Archives of Scientific and Practical Medicine, formerly edited by the same gentleman in conjunction with Dr. Brown-Séquard, and of the American Clinical Lectures.

- At the trial of a certain "Dr. Baker" for giving a false certificate as to the cause of the death of a young woman upon whom one " Dr. Bradford" produced an abortion which resulted fatally (for which the latter was sentenced to state's-prison for fifteen years), the counsel for the defendant requested that his client be tried by a jury of physicians, his only "peers" in a medical case like this. The judge, however, decided that a common-law jury would be perfectly competent to try the case, and in giving this opinion rather naïvely added that he did not believe that twelve physicians could be found who would agree on anything.

-The number of cases of scarlet fever reported in New York last week was 184. Of diphtheria in the same time there were 64 cases. The week before the total number of cases of scarlet fever reported was 216, and of diphtheria 54. At the health department it was said that these diseases were diminishing in tenement districts, and increasing in first-class private houses.

PHILADELPHIA.

Professor William Goodell presented an interesting paper, at a recent meeting of the County Medical Society, upon vegetations of the endome trium, the term including a variety of small growths developing upon the mucous membrane, and leading to congestion and menorrhagia. Of these, he described (1.) Fungous Degeneration of the Endometrium (endometritis hy perplastica), a non-malignant condition, for which he recommended the curette, with subsequent applications of tincture of iodine. In long-standing cases, a repetition of the operation is sometimes required, and nitric acid may be substituted for the iodine. (2.) Villous Degeneration of the Endometrium is not much unlike the preceding variety, except that the growths are more like pieces of boiled tapioca or fragments of brain than ordinary granulations. Submitted to examination by different microscopists, they were variously pronounced villous cancer, papilloma, cystic papillary adenoma, and a similar case in Dresden was considered by Hirschfeld to be a cylinder-celled adeCases have also been reported by Drs. Lusk of New York, Breinig of Pennsylvania, and Matthews Duncan. The prognosis should be a guarded one; but life may be prolonged by frequent removal of the growths. (3.) Sarcomatous Degeneration of the Endometrium the writer declared to be more malignant than epithelial cancer. Irregular and profuse menstruation, and intermenstrual leucorrhoea gradually becoming more and more fœtid, are the first symptoms," which are afterwards accompanied by the usual signs of enlargement of the uterus and by pains. The tumor may partly protrude from the os. Its diffuse growth, the absence of capsule, its friability and placentalike structure to the touch, and later its excessive fœtor, stamp it with an almost unquestionable microscopic individuality. The treatment consists in removal and cauterization, but the prognosis is very unfavorable; though the fatal termination, according to the author, might be greatly postponed by operative measures such as described.

noma.

66

-At the last meeting of the Academy of Natural Sciences, Dr. Leidy called attention to a mass of living hair worms of the genus gordius. There were upwards of sixty individuals, tangled up into a ball, from the surface of which the heads waved about like the snakes on the head of the fabled Medusa. In the mass were seven males, which could be distinguished by their lighter color and other peculiarities. The species was thought to be gordius robustus, although the different species of gordius required further study before being definitely distinguished.

Dr. Leidy also called attention to the liver of a rat containing numerous cysts, in which were imbedded cysticerci, or immature tape-worms. Numerous specimens of the mature worms were also found infesting rats, few of those examined being free from them. The larval forms were provided with strong hook-like appendages, but the mature worms were comparatively inoffensive looking, the heads being unprovided with hooks like the tenia mediocanellata of the human subject. The specimens exhibited had been received from Dr. Coues, of the army, and were all obtained from specimens captured in Carroll County, Mo.

The secretary announced that at the next meeting of the academy Dr. H. C. Chapman would report the results of his study of the chimpanzee which lately died at the Zoological Garden. His remarks will be illustrated by photographs, drawings, and dissections of the animal itself.

The director of the microscopical section, Dr. Kenderdine, exhibited a new pattern of sub-stage for the microscope, just brought out by the ingenious optician, Mr. Zentmayer, of this city, which, it seemed to him, combine features. of excellence commending it to the notice of working microscopists.

