Dr. Balfour succeeded in marvelously improving the health of the boys in the Duke of York's school."

A series of lectures on the chemistry of cookery would be an innovation, perhaps, in the chemical course in medical schools, but its results would prove the wisdom of the Faculty which should first establish the novelty. I look forward to the time when practical cooking shall be made a branch of study for girls in our common schools. It is at least as useful as trigonometry, more important than technical grammar, and a thousand times more practical than "mental philosophy."

V.

I may be permitted here to step across the line separating the sanitary from the sanatory sphere of professional activity, and call attention to the lack of rational practice in the treatment of corpulency, a condition in which drugs are confessedly of little avail, and which we must manage by an appropriate regimen.

The Banting system of treatment, as is well known, depends upon the withdrawal of fats and carbo-hydrates from the dietary, and almost exclusive restriction to proteids. It has been shown in the foregoing, however, that an individual living upon proteids alone, loses not only fat, but albuminoid tissue very rapidly. He loses, what he can ill afford to lose-strength.

The Banting system has been generally abandoned by thoughtful physicians, although it is still extensively practiced by the laity, under the advice of the writers of health manuals and popular medical guides.

The method of cure of corpulence, advised two or three years ago by Prof. Ebstein, is also objectionable from a sanitary point of view. This distinguished clinician has pointed out forcibly the dangers of the Banting system, but likewise errs in his recommendations. Prof. Ebstein allows proteids and fats, even encouraging the patient in the use of the latter, but withdraws carbohydrates, which have a large share in fat production. He also restricts the patient in the use of drinks. The latter point seems likewise to be the cardinal principle of the treatment which enabled the now notorious Dr. Schwenninger to reduce the adiposis of the German Chancellor.

Prof. Winternitz, of Vienna, in a recent review of the Banting and Ebstein cures, admits that they will unquestionably produce

* Manual of Practical Hygiene, 6th ed., Vol. I, p. 220.

emaciation, but at the same time diminution of strength and incapacity for exertion. Deprivation of fluids reduces fat, it is true, but it also diminishes muscular tissue, and hence leads to inanition.

Prof. Germain Sée, of Paris, thinks that the deprivation of water in all the schemes of treatment of obesity, is not only cruel, but useless. While water favors digestion, he says, it also hastens tissue change. It is, therefore, irrational to exclude drinks from the dietary of the corpulent. M. Sée believes that coffee and tea should be freely used with the meals in the treatment of obesity. He also favors a diet of fats and proteids, with restriction of hydrocarbons.

Milk diet alone has been used with success, and is an excellent means of reducing excessive fat. No hydrocarbonaceous food must be taken with it. Pure milk diet is, however, a form of slow starvation like Bantingism, and open to the same objections, though to a less degree. It cannot be indefinitely continued.

"Every cure of corpulence," says Brillat Savarin, "must begin with these three maxims or general principles: discretion in eating, moderation in sleep and exercise on foot or horse-back." The last mentioned is most important, and should be placed first. The only rational way to get rid of fat which has accumulated in excess is to burn it up. In other words, by active exercise to hasten the combustion (oxidation) of fat, and to strengthen by regular use the muscular system. No class of proximate principles can be excluded from the diet for a long time without producing symptoms of innutrition. All should therefore be represented in the food,-proteids, fats, carbo-hydrates, salts and water. Exercise, which is not necessarily required to be violent, will alone, with temperance in eating and drinking, suffice to reduce the fat. The annoying hyperidrosis from which so many fat people suffer, can only be effectively controlled by producing firmer tissues through exercise. Drugs are of very little value in the treatment of this symptom, as I have learned from much unsatisfactory experience.

That exercise, without any radical modification of diet, can get rid of fat, is evidenced by the following instance, related by Mr. William Blaikie, the author of one of the best books on exercise and training ever written.* The case is that of a man of middle age, of sedentary occupation: "On the 18th day of January,

* How to Get Strong and How to Stay So. New York: Harper Bros., 1883, p. 157.

1877, he weighed 305 pounds, and he had become so unwieldy that his flesh was a source of great hindrance to him. He determined, if possible, to get rid of some of it. Having to be at work all day, he could only effect his purpose in the evenings, or not at all. So, making no especial change in his diet, he took to walking, and soon began to average from three to five miles an evening at the best pace he could make. In the cold months, he says that he often perspired so that small icicles would form on the ends of his hair. Asking if it did not come a little stiff sometimes on stormy nights, or when he was very tired, and whether he did not omit his exercise at such times, he said no, but on the contrary added two miles, which shows the timber the man was made of.

"On the 18th of June of the same year, just five months from the start, he weighed but 215 pounds, having actually taken off 90 pounds, and had so altered that his former clothes would not fit him at all." Afterward he reduced his weight by a continuation of the exercise to 200 pounds.

