I. Mixing garbage with ashes, etc., and ashes, tin-cans, old shoes, etc., interferes with difficult solution. The size and location of the the collection and disposal of garbage. Gar- city (whether inland or along the sea-board), bage utensils are often of themselves a nuisance. determines in a great measure the methods to Wooden vessels, especially in the summer, be- be employed. A combination of two or more come offensive from more or less absorption of methods may be necessary. Those generally liquid garbage, unless coated with a non-ab-employed are as follows:sorbent material. Galvanized iron pails are the best receptacles for the putrescent refuse of the kitchen. The pails should have air-tight coverings, and should be of a size to admit of easy handling, yet large enough to hold the accumulations of two or three days. Before being used for fresh deposits they should be thoroughly cleansed. Disinfectants should not be substituted for thorough cleanliness. Recent observations have shown that the ordinary methods of disinfection are not wholly reliable, and often give a false security where danger really exists. It has been said, and with much truth, that disinfectants cannot take the place of cleanliness any more than Cologne can take the place of soap and water. Owing to the early and rapid decomposition of kitchen-offal, removal should be made daily in the summer, and two or three times a week during the winter. In Philadelphia, garbage and offal are removed twice each week in January, February, March, and December; four times each week in April, May, June, and November; and six times each week in July, August, September, and October. This cannot be considered an excessive effort at cleanliness, when Parisians think it incumbent upon them to clean the streets of Paris every twenty-four hours, and that, too, between the hours of 3 and 6 A.M. I. The practice of mixing garbage with ashes, etc., and dumping them together upon vacant lots, is not uncommon in some cities. It cannot, however, be too strongly condemned. Were ashes free from admixture with other substances, they would in most cases form suitable filling. But more or less rubbish and dead organic matter is mixed with them, even though the law requires that ash-barrels be filled only with ashes. It is claimed that the absorbent power of ashes and earthy matter deodorizes garbage. This is in part true, but decomposition occurs so early, and is so rapid in kitchen garbage, that it often takes place before its admixture with ashes, and deodorization, therefore, is not always complete. Again, it is known that garbage and other organic refuse mixed with ashes, rubbish, etc., and thrown upon vacant places, undergoes decomposition very slowly, owing to the want of a free supply of oxygen. This, carried on in places long occupied by successive generations, exhausts the self-purifying energies of the soil. Excavations Garbage carts should be well-constructed of land made up many years previously of vehicles, water-tight, lined with some impervi- ashes, kitchen refuse, etc., have disclosed deous material to prevent absorption, and fitted composing organic matter. Living upon such with air-tight covers to prevent the escape of land is not without danger, both of disease and gaseous odors. They are, however, expensive death. Offensive emanations in such places in their original cost, and are with more or contaminate, to a greater or less degree, the less difficulty kept in repair. If used, they air, while the matter exposed to rain-storms polshould be made especially for the service. lutes the ground by soakage, and mingling Water-tight barrels with suitable covers are used these with whatever water the soil may contain, in some cities in preference to carts. When of often carries to wells and springs the deadliest suitable size, the barrels are more easily handled poison. Drinking from the barnyard well has and cleansed, and are much cheaper. They often demonstrated this to the farmer. Aside can be transported upon trucks, and they afford from air and soil contamination, the decompoless exposure while being filled than carts, and sition of organic matter may give rise to the less chance for the escape of nauseous odors. germs of specific fevers. It is known that deThey have, moreover, the advantage in that composition is not strictly a chemical change, they can be left at hotels, while the one filled but that it is in part a vital process. It was is taken away. formerly believed that when death dissolved The final disposal of garbage is a problem of the bonds by which the living elements are The dumping of all garbage into the sea offers the best suggestion for its disposal in cities bordering on the coast. This is done in New York, Brooklyn, and Boston. New York employs ten boats, each of five hundred tons burden, known as Barney dumping-boats, kitchen refuse, and deposit them at a safe dis- held, they rearranged themselves into new and more simple chemical compounds from their union with oxygen, and were thus reduced to their elementary state. But experimentation has shown that decomposition does not wholly take