- Mrs. Hannah Green, better known as "Granny Green," who was the oldest inmate of the Home of the Little Sisters of the Poor, in this city, died at that institution on Wednesday; it is believed that she was in the one hundred and fifteenth year of her age. For the past thirty years Mrs. Green had been dependent on the charity of kind friends, who, when the Home of the Little Sisters of the Poor was opened, about nine years ago, had her placed therein; an unmarried daughter, with whom she had lived up to that time, and who was then sixty-five years old, being unable through failing health to provide. for her own wants, much less assist her more aged relative. In her habits "Granny Green" was always temperate, objecting to taking wine or liquor of any kind, even medicinally. She was formerly fond of smoking the pipe, but recently gave up its use. She ate and slept well, and conversed freely and intelligently, delighting in the company of visitors, though entirely blind, and confined to her bed for several years past. Not much is known concerning Mrs. Green's antecedents, or when she first came to this country, but it is pretty well authenticated that she was born in the county of Donegal, Ireland, in 1764.

-The new state hospital for the southeastern district of Pennsylvania now building near Norristown, is to be provided with electric call bells and telephones.

Dr. J. Milner Fothergill, of London, has been elected an associate member of the Philadelphia College of Physicians.

LETTER FROM LONDON.

SEWERAGE SYSTEMS.

MR. EDITOR,-In his most interesting centennial discourse at Philadelphia, in 1876, Dr. Bowditch published the results obtained from a kind of sanitary census which he had taken prior to writing his address; and one of the points to which he called attention was the question of the disposal of sewage in the principal towns of the United States. To judge by the answers he received to his inquiries, the sewage question appears to be for the most part in a very undeveloped and one may almost say in a chaotic state in America. In England we are only at the beginning of the great struggle between health and sewage disposal; but it is fair to ourselves to say that for some years past we have been making strenuous efforts to better our position, and that we may shortly expect to see some great result from the improvements which have been, or which are about to be, introduced in the methods of dealing with our sewage. The question, so far as it concerns this country, is one of comparatively recent date, for it is only within the last forty years that any attempt has been made to do away with the primitive cess-pool system, except, perhaps, in London and one or two of the larger provincial towns, where a few rough and ill-arranged brick drains had been in use for a longer period. In 1847 an act of Parliament was passed, making it compulsory in London to connect house drains with the public sewers, and at the same time considerable efforts were made to improve the condition of these sewers, and to make them capable of bearing the new strain which was put upon them. No attempt, however, was yet made to connect the drains of the town into one great system, and for some years they remained split up into a number of independent units, the main channel resulting from each of these being carried down to the nearest point in the Thames, and its contents emptied into the river. It was not many years before the state of the river was such as to be perfectly intolerable. The water became black and stinking; no fish could live in it; the health of the inhabitants of those parts of the town which bordered the river suffered severely from the tainted atmosphere; and it was felt by such sanitary authori ties as at that time existed that it was of little use to attempt to improve the general state of the metropolis whilst it was traversed by a river which had now become no better than an immense open sewer. Public opinion at length was so awakened to the existing evils that in 1858, eleven years after the power of the legislature was first called into play on the subject, an act was passed through Parliament authorizing the authorities of the town to construct a vast and complete system of sewers, by which the sewage of the whole of London should be collected into two channels, one on each side of the Thames, and should be carried down the river some miles away from London, to be turned into the stream at high tide, with a view to its being carried out to sea with the ebb. These works were completed after several years of great labor, and the Metropolitan Main-Drainage System constitutes at the present day probably the greatest engineering work of the kind in existence.

The impetus given to the development of systematic drainage in large towns

by the construction of the main-drainage works in London produced its effect all over the country, with the result that, as time passed on, one after another of the large towns of the kingdom was provided with a similar system, until at length the great majority were more or less efficiently sewered. But now arose a fresh difficulty. Comparatively few of these towns were situated like London, within a few miles of the mouth of a tidal river, and many of them had been built upon the banks of streams which passed through the centre of other large towns before reaching the sea, perhaps constituting the sole source of their water supply. It was not long before loud complaints were heard from these lower towns that their river was polluted with all kinds of excrementitious and manufacturing refuse before reaching them; that the mere presence of the stream was an offense to the town; and that it was quite out of the question to think of using the water for drinking. The position of London, though enabling her to get rid of her own refuse with as little annoyance as possible to other people, was just such as to make her the more liable to suffer at the hands of her neighbors, and being the biggest town in the kingdom, and the seat of the legislature, she was the first to make her voice heard in the matter; which she did so effectually that in 1866 she succeeded in passing a bill through Parliament which enacted that from that time no fresh outfalls for sewage into the Thames should be constructed above the metropolis, and that those towns which were already using the river for this purpose should within a reasonable time either cease to do so, or should render the sewage harmless before allowing it to flow into the stream.

