ANNUAL ADDRESS.

THE REMOVAL AND DESTRUCTION OF ORGANIC

WASTES.

BY COL. GEORGE E. WARING, JR., M. INST. C. E.

Of Newport, R. I.

In responding to the invitation to deliver your annual address, I find myself in a position of no little embarrassment. While I thank you most heartily for the honor you have done me, I cannot feel that your selection has been well made. You, as a body of physicians and surgeons, gathered for your anniversary, had, I think, the right to look for instruction and information from one who is versed in the details of the science on which your noble profession is based. Instead of this, you are condemned to listen to one to whom nearly every detail of the science and practice of your art is absolutely unknown. I can hardly even lay claim to a subjective knowledge of the latter, for among the good things that have befallen me I have never had the training of a good patient.

I belong to a profession that is called upon to do some of the rough mechanical work on which the improvement of certain conditions of living depends, and this is the nearest approach that I can offer to a justification of the choice you have made.

A very large, but not very well defined, proportion of the diseases with which you have to deal, and a large but equally undefined proportion of the mortality resulting, are believed by many to be more or less directly due to conditions growing out of civilized methods of life. It has been very well demonstrated, and the demonstration is a matter of lucid record, that the class of diseases referred to, in their causation and in their fatality, are dependent upon certain surrounding circumstances which are an

incidental accompaniment of the life of the family and of the community. These circumstances grow out of our relation to organic matter which we have used, and which, in the economy of the person or of the household, we have discarded. It can no longer be doubted that diseases of the class under consideration. are either dependent on, or are influenced by, a neglectful or unwise disposal of these wastes,-wastes whose production is inseparable from human life and development and industry. It is not necessary to describe the prevailing defects. Every intelligent person, and surely every physician, is more than familiar with them. It is admitted on all hands that it is possible so to regulate this disposal as to reduce, and to reduce enormously, the sick-rate and the death-rate due to the wide range of diseases which improper disposal fosters. It can hardly be doubted that certain diseases, of which typhoid fever is a type, are susceptible of absolute eradication. In his recent address, as President of the Sanitary Institute of Great Britain, Dr. De Chaumont, of Netley Hospital, gave a startling array of statistics, showing the degree to which fevers had lost frequency and fatality under the better sanitary arrangements prevailing throughout the British army and throughout the community. He says:

"The fever-rate in 1855 was 38 per cent. less than in 1842, and that in 1881 was 47 per cent. less than in 1855, and 67 per cent. less than in 1842. The proportion to total deaths was 28 per cent. less in 1855 than in 1842, whilst in 1881 it was 43 per cent. less than in 1855, and 67 per cent. less than in 1842. Much of this diminution is no doubt due to diminished typhus and simple continued fever, the improvement following very much on the same lines as that which has apparently diminished consumption. But we shall find a sensible diminution in the enteric rate above, for in 1869, the first year in which it was separated, we find that the deaths were 390 per million living, whereas in 1881 there were only 212, a fall of 46 per cent., or of 44 per cent., if we allow for the former erroneous return of cases among children as remittent fever. Now this improvement means emphatically improved drainage and excreta removal, but the fact that we still lose some five or six thousand lives per annum in England and Wales alone shows how much still remains to be done.

"In the army we formerly suffered much from fever, even at home. Forty years ago the deaths were 2.4 per 1,000, and they

formed 14 per cent. of the total deaths. In 1860 the number fell to about one-fourth, only 0.64 against 2.4, and 6.4 per cent. of the total deaths against 14. In 1883 the number had still further fallen to 0.25 per 1,000 (0.24 enteric), and the ratio to total deaths 4.1 per cent., or taking enteric alone, 3.9 per cent. This compares favorably with the civil returns of males of the same age among whom the ratio is 0.301 per 1,000, or 25 per cent. higher than the army ratio. The proportion of fever deaths (enteric) to total deaths is almost the same, viz.: 4.12. Now this gratifying improvement can be distinctly traced to two main things, viz.: improved drainage and improved water supply. With these enteric fever soon disappears. One satisfactory instance I may cite, viz. that of the Royal Marine Artillery Barracks at Eastney, among the finest in the Kingdom. It is 21 years since they were first occupied, during the first 14 of which they were never free from enteric fever. In 1878 they had a very severe attack, which cost several lives. In conjunction with my former colleague, Professor Macdonald, now Inspector-General of Hospitals and Fleets at Plymouth, I made an inspection of the place, and we found the drains in bad order and totally unventilated, except into the dwellings by the sinks and waste-pipes. We made certain recommendations for remedying the evil, and those recommendations were at once carried out, under the direction of Col. Crease. The gratifying result has been that for the last seven years, up to the present time, there has never been a single case of enteric fever arising in the barracks, although the disease has been frequently present in the houses around them. The state of the Portsmouth drainage is very bad, but an improved scheme has been decided upon, and when it is carried out, I think in all likelihood enteric fever may disappear, as it has already done at Eastney.