Walking is, of course, not the only form in which active exercise may be taken; but it is generally the most agreeable and efficient. Horse-back riding is also effective, but in less degree. The wood-chopping exercise of the late Horace Greeley, or of the English Premier, is an excellent method of burning up fat and toning the muscular system. These methods of exercising are all to be recommended, because they are taken in the open air. Indoor training, with dumb-bells, Indian clubs, the weight, or the bars is less useful than the methods of outdoor exercise mentioned. The free use of baths and of purgative mineral waters aids in the reduction of the superfluous flesh.

While no necessary article should be forbidden, the use of sugar and spirits must be restricted. Coffee and tea should be drunk without being sweetened,* and beer, ale or porter should be entirely cut off. Such vegetables as contain much sugar or starch should. also be avoided, but the main thing is the regular active exercise, and corpulent patients will gradually find health and comfort returning with the reduction of their avoirdupois.

*Saccharine, a product obtained from coal tar, promises to be useful as a substitute for sugar, in the dietetic treatment of diabetes and corpulence. Chemically, the substance is an anhydro-orthosulphamin benzoic acid. It is intensely sweet-a single grain being sufficient to sweeten a cup of coffee. It is as yet very expensive, but doubtless will in time become cheaper. It promises to be useful as a substitute for sugar in digestive derangements, more particularly in children.

SEWERAGE AND HOUSE DRAINAGE.

BY E. G. WATERS, M. D.

The fact that man does not consume all the fuel he takes, nor assimilate all the nutriment he receives in food and drink, results in practical inconvenience, and compels ulterior interference for the removal of excreta. Excluding the amount of constant loss by way of the skin and lungs, there remains a mass of residue which, in the aggregate, where individuals collect permanently in numbers, as in towns and cities, attains vast proportions.

Dr. Parkes, as quoted on page 103 of Dr. Rohé's valuable "TextBook of Hygiene," estimates the annual amount of focal and urinary discharge of a mixed population of men, women and children representing 1,000 persons, at 25 tons of the one, and 91,250 gallons of the other. To this is to be added the kitchen waste, that resulting from lavatory uses, and the refuse from factories of various kinds, all of which demand attention from the urgent need for their immediate removal. The minimum allowance of water to each individual for household purposes is put at 35 gallons.

From the above estimates are to be separated the accumulations of the materials of coarser garbage, street-sweepings, and the amount of rainfall in different localities. The difficulties presenting themselves to the solution of the problem for the satisfactory disposal of these wastes in the case of populous cities, threaten to increase rather than to diminish in magnitude, on account of the tendency of people to segregate. Thus, the U. S. Census for 1880 shows that while in 1790 only one-thirtieth of the population of the whole country lived in towns and cities, that of 1870 increased the proportion to nearly one-fourth, and that the one for 1880 promised to show that the ratio in the same direction was advancing at a continuously rapid rate. Apart from the many questions of social and economic importance and interest suggested by the

above statement, others that belong chiefly to the study of the sanitarian and physician are presented for examination and solution.

Several methods have been devised for the removal of household wastes of all sorts which may be briefly embraced under the 'three heads of earth, air and water. The hiding out of sight, and beyond the possibility of causing offense, the dejections from the human body, was enjoined by Moses upon the Israelites during their desert wanderings, as may be read in Deuteronomy 23: 12, 13. The employment of earth for this purpose, with the object of deodorising and rendering harmless similar discharges, was revived not many years ago by an English clergyman, the Rev. Henry Moule, Vicar of Fordington, by the use of a simple apparatus known as the earth-closet. This invention was introduced into this country in the year 1868, became the subject of animated discussion, and for years steadily grew in favor. Its use is limited in practice to private dwellings in rural districts, and to the smaller villages and towns. That its use is capable of securing highly satisfactory results wherever mechanical difficulties and expense do not prevent, cannot for a moment be questioned. An ordinary commode so arranged that the bottom of the receiver shall be constantly covered with dry earth or coal ashes, with an additional reservoir to hold this material in sufficient quantity for daily use, represent the elements of the invention. By means of a handle and a suitable scoop or ladle, immediately after using, an amount of the dry earth or ashes about twice that of the fœces voided, is tilted upon the mass, thus hiding it from the eye and arresting the gaseous emanations offensive to the smell. Inside of dwellings, cleanliness requires daily emptying of these receptacles, but when they are located outside in yards or gardens, the contents may be permitted to accumulate until the receptacles are nearly full. Then they are to be emptied and stored for agricultural uses, and the cycle is begun and renewed again. In some cases the old contents, their organic constituents having been thoroughly oxidised, are employed over and over again until the same agent has been made to perform this office seven or eight times.

Mr. Latrobe, calling attention to the physical difficulties of applying this method to the needs of large cities, in a paper published in the Report of the State Board of Health for 1884, quotes Mr. Bateman, an English hydraulic engineer, as saying, that Lon