place, save in the presence of atmospheric germs. I use the term "atmospheric germs,' "which carry off all decayed vegetable fruit, and because the germs are found floating everywhere in air, water, and soil, and upon all objects, whether animate or inanimate. They are more numerous than all other forms of life combined, and they have for their function the power to reduce, through putrefactive changes, dead organic matter into its original elements, from which it again becomes serviceable to new life. Found within the human system as well as without, their very universality forbids the view that they constitute the contagia of specific fevers. But being vital, they may, during the putrefactive changes it is their province to induce, become poisoned, and it is diseased germs, together with the morbid material they convey into the system, that become dangerous to life. The doc-gow, garbage is removed to depots and there trine that specific fevers are of germ origin more clearly explains the phenomena of those fevers than any hypothesis heretofore advanced. II. Feeding to swine. This offers a good solution of the disposal of garbage, where it has no marketable value, or cannot be carried out to sea. To as great an extent as possible, garbage should be cremated in the kitchen range or stove, when it can be done without annoyance to the household. This, however, is is often impracticable in the summer, especially in large families, owing to the use of fruits and vegetables containing a large proportion of waste. Neither is the average kitchen range constructed with a view to such purposes, nor is coal adapted for the consumption of moist substances. In Glas cremated, but there are no appliances for its cremation on a large scale in this country. The cost of the plant for large crematories renders the method at first sight objectionable, but without a properly constructed plant, it would be decidedly obnoxious. Their intro It has been said that swine were created especially for the consumption of "swill." Especial pains is taken in some places in collect-duction in the large inland cities is only a matter ing garbage, on account of its marketable value as food for swine. But it cannot be argued that swill-fed pork is equal to corn-fed, and, therefore, this method is not generally popular. It is used to the best advantage in the country, among farmers, where all kitchen and dairy refuse is carried twice a day to the hog-pen. There it is probably unobjectionable, but in the city, during the hot weather, the condition of the average swill-pail becomes such that the contents are frequently full of living, animal matter. The swine, to which this is fed, are sold in city markets, to appear in various forms upon the city tables a result not to be looked upon with entire satisfaction. III. The making of garbage into compost. This is one of the least objectionable methods for its disposal; but the large shrinkage makes it less remunerative than would at first appear. It cannot compete in value for the fertilization of land with sewage and other similar waste. IV. Removal to sea. of time. The growth of these cities, the constantly increasing distance from their business centres to the open country, and the higher standards of cleanliness now being enforced in other directions are strong arguments in favor of crematories for garbage. In the matter of garbage, rich and poor alike are exceedingly careless. Thorough supervision, therefore, in every part of the city in regard to the collection, removal, and disposal of garbage; frequent inspection of cellars and yards by officials of the Board of Health-these should not be considered too great an effort in the direction of cleanliness. Care and thoroughness in this direction will strongly evidence official enterprise, attested by marked improvement in public health, and a visible decrease of summer mortality. IF you need anything consult the advertising pages of THE BULLETIN. WE vouch for all our advertisers. Patronize them. THE PHYSIOLOGICAL ACTION OF fifteen or twenty minutes after application, as a Es ESERINE. BY JOHN WATSON, M.D. `SERINE, which is one of the active principles of physostigma or calabar bean, acts powerfully as a myotic when applied directly to the eye. I have been using small tabloids, each one containing th of a grain of eserine, which can be easily introduced into the inner canthus of the eye, where they are soon dissolved by the lachrymal secretions. With tabloids of the above strength contraction of the pupil occurred five minutes after introduction, which contraction increased rapidly, so that in another three or four minutes the pupils had diminished to the size of pinpoints. On an average this extreme contraction continued for about twelve hours, after which it gradually passed off so that in another three or four hours the eye appeared quite normal again. These effects were noticed only in the eye to which the tabloids were applied, the other eye remaining unaffected. There was marked dilatation of the conjunctival blood vessels with great twitching of the eye, the myopia was extremely well marked, with great