"But in spite of the progress already made enteric fever still kills about 8,000 persons every year in the United Kingdom, and seriously injures many more, each case of death implying from eight to ten attacks, so that there still remains plenty to be done before we get rid of this scourge. Our experience also in recent campaigns shows how quickly the disease declares itself, when a number of men, especially young men, are brought together in circumstances which render good sanitation difficult, as must always be the case in war."

Comparing fevers with cholera, Dr. De Chaumont says: "Even in epidemic years the deaths from fever sometimes equaled those from cholera. For instance, in 1854 there died in England and Wales 20,000 from cholera and 19,000 from fevers, and in 1866 there died 18,000 from cholera and 21,000 from fevers, or in the two last epidemics the total cholera deaths were 38,000, whilst the total fever deaths were 40,000.

"Observe, too, that this group of fevers does not include scarlet or other eruptive fevers. Altogether the deaths from fevers in the United Kingdom during these fifty-four years cannot have been less than a million and a half, or eight times the mortality. due to cholera. We have thus had a constant enemy to deal with, the mere familiarity with which has bred a certain degree of contempt. On the other hand, the more impressive onslaught of cholera has roused us, from time to time, to more vigorous action, to such an extent, indeed, that we may say that cholera has been more of a blessing than a curse, and that it has saved many more lives than it has killed. The action which was found necessary on its account has been fruitful in diminishing other diseases favored or propagated by insanitary conditions. The epidemic in the year 1849 was the most severe wave of cholera that has ever spread over the world, and the mortality of that year was the highest we have had. In 1854 the loss was very much less, and in 1866 it was smaller still. In 1873-5 the disease was spread over the continent of Europe, but although frequently introduced into this country it never managed to find a foothold. And in the present time the disease has existed since 1882 in Egypt, Italy, France and Spain, but it has not established itself here, in spite of our constant intercourse with those countries. The result is doubly interesting, because it proves on the one hand the utter futility of quarantine by land or sea, a point we have long contended for, and on the other the paramount importance of hygienic measures. Quarantine has never been practiced by us since 1832, and even then it was only in a partial way. In other countries where it has been rigidly and vexatiously exercised, it has been quite inadequate to keep out the disease. In fact, it has tended to foster it and to increase the danger. The truth is, it is wiser to render the soil sterile to the seed than to try vainly to keep out the seed by clumsy expedients, which are about as efficacious as if a tortoise were set to catch a butterfly.

We have wisely, in

this country, devoted our expenditure to internal sanitation, to the provision of pure water and good drainage, and such other matters of sanitation as have been found practicable."

Dr. Billings, in his Census report makes the estimate, and I know that he considers it a very moderate one, that the number of unnecessary deaths in the United States-that is, the deaths due to strictly preventable diseases-aggregate over 100,000 per annum. It is needless to remind you of the number of cases of painful illness that these deaths represent, or more than to remind you of the enormous cost to the community that such death and sickness entail.

The preventive measures by which these diseases may be controlled are largely, of course, in the hands of the municipal authorities, who have control of the sanitary regulations of towns. and cities; but there is much that is beyond their ken which comes more directly under the eye and under the control of the physician, who is not only the natural sanitary adviser of the individual and of the family, but who also, in his corporate capacity, is the great instructor and hand-strengthener of municipal health authorities.

The problem of removing and of putting beyond the power to do harm--that is, of destroying-organic wastes is a large one, and one which has been taken up almost de novo during the active life of men who are still active in the work. It is not to be wondered at that the appalling magnitude of this problem has caused it to be regarded as an intricate and difficult one. Efforts toward its solution had to be made with the means at hand, and under the guidance of men who, however learned, had no precedent to guide them and no positive indication on which to base their theories. Much of the early work was crude work, and all that has been done has stamped itself on professional tradition to a degree that has sometimes given great impetus to false starts.

As we now understand it, the problem, great though it is and difficult though it is, is not an intricate one. It is by no means to be understood that we have reached its best nor its complete solution. It does seem clear, however, that we now know enough of its factors to apply ourselves much more intelligently than our predecessors could do, to its practical solution.

Among the traditions that have become most firmly fixed in the popular mind is the one which is indicated by the technical word