THE LAUREL SANITARIUM FOUNDED 1905 Midway between Baltimore and Washington LAUREL, MARYLAND Accessible by B. & O. R. R. from both Baltimore and Washington. Nervous and mental diseases treated. Selected cases of drug and alcoholic addictions. Separate buildings for male and female patients Capacity limited to 75 cases. Rates from $15.00 to $50.00 per week. Reduced monthly rate for chronic cases. Both voluntary and committed patients received. MEDICAL DIRECTORS Jesse C. Coggins, M.D. Formerly Asst. Physician at Maryland Hospital for the Insane for nine years. Cornelius DeWeese, M.D. Bullet in readers may depend upon the integrity of our advertisers NOTE: The Publication Committee desires to receive suggestions from members of the Faculty, that Vol. IV BALTIMORE, december, 1911 No. 6 INAUGURAL RECEPTION. On January 5, 1912, there will be a joint meeting of the Sections on Medi- A reception will be tendered the President, after which a light collation PHYSICIANS' DEFENSE. That there may be no misunderstanding in future as to whether a 87 THE DISPOSAL OF SEWAGE IN SMALL TOWNS AND COUNTRY DWELLINGS. BY WM. ROYAL STOKES, M.D. The importance of proper methods of sewage disposal in small towns and country dwellings assumes a dual importance in modern hygiene, since the health of the local community and of other adjacent communities may both depend upon the efficient treatment of the sewage. The work of Fulton and others has demonstrated that typhoid fever is more prevalent in the country and small towns than in large cities, and this fact can be partially accounted for by the careless and even criminal methods of sewage disposal often practiced in rural districts. The most dangerous of these methods consists in the use of the surface privy, and the spread of typhoid fever and other intestinal diseases from such sources accounts for a large number of cases of the intestinal infections in small towns and on farms. These infections are spread mainly by flies, whose bodies laden with filth from the privy are capable of infecting the food in the kitchen and dining room, as well as the milk in the adjacent dairy. The surface washings from such sources may also contaminate springs and wells, and the water thus becomes a source of danger. They may even infect streams used for dairy purposes, and thus indirectly introduce pathogenic bacteria into the milk. The cesspool is often very dangerous in rural communities or on a farm, since the contents may gradually percolate to such a distance as to contaminate drinking wells and springs at some distance from the cesspit itself. Especially in rocky or porous soil the bacteria of the various intestinal diseases may thus enter the drinking water and spread typhoid fever and other intestinal infections. A second and far more serious danger may often accompany the improper disposal of sewage in country districts, and this menace threatens the neighboring towns or even large cities which may derive their water supply from a stream or river receiving the sewage from some hamlet upstream.. The remedies for these two distinct conditions are different, and the protection of a local community against itself will be first considered. The simplest method for the safe disposal of the excreta in privies on farms or in small villages consists in the use of a box receiver which is tightly constructed and placed some distance above the ground. A pint of fine earth should be used to mix with the dejecta, and the material is thus rendered. inoffensive, and can be hauled away and buried. Water-tight cans may also be used in a similar way, and the flies should be kept away from the dejecta by proper methods of screening. On large dairy farms and on private farms whenever the owners can afford it, the Waring system should DISPOSAL OF SEWAGE IN SMALL TOWNS 89 be used. In this system the sewage flows from a receiving tank into the upper layers of the soil, where the saprophytic bacteria dispose of the organic matter and the dangerous organisms. The obligations of an individual or a community include its duty towards itself and its duty towards it neighbor, and a part of this latter requirement consists in avoiding the pollution of a neighbor's water supply with sewage capable of producing the various intestinal diseases. Individuals whose farms or village dwellings abut upon streams should be compelled to dispose of their sewage by any of the methods mentioned above, and when large towns are so situated they should treat their sewage by means of precipitation, the septic tank, sprinkling, and filtration method now in use in so many institutions, towns, villages, and even cities. There are certain conditions, however, in which a community has an expensive system, which pours its filth into some water supply, and causes a slaughter of the innocent in a neighboring city or town. The installation of another system might be too great an expense for the offending communities, and they thus continue to offend. Fortunately, sanitarians now possess a remedy for such an apparently hopeless conditions and this consists in the disinfection of the sewage by calcium hypochlorite before it is poured into a water-course. By the use of a quantity producing five parts of available chlorine per million parts of water the sewage would seem to be rendered free from harmful bacteria, and by this method the pollution of water supplies or oyster beds can be avoided. The question of the proper disposal of household waste in country districts becomes an important one in connection with the prevention of uncinariasis, or hook worm disease, which is produced by a special variety of worm discovered by Stiles in 1902, and called Necator americanus. This disease is quite prevalent throughout the South Atlantic States, is more prevalent in rural districts, and the infection occurs chiefly in districts containing much sandy soil. The infection takes place either through the skin or by the mouth, and when it enters through the latter route it is due to the eating of contaminated vegetables or fruit. Infection by means of the skin is transmitted through the embryos which are voided from the intestine and which develop in the feces after they have been passed by the patient. These embryos usually enter the subcutaneous tissues through minute lesions of the skin of the feet. This special form of dermititis is called "Ground Itch," and the condition is thus spread by the indiscriminate disposal of sewage and feces upon the sandy soil so prevalent in certain regions in the south. The question of the proper disposal of sewage, therefore, in factory towns, villages, rural districts and farms, by means of the sanitary privy assumes great importance in preventing the spread of this infection, and this entire subject has been greatly advanced by work of Charles Wardell Stiles. In Public Health Bulletin No. 37 of the Public Health and Marine Hospital Service this investigator has described the sanitary privy, its purpose and construction, and although it would be out of place in this brief review of the subject to enter upon details concerning this matter, yet a few points in this article might be emphasized to advantage. After emphasizing the prevalence of soil pollution throughout the south, and describing the various intestinal diseases, which are spread by this medium, such as Cochin China diarrhea, amebic dysentery, bacillary dysentery, and uncinariasis, he points out that a privy should be designed primarily to prevent the pollution of the soil and stop the spread of disease by means of organisms contained in the excreta. In describing the essential parts of such a privy he emphasizes the fact that the receptacle for excreta should be safeguarded against all such agents of disease dissemination as rain, insects, flies, chickens, swine and dogs. Secondly, it should serve as a proper retiring room, insuring privacy to the individual. After describing the unsanitary privy, the modern sanitary structure is described in detail. The most important points in its construction consist in the use of galvanized pails placed beneath the seat, and protected from the outside by means of ventilators, which should be wire-screened to keep out the flies. The use of disinfectants in the receptacle are described, and the use of top soil, lime, or a 5 per cent solution of crude carbolic acid, or the use of cresol, one part of this solution being used to nineteen of water, are all recommended for use. The construction of the sanitary privy is described in detail in the bulletin, and the special importance of such a structure for schools is pointed out. A compulsory sanitary privy law involving a privy license is also recommended, and by this method it is thought that many of the intestinal infections including uncinariasis, or hook worm disease, can be prevented. In the year 1900 there were reported 35,379 deaths from typhoid fever in the United States, and this means about 353,790 cases. The total loss to the country in money was about $212,000,000 so that the prevention of even a moderate proportion of these cases would save money and suffering, as well as prevent death. The methods of sewage disposal outlined above, if properly carried out will do much to mitigate this plague, and these methods should be controlled by a special department of the State Department of Health, namely, a Bureau of Sanitary Engineering. It is to be hoped that the next legislature will see fit to provide the State Department of Health with enough funds to create such a department, and as our methods of sewage disposal are improved throughout the state, it is certain that our typhoid cases will decrease in number. |