dimness of vision. On closing the normal eye and trying to walk-the eye which had been experimented upon remaining open-it was found difficult to do so, owing to the imperfect manner with which surrounding objects could be seen, so sundry blows and falls resulted. Throbbing and uncomfortable shooting pains were experienced down the nasal bone corresponding to the eye in which the drug was introduced. A feeling of nausea and faintness was sometimes experienced, but this was by no means a constant symptom. The pulse was slowed in about a quarter of an hour after application and became feeble, at the same time a feeling of giddiness and syncope was invariably felt, and abundant perspiration occurred, a feeling of lassitude and disinclination for active exertion was generally, though not invariably, present. rule; though after using six of the tabloids, the pupil contracted in about ten minutes after the application. WESTMINSTER HOSPITAL, LONDON. CASE OF BELLADONNA POISONING DURING PARTURITION; RECOVERY. BY ALFRED S. GUBB, L.R.C.P., M.R.C.S., LONDON. H ENRIETTA C—, æt. 32, about to be confined of her third child, was attended by the village midwife, who was in the habit of replacing the local doctor in normal cases with his assent. As the labor was very slow and the progress small, the midwife sent to the surgery for some ergot, providing the messenger with a bottle to bring it back in. The doctor gave the bottle to his assistant telling him simply to fill it. The latter, not knowing either what the bottle had contained or what was required, smelled at the cork and, recognizing the odor of belladonna liniment, he forthwith filled the bottle with this and handed it to the messenger, not, however, omitting to paste a "poison" label across the phial. The midwife on receiving it promptly administered a teaspoonful to the patient, and, as in half an hour labor did not sensibly advance, another teaspoonful was made to follow the first. In the course of a couple of hours, however the "carryings on" of her patient thoroughly alarmed the midwife, the patient talked incoherently, had a "dazed" look on her face, and threw her limbs about quite indiscriminately. There was some sickness, but the patient gradually became comatose, and only muttered unintelligibly when spoken to loudly or shaken. The doctor was sent for, and when he arrived the patient was lying helpless on the ground, where her previously disordered movements had placed her; she did not reply to any questions even when put in a loud voice, nor did she rouse on being shaken, though she mumbled something on being put to bed. An emetic of mustard was administered, which produced vomiting after a little delay, but the patient still remained unconscious, with half open eyes and a rapid, shallow breathing. On vaginal examination the head was found low down on the perineum, the forceps were accordingly applied, and delivery of cancer of the breast. Has had fifteen effected without difficulty, the placenta following in due course and with no hemorrhage. The woman gave no signs of pain during these proceedings, and continued to sleep on for several hours. Ultimately she awoke and was much astonished on being told that the child was born, having herself no recollection of what had taken place. She said she felt "dazed," and complained of dryness of the mouth and throat, with headache and lassitude. Her speech was difficult and indistinct, probably from the dryness of the mouth. The symptoms gradually passed off, and she made an excellent recovery, without an untoward symp CHARING CROSS HOSPITAL. Polypus of Rectum.-Henry T—, æt. 14, schoolboy, states that he had suffered from some inconvenience about the bowel for about twelve months, and that lately he has been losing blood. He first noticed a mass protruding after the bowels had acted a short time ago. Is subject to "fits." On examination a pedunculated, warty mass was found protruding from the anus, which bled easily on being touched. The pedicle is long, and attached to the posterior surface of the rectum. The boy appears otherwise in good health. Mr. Whitehead ligatured the polypus close to its attachment and removed the mass. The boy made an uninterrupted recovery, and was discharged cured ten days after admission. Case of Anthrax.-George M—, æt. 54, French polisher, applied on account of an angry-looking swelling, measuring some six inches by four, situated on the back between the scapula. In its centre the skin had broken down, exposing the cellular tissue beneath. The surface was covered with sloughs, and discharged abundantly. On probing, it was found to be between two and three inches deep, and the skin around it is undermined. He passes his urine frequently and with difficulty. His appetite is poor and his sleep disturbed. Is very thirsty. Urine, sp. g. 1020, and contains sugar. His father died of old age, his mother children, of which eleven are living. Had a carbuncle on his neck some five years since, which lasted three weeks, and just lately he had been laid up with an abscess on the foot. On admission on the 1st inst., Mr. Bloxam removed some of the sloughing