments, Time necessary for the Animals
to acquire the Predisposition 128
■ Table, Gases Dissolved in Kaw Sewage 101
Table, Investigations into the Micro-Organic Life in Sewer Air 50
Table, Leeds Drain-Testing. Findings in 1,121 Houses in which
Typhoid or Diphtheritic Disease was supposed to be present 196
Table, Leicester Mortality from Typhoid Fever and Number of
Certificates for 20 years, 1875 to 1894 202
Table, Leicester Open and Closed Manhole and Lamphole Covers,
September, 1894 200
Table, Leicester Typhoid-Infected Houses with Defective Drainage... 195
Table, Mephitic Vapours in Disused and Un ventilated Cellar
Dwellings 101
Table, Munich Typhoid Mortality 189
Table, Particulars and Numbers of Animals Experimented on by
Dr. Alessi 62
Table, Poisonous Gases in Cesspits 44
Temperature, Variation of, in Paris Sewers 103
Terms Used in Treatise, Definition of 14 and 15
Testing Drains 32, 33
Thierling 139
Tubs, see " Conservancy Methods."
Tubs or Pails and Typhoid-Fever Coincidence 21, 22
Typhoid Bacillus, Action upon Animals 60
Typhoid Bacillus can exist without Oxygen 29
Typhoid Bacillus cause of Typhoid Fever 27, 55
Typhoid Bacillus, Difificulty of finding, in Water 57
Typhoid Bacillus does not form lasting Spores 29
Typhoid Bacillus does not make great demands on its Nutritive
Medium 29
"Typhoid Bacillus, Experiments with, by Alessi 62 to 69, 120 to 130
Typhoid Bacillus found in Urine and Stools of Typhoid Patients ... 28
Typhoid Bacillus, Identification of, very difficult 28, 56, 116, 117
Typhoid Bacillus, Inoculation of Lower Animals with... 59, 60, 120 to 130
Typhoid Bacillus, It is possible, but not very probable, that it is
carried about by Sewer Air 57
Typhoid Bacillus, Media through which it is disseminated— Air,
Water, Milk, Linen, Cloths, Dirty Hands, Instruments, etc. ..... 29
Typhoid Bacillus not Cause but Product of Typhoid Fever 28
SEWER GAS AND HEALTH. — INDEX. 223
'Typhoid Bacillus perishes quickly in Direct Sunlight 29
Typhoid Bacillus, Presence in Sewage 56, 116, 117
Typhoid Bacillus, Temperature Influence on Typhoid Bacillus 29
Typhoid Bacillus, Vitality in Indifferent Media, such as Sewage and
Water 28, 117
Typhoid Fever amongst Sewermen 39
Typhoid Fever and Emanations from Sewers 4, 6
Typhoid Fever and Faulty Drains 32, 33, 195 to 198
Typhoid Fever and Sewer Air, Experimental Kesearches into their
Causal Relations 59 to 69, 119 to 130
Typhoid Fever and the Closing of Sewer Ventilating Covers in the
Centre of Streets at Leicester 81 to 83, 199 to 209
Typhoid Fever and Tubs or Pails 21 and 22
Typhoid Fever caused by Specific Contagium Animatum 27
Typhoid Fever, Conditions for Spread of Typhoid Fever more
favourable in Conservancy Methods than in Water-Carriage
System 78, 79
Typhoid Fever, Connection between Typhoid Fever and Sewer
Gas 74 to 79
Typhoid Fever does not seem to affect Domestic Animals 59
Typhoid Fever, Etiology and Epidemiology of 26 to 29
Typhoid Fever in a House with Faulty Drainage. 163, 164
Typhoid Fever is not disseminated by Sewage Farms 72
Typhoid Fever not caused by Sewer Gas 55
Typhoid Fever, Outbreak at Caius College, Cambridge, 1874 30, 156
Typhoid Fever, Outbreak at Croydon, 1875 30, 156
Typhoid Fever, Outbreak at Foundling Hospital, St. Pancras, 1891,
30, 159
Typhoid Fever, Outbreak at Leeds Fever Hospital 30, 160 to 163
Typhoid Fever, Outbreak at Melton Mowbray, 1880 30, 158
Typhoid Fever, Outbreak at Sherborne, 1882 30, 159
Typhoid Fever, Outbreak at Worthing, 1865 30, 156
Typhoid Fever, Outbreak at York, 1884 30, 158
Typhoid Fever, Outbreak in Germany 30
Typhoid Fever, Outbreak of, attributed to Sewer Gas.. 30 to 31, 156 to 164
Typhoid Fever Result of Putrid Process 27
Typhoid Mortality and the Ventilation of Sewers at Leicester... 199 to 209
Typhoid Mortality in Berlin 188 to 193
Typhoid Mortality in English Towns before and after the carrying
out of Sanitary Works 186
Typhoid Mortality, Influence of Sanitary Works upon 186 to 194
Typhoid Mortality in German Towns after Baron 188 to 189
Typhoid Mortality in Munich 187
U.
Uffelmann, Micro-Organisms in House Drains 50, 103
TJffelmann, Opinion of Sewer -Gas Theory 30, 164
Vapours in Disused and Unventilated Cellar Dwellings 46, 101
Vaults, see " Conservancy Methods. "
Ventilation of Sewers 80 to 83
Ventilation of Sewers and the Typhoid Mortality of Leicester... 199 to 209
224 SEWER GAS AND HEALTH. — INDEX.
Ventilation of Sewers, Necessity for 47"
Virulence of Pathogenic Germs in Sewage 54, 55-
Vitality of Human System lowered through Sewer Gas 36
Vitality of Typhoid Bacillus in Different Media, such as Sewage
and Water 28
Vomiting Due to Sewer Gas 35-
W.
Warrington, Continuance of Pail System 23
Water as Carrier of the Typhoid Bacillus 29
Water-Carriage System, Advantages over Conservancy Methods.. 20 to 25
Water-Carriage System less favourable to Spread of Typhoid
Fever than Conservancy Methods 78, 79'
Water-Carriage System, Opponents of, in Germany 6-
Water, Difficulty of finding Cholera Germ in 57
Water, Difficulty of finding Typhoid Bacillus in 57
Water, Vitality of Typhoid Bacillus in Water 28
Waterworks do not contribute in the same degree to an Improve-
ment of Public Health as Sewerage Works 75, 186 to 194
Waterworks, Influence upon Public Health 74 to 79, 186 to 194
Westminster Palace, Air in Sewers 45, 104, 105
Wet Surfaces, Germs do not rise from 51, 54
Weyl 193
Wicksteed 199
Widnes Sew6r Accident 146
Wiesbaden Sewermen, Health of 136
Wills, Justice 34, 185
Worthing. Outbreak of Typhoid Fever, 1865 30, 156
Wright, Dedication to Sir Thomas iii.
Y.
Yellow Fever > 5, 26
York, Outbreak of Typhoid Fever in 1884 30, 158
Z.
Zjonotic Diseases « 5'
Zymotic Diseases, see also " Infectious Diseases."
BIOGS & CO.'S BOOK X^IST.
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