This act, however, only applied to the Thames, and it was ten years before the legislation was extended to the whole country. In 1876 an act was passed called the Rivers Pollution Act, of which a short summary was given in your journal for April 11, 1878, the purpose of which was practically to make general the injunction hitherto restricted to the Thames, and to prevent the country from employing its rivers as places for the indiscriminate disposal of its refuse.

It is this act which has done more than anything else to stimulate improvement in the matter of the disposal of sewage, and which is in fact producing a complete revolution in the whole question. So few towns are altogether sinless as regards river pollution that the force of the act is almost universally felt, and all over the country experiments are being tried and systems are being carried out with a view in some places simply to the epuration of the sewage, and in others to its simultaneous epuration and utilization.

Speaking roughly, there are five different ways in which it has been attempted to dispose of sewage with safety. Four of these deal with sewage which has been removed by the ordinary method of water-carriage; in the fifth the excreta are collected in cess-pools, pails, or other receptacles which can be frequently emptied, and their contents sold to farmers for agricultural purposes.

Of the four methods applicable to the water-carriage system, the first subjects the sewage water to filtration through charcoal, gravel, or other porous substances, with the view of separating the solids prior to discharging it into the river.

In the second method the same object is attained by passing the sewer

water into large tanks, where it is allowed to stand and to deposit its solids before flowing into the stream. In the third method the sewage is subjected to some form of chemical procedure to precipitate some of the material held in solution; whilst in the fourth the main principle consists in spreading the waters by carefully prepared systems of irrigation over farm lands, the purification being entrusted to the natural action of vegetable growth in conjunc tion with the assimilative power of soils for all kinds of organic and inorganic materials. Of these processes it is obvious at the outset that the methods of purification by simple filtration or deposition must be wholly inadequate to satisfy the requirements of the Rivers Pollution Act. It is equally obvious that the pail and irrigation schemes, if properly carried out, must settle the difficulty so far as the rivers are concerned; and with these systems the questions to be settled are whether they are practicable on a large scale, and whether they can be employed without producing other evils, which from the sanitary point of view may be almost as serious as those of river pollution. The efficiency of chemical processes in purifying sewage is a question that can only be settled by experience, and as a considerable number of such processes have been fully tested in this country it may be said that we are now in a position to speak definitely on this subject.

I will say a few words to begin with on the cess-pool or pail system. This is the plan adopted in a very large number of towns in the United Kingdom, but it must not be supposed that all of these towns have adopted it with a definite view to sanitary requirements. On the contrary, with very many of them the fact that they collect their excreta in cess-pools simply means that they have not yet arrived at that degree of sanitary enlightenment which is indicated by the construction of a distinct system of sewers, and hence that they are only prevented by their incapacity and general carelessness from offending in the matter of river pollution. In towns where this is the case the state of things is, as a rule, so horribly filthy and unhealthy that legislation is quite as necessary for them as for towns which turn their sewage untreated straight into the rivers; the only difference between the two cases being that in the latter the law has to be directed against manslaughter, whilst in the former its aim must be to prevent suicide. There is, however, a considerable number of towns, including some of our largest provincial towns, where a system of this nature has been adopted after the most careful consideration, and where the greatest care is taken to render its action efficient.

There is one great advantage which all systems of this kind have over those which are based upon water-carriage. In all towns the sewage question presents three problems: the first relates to the collection of the sewage; the second to its conveyance; and the third to its disposal. In most of our large towns the second problem is already definitely disposed of, but the first still remains a question which is almost as pressing and important as the third. All the systems dependent upon water-carriage deal only with the third problem, leaving the first wholly untouched. The cess-pool or pail system, on the contrary, deals at the same time with both of these questions, and in settling what is to be done with the excreta disposes of the problem of collection. In large manufacturing towns, where the great bulk of the population belongs to