tissues, and ordered a poultice with liq. potassa permanganas. Temperature 101° Fahr. To take gr. j of pulv. opii twice a day, and a mixture containing mxx of tincture of perchloride of iron three times a day. Subsequently sloughs were removed, and the carbuncle circumscribed by a broad strip of adhesive plaster. Patient passed 134 ounces of urine in twenty-four hours, containing sugar. He is very weak, and suffers intensely from thirst. On the 10th, the patient was seized with severe rigor, which commenced at a quarter past nine and lasted until a quarter past ten, followed by profuse sweating. His temperature went up to 105.3° Fahr., at twelve his temperature was 104.3° Fahr. He died the next day after lying a few hours in a semi-unconscious condition. Carious Cavity in Head of Astragalus.Charles H-, æt. 19, tailor, came in with the following history: Twelve years ago he received a severe kick on his right foot, resulting in severe pain, which lasted over a year, and was accompanied by a good deal of swelling. At the end of the year some necrosed bone was removed, and the foot apparently got quite well, the patient being able to walk without pain. About two years after the operation a sore again. formed, and this continued for some years, getting better and then breaking down. For the last three years the foot has been in a satisfactory condition, but a few months ago he "sprained" his foot, and this led to the reopening of the wound, which discharged pus, and from which pieces of dead bone came away occasionally. Patient is evidently strumous. On examination of the foot a sinus was found over the head of the astragalus, discharging some thick pus, and on probing carious bone was easily felt. The whole foot was cedematous and painful when pressed upon. The next day, the patient being under chloroform, Mr. Bloxam made an incision one and one-half inches in length over the anterior surface of the astragalus and gouged out a quantity of carious bone, making a counter opening on the plantar surface, in which he inserted a drainage-tube. The wound was filled with iodoform, and dry lint applied. Subsequently another opening had to be made on the outer side of the foot, to liberate a further collection of pus. The wounds were allowed to granulate from the bottom, and the patient recovered, with a very serviceable foot. Case of Recto-Vesical Fistula Opening through Prostate. --Joseph J, æt. 52, printer, applied in February, on account of his passing his urine per rectum. There was a history of gonorrhoea thirty years ago, lasting over several months, which was treated with internal remedies and injections. He had noticed the first signs of a stricture about fourteen years ago, and the conditions gradually got worse until he became quite unable to pass his urine naturally. He first went to an irregular practitioner, who passed elastic catheters, and under his treatment the stricture got worse, and ultimately became impassable. He then applied to his club doctor, who, after a great deal of trouble, succeeded in passing a silver instrument and drew off a very large quantity of urine. After this he was instructed to pass a gum elastic catheter himself (about No. 7), and improved so much that he thought he had quite recovered, the catheter passing with the greatest ease. He had no discomfort, nor, indeed, symptoms of any kind, until he noticed that a small quantity of urine escaped per rectum and this steadily increased in quantity. About a year ago he was admitted into Guy's Hospital where he was examined and put on tonics. He was told to use the gum elastic catheters for himself, and ultimately left the hospital without much improvement. or three M. Sig.-Teaspoonful every two hours. With this treatment is usually combined a tea made of watermelon seed or elm bark. My failures with this treatment have been very few. In a few instances, where the case seemed somewhat rebellious, I have given the elaterium strong enough to get the cathartic effect of the drug. The specimen of elaterium from which the tincture is made should be perfectly pure, or the results cannot be depended upon. The way that I prepare the tincture is to exhaust one grain of elaterium in an ounce of pure alcohol, to which four drops of nitric acid have been added. TONIC MIXTURE FOR CHILDREN. B. Phosphoric acid (dil.), āā 3ij. āā Ziss. On admission he was evidently much debilitated, and complained of a troublesome cough. On examining the rectum by means of a specu- a day. lum, an opening of considerable size was found between the bladder and rectum, traversing the prostate. He had a good deal of pain on passing water. Some days the catheter would be passed without much difficulty, and at other times this could not be done. His general health was so poor that he was recommended to a convalescent hospital. EVERYTHING new and of value to the Profession is advertised in THE BULLETIN. Acidi phosphorici dilut. Tinct. gentianæ comp. 3iss. 3ij. 3ij. M. Sig. One teaspoonful before meals. INFANTILE COLIC. * B. Ammonii bromidi Tinct. capsici Syr. zingiberi 3ss. miv. 3j. Ziss. M. Sig.-One teaspoonful every hour when necessary. |