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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. 




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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 


, ) 


}, 


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 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 
(calle d 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. 



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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 



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 













3 



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. 



MUNICIPAL ENGINEERS' SERIES. 

Municipal engineering has during the past few years made rapid strides. The 
■engineers of to-day are men of great ability, wide experience, and hold positions of 
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the series of text-books to which attention is now drawn. These books are intended 
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Seweragre and Sewagre Disposal of a Small Town. 

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The Construction of Carriageways and Footways. 

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BIGGS & Cp.'S SOOK LIST. 

ELECTRICAL ENGINEERS' SERIES. 
Practical Electrical Engrineering. 

In Two Vols. Bound in Dark-Green Cloth Oold Lettered. By well-known 
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Dynamos, Alternators, and Transformers. 

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Electrical Distribution : Its Theory and Practice. 

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First Principles of Electrical Engineering. 

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Popular Electric Lighting. 

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Theory and Practice of Electro-Deposition: 

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BIGGS & CO;S BOOK LIST (continued) : 
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Pirst Principles of Electricity and Magnetism. 

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Town Councillors' Handbook to Electric Lighting. 

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Pirst Principles of Building : 

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from its perusal." — Engineering Review. 



** THE ELECTRICAL ENGINEER." 

A Journal of Electrical Engineering, with which is incorporated "Electric 
Light." Edited by C. H. W. BIGGS. Published FRIDAY. Price 